Cost-Sensitive Decision Trees with Completion Time Requirements

In many classification tasks, managing costs and completion times are the main concerns. In this paper, we assume that the completion time for classifying an instance is determined by its class label, and that a late penalty cost is incurred if the deadline is not met. This time requirement enriches the classification problem but posts a challenge to developing a solution algorithm. We propose an innovative approach for the decision tree induction, which produces multiple candidate trees by allowing more than one splitting attribute at each node. The user can specify the maximum number of candidate trees to control the computational efforts required to produce the final solution. In the tree-induction process, an allocation scheme is used to dynamically distribute the given number of candidate trees to splitting attributes according to their estimated contributions to cost reduction. The algorithm finds the final tree by backtracking. An extensive experiment shows that the algorithm outperforms the top-down heuristic and can effectively obtain the optimal or near-optimal decision trees without an excessive computation time.classification, decision tree, cost and time sensitive learning, late penalty

Disseminated nocardiosis with thyroid involvement: A case report

Nocardiosis is a life-threatening infection that affects the lungs, skin, and central nervous system, particularly in immune-compromised patients. We report a case of disseminated nocardiosis with pneumonia, brain abscesses, meningitis, and thyroiditis, for an individual with recent steroid therapy. Recovery was uneventful with a 4-month course of sulfamethoxazole–trimethoprim

Monitoring Apnea in the Elderly by an Electromechanical System with a Carbon Nanotube-based Sensor

SummaryBackgroundBreathing, a part of respiration, is one of the vital functions. Breathing disorders are common in the elderly. An effective breathing sensor for real-time detection of apnea is important in clinical critical care. We aimed to construct a real-time warning platform with a combination of carbon nanotubes (CNTs) and related nano-electromechanical system (NEMS) for elderly care.MethodsThrough a specific acid-treated procedure, multiwalled carbon nanotubes (MWCNTs) were immobilized on a thin silicon dioxide (SiO2) film, coated on a heated silicon wafer. Techniques of photolithography and sputtering with chromium and gold were then implemented on the MWCNT film to develop micro-interdigitated electrodes as a base for the breathing sensor. The sensor was equipped with a programmed microchip processor to become a warning detector for abnormal human breathing, namely less than six breaths per minute. Elderly volunteers were enrolled for examining the effective sensitivity of this novel electromechanical device.ResultsThere were 15 elderly volunteers (9 males and 6 females) tested in this experiment. The dynamic analyses of the MWCNT sensor to exhaled breath showed that it had characteristics of rapid response, high aspect ratio, small tip ratio, and high electrical conductivity. Responses of the MWCNT sensor to exhaled breath was recorded according to different performance parameters, i.e., strength, frequency, flow rate, and breath components. In this study, variable pattern-simulated tests showed that a MWCNT sensor combined with a processor could accurately evoke warning signals (100% of sensitivity rate), indicating its effectiveness and usefulness for detecting abnormal breathing rates, especially apnea.ConclusionOur results showed that a new device composed of an NEMS by combining an MWCNT sensor and complementary metal-oxide semiconductor (CMOS) circuits could be integrated to effectively detect apnea in the elderly. This novel device may improve the pattern of safe respiratory care for the elderly in the future

Carbapenem-Resistant Enterobacteriaceae Infections: Taiwan Aspects

Carbapenem-resistant Enterobacteriaceae (CRE), a major resistance concern emerging during the last decade because of significantly compromising the efficacy of carbapenem agents, has currently become an important focus of infection control. Many investigations have shown a high association of CRE infections with high case-fatality rates. In Taiwan, a few surveys observed that a significant proportion (29–47%) of the CR-Klebsiella pneumoniae isolates harbored a plasmidic allele encoding K. pneumoniae carbapenemases (KPC, especially KPC-2). A significant increase in the number of oxacillinase (OXA)-48-like carbapenemases among CR-K. pneumoniae isolates was observed between 2012 and 2015. By striking contrast, isolates of CR-Escherichia coli and CR-Enterobacter species in Taiwan had a much lower percentage of carbapenemase production than CR-K. pneumoniae isolates. This differs from isolates found in China as well as in the India subcontinent. Apart from the hospital setting, CRE was also cultured from the inpatients from communities or long-term care facilities (LTCF). Therefore, implementation of regular CRE screening of LTCF residents, strict disinfectant use in nursing homes and hospital settings, and appropriate control of antibiotic prescriptions is suggested to alleviate the spread of clinical CRE isolates in Taiwan. Although there are some promising new antibiotics against CRE, such as ceftazidime-avibactam, meropenem-vaborbactam, aztreonam-avibactam and cefiderocol, these agents are not available in Taiwan currently. Therefore, in order to effectively decrease case-fatality rates among patients with the infections owing to carbapenemase-producing CRE isolates, combination antibiotic schemes, including colistin (or amikacin) and/or tigecycline in combination with an anti-pseudomonal carbapenem agent, remain the mainstay for treating clinical CRE infections

In vitro activities of antimicrobial combinations against planktonic and biofilm forms of Stenotrophomonas maltophilia

ObjectivesTo investigate the in vitro activity of antibiotic combinations against Stenotrophomonas maltophilia isolates and their associated biofilms.MethodsThirty-two S. maltophilia clinical isolates with at least twenty-five different pulsotypes were tested. The antibacterial activity of various antibiotic combinations against seven randomly selected planktonic and biofilm-embedded S. maltophilia strains with strong biofilm formation was assessed using broth methods. Extraction of bacterial genomic DNA and PCR detection of antibiotic resistance and biofilm-related genes were also performed.ResultsThe susceptibility rates of levofloxacin (LVX), fosfomycin (FOS), tigecycline (TGC) and sulfamethoxazole-trimethoprim (SXT) against 32 S. maltophilia isolates were 56.3, 71.9, 71.9 and 90.6%, respectively. Twenty-eight isolates were detected with strong biofilm formation. Antibiotic combinations, including aztreonam-clavulanic (ATM-CLA) with LVX, ceftazidime-avibactam (CZA) with LVX and SXT with TGC, exhibited potent inhibitory activity against these isolates with strong biofilm formation. The antibiotic resistance phenotype might not be fully caused by the common antibiotic-resistance or biofilm-formation gene.ConclusionS. maltophilia remained resistant to most antibiotics, including LVX and β-lactam/β-lactamases; however, TGC, FOS and SXT still exhibited potent activity. Although all tested S. maltophilia isolates exhibited moderate-to-strong biofilm formation, combination therapies, especially ATM-CLA with LVX, CZA with LVX and SXT with TGC, exhibited a higher inhibitory activity for these isolates

Enteric bacterial loads are associated with interleukin-6 levels in systemic inflammatory response syndrome patients

AbstractBackgroundLoss of intestinal integrity is a critical contributor to excessive inflammation following severe trauma or major surgery. In the case of enterocyte damage, intestinal fatty acid-binding protein (IFABP) is released into the extracellular space. Excessive production of interleukin (IL)-6 can induce systemic inflammatory response syndrome (SIRS). However, the correlation of IL-6 with gut barrier failure and bacterial translocation in critically ill patients has not been well characterized.PurposesTo define the relationship between enteric bacterial loads and IL-6 levels in patients with SIRS.MethodsVariables related to prognosis and treatment were measured in 85 patients with SIRS upon admission to the emergency room. IL-6 and IFABP were measured using an enzyme-linked immunosorbent assay. Enteric bacterial loads in blood were measured through quantitative real-time polymerase chain reaction with primers specific for enteric bacteria.ResultsMultivariate analysis revealed a positive correlation between enteric bacterial loads and IL-6 levels in blood. Elevated IFABP concentration was associated with low blood pressure, high respiration rate, hyperglycemia, and high Sequential Organ Failure Assessment score. Elevated C-reactive protein concentrations were associated with higher soluble CD14 levels in blood.ConclusionEnterocyte damage is associated with hypotension and tachypnia in patients with SIRS. Gut function failure may permit enteric bacteria to enter the blood, thereby elevating IL-6 levels and inducing a systemic inflammatory response, resulting in multiple organ failure

Melioidosis Outbreak after Typhoon, Southern Taiwan

From July through September 2005, shortly after a typhoon, 40 cases of Burkholderia pseudomallei infection (melioidosis) were identified in southern Taiwan. Two genotypes that had been present in 2000 were identified by pulsed-field gel electrophoresis. Such a case cluster confirms that melioidosis is endemic to Taiwan

Hyperbilirubinemia with urinary tract infection in infants younger than eight weeks old

AbstractBackgroundHyperbilirubinemia is one of the most common causes for hospital admission in neonatal infants. Previous studies have found that jaundice may be one of the initial symptoms related to urinary tract infection (UTI) in infants. This study is to evaluate the incidence and related factors of neonatal infants with the initial presentation of hyperbilirubinemia and final diagnosis of UTI in a tertiary teaching hospital.MethodsWe retrospectively investigated the medical records of admitted infants younger than 8 weeks old with hyperbilirubinemia between January and December 2008. The jaundiced infants having tests of urinalysis were enrolled into our study and grouped into UTI or no UTI group according to the findings of urinary culture.ResultsA total of 217 neonatal jaundiced infants were enrolled. Among them, 12 cases (5.5%) were grouped into the UTI group, and the most common cultured bacterium from their urine was Escherichia coli. There was no significant difference in the babies’ birth weight, maternal conditions, or total bilirubin levels between the two groups. There was also no significant difference between the two groups in their admission age (9.7 ± 13.5 days vs. 6.1 ± 6.7 days in UTI and no UTI groups, respectively) or the ratio of outpatients (50% vs. 25% in UTI and no UTI groups, respectively) (p > 0.05). The cases of UTI group had significantly lower hemoglobin (15.2 ± 2.7 g/dL vs. 17.2 ± 2.3 g/dL, respectively) and higher formula feeding rate (8.3% vs. 2.9%, respectively) than the no UTI group (p < 0.05).ConclusionThe incidence of UTI in the admitted infants with hyperbilirubinemia was as high as approximately 5.5%. The most common cultured bacterium in urine was E coli. Therefore, performing urinary tests to exclude the possibility of coincidental UTI may be necessary for admitted jaundiced infants younger than 8 weeks old