Development and validation of an interpretable model for predicting sepsis mortality across care settings.

There are numerous prognostic predictive models for evaluating mortality risk, but current scoring models might not fully cater to sepsis patients' needs. This study developed and validated a new model for sepsis patients that is suitable for any care setting and accurately forecasts 28-day mortality. The derivation dataset, gathered from 20 hospitals between September 2019 and December 2021, contrasted with the validation dataset, collected from 15 hospitals from January 2022 to December 2022. In this study, 7436 patients were classified as members of the derivation dataset, and 2284 patients were classified as members of the validation dataset. The point system model emerged as the optimal model among the tested predictive models for foreseeing sepsis mortality. For community-acquired sepsis, the model's performance was satisfactory (derivation dataset AUC: 0.779, 95% CI 0.765-0.792; validation dataset AUC: 0.787, 95% CI 0.765-0.810). Similarly, for hospital-acquired sepsis, it performed well (derivation dataset AUC: 0.768, 95% CI 0.748-0.788; validation dataset AUC: 0.729, 95% CI 0.687-0.770). The calculator, accessible at https://avonlea76.shinyapps.io/shiny_app_up/ , is user-friendly and compatible. The new predictive model of sepsis mortality is user-friendly and satisfactorily forecasts 28-day mortality. Its versatility lies in its applicability to all patients, encompassing both community-acquired and hospital-acquired sepsis.

An ultra-sensitive colloidal quantum dot infrared photodiode exceeding 100 000% external quantum efficiency via photomultiplication.

In this study, we present ultrasensitive infrared photodiodes based on PbS colloidal quantum dots (CQDs) using a double photomultiplication strategy that utilizes the accumulation of both electron and hole carriers. While electron accumulation was induced by ZnO trap states that were created by treatment in a humid atmosphere, hole accumulation was achieved using a long-chain ligand that increased the barrier to hole collection. Interestingly, we obtained the highest responsivity in photo-multiplicative devices with the long ligands, which contradicts the conventional belief that shorter ligands are more effective for optoelectronic devices. Using these two charge accumulation effects, we achieved an ultrasensitive detector with a responsivity above 7.84 × 102 A W-1 and an external quantum efficiency above 105% in the infrared region. We believe that the photomultiplication effect has great potential for surveillance systems, bioimaging, remote sensing, and quantum communication.

Ultra-Low Noise Level Infrared Quantum Dot Photodiodes with Self-Screenable Polymeric Optical Window.

Quantum dot photodiodes (QPDs) have garnered significant attention because of their unparalleled near-infrared (NIR) detection capabilities, primarily attributable to their size-dependent bandgap tunability. Nevertheless, the broadband absorption spectrum of QPD engenders substantial noise floor within superfluous visible light regions, notably hindering their use in several emerging applications necessitating the detection of faint micro-light signals. To overcome these hurdles, a self-screenable NIR QPD featuring an internal optical filter with a thick polymeric interlayer to reduce electronic noise is demonstrated. This effectively screens out undesirable visible light regions while reducing the ionized defect owing to decreased density of state, yielding an extremely low dark current (≈1010 A cm-2 at V = -1 V). Consequently, the electronic noise spectral density is attained at levels below ≈10-27 -10-28 A2 Hz-1 , and responsivity (R) dropped to 92% within the visible light spectrum.

High-Performance Self-Powered Quantum Dot Infrared Photodetector with Azide Ion Solution Treated Electron Transport Layer.

The demand for self-powered photodetectors (PDs) capable of NIR detection without external power is growing with the advancement of NIR technologies such as LIDAR and object recognition. Lead sulfide quantum dot-based photodetectors (PbS QPDs) excel in NIR detection; however, their self-powered operation is hindered by carrier traps induced by surface defects and unfavorable band alignment in the zinc oxide nanoparticle (ZnO NP) electron-transport layer (ETL). In this study, an effective azide-ion (N3 - ) treatment is introduced on a ZnO NP ETL to reduce the number of traps and improve the band alignment in a PbS QPD. The ZnO NP ETL treated with azide ions exhibited notable improvements in carrier lifetime and mobility as well as an enhanced internal electric field within the thin-film heterojunction of the ZnO NPs and PbS QDs. The azide-ion-treated PbS QPD demonstrated a increase in short-circuit current density upon NIR illumination, marking a responsivity of 0.45 A W-1 , specific detectivity of 4 × 1011 Jones at 950 nm, response time of 8.2 µs, and linear dynamic range of 112 dB.

Highly Conductive and Sensitive Wearable Strain Sensors with Metal/Nanoparticle Double Layer for Noninterference Voice Detection.

Human voice recognition via skin-attachable devices has significant potential for gathering important physiological information from acoustic data without background noise interference. In this study, a highly sensitive and conductive wearable crack-based strain sensor was developed for voice-recognition systems. The sensor was fabricated using a double-layer structure of Ag nanoparticles (NPs) and Ag metal on a biocompatible polydimethylsiloxane substrate. The top metal layer acts as a conducting active layer, whereas the bottom Ag NP layer induces channel cracks in the upper layer, effectively hindering current flow. Subsequently, the double-layer film exhibits a low electrical resistance value (<5 × 10-5 Ω cm), ultrahigh sensitivity (gauge factor = 1870), and a fast response/recovery time (252/168 µs). A sound wave was detected at a high frequency of 15 kHz with a signal-to-noise ratio (SNR) over 40 dB. The sensor exhibited excellent anti-interference characteristics and effectively differentiated between different voice qualities (modal, pressed, and breathy), with a systematic analysis revealing successful detection of the laryngeal state and glottal source. This ultrasensitive wearable sensor has potential applications in various physiological signal measurement methods, personalized healthcare systems, and ubiquitous computing.

Charge transport transition of PEDOT:PSS thin films for temperature-insensitive wearable strain sensors.

In this study, a temperature-insensitive strain sensor that detects only the strain without responding to the temperature was designed. The transport mechanism and associated temperature coefficient of resistance (TCR) of a poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) thin film were modified through secondary doping with dimethyl sulfoxide (DMSO). Upon DMSO-doping, the carrier transport mechanism of the PEDOT:PSS thin film transitioned from hopping to band-like transport, with a morphological change. At the DMSO doping level, which caused the critical point of the transport transition, the resistance of the thin film was maintained with a change in temperature. Consequently, the TCR of the optimized PEDOT:PSS thin film was less than 9 × 10-5 K-1, which is 102 times lower than that of the as-prepared films. The carrier mobility of the PEDOT:PSS thin film was effectively improved with the morphological change due to DMSO doping and was investigated through combinational analysis. Ultimately, the wearable strain sensor prepared using the optimized PEDOT:PSS thin film responded stably to the applied strain with a gauge factor of 2 and exhibited excellent temperature anti-interference.

Impact of early nutrition and feeding route on clinical outcomes of neurocritically ill patients.

Early proper nutritional support is important to critically ill patients. Nutritional support is also associated with clinical outcomes of neurocritically ill patients. We investigate whether early nutrition is associated with clinical outcomes in neurocritically ill patients. This was a retrospective, single-center, observational study including neurosurgical patients who were admitted to the intensive care unit (ICU) from January 2013 to December 2019. Patients who started enteral nutrition or parenteral nutrition within 72 hours after ICU admission were defined as the early nutrition group. The primary endpoint was in-hospital mortality. The secondary endpoint was an infectious complication. Propensity score matching (PSM) and propensity score weighting overlap weights (PSOW) were used to control selection bias and confounding factors. Among 1,353 patients, early nutrition was performed in 384 (28.4%) patients: 152 (11.2%) early enteral nutrition (EEN) and 232 (17.1%) early parenteral nutrition (EPN). In the overall study population, the rate of in-hospital mortality was higher in patients with late nutrition than in those with early nutrition (P<0.001). However, there was no significant difference in in-hospital mortality and infectious complications incidence between the late and the early nutrition groups in the PSM and PSOW adjusted population (all P>0.05). In the overall study population, EEN patients had a low rate of in-hospital mortality and infectious complications compared with those with EPN and late nutrition (P<0.001 and P = 0.001, respectively). In the multivariable analysis of the overall, PSM adjusted, and PSOW adjusted population, there was no significant association between early nutrition and in-hospital mortality and infectious complications (all P>0.05), but EEN was significantly associated with in-hospital mortality and infectious complications (all P<0.05). Eventually, early enteral nutrition may reduce the risk of in-hospital mortality and infectious complications in neurocritically ill patients.

Protocol and clinical characteristics of patients under 'at-home care' for COVID-19 in South Korea: a retrospective cohort study.

OBJECTIVE: As the number of patients with COVID-19 increased, at-home care was introduced for the first time in South Korea. This study aimed to analyse the characteristics and outcomes of patients who were treated under at-home care. DESIGN, SETTING AND PARTICIPANTS: This retrospective cohort study targeted patients under at-home care for COVID-19 in Yeongdeungpo-gu in Seoul, Korea, from 18 October 2021 to 12 December 2021. The public health centre selected eligible patients for at-home care and registered with our institution. Nurses monitored patients, and doctors decided to transfer healthcare facilities and release the quarantined patients according to their symptoms. OUTCOME MEASURES: Patient characteristics during the course of at-home care. RESULTS: A total of 1422 patients were enrolled and 9574 patient-days were managed. Most patients were aged ≥60 years (22.7% (n=323)), and 82.8% did not have underlying conditions. The median length of care for patients was 8 days (IQR: 5-10 days). During the study period, 986 (69.3%) patients were released from quarantine, 82 (5.8%) patients were transferred to facilities and 354 (24.9%) patients were still under at-home care at the end of the study period. The most common cause of transfer was sustained fever (n=30; 36.6%), followed by dyspnoea and desaturation (n=17; 20.7%). Factors associated with transfer were diabetes (OR: 3.591, 95% CI 1.488 to 8.665, p=0.004), pregnancy (OR: 5.839, 95% CI 1.035 to 32.935, p=0.046) and being presymptomatic at diagnosis (OR: 4.015, 95% CI 1.559 to 10.337, p=0.004). CONCLUSIONS: There were no specific problems related to patient safety when operating at-home care. Patients with risk factors, such as diabetes, were more likely to be transferred to healthcare facilities. For safe at-home care, it is necessary to prepare for an appropriate response to the emergency.

Wearable anti-temperature interference strain sensor with metal nanoparticle thin film and hybrid ligand exchange.

Anti-interference characteristics, whereby undesirable signal interference is minimized, are required for multifunctional sensor platforms. In this study, an anti-temperature-interference resistive-type strain sensor, which does not respond to temperature but only to strain, is designed. Anti-interference properties were achieved by modulating the temperature coefficient of resistance (TCR) of metal nanoparticles (NPs) through hybrid chemical treatment with organic and halide ligands that induce negative and positive TCRs, respectively. Consequently, a very low TCR of 1.9 × 10-5 K-1 was obtained. To investigate the origin of this near-zero TCR, analyses of correlated electrical, thermal, and mechanical properties were performed in addition to structural characterization and analysis. Density functional theory calculations and electrical percolation modeling were performed to illuminate the transport behavior in the near-zero-TCR NP thin films. Finally, we fabricated a high-performance anti-temperature-interference strain sensor using a solution process. The sensors detect a variety of strains, including those arising from large movements, such as wrist and knee movements, and fine movements, such as artery pulses or movements made during calligraphy, and did not respond to temperature changes.

Postvaccination Multisystem Inflammatory Syndrome in Adult with No Evidence of Prior SARS-CoV-2 Infection.

Ten days after receiving the first dose of coronavirus disease vaccine, a 22-year-old woman in South Korea experienced myocarditis, myopathy, pericarditis, and gastroenteritis; rash subsequently developed. There was no evidence of prior infection with severe acute respiratory syndrome coronavirus 2. The diagnosis was multisystem inflammatory syndrome resulting from coronavirus disease vaccination.

Antibiotic Resistance Patterns of Enterobacteriaceae Isolated from Patients with Healthcare-Associated Infections.

BACKGROUND: There have been recent proposals to categorize healthcare-associated infections (HCAIs) separately from community-acquired infections (CAIs). The aim of this study was to compare the antibiotic resistance of pathogens causing CAIs, HCAIs, and hospital-acquired infections (HAIs) in Korea, and to investigate the need for different empirical antibiotics therapy for CAIs and HCAIs. MATERIALS AND METHODS: This prospective study was conducted in a university hospital between March and December 2019. Inpatients who underwent a bacterial culture within 2 days of hospitalization, with a Enterobacteriaceae strain identified at the infection site and available antibiotic susceptibility results, were included in the analysis. Infections were classified as CAIs, HCAIs or HAIs, depending on the source. RESULTS: Of the 146 patients included in the analysis, the prevalence of fluoroquinolone-resistant Enterobacteriaceae was 18.8%, 38.5%, and 55.0%; the prevalence of pathogens showing third-generation cephalosporins resistance was 8.3%, 50.0%, and 60.0%; and the prevalence of pathogens showing piperacillin-tazobactam resistance was 8.3%, 7.7%, 15.0% in the CAIs, HCAIs, and HAIs groups, respectively. The prevalence of extended-spectrum beta-lactamase-positive pathogens was 6.3%, 47.3%, and 55.0% in the CAIs, HCAIs, and HAIs group, respectively, with no significant difference between the HCAIs and HAIs groups. Resistance patterns of the HCAIs group more closely resembled those of the HAIs group than those of the CAIs group. CONCLUSION: The pathogens isolated from patients with HCAIs showed resistance patterns that were more similar to those of patients with HAIs than those with CAIs. Thus, CAIs and HCAIs should be distinguished from each other when selecting antibiotic agents.

Positivity of Carbapenemase-producing Enterobacteriaceae in Patients Following Exposure within Long-term Care Facilities in Seoul, Korea.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) are emerging as a worldwide threat. Long-term care facilities (LTCFs) are considered a reservoir for CPE and play a central role in transmission to acute care hospitals. We investigated the CPE positivity in patients exposed to CPE in LTCFs. Furthermore, we analyzed the CPE positivity rates in the environment exposed to CPE. METHODS: We collected rectal swab specimens from patients residing in LTCFs who were exposed to CPE. Environmental sampling was performed by infection control practitioners from sites classified as patient private space, common space in the patient room, common space other than patient rooms, and nursing station. Each sample was cultured on a Chrom Klebsiella pneumoniae carbapenemase (KPC) agar for CPE screening. The positive isolates were subjected to a polymerase chain reaction to identify the presence of blaKPC, blaVIM, blaIMP, blaOXA-48, and blaNDM and determine CPE genotype. RESULTS: From 65 index cases, a total of 24 hospitals and 481 patients were enrolled; 414 patients who had resided in the same patient room as a patient with confirmed CPE and 67 patients who were newly admitted to that patient room. A total of 117 (24.3%) patients were positive for CPE among which 93 (22.5%, 93/414) were already admitted patients and 24 (35.8%, 24/67) were newly admitted patients. A total of 163 CPEs were detected and K. pneumoniae (n = 104, 63.8%) was the most common bacteria followed by Escherichia coli (n = 43, 26.4%) and Citrobacter koseri (n = 11, 6.7%). Environmental sampling was performed in 24 hospitals and 604 sites. A total of 12 sites (2.0%) were positive for CPE and sink in the nursing station (n = 6, 4.2%) was the most contaminated space. CONCLUSION: CPE colonization rates in patients exposed to CPE in LTCFs were higher than those found in acute care hospitals. Proper infection control measures for detecting and reducing CPE colonization in patients residing in LTCFs are required. Newly admitted patients could also be carriers; therefore, infection control for newly admitted patients also needs to be thorough.

Colistin monotherapy versus colistin-based combination therapy for treatment of bacteremia in burn patients due to carbapenem-resistant gram negative bacteria.

Carbapenem-resistant gram negative pathogen (CR-GNP) infection in burn patients is a growing concern since treatment options are limited and resistance to the main line of treatment, colistin, is increasing. The goal of this study was to compare treatment outcomes of colistin monotherapy versus colistin-based combination therapy for CR-GNP bacteremia in burn patients. A retrospective observational study was conducted between 2014 and 2017 in Hangang Sacred Heart Hospital located in Seoul, South Korea. Among the burn patients admitted to the burn intensive care unit with CR-GNP bacteremia due to wound infections, colistin monotherapy or colistin-based combination therapy were investigated. We determined both eradication rate within seven days as well as mortality rate within 30 days. A total of 84 burn patients with CR-GNP bacteremia were analyzed-32 were treated with colistin monotherapy and 52 with colistin-based combination therapy. We found that eradication rate within 7 days and 30-day mortality rate were not significantly different between the two groups (71.9% versus 75.0%, P = 0.752 and 31.2% versus 38.5%, P = 0.503). In the Cox regression analysis, Charlson's comorbidity index, renal replacement therapy before colistin use, and duration of antibiotics were associated with 30-day mortality (HR, 1.23; 95% CI, 1.02-1.49; P = 0.030, HR, 2.28; 95% CI, 1.05-4.94; P = 0.037 and HR, 0.94; 95% CI, 0.89-0.99, P = 0.042, respectively). Colistin-based combination therapy did not show significant differences with regard to microbiologic and clinical outcomes compared with colistin monotherapy.

Changes in the prevalence of causative pathogens isolated from severe burn patients from 2012 to 2017.

Infection is the leading cause of mortality in severe burn patients, benefitting from periodic monitoring of changes in bacterial prevalence and antibiotic resistance trends. This single facility retrospective study evaluated blood culture results for patients hospitalized in the burn intensive care unit (BICU) from January 2012 to December 2017. A total of 969 samples from 420 patients were reviewed. Isolated pathogens were recorded by year and the number of days of hospitalization. Results showed that Acinetobacter baumanni was the most predominant isolated pathogen, followed closely by Pseudomonas aeruginosa, Klebsiella spp., and Enterococcus spp. Throughout this 6-year study, several significant trends were noted; Klebsiella species increased, while P. aeruginosa decreased. Staphylococcus aureus and Klebsiella species gradually increased, and P. aeruginosa doubled as the length of hospital stay increased to 22 days. Interestingly, as the length of the hospital stay increased, the proportion of Carbapenem-resistant Enterobacteriaceae (CRE) significantly increased up to 45.0% at 22 days (P=0.003). Conversely, the proportion of Acinetobacter baumannii gradually decreased as the days hospitalized increased. Overall, the rate of multidrug-resistant (MDR) bacteremia found in burn patients was substantially higher than that in other patients and appeared from the earliest phase of hospitalization. Therefore, early use of antibiotics targeting MDR Gram-negative bacteria in burn patients admitted to the BICU might be warranted. Further, since CRE infections increase in abundance over time, significant effort should be made to manage the initial CRE infections of burn patients before they can multiply into a life-threatening situation.

A phase II study of capecitabine and oral leucovorin as a third-line chemotherapy in patients with metastatic colorectal cancer.

PURPOSE: This study was conducted to evaluate the efficacy and safety of the combination of capecitabine and oral leucovorin (LV) as a third-line chemotherapy for patients with metastatic colorectal cancer (CRC) showing resistance to irinotecan- and oxaliplatin-containing regimens. METHOD: Patients who showed disease progression while receiving or within 6 months of discontinuing irinotecan- and oxaliplatin-containing regimens received capecitabine 825 mg/m(2) in combination with oral LV at a fixed dose of 30 mg, twice a day for 2 weeks followed by a 1-week rest. RESULTS: Twenty-five patients were enrolled from July 2011 to June 2014. Three patients achieved PR, and 11 showed SD. The overall response rate was 12 %, and disease control rate was 56 %. With a median follow-up of 6.8 months, the median time to progression was 2.8 months and the median overall survival was 7.1 months. The most common non-hematologic toxicity was hand-foot syndrome (40 %), followed by mucositis (28 %) and diarrhea (12 %). Grade 3 hand-foot syndrome occurred in two patients (8 %), and grade 3 mucositis in one. Hematologic toxicities were mild, and only one patient developed grade 3 thrombocytopenia. CONCLUSION: The combination of capecitabine and oral LV showed a modest activity and tolerable toxicity profile in metastatic CRC patients pretreated with irinotecan- and oxaliplatin-containing regimens. Oral LV seems to be able to reduce the usual dose of capecitabine when the two drugs are combined.

A case of a patient with Takayasu arteritis treated with left subclavian artery stent implantation.

Takayasu arteritis is an uncommon chronic inflammatory arteritis affecting large vessels, predominantly the aorta and its main branches. This disease, primarily known to be frequent in Asia and Latin America region, occurs mainly in young people between the ages of 15 and 25 years, with a male to female ratio of 1:9. Here, we report a young Asian female patient with Takayasu arteritis affecting multiple arteries and treated with percutaneous transluminal angioplasty. .

Bispectral index monitoring to assess the level of consciousness in patients with brain injury.

BACKGROUND: It is important to assess the level of consciousness in patients with brain injuries to determine modes of treatment and prognosis. We evaluated the Bispectral Index (BIS) to determine if it could be used as an objective tool for evaluation of the level of consciousness in brain-injured patients. We also compared the BIS values to clinical sedation scales such as the Glasgow Coma Scale (GCS), Richmond Agitation-Sedation Scale (RASS), and the Reaction Level Scale (RLS). METHODS: Thirty eight patients with brain injuries that were admitted to the neurosurgery intensive care unit (NSICU) were enrolled in this study. An investigator evaluated the clinical sedation scales (GCS, RASS, RLS), while a blind observer noted the BIS in the same patient. The BIS score was obtained three times at an interval of 5 hours. The BISs were measured for 1 minute at 5 min prior to the nursing assessment, during the nursing assessment, and at 5 min after the nursing assessment. The BISs used in the data analysis were the maximal, minimal, and mean values obtained during 1 min, which were defined as BISmax, BISmin, and BISmean. A Spearman's rank correlation coefficient was used to determine if the clinical sedation scales were correlated with the BIS scores. RESULTS: In 38 patients, the BISmax, BISmin, and BISmean were found to be significantly correlated with the GCS, RASS, and RLS. The BISmean had the highest correlation with GCS (r = 0.445, P < 0.01), while the BIS min had the lowest correlation with RLS (r = -0.278, P < 0.01). CONCLUSIONS: The results of BIS monitoring were found to be significantly correlated with sedation scales in patients with brain injuries. These findings suggest that BIS can be used as an objective and continuous method for assessment of the level of consciousness in patients with brain injury.