Mutations in porin LamB contribute to ceftazidime-avibactam resistance in KPC-producing Klebsiella pneumoniae.

Ceftazidime-avibactam (CAZ-AVI) shows promising activity against carbapenem-resistant Klebsiella pneumoniae (CRKP), however, CAZ-AVI resistance have emerged recently. Mutations in KPCs, porins OmpK35 and/or OmpK36, and PBPs are known to contribute to the resistance to CAZ-AVI in CRKP. To identify novel CAZ-AVI resistance mechanism, we generated 10 CAZ-AVI-resistant strains from 14 CAZ-AVI susceptible KPC-producing K. pneumoniae (KPC-Kp) strains through in vitro multipassage resistance selection using low concentrations of CAZ-AVI. Comparative genomic analysis for the original and derived mutants identified CAZ-AVI resistance-associated mutations in KPCs, PBP3 (encoded by ftsI), and LamB, an outer membrane maltoporin. CAZ-AVI susceptible KPC-Kp strains became resistant when complemented with mutated blaKPC genes. Complementation experiments also showed that a plasmid borne copy of wild-type lamB or ftsI gene reduced the MIC value of CAZ-AVI in the induced resistant strains. In addition, blaKPC expression level increased in four of the six CAZ-AVI-resistant strains without KPC mutations, indicating a probable association between increased blaKPC expression and increased resistance in these strains. In conclusion, we here identified a novel mechanism of CAZ-AVI resistance associated with mutations in porin LamB in KPC-Kp

INTEnsive ambulance-delivered blood pressure Reduction in hyper-ACute stroke Trial (INTERACT4) : study protocol for a randomized controlled trial

Background: Early pre-hospital initiation of blood pressure (BP) lowering could improve outcomes for patients with acute stroke, by reducing hematoma expansion in intracerebral hemorrhage (ICH), and time to reperfusion treatment and risk of intracranial hemorrhage in ischemic stroke (IS). We present the design of the fourth INTEnsive ambulance-delivered blood pressure Reduction in hyper-ACute stroke Trial (INTERACT4). Methods: A multi-center, ambulance-delivered, prospective, randomized, open-label, blinded endpoint (PROBE) assessed trial of pre-hospital BP lowering in 3116 hypertensive patients with suspected acute stroke at 50+ sites in China. Patients are randomized through a mobile phone digital system to intensive BP lowering to a target systolic BP of < 140 mmHg within 30 min, or guideline-recommended BP management according to local protocols. After the collection of in-hospital clinical and management data and 7-day outcomes, trained blinded assessors conduct telephone or face-to-face assessments of physical function and health-related quality of life in participants at 90 days. The primary outcome is the physical function on the modified Rankin scale at 90 days, analyzed as an ordinal outcome with 7 categories. The sample size was estimated to provide 90% power (α = 0.05) to detect a 22% reduction in the odds of a worse functional outcome using ordinal logistic regression. Discussion: INTERACT4 is a pragmatic clinical trial to provide reliable evidence on the effectiveness and safety of ambulance-delivered hyperacute BP lowering in patients with suspected acute stroke. Trial registration: ClinicalTrials.gov NCT03790800. Registered on 2 January 2019; Chinese Trial Registry ChiCTR1900020534. Registered on 7 January 2019. All items can be found in this protocol paper

An Adaptive Transmitting Scheme for Interrupted Sampling Repeater Jamming Suppression

The interrupted sampling repeater jamming (ISRJ) based on a digital radio frequency memory (DRFM) device is a new type of coherent jamming. This kind of jamming usually occurs as main-lobe jamming and has the advantages of low power requirements and easy parameter adjustment, posing a serious threat to the modern radar systems. In order to suppress the ISRJ, this paper proposes an adaptive transmitting scheme based on a phase-coded signal. The scheme firstly performs jamming perception to estimate the jamming parameters, then, on this basis, optimizes the waveform with genetic algorithm. With the optimized waveform, the jamming signal is orthogonal to the target echo, thus it can be easily suppressed with pulse compression. Simulation experiments are performed to verify the effectiveness of the scheme and the results suggest that the peak-to-side-lobe ratio (PSR) and integrated side-lobe level (ISL) of the pulse compression can be improved by about 16 dB and 15 dB, respectively, for the case where the jamming-to-signal ratio (JSR) is 13 dB

Stochastic Drone Fleet Deployment and Planning Problem Considering Multiple-Type Delivery Service

Drone delivery has a great potential to change the traditional parcel delivery service in consideration of cost reduction, resource conservation, and environmental protection. This paper introduces a novel drone fleet deployment and planning problem with uncertain delivery demand, where the delivery routes are fixed and couriers work in collaboration with drones to deliver surplus parcels with a relatively higher labor cost. The problem involves the following two-stage decision process: (i) The first stage determines the drone fleet deployment (i.e., the numbers and types of drones) and the drone delivery service module (i.e., the time segment between two consecutive departures) on a tactical level, and (ii) the second stage decides the numbers of parcels delivered by drones and couriers on an operational level. The purpose is to minimize the total cost, including (i) drone deployment and operating cost and (ii) expected labor cost. For the problem, a two-stage stochastic programming formulation is proposed. A classic sample average approximation method is first applied. To achieve computational efficiency, a hybrid genetic algorithm is further developed. The computational results show the efficiency of the proposed approaches

Clutter Jamming Suppression for Airborne Distributed Coherent Aperture Radar Based on Prior Clutter Subspace Projection

Airborne distributed coherent aperture radar is of great significance for expanding the detection capability of the system. However, the extra observation dimension introduced by its sparse configuration also deteriorates the performance of traditional adaptive processing in a non-uniform environment. This paper focuses on moving target detection when the system works in a clutter–jamming-coexisting environment. In order to make full use of the specific low-rank structure to reduce the requirement for training data, this paper proposes a two-stage adaptive scheme that cancels jamming and clutter separately. The proposed suppression scheme first excludes the mainlobe jamming component from the training data based on the prior clutter subspace projection and performs intra-node clutter suppression. Then, the remaining jamming is jointly canceled based on the covariance obtained with its inter-pulse mixture model. Numerical examples show that this scheme can effectively reduce the blocking effect of main lobe jamming on high-speed targets but, due to the inaccuracy of the prior subspace, there is a certain additional loss of signal-to-noise ratio for near stationary targets. The simulation also shows that the proposed scheme is equally applicable to systems with a time-varying distributed geometry

Bi-objective optimization of a reentrant flow shop scheduling with exact time lag considering energy cost

International audience— In this paper, we study a bi-objective optimization of the two-machine reentrant flow shop scheduling problem with an exact time lag considering energy consumption cost. This problem is proposed by Amrouche et al. (2016), in which each job must be operated from the first machine M1 to the second machine M2 and then back to the first machine M1 with an exact time lag lj between the two operations on the first machine. The two objectives are: (1) minimization of the total energy consumption cost and (2) makespan. To describe the problem precisely, we propose a bi-objective mixed integer programming formulation. An-constraint method and NSGA-II approach are proposed to obtain the optimal Pareto front and approximate Pareto solutions for the problem. The frameworks of the proposed methods are presented in this paper

High-Efficiency Optimization Algorithm of PMEPR for OFDM Integrated Radar and Communication Waveform Based on Conjugate Gradient

The tone reservation (TR) approach is mainly adopted to reduce the peak-to-mean envelope power ratio (PMEPR) of orthogonal frequency division multiplexing (OFDM) waveform with low TR ratio (TRR) in classic 4G communication systems. However, for the OFDM integrated radar and communication waveform, high TRR is necessary to simultaneously maintain the radar detection performance as well as communication performance. For cases with high TRR, the traditional waveform optimization algorithms have low execution efficiency and a poor PMEPR convergence level, and thus a new algorithm is needed. This paper proposes a new PMEPR optimization algorithm based on conjugate gradient. Firstly, by introducing the concept of Lp-norm, the PMEPR of the OFDM waveform is accurately remodeled as the objective function of the waveform optimization problem. Secondly, the conjugate gradient of the objective function is analytically derived to form the basis of the efficient PMEPR optimization. Finally, a PMEPR optimization algorithm based on the Polak–Ribière–Polyak (PRP) conjugate gradient is proposed. The simulation results verified the proposed algorithm in terms of optimization efficiency, as well as convergence level, and the initial experimental results suggested the practicality of the proposed algorithm

Integrated Radar and Communications Waveform Design Based on Multi-Symbol OFDM

Integrated radar and communications (IRC) technology has become very important for civil and military applications in recent years, and IRC waveform design is a major challenge for IRC development. In this paper, we focus on the IRC waveform design based on the multi-symbol orthogonal frequency division multiplexing (OFDM) technique. In view of the defects resulting from high peak-to-mean envelope power ratios (PMEPRs) and high range sidelobes in IRC systems, an intelligent and effective IRC waveform design method jointly optimized with the PMEPR and peak-to-sidelobe ratio (PSLR) is proposed. Firstly, a flexible tone reservation (TR)-based IRC waveform structure is applied in both temporal and frequency domains, i.e., multi-symbol OFDM waveform. Secondly, the optimization problem considering PMEPR and PSLR and extending them to the Lp-norm form is reformulated. Then, the conjugate gradient of the objective function is analytically derived and the conjugate gradient algorithm (CGA) is presented to simultaneously improve the PMEPR and PSLR. Finally, the simulation results show that the proposed algorithm can efficiently generate IRC waveforms with an excellent PMEPR, PSLR, radar signal-to-noise ratio (SNR), and bit error rate (BER) performance