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The aim of this work was to develop and evaluate the reinforcement learning algorithm VentAI, which is able to suggest a dynamically optimized mechanical ventilation regime for critically-ill patients. We built, validated and tested its performance on 11,943 events of volume-controlled mechanical ventilation derived from 61,532 distinct ICU admissions and tested it on an independent, secondary dataset (200,859 ICU stays; 25,086 mechanical ventilation events). A patient “data fingerprint” of 44 features was extracted as multidimensional time series in 4-hour time steps. We used a Markov decision process, including a reward system and a Q-learning approach, to find the optimized settings for positive end-expiratory pressure (PEEP), fraction of inspired oxygen (FiO2) and ideal body weight-adjusted tidal volume (Vt). The observed outcome was in-hospital or 90-day mortality. VentAI reached a significantly increased estimated performance return of 83.3 (primary dataset) and 84.1 (secondary dataset) compared to physicians’ standard clinical care (51.1). The number of recommended action changes per mechanically ventilated patient constantly exceeded those of the clinicians. VentAI chose 202.9% more frequently ventilation regimes with lower Vt (5–7.5 mL/kg), but 50.8% less for regimes with higher Vt (7.5–10 mL/kg). VentAI recommended 29.3% more frequently PEEP levels of 5–7 cm H2O and 53.6% more frequently PEEP levels of 7–9 cmH2O. VentAI avoided high (>55%) FiO2 values (59.8% decrease), while preferring the range of 50–55% (140.3% increase). In conclusion, VentAI provides reproducible high performance by dynamically choosing an optimized, individualized ventilation strategy and thus might be of benefit for critically ill patients.
Driven by decreasing PV and energy storage prices, increasing electricity costs and policy supports from Thai government (self-consumption era), rooftop PV and energy storage systems are going to be deployed in the country rapidly that may disrupt existing business models structure of Thai distribution utilities due to revenue erosion and lost earnings opportunities. The retail rates that directly affect ratepayers (non-solar customers) are expected to increase. This paper focuses on a framework for evaluating impacts of PV with and without energy storage systems on Thai distribution utilities and ratepayers by using cost-benefit analysis (CBA). Prior to calculation of cost/benefit components, changes in energy sales need to be addressed. Government policies for the support of PV generation will also help in accelerating the rooftop PV installation. Benefit components include avoided costs due to transmission losses and deferring distribution capacity with appropriate PV penetration level, while cost components consist of losses in revenue, program costs, integration costs and unrecovered fixed costs. It is necessary for Thailand to compare total costs and total benefits of rooftop PV and energy storage systems in order to adopt policy supports and mitigation approaches, such as business model innovation and regulatory reform, effectively.
Internet of Things (IoT) and Artificial Intelligence (AI) are one of the most promising and disruptive areas of current research and development. However, these areas require deep knowledge in multiple disciplines such as sensors, protocols, embedded programming, distributed systems, statistics and algorithms. This broad knowledge is not easy to acquire and the software used to design these systems is becoming increasingly complex. Small and medium-sized enterprises therefore have problems in developing new business ideas. However, node- and block-based software tools have also been released and are freely available as open source toolboxes. In this paper, we present an overview of multiple node- and block-based software tools to develop IoT- and AI-based business ideas. We arrange these tools according their capabilities and further propose extension and combinations of tools to design a useful open-source library for small and medium-sized enterprises, that is easy to use and helps with rapid prototyping, enabling new business ideas to be developed using distributed computing.
1. Among the many concerns for biodiversity in the Anthropocene, recent reports of flying insect loss are particularly alarming, given their importance as pollinators, pest control agents, and as a food source. Few insect monitoring programmes cover the large spatial scales required to provide more generalizable estimates of insect responses to global change drivers.
2. We ask how climate and surrounding habitat affect flying insect biomass using data from the first year of a new monitoring network at 84 locations across Germany comprising a spatial gradient of land cover types from protected to urban and crop areas.
3. Flying insect biomass increased linearly with temperature across Germany. However, the effect of temperature on flying insect biomass flipped to negative in the hot months of June and July when local temperatures most exceeded long-term averages.
4. Land cover explained little variation in insect biomass, but biomass was lowest in forests. Grasslands, pastures, and orchards harboured the highest insect biomass. The date of peak biomass was primarily driven by surrounding land cover, with grasslands especially having earlier insect biomass phenologies.
5. Standardised, large-scale monitoring provides key insights into the underlying processes of insect decline and is pivotal for the development of climate-adapted strategies to promote insect diversity. In a temperate climate region, we find that the positive effects of temperature on flying insect biomass diminish in a German summer at locations where temperatures most exceeded long-term averages. Our results highlight the importance of local adaptation in climate change-driven impacts on insect communities.
Das Ziel der Bundesregierung von jährlich 400.000 neuen Wohnungen (davon 100.000 mit Sozialbindung) ist gefährdet. Deutschland steht nämlich möglicherweise eine längere Stagflationsphase bevor, die nicht zuletzt durch den Abriss von Lieferketten und den Anstieg der Energiepreise bedingt ist. Investoren von Wohnungen geraten dabei wirtschaftlich in die Zange: Einerseits sind die Möglichkeiten, weitere Mieterhöhungen durchzusetzen, aufgrund sinkender Realeinkommen beschränkt. Auf der anderen Seite explodiert aufgrund steigender Baukosten und Zinsen die Kostenseite. Dies alles dürfte sich auf die Investitionsbereitschaft sehr negativ auswirken, zumal derzeit noch keine Erleichterung in Gestalt eines deutlichen Absinkens der Bodenpreise zu erkennen ist. Letzteres ist allerdings ein Argument für den verstärkten Einsatz von öffentlich ausgegebenen Erbbaurechten, über die auch Sozialbindungen für die gesamte Vertragslaufzeit auferlegt werden können.
Allerdings können u. U. in der sich abzeichnenden wirtschaftlichen Situation durchaus auch Erbbaurechtnehmer mit Bestandsverträgen in Probleme geraten. Die Ursache hierfür sind Anpassungen der Erbbauzinsen, deren Entwicklung an die Inflationsrate gekoppelt ist. Zwar existiert eine gesetzliche Billigkeitsprüfung. Diese setzt in ihrer gegenwärtigen Ausgestaltung aber möglicherweise zu geringe Hürden bei inflationsbedingt starken Erhöhungen der Erbbauzinsen. Diese Hürden könnte einerseits aber erhöht werden, indem neben den Bruttoverdiensten der Arbeitnehmer auf die Kerninflationsrate anstatt der Verbraucherpreissteigerungen Bezug genommen wird. Eine Alternative besteht in der Bezugnahme der Kappungsgrenze auf den Wohnungsmietindex, was allerdings einen Bruch mit der bisherigen wirtschaftlichen Logik der Kappungsgrenze bedeutet.
Bei von der öffentlichen Hand ausgegebenen Erbbaurechten würde sich ebenfalls eine freiwillige Bezugnahme der Anpassung der Erbbauzinsen im Rahmen von Gleitklauseln an der Kerninflationsrate empfehlen.
Die erstmalige Ausgabe von Erbbaurechten durch die öffentliche Hand sollte orientiert an langfristigen Baufinanzierungszinsen erfolgen. Dabei wäre jedoch ein Abschlag mit Blick auf die erwartete (Kern-) Inflation vorzunehmen, die bei Erbbaurechtsverträgen wegen der hier möglichen Wertsicherungsklauseln deutlich weniger auf die Rendite als bei Baufinanzierungen durchschlägt. Die Länder sind hier v. a. dahingehend gefordert, in den Gemeindeordnungen klarzustellen, dass ein derartiges Vorgehen nicht gegen das Gebot der Abgabe von Vermögenswerten zum „vollen Wert“ verstößt.
Ebenfalls vornehmlich den Aufgabenbereich der Länder (aber auch der Gemeinden) betrifft die Notwendigkeit, eine eigenständige Förderkulisse für bezahlbaren Wohnraum über Erbbaurechte aufzustellen, die perspektivisch die gesamte Vertragslaufzeit umfasst. Eine weitere Absenkung der Erbbauzinsen über das oben diskutierte Niveau (Orientierung an inflationsadjustierten langfristigen Baufinanzierungszinsen) stellt i.d.R. nur eine zweitbeste Lösung dar.
A common answer to the financial challenges of green transformation and the shortcomings of the current taxation system is the “double dividend approach”. Environmental taxes should either feed the public purse in order to remove other distorting taxes, or directly contribute to financing green transformation. Germany adopted the former approach. However, this article argues, by using the example of Germany, that “good taxes” in terms of public finance should be neutral in terms of environmental protection and vice versa. Neutral taxation in terms of environmental impacts can be best achieved by applying the “Henry George principle”. Additionally, neutral taxation in terms of public finance is best achieved if the revenues from environmental taxes are redistributed to the citizens as an ecological basic income. Thus, distortive effects of environmental charges in terms of distribution and political decision-making might be removed. However, such a financial framework could be introduced step by step, starting with a tax shift.
This paper presents a feasibility study for the production of recycled glycol modified polyethylene terephthalate (PETG) material for additive manufacturing. Past studies showed a variety of results for the recycling of 3D-printing material, therefore the precise effect on the material properties is not completely clear. For this work, PETG waste of the same grade was recycled once and further processed into 3D printing filament. The study compares three blend ratios between purchased plastic pellets and recycled pellets to determine the degradation effect of one recycling cycle and possible blend ratios to counter these effects. Furthermore, the results include a commercially available filament. The comparison uses the filament diameter, the dimensional accuracy of the printed test specimen and mechanical properties as quality criteria. The study shows that the recycled material has a minor decrease concerning the tensile strength and Young’s modulus.
Introduction: The use of social marketing strategies to induce the promotion of cognitive health has received little attention in research. The objective of this scoping review is twofold: (i) to identify the social marketing strategies that have been used in recent years to initiate and maintain health-promoting behaviour; (ii) to advance research in this area to inform policy and practice on how to best make use of these strategies to promote cognitive health.
Methods and analysis: We will use the five-stage methodological framework of Arksey and O'Malley. Articles in English published since 2010 will be searched in electronic databases (the Cochrane Library, DoPHER, the International Bibliography of the Social Sciences, PsycInfo, PubMed, ScienceDirect, Scopus). Quantitative and qualitative study designs as well as reviews will be considered. We will include those articles that report the design, implementation, outcomes and evaluation of programmes and interventions concerning social marketing and/or health promotion and/or promotion of cognitive health. Grey literature will not be searched. Two independent reviewers will assess in detail the abstracts and full text of selected citations against the inclusion criteria. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart for Scoping Reviews will be used to illustrate the process of article selection. We will use a data extraction form, present the results through narrative synthesis and discuss them in relation to the scoping review research questions.
Ethics and dissemination: Ethics approval is not required for conducting this scoping review. The results of the review will be the first step to advance a conceptual framework, which contributes to the development of interventions targeting the promotion of cognitive health. The results will be published in a peer-reviewed scientific journal. They will also be disseminated to key stakeholders in the field of the promotion of cognitive health.
Static (one-legged stance) and dynamic (star excursion balance) postural control tests were performed by 14 adolescent athletes with and 17 without back pain to determine reproducibility. The total displacement, mediolateral and anterior-posterior displacements of the centre of pressure in mm for the static, and the normalized and composite reach distances for the dynamic tests were analysed. Intraclass correlation coefficients, 95% confidence intervals, and a Bland-Altman analysis were calculated for reproducibility. Intraclass correlation coefficients for subjects with (0.54 to 0.65), (0.61 to 0.69) and without (0.45 to 0.49), (0.52 to 0.60) back pain were obtained on the static test for right and left legs, respectively. Likewise, (0.79 to 0.88), (0.75 to 0.93) for subjects with and (0.61 to 0.82), (0.60 to 0.85) for those without back pain were obtained on the dynamic test for the right and left legs, respectively. Systematic bias was not observed between test and retest of subjects on both static and dynamic tests. The one-legged stance and star excursion balance tests have fair to excellent reliabilities on measures of postural control in adolescent athletes with and without back pain. They can be used as measures of postural control in adolescent athletes with and without back pain.
Background: Tobacco smoking prevalence continues to be high, particularly among adolescents and young adults with lower educational levels, and is therefore a serious public health problem. Tobacco smoking and problem drinking often co-occur and relapses after successful smoking cessation are often associated with alcohol use. This study aims at testing the efficacy of an integrated smoking cessation and alcohol intervention by comparing it to a smoking cessation only intervention for young people, delivered via the Internet and mobile phone.
Methods/Design: A two-arm cluster-randomised controlled trial with one follow-up assessment after 6 months will be conducted. Participants in the integrated intervention group will: (1) receive individually tailored web-based feedback on their drinking behaviour based on age and gender norms, (2) receive individually tailored mobile phone text messages to promote drinking within low-risk limits over a 3-month period, (3) receive individually tailored mobile phone text messages to support smoking cessation for 3 months, and (4) be offered the option of registering for a more intensive program that provides strategies for smoking cessation centred around a self-defined quit date. Participants in the smoking cessation only intervention group will only receive components (3) and (4). Study participants will be 1350 students who smoke tobacco daily/occasionally, from vocational schools in Switzerland. Main outcome criteria are 7-day point prevalence smoking abstinence and cigarette consumption assessed at the 6-month follow up.
Discussion: This is the first study testing a fully automated intervention for smoking cessation that simultaneously addresses alcohol use and interrelations between tobacco and alcohol use. The integrated intervention can be easily implemented in various settings and could be used with large groups of young people in a cost-effective way.