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John Prowle

@johnprowle

Critical Care Nephrologist

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Latest posts by John Prowle @johnprowle

Wish I’d seen this when solving Advent of Code 2025 day 10 part 2

03.02.2026 15:00 πŸ‘ 0 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0
Advent of Code 2025

I just completed all 12 days of Advent of Code 2025! #AdventOfCode adventofcode.com

13.12.2025 17:29 πŸ‘ 3 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0
library(memoise)

map2 <- memoise(function(start,end,G){
  x=neighbors(G,start,mode="out")
  if(length(x)==0){return(0)}
  if(end%in%names(x)){return(1)}
  else{
  m=0
  for(i in 1:length(x)){
    m=m+map2(x[i],end,G)
  }
  return(m)}
}
)

map2("svr","fft",G11)*map2("fft","dac",G11)*map2("dac","out",G11)

library(memoise) map2 <- memoise(function(start,end,G){ x=neighbors(G,start,mode="out") if(length(x)==0){return(0)} if(end%in%names(x)){return(1)} else{ m=0 for(i in 1:length(x)){ m=m+map2(x[i],end,G) } return(m)} } ) map2("svr","fft",G11)*map2("fft","dac",G11)*map2("dac","out",G11)

No pruning required! Recursively count neighbours of each vertex in the directed graph until you get to your target vertex (count 1) or the end of the road (count 0) with memoisation. See alt text

12.12.2025 00:31 πŸ‘ 1 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0
Post image

I've completed "Movie Theater" - Day 9 - Advent of Code 2025 #AdventOfCode adventofcode.com/2025/day/9
I'm convinced this is an elaborate Star Wars joke. Impossible objective? Movie Theatre? Turn off the targeting computer & 'use the force' to shoot the end of the 'Death Star Trench Run' @was.tl

10.12.2025 00:19 πŸ‘ 3 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0

Yes part 2 is actually solvable by hand with a print out! Perhaps this hard problem has a β€˜thermal exhaust port’…

09.12.2025 21:38 πŸ‘ 1 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0

I cheated with memoise πŸ˜‰ - However the R solution from @thoughtfulnz.bsky.social is much more elegant.

09.12.2025 20:54 πŸ‘ 2 πŸ” 0 πŸ’¬ 2 πŸ“Œ 0

Speeds up 20-fold by only checking locations with paper rolls

04.12.2025 12:15 πŸ‘ 1 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0

#Part2
x1 <- x
x2 <- x-x
repeat{
p <- which(x1==1, arr.ind = T)
for(i in 1:nrow(p)){
x2[p[i,,drop=F]]=as.numeric(sum(x1[(p[i,1]-1):(p[i,1]+1),(p[i,2]-1):(p[i,2]+1)])>4)}
if(sum(x1)==sum(x2)){break()}
x1 <- x2
x2 <- x2-x2}
sum(x)-sum(x1)

04.12.2025 12:05 πŸ‘ 1 πŸ” 0 πŸ’¬ 1 πŸ“Œ 0

#Part1
input_d4 |> read_lines()|> str_split("",simplify=T)
x <- x=="@"
x=cbind(rep(0,nrow(x)),x,rep(0,nrow(x)))
x=rbind(rep(0,ncol(x)),x,rep(0,ncol(x)))
p <- which(x==1, arr.ind = T)
tot <- 0
for(i in 1:nrow(p)){
tot <- tot+(sum(x[(p[i,1]-1):(p[i,1]+1),(p[i,2]-1):(p[i,2]+1)])<5)}
tot

04.12.2025 12:05 πŸ‘ 1 πŸ” 0 πŸ’¬ 1 πŸ“Œ 0

A brief history of the discovery of the immunoglobulins and the origin of the modern immunoglobulin nomenclature

onlinelibrary.wiley.com/doi/epdf/10....

29.10.2025 10:09 πŸ‘ 2 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0

After 14 days in ICU eGFR or eCrCl will over estimate true GFR more than TWO-fold yet they are still often quoted as guides to drug dosing!

26.10.2025 18:43 πŸ‘ 1 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0
Advert for Transition course in Critical Care Nephrology https://www.esicm.org/intensive-care-nephrology-2-2/

Advert for Transition course in Critical Care Nephrology https://www.esicm.org/intensive-care-nephrology-2-2/

Please consider joining this exciting and cutting edge course in intensive care nephrology in person at ESICM Lives 2025 with a superb international faculty.

www.esicm.org/intensive-ca...

10.09.2025 10:29 πŸ‘ 1 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0
Preview
Intensive Care Nephrology: building future progress on a legacy of success - ESICM Save the date - Explore how decades of research and clinical innovation in Intensive Care Nephrology are shaping the future of kidney care for critically ill patients. This session will highlight pion...

Please join our ESICM AKI section webinar tomorrow

Intensive Care Nephrology: building future progress on a legacy of success

11 SEPTEMBER 2025. 16:00 - 17:00 CEST and available online on the ESICM website

www.esicm.org/new-webinar-...

European Society of Intensive Care Medicine - ESICM

10.09.2025 10:22 πŸ‘ 1 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0

As intravenous fluids are rapidly lost to the interstitial space any affect on cardiac output and GFR will be very transient…

07.09.2025 21:38 πŸ‘ 1 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0

However creatinine concentration decrease reduces its excretion for any fixed GFR causing loss of steady state and rapid accumulation of creatinine in the expanded volume until concentration is normalized and steady state is regained. This can be easily modeled and takes a few hours at most.

07.09.2025 21:36 πŸ‘ 4 πŸ” 0 πŸ’¬ 1 πŸ“Œ 0
Rinaldo Bellomo: relentless architect of modern intensive care

A great honour to contribute to this article celebrating the inspirational scientific contributions of Rinaldo Bellomo. rdcu.be/epoBg

04.06.2025 09:53 πŸ‘ 2 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0
QR code for the survey

QR code for the survey

Support a QMUL international Critical Care Master's student in our survey on international practices in acute renal replacement therapy!

forms.office.com/e/PEWXmRN9h0

31.05.2025 13:52 πŸ‘ 0 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0
Microsoft Forms

Interested or confused by acid-base physiology in the ICU? Please participate a short online survey for healthcare professionals and students: β€œClinical Approaches to Acid-Base Disorders” and support an critical care MSc student project.

forms.cloud.microsoft/e/Npxyek5yrG

28.05.2025 11:23 πŸ‘ 0 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0
Preview
Obituary: Rinaldo Bellomo - ESICM In Memory of Professor Rinaldo Bellomo

It’s a time of great personal sadness for me personally and across the intensive care community. Remembering the great and ongoing legacy of Rinaldo Bellomo as well as his great friendship and mentorship. www.esicm.org/obituary-rin...

07.05.2025 09:47 πŸ‘ 1 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0

Also our good friend the Canadian Intensivist!!

19.04.2025 17:46 πŸ‘ 1 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0
Preview
Hyponatremia in the Dialysis Population Sodium derangements are among the most frequently encountered electrolyte disorders in patients with end-stage renal disease. As dialysis patients are predisposed to hyponatremia via multiple pathways...

I’m no expert in this area but this is a good start I think: www.kireports.org/article/S246...

09.04.2025 06:16 πŸ‘ 0 πŸ” 0 πŸ’¬ 1 πŸ“Œ 0

What about hyponatraemia in chronic dialysis patients? - common and impactful - mostly but not exclusively due to fluid overload??

07.04.2025 17:38 πŸ‘ 5 πŸ” 0 πŸ’¬ 2 πŸ“Œ 0

Incredibly valuable approach. I’m interested in ordinal longitudinal outcomes based on an organ failure score - ie where there might be more than one way to achieve the same level. Can this approach be applied to this type of ordinal outcome variable?

20.03.2025 08:14 πŸ‘ 0 πŸ” 0 πŸ’¬ 1 πŸ“Œ 0
Preview
Acute Kidney Injury and Risk of Death After Elective... : Anesthesia & Analgesia ndergoing elective in-patient surgery. AKI was defined using Kidney Disease Improving Global Outcomes criteria. Patients missing preoperative creatinine data were excluded. We used multivariable logis...

My approach was by no means perfect but see journals.lww.com/anesthesia-a...

20.03.2025 05:03 πŸ‘ 0 πŸ” 0 πŸ’¬ 1 πŸ“Œ 0

So what you need to model is an interaction term between age and eGFR with eGFR fitted to a spline (ie rcs). If you use creatinine then you would do the same but an interaction with sex would also be needed!

20.03.2025 05:01 πŸ‘ 2 πŸ” 0 πŸ’¬ 1 πŸ“Œ 0

That is an eGFR of 100 at age 20y equates lowest risk but at 75y this would equate to sarcopenia and the nadir of risk might be eGFR 70.

20.03.2025 04:56 πŸ‘ 0 πŸ” 0 πŸ’¬ 1 πŸ“Œ 0

A good question John and one I’ve looked at previously. eGFR (and creatinine) has a u-shaped relationship with risk of death - the minima of this risk profile varies with age.

20.03.2025 04:54 πŸ‘ 1 πŸ” 0 πŸ’¬ 1 πŸ“Œ 0
World Kidney Day 2025
World Kidney Day 2025 YouTube video by ESICM

World Kidney Day 2025 & Intensive Care Nephrology: Listen to our discussion and reflections from the European Society of Intensive Care Medicine Acute Kidney Injury Section. youtu.be/trX8Zpq_l60

13.03.2025 15:19 πŸ‘ 0 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0

In another thought differentiating urinoma as a cause of a post-transplant collection in the context of severe DGF (ATN) can’t be reliably made based on fluid biochemistry as composition of urine CAN be similar to plasma

02.02.2025 11:04 πŸ‘ 1 πŸ” 0 πŸ’¬ 0 πŸ“Œ 0