Control Criteria Research Articles

Spatial infection control in burn center organization: a burn center design experience for evidence-based architecture

PurposeThis study discusses that the necessary criteria and the solution approach taken to resolve the main spatial infection problems with a burn center design should be evaluated holistically to achieve spatial infection control in a burn center. The burn center design plays an important role in protecting severely burned patients from infection because the microbial flora of the hospital can affect the infection risk. In hospitals, sterilization and disinfection are the basic components of infection prevention; however, the prevention and control of infection for burn patients also requires the design of burn centers that adhere to a specific set of criteria that considers spatial infection control in addition to appropriate burn treatment methods and treatments. In this study, a burn facility converted from a burn unit into a burn center is introduced and the necessary design inputs for the transformation are discussed because there is no holistic study in the literature that delas with all the spaces that should be in a burn center and relations between spaces. This study aims to define the functional relations between each of the units and the spaces that change according to different sterilization demands in the burn center for ensuring spatial infection control. Furthermore, it aims to propose a method for ensuring continuity in the control of spatial infections.Design/methodology/approachThe burn care and health facilities guidelines are examined within the framework of spatial standards, together with a comprehensive literature review. The design method was based on the spread of microorganisms and the effect of human movement on space and spatial transitions in the burn center, according to all relevant literature reviews. To determine the extent to which the differences in treatment protocols of burn care guidelines were reflected in the space, interviews were conducted with burn facility officials. The plan–do–check–act (PDCA) method is also modeled to ensure the continuity of infection control in the burn center.FindingsThe burn center design findings are classified under three main headings, namely, location of the burn center in the hospital, spatial organization and physical features of the burn center and the air flowing system. The importance of the interactions among the criteria for spatial infection control has been revealed. Due to the physical space characteristics and air flow characteristics that change according to human movement and the way microorganisms spread, it has been seen that designing the air flow and architectural aspects together has an effective role in providing spatial infection control. Accordingly, a functional relation scheme for the center has been suggested. It is also proposed as a model to ensure the continuity of infection control in the burn center.Practical implicationsThis research presents spatial measures for infection control in burn centers for practitioners in health-care settings such as designers, engineers, doctors and nurses. The PDCA method also leads to continuity of infection control for hospital management.Originality/valueThis is the first study, to the best of the authors’ knowledge, to focus on developing the criteria for spatial infection control in burn center. Moreover, the aim is to create a function chart that encompasses the relationships between the units within the burn center design so that infection control can be coordinated spatially.

VOT and VFT-Based hybrid digital hysteresis control for UPS inverter

When the digital hysteresis current control (DHCC) strategy is applied to control the uninterruptible power supply (UPS) inverter, here are some issues such as large hysteresis tracking error caused by sampling interval and severe switching frequency swing caused by rapid change rate of inductor current. To address these issues, this paper presents a digital control strategy based on the hybrid digital hysteresis current control (HDHCC) of variable opening time (VOT) and variable falling time (VFT) for UPS inverter. Firstly, the HDHCC structure is established and the working principle of the inverter system is described in detail. Then, the tracking error and switching frequency error of the DHCC are derived. Based on the performance requirement of quasi-constant frequency control of UPS inverter, VOT and VFT control criteria without the dependency of circuit parameters are given. The experimental results demonstrate that the hybrid digital hysteresis control strategy based on VOT and VFT has the advantages of high current tracking accuracy, accurate switching frequency control, small output voltage waveform distortion, and simple implementation.

Expert consensus on the morphological evaluation of human cleavage-stage embryos and blastocysts.

Expert consensus on the morphological evaluation of human cleavage-stage embryos and blastocysts.

Data-Driven Genome-Wide Association Study of Pain Trajectories in Persons with Parkinson’s Disease (P7-11.012)

<h3>Objective:</h3> To conduct the first genome-wide association study (GWAS) of pain in persons with Parkinson’s disease (PWP). <h3>Background:</h3> Pain is a common and complex non-motor symptom experienced by ~60% of PWP. Little is known about the genetic and non-genetic determinants of pain in PWP. <h3>Design/Methods:</h3> Using data spanning ~4.5 years from 8,612 PWP who are early in their disease course (&lt;3 years), and available through the Fox Insight Data Exploration Network, we empirically discerned 5 subgroups of PWP with similar longitudinal patterns of pain using latent class growth analysis. 4,411 PWP were also genotyped across two customized Illumina platforms that had significant overlap. Quality control criteria (minor allele frequency &lt;1%, Hardy Weinberg Equilibrium p&lt;5×10⁻⁵) were imposed prior imputation using the TOPMed reference panel. After post-imputation quality control (same as above + imputation R²&gt;70%), there were 7.7×10⁶ genetic variants. We retained 4,159 PWP who self-identified as White and who genetically clustered with other European samples. For this analysis, we focused on a GWAS of the most severe pain subgroup (N=97) to the least impaired subgroup (N=934). Gene-based and pathway enrichment analyses were also conducted. <h3>Results:</h3> For the GWAS of extreme pain phenotypes, top genic SNP association were <i>MAPK8</i>-rs72794357 (OR=4.6; p=1×10⁻⁶) and <i>VLDLR-</i>rs4741753 (OR=2.2; p=1.5×10⁻⁶) and top gene-based results included <i>CTNNB1</i> (p=3.5×10⁻⁵) and <i>KLK7</i> (p=7.7×10⁻⁵). These results are intriguing since <i>MAPK8</i> is involved in opioid receptor pathways, <i>VLDLR</i> is a ApoE receptor involved in brain development through Reelin signaling, <i>CTNNB1</i> promotes neurogenesis and de novo mutations have been associated with polyneuropathy in lower limbs, and <i>KLK7</i> is an astrocyte-derived amyloid-β degrading enzyme. Overall there was an enrichment of genes associated with oxytocin signaling (p=0.14), opioid signaling (p=0.045), and Wnt signaling pathway (p=0.021). <h3>Conclusions:</h3> The findings are consistent with known neuropathic mechanisms, thus therapeutic targets for these mechanisms may be relevant for PWP. <b>Disclosure:</b> The institution of Miss Liu has received research support from NIH/NIGMS. The institution of Miss Liu has received research support from Diana Jacobs Kalman/AFAR Scholarships for Research in the Biology of Aging The Program. The institution of Miss Liu has received research support from Michael J. Fox Foundation. Doug Gunzler has nothing to disclose. Dr. Gunzler has received research support from NIH/NINDS. The institution of Dr. Gunzler has received research support from Biogen. The institution of Dr. Gunzler has received research support from Amneal. Dr. Gunzler has received research support from Michael J Fox Foundation. Dr. Crawford has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers in Genetics. The institution of Dr. Crawford has received research support from NIH/NIDDK. The institution of Dr. Crawford has received research support from NIH/NCATS. The institution of Dr. Crawford has received research support from VA. The institution of Dr. Crawford has received research support from NIH/NIGMS. The institution of Dr. Crawford has received research support from NHGRI. The institution of Dr. Crawford has received research support from NIH/NIA. Dr. Crawford has received personal compensation in the range of $500-$4,999 for serving as a Member with NIH Study Section. The institution of Prof. Briggs has received research support from NIH. The institution of Prof. Briggs has received research support from Michael J. Fox Foundation.

Obesity increased the risk of SARS-CoV-2 positivity in children.

To determine the effects of obesity in childhood on SARS-CoV-2 infection. A population-based, cross-sectional study combining the Israeli Growth Survey and COVID-19 data for children with at least one SARS-CoV-2 test from 16 February 2020 to 20 December 2021. Overweight and obesity status were based on body mass index and the Center for Disease Control criteria. Multivariate logistics regression was performed to validate reliability for weight categories at the age of approximately 6 years compared with weights at approximately 12 years. A total of 444 868 records for children with an overall positivity rate of 22% were studied. The mean age was 9.5 years. The odds ratios of children with obesity or overweight after controlling for sex at 6 years to test positive were 1.07-1.12 and 1.06-1.08 (depending on the model), respectively, compared to those with healthy range body mass index. Excess weight appears to increase the risk of SARS-CoV-2 infection. This finding should be considered for public health planning. For example, children with overweight and obesity should be prioritised for vaccination. Excess weight in childhood can be harmful at a young age and not only for long-term health.

Effective and Practical Complete Blood Count Delta Check Method and Criteria for the Quality Control of Automated Hematology Analyzers.

Delta checks increase patient safety by identifying automated hematology analyzer errors. International standards and guidelines for the complete blood count (CBC) delta check method have not been established. We established an effective, practical CBC delta check method and criteria. We assessed five delta check methods for nine CBC items (Hb, mean corpuscular volume, platelet count, white blood cell [WBC] count, and five-part WBC differential counts) using 219,804 blood samples from outpatients and inpatients collected over nine months. We adopted the best method and criteria and evaluated them using 42,652 CBC samples collected over two weeks with a new workflow algorithm for identifying test errors and corrections for Hb and platelet count. The median delta check time interval was 1 and 21 days for inpatients and outpatients (range, 1-20 and 1-222 days), respectively. We used delta values at 99.5% as delta check criteria; the criteria varied among the five methods and between outpatients and inpatients. The delta percent change (DPC)/reference range (RR) rate performed best as the delta check for CBC items. Using the new DPC/RR rate method, 1.7% of total test results exceeded the delta check criteria; the retesting and resampling rates were 0.5% and 0.001%, respectively. We developed an effective, practical delta check method, including RRs and delta check time intervals, and delta check criteria for nine CBC items. The criteria differ between outpatients and inpatients. Using the new workflow algorithm, we can identify the causes of criterion exceedance and report correct test results.

Sex differences and the effect of female sex hormones on auditory function: a systematic review.

First, to discuss sex differences in auditory function between women and men, and whether cyclic fluctuations in levels of female sex hormones (i.e., estradiol and progesterone) affect auditory function in pre-menopausal and post-menopausal women. Second, to systematically review the literature concerning the discussed patterns in order to give an overview of the methodologies used in research. Last, to identify the gap in knowledge and to make recommendations for future work. Population, Exposure, Control, Outcome and Study design (PECOS) criteria were used in developing the review questions. The review protocol follows the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and was pre-registered in the Prospective Register of Systematic Reviews (PROSPERO; CRD42020201480). Data Sources: EMBASE, PubMed, MEDLINE (Ovid), PsycINFO, ComDisDome, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library, and scanning reference lists of relevant studies, and internet resources (i.e., Mendeley) were used. Only studies published between 1999 and 2022, in English, or in English translation, were included. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS). Sex differences: Women had more sensitive hearing (measured at the level of peripheral and central auditory system) than men. Cyclic fluctuations: Auditory function in women fluctuated during the menstrual cycle, while no such fluctuations in men over the same time period were reported. Hearing sensitivity improved in women during the late follicular phase, and decrease during the luteal phase, implying an effect of female sex hormones, although the specific effects of estradiol and progesterone fluctuations on the central auditory system remain unclear. Hearing sensitivity in women declined rapidly at the onset of menopause. The review has shown the following. Consistent sex differences exist in auditory function across the auditory pathway with pre-menopausal women often showing better function than age-matched men. Moreover, pre-menopausal women show fluctuations in hearing function across the menstrual cycle with a better function during the peak of estradiol or when the ratio of estradiol to progesterone is high. Third, menopause marks the onset of hearing loss in women, characterized by a rapid decline in hearing sensitivity and a more pronounced loss than in age-matched men. Finally, the systematic review highlights the need for well-designed and -controlled studies to evaluate the influence of estradiol and progesterone on hearing by consistently including control groups (e.g., age-matched man), using objective tests to measure hormonal levels (e.g., in saliva or blood), and by testing participants at different points across the menstrual cycle. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020201480, identifier CRD42020201480.

COMPLETE AUDIT CYCLE: PERI-OPERATIVE GLYCEMIC CONTROL IN CMH LAHORE

Hyperglycemia is associated with an increased risk of complications in patients undergoing surgery. Hyperglycemia from diabetes must be differentiated from stress-induced hyperglycemia, which typically presents post-operatively and resolves as the surgery-induced stress subsides. It is imperative to differentiate between the two due to the severe complications of diabetic hyperglycemia, which can often be confused with its stressed induced counterpart. Good glycemic control is the best strategy to avoid post-operative complications and morbidity. An assessment of peri-operative blood glucose levels of known diabetics admitted to CMH Lahore was done, and recommendations were introduced to achieve better glycemic control. Subsequently preventing post-surgical complications, improving wound healing and overall recovery, and ultimately decreasing morbidity. The aim of the audit was the assessment of peri-operative glycemic control in known diabetics admitted for surgery in CMH Lahore. Existing problems regarding poor glycemic control were identified, and recommendations were given to rectify said problems. We aimed to study the effectiveness of glucose control due to these planned interventions. Patients were included based on eligibility criteria, and a record of the patients was updated daily on the Excel sheet using the glucose control audit tool (attached below). The highest BSR reading per day was added. Good or poor glycemic control was determined by the highest BSR readings on post-op days 0, 1, and 2. If 2 or more readings met the criteria for good glycemic control, the patient was labeled to have good glycemic control. In Cycle 1, patients were managed peri-operatively with insulin as per the sliding scale. 13% of patients had good glycemic control on this regimen. Interventions were introduced for Cycle 2, with the recommendation of altering insulin/drug regimens as per NHS/ADA guidelines. 16.6% of patients were found to achieve good glycemic control; however, it was noted that these recommendations were not followed consistently. Based on the results, it can be concluded that the management of inpatient diabetes is a team effort, interventions recommended using established guidelines should be followed stringently, and existing protocols should be updated accordingly. Proper management of inpatient hyperglycemia starts with each team member performing their respective role to their best; this is vital in preventing post-operative complications associated with poor glycemic control.

Prevalence and associations between food insecurity and overweight/obesity among native Hawaiian and Pacific Islander adolescents.

This study estimates the prevalence of, and associations between, family food insecurity and overweight/obesity among Native Hawaiian and Pacific Islander (NHPI) adolescents and explores socio-demographic factors which might have a moderation effect on the association. Cross-sectional study using 2014 NHPI-National Health Interview Survey data reported by a parent or guardian. Family-level food security was assessed by the US Department of Agriculture 10-item questionnaire. BMI for age and sex ≥ 85th and 95th percentiles defined overweight and obesity, respectively, according to US Centers for Disease Control and Prevention criteria. The USA, including all 50 states and the District of Columbia. 383 NHPI adolescents aged 12-17 in the USA. A third (33·5 %) of NHPI adolescents aged 12-17 were overweight (19·1 %) or obese (14·4 %); 8·1 % had low food security; and 8·5 % had very low food security. Mean family food security score was 1·06, which corresponds to marginal food security. We found no association between family food insecurity and adolescent overweight/obesity or between any other covariates and overweight/obesity, except for family Supplemental Nutrition Assistance Program (SNAP) participation. Odds of being overweight/obese were 77 % lower for adolescents in families participating in SNAP (OR: 0·23, 95 % CI: 0·08, 0·64, P = 0·007). The association between SNAP participation and lower odds of overweight/obesity was particularly pronounced for adolescent girls in food-insecure families. The association between SNAP participation and lower odds of overweight/obesity suggests potential benefit of research to determine whether interventions to increase SNAP enrollment would improve NHPI adolescents' health outcomes.

Methodological Middle Spaces: Addressing the Need for Methodological Innovation to Achieve Simultaneous Realism, Control, and Scalability in Experimental Studies of AI-Mediated Communication

As AI-mediated communication (AI-MC) becomes more prevalent in everyday interactions, it becomes increasingly important to develop a rigorous understanding of its effects on interpersonal relationships and on society at large. Controlled experimental studies offer a key means of developing such an understanding, but various complexities make it difficult for experimental AI-MC research to simultaneously achieve the criteria of experimental realism, experimental control, and scalability. After outlining these methodological challenges, this paper offers the concept of methodological middle spaces as a means to address these challenges. This concept suggests that the key to simultaneously achieving all three of these criteria is to abandon the perfect attainment of any single criterion. This concept's utility is demonstrated via its use to guide the design of a platform for conducting text-based AI-MC experiments. Through a series of three example studies, the paper illustrates how the concept of methodological middle spaces can inform the design of specific experimental methods. Doing so enabled these studies to examine research questions that would have been either difficult or impossible to investigate using existing approaches. The paper concludes by describing how future research could similarly apply the concept of methodological middle spaces to expand methodological possibilities for AI-MC research in ways that enable contributions not currently possible.

SAIL study of stroke, systemic embolism and bleeding outcomes with warfarin anticoagulation in non-valvular atrial fibrillation (S4-BOW-AF).

In patients with non-valvular atrial fibrillation (NVAF) prescribed warfarin, the association between guideline defined international normalised ratio (INR) control and adverse outcomes in unknown. We aimed to (i) determine stroke and systemic embolism (SSE) and bleeding events in NVAF patients prescribed warfarin; and (ii) estimate the increased risk of these adverse events associated with poor INR control in this population. Individual-level population-scale linked patient data were used to investigate the association between INR control and both SSE and bleeding events using (i) the National Institute for Health and Care Excellence (NICE) criteria of poor INR control [time in therapeutic range (TTR) <65%, two INRs <1.5 or two INRs >5 in a 6-month period or any INR >8]. A total of 35 891 patients were included for SSE and 35 035 for bleeding outcome analyses. Mean CHA2DS2-VASc score was 3.5 (SD = 1.7), and the mean follow up was 4.3 years for both analyses. Mean TTR was 71.9%, with 34% of time spent in poor INR control according to NICE criteria.SSE and bleeding event rates (per 100 patient years) were 1.01 (95%CI 0.95-1.08) and 3.4 (95%CI 3.3-3.5), respectively, during adequate INR control, rising to 1.82 (95%CI 1.70-1.94) and 4.8 (95% CI 4.6-5.0) during poor INR control.Poor INR control was independently associated with increased risk of both SSE [HR = 1.69 (95%CI = 1.54-1.86), P < 0.001] and bleeding [HR = 1.40 (95%CI 1.33-1.48), P < 0.001] in Cox-multivariable models. Guideline-defined poor INR control is associated with significantly higher SSE and bleeding event rates, independent of recognised risk factors for stroke or bleeding.

Influence of Homogeneous Dose Distribution Inside the Cancer Target on Local Control in Glioblastomas

Purpose: Assessment of the effect of homogeneous distribution inside the radiation target on local control in glioblastoma.&#x0D; Material and methods: In patients under the age of 50, fractionation with the prescribed dose of 2 and 3 Gy was alternately used: the first patient was prescribed a regimen with a dose of 3 Gy, the next – with a dose of 2 Gy (a study involving a pairwise selection strategy). The same approach is used for the older age group (50 years and more). A total of 141 patients had morphologically confirmed glioblastoma (grade 4). 10 patients who had not completed a full course of radiation therapy were excluded. Additionally, 27 patients with GBM were added, treated in the experimental study of National Medical Research Radiological Centre without methodological features. In total, 158 patients were included in the study. 74 patients were treated with the prescribed dose of 2 Gy, 84 had a dose of 3 Gy.&#x0D; Results: The median homogeneity index in our study was 7.5 (95% Cl: 6,7-8,3). The minimum HI indicator was at the level of 2.5, the maximum – 36.9. We managed to identify the most informative level of the homogeneity index according to the criterion of local control. The median disease-free survival in the group with HI&gt;=8.5 was 7.9 months (n=62; 95 % Cl: 1.6-14.2), in the group with a lower level of homogeneity - 5.4 months (n=96; p=0.024). The significance of the highlighted HI range depended on the fractionation mode used. The median relapse–free survival with fractionation of 3 Gy in the group with HI&gt;=8.5 was 12.7 months (n=38), in the group with a lower level of homogeneity - 8.3 months (n=46; p=0.020). In the group with fractionation regime of 2 Gy: 6.4 and 3.8 months, respectively (n=24/50; p=0.336). The median overall survival in the group with HI&gt;=8.5 was 27.2 months, in the group with a lower level of homogeneity – 21.2 months (p=0.904).&#x0D; Conclusion: The level of homogeneity has no significance according to the criterion of overall survival. Despite the fact that this predictor is of value only in scientific terms, the fact of its influence on local control allows to continue research in this direction. This primarily concerns the fractionation regimen with a prescribed dose of 3 Gy.

Herbivory by Atta vollenweideri: Reviewing the significance of grass-cutting ants as a pest of livestock.

The grass-cutting ant Atta vollenweideri is well suited for studies examining the negative effect leaf-cutting ants have on livestock production in South American grasslands because they forage on the same plants as cattle. This study investigated the impact of A. vollenweideri on livestock production in Argentinean rangelands. First, we assessed A. vollenweideri herbivory rates and its economic injury level (EIL). Second, using satellite imagery in a region covering 15,000 ha, we estimated the percentage of this area that surpassed the calculated EIL. Results showed that A. vollenweideri consumed approximately 276kg of dry plant weight/ha/year, foraging mostly on grasses (70%). Additionally, ants cut 25% of herbs and 5% of trees. In summer and autumn, ants consumed more grasses, while in winter and spring, herbs and trees were also significantly cut. Ants consumed 7% of the forage demand needed to raise a calf according to the management regime applied by farmers. Our calculated EIL (5.85 nests/ha) falls in the range of previous studies. Colonies were absent in 93.6% of the surveyed area, while their density was below the EIL in 6.2% of the area. A. vollenweideri populations surpassed the EIL in only 0.2% of the area, which corresponds to 2.6% of the locations holding colonies. These results question the perception that Atta leaf-cutting ants are a pest of livestock production. Although ants consume a small percentage of cattle's forage demand, evidence that ants and cattle are competing in the few cases in which density surpasses the EIL is arguable. First, grass-cutting ants are capable of consuming herbs and trees in addition to the grasses on which cattle mostly feed. Second, there is no evidence indicating that both are cutting the same plant portions when preferences overlap. Third, evidence suggests that ants are not displaced under high-pressure grazing regimes by cattle. In the countries where A. vollenweideri is present, decision makers have promulgated several acts making its control mandatory. It is time to revisit the pest status of A. vollenweideri and include the use of EIL as a control criterion.

Association of Preoperative Glycated Hemoglobin and Early Postoperative Infections After Elective Craniotomy: A Retrospective Cohort Study

The prognostic value of preoperative glycated hemoglobin (HbA1c) testing is controversial. The available evidence on the role of preoperative HbA1c in predicting postoperative complications after different surgical procedures has been conflicting. The primary aim of our retrospective observational cohort study was to assess the association between preoperative HbA1c and postoperative infections after elective craniotomy. We extracted and analyzed data from an internal hospital database on 4564 patients who underwent neurosurgical intervention from January 2017 to May 2022. The primary outcome measure of the present study was infections established in the first week after surgery using the Centers for Disease Control and Prevention criteria. The records were stratified by the HbA1c values and intervention types. For patients who had undergone brain tumor removal with a preoperative HbA1c ≥6.5%, the odds of early postoperative infections were increased (odds ratio, 2.08; 95% confidence interval, 1.16-3.72; P= 0.01). We found no association between HbA1c and early postoperative infections for patients who had undergone elective cerebrovascular intervention, cranioplasty, or a minimally invasive procedure. After adjusting for age and gender, the threshold for significant infection risk for neuro-oncological patients increased with an HbA1c ≥7.5% (adjusted odds ratio, 2.97; 95% confidence interval, 1.37-6.45; P= 0.0058). For patients undergoing elective intracranial surgery for brain tumor removal, a preoperative HbA1c ≥7.5% is associated with a higher infection rate within the first postoperative week. Future prospective studies are required to assess the prognostic value of this association for clinical decision-making.

Abstract 5547: Evaluation of two clinically focused targeted NGS systems for liquid biopsy testing shows a high level of concordance in resulting actionable mutations

Abstract Introduction: The use of blood-based molecular diagnostics is increasingly becoming routine in clinical oncology practice. The purpose of this study was to evaluate variant resulting concordance for the four major somatic variant classes using two clinical next-generation sequencing (NGS) systems for conducting highly sensitive blood-based analyses. All donor specimens were de-identified remnants from patients previously diagnosed with advanced NSCLC. We utilized two independent panels, systems and bioinformatic pipelines that are focused on clinical testing for key actionable variants. The fifty-gene panel Oncomine Precision Assay (OPA) GX was performed on the Genexus Integrated Sequencer and the 52 gene GeneStrat NGS (GSNGS) test was run as a reference on the Ion GeneStudio S5 PRIME system. The four major classes of mutations evaluated included Single Nucleotide Variants (SNV), Insertions and Deletions (INDEL), copy number amplifications (CNAs) and gene fusions. Methods: For this study, de-identified reference GSNGS cell-free nucleic acid (cfNA) remnant specimens (n=33 variants) that passed all validated QC bioinformatics thresholds were blinded and tested on the Genexus. DNA concentration was measured by fluorometry, and specimens were diluted to an input of 6.6 ng to 53.4 ng for library preparation. The Genexus system is pre-programmed to process specimens to result generation. Variant calls for all mutation classes were conducted using the on-board bioinformatics pipelines, and results were compared to those generated by the GeneStrat NGS Test. We included specimens harboring somatic variant mutations in KRAS, NRAS, BRAF, EGFR, ERBB2, and FGFR; CNAs; EML4-ALK fusions; and MET exon 14 skipping. Results: All samples passed the OPA (Genexus) bioinformatic quality control criteria and mapped reads were highly consistent, demonstrating accuracy of calls between both the Ion Torrent platforms, informatic pipelines and panels. We observed 100% concordance in variant calls for SNVs, INDELs and fusions between the two platforms. There was one CNA variant observed on the S5 that was not called by the Genexus workflow, yielding overall concordance of 97% (32 of 33). Of note, 44 additional somatic variants (SNV and INDELs) and 1 additional fusion were detected using the Genexus workflow. This was due to the lower threshold for variant calling on this system. Conclusion: The high concordance of the independent workflows for the detection of nucleic acid variants in circulation demonstrates the capability of both systems to be used for testing of clinical specimens. Specifically, actionable variants in the four major mutation classes were successfully detected in the reference and test specimen set. As a part of clinical validation, orthogonal testing of variants will need to be conducted. Citation Format: Sarah Kreston, Claire Gould, Kylie Blair, Leisa Jackson, Janice Riley, Gary A. Pestano. Evaluation of two clinically focused targeted NGS systems for liquid biopsy testing shows a high level of concordance in resulting actionable mutations. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5547.

Ventilator-associated Pneumonia in the Intensive Care Unit of the Institute of Oncology Ljubljana in 2021 and the Role of Nurses in its Prevention

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common infection in critically ill patients and has the highest mortality. It prolongs ventilation time and length of stay, increases antibiotic consumption, increases the likelihood of death, increases the cost of treatment, and is difficult to diagnose. AIM: At the intensive care unit (ICU) of the Institute of Oncology, Ljubljana, we prospectively monitor risk factors for VAP and its incidence. It is a mixed surgical/internal ICU. METHODS: A centers of disease control and prevention VAP diagnosis criteria and strategies to prevent VAP were used. Registered nurses recorded risk factors in all intubated patients in all three shifts, and the diagnosis protocol was completed by the physician in case of antibiotic administration in suspected VAP. RESULTS: The expected incidence of VAP is around 18/1,000 ventilated days. In 2021, 67 patients were mechanically ventilated in our ICU (patients who completed ventilation in that year). The total time spent on ventilation was 17,143 h or 714.3 days. As the criteria for ventilator-assisted pneumonia (VAP) is &gt;48 h of ventilation, we excluded 19 patients who had been ventilated for 48 h or less. Among 48 patients who were ventilated for &gt; 48 h, the total ventilation was 16,765 h or 698.5 days. We recorded 8 VAP in 714 days, which is 1 VAP per 89 days of ventilation or 11.2/1,000 ventilation days. Healthcare staff, especially registered nurses, play a major role in VAP prevention, providing care every day, all days of the week. Most prevention interventions and strategies are part of routine nursing care. Lack of knowledge about infection prevention and appropriate nursing care among nurses can become a barrier to adherence to evidence-based guidelines for the prevention of VAP. CONCLUSION: This study will help nurses to learn about VAP and its prevention in detail so that they can apply the knowledge in clinical practice. Understanding the pathophysiology of VAP, its risk factors and the nursing care bundle is essential for appropriate prevention and treatment of VAP. Specific protocols, strategies, and active control should be available in each ICU regarding the care bundle.

Controllability Criteria on Discrete-Time Impulsive Hybrid Systems With Input Delay

Due to the importance of the hybrid systems, the controllability for linear discrete-time impulsive hybrid systems with input delay (DIHSID) is investigated by resorting to the geometric and algebraic analytical methods in this article. First, the null reachability and controllability geometric conditions are studied. Specifically, the null reachable set and controllable set for every impulsive and switching sequence are obtained by the properties of the invariant subspace. Besides, a new subspace sequence is constructed to analyze the null reachability and controllability of DIHSID. Second, the complete controllability of DIHSID is investigated by algebraic methods. In the form of Gramian matrices, several sufficient complete controllability conditions for DIHSID are established without assuming the nonsingularity of all impulsive matrices. Furthermore, a less conservative complete controllability criterion that is necessary and sufficient is developed by introducing a row matrix of some Gramian matrices. Finally, two illustrating examples show the effectiveness of the developed controllability theory.

Time Parameters Shape the Controllability of Temporally Switching Networks

Based on temporally switching networks, this work studies the influence of time parameters on network controllability. In particular, this work presents a necessary and sufficient condition under which the network controllability must take into account time parameters. For the time parameters that never participate in determining network controllability, a more concise expression of controllability criterion is derived. From the perspective of input matrix formulation, this work also presents a sufficient condition under which the network controllability could avoid the interference of time parameters. By taking control energy as the quantitative measurement, the increase in time parameter would decrease the lower bound of minimum control energy. However, the increase in time parameter may cause an upsurge in the upper bound of minimum control energy. In addition, we find that there exists a statistically significant correlation between time parameter influence level and network characteristic. This work highlights for the first time that subtle changes in time parameters could reshape or even worsen the controllability of temporally switching networks.

Controllability of Continuous-Time Bilinear Systems Without Using the Lie-Algebraic Conditions: A New Perspective

In this paper, we propose a new perspective to study controllability of continuous-time bilinear systems without using the Lie-algebraic conditions. Specifically, we first consider controllability of the bilinear systems in the single-input case under a commutativity condition. We show that, although the Lie algebra rank condition, which is necessary for a classical controllability result to work, does not fit such bilinear systems, they can still be controllable. Our approach to prove controllability is using controllability of the discrete-time counterparts of the continuous-time systems, and we derive a necessary and sufficient controllability criterion without the Lie algebra rank condition, which is algebraically verifiable for any finite dimension. More importantly, through this controllability study, we propose a new perspective to deal with the controllability problems of continuous-time bilinear systems by changing the verification of the Lie algebra rank condition to solving two linear algebra problems. Examples are given to illustrate the obtained controllability results of this paper.

Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs.

Extracorporeal membrane oxygenation (ECMO) has been used successfully to support adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cardiac or respiratory failure refractory to conventional therapies. Comprehensive reports of children and adolescents with SARS-CoV-2-related ECMO support for conditions, including multisystem inflammatory syndrome in children (MIS-C) and acute COVID-19, are needed. Case series of patients from the Overcoming COVID-19 public health surveillance registry. Sixty-three hospitals in 32 U.S. states reporting to the registry between March 15, 2020, and December 31, 2021. Patients less than 21 years admitted to the ICU meeting Centers for Disease Control criteria for MIS-C or acute COVID-19. None. The final cohort included 2,733 patients with MIS-C (n = 1,530; 37 [2.4%] requiring ECMO) or acute COVID-19 (n = 1,203; 71 [5.9%] requiring ECMO). ECMO patients in both groups were older than those without ECMO support (MIS-C median 15.4 vs 9.9 yr; acute COVID-19 median 15.3 vs 13.6 yr). The body mass index percentile was similar in the MIS-C ECMO versus no ECMO groups (89.9 vs 85.8; p = 0.22) but higher in the COVID-19 ECMO versus no ECMO groups (98.3 vs 96.5; p = 0.03). Patients on ECMO with MIS-C versus COVID-19 were supported more often with venoarterial ECMO (92% vs 41%) for primary cardiac indications (87% vs 23%), had ECMO initiated earlier (median 1 vs 5 d from hospitalization), shorter ECMO courses (median 3.9 vs 14 d), shorter hospital length of stay (median 20 vs 52 d), lower in-hospital mortality (27% vs 37%), and less major morbidity at discharge in survivors (new tracheostomy, oxygen or mechanical ventilation need or neurologic deficit; 0% vs 11%, 0% vs 20%, and 8% vs 15%, respectively). Most patients with MIS-C requiring ECMO support (87%) were admitted during the pre-Delta (variant B.1.617.2) period, while most patients with acute COVID-19 requiring ECMO support (70%) were admitted during the Delta variant period. ECMO support for SARS-CoV-2-related critical illness was uncommon, but type, initiation, and duration of ECMO use in MIS-C and acute COVID-19 were markedly different. Like pre-pandemic pediatric ECMO cohorts, most patients survived to hospital discharge.