A simple current control strategy for a four-leg indirect matrix converter

In this paper the experimental validation of a predictive current control strategy for a four-leg indirect matrix converter is presented. The four-leg indirect matrix converter can supply energy to an unbalanced three-phase load whilst providing a path for the zero sequence load. The predictive current control technique is based on the optimal selection among the valid switching states of the converter by evaluating a cost function, resulting in a simple approach without the necessity for modulators. Furthermore, zero dc-link current commutation is achieved by synchronizing the state changes in the input stage with the application of a zero voltage space vector in the inverter stage. Simulation results are presented and the strategy is experimentally validated using a laboratory prototype

Predictive current control with instantaneous reactive power minimization for a four-leg indirect matrix converter

This paper presents the experimental valida¬tion of a predictive current control strategy with minimiza¬tion of the instantaneous reactive input power for a Four-Leg Indirect Matrix Converter (4Leg-IMC). The topology includes an input matrix converter stage, which provides the dc voltage for a four-leg voltage source converter (VSC) output stage. The VSC’s fourth leg provides a path for the zero sequence load current. The control technique is based on a finite control set model predictive control (FCS-MPC) strategy, whereby the switching states for the input and out¬put converters are selected by evaluating a predictive cost function. This results in a simpler approach than that seen in other well-known modulation methods, such as three-dimensional space vector modulation (3D-SVM). Positive dc voltage, (a requirement for the safe operation of the IMC) and minimization of the instantaneous input reactive power are obtained, while maintaining good tracking of the load reference currents. Furthermore, soft switching is achieved by synchronizing the state changes in the input stage with the application of zero voltage space vectors in the inverter stage. The control strategy is experimentally verified using a laboratory prototype

Vector control of an open-ended winding induction machine based on a two-output indirect matrix converter

The open-ended winding induction machine fed from a standard two-level Voltage Source Inverter (VSI) arrangement is an attractive solution for AC drives. An alternative power converter approach is to use an Indirect Matrix Converter (IMC) consisting of a matrix converter AC-DC input stage and two VSI output stages. This latter topology provides fully bidirectional power flow operation and requires only a small input filter. In this paper, a vector control strategy for an open-ended winding cage induction machine fed by a two-output IMC is presented. The modulation scheme for the input power converter stage aims to modify the virtual DC link voltage depending on the load voltage requirement. Additionally, the modulation strategy for the dual-inverter output aims to eliminate the zero sequence voltage applied to the load. A vector control scheme is used and the full system is modelled using a PSIM and MATLAB/Simulink platform. Experimental results from a 7.5 kW prototype are presented, demonstrating the feasibility of the topology and control strategy

Open-end winding induction machine fed by a dual-output indirect matrix converter

Open-ended winding induction machines fed from standard two-level Voltage Source Inverters (VSI) provide an attractive arrangement for AC drives. An alternative approach is to use a dual output Indirect Matrix Converter (IMC). It is well known that the IMC provides fully bidirectional power flow operation, with small input size filter requirements. Whilst a standard IMC consists of an AC-DC matrix converter input stage followed by a single VSI output stage, it is possible to replicate the VSI to produce multiple outputs. In this paper an open-end winding induction machine fed by an IMC with two output stages is presented. The IMC modulation strategy aims to reduce the common-mode voltage whilst compensating any zero sequence voltage fed to the machine. The system is modeled using a PSIM and MATLAB/Simulink platform. Experimental results demonstrating the viability of the method are presented using a 7.5 kW prototype

Propuesta de intervención de la enfermedad isquémica Coronaria del departamento de Arauca con población de 38-55 años

En esta propuesta intervención se describe la enfermedad isquémica coronaria en el departamento de Arauca teniendo como referencia el Asís( Análisis de situación de salud), dónde se evidencia mediante un trabajo investigativo de análisis e interpretación, medidas de intervención con el fin de mitigar los factores de riesgo de la enfermedad anteriormente descrita y mejorar la calidad de vida de los habitantes del departamento para garantizar mediante los promotores de salud el derecho a la vida y al disfrute de una salud adecuada. Asimismo esta propuesta se centra en los objetivos, una contextualización del problema, los actores, alcance y responsabilidad de la propuesta en el departamento Arauca, una descripción detallada de las estrategias y actividades a realizar así como la línea operativa y enfoque que aborda según el plan decenal de salud pública, la descripción de los objetivos de desarrollo sostenible, la finalidad de la propuesta haciendo énfasis en los resultados en salud y el costo-efectividad en el sistema de salud, las conclusiones y las respectivas referencias bibliográficas. En el transcurso de la propuesta se evidencian cifras y datos acerca de las enfermedades no transmisibles entre las que se encuentran las enfermedades coronarias de la cual se subdivide o se encuentra la enfermedad isquémica coronaria que presenta la comunidad del departamento de Arauca y la cual debe seguirse controlando debido a que está enfermedad está generando altos índices de mortalidad a nivel mundialThis intervention proposal describes coronary ischemic disease in the department of Arauca taking as reference the Assisi (Analysis of health situation), where it is evidenced through a research work of analysis and interpretation intervention measures in order to mitigate the risk factors of the disease described above and improve the quality of life of the inhabitants of the department to guarantee through the health promoters the right to life and the enjoyment of adequate health. Likewise, this proposal focuses on the objectives, a contextualization of the problem, the actors, scope and responsibility of the proposal in the department of Arauca, a detailed description of the strategies and activities to be carried out as well as the operational line and approach that addresses according to the ten-year public health plan as the description of the sustainable development goals, the purpose of the proposal emphasizing health outcomes and the cost-effectiveness in the health system, the conclusions and the respective bibliographic references. In the course of the proposal, figures and data are evidenced about noncommunicable diseases, among which are coronary diseases from which the coronary ischemic disease presented by the community of the department of Arauca is subdivided or is found, which must continue to be controlled because this disease is generating high mortality rates worldwide

Model-Based Predictive Rotor Current Control Strategy for Indirect Power Control of a DFIM Driven by an Indirect Matrix Converter

This paper presents a new control strategy using model-based predictive current control (MB-PCC) for a doubly fed induction machine (DFIM) driven by an indirect matrix converter (IMC). This strategy proposes the control of rotor currents, whose references are calculated from active and reactive stator power set points and the dynamic model of the DFIM. The control strategy works well in the four P-Q operating regions of the DFIM. The grid synchronization process is carried out by setting the P-Q power set points to zero. The results presented include the DFIM synchronization procedure as well as the active and reactive power control at variable shaft speed to validate the feasibility of the proposed strategy

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat