Diversity of multi-drug resistant Acinetobacter baumannii population in a major hospital in Kuwait

Acinetobacter baumannii is one of the most important opportunistic pathogens that causes serious health care associated complications in critically ill patients. In the current study we report on the diversity of the clinical multi-drug resistant (MDR) A. baumannii in Kuwait by molecular characterization. One hundred A. baumannii were isolated from one of the largest governmental hospitals in Kuwait. Following the identification of the isolates by molecular methods, the amplified blaOXA-51-like gene product of one isolate (KO-12) recovered from blood showed the insertion of the ISAba19 at position 379 in blaOXA-78. Of the 33 MDR isolates, 28 (85%) contained blaOXA-23, 2 (6%) blaOXA-24 and 6 (18%) blaPER-1 gene. We did not detect blaOXA-58, blaV IM, blaIMP, blaGES, blaV EB, and blaNDM genes in any of the tested isolates. In three blaPER-1 positive isolates the genetic environment of blaPER-1 consisted of two copies of ISPa12 (tnpiA1) surrounding the blaPER-1 gene on a highly stable plasmid of ca. 140-kb. Multilocus-sequence typing (MLST) analysis of the 33 A. baumannii isolates identified 20 different STs, of which six (ST-607, ST-608, ST-609, ST-610, ST-611, and ST-612) were novel. Emerging STs such as ST15 (identified for the first time in the Middle East), ST78 and ST25 were also detected. The predominant clonal complex was CC2. Pulsed-field gel electrophoresis and MLST defined the MDR isolates as multi-clonal with diverse lineages. Our results lead us to believe that A. baumannii is diverse in clonal origins and/or is undergoing clonal expansion continuously while multiple lineages of MDR A. baumannii circulate in hospital ward simultaneously

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Consensus-based distributed adaptive target tracking in camera networks using Integrated Probabilistic Data Association

Abstract In this paper, a novel consensus-based adaptive algorithm for distributed target tracking in large scale camera networks is presented, aimed at situations characterized by limited sensing range, high-level clutter, and possibly occulted targets. The concept of Integrated Probabilistic Data Association (IPDA) is introduced in the distributed adaptive tracker design so that the proposed algorithm, named IPDA Adaptive Consensus Filter (IPDA-ACF), incorporates probabilities of acquiring target-originated measurements, conditioned on either target perceivability or target existence. A distributed adaptation scheme represents the core element of the algorithm, allowing fast convergence under a large variety of operating conditions, emphasizing the influence of the nodes with the highest probability of obtaining target-originated measurements. A theoretical analysis of stability and reduction of noise influence allows getting an insight into the relationship between the local trackers and the global consensus scheme. A comparison with analogous existing methods done by extensive simulations shows that the proposed method achieves the best performance, in spite of lower communication and computation requirements

Common underlying conditions among patients yielding <i>C</i>. <i>tropicalis</i> isolates.

<p>Common underlying conditions among patients yielding <i>C</i>. <i>tropicalis</i> isolates.</p

A Case-Based Reasoning and Random Forest Framework for Selecting Preventive Maintenance of Flexible Pavement Sections

Pavement maintenance decision-making is receiving significant attention in recent research, since pavement infrastructure is aging and deteriorating. The decision-making process is mainly related to selecting the most appropriate maintenance intervention for pavement sections to ensure performance and enhance safety. Several preventive maintenance methods have been proposed in the previous studies, yet the potential of implementing Case-Based Reasoning (CBR) in pavement maintenance decision-making has been investigated rarely. The CBR is an artificial intelligence technique, it is knowledge-based on several known cases, which are used to adapt a solution for a new case through retrieving similar cases. This research introduces the CBR to the area of pavement management to select the most appropriate preventive maintenance strategy for flexible pavement sections. The needed database was extracted from maintenance cases at Long-Term Pavement Performance Program. The criteria used to characterize condition of each section were identified based on the common practices in pavement maintenance published in the literature and implemented in the field. To assign weights to the selected criteria, different machine learning techniques were tested, and subsequently, Random Forest (RF) algorithm was selected to be integrated with the proposed CBR method producing the CBR-RF framework. A case study was analyzed to validate the proposed framework and a sensitivity analysis was conducted to assess the influence of each criterion on case retrieval accuracy and overall framework performance. Results indicated that the CBR-RF approach could assist effectively in the preventive maintenance decision-making with regard to new cases by learning from the previous similar cases. Accordingly, several agencies can depend on the proposed framework, while facing similar decision-making problems. Future research can compare the CBR-RF framework with other machine learning algorithms using the same dataset included in this research

An UPGMA-derived dendrogram based on allelic profile of 6 gene fragments from 63 <i>C</i>. <i>tropicalis</i> isolate from Kuwait.

<p>Similarity is presented in percentages using the scale bar in the upper left corner. The columns from left to right include, isolate number, MLST-based diploid sequence type (DST), clinical specimen yielding the isolate, data of isolation, hospital ward/unit where the patients were housed and eBURST group. Repeat isolates from the same patient are indicated by alphabets within brackets and DSTs for cluster isolates are shown by an asterisk (*) before the DST.</p

Clinical and epidemiological characteristics of patients yielding <i>C</i>. <i>tropicalis</i> isolates belonging to the three MLST-based clusters.

<p>Clinical and epidemiological characteristics of patients yielding <i>C</i>. <i>tropicalis</i> isolates belonging to the three MLST-based clusters.</p

Minimum spanning tree showing relationship of 63 <i>C</i>. <i>tropicalis</i> isolates from Kuwait with 804 isolates from other countries available from the MLST website as of January 2017.

<p>Each circle corresponds to a unique genotype, and lines between circles represent relative distance between isolates. The sizes of the circles correspond to the number of isolates of the same genotype (DST). Connecting lines correspond to the number of allele differences between genotypes, with a solid thick line connecting genotypes that differ in one locus, a solid thin line connecting genotypes that differ in two-three loci, a dashed line connecting genotypes that differ in four loci, and a dotted line connecting genotypes that differ in more than four loci.</p