Background: Blood cultures are a fundamental tool in the diagnosis of infections, but they can lead to clinical confusion and waste resources when they yield false results. To optimize blood-culture orders at our institution, we developed an evidence-based clinical guideline (Fig. 1) to be used by frontline providers on nonneutropenic hospitalized adult inpatients. We retrospectively reviewed charts of patients with positive blood cultures to evaluate whether frontline providers and infectious diseases (ID) attending physicians were able to consistently interpret the guidelines to determine whether blood cultures were drawn appropriately. Methods: In total, 95 nonneutropenic adults with an initial positive blood culture collected while on an inpatient unit were identified through a query of the electronic medical record from January 2021 through June 2022. Patients with polymicrobial bacteremia and bacteremia due to Enterococcus, Streptococcus, and gram-positive rods were excluded. Moreover, 4 medical resident physicians reviewed all patients and 2 ID attending physicians reviewed one-quarter of cases; all were blinded to the culture results. Blood cultures were determined to be either appropriately or inappropriately performed based on our institution’s guideline. The free-marginal multirater κ statistics with 95% CIs were calculated to evaluate interrater agreement. Results: Baseline patient demographics are shown in Table 1. Immune compromise without neutropenia was noted in 21 of 95 patients. Most patients were at high risk for bacteremia (72%) per our institutional guideline, most of whom were septic (67.7%). Low risk for bacteremia was found in only 12.3% of reviews. Medical resident physicians, ID attending physicians, and all reviewers combined agreed on whether blood cultures were drawn appropriately or inappropriately (84.2%, 92%, and 86.4% agreement rates, respectively). The free-marginal κ statistic was highest for ID attending physicians (0.84; 95% CI, 0.62–0.78), followed by attending physicians and resident physicians combined (0.73; 95% CI, 0.56–0.90), and resident physicians alone (0.68; 95% CI, 0.58–0.78). In the 21 patients with immune compromise, the agreement rates on blood culture appropriateness remained high among all reviewers, resident physicians, and ID attending physicians were 86.6%, 90.5%, and 95%, respectively. Conclusions: In our retrospective study of nonneutropenic hospitalized adult inpatients, frontline providers and ID attending physicians interpreted blood-culture guidelines consistently, largely agreeing on which patients had cultures drawn appropriately. Agreement among ID attending physicians was excellent and remained substantial among medical resident physicians. Guidelines on the appropriate use of blood cultures are vital to limiting unnecessarily collected cultures, which can lead to extended length of stay and increase cost across hospital systems. Further analyses on the clinical impact of this guideline are ongoing.

Disclosures: None

Accurate tracking and reconstruction of surgical scenes is a critical enabling technology toward autonomous robotic surgery. In endoscopic examinations, computer vision has provided assistance in many aspects, such as aiding in diagnosis or scene reconstruction. Estimation of camera motion and scene reconstruction from intra-abdominal images are challenging due to irregular illumination and weak texture of endoscopic images. Current surgical 3D perception algorithms for camera and object pose estimation rely on geometric information (e.g., points, lines, and surfaces) obtained from optical images. Unfortunately, standard hand-crafted local features for pose estimation usually do not perform well in laparoscopic environments. In this paper, a novel self-supervised Surgical Perception Stereo Visual Odometer (SPSVO) framework is proposed to accurately estimate endoscopic pose and better assist surgeons in locating and diagnosing lesions. The proposed SPSVO system combines a self-learning feature extraction method and a self-supervised matching procedure to overcome the adverse effects of irregular illumination in endoscopic images. The framework of the proposed SPSVO includes image pre-processing, feature extraction, stereo matching, feature tracking, keyframe selection, and pose graph optimization. The SPSVO can simultaneously associate the appearance of extracted feature points and textural information for fast and accurate feature tracking. A nonlinear pose graph optimization method is adopted to facilitate the backend process. The effectiveness of the proposed SPSVO framework is demonstrated on a public endoscopic dataset, with the obtained root mean square error of trajectory tracking reaching 0.278 to 0.690 mm. The computation speed of the proposed SPSVO system can reach 71ms per frame.

We present experimental evidence of multifractality and scale-free network topology in a noise-perturbed laminar jet operated in a globally stable regime, prior to the critical point of a supercritical Hopf bifurcation and prior to the saddle-node point of a subcritical Hopf bifurcation. For both types of bifurcation, we find that (i) the degree of multifractality peaks at intermediate noise intensities, (ii) the conditions for peak multifractality produce a complex network whose node degree distribution obeys an inverse power-law scaling with an exponent of $2 < \gamma < 3$, indicating scale-free topology and (iii) the Hurst exponent and the global clustering coefficient can serve as early warning indicators of global instability under specific operating and forcing conditions. By characterising the noise-induced dynamics of a canonical shear flow, we demonstrate that the multifractal and scale-free network dynamics commonly observed in turbulent flows can also be observed in laminar flows under certain stochastic forcing conditions.

The association between early reproductive events and health status in later life has always been of interest across disciplines. The purpose of this study was to investigate whether there was an association between the number of children born in the early years of elderly women and their depression in later life based on a sample of older women aged 65 years and above with at least one child in rural China. Data from the Chinese Longitudinal Healthy Longevity Survey in 2018, this study used the ordinary least square method to conduct empirical research. This study has found a significant correlation between an increase in the number of children and depression in older rural women. When considering the sex of the child, the number of daughters had a greater and more significant impact on depression. Number of children may exacerbate depression of older women through declining self-rated health and reduced social activity, while increased inter-generational support alleviated depression. The association between number of children born and depression also existed in urban older women, though not significant. Therefore, it is suggested to accelerate the improvement of supporting policies related to childbirth, developing a healthy and scientific fertility culture, and improving rural maternal and child health services. Women should be assisted in balancing their roles in the family and in society, and in particular in sharing the burden of caring for children. Targeted efforts to increase old-age protection for older people.

The mass balance of glaciers requires more detailed and continuous observations to understand their seasonal change in relation to climate. Here, we designed and installed an automated real-time monitoring platform at 4645 m a.s.l. on the Baishui River Glacier No.1 to collect continuous high-resolution observational data, and analyzed the seasonal dynamic from glacier movement and surface mass balance from glacier melting and snow accumulation. The results showed that the platform moved northeastward ~12.9 m at a rate of 0.06 ± 0.02 m d−1 between September 2021 and April 2022. The surface mass balance showed a varied temporal period. July and August were the main ablation periods, while ablation decreased and ceased in September. The glacier neither melted nor accumulated much between October and December, but began to have rapid snow accumulation in January. The glacier surface temperature varied with the air temperature and showed significant inter-seasonal differences among monsoon, post-monsoon and winter seasons. The surface mass balance also exhibited a strong response to the air temperature changes, with an average decrease of 1°C the point mass balance increased by 0.11 m w.e. from monsoon to post-monsoon and 0.22 m w.e. from post-monsoon to winter. Moreover, we found snowfall caused a decrease in the glacier surface temperature by increasing the surface albedo.

Cyperus rotundus L. is a globally distributed noxious weed that poses a significant challenge for control due to its fast and efficient propagation through the tuber, which is the primary reproductive organ. Gibberellic acid (GA3) has proved to be crucial for tuberization in tuberous plants. Therefore, understanding the relationship between GA3 and tuber development and propagation of C.roundus will provide valuable information for controlling this weed. This study shows that the content of GA3 decreases with tuber development, which corresponds to lower expression of bioactive GA3 synthesis genes (CrGA20ox, two CrGA3oxs) and two up-regulated GA3 catabolism genes (CrGA2oxs), indicating that GA3 is involved in tuber development. Simultaneously, the expressions of CrDELLAs and CrGID1 decline with tuber growth and GA3 decreasing, and Yeast two-hybrid (Y2H) assays confirm that the GA3 signaling is DELLA-dependent. Furthermore, exogenous application of GA3 markedly reduces the number and the width of tuber, and represses the growth of tuber chain, further confirming the negative impact that GA3 has on tuber development and propagation. Taken together, these results demonstrate that GA3 is involved in tuber development and regulated by the DELLA-dependent pathway in C. rotundus, and plays a negative role in tuber development and propagation.

Despite observed ethnic differences in eating patterns and obesity, evidence in China is limited. This study examined ethnic differences in eating patterns and their associations with weight outcomes among multi-ethnic adults in West China. A cross-sectional survey collected self-reported data on demographics, eating behaviours, weight and height in 2021. Principal component analysis and multivariate regression were conducted to identify eating patterns and examine their associations with weight outcomes. In total, 4407 subjects aged ≥ 18 years were recruited across seven provinces in West China. Four eating patterns were identified: ‘meat-lover’ – characterised by frequent consumption of meat and dairy products, ‘indulgent’ – by frequent intakes of added salt, sugar, alcohol and pickled food, ‘diversified-eating’ – by frequently consuming food with diversified cooking methods and eating out and ‘nutri-health-concerned’ – by good food hygiene behaviours and reading food labels. Ethnic differences in eating patterns were observed. Compared with Han, Hui were less likely to exhibit meat-lover or diversified-eating patterns; Tibetans were less likely to have meat-lover or nutri-health-concerned patterns; Mongolians were more likely to have indulgent pattern. BMI was positively associated with meat-lover pattern in both genders (exp(β): 1·029; 95 % CI: 1·001, 1·058 for men; 1·018; 1·000, 1·036 for women) and negatively associated with nutri-health-concerned pattern in women (0·983; 0·966, 1·000). Mongolians were two times more likely to be overweight/obese than Han (OR: 3·126; 1·688, 5·790). Considerable ethnic differences existed in eating patterns in West China. Mongolians were more likely to be overweight/obese, which was associated with their indulgent eating patterns. Ethnic-specific healthy eating intervention programs are needed.

SARS-CoV-2 rapidly spreads among humans via social networks, with social mixing and network characteristics potentially facilitating transmission. However, limited data on topological structural features has hindered in-depth studies. Existing research is based on snapshot analyses, preventing temporal investigations of network changes. Comparing network characteristics over time offers additional insights into transmission dynamics. We examined confirmed COVID-19 patients from an eastern Chinese province, analyzing social mixing and network characteristics using transmission network topology before and after widespread interventions. Between the two time periods, the percentage of singleton networks increased from 38.9$ \% $ to 62.8$ \% $$ (p<0.001) $; the average shortest path length decreased from 1.53 to 1.14 $ (p<0.001) $; the average betweenness reduced from 0.65 to 0.11$ (p<0.001) $; the average cluster size dropped from 4.05 to 2.72 $ (p=0.004) $; and the out-degree had a slight but nonsignificant decline from 0.75 to 0.63 $ (p=0.099). $ Results show that nonpharmaceutical interventions effectively disrupted transmission networks, preventing further disease spread. Additionally, we found that the networks’ dynamic structure provided more information than solely examining infection curves after applying descriptive and agent-based modeling approaches. In summary, we investigated social mixing and network characteristics of COVID-19 patients during different pandemic stages, revealing transmission network heterogeneities.

This paper studies the synchronization control of the blanket remote maintenance robot (BRMR) of the China fusion engineering test reactor (CFETR). First, the general state space mathematical model of BRMR was established by using a physical-based method. Second, based on the receding horizon optimization of model predictive control (MPC) and cross-coupling error reduction in cross-coupling control (CCC), the innovative MPC-CCC controller was proposed to realize the single-system and multisystem error convergence and high accuracy transportation of blanket through the high accuracy synchronization control of BRMR. Third, to verify the control effectiveness of the MPC-CCC controller, two types of simulations and experiments were implied compared with the original proportional-integral (PI) controller in Mover. Results showed that simulation and experiments were highly consistent. It is found that the use of an MPC-CCC controller can result in up to a 70% reduction in displacement error and up to a 59% reduction in synchronization error compared to the PI controller. And the accuracy of the MPC-CCC controller satisfies the real requirement of the maintenance process of the blanket. This work provides the theoretical basis and practical experience for the highly stable, safe, and efficient maintenance of blankets in the future.

A 198.8 m deep borehole was drilled through ice to subglacial bedrock in the northwestern marginal part of Princess Elizabeth Land, ~12 km south of Zhongshan Station, in January–February 2019. Three years later, in February 2022, the borehole temperature profile was measured, and the geothermal heat flow (GHF) was estimated using a 1-D time-dependent energy-balance equation. For a depth corresponding to the base of the ice sheet, the GHF was calculated as 72.6 ± 2.3 mW m−2 and temperature −4.53 ± 0.27°C. The regional averages estimated for this area based, generally, on tectonic setting vary from 55 to 66 mW m−2. A higher GHF is interpreted to originate mostly from the occurrence of metamorphic complexes intruded by heat-producing elements in the subglacial bedrock below the drill site.

Vortex shedding in the wake of a cylinder in uniform flow can be suppressed via the application of a porous coating; however, the suppression mechanism is not fully understood. The internal flow field of a porous coated cylinder (PCC) can provide a deeper understanding of how the flow within the porous medium affects the wake development. A structured PCC (SPCC) was three-dimensionally printed using a transparent material and tested in water tunnel facilities using flow visualisation and tomographic particle image velocimetry at outer-diameter Reynolds numbers of $Re = 7 \times 10^{3}$ and $7.3 \times 10^{4}$, respectively. The internal and near-wall flow fields are analysed at the windward and mid-circumference regions. Flow stagnation is observed in the porous layer on the windward side and its boundary is shown to fluctuate with time in the outermost porous layer. This stagnation region generates a quasi-aerodynamic body that influences boundary layer development on the SPCC inner diameter, that separates into a shear layer within the porous medium. For the first time via experiment, spectral content within the separated shear layer reveals vortex shedding processes emanating through single pores at the outer diameter, providing strong evidence that SPCC vortex shedding originates from the inner diameter. Velocity fluctuations linked to this vortex shedding propagate through the porous layers into the external flow field at a velocity less than that of the free stream. The Strouhal number linked to this velocity accurately predicts the SPCC vortex shedding frequency.