Biological nutrient removal and physical properties of halophilic aerobic granular sludge (hAGS) cultivated from autochthonous seawater-born microbes were investigated under hypersaline seawater conditions. hAGS achieved stable total nitrogen (TN) and total phosphorus (TP) removals of 96 ± 3% and 95 ± 4%, respectively, from seawater-based wastewater at 3.4% salt. At 4 to 12% salt concentrations, stable TN and TP removals of 82-99% and 95-96%, respectively, were maintained over 4 months under seawater conditions. Ammonium and phosphorus were mainly removed by nitritation-denitritation and enhanced biological phosphorus removal pathways, respectively. Stappiaceae (45%) and Rhodobacteraceae (21%) were the dominant genera in hAGS performing nutrient removal at 12% salt. hAGS contained acid-soluble extracellular polymeric substance as the major structural polymer which increased from 0.43 ± 0.02 g/gTS at 3.4% salt to 0.93 ± 0.03 g/gTS at 12% salt. Cultivation of hAGS from autochthonous wastewater-microbes can be a promising approach for achieving biological nitrogen and phosphorus removals from hypersaline seawater-based wastewaters.In this study, denitrification was performed using pyrite as sole electron donor. The nitrate reducing rate ranged from 0.61 to 0.95 mM/d. The production of nitrous oxide (N2O) was observed, accounting for 20% of the total nitrate reduction. The isotope fractionation indicated that N2O production was mainly caused by the bacterial denitrification, instead of chemical denitrification by Fe(Ⅱ). Thiobacillus was the predominant genus, of which relative abundance decreased after the incubation with pyrite. Conversely, other genera belonging to Actinobacteria, like Rhodococcus, increased by more than 10 times. These Actinobacteria-like bacteria lack nitrous oxide reductase, which might be the reason for high N2O production. Furthermore, the predicted microbial functions analysis by PICRUSt2 showed that the genes (menC/E/G) involved in the biosynthesis of electron shuttles (menaquinone-related redox-active molecule), which were remarkably enriched during the process, suggesting that the first step of pyrite oxidation might be driven by the microbial derived electron shuttles.
  Intensive care interventions that prolong life without achieving meaningful benefit are considered clinically "inappropriate". In 2012, the frequency of perceived-inappropriate critical care was 10.8% at one academic health system; and we aimed to re-evaluate this frequency.
 
  For 4 months in 2017, we surveyed critical care physicians daily and asked whether each patient was receiving appropriate, probably inappropriate, or inappropriate critical care. Patients were categorized into three groups 1) patients for whom treatment was never inappropriate, 2) patients with at least one assessment that treatment was probably inappropriate, but no inappropriate treatment assessments, and 3) patients who had at least one assessment of inappropriate treatment.
 
  Fifty-five physicians made 10,105 assessments on 1424 patients. Of these, 94 (6.6%) patients received at least one assessment of inappropriate critical care, which is lower than 2012 (10.8% (p < 0.01)). Comparing 2017 and 2012, patient age, MS-DRG, length of stay, and hospital mortality were not significantly different (p > 0.05). Inpatient mortality in 2017 was 73% for patients receiving inappropriate critical care.
 
  Over five years the proportion of patients perceived to be receiving inappropriate critical care dropped by 40%. Understanding the reasons for such change might elucidate how to continue to reduce inappropriate critical care.
 Over five years the proportion of patients perceived to be receiving inappropriate critical care dropped by 40%. Understanding the reasons for such change might elucidate how to continue to reduce inappropriate critical care.
  Optimization of antibiotic therapy is still urgently needed in critically ill patients.  https://www.selleckchem.com/products/Acadesine.html  The aim of the ONTAI survey (online survey on the use of Therapeutic Drug Monitoring of antibiotics in intensive care units) was to evaluate which strategies intensive care physicians in Germany use to improve the quality of antibiotic therapy and what role a Therapeutic Drug Monitoring (TDM) plays.
 
  Among the members of the German Society for Anaesthesiology and the German Society for Medical Intensive Care Medicine and Emergency Medicine, a national cross-sectional survey was conducted using an online questionnaire.
 
  The questionnaire was completely answered by 398 respondents. Without TDM, prolonged infusion was judged to be the most appropriate dosing regimen for beta lactams. A TDM for piperacillin, meropenem and vancomycin was performed in 17, 22 and 75% of respondents, respectively. For all beta lactams, a TDM was requested more often than it was available. There was great uncertainty as to the optimal pharmacokinetic/pharmacodynamic index for beta-lactams. 86% of the respondents who received minimal inhibitory concentrations adapted the therapy accordingly.
 
  German intensive care physicians are convinced of TDM for dose optimization. However, practical implementation, the determination of MICs and defined target values are still lacking.
 German intensive care physicians are convinced of TDM for dose optimization. However, practical implementation, the determination of MICs and defined target values are still lacking.Pathological identity-related functioning is a core feature of borderline personality disorder (BPD) that is grievously underrepresented in the empirical literature. Burgeoning evidence indicates that identity pathology is multifaceted, influenced by transactions between social and endogenous processes, and associated with a wide variety of maladaptive outcomes. Although historically defined by patterns of instability (e.g. frequent and rapid changes to career goals, religious beliefs, core values, friend groups, etc.), accumulating research indicates that identity pathology also manifests as distress and functional impairment related to excessive rigidity (i.e. unrelenting negative self-evaluations; overidentification with a restricted role or group membership) and/or incongruous behavior (i.e. simultaneously holding discordant beliefs/values/attitudes, actions that are grossly contradictory with values, incoherent sense of self, etc.). Despite the complex nature of this construct, and its centrality to BPD, researchers often assess identity pathology indirectly, inadequately, or fail to measure it entirely.