Continuous Monitoring Research Articles

Analytical Evaluation of the WebSocket and WebTransport Protocols for the Class of SCADA Systems Operating Within the Intranet

The purpose of research. In recent years, web technologies have been actively used in many process control systems, including SCADA. Such systems allow continuous monitoring of the test object in real time. In this regard, there is a need for frequent data transmission for their further display. To solve this problem, network protocols are used, which continue to develop rapidly to this day.Materials and methods. SCADA systems are used in many industries: aviation, ground transportation, rocket and space technology, systems for receiving and processing telemetry information. Among them, a class of SCADA systems operating within the intranet stands out. This can be an internal network of the enterprise, a hangar or a small test stand for tracking the indexes of measuring equipment. Therefore, today, more than ever, open and publicly available materials are important for understanding modern network solutions that reduce the time spent on data transmission and their further visualization. Such information will be of particular value to students studying network and web technologies.Results. As a result of the research, taking into account the limitations of the SCADA system and network being developed, the time characteristics for the WebSocket and WebTransport protocols have been determined, and the most optimal solution for a typical load is proposed. In the presented paper, the issues of data transfer between the client and server parts for a class of SCADA systems operating within an intranet are considered. In this regard, it is proposed to consider the two most suitable solutions for this task. These are application layer network protocols of the OSI model: WebSocket and WebTransport. In addition, transport layer protocols (TCP and QUIC) are taken into account, since they can also affect time characteristics. Data transmission issues are considered in the context of the SCADA data display and monitoring system. The server part is developed using C#, and the client is developed using JavaScript. A number of experiments are carried out for boundary cases and typical loads, on the basis of which the dependence of data transmission time on their volume is determined.Conclusion. The approach given in the paper on collecting network traffic and analyzing time characteristics will also be useful as part of the educational process for teaching students in the courses “Computer Networks” and “Internet Technologies”.

Application of the integrated well-surface facility production system for selecting the optimal operating mode of equipment

This work is dedicated to the analysis and development of an integrated production system that combines wells and surface facilities to select the optimal operating mode for equipment. The main focus is on studying data analysis methods, as well as collecting and processing information, which ensures high accuracy in process control and optimal use of technological capabilities. The integration of data from various levels of the production chain, from the well to the surface facilities, opens up new opportunities for optimizing equipment performance and improving resource management quality. Integration of wells and surface facilities – The effective integration of wells and surface facilities is crucial for optimizing production processes, minimizing operational costs, and reducing environmental impact. Integrated management systems allow the automation of many processes, providing continuous monitoring of operating parameters, automatic adjustment of settings, and supplying data for quick decision-making. This includes real-time data collection, analysis, and the use of the obtained information to select optimal operating modes, which helps improve both overall efficiency and safety in production processes. In the modern oil and gas industry, the efficient use of equipment at all stages of hydrocarbon production is of particular importance. Optimizing the operation of wells and surface facilities is a key aspect for increasing economic efficiency and reducing environmental impact. In this regard, the development and application of integrated systems that enable real-time control and adaptation of equipment operating modes has become a relevant and significant task.

Determining doses for backfill cohorts based on patient-reported outcome

BackgroundIncorporating backfill cohorts in phase I oncology trials is a recently developed strategy for dose optimization. However, the efficacy assessment window is long in general, causing a lag in identifying ineffective doses and more patients being backfilled to those doses. There is necessity to investigate how to use patient-reported outcomes (PRO) to determine doses for backfill cohorts.MethodsWe propose a unified Bayesian design framework, called ‘Backfill-QoL’, to utilize patient-reported quality of life (QoL) data into phase I oncology trials with backfill cohorts, including methods for trial monitoring, algorithm for dose-finding, and criteria for dose selection. Simulation studies and sensitivity analyses are conducted to evaluate the proposed Backfill-QoL design.ResultsThe simulation studies demonstrate that the Backfill-QoL design is more efficient than traditional dose-expansion strategy, and fewer patients would be allocated to doses with unacceptable QoL profiles. A user-friendly Windows desktop application is developed and freely available for implementing the proposed design.ConclusionsThe Backfill-QoL design enables continuous monitoring of safety, efficacy and QoL outcomes, and the recommended phase II dose (RP2D) can be identified in a more patient-centered perspective.

TECHNOLOGICAL COMPLICATIONS (FORMATION DAMAGE) DURING CO2 INJECTION FOR ENHANCED OIL RECOVERY. PART 3. PREVENTING AND REPAIRING FORMATION DAMAGE CAUSED BY CO2 INJECTION

The article considers technological complications arising during CO2 injection for enhanced oil recovery, with a focus on the formation of asphaltenes in the pore space and their negative impact on production efficiency. Formation of asphaltene solids in the reservoir leads to an increase in the skin factor, their removal to the wells, accumulation in the wellbore and on the surface of the equipment, which reduces oil flow to the well and requires expensive remedial work. Methods of identification and monitoring of asphaltene deposits are considered. Results of laboratory studies confirming the difficulty of quantitative assessment of asphaltene deposition are given, as well as practical examples of application of various technologies for their prevention and removal. Methods including the use of inhibitors and dispersants and the use of aromatic solvents to restore reservoir properties are reviewed. It also emphasises the need for continuous monitoring of field operations and the development of effective asphaltene management methods, which is critical to improving the economic feasibility of CO2 injection projects.

The Optimized Use of a Contact-Free Continuous Monitoring System on Clinical Outcomes During COVID-19

Objectives The purpose of this study was to examine the impact of a contact-free continuous monitoring system on clinical outcomes including unplanned intensive care unit (ICU) transfer (primary), length of stay (LOS), code blue, and mortality. A secondary aim was to evaluate the return on investment associated with implementing the contact-free continuous monitoring program during the COVID public health emergency. Methods An interrupted time series evaluation was conducted to examine the association between the use of contact-free continuous monitoring and clinical outcomes. A cost-benefit analysis was planned to evaluate the return on investment. Results Use of contact-free continuous monitoring was not significantly associated with unplanned ICU transfers, deaths, ICU LOS, and or rapid response team calls. However, there were significant increases in code blue events (P = 0.02) and mean hospital LOS (P = 0.01) in the postimplementation period when compared with the preimplementation period. Due to the lack of improvement, costs were calculated but a cost-benefit analysis was not conducted. Conclusions Contact-free continuous monitoring bed use during the COVID-19 public health emergency was not associated with improvements in clinical outcomes, although there was substantial confounding. Future studies should include large randomized controlled trials to control for factors not under direct experimental control including unit staffing, staff turnover, and differences in the patient population related to surges in the COVID-19 pandemic.

Wearable sensors for cardiological monitoring in the SUS: regulatory challenges and impacts on Brazilian Public Health

Cardiovascular diseases are the leading cause of death in Brazil, with approximately 400,000 deaths annually, which corresponds to almost 30% of all deaths in the country. In addition to the impact on mortality, these conditions generate an enormous economic burden for the health system, with costs associated with the treatment of diseases such as heart attack and heart failure exceeding R$50 billion per year. In this context, the use of wearable devices for continuous monitoring of cardiovascular parameters emerges as an opportunity to improve the management and prevention of these diseases. This study conducts a scoping review of the regulatory challenges involved in the incorporation of wearables into the Unified Health System (SUS), with a focus on cardiological monitoring. Articles published between 2019 and 2024 were analyzed, discussing issues such as data accuracy, interoperability between systems, protection of sensitive data, and training of health professionals. In addition, the study examines the economic and social implications of the adoption of these technologies in a context of profound socioeconomic inequalities. The results indicate that, although wearables have the potential to transform cardiovascular care in Brazil, regulatory and technical barriers still limit their large-scale adoption in the SUS. Adequate regulation, aligned with the General Data Protection Law (LGPD), and investments in infrastructure and training are essential for the safe and effective integration of these technologies into public health.

Genomic characteristics, disease outcome and heterologous vaccine effectiveness among cases with SARS CoV-2 infection

BackgroundIn the pursuit of global health security, continuous monitoring of vaccine effectiveness across various viral strains emerges as a crucial imperative. The emergence of SARS-CoV-2 major variants of concern (VOCs), including Alpha, Beta, Delta, and Omicron, has added complexity to the COVID-19 vaccination landscape.ObjectivesTo assess illness severity, evaluate vaccine efficacy across varying doses and types, and determine effectiveness against major VOCs within the population.MethodsThis retrospective cohort study, conducted in Abu Dhabi, United Arab Emirates, focuses on a cohort of 44,073 SARS-CoV-2 positive cases from February 2021 to May 2022, dominated by the Delta and Omicron variants. The study employed a nested case-control design, analyzing hospital admissions for confirmed SARS-CoV-2 infection.ResultsVaccine effectiveness was higher among heterologus-boosted individuals at 87% (95% CI:79%-93%) compared to homologus-boosted individuals at 59% (95% CI: 48%-68%) and fully vaccinated, non-boosted adults at 53% (95% CI: 46%-59%). These findings highlight the importance of heterologous boosting, particularly against rapidly evolving viral variants, offering valuable insights for refining pandemic response strategies.ConclusionThe study underscores the critical need for ongoing assessment and adaptation of vaccination strategies to the evolving viral landscape.

Continuous heart rate monitoring in atrial fibrillation with multispectral photoplethysmography

Heart attacks and strokes account for more than four out of every five Cardiovascular Disease (CVD) deaths, with one-third occurring before age 70 years. Atrial fibrillation (AF), a common cause of ischemic strokes, can significantly reduce mortality rates through continuous monitoring, timely diagnosis, accurate confirmation, and early prognosis. This can be achieved by employing Multi-Spectral Photoplethysmography (MSPPG) technology as an alternative diagnostic tool to Electrocardiography (ECG). This investigation is implemented by determining the Heart Rate (HR) of AF-affected patients using a developed MSPPG-based wrist-worn device, keeping ECG as a standard gold reference. The Multispectral-based wrist-worn wearable Photoplethysmography device employs an optical bio-sensing, integrated BIOFY sensor to acquire the MSPPG signals using two green (526 nm), one red (660 nm) and one infrared (950 nm) LED and two photodetectors (Broadband detector, IR-cut detector). The MSPPG signals acquired using a microcontroller unit are stored in an On-device storage system simultaneously in the IoT Platform. Statistical analysis techniques were employed to compare the HR detected using the MSPPG technique with the HR measured from the gold-standard ECG. The accuracy paves the way for implementing the proposed MSPPG technology in detecting AF conditions in terms of HR, further laying the foundation for earlier detection of AF. Wearable PPG-based devices face a significant issue of motion artifacts that can be overcome using the MSPPG technique. The research advancements can potentially increase the accessibility of HR monitoring in AF patients, conveniently integrating into daily routines without restricting day-to-day activities.

Strengthening science education in basic education through a professional development program on participatory action research for science teachers

Science education empowers individuals with critical thinking and problem-solving skills as well as creativity which drive sustainable development, social progress, and economic growth. Unfortunately, the basic education science curriculum does not seem to prepare students to become scientifically literate for a number of reasons. Toward this vein, this calls for science teachers to be creative being at the forefront of implementing science education curriculum successfully. One mechanism to draw out their creativity is to mentor and engage them in participatory action research. Hence, a four-year professional development program for science teachers aimed at designing, implementing, and publishing participatory action research project was introduced to them by specialists from a higher education institution as their community extension project. The program consisted of mentoring on action research problem conceptualization until publication of teachers' project, continuous monitoring, and feedbacking to support their progress. Guskeys' (2000) five level evaluation model for professional development program effectiveness serves as the guiding framework for evaluation. Quantitative and qualitative data were gathered from the participating science teachers of the school. It started with conducting an initial assessment of their action research skills as basis of the proposed professional development program on participatory action research. At the end of the program, the teachers disseminated their project in a reputable science education journal. The four-year professional development program resulted to a robust impact in all five levels of Guskey's evaluation model, namely: teachers' reactions, teachers' learning, organization support and change, teachers' use of new knowledge and skills, and student learning outcomes. The success of this program highlights the importance of sustained, collaborative, and research-oriented professional development program in form of action research mentoring. Moreover, the outcomes of the study suggest the need for a professional development program evaluation framework that will facilitate the evaluation of the program effectiveness.

Looks Can Be Deceiving: Diagnostic Power of Exome Sequencing in Debunking 15q11.2 Copy Number Variations

Background/Objectives: The pathogenetic role of 15q11.2 Copy Number Variations (CNVs) remains contentious in the scientific community, as microdeletions and microduplications in this region are linked to neurodevelopmental disorders with variable expressivity. This study aims to explore the diagnostic utility of Exome Sequencing (ES) in a cohort of pediatric patients with 15q11.2 CNVs. Methods: We enrolled 35 probands with 15q11.2 microdeletions or microduplications from two genetic centers between January 2021 and January 2023. Chromosomal Microarray Analysis (CMA) and ES were performed with written consent obtained from all parents. Pathogenic variants were classified according to ACMG guidelines. Results: CMA identified additional pathogenic CNVs in 3 of 35 children (9%). Subsequent ES revealed likely pathogenic or pathogenic variants in 11 of 32 children (34%). Notably, a higher percentage of isolated autism spectrum disorder (ASD) diagnoses was observed in patients without other CNVs or point mutations (p = 0.019). Conclusions: The ES analysis provided a diagnostic yield of 34% in this pediatric cohort with 15q11.2 CNVs. While the study does not dismiss the contribution of the CNV to the clinical phenotype, the findings suggest that ES may uncover the underlying causes of neurodevelopmental disorders. Continuous monitoring and further genetic testing are recommended for all 15q11.2 CNV carriers to optimize clinical management and familial counseling.

Effect of Interrupting Prolonged Sitting with Frequent Activity Breaks on Postprandial Glycemia and Insulin Sensitivity in Adults with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion Therapy: A Randomized Crossover Pilot Trial.

Objective: This study examined acute effects of interrupting prolonged sitting with short activity breaks on postprandial glucose/insulin responses and estimations of insulin sensitivity in adults with type 1 diabetes (T1D). Method: In a randomized crossover trial, eight adults (age = 46 ± 14 years [mean ± SD], body mass index [BMI] = 27.2 ± 3.8 kg/m2) receiving continuous subcutaneous insulin infusion (CSII) therapy completed two 6-h conditions as follows: uninterrupted sitting (SIT) and sitting interrupted with 3-min bouts of simple resistance activities (SRAs) every 30 min. Basal and bolus insulin were standardized across conditions except in cases of hypoglycemia. Postprandial responses were assessed using incremental area-under-the-curve (iAUC) and total AUC (tAUC) from half-hourly venous sampling. Meal-based insulin sensitivity determined from glucose sensor and insulin pump (SiSP) was assessed from flash continuous glucose monitor and insulin pump data. Outcomes were analyzed using mixed models adjusted for sex, BMI, treatment order, and preprandial values. Results: Glucose iAUC did not differ by condition (SIT: 19.8 ± 3.0 [estimated marginal means ± standard error] vs. SRA: 14.4 ± 3.0 mmol.6 h.L-1; P = 0.086). Despite CSII being standardized between conditions, insulin iAUC was higher in SRA compared to SIT (137.1 ± 22.7 vs. 170.9 ± 22.7 mU.6 h.L-1; P < 0.001). This resulted in a lower glucose response relative to the change in plasma insulin in SRA (tAUCglu/tAUCins: 0.32 ± 0.02 vs. 0.40 ± 0.02 mmol.mU-1; P = 0.03). SiSP was also higher at dinner following the SRA condition, with no between-condition differences at breakfast or lunch. Conclusion: Regularly interrupting prolonged sitting in T1D may increase plasma insulin and improve insulin sensitivity when meals and CSII are standardized. Future studies should explore underlying mechanistic determinants and the applicability of findings to those on multiple daily injections. Trial Registration: Australian and New Zealand Clinical Trial Registry Identifier-ACTRN12618000126213 (www.anzctr.org.au).

A 4D time‐lapse morphometry method to quantify bone formation and resorption during distraction osteogenesis

AbstractDistraction osteogenesis (DO) is widely utilized for treating limb length discrepancy, nonunion, bone deformities and defects. This study sought to develop a 4D time‐lapse morphometry method to quantify bone formation and resorption in mouse femur during DO based on image registration of longitudinal in vivo micro‐CT scans. Female C57BL/6 mice (n = 7) underwent osteotomy, followed by 5 days of latency, 10 days of distraction and 35 days of consolidation. The mice were scanned with micro‐CT at Days 5, 15, 25, 35, 45, and 50. Histological sectioning and Movat Pentachrome straining were performed at Day 50. After registration of two consecutive micro‐CT images of the same bone (day x and day y), the spatially‐ and temporally‐linked sequences of formation, resorption and quiescent bones at the distraction gap were identified and bone formation and resorption rates (BFRdayx‐y and BRRdayx‐y) were calculated. The overall percentage error of the registration method was 2.98% ± 0.89% and there was a strong correlation between histologically‐measured bone area fraction and micro‐CT‐determined bone volume fraction at Day 50 (r = 0.89, p &lt; 0.05). The 4D time‐lapse morphometry indicated a rapid bone formation during the first 10 days of the consolidation phase (BFRday15–25 = 0.14 ± 0.05 mm3/day), followed by callus reshaping via equivalent bone formation and resorption rates. The 4D time‐lapse morphometry method developed in this study allows for a continuous quantitative monitoring of the dynamic process of bone formation and resorption following distraction, which may offer a better understanding of the mechanism for mechano‐regulated bone regeneration and aid for development of new treatment strategies of DO.

Using continuous glucose monitoring (CGM) to understand glucose control in women with obesity during pregnancy

SummaryIn women with obesity but without diabetes, the factors driving poor pregnancy outcomes are inadequately understood. This study explores glucose as a potential mediator of adverse pregnancy outcomes in women with obesity. A two‐arm observational study was conducted in a single maternity hospital in Melbourne, Australia. Thirty‐eight women without diabetes, 20 of normal weight (BMI 20–24.9 kg/m2) and 18 with obesity (BMI ≥30 kg/m2), wore a continuous glucose monitor and had anthropometry and blood samples collected in early, mid and late pregnancy. Subjects who developed gestational diabetes were excluded prior to analysis. Groups were compared with respect to patient‐day mean glucose, mean blood glucose, daytime and nighttime glucose AUC, post‐prandial glucose AUC, HOMA‐IR and QUICKI. Five subjects developed gestational diabetes and were excluded from the analysis. Compared to controls (n = 19), women with obesity (n = 14) had significantly higher PDMG (p &lt; .001), daytime and nighttime glucose AUC (p &lt; .01) and post‐breakfast glucose AUC (p &lt; .001 and p = .043) and post‐dinner glucose AUC (p &lt; .001) in early and mid‐pregnancy. Mean plasma glucose and post‐lunch glucose AUC were only higher in women with obesity in early pregnancy (p = .009 and p &lt; .001, respectively). In mid and late pregnancy, HOMA‐IR was significantly higher (p &lt; .05) and QUICKI (p &lt; .01) significantly lower in the women with obesity compared to controls. Most parameters that used to assess glycaemic control in pregnancy demonstrated significantly higher plasma glucose in women with obesity compared to controls. This supports the hypothesis that glucose is a mediator of adverse pregnancy outcomes in women with obesity.

Machine Vision AI in Railroad Safety: Advanced Inspection Techniques

This article explores the transformative impact of machine vision AI in railroad safety, focusing on advanced inspection techniques. It examines the integration of technologies such as line scan cameras, LiDAR, and IoT sensors in enabling comprehensive 360-degree inspections of railway infrastructure and rolling stock. The article discusses key innovations in continuous monitoring, data processing, and AI-driven analysis, highlighting their potential to significantly enhance defect detection accuracy, reduce maintenance costs, and prevent accidents. Real-world applications in structural integrity assessment and overhead line inspection are presented, along with an analysis of current challenges and future developments in the field. The article underscores the paradigm shift from reactive to proactive maintenance strategies, promising a safer and more efficient future for rail transport.

Scan-to-BIM Process and Architectural Conservation: Towards an Effective Tool for the Thematic Mapping of Decay and Alteration Phenomena

Ancient monumental complexes need continuous analysis and monitoring operations to preserve a good conservation status. For this reason, the analysis of decay and alteration phenomena represents one of the main activities for their preservation. At the same time, the diffusion of Heritage Building Information Modelling (HBIM) methodology opens new scenarios for the management of Architectural Heritage. The paper describes the workflow based on a Scan-to-BIM approach for the generation of a decay map in an HBIM model. The workflow was applied to a significant case study, the church of “Santa Maria della Grotta” in Marsala (Italy). This church, partially excavated in a sandstone bank, is part of a larger heritage site consisting of a series of hypogea and a Punic necropolis dating back more than a thousand years. The Scan-to-BIM process, relying on an integrated survey combining mobile laser scanning and photogrammetric technologies, enabled the achievement of a complete 3D parametric model of the monument and, altogether, a detailed decay map in a BIM environment. The mapping process focused on the production of thematic maps of perimetral walls according to an abacus of decays implemented in a BIM system, useful for the analysis and conservation of the church. The work demonstrates how the Scan-to-BIM process is an efficient approach for 3D data collection and how it could facilitate the identification and mapping of pathogenic phenomena. Furthermore, the inclusion of this kind of information in the BIM model represents an effective tool for the maintenance and restoration of built heritage.

A RELEVÂNCIA DOS FARMACÊUTICOS NO AVANÇO E NOS DESAFIOS DO DESENVOLVIMENTO DE ANTIDEPRESSIVOS: EFICÁCIA, SEGURANÇA E ADESÃO AO TRATAMENTO.

Introduction: This article explores the crucial role of pharmacists in advancing and managing the challenges related to antidepressant development, focusing specifically on efficacy, safety, and treatment adherence. The collected data highlight how pharmacists contribute to the efficacy of antidepressants through appropriate medication selection, dose adjustment, and continuous patient monitoring. Additionally, it discusses the merit of pharmacists in ensuring patient safety, inferring the identification and management of side effects, as well as strategies to achieve better treatment adherence, which is often compromised by adverse effects and the complexity of therapeutic regimens. Methodology: Studies from 2020 to 2024 were included, employing a combination of quantitative and qualitative approaches, with data gathered from bibliographic references within the platforms: PubMed, Scielo, Lilacs, and DeCS from BVS, which provided a cohesive basis for the creation of this work. Results: The research revealed that pharmacists play a fundamental role in optimizing antidepressant efficacy and reducing associated safety risks, as well as in implementing strategies to improve treatment adherence, such as patient education and personalized support. Conclusion: Despite advancements in antidepressant development, challenges related to efficacy, safety, and adherence remain significant. Pharmacists are essential in overcoming these challenges and ensuring more effective and safe treatment for patients. Continued research is necessary to explore new management strategies and support the ongoing advancement of antidepressant pharmacotherapy.

A demonstration of 24-hour continuous optical turbulence monitoring in a city

A demonstration of 24-hour continuous optical turbulence monitoring in a city

Theory of AI-driven scheduling (TAIS): a service-oriented scheduling framework by integrating theory of constraints and AI

This paper introduces the Theory of AI-driven scheduling (TAIS), an innovative framework designed to revolutionise service-oriented scheduling (In the context of this paper, ‘service-oriented’ refers to the design and execution of scheduling processes that are specifically tailored to meet the dynamic and varied needs of service-manufacturing industries. This approach emphasises adaptability, customer-centric scheduling, and the efficient allocation of resources to enhance product and service delivery.) by integrating the theory of constraints (TOC) (see APPENDIX I) with cutting-edge Artificial Intelligence (AI) technologies. TAIS extends the traditional five steps of TOC by introducing three additional layers to enhance adaptability, efficiency, and applicability in service-oriented environments. TAIS incorporates continuous monitoring and adjustment mechanisms across all five TOC steps to improve adaptability, ensuring real-time responsiveness to dynamic scheduling challenges. To enhance efficiency, TAIS integrates lifecycle management and governance into the core framework, which helps in the efficient allocation of resources throughout the scheduling process. Lastly, TAIS includes robust security and compliance measures to bolster applicability. By leveraging AI, TAIS offers a predictive, flexible, and scalable solution capable of addressing the complexities and rapid changes inherent in dynamic scheduling tasks and providing a significant leap forward in scheduling and operations management.

Using a Quality-Controlled Dataset From ViSi Mobile Monitoring for Analyzing Posture Patterns of Hospitalized Patients: Retrospective Observational Study.

ViSi Mobile has the capability of monitoring a patient's posture continuously during hospitalization. Analysis of ViSi telemetry data enables researchers and health care providers to quantify an individual patient's movement and investigate collective patterns of many patients. However, erroneous values can exist in routinely collected ViSi telemetry data. Data must be scrutinized to remove erroneous records before statistical analysis. The objectives of this study were to (1) develop a data cleaning procedure for a 1-year inpatient ViSi posture dataset, (2) consolidate posture codes into categories, (3) derive concise summary statistics from the continuous monitoring data, and (4) study types of patient posture habits using summary statistics of posture duration and transition frequency. This study examined the 2019 inpatient ViSi posture records from Atrium Health Wake Forest Baptist Medical Center. First, 2 types of errors, record overlap and time inconsistency, were identified. An automated procedure was designed to search all records for these errors. A data cleaning procedure removed erroneous records. Second, data preprocessing was conducted. Each patient's categorical time series was simplified by consolidating the 185 ViSi codes into 5 categories (Lying, Reclined, Upright, Unknown, User-defined). A majority vote process was applied to remove bursts of short duration. Third, statistical analysis was conducted. For each patient, summary statistics were generated to measure average time duration of each posture and rate of posture transitions during the whole day and separately during daytime and nighttime. A k-means clustering analysis was performed to divide the patients into subgroups objectively. The analysis used a sample of 690 patients, with a median of 3 days of extensive ViSi monitoring per patient. The median of posture durations was 10.2 hours/day for Lying, 8.0 hours/day for Reclined, and 2.5 hours/day for Upright. Lying had similar percentages of patients in low and high durations. Reclined showed a decrease in patients for higher durations. Upright had its peak at 0-2 hours, with a decrease for higher durations. Scatter plots showed that patients could be divided into several subgroups with different posture habits. This was reinforced by the k-means analysis, which identified an active subgroup and two sedentary ones with different resting styles. Using a 1-year ViSi dataset from routine inpatient monitoring, we derived summary statistics of posture duration and posture transitions for each patient and analyzed the summary statistics to identify patterns in the patient population. This analysis revealed several types of patient posture habits. Before analysis, we also developed methodology to clean and preprocess routinely collected inpatient ViSi monitoring data, which is a major contribution of this study. The procedure developed for data cleaning and preprocessing can have broad application to other monitoring systems used in hospitals.

Emergence of the mobile RND-type efflux pump gene cluster tmexCD1-toprJ1 in Klebsiella pneumoniae clinical isolates in Japan.

Tigecycline is an antimicrobial agent with a broad spectrum of activity against both Gram-positive and Gram-negative bacteria. However, mobile tigecycline resistance gene clusters, such as tnfxB-tmexCD-toprJ, have spread globally. The prevalence of tigecycline-resistant Enterobacterales in clinical settings in Japan is unknown. To investigate the tnfxB-tmexCD-toprJ gene cluster in the genome sequences of Enterobacterales clinical isolates in Japan. We investigated the tnfxB-tmexCD-toprJ cluster from the genome sequences of 5143 Enterobacterales isolates collected from 175 hospitals around Japan between 2019 and 2020 as part of a national genomic surveillance program for antimicrobial-resistant bacteria. The tnfxB1-tmexCD1-toprJ1 cluster was detected in two Klebsiella pneumoniae isolates in 2019. One isolate possessed a 299.4 kb IncFIB(K) plasmid, pJBBGAAF19431, and the other possessed a 224.9 kb IncHI1B/IncFIB(K) hybrid plasmid, pJBEAACG19501, co-carrying multiple antimicrobial resistance genes, including extended-spectrum β-lactamase genes, blaOXA-1 and blaCTX-M-27, respectively, along with tnfxB1-tmexCD1-toprJ1. The genetic context of the tnfxB1-tmexCD1-toprJ1-surrounding structure on pJBBGAAF19431 was similar to that of a K. pneumoniae plasmid pHNAH8I-1 from a chicken in China in 2017, and the cluster was embedded in an apparently intact mobile DNA element: strand-biased circularizing integrative element. The tnfxB1-tmexCD1-toprJ1 on pJBEAACG19501 was embedded in a Tn3 family transposon related to TnAs1. The plasmid pJBEAACG19501 was highly similar to that of K. pneumoniae, isolated from humans in China in 2021. tmexCD-toprJ was present in Japan as of 2019. Even in Japan, where the clinical use of tigecycline is significantly rare, tmexCD-toprJ-harbouring multidrug-resistant Enterobacterales is a public health threat and requires continuous monitoring.