Background: Ventilator associated pneumonia (VAP) is associated with significant rates of morbidity and all-cause mortality. Active VAP surveillance can identify risk factors for which targeted preventive measures can be implemented. However, surveillance efforts are complicated by challenges associated with accurate VAP diagnosis. We aimed to improve the accuracy and automation of existing VAP diagnostic algorithms to better identify patients at risk. Methods: The study was conducted at NYU Langone Health from June 2022 through December 2023. We created a semi-automated VAP surveillance system using the Centers for Disease Control & Prevention (CDC) ventilator associated event (VAE) definition as a base framework (Figure 1). We modified this definition to include additional elements, such as having a sputum culture ordered within 48 hours of worsening oxygen status, regardless of culture result. Using this algorithm—followed by manual clinician reviews—we retrospectively assessed possible VAP cases to determine the ability of our surveillance system to correctly identify VAP. Results: Of the 123 possible VAP cases identified through our automated system, 75 (61%) were correctly diagnosed as VAP after clinical review. This reflects a rate of 1.5 infections per 1000 ventilation days across the system and 1.85 infections per 100 patients ventilated for greater than 2 days. Of the 48 remaining patients without VAP after clinical review, 25% (n=12) were characterized as having hospital-acquired pneumonia, 21% (n=10) as acute respiratory distress syndrome or infection at another site and 10% (n=5) as pulmonary embolism/infarction. Among all patients identified through this automated system (VAP and non-VAP), 53% experienced in-hospital death. Discussion: Our automated VAP surveillance algorithm identified 123 cases of potential VAP, 61% of which were consistent with a clinical diagnosis of VAP upon manual chart review. Our VAP rate of 1.5 infections per 1000 ventilation days was similar to published rates at other North American hospital systems. The high in-hospital mortality rate among these patients highlights the need for improved surveillance systems and earlier interventions to reduce the risk of VAP. There are several limitations to the CDC’s VAE definition, including its requirement of a positive microbiologic culture and focus on sputum quality. This potentially misses cases of culture-negative VAP in patients receiving antibiotics prior to sputum collection. Our goal is to continue to validate and improve our algorithm’s ability to correctly identify patients with clinical VAP, so that targeted prevention efforts can be focused upon the patients with the highest risk for poor outcomes.

Disclosure: Madeline DiLorenzo: Stocks - Abbvie, Amgen Inc., Becton Dickinson, Biogen Inc., Bristol Myers and Squibb, CVS Health, Davita Inc., Elevance Health, Gilead, Henry Schein, Hologic Inc., Humana Inc., Jazz Pharmaceuticals, Laboratory Corp, Merck and Co., Quest Diagnostics, ResMed Inc., Teladoc Health, Vertex Pharmaceuticals, West Pharmaceuticals

Much research on the antecedents of proactive behavior has appeared in the literature, but this research introduces a new ritual perspective to rethink this question. Drawing on the process model of interaction rituals, we propose that work rituals urge employees to share emotional energy, and then, employees are likely to experience a higher level of work meaningfulness. In turn, employees tend to engage in more proactive behavior. Using data from a random assignment field experiment involving 204 employees from a communication corporation in China, we found support for our hypotheses. The implications of our research for theory and practice are discussed.

The collector for separating diasporic bauxite serves as a type of flotation reagent by adsorbing selectively on diaspore to make it hydrophobic enough to separate it from the aluminosilicates. Although the flotation process is considered economical in the desilication of Chinese diasporic bauxite, the existing collectors fail to separate these ores because of their poor adsorption selectivity over other minerals. The present study was an attempt to seek a collector for selective flotation of diaspore over aluminosilicates. A novel carboxyl hydroxamic acid compound, 2,2-bis(hydroxycarbamoyl) decanoic acid (BHDA), was designed and synthesized, and the flotation behavior of diaspore, kaolinite, and illite was investigated by flotation tests with BHDA. The interactions between the BHDA and the minerals were also explored by Fourier-transform infrared spectroscopy (FTIR), zeta-potential measurement, and density functional theory (DFT) calculation. Using BHDA as the collector, the pulp pH value affected the floatability of diaspore significantly while the floatability of kaolinite or illite was unaffected or only slightly affected. The dosage of BHDA had little effect on the floatability of the three minerals. The greatest difference in floatability between diaspore and aluminosilicates occurred at mid-range pulp pH (7). Large shifts in characteristic absorption peaks and new absorption peaks were observed for BHDA-treated diaspore but were absent from BHDA-treated aluminosilicates. The change in the negative zeta potential of diaspore was also greater than those of aluminosilicates in the presence of BHDA. The O atoms in the carboxyl and hydroxycarbamoyl of BHDA have highly negative charges, and favorable stereo conditions existed to form five- or six-membered rings, resulting in their coordination with the Al atoms of diaspore, leading to chemisorption in chelate rings; the adsorption of BHDA on kaolinite or illite, on the other hand, was mainly physical in nature. The BHDA was, therefore, highly selective in the flotation between diaspore and aluminosilicates and possibly suitable for the separation of diasporic bauxite.

Cold-induced thermogenesis plays an important role in the survival of lambs exposed to low air temperatures. The liver produces and mediates heat production in mammals; however, to date, little is known about the role of liver genes in cold-induced thermogenesis in lambs. In this study, the difference in the liver transcriptome between Altay and Hu ewe lambs was compared. Because of different backgrounds of the two breeds, we hypothesized that the transcriptome profiles of the liver would differ between breeds when exposed to cold. Cold-exposed Altay lambs activated 8 candidate genes (ACTA1, MYH1, MYH2, MYL1, MYL2, TNNC1, TNNC2, and TNNT3) involved in muscle shivering thermogenesis; 3 candidate genes (ATP2A1, SLN, and CKM) involved in muscle nonshivering thermogenesis related to the Ca2+ signal and creatine cycle; and 6 candidate genes (PFKM, ALDOC, PGAM2, ENO2, ENO3, and ENO4) involved in enhancing liver metabolism. In contrast, the liver may not act as the main tissue for thermogenesis in cold-exposed Hu lambs. We concluded that Altay lambs rely on liver-mediated shivering and nonshivering thermogenesis by muscle tissue to a greater extent than Hu lambs. Results from this study could provide a theoretical foundation for the breeding and production of cold-resistant lambs.

During the early stages of human pregnancy, successful implantation of embryonic trophoblast cells into the endometrium depends on good communication between trophoblast cells and the endometrium. Abnormal trophoblast cell function can cause embryo implantation failure. In this study, we added cyclosporine A (CsA) to the culture medium to observe the effect of CsA on embryonic trophoblast cells and the related mechanism. We observed that CsA promoted the migration and invasion of embryonic trophoblast cells. CsA promoted the expression of leukaemic inhibitory factor (LIF) and fibroblast growth factor (FGF). In addition, CsA promoted the secretion and volume increase in vesicles in the CsA-treated group compared with the control group. Therefore, CsA may promote the adhesion and invasion of trophoblast cells through LIF and FGF and promote the vesicle dynamic process, which is conducive to embryo implantation.

Human cystic echinococcosis (CE) is a zoonotic disorder triggered by the larval stage of Echinococcus granulosus (E. granulosus) and predominantly occurred in the liver and lungs. The M2 macrophage level is considerably elevated among the liver of patients with hepatic CE and performs an integral function in liver fibrosis. However, the mechanism of CE inducing polarisation of macrophage to an M2 phenotype is unknown. In this study, macrophage was treated with E. granulosus cyst fluid (EgCF) to explore the mechanism of macrophage polarisation. Consequently, the expression of the M2 macrophage and production of anti-inflammatory cytokines increased after 48 h treatment by EgCF. In addition, EgCF promoted polarisation of macrophage to an M2 phenotype by inhibiting the expression of transcriptional factor hypoxia-inducible factor 1-alpha (HIF-1α), which increased the expression of glycolysis-associated genes, including hexokinase 2 (HK2) and pyruvate kinase 2 (PKM2). The HIF-1α agonist ML228 also inhibited the induction of macrophage to an M2 phenotype by EgCF in vitro. Our findings indicate that E. granulosus inhibits glycolysis by suppressing the expression of HIF-1α.

This study presents a novel 4-DOF two-limb gripper mechanism with a simple design that offers high adaptability for different objects. The mechanism integrates a three-finger end effector and employs a 2-DOF driving system in both serial kinematic chains mounted on the base, addressing performance problems caused by moving actuators. First, the architecture of the gripper mechanism is described, and its mobility is verified. Next, the inverse and forward kinematic problems are solved, and the Jacobian matrix is derived to analyze the singularity conditions. The inverse and forward singularity surfaces are plotted. The workspace is investigated using a search method, and two indices, manipulability and dexterity, are studied. The proposed manipulator’s parameters are optimized for improved dexterity. The novel gripper mechanism has high potential for grasping different types of parts within a large workspace, making it a valuable addition to the field of robotics.

Modelling mortality co-movements for multiple populations has significant implications for mortality/longevity risk management. This paper assumes that multiple populations are heterogeneous sub-populations randomly drawn from a hypothetical super-population. Those heterogeneous sub-populations may exhibit various patterns of mortality dynamics across different age groups. We propose a hierarchical structure of these age patterns to ensure the model stability and use a Vector Error Correction Model (VECM) to fit the co-movements over time. Especially, a structural analysis based on the VECM is implemented to investigate potential interdependence among mortality dynamics of the examined populations. An efficient Bayesian Markov Chain Monte-Carlo method is also developed to estimate the unknown parameters to address the computational complexity. Our empirical application to the mortality data collected for the Group of Seven nations demonstrates the efficacy of our approach.

The effects of monolaurin (ML) on the health of piglets infected with porcine epidemic diarrhoea virus (PEDV) have not been fully understood. This study aimed to investigate its role in blood biochemical profile, intestinal barrier function, antioxidant function and the expression of antiviral genes in piglets infected with PEDV. Thirty-two piglets were randomly divided into four groups: control group, ML group, PEDV group and ML + PEDV group. Piglets were orally administrated with ML at a dose of 100 mg/kg·BW for 7 d before PEDV infection. Results showed that PEDV infection significantly decreased D-xylose content and increased intestinal fatty acid-binding protein content, indicating that PEDV infection destroyed intestinal barrier and absorption function. While it could be repaired by ML administration. Moreover, ML administration significantly decreased plasma blood urea nitrogen and total protein content upon PEDV infection. These results suggested ML may increase protein utilisation efficiency. ML administration significantly decreased the number of large unstained cells and Hb and increased the number of leucocytes and eosinophils in the blood of PEDV-infected piglets, indicating ML could improve the immune defense function of the body. In the presence of PEDV infection, ML administration significantly increased superoxide dismutase and catalase activities in blood and colon, respectively, indicating ML could improve antioxidant capacity. Besides, ML administration reversed the expression of ISG15, IFIT3 and IL-29 throughout the small intestine and Mx1 in jejunum and ileum, indicating the body was in recovery from PEDV infection. This study suggests that ML could be used as a kind of feed additive to promote swine health upon PEDV infection.

This paper presents a robust train localisation system by fusing a Global Navigation Satellite System (GNSS) with an Inertial Navigation System (INS) in a tightly-coupled (TC) strategy. To improve navigation performance in GNSS partly blocked areas, an advanced map-matching (MM) measurement-augmented TC GNSS/INS method is proposed via an error-state unscented Kalman filter (UKF). The advanced MM generates a matched position using a one-step predicted position from a UKF time update step with binary search algorithm and a point–line projection algorithm. The matched position inputs as an additional measurement to fuse with the INS position to augment the degraded GNSS pseudorange measurement to optimise the state estimation in the UKF measurement update step. Both the real train test on the Qinghai–Tibet railway and the simulation were carried out and the results confirm that the proposed advanced MM measurement-augmented TC GNSS/INS with error-state UKF provides the best horizontal positioning accuracy of 0 ⋅ 67 m, which performs an improvement of about 71% and 90% with respect to TC GNSS/INS with only error-state UKF and only error-state Extended Kalman filter in GNSS partly blocked areas.

Coastal eutrophication and hypoxia remain a persistent environmental crisis despite the great efforts to reduce nutrient loading and mitigate associated environmental damages. Symptoms of this crisis have appeared to spread rapidly, reaching developing countries in Asia with emergences in Southern America and Africa. The pace of changes and the underlying drivers remain not so clear. To address the gap, we review the up-to-date status and mechanisms of eutrophication and hypoxia in global coastal oceans, upon which we examine the trajectories of changes over the 40 years or longer in six model coastal systems with varying socio-economic development statuses and different levels and histories of eutrophication. Although these coastal systems share common features of eutrophication, site-specific characteristics are also substantial, depending on the regional environmental setting and level of social-economic development along with policy implementation and management. Nevertheless, ecosystem recovery generally needs greater reduction in pressures compared to that initiated degradation and becomes less feasible to achieve past norms with a longer time anthropogenic pressures on the ecosystems. While the qualitative causality between drivers and consequences is well established, quantitative attribution of these drivers to eutrophication and hypoxia remains difficult especially when we consider the social economic drivers because the changes in coastal ecosystems are subject to multiple influences and the cause–effect relationship is often non-linear. Such relationships are further complicated by climate changes that have been accelerating over the past few decades. The knowledge gaps that limit our quantitative and mechanistic understanding of the human-coastal ocean nexus are identified, which is essential for science-based policy making. Recognizing lessons from past management practices, we advocate for a better, more efficient indexing system of coastal eutrophication and an advanced regional earth system modeling framework with optimal modules of human dimensions to facilitate the development and evaluation of effective policy and restoration actions.

In this paper, we investigate the pricing of vulnerable European options in a market where the underlying stocks are not perfectly liquid. A liquidity discount factor is used to model the effect of liquidity risk in the market, and the default risk of the option issuer is incorporated into the model using a reduced-form model, where the default intensity process is correlated with the liquidity risk. We obtain a semiclosed-form pricing formula of vulnerable options through the inverse Fourier transform. Finally, we illustrate the effects of default risk and liquidity risk on option prices numerically.

Dynamics of two-dimensional flow past a rigid flat plate with a trailing closed flexible filament acting as a deformable afterbody are investigated numerically by an immersed boundary-lattice Boltzmann method for the fluid flow and a finite element method for the filament motion. The effects of Reynolds number ($Re$) and length ratio ($Lr$) on the flow patterns and dynamics of the rigid-flexible coupling system are studied. Based on our numerical results, five typical state modes have been identified in $Lr\unicode{x2013}Re$ plane in terms of the filament shape and corresponding dynamics, i.e. static deformation, micro-vibration, multi-frequency flapping, periodic flapping and chaotic flapping modes, respectively. Benefiting from the passive flow control by using the flexible filament as a deformable afterbody, the coupled system may enjoy a significant drag reduction (up to $22\,\%$) compared with bare plate scenarios ($Lr=1$). Maximum drag reduction achieved at $L_{c,{min}} \in [1.8, 2]$ is often accompanied by the onset of the system state transition. The flow characteristic and its relation to the change in hydrodynamic drag are further explored in order to reveal the underlying mechanisms of the counterintuitive dynamical behaviour of the coupled system. The scaling laws for the form drag and the friction drag, which arise from the pressure and viscous effects, respectively, are proposed to estimate the overall drag acting on the system. The results obtained in the present study may shed some light on understanding the dynamical behaviour of rigid-flexible coupling systems.

The propulsion of a pitching flexible plate in a uniform flow is investigated numerically. The effects of bending stiffness ($K$), pitching amplitude ($A_L$) and frequency ($St$) on the wake patterns, thrust generations and propulsive performances of the fluid–plate system are analysed. Four typical wake patterns, i.e. von Kármán, reversed von Kármán, deflected and chaotic wakes, emerge from various kinematics, and the $St-A_L$ wake maps are given for various $K$. The drag-to-thrust transitions (DTT) and the wake transitions (WT) between the von Kármán and reversed von Kármán wakes are examined. Results indicate that the WT and DTT boundaries can be scaled by the chord-averaged distance of travel, $\mathcal {L}$, which leads to $\mathcal {L}\times St \approx 1$ and $\mathcal {L}\times St \approx 1.2$, respectively. Further, the resonance mechanism for the performance enhancement is revealed and confirmed in a wide range of parameters. The dimensionless average speed of plate, $\mathcal {U^*}\left (=\mathcal {L}\times St\right )$, is adopted merely to characterize the propulsive performances. For the first time, the $\mathcal {U^*}$-based scaling laws for the thrust and power are revealed in pitching rigid and flexible plates for various $A_L$ and $St$. This study may deepen our understanding of biological swimming and flying, and provide a guide for bionic design.

The pandemic caused by severe acute respiratory syndrome coronavirus 2 is sweeping the world, threatening millions of lives and drastically altering our ways of living. According to current studies, failure to either activate or eliminate inflammatory responses timely and properly at certain stages could result in the progression of the disease. In other words, robust immune responses to coronavirus disease 2019 (COVID-19) are critical. However, they do not theoretically present in some special groups of people, including the young, the aged, patients with autoimmunity or cancer. Differences also do occur between men and women. Our immune system evolves to ensure delicate coordination at different stages of life. The innate immune cells mainly consisted of myeloid lineage cells, including neutrophils, basophils, eosinophils, dendritic cells and mast cells; they possess phagocytic capacity to different degrees at different stages of life. They are firstly recruited upon infection and may activate the adaptive immunity when needed. The adaptive immune cells, on the other way, are comprised mainly of lymphoid lineages. As one grows up, the adaptive immunity matures and expands its memory repertoire, accompanied by an adjustment in quantity and quality. In this review, we would summarise and analyse the immunological characteristics of these groups from the perspective of the immune system ‘evolution’ as well as ‘revolution’ that has been studied and speculated so far, which would aid the comprehensive understanding of COVID-19 and personalised-treatment strategy.

Family feasting during the Spring Festival is a Chinese tradition. However, close contact during this period is likely to promote the spread of coronavirus disease 2019 (COVID-19). This study developed a dynamic infectious disease model in which the feast gatherings of families were considered the sole mode of transmission. The model simulates COVID-19 transmission via family feast gatherings through a social contact network. First, a kinship-based, virtual social contact network was constructed, with nodes representing families and connections representing kinships. Families in kinship with each other comprised of the largest globally coupled network, also known as a clique, in which a feast gathering was generated by randomly selecting two or more families willing to gather. The social contact network in the model comprised of 215 cliques formed among 608 families with 1517 family members. The modelling results indicated that when there is only one patient on day 0, the number of new infections will reach a peak on day 29, and almost all families and their members in the social contact network will be infected by day 60. This study demonstrated that COVID-19 can spread rapidly through continuous feast gatherings through social contact networks and that the disease will run rampant throughout the network.