Risk factors and clinical outcomes of carbapenem-resistant Klebsiella pneumoniae bacteraemia in children: a retrospective study.

OBJECTIVES: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is increasingly being identified in children, but data on the clinical outcomes in this population are limited. This study aimed to characterise the risk factors for 30-day mortality with CRKP bloodstream infection (BSI) in children. METHODS: A retrospective study was performed from January 2018 to December 2021 at the First Affiliated Hospital of Zhengzhou University. Patients aged < 18 years and with CRKP BSI were included. Multivariable Cox and logistic regression were performed to determine risk factors for death and the development of septic shock following CRKP infection, respectively. RESULTS: This study identified 33 neonates aged 0-4 weeks and 37 older children. The 30-day mortality rate was 39.4% in neonates and 43.2% in older children. In the neonatal population, a higher Pitt bacteremia score (HR 1.694; 95% CI 1.313-2.186; P < 0.001) was an independent risk factor for 30-day mortality. In the non-neonatal population, higher platelet count (HR 0.990; 95% CI 0.982-0.998; P = 0.010), the use of carbapenems (HR 0.212; 95% CI 0.064-0.702; P = 0.011) and appropriately targeted antimicrobial treatment (HR 0.327; 95% CI 0.111-0.969; P = 0.044) were associated with decreased 30-day mortality. Monocyte count < 0.1 × 109 cells/L (OR 3.615; 95% CI 1.165-11.444; P = 0.026) and a higher Pitt bacteremia score (OR 1.330; 95% CI 1.048-1.688; P = 0.019) were identified as risk factors for the development of septic shock. CONCLUSIONS: Carbapenem-resistant Klebsiella pneumoniae BSI was associated with high mortality in children. Appropriate antimicrobial treatment is important to improve survival, but more work is needed to assess the efficacy of specific treatment regimens in children.

A Novel Feeder Link Handover Strategy for Backhaul in LEO Satellite Networks.

Thanks to their wide coverage and relatively low latency compared to geosynchronous satellites, Low Earth Orbit (LEO) satellite networks have been regarded as one of the most promising solutions to provide global broadband backhaul for mobile users and IoT devices. In LEO satellite networks, the frequent feeder link handover invokes unacceptable communication interruptions and affects the backhaul quality. To overcome this challenge, we propose a maximum backhaul capacity handover strategy for feeder links in LEO satellite networks. To improve the backhaul capacity, we design an available backhaul capacity ratio to jointly consider feeder link quality and the inter-satellite network in handover decisions. In addition, we introduce a service time factor and handover control factor to reduce the handover frequency. Then, we propose the handover utility function based on the designed handover factors and propose a greedy-based handover strategy. Simulation results show that the proposed strategy outperforms conventional handover strategies in backhaul capacity with low handover frequency.

The Impact of Item Difficulty on Judgment of Confidence-A Cross-Level Moderated Mediation Model.

The factors that influence metacognitive judgments often appear in combination, rather than in isolation. The multi-cue utilization model proposes that individuals often make use of multiple cues when making judgments. Previous studies have focused on the integration of intrinsic and extrinsic cues, while the current investigation examines the integration and influence of intrinsic cues and mnemonic cues. Judgment of confidence is a common form of metacognitive judgment. In this study, 37 college students completed Raven's Progressive Matrices and made judgments of confidence. We used the cross-level moderated mediation model to explore the impact of item difficulty on confidence judgments. Our results indicated that item difficulty negatively predicts the level of confidence. Item difficulty has an impact on the confidence evaluation by altering the processing fluency of intermediate variables. The joint effect of intrinsic cue item difficulty and mnemonic cue processing fluency influences confidence judgments. Additionally, we found that intelligence moderates the effect of difficulty on processing fluency across levels. Specifically, individuals with higher intelligence exhibited lower fluency on difficult tasks and higher fluency on simple tasks than individuals with lower intelligence. These findings expand on the multi-cue utilization model and integrate the influence mechanism of intrinsic and mnemonic cues on confidence judgments. Finally, we propose and verify a cross-level moderated mediation model that explains how item difficulty affects confidence judgments.

Monitoring nature's calendar from space: Emerging topics in land surface phenology and associated opportunities for science applications.

Vegetation phenology has been viewed as the nature's calendar and an integrative indicator of plant-climate interactions. The correct representation of vegetation phenology is important for models to accurately simulate the exchange of carbon, water, and energy between the vegetated land surface and the atmosphere. Remote sensing has advanced the monitoring of vegetation phenology by providing spatially and temporally continuous data that together with conventional ground observations offers a unique contribution to our knowledge about the environmental impact on ecosystems as well as the ecological adaptations and feedback to global climate change. Land surface phenology (LSP) is defined as the use of satellites to monitor seasonal dynamics in vegetated land surfaces and to estimate phenological transition dates. LSP, as an interdisciplinary subject among remote sensing, ecology, and biometeorology, has undergone rapid development over the past few decades. Recent advances in sensor technologies, as well as data fusion techniques, have enabled novel phenology retrieval algorithms that refine phenology details at even higher spatiotemporal resolutions, providing new insights into ecosystem dynamics. As such, here we summarize the recent advances in LSP and the associated opportunities for science applications. We focus on the remaining challenges, promising techniques, and emerging topics that together we believe will truly form the very frontier of the global LSP research field.

Boosting the Oxygen Evolution Reaction by Controllably Constructing FeNi3/C Nanorods.

Transition bimetallic alloy-based catalysts are regarded as attractive alternatives for the oxygen evolution reaction (OER), attributed to their competitive economics, high conductivity and intrinsic properties. Herein, we prepared FeNi3/C nanorods with largely improved catalytic OER activity by combining hydrothermal reaction and thermal annealing treatment. The temperature effect on the crystal structure and chemical composition of the FeNi3/C nanorods was revealed, and the enhanced catalytic performance of FeNi3/C with an annealing temperature of 400 °C was confirmed by several electrochemical tests. The outstanding catalytic performance was assigned to the formation of bimetallic alloys/carbon composites. The FeNi3/C nanorods showed an overpotential of 250 mV to afford a current density of 10 mA cm-2 and a Tafel slope of 84.9 mV dec-1, which were both smaller than the other control samples and commercial IrO2 catalysts. The fast kinetics and high catalytic stability were also verified by electrochemical impendence spectroscopy and chronoamperometry for 15 h. This study is favorable for the design and construction of bimetallic alloy-based materials as efficient catalysts for the OER.

Spatiotemporal variations in the incidence of bacillary dysentery and long-term effects associated with meteorological and socioeconomic factors in China from 2013 to 2017.

Bacillary dysentery is a global public health problem that exhibits manifest spatiotemporal heterogeneity. However, long-term variations and regional determinant factors remain unclear. In this study, the Bayesian space-time hierarchy model was used to identify the long-term spatiotemporal heterogeneity of the incidence of bacillary dysentery and quantify the associations of meteorological factors with the incidence of bacillary dysentery in northern and southern China from 2013 to 2017. GeoDetector was used to quantify the determinant powers of socioeconomic factors in the two regions. The results showed that the incidence of bacillary dysentery peaked in summer (June to August), indicating temporal seasonality. Geographically, the hot spots (high-risk areas) were distributed in northwestern China (Xinjiang, Gansu, and Ningxia) and northern China (including Beijing, Tianjin, and Hebei), whereas the cold spots (low-risk areas) were concentrated in southeastern China (Jiangsu, Zhejiang, Fujian, and Guangdong). Moreover, significant regional differences were found among the meteorological and socioeconomic factors. Average temperature was the dominant meteorological factor in both northern and southern China. In northern and southern China, a 1 °C increase in the average temperature led to an increase of 1.01% and 4.26% in bacillary dysentery risk, respectively. The dominant socioeconomic factors in northern and southern China were per capita gross domestic product and the number of health technicians, with q statistic values of 0.81 and 0.49, respectively. These findings suggest that hot, moist, and overcrowded environments or poor health conditions increase the risk of bacillary dysentery. This study provides suggestions and serves as a basis for surveillance efforts. Further, the suggestions may aid in the control of bacillary dysentery and in the implementation of disease prevention policies.

Assessment of varying changes of vegetation and the response to climatic factors using GIMMS NDVI3g on the Tibetan Plateau.

Under the context of global climate change, vegetation on the Tibetan Plateau (TP) has experienced significant changes during the past three decades. In this study, the spatiotemporal changes of growing season vegetation index (GSVI) on the TP were analyzed using various methods from pixel level to ecoregion level. In addition, a relative importance approach was employed to investigate the regulating effect of temperature and precipitation on vegetation. During the period of 1982-2012, vegetation on the TP was generally experiencing a greening trend, but with pronounced fluctuations. The interannual variation of the long-term GSVI was most significant in the Qaidam Basin and southern forest. At ecoregion scale, vegetation in the arid and frigid arid zones showed a browning tendency, with other ecoregions presenting greener trends. Over a large proportion of the TP, there exist change points in the GSVI time series, which were mainly concentered around the year 1996 and 2000. The Hurst exponent identified that a majority (88%) of the vegetation on the plateau would maintain a persistent trend in the future, which would mainly consist of undetermined development and greening trends. TP vegetation during the 1990s experienced more greening than in the 1980s or 2000s according to the interdecadal analysis. The long-term change in growing season vegetation was most positively correlated with the temperature during the same period, followed by the temperature in the preseason and postseason periods. There were more negative relationships of vegetation change with precipitation than with temperature. The relative contribution of the temperature to the vegetation changes exhibited an opposite spatial pattern to that of precipitation. Overall, the findings in this work provide an essential archive of decade-scale vegetation dynamics that may be helpful for projecting the future ecosystem dynamics on the Tibetan Plateau, such as the consistent greening.

Effects of temperature fluctuations on spatial-temporal transmission of hand, foot, and mouth disease.

Hand, foot, and mouth disease (HFMD), predominantly occurs among infants and children. Previous studies have shown that suitable, stable temperatures favor HFMD virus reproduction; however, temperature fluctuations also affect virus transmission, and there are, so far, no studies concerning the association between such fluctuations and the incidence of HFMD. The objective of this study was to map the spatial-temporal distribution of HFMD incidence and quantify the long-term effects of temperature fluctuations on HFMD incidence in children. HFMD cases in children under five, from January 2009 to December 2013, in Beijing, Tianjin, and Hebei provinces of China, were used in this study. The GeoDetector and Bayesian space-time hierarchy models were employed to explore the spatial-temporal association between temperature fluctuations and HFMD incidence. The results indicate that HFMD incidence had significant spatial stratified heterogeneity (GeoDetector q-statistic = 0.83, p < 0.05), and that areas with higher risk mainly appeared in metropolises and their adjacent regions. HFMD transmission was negatively associated with temperature fluctuations. A 1 °C increase in the standard deviation of maximum and minimum temperatures was associated with decreases of 8.22% and 11.87% in the risk of HFMD incidence, respectively. The study suggests that large temperature fluctuations affect virus growth or multiplication, thereby inhibiting the activity of the virus and potentially even leading to its extinction, and consequently affecting the spatial-temporal distribution of HFMD. The findings can serve as a reference for the practical control of this disease and offer help in the rational allocation of medical resources.

Internet of Things to network smart devices for ecosystem monitoring.

Smart, real-time, low-cost, and distributed ecosystem monitoring is essential for understanding and managing rapidly changing ecosystems. However, new techniques in the big data era have rarely been introduced into operational ecosystem monitoring, particularly for fragile ecosystems in remote areas. We introduce the Internet of Things (IoT) techniques to establish a prototype ecosystem monitoring system by developing innovative smart devices and using IoT technologies for ecosystem monitoring in isolated environments. The developed smart devices include four categories: large-scale and nonintrusive instruments to measure evapotranspiration and soil moisture, in situ observing systems for CO2 and δ13C associated with soil respiration, portable and distributed devices for monitoring vegetation variables, and Bi-CMOS cameras and pressure trigger sensors for terrestrial vertebrate monitoring. These new devices outperform conventional devices and are connected to each other via wireless communication networks. The breakthroughs in the ecosystem monitoring IoT include new data loggers and long-distance wireless sensor network technology that supports the rapid transmission of data from devices to wireless networks. The applicability of this ecosystem monitoring IoT is verified in three fragile ecosystems, including a karst rocky desertification area, the National Park for Amur Tigers, and the oasis-desert ecotone in China. By integrating these devices and technologies with an ecosystem monitoring information system, a seamless data acquisition, transmission, processing, and application IoT is created. The establishment of this ecosystem monitoring IoT will serve as a new paradigm for ecosystem monitoring and therefore provide a platform for ecosystem management and decision making in the era of big data.

Photonic generation of linearly chirped microwave waveforms using a monolithic integrated three-section laser.

Photonic generation of linearly chirped microwave waveforms (LCMWs) using a monolithic integrated three-section laser is experimentally demonstrated in this work. All three sections of the laser cavity, including the front DFB section, phase section and rear DFB section, have the same active layer, which can avoid the butt-joint re-growth process. The gratings in both DFB sections are fabricated by the Reconstruction Equivalent Chirp technique, which can significantly decrease the difficulties in realizing precise grating structure. By adjusting the integrated three-section semiconductor laser to work in the period-one (P1) state and applying a sweeping signal to the front DFB section, the beating signal, i.e., an LCMW with a large time bandwidth product (TBWP), can be generated. In the current proof-of-concept experiment, an LCMW with a large TBWP up to 5.159 × 105 is generated, of which the bandwidth and the duration time are 6.7 GHz and 77 us respectively. The compressed pulse width is 150 ps. In addition, by adjusting the bias currents of the rear DFB section and front DFB section as well as the amplitude of the sweeping signals, LCMWs with tunable center frequency and tunable bandwidth can be achieved.

Modulation properties enhancement in a monolithic integrated two-section DFB laser utilizing side-mode injection locking method.

A monolithic optical injection-locked (MOIL) DFB laser with large stable injection locking range is experimentally demonstrated using the side-mode injection locking technique. The low-frequency roll-off in the MOIL DFB laser is suppressed significantly. The relaxation oscillation frequency is measured to be 26.84 GHz and the intrinsic 3-dB response bandwidth is more than 30 GHz, which is about 20 GHz higher than that of the free running DFB laser. The nonlinear distortions, including the 1-dB compression point, second harmonic distortion (2HD) and third-order intermodulation distortion (IMD3), are also suppressed significantly. A simple radio-over-fiber system transmitting 40 Msymbol/s 32-QAM signal with 6 GHz carrier is achieved using the MOIL DFB laser. After 50 km transmission, the average error vector magnitude (EVM) of the whole link is 2.94% in injection locked state, while the EVM in free running DFB laser is 5.25% as a comparison. To our knowledge, this is the first time that the MOIL DFB laser is realized utilizing the side-mode injection locking method.

A conserved unusual posttranscriptional processing mediated by short, direct repeated (SDR) sequences in plants.

In several stress responsive gene loci of monocot cereal crops, we have previously identified an unusual posttranscriptional processing mediated by paired presence of short direct repeated (SDR) sequences at 5' and 3' splicing junctions that are distinct from conventional (U2/U12-type) splicing boundaries. By using the known SDR-containing sequences as probes, 24 plant candidate genes involved in diverse functional pathways from both monocots and dicots that potentially possess SDR-mediated posttranscriptional processing were predicted in the GenBank database. The SDRs-mediated posttranscriptional processing events including cis- and trans-actions were experimentally detected in majority of the predicted candidates. Extensive sequence analysis demonstrates several types of SDR-associated splicing peculiarities including partial exon deletion, exon fragment repetition, exon fragment scrambling and trans-splicing that result in either loss of partial exon or unusual exonic sequence rearrangements within or between RNA molecules. In addition, we show that the paired presence of SDR is necessary but not sufficient in SDR-mediated splicing in transient expression and stable transformation systems. We also show prokaryote is incapable of SDR-mediated premRNA splicing.