A biofloc system avoids the adverse effects of diets with suboptimal protein levels on zootechnical performance, intestinal histomorphometry, and protein metabolism of Nile tilapia juvenile fed Spirulina biomass (Arthrospira platensis) as an alternative protein source.

This study aimed to evaluate the effect of the biofloc technology (BFT) system and the replacement of fish meal with Spirulina biomass on productive performance, intestinal histomorphometry, plasma biochemistry, and oxidative stress of Nile tilapia juveniles (Oreochromis niloticus) fed suboptimal levels of protein. Two factors were evaluated: production systems (clear water × BFT) and replacement of fish meal with Spirulina (0, 33, 66 e 100%). The design was in a 2 × 4 randomized factorial scheme with four replications, and the fish were evaluated for 48 days. Four isoproteic (28% crude protein) diets were formulated with gross energy values close to 4300 kcal kg-1. Nile tilapia juveniles (0.23 ± 0.01 g) were distributed in 16 circular tanks (70 L) at seven fish/tank. The diets were formulated with protein levels approximately 20% below that required for the species and life stage. No interaction was observed between the factors evaluated (production systems × Spirulina inclusion). Rearing the fish in the BFT system avoided the adverse effects of diets with suboptimal protein levels on performance, intestinal histomorphometry, and protein metabolism. Lower values lower lipid peroxidation and higher antioxidant capacity were observed in fish reared in the BFT system, showing evidence of improvements in antioxidant responses and lower levels of physiological oxidative stress. Spirulina completely replaced fish meal in the diets of Nile tilapia juveniles without adverse effects on intestinal morphometry, protein metabolism, and antioxidant response. Replacing 66% of fish meal with Spirulina improved the productive performance, regardless of the rearing system.

Environmental Biofilms from an Urban Community in Salvador, Brazil, Shelter Previously Uncharacterized Saprophytic Leptospira.

Biofilms are complex microecosystems with valuable ecological roles that can shelter a variety of microorganisms. Spirochetes from the genus Leptospira have been observed to form biofilms in vitro, in rural environments, and in the kidneys of reservoir rats. The genus Leptospira is composed of pathogenic and non-pathogenic species, and the description of new species is ongoing due to the advent of whole genome sequencing. Leptospires have increasingly been isolated from water and soil samples. To investigate the presence of Leptospira in environmental biofilms, we collected three distinct samples of biofilms formed in an urban setting with poor sanitation: Pau da Lima, in Salvador, Bahia, Brazil. All biofilm samples were negative for the presence of pathogenic leptospires via conventional PCR, but cultures containing saprophytic Leptospira were identified. Whole genomes were generated and analyzed for twenty isolates obtained from these biofilms. For species identification, we used digital DNA-DNA hybridization (dDDH) and average nucleotide identity (ANI) analysis. The obtained isolates were classified into seven presumptive species from the saprophytic S1 clade. ANI and dDDH analysis suggest that three of those seven species were new. Classical phenotypic tests confirmed the novel isolated bacteria as saprophytic Leptospira. The isolates presented typical morphology and ultrastructure according to scanning electron microscopy and formed biofilms under in vitro conditions. Our data indicate that a diversity of saprophytic Leptospira species survive in the Brazilian poorly sanitized urban environment, in a biofilm lifestyle. We believe our results contribute to a better understanding of Leptospira biology and ecology, considering biofilms as natural environmental reservoirs for leptospires.

Designing spiking neural networks for robust and reconfigurable computation.

Networks of spiking neurons constitute analog systems capable of effective and resilient computing. Recent work has shown that networks of symmetrically connected inhibitory neurons may implement basic computations such that they are resilient to system disruption. For instance, if the functionality of one neuron is lost (e.g., the neuron, along with its connections, is removed), the system may be robustly reconfigured by adapting only one global system parameter. How to effectively adapt network parameters to robustly perform a given computation is still unclear. Here, we present an analytical approach to derive such parameters. Specifically, we analyze k-winners-takes-all (k-WTA) computations, basic computational tasks of identifying the k largest signals from a total of N input signals from which one can construct any computation. We identify and characterize different dynamical regimes and provide analytical expressions for the transitions between different numbers k of winners as a function of both input and network parameters. Our results thereby provide analytical insights about the dynamics underlying k-winner-takes-all functionality as well as an effective way of designing spiking neural network computing systems implementing disruption-resilient dynamics.

The New Omics Era into Systems Approaches: What Is the Importance of Separation Techniques?

Omics sciences have been facing challenges in different fields, especially in life sciences. One of these challenges involves assessing biology into systems interpretation. With the advance of genomics, molecular biology has been projected into the realm of systems biology. In a different direction, systems approaches are making definitive strides toward scientific understanding and biotechnological applications. Separation techniques provided meaningful progress in the omics era, conducting the classical molecular biology to contemporary systems biology. In this introductory chapter, the relevance of these techniques to the development of different omics sciences, within the systems biology context, will be discussed.

Decoding complex state space trajectories for neural computing.

In biological neural circuits as well as in bio-inspired information processing systems, trajectories in high-dimensional state-space encode the solutions to computational tasks performed by complex dynamical systems. Due to the high state-space dimensionality and the number of possible encoding trajectories rapidly growing with input signal dimension, decoding these trajectories constitutes a major challenge on its own, in particular, as exponentially growing (space or time) requirements for decoding would render the original computational paradigm inefficient. Here, we suggest an approach to overcome this problem. We propose an efficient decoding scheme for trajectories emerging in spiking neural circuits that exhibit linear scaling with input signal dimensionality. We focus on the dynamics near a sequence of unstable saddle states that naturally emerge in a range of physical systems and provide a novel paradigm for analog computing, for instance, in the form of heteroclinic computing. Identifying simple measures of coordinated activity (synchrony) that are commonly applicable to all trajectories representing the same percept, we design robust readouts whose sizes and time requirements increase only linearly with the system size. These results move the conceptual boundary so far hindering the implementation of heteroclinic computing in hardware and may also catalyze efficient decoding strategies in spiking neural networks in general.

Stochastic facilitation in heteroclinic communication channels.

Biological neural systems encode and transmit information as patterns of activity tracing complex trajectories in high-dimensional state spaces, inspiring alternative paradigms of information processing. Heteroclinic networks, naturally emerging in artificial neural systems, are networks of saddles in state space that provide a transparent approach to generate complex trajectories via controlled switches among interconnected saddles. External signals induce specific switching sequences, thus dynamically encoding inputs as trajectories. Recent works have focused either on computational aspects of heteroclinic networks, i.e., Heteroclinic Computing, or their stochastic properties under noise. Yet, how well such systems may transmit information remains an open question. Here, we investigate the information transmission properties of heteroclinic networks, studying them as communication channels. Choosing a tractable but representative system exhibiting a heteroclinic network, we investigate the mutual information rate (MIR) between input signals and the resulting sequences of states as the level of noise varies. Intriguingly, MIR does not decrease monotonically with increasing noise. Intermediate noise levels indeed maximize the information transmission capacity by promoting an increased yet controlled exploration of the underlying network of states. Complementing standard stochastic resonance, these results highlight the constructive effect of stochastic facilitation (i.e., noise-enhanced information transfer) on heteroclinic communication channels and possibly on more general dynamical systems exhibiting complex trajectories in state space.

Noise-constrained switching times for heteroclinic computing.

Heteroclinic computing offers a novel paradigm for universal computation by collective system dynamics. In such a paradigm, input signals are encoded as complex periodic orbits approaching specific sequences of saddle states. Without inputs, the relevant states together with the heteroclinic connections between them form a network of states-the heteroclinic network. Systems of pulse-coupled oscillators or spiking neurons naturally exhibit such heteroclinic networks of saddles, thereby providing a substrate for general analog computations. Several challenges need to be resolved before it becomes possible to effectively realize heteroclinic computing in hardware. The time scales on which computations are performed crucially depend on the switching times between saddles, which in turn are jointly controlled by the system's intrinsic dynamics and the level of external and measurement noise. The nonlinear dynamics of pulse-coupled systems often strongly deviate from that of time-continuously coupled (e.g., phase-coupled) systems. The factors impacting switching times in pulse-coupled systems are still not well understood. Here we systematically investigate switching times in dependence of the levels of noise and intrinsic dissipation in the system. We specifically reveal how local responses to pulses coact with external noise. Our findings confirm that, like in time-continuous phase-coupled systems, piecewise-continuous pulse-coupled systems exhibit switching times that transiently increase exponentially with the number of switches up to some order of magnitude set by the noise level. Complementarily, we show that switching times may constitute a good predictor for the computation reliability, indicating how often an input signal must be reiterated. By characterizing switching times between two saddles in conjunction with the reliability of a computation, our results provide a first step beyond the coding of input signal identities toward a complementary coding for the intensity of those signals. The results offer insights on how future heteroclinic computing systems may operate under natural, and thus noisy, conditions.

Analysis of the Environmental Management System based on ISO 14001 on the American continent.

The American continent is in broad economic and industrial development. Consequently, a more detailed discussion of the impacts generated by such development is needed. Moreover, there is an increase in the number of ISO 14001 certificates issued to this continent. Given the above, no studies were found that bridge the gap to identify the influence of different factors on ISO 14001 in the Americas. Thus, this article has as its main aim to check which economic, environmental and cultural factors have influence on ISO 14001 Certification in the American Continent. The data were collected in the ISO Survey, World Bank, United Nations Development Programme and International Energy Agency. Among the countries of that continent, thirteen were analyzed and only two did not show the economic factors as the influence factor in the multiple regression models fitted with Brazil and the United State. In these models, all presented environmental factors as influencing factors. Only in Brazil the index HDI presented as cultural factor in multiple regression model fitted. The economic factors: Gross Domestic Product and exports of goods and services and environmental: Carbon Dioxide (CO2) and fossil fuel consumption were the most influential in ISO 14001 certification. Venezuela, Uruguay, Colombia and the United States were countries that had factors dependent on each other, featuring the environmental marketing. Briefly, this study brings up several implications: to the academy, with the proposal of new concepts and guidance on the factors that assist in ISO 14001 certification in the American Continent. Additionally, taking into account the industry, the factors serve as efficiency parameters for the implementation of ISO 14001 standard, and for the Government to improve through factors that do not fit in multiple regression models.

Prediction of pollutant emission characteristics in ISO50001 energy management in the Americas: Uni and multivariate machine learning approach.

The American continent is experiencing significant economic and industrial development driven by sustainability principles. In this context, discussions on improving energy consumption have become increasingly frequent and dynamic across various sectors of civil society, including the implementation of energy efficiency measures as advocated by the ISO50001 energy management standard. However, there is a pressing need to investigate which socioeconomic aspects are responsible for the issuance of this certification in the Americas and how these factors relate to characteristic industrial emissions, especially particulate matter. This study aims to evaluate the socioeconomic factors influencing ISO50001 standard issuance and how these adjusted factors correlate with particulate matter of 2.5 µm and 10 µm dimensions. To achieve this, machine learning techniques were employed, considering the complex nature and risk of data overfitting. Model fitting was performed through multiple lasso regression, and the relationship between the adjusted factors was examined through cross-correlation analysis. The analyses indicate a strong correlation of adjusted macroeconomic indicators, especially with PM2.5, suggesting an association with cardiorespiratory problems and methane-related origins. This work is of great relevance to academia as it proposes new concepts regarding the interaction between energy efficiency standards and particulate matter. For the industrial sector, the adjusted factors provide guidance for standard implementation while also helping to mitigate health issues. Additionally, for the government, these results can assist in formulating policies to address specific health problems related to this area.

National survey regarding obstetricians' perspective of obstetric emergencies in Brazil.

INTRODUCTION: The maternal mortality rate in developing countries, such as Brazil, has significantly increased since 2020. Obstetric Emergencies (OE) account for 72.5% of these deaths. A national survey was conducted in Brazil to evaluate how gynecologists and obstetricians deal with OE and identify the main difficulties regarding theoretical/practical knowledge and structural resources. METHODS: An electronic questionnaire assessing resource availability, health teams, institutional protocols, and provision of OE training courses was completed by Brazilian obstetricians. RESULTS: More than 90 % of the questionnaire respondents reported treating a pregnant and/or puerperal patient with severe morbidity and that their health network has human resources, trained professionals, and structural resources required for this type of care. However, few respondents participate in continuing education programs (36 %) or specific training for the medical team (61.41 %). The implementation rates of obstetric risk identification protocols (33.09 %), a rapid response team (46.54 %), and boxes and emergency cart assembly teams (71.68 %) were determined. CONCLUSION: A high Maternal Mortality Ratio (MMR) may be related to disorganized healthcare systems, low implementation of risk classification protocols for the care of severe maternal and fetal conditions, and lack of access to continued/specific training programs. The Brazilian MMR is multifactorial. According to obstetricians, Brazilian health services include care teams, essential medications, obstetric centers, and clinical analysis laboratories, though they lack systematized processes and permanent professional training for qualified care of OE.

New insights into chicken processing wastewater treatment: the role of the microalgae Parachlorella kessleri on nitrogen removal.

Microalgal Technologies have recently been employed as an alternative treatment for high nitrogen content wastewater. Nitrogen is an essential nutrient for microalgae growth, and its presence in wastewater may be an alternative source to synthetic medium, contributing to a circular economy. This study aimed to investigate the effect of using Parachlorella kessleri cultivated in wastewater from the thermal processing of chicken meat. Experiments were performed to obtain the ideal sampling site, inoculum dosage, and contact time. P. kessleri had better growth in the sample from the settling basin. Nitrogen removal was 95% (0,15 mg TNK/107 cells) in 9 days, and the final nitrogen concentration was lower than 20 mg/L, and the nitrate concentration was lower than 1 mg/L. However, during the third cycle in the kinetic assay, there was a decline in the microalgae growth, occasioned by the accumulation of nitrite (38,4 mg/L) in the inside of the cell. The study demonstrated that nitrogen concentration is directly related to the cell growth of the algae. Parachlorella kessleri efficiently removed nitrogen from chicken meat thermal processing wastewater and is a potential option for tertiary treatment and valorisation of such effluent as a nitrogen source.

Do the oxidative stress biomarkers predict COVID-19 outcome? An in-hospital cohort study.

In SARSCoV-2 infections, excessive activation of the immune system dramatically elevates reactive oxygen species levels, harms cell structures, and directly increases disease severity and mortality. We aimed to evaluate whether plasma oxidative stress biomarker levels could predict mortality in adults admitted with Coronavirus Disease 2019 (COVID-19), considering potential confounders. We conducted a cohort study of 115 adults (62.1 ± 17.6 years, 65 males) admitted to a Brazilian public hospital for severely symptomatic COVID-19. Serum levels of α-tocopherol, glutathione, superoxide dismutase, 8-hydroxy-2'-deoxyguanosine, malondialdehyde, and advanced oxidation protein products were quantified at COVID-19 diagnosis using real-time polymerase chain reaction. Serum levels of α-tocopherol, glutathione, superoxide dismutase, and advanced oxidation protein products differed significantly between survivors and non-survivors. Serum glutathione levels below 327.2 µmol/mL were associated with a significant risk of death in COVID-19 patients, even after accounting for other factors (adjusted hazard ratio = 3.12 [95% CI: 1.83-5.33]).

Computation by switching in complex networks of states.

Complex networks of dynamically connected saddle states persistently emerge in a broad range of high-dimensional systems and may reliably encode inputs as specific switching trajectories. Their computational capabilities, however, are far from being understood. Here, we analyze how symmetry-breaking inhomogeneities naturally induce predictable persistent switching dynamics across such networks. We show that such systems are capable of computing arbitrary logic operations by entering into switching sequences in a controlled way. This dynamics thus offers a highly flexible new kind of computation based on switching along complex networks of states.

COMPLEMENTARY AND ALTERNATIVE MEDICINE USE IN BRAZILIAN PATIENTS WITH INFLAMMATORY BOWEL DISEASE.

BACKGROUND: The conventional treatment of inflammatory bowel disease (IBD) is based on drug therapy, but different studies have shown a progressive increase in the use of complementary and alternative medicine (CAM). The most used CAM comprises of acupuncture, traditional Chinese medicine, Ayurvedic medicine, homeopathy, and herbal medicine, as well as more modern practices, including aromatherapy and reflexology. Data from CAM use in Brazil has previously been scarce and there are no studies among Brazilian patients with IBD. OBJECTIVE: The aim of the study was to evaluate the frequency of, and factors associated with the use of CAM among IBD patients in Brazil, in addition to estimating the satisfaction with CAM use. METHODS: A cross-sectional study was performed in adult IBD outpatients from two Southeastern Brazilian referral centers, with a total a sample of 227 individuals. A semi-structured questionnaire was used containing CAM products - tea, probiotics, omega 3 or glutamine, homeopathy, and herbal therapy, and factors associated with CAM use and patient satisfaction. We used descriptive statistics, association tests (P<0.05) and logistic regression for statistical analyses. RESULTS: In total, 126 patients with Crohn's disease and 101 with ulcerative colitis were included. The mean age was 41.19±14.49 years and 57.27% were female. The time since diagnosis was 10.58±7.5 years, and most patients were in clinical remission. Twenty-nine patients (12.8%) reported having used CAM for IBD treatment, such as tea (5.29%), probiotics (5.29%), omega-3 or glutamine (1.76%), homeopathy (0.88%), and herbal therapies (0.44%). Despite the low frequency, patients were satisfied (>50%). There was no difference between CAM use in Crohn's disease as compared to ulcerative colitis patients (P=0.1171). The factors associated with the use of CAM were regular or poor quality of life (odds ratio 2.084; 95% confidence interval 1.147-3.786, P=0.0159) and a shorter time since diagnosis (odds ratio 0.956; 95% confidence interval 0.918-0.995; P=0.0260). CONCLUSION: The prevalence of CAM use was low, but satisfactory among Brazilian IBD patients. The application of CAM has been associated with poor quality of life and shorter disease duration compared to patients with no use of CAM.

Vitamin D deficiency predicts 30-day hospital mortality of adults with COVID-19.

BACKGROUND & AIMS: Several studies have shown conflicting results for the relationship between vitamin D deficiency and COVID-19 outcomes. Here, we aimed to evaluate whether plasma 25(OH)D levels predict mortality in adults admitted with COVID-19, considering potential confounders. METHODS: We conducted a retrospective cohort study that included 115 adults (age 62.1 ± 17.6 years, 65 males) admitted to a Brazilian public hospital for severely symptomatic COVID-19. Subjects were classified into two groups according to their plasma levels of 25(OH)D: sufficiency (≥50 nmol/L) and the deficiency (<50 nmol/L). The diagnosis of COVID-19 was performed using real-time polymerase chain reaction (qPCR). In addition, direct competitive chemiluminescence immunoassay assessed serum 25(OH)D levels. RESULTS: The all-cause 30-day mortality was 13.8% (95% CI: 6.5%-21%) in the group of patients with sufficient plasma 25(OH)D levels and 32.1% (95% CI: 14.8%-49.4%) among those with deficient plasma 25(OH)D levels. Cox regression showed that plasma 25(OH)D levels remained a significant predictor of mortality even after adjusting for the covariates sex, age, length of the delay between symptom onset and hospitalization, and disease severity (HR = 0.98, 95% CI: 0.96-1.00; p = 0.02). CONCLUSION: Vitamin D deficiency predicts higher mortality risk in adults with COVID-19.

Retraction notice to "Use of ivermectin in the treatment of Covid-19: A pilot trial" [Toxicol. Rep. 8 (2021) 505-510].

[This retracts the article DOI: 10.1016/j.toxrep.2021.03.003.].

Impact of implementing an exclusively dedicated respiratory isolation room in a Brazilian tertiary emergency department.

BACKGROUND: Occupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed. GOAL: To evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method. METHODS: A group of patients in need of respiratory isolation were first identified--group I (2004; 29 patients; 44.1±3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year--group II (2007; 50 patients; 43.4±1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained. RESULTS: Implementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5±9.3 × 3.7±2.0; p=0.0180) and from indication to effective respiratory isolation (13.3±3.0 × 2.94±1.06; p=0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 × 75.4/100.000 patients; p<0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p<0.001 greater for 2007. CONCLUSION: Implementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.

Comparison Between Short Text Messages and Phone Calls to Reduce No-Show Rates in Outpatient Medical Appointments: A Randomized Trial.

The objective of this study was to evaluate the impact of telephone calls and short text messages (SMS) on no-show rates regarding scheduled appointments with a general practitioner. In a prospective, intervention-controlled, and randomized study, we divided 306 patients into 3 groups: telephone call, SMS, and no intervention. We compared no-show rates, as well as variables that influenced it. The lowest percentage of no-show (9.5%) occurred in the telephone call group, while the SMS group presented at 21% and the no-intervention group at 22.8% (P = .025). Telephone calls proved to be a superior strategy to text messaging.

Use of ivermectin in the treatment of Covid-19: A pilot trial.

OBJECTIVES: In this randomized open-label trial pilot study we assessed the antiviral effects and safety of various doses of ivermectin in patients with mild clinical symptoms of COVID-19. METHODS: Patients were randomly assigned to receive standard of care (SOC) treatment at hospital admission; SOC plus ivermectin 100 mcg/kg; SOC plus ivermectin 200 mcg/kg; or SOC plus ivermectin 400 mcg/kg. The primary assessed endpoint was the proportion of patients who achieved two consecutive negative SARS-CoV-2 RT PCR tests within 7 days of the start of the dosing period. This study was registered at ClinicalTrials.gov (NCT04431466). RESULTS: A total of 32 patients were enrolled and randomized to treatment. SOC treatment together with ivermectin did not result in any serious adverse events. All patients exhibited a reduction in SARS-CoV-2 viral load within 7 days; however, those who received ivermectin had a more consistent decrease as compared to the SOC alone group, characterized by a shorter time for obtaining two consecutive negative SARS-CoV-2 RT PCR tests. CONCLUSIONS: Ivermectin is safe in patients with SARS-CoV-2, reducing symptomatology and the SARS-CoV-2 viral load. This antiviral effect appears to depend on the dose used, and if confirmed in future studies, it suggests that ivermectin may be a useful adjuvant to the SOC treatment in patients with mild COVID-19 symptoms.

Triage and flow management in sepsis.

BACKGROUND: Sepsis is a major public health problem, with a growing incidence and mortality rates still close to 30% in severe cases. The speed and adequacy of the treatment administered in the first hours of sepsis, particularly access to intensive care, are important to reduce mortality. This study compared the triage strategies and intensive care rationing between septic patients and patients with other indications of intensive care. This study included all patients with signs for intensive care, enrolled in the intensive care management system of a Brazilian tertiary public emergency hospital, from January 1, 2010, to December 31, 2016. The intensivist periodically evaluated the requests, prioritizing them according to a semi-quantitative scale. Demographic data, Charlson Comorbidity Index (CCI), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA), as well as surgical interventions, were used as possible confounding factors in the construction of incremental logistic regression models for prioritization and admission to intensive care outcomes. RESULTS: The study analyzed 9195 ICU requests; septic patients accounted for 1076 cases (11.7%), 293 (27.2%) of which were regarded as priority 1. Priority 1 septic patients were more frequently hospitalized in the ICU than nonseptic patients (52.2% vs. 34.9%, p <  0.01). Septic patients waited longer for the vacancy, with a median delay time of 43.9 h (interquartile range 18.2-108.0), whereas nonseptic patients waited 32.5 h (interquartile range 11.5-75.8)-p <  0.01. Overall mortality was significantly higher in the septic group than in the group of patients with other indications for intensive care (72.3% vs. 39.8%, p <  0.01). This trend became more evident after the multivariate analysis, and the mortality odds ratio was almost three times higher in septic patients (2.7, 2.3-3.1). CONCLUSION: Septic patients had a lower priority for ICU admission and longer waiting times for an ICU vacancy than patients with other critical conditions. Overall, this implied a 2.7-fold increased risk of mortality in septic patients.