Search

Objective: To identify central-line (CL)–associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs). Design: From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms. Setting: The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries. Patients: In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs. Methods: For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs). Results: The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03; 95% CI, 1.03–1.04; P < .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04; 95% CI, 1.03–1.04; P < .0001), surgical hospitalization (aOR, 1.12; 95% CI, 1.03–1.21; P < .0001), tracheostomy use (aOR, 1.52; 95% CI, 1.23–1.88; P < .0001), hospitalization at a publicly owned facility (aOR, 3.04; 95% CI, 2.31–4.01; P Conclusions: The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy; using PICC instead of internal-jugular or femoral CL; and implementing evidence-based CLABSI prevention recommendations.

Objective: To identify risk factors for mortality in intensive care units (ICUs) in Asia. Design: Prospective cohort study. Setting: The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam. Participants: Patients aged >18 years admitted to ICUs. Results: In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line–associated bloodstream infection (CLABSI; aOR, 2.36; P < .0001), ventilator-associated event (VAE; aOR, 1.51; P < .0001), catheter-associated urinary tract infection (CAUTI; aOR, 1.04; P < .0001), and female sex (aOR, 1.06; P < .0001). Older age increased mortality risk by 1% per year (aOR, 1.01; P < .0001). Length of stay (LOS) increased mortality risk by 1% per bed day (aOR, 1.01; P < .0001). Central-line days increased mortality risk by 2% per central-line day (aOR, 1.02; P < .0001). Urinary catheter days increased mortality risk by 4% per urinary catheter day (aOR, 1.04; P < .0001). The highest mortality risks were associated with mechanical ventilation utilization ratio (aOR, 12.48; P < .0001), upper middle-income country (aOR, 1.09; P = .033), surgical hospitalization (aOR, 2.17; P < .0001), pediatric oncology ICU (aOR, 9.90; P < .0001), and adult oncology ICU (aOR, 4.52; P < .0001). Patients at university hospitals had the lowest mortality risk (aOR, 0.61; P < .0001). Conclusions: Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS; strategies to reduce central-line, urinary catheter, and mechanical ventilation use; and HAI prevention recommendations.

Background The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. Methods A prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression. Results Between 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06–1.30; p p p p p p p p p p p p p Conclusion Some of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.

This study examines the impact of the COVID-19 pandemic on health care-associated infection (HAI) incidence in low- and middle-income countries (LMICs).Patients from 7 LMICs were followed up during hospital intensive care unit (ICU) stays from January 2019 to May 2020. HAI rates were calculated using the International Nosocomial Infection Control Consortium (INICC) Surveillance Online System applying the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN) criteria. Pre-COVID-19 rates for 2019 were compared with COVID-19 era rates for 2020 for central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), mortality, and length of stay (LOS).A total of 7,775 patients were followed up for 49,506 bed days. The 2019 to 2020 rate comparisons were 2.54 and 4.73 CLABSIs per 1,000 central line days (risk ratio [RR] = 1.85, p = .0006), 9.71 and 12.58 VAEs per 1,000 mechanical ventilator days (RR = 1.29, p = .10), and 1.64 and 1.43 CAUTIs per 1,000 urinary catheter days (RR = 1.14; p = .69). Mortality rates were 15.2% and 23.2% for 2019 and 2020 (RR = 1.42; p.0001), respectively. Mean LOS for 2019 and 2020 were 6.02 and 7.54 days (RR = 1.21, p.0001), respectively.This study documents an increase in HAI rates in 7 LMICs during the first 5 months of the COVID-19 pandemic and highlights the need to reprioritize and return to conventional infection prevention practices.

Objective: Rates of ventilator-associated pneumonia (VAP) in low- and middle-income countries (LMIC) are several times above those of high-income countries. The objective of this study was to identify risk factors (RFs) for VAP cases in ICUs of LMICs. Design: Prospective cohort study. Setting: This study was conducted across 743 ICUs of 282 hospitals in 144 cities in 42 Asian, African, European, Latin American, and Middle Eastern countries. Participants: The study included patients admitted to ICUs across 24 years. Results: In total, 289,643 patients were followed during 1,951,405 patient days and acquired 8,236 VAPs. We analyzed 10 independent variables. Multiple logistic regression identified the following independent VAP RFs: male sex (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.16–1.28; P < .0001); longer length of stay (LOS), which increased the risk 7% per day (aOR, 1.07; 95% CI, 1.07–1.08; P < .0001); mechanical ventilation (MV) utilization ratio (aOR, 1.27; 95% CI, 1.23–1.31; P < .0001); continuous positive airway pressure (CPAP), which was associated with the highest risk (aOR, 13.38; 95% CI, 11.57–15.48; P < .0001); tracheostomy connected to a MV, which was associated with the next-highest risk (aOR, 8.31; 95% CI, 7.21–9.58; P < .0001); endotracheal tube connected to a MV (aOR, 6.76; 95% CI, 6.34–7.21; P < .0001); surgical hospitalization (aOR, 1.23; 95% CI, 1.17–1.29; P < .0001); admission to a public hospital (aOR, 1.59; 95% CI, 1.35-1.86; P < .0001); middle-income country (aOR, 1.22; 95% CI, 15–1.29; P < .0001); admission to an adult-oncology ICU, which was associated with the highest risk (aOR, 4.05; 95% CI, 3.22–5.09; P < .0001), admission to a neurologic ICU, which was associated with the next-highest risk (aOR, 2.48; 95% CI, 1.78–3.45; P < .0001); and admission to a respiratory ICU (aOR, 2.35; 95% CI, 1.79–3.07; P < .0001). Admission to a coronary ICU showed the lowest risk (aOR, 0.63; 95% CI, 0.51–0.77; P < .0001). Conclusions: Some identified VAP RFs are unlikely to change: sex, hospitalization type, ICU type, facility ownership, and country income level. Based on our results, we recommend focusing on strategies to reduce LOS, to reduce the MV utilization ratio, to limit CPAP use and implementing a set of evidence-based VAP prevention recommendations.

Ventilator associated pneumonia (VAP) rates in Asia are several times above those of US. The objective of this study is to identify VAP risk factors.We conducted a prospective cohort study, between March 27, 2004 and November 2, 2022, in 279 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam).153,717 patients, followed during 892,996 patient-days, acquired 3,369 VAPs. We analyzed 10 independent variables. Using multiple logistic regression we identified following independent VAP RFs= Age, rising VAP risk 1% per year (aOR=1.01; 95%CI=1.00-1.01, P.0001); male gender (OR=1.17; 95%CI=1.08-1.26, P.0001); length of stay, rising VAP risk 7% daily (aOR=1.07; 95%CI=1.06-1.07, P.0001); mechanical ventilation (MV) device utilization (DU) ratio (OR=1.43; 95%CI=1.36-1.51; p.0001); tracheostomy connected to a MV (OR=11.17; 95%CI=9.55-14.27; p.0001); public (OR=1.84; 95%CI=1.49-2.26, P.0001), and private (OR=1.57; 95%CI=1.29-1.91, P.0001) compared with teaching hospitals; upper-middle income country (OR=1.86; 95%CI=1.63-2.14, P.0001). Regarding ICUs, Medical-Surgical (OR=4.61; 95%CI=3.43-6.17; P.0001), Neurologic (OR=3.76; 95%CI=2.43-5.82; P.0001), Medical (OR=2.78; 95%CI=2.04-3.79; P.0001), and Neuro-Surgical (OR=2.33; 95%CI=1.61-3.92; P.0001) showed the highest risk.Some identified VAP RFs are unlikely to change= age, gender, ICU type, facility ownership, country income level. Based on our results, we recommend limit use of tracheostomy, reducing LOS, reducing the MV/DU ratio, and implementing an evidence-based set of VAP prevention recommendations.

The International Nosocomial Infection Control Consortium has found a high ICU mortality rate. Our aim was to identify all-cause mortality risk factors in ICU-patients.Multinational, multicenter, prospective cohort study at 786 ICUs of 312 hospitals in 147 cities in 37 Latin American, Asian, African, Middle Eastern, and European countries.Between 07/01/1998 and 02/12/2022, 300,827 patients, followed during 2,167,397 patient-days, acquired 21,371 HAIs. Following mortality risk factors were identified in multiple logistic regression: Central line-associated bloodstream infection (aOR:1.84; P.0001); ventilator-associated pneumonia (aOR:1.48; P.0001); catheter-associated urinary tract infection (aOR:1.18;P.0001); medical hospitalization (aOR:1.81; P.0001); length of stay (LOS), risk rises 1% per day (aOR:1.01; P.0001); female gender (aOR:1.09; P.0001); age (aOR:1.012; P.0001); central line-days, risk rises 2% per day (aOR:1.02; P.0001); and mechanical ventilator (MV)-utilization ratio (aOR:10.46; P.0001). Coronary ICU showed the lowest risk for mortality (aOR: 0.34;P.0001).Some identified risk factors are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; Central line-associated bloodstream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection, LOS, and MV-utilization. So, to lower the risk of death in ICUs, we recommend focusing on strategies to shorten the LOS, reduce MV-utilization, and use evidence-based recommendations to prevent HAIs.

Background: Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors (RF) in Asia. Methods: From 03/27/2004 to 02/11/2022, we conducted a multinational multicenter prospective cohort study in 281 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam). For estimation of CLABSI rate we used CL-days as denominator and number of CLABSI as numerator. To estimate CLABSI RF for we analyzed the data using multiple logistic regression, and outcomes are shown as adjusted odds ratios (aOR). Results: A total of 150,142 patients, hospitalized 853,604 days, acquired 1514 CLABSIs. Pooled CLABSI rate per 1000 CL-days was 5.08; per type of catheter were: femoral: 6.23; temporary hemodialysis: 4.08; jugular: 4.01; arterial: 3.14; PICC: 2.47; subclavian: 2.02. The highest rates were femoral, temporary for hemodialysis, and jugular, and the lowest PICC and subclavian. We analyzed following variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization ratio, CL-type, tracheostomy use, hospitalization type, ICU type, facility ownership and World Bank classifications by income level. Following were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 4% daily (aOR = 1.04; 95% CI = 1.03–1.04; p Conclusions: The following CLABSI RFs are unlikely to change: country income level, facility-ownership, hospitalization type, and ICU type. Based on these findings it is suggested to focus on reducing LOS, CL-days, and tracheostomy; using subclavian or PICC instead of internal-jugular or femoral; and implementing evidence-based CLABSI prevention recommendations.

It is very necessary for an intelligent heavy truck to have the ability to prevent rollover independently. However, it was rarely considered in intelligent vehicle motion planning. To improve rollover stability, a motion planning strategy with autonomous anti rollover ability for an intelligent heavy truck is put forward in this paper. Considering the influence of unsprung mass in the front axle and the rear axle and the body roll stiffness on vehicle rollover stability, a rollover dynamics model is built for the intelligent heavy truck. From the model, a novel rollover index is derived to evaluate vehicle rollover risk accurately, and a model predictive control algorithm is applicated to design the motion planning strategy for the intelligent heavy truck, which integrates the vehicle rollover stability, the artificial potential field for the obstacle avoidance, the path tracking and vehicle dynamics constrains. Then, the optimal path is obtained to meet the requirements that the intelligent heavy truck can avoid obstacles and drive stably without rollover. In addition, three typical scenarios are designed to numerically simulate the dynamic performance of the intelligent heavy truck. The results show that the proposed motion planning strategy can avoid collisions and improve vehicle rollover stability effectively even under the worst driving scenarios.

Anti-rollover is an important performance for automated heavy trucks, which has been seldomly considered in the motion planning. This paper proposes an anti-rollover motion planning based on model predictive control (MPC) for automated heavy trucks. Taking the coupling of roll motion of sprung mass of the front axle with that of the drive axle into consideration, a seven degrees of freedom rollover dynamics model is established, and an evaluation index that can accurately describe the rollover motion is derived for heavy trucks. Then, a model predictive control strategy is designed for motion planning that combines the rollover dynamics, the artificial potential field for obstacle avoidance, and the trajectory tracking. In addition, the optimal path is calculated that considers collision avoidance, anti-rollover and vehicle dynamic constraints. Furthermore, three typical scenarios are applied to validate the performance of the proposed motion planning algorithm. The obtained results demonstrate that the proposed anti-rollover motion planning can effectively avoid collisions and reduce the rollover risk simultaneously when confronting edge scenarios.

The rollover dynamics has been few touched on during the study of path planning in current researches. This paper proposed an anti-rollover motion planning for heavy-duty vehicle. Taking the coupling of roll motion of sprung mass of the front axle with that of the drive axle into consideration, 7 degrees of freedom vehicle rollover model is established, and an evaluation index that can accurately describe the rollover motion state is derived. Then, the Model Predictive Control (MPC) is designed for motion planning which combining the rollover dynamics, artificial potential field for obstacle avoidance and trajectory tracking. Thus, the optimal path without collision risk, rollover trend and vehicle dynamics constraint is calculated. Finally, some typical scenarios are applied to validate the performance of the proposed motion planning. Results state that the anti-rollover motion planning can avoid collisions effectively and reduce the rollover risk simultaneously.

Motivation The Cancer Genome Atlas (TCGA) program has produced huge amounts of cancer genomics data providing unprecedented opportunities for research. In 2014, we developed TCGA-Assembler, a software pipeline for retrieval and processing of public TCGA data. In 2016, TCGA data were transferred from the TCGA data portal to the Genomic Data Commons (GDCs), which is supported by a different set of data storage and retrieval mechanisms. In addition, new proteomics data of TCGA samples have been generated by the Clinical Proteomic Tumor Analysis Consortium (CPTAC) program, which were not available for downloading through TCGA-Assembler. It is desirable to acquire and integrate data from both GDC and CPTAC. Results We develop TCGA-assembler 2 (TA2) to automatically download and integrate data from GDC and CPTAC. We make substantial improvement on the functionality of TA2 to enhance user experience and software performance. TA2 together with its previous version have helped more than 2000 researchers from 64 countries to access and utilize TCGA and CPTAC data in their research. Availability of TA2 will continue to allow existing and new users to conduct reproducible research based on TCGA and CPTAC data. Availability and implementation http://www.compgenome.org/TCGA-Assembler/ or https://github.com/compgenome365/TCGA-Assembler-2 Supplementary information Supplementary data are available at Bioinformatics online.

For a heavy vehicle, active steering can effectively prevent rollover, however, it also changes the operation of the vehicle away from the driver's intentions. To improve rollover stability and reduce tracking error, an optimised slide mode steering control strategy is proposed. Four degrees of freedom linear model is used, which includes lateral, yaw, and roll motions of the sprung mass and unsprung mass. This model is also validated to describe heavy vehicle rollover dynamics. From the model, slide mode control based roll angle and lateral displacement strategies are developed, respectively, and the optimised slide mode steering control strategy is presented to track the set routes and prevent vehicle rollover. Furthermore, some typical numerical cases are simulated to demonstrate the effectiveness of the control strategies. The results show that the optimised strategy can effectively prevent vehicle rollover and significantly improve the performance of tracking the driver's intention for a heavy vehicle.

Summary Chromosomal copy number variation (CNV) refers to a polymorphism that a DNA segment presents deletion or duplication in the population. The computational algorithms developed to identify this type of variation are usually of high computational complexity. Here we present a user-friendly R package, modSaRa, designed to perform copy number variants identification. The package is developed based on a change-point based method with optimal computational complexity and desirable accuracy. The current version of modSaRa package is a comprehensive tool with integration of preprocessing steps and main CNV calling steps. Availability and Implementation modSaRa is an R package written in R, C ++ and Rcpp and is now freely available for download at http://c2s2.yale.edu/software/modSaRa . Contact heping.zhang@yale.edu. Supplementary information Supplementary data are available at Bioinformatics online.

Protein-resistant polyurethane (PU) surfaces were prepared by sequentially grafting poly(2-hydroxyethyl methacrylate) (poly(HEMA)) and poly(oligo(ethylene glycol) methacrylate) (poly(OEGMA)) via surface-initiated atom transfer radical polymerization (s-ATRP). The chain lengths of poly(HEMA) and poly(OEGMA) were regulated via the ratio of monomer to sacrificial initiator in solution. The surfaces were characterized by water contact angle and X-ray photoelectron spectroscopy (XPS). The protein resistant properties of the surfaces were assessed by single and binary adsorption experiments with fibrinogen (Fg), lysozyme (Lys), and lactalbumin (Lac). The adsorption of all three proteins on the sequentially grafted poly(HEMA)-poly(OEGMA) surfaces (PU/PH/PO) was greatly reduced compared with the unmodified PU. Adsorption decreased with increasing poly(OEGMA) chain length. On the PU/PH/PO surface with longest poly(OEGMA) chain length (∼100), the decrease in Lys adsorption was in the range of 95–98% and the decrease in Fg and Lac adsorption was >99% compared with the unmodified PU. Adsorption from binary protein solutions showed that the PU/PH/PO surfaces resisted these proteins more or less equally, that is, independent of protein size. © 2010 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2010.

Poly(2-methacryloyloxyethyl phosphorylcholine) (poly(MPC)) was grafted from various polymeric substrates to prepare protein-resistant materials. The poly(MPC) chain length was adjusted via the ratio of monomer to sacrificial initiator in solution. The surfaces were characterized by water contact angle and X-ray photoelectron spectroscopy (XPS). The protein-resistant properties of the poly(MPC)-grafted surfaces were evaluated by single adsorption experiments with fibrinogen and lysozyme. It was shown that the simple three-step grafting method could be applied to modify various biomaterial surfaces including polyurethane and silicones. The adsorption of fibrinogen and lysozyme to the modified surfaces was greatly reduced compared to the unmodified surfaces, and adsorption decreased with increasing poly(MPC) chain length. On polyurethane film grafted with poly(MPC) of chain length 100, the reduction in adsorption was approx. 96% for lysozyme and approx. 99% for fibrinogen.

Water-soluble poly(oligo(ethylene glycol) methacrylate) (poly(OEGMA)) with various main chain and side chain lengths were grafted to polyurethane (PU) surface by surface-initiated atom transfer radical graft polymerization (s-ATRgP). The polymer main chain length was varied by varying the molar ratio of monomer to free initiator in solution (typically 5:1, 50:1, 100:1). Three different side chain lengths were obtained using different OEGMA monomers (MW 300, 475, 1100 g/mol). Water contact angle and X-ray photoelectron spectroscopy (XPS) were used to characterize the modified PU surfaces. The respective effects of poly(OEGMA) main chain and side chain lengths on fibrinogen (Fg) and lysozyme (Lys) adsorption were investigated in single protein systems at room temperature in TBS, pH 7.4. The poly(OEGMA)-grafted PU surfaces were found to be highly protein-resistant, with reductions of Fg and Lys adsorption in the range of 84-98% and 67-91%, respectively, compared to the unmodified PU surface. The adsorption of both proteins decreased with increasing poly(OEGMA) main chain length for a given side chain length (number of EO units). For a given main chain length, the Fg adsorption level did not change significantly with increasing side chain length. However, Lys adsorption increased with increasing side chain length, possibly due to decreasing graft density as monomer size and footprint on the surface increase. Adsorption resistance was generally greater for the bigger protein.