Extended Hierarchical Fuzzy Interpreted Petri Net

Petri nets (PNs) have many advantages such as graphical representation, formal description, and the possibility of sequential and concurrent control. An important aspect of using PNs is hierarchical modeling, which may be provided in different ways. In this paper, a new concept and definition of the hierarchical structure for Fuzzy Interpreted Petri Net (FIPN) are proposed. The concept of macroplace with several input, output, and input-output places is introduced to the net. The functionality of the macroplace instances and the hierarchy graph are also proposed. They are implemented in a computer simulator called HFIPN-SML. In this study, FIPN is employed since it allows the use of analogue sensors directly for process control. Better visualization and more precise control are among advantages of the introduced approach.

Recyclable, Antibacterial, Isoporous Through-Hole Membrane Air Filters with Hydrothermally Grown ZnO Nanorods

Reusable, antibacterial, and photocatalytic isoporous through-hole air filtration membranes have been demonstrated based on hydrothermally grown ZnO nanorods (NRs). High-temperature (300~375 °C) stability of thermoset-based isoporous through-hole membranes has enabled concurrent control of porosity and seed formation via high-temperature annealing of the membranes. The following hydrothermal growth has led to densely populated ZnO NRs on both the membrane surface and pore sidewall. Thanks to the nanofibrous shape of the grown ZnO NRs on the pore sidewall, the membrane filters have shown a high (>97%) filtration efficiency for PM2.5 with a rather low-pressure (~80 Pa) drop. The membrane filters could easily be cleaned and reused many times by simple spray cleaning with a water/ethanol mixture solution. Further, the grown ZnO NRs have also endowed excellent bactericidal performance for both Gram-positive S. aureus and Gram-negative S. enteritidis bacteria. Owing to the wide bandgap semiconductor nature of ZnO NRs, organic decomposition by photocatalytic activity under UV illumination has been successfully demonstrated. The reusable, multifunctional membrane filters can find wide applications in air filtration and purification.

90. Deimplementation: Use of Electronic Clinical Decision Support to Reduce Unnecessary Erythrocyte Sedimentation Rate (ESR) Ordering

Background In recent years, several de-implementation initiatives have focused on diagnostic testing. One such initiative, the Choosing Wisely campaign, recommends against routine use of erythrocyte sedimentation rate (ESR) for assessment of acute undiagnosed inflammation or infection. With the development of newer biomarkers of inflammation, particularly C-reactive protein (CRP), there is a decreasing role for ESR in screening for acute-onset conditions; however, ESR continues to be commonly ordered. Methods We examined ESR and CRP ordering practices at the Children’s Hospital of Philadelphia (CHOP) from July 2019 to July 2020 and found that 80% of ESR orders were placed concurrently with an order for CRP. We aimed to reduce ESR ordering by 20% at CHOP by using electronic clinical decision support in the form of embedded order guidance for ESR orders placed in the Emergency Department (ED) and inpatient setting. We examined the effect of the clinical decision support by assessing ESR ordering rate, defined by ESR orders per monthly patient days for the inpatient setting and ESR orders per monthly ED visits for the ED setting. We then examined differences in ordering rates using a quasi-experimental model with a concurrent control (basic metabolic panel). ESR Electronic Clinical Decision Support Intervention Inpatient and ED versions of the embedded electronic clinical decision support for ESR orders. Results Prior to implementation of the electronic decision support intervention, the median monthly rate of ESR orders was 13.6 per 1000 patient days and 70.3 per 1000 ED visits. During the initial month after implementation, we found that ESR ordering was 12.5 in inpatient and 46.4 in ED, reflecting decreased rates of ordering. The median monthly rate of basic metabolic panel orders (concurrent control) was 194.5 per 1000 patient days and 110.0 per 1000 ED visits. This was unchanged after intervention. Conclusion We conclude that electronic clinical decision support is a potentially effective deimplementation method for improving diagnostic test utilization, even with non-disease specific testing such as inflammatory markers. However, continued post-implementation data monitoring and analysis is needed to determine if this is a true difference and sustainable trend. Disclosures All Authors: No reported disclosures

128Study data within systematic reviews of intensive care interventions analysed as a cluster randomized trial

Focus of Presentation Cluster randomized trials (CRT) can address infectious disease research questions at the whole-of-population level, such as herd protection and herd peril effects, that cannot be answered within randomized controlled trials. For adequate power, ideally, a CRT will have at least 40 clusters. Findings Studies of decontamination (using either chlorhexidine or topical antibiotics) to prevent ICU-acquired infections among adult patients requiring prolonged mechanical ventilation (MV) have been summarized in > 15 systematic reviews. Of 83 studies of topical antibiotics, 69 had concurrent control (CC) versus non-concurrent control (NCC; n = 14) design (Figure below; solid symbols are intervention group patients). The mean ICU pneumonia incidence for topical antibiotic study CC control groups (34.5%; 95% CI, 29.1-40.4) is higher versus a literature benchmark (26.1%; 23.3%-29.1%), and versus NCC control groups (29.9%; 21.4-40.4) and versus chlorhexidine study CC control groups (25.5%; 19.6 – 32.5; n = 17). Conclusions/Implications Benchmarking the event rates among control groups versus the event rate among non-intervention studies for MV patients provide a measure of the contextual effect of the intervention. Differing intervention effects for studies with CC versus NCC design implicates herd effects. Key messages Systematic reviews of interventions that include studies with CC versus NCC design provide a natural experiment of contextual effects where their study otherwise would be difficult or, for adverse herd effects, unethical.

Selective digestive decontamination, a seemingly effective regimen with individual benefit or a flawed concept with population harm?

Selective digestive decontamination (SDD) regimens, variously constituted with topical antibiotic prophylaxis (TAP) and protocolized parenteral antibiotic prophylaxis (PPAP), appear highly effective for preventing ICU-acquired infections but only within randomized concurrent control trials (RCCT’s). Confusingly, SDD is also a concept which, if true, implies population benefit. The SDD concept can finally be reified in humans using the broad accumulated evidence base, including studies of TAP and PPAP that used non-concurrent controls (NCC), as a natural experiment. However, this test implicates overall population harm with higher event rates associated with SDD use within the ICU context.

Electric vehicle integrated MPC scheme for concurrent control of voltage and frequency in power system network

The growing integration of renewable sources with grid poses challenges in the field of voltage and frequency control. This study features combined automatic voltage regulator and load frequency control model of a three-area power system network with each area containing thermal and diesel power plants along with the introduction of solar thermal power plant, wind, and geothermal power plants. The Harris Hawks Optimization (HHO) based centralized Model Predictive Controller (MPC) has been discussed and implemented for the effective and simultaneous control of voltage and frequency in all three areas of the wind integrated power plant. To further deal with increased oscillations in frequency profile of the system caused due to renewable integration, the electric vehicle (EV) participation has been considered in each area to provide an auxiliary control against frequency deviations. Effectiveness of the proposed EV based MPC-HHO algorithm has been successfully verified after adding different nonlinearities, parameter uncertainties, disturbances, and time-delays in the wind integrated power system.