Increased Involvement of Klebsiellapneumoniae and Enterococcusfaecium in Healthcare-Associated Infections of Intensive Care Units in Taiwan

Background: Healthcare-associated infections (HAIs) cause increases in length of stay, mortality, and healthcare costs. A previous study conducted in Taiwan obtained similar results to those reported in Korea and Japan in 2015. Changes in microorganisms have been noted in recent years. Understanding the recent condition of HAIs in intensive care units (ICUs) can enable healthcare providers to develop effective infection control protocols to reduce HAIs. Methods: We used the Taiwan Nosocomial Infection Surveillance System to evaluate the incidence densities of HAIs, the proportions of causative pathogens, and the proportions of antimicrobial resistance (AMR). The Poisson regression model was constructed to incidence density, and the chi-square test was used to assess proportion. Results: The incidence density of HAIs decreased 5.7 to 5.4 per 1000 person-days. However, the proportions of Klebsiella pneumoniae and Enterococcus faecium significantly increased. In addition, the proportions of carbapenem-resistant K. pneumoniae and vancomycin-resistant Enterococcus faecium significantly increased over time. Conclusion: Analysis of the microorganisms involved in HAIs in ICUs showed elevated proportions of K. pneumoniae and E. faecium with AMR. Infection control protocols have been implemented for several years and require improvements regarding environmental cleanliness and medical staff prevention.

Identification and estimation of bioactive constituents Negundoside, Berberine chloride, and Marmelosin by HPLC and HPTLC for development of quality control protocols for Ayurvedic medicated oil formulation

Background Anu Taila is an ancient medicated oil Ayurvedic preparation that is commonly used for nasya karma. It contains more than 25 herbs and goat milk as per the Ayurvedic Formulary of India (AFI). It strengthens the neck, shoulder, and chest muscles and improves the capacity of sense organs. It delays the aging process and reduces hair fall. Recent studies showed that it is also useful in COVID-19. In the current study, an attempt to develop quality control protocols and evaluate the standardization parameters like refractive index, iodine value, saponification value, peroxide value, acid value, rancidity, HPTLC fingerprint profile along with major bioactive compound and quantification of Berberine chloride, Negundoside, and Marmelosin by HPLC. Establishing quality protocol and standard parameters like physicochemical parameters and estimation of bioactive compounds of this preparation is significant for quality control. Results In this study, HPTLC identifies bioactive chemical compounds like Berberine chloride, Marmelosin, Negundoside, glycyrrhizin, and para hydroxybenzoic acid (PHBA), Lupeol, Embelin, and Solasodine, which were present in the Anu Taila formulation. HPLC was used to estimate the bioactive marker compounds Negundoside, Berberine chloride, and Marmelosin were present in the Anu Taila formulation. The quantitative evaluation of Berberine chloride (0.0013%), Marmelosin (0.0366%), Negundoside (0.0086%) is present in Anu Taila formulation. Conclusion The study reveals that sufficient quality control parameters were followed during the preparation of the formulation. Physicochemical analysis was carried out as per the guidelines of Ayurvedic Pharmacopeia of India. HPTLC and HPLC profiles generated in this particular study can be considered as a preliminary tool ascertaining the authenticity of Anu Taila.

Distributed fixed-time cooperative control of an islanded microgrid under event-triggered mechanism

The secondary cooperative control problem of an islanded microgrid through event-triggered mechanism is investigated in this paper. A distributed fixedtime secondary cooperative control strategy is proposed to obtain frequency and voltage magnitude secondary restoration, and also a proportional active power sharing under an undirected topology. We consider a centralized event-triggered mechanism to alleviate the communication burden and reduce the frequency of controllers update. Through this mechanism, the distributed fixed-time control protocols using frequency, voltage magnitude and active power sampling measurement values of distributed generations (DGs) only when the predefined event-triggered condition is satisfied. Compared with the conventional distributed asymptotic control protocols under period-triggered communication, the secondary control objectives of an islanded microgrid are achieved within a fixed settling time by applying the presented distributed fixed-time control approach, and the upper bound of settling time is unrelated to any initial states. Meanwhile, the presented centralized event-triggered communication method exhibits excellent performance in alleviating communication burden and promoting control efficiency. The theoretical proof is given by adopting Lyapunov method. The simulation studies are conducted to illustrate the effectiveness of the proposed control scheme.

KNOWLEDGE AND AWARENESS OF CORONAVIRUS DISEASE-19 PROTOCOLS AMONG ANESTHESIA TECHNOLOGISTS AND TRAINEES IN WEST INDIA

Objectives: The main objective of the study is to assess the knowledge and awareness of all the anesthesia technologists and trainees regarding coronavirus disease (COVID-19) infection control protocols. The health and safety of anesthesia technologists are of great importance which can ultimately aid in minimizing the risk of infection among them and facilitate them to offer exceptional care to the patients. Methods: This cross-sectional online survey was conducted on COVID-19 protocols using an online questionnaire that assesses the basic knowledge and awareness about infection control protocols. A total of 231 participant’s responses were recorded using Google form and analyzed using the Statistical Package for the Social Sciences. Results: The present study showed that participant’s overall knowledge was good but they were not well trained on infection control protocol. Only 19.04% of participants were well trained about the protocol. The majority of the participants are well aware of the Personal Protective Equipment’s-related information. Conclusions: To deal with this current situation, educational intervention on infection control protocol is urgently required to train Anesthesia technologists and trainees to defend against coronavirus.

A Comprehensive Survey of Medium Access Control Protocols for Wireless Body Area Networks

Wireless body area networks (WBANs) have emerged as a promising technology for health monitoring due to their high utility and important role in improving human health. WBANs consist of a number of small battery-operated biomedical sensor nodes placed on the body or implanted, which are used to monitor and transmit important parameters such as blood pressure, electrocardiogram (ECG), and electroencephalogram (EEG). WBANs have strict requirements on energy efficiency and reliability during data collection and transmission. The most appropriate layer to address these requirements is the MAC layer. Medium access control protocols play an essential role in controlling the operation of radio transceivers and significantly affect the power consumption of the whole network. In this paper, we present a comprehensive survey of the most relevant and recent MAC protocols developed for WBANs. We discuss design requirements of a good MAC protocol for WBANs. We further review the different channel access mechanisms for WBANs. Then, we investigate the existing designed MAC protocols for WBANs with a focus on their features along with their strengths and weaknesses. Finally, we summarize the results of this work and draw conclusions.

Improving the patient-reported outcome sections of clinical trial protocols: a mixed methods evaluation of educational workshops

IntroductionFailure to incorporate key patient-reported outcome (PRO) content in trial protocols affects the quality and interpretability of the collected data, contributing to research waste. Our group developed evidence-based training specifically addressing PRO components of protocols. We aimed to assess whether 2-day educational workshops improved the PRO completeness of protocols against consensus-based minimum standards provided in the SPIRIT-PRO Extension in 2018.MethodAnnual workshops were conducted 2011–2017. Participants were investigators/ trialists from cancer clinical trials groups. Although developed pre-2018, workshops covered 15/16 SPIRIT-PRO items. Participant feedback immediately post-workshop and, retrospectively, in November 2017 was summarised descriptively. Protocols were evaluated against SPIRIT-PRO by two independent raters for workshop protocols (developed post-workshop by participants) and control protocols (contemporaneous non-workshop protocols). SPIRIT-PRO items were assessed for completeness (0 = not addressed, 10 = fully addressed). Mann-Whitney U-tests assessed whether workshop protocols scored higher than controls by item and overall.ResultsParticipants (n = 107) evaluated the workshop positively. In 2017, 16/41 survey responders (39%) reported never applying in practice; barriers included role restrictions (14/41, 34%) and lack of time (5/41, 12%). SPIRIT-PRO overall scores did not differ between workshop (n = 16, mean = 3.84 (standard deviation = 1.86)) and control protocols (n = 6, 2.46 (1.35)), (p = 0.09). Workshop protocols scored higher than controls on two items: ‘specify PRO concepts/domains’ (p = 0.035); ‘specify analysis methods’ (p = 0.011).ConclusionAlthough participants were highly satisfied with these workshops, the completeness of PRO protocol content improved only slightly. Additional knowledge translation efforts are needed to assist protocol writers address SPIRIT-PRO guidance and avoid research waste that may eventuate from sub-optimal PRO protocol content.

Decentralized Adaptive Control for Quasi-Consensus in Heterogeneous Nonlinear Multiagent Systems

This paper proposes some novel decentralized adaptive control protocols to settle the quasi-consensus problem of multiagent systems with heterogeneous nonlinear dynamics. Based on local communication with the leader and between the followers, some innovative control protocols are put forward to adapt the control gains and coupling weights simultaneously and to steer the consensus errors to some bounded areas. In particular, two new inequalities are proposed to establish the Lyapunov-based adaptive controller design approach for quasi-consensus. Some quasi-consensus criteria are derived by utilizing the designed controllers, in which the error bound can be modulated on the basis of the adaptive controller parameters. Numerical tests are conducted to show the feasibility of the theoretical derivation. Our findings highlight quasi-consensus in heterogeneous multiagent systems without adding some additional complex nonlinear control terms to cancel the dynamical differences between agents.