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1.
Environ Sci Pollut Res Int ; 31(11): 16865-16883, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38324151

RESUMO

Small and medium-sized businesses (SMEs) increasingly know the benefits of improving resource efficiency and closing loops. These benefits include lowering material costs, establishing competitive advantages, and gaining access to new markets. As a consequence of implementing new regulations, manufacturing companies, particularly those in the automobile industry, are compelled to modify and change their business practices related to the circular economy (CE). More stringent the implementation of environmentally responsible policies and strengthening environmental regulations. CE is the most important factor in improving environmental conditions since it reduces waste and boosts output. This facet calls for the attention of fresh academics and policymakers with years of relevant expertise. Recent studies have investigated how green logistics management might improve a company's overall performance in terms of environmental responsibility. However, we believe that the connection between environmentally responsible companies is not a direct one but rather one that is mediated by the practices of circular economies. We investigate the direct and indirect effects of the environmentally responsible impact of proper logistics management on organizations' overall environmental performance via the application of circular economy practices. Our theoretical underpinnings are the resource-based viewpoint and the resource dependence theory. This research also investigates whether or not the traceability of the supply chain has a mitigating influence on the connections. We evaluated the hypotheses using the PLS-SEM method, drawing on the empirical data provided by 245 Chinese factories considered modest or medium size. The results demonstrate that the management of green logistics has a constructive effect on circular economy practices and businesses' sustainability performance. In addition, although it greatly impacts circular economy practice among SMEs, supply chain traceability does not attenuate the connection between eco-friendly supply chain management and environmental impact. Green logistics management in SMEs is linked to improved sustainability performance via the circular economy practice. To further verify the efficacy of the mediation, we also ran the sober test. Our results strengthen knowledge of circular economy, environmentally friendly logistics management practices, and sustainability performance while advancing natural resource-based planning and the resource dependence theory, which are the two approaches. Given the scarcity of information research analyzing the interplay between these factors, our results are very significant.


Assuntos
Comércio , Indústrias , Meio Ambiente , Empresa de Pequeno Porte , Organizações
2.
Org Lett ; 25(50): 9030-9035, 2023 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-38019556

RESUMO

Herein, a base metal-enabled chemodivergent cyclization of propargylamines for the atom-economic construction of nitrogen heterocycles has been developed. Due to the different modes of activation of metal to propargylamine, copper-catalyzed 6-endo-dig cyclization generates functionalized 2-substitued quinoline-4-carboxylates, while iron-promoted cascade amino Claisen rearrangement, aromatization, and aza-Michael addition afford diverse 2-substituted indole-3-carboxylate derivatives. Excellent selectivity, broad functional group tolerance, mild conditions, and flexible late-stage functionalization illustrate the high efficiency and synthetic utility of this chemodivergent reaction.

3.
J Manag Care Spec Pharm ; 29(10): 1119-1128, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37776119

RESUMO

BACKGROUND: Chronic migraine (CM) is a common neurologic disorder that imposes substantial burden on payers, patients, and society. Low rates of persistence to oral migraine preventive medications have been previously documented; however, less is known about persistence and costs associated with innovative nonoral migraine preventive medications. OBJECTIVE: To evaluate real-world persistence and costs among adults with CM treated with onabotulinumtoxinA (onabotA) or calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs). METHODS: This was a retrospective, longitudinal, observational study analyzing the IBM MarketScan Commercial and Medicare databases. The study sample included adults with CM initiating treatment with either onabotA or a CGRP mAb on or after January 1, 2018. Persistence and costs over 12 months after treatment initiation were evaluated using chi-square and Student's t-tests. Persistence to onabotA was compared with CGRP mAbs as a weighted average of the class and by individual CGRP mAbs. Mean pharmacy (acute and preventive), medical (inpatient, emergency department, and outpatient), and total costs are reported. Multivariate regression analyses were conducted to generate adjusted estimates of persistence and costs after controlling for potential confounders (age, sex, region, insurance type, number of baseline comorbidities, Charlson Comorbidity Index, and number of previously used oral migraine preventive medications). RESULTS: Of 66,303 individuals with onabotA or CGRP mAb claims, 2,697 with CM met the inclusion/exclusion criteria. In the total population, individuals were primarily female (85.5%), lived in the South (48.5%), and had a mean (SD) age of 44 (12) years, which was consistent across the onabotA and CGRP mAb cohorts. Common comorbid conditions included anxiety (23.9%), depression (18.2%), hypertension (16.5%), and sleep disorders (16.9%). After adjusting for potential confounding variables, persistence to onabotA during the 12-month follow-up period was 40.7% vs 27.8% for CGRP mAbs (odds ratio [OR] = 0.683; 95% CI = 0.604-0.768; P < 0.0001). Persistence to erenumab, fremanezumab, and galcanezumab was 25.5% (OR = 0.627; 95% CI = 0.541-0.722; P < 0.0001), 30.3% (OR = 0.746; 95% CI = 0.598-0.912; P = 0.0033), and 33.7% (OR = 0.828; 95% CI = 0.667-1.006; P = 0.058). All-cause ($18,292 vs $18,275; P = 0.9739) and migraine-related ($8,990 vs $9,341; P = 0.1374) costs were comparable between the onabotA and CGRP mAb groups. CONCLUSIONS: Among adults with CM receiving onabotA and CGRP mAbs, individuals initiating onabotA treatment had higher persistence compared with those receiving CGRP mAbs. Total all-cause and migraine-related costs over 12 months were comparable between those receiving onabotA and CGRP mAbs. DISCLOSURES: This study was sponsored by Allergan (prior to its acquisition by AbbVie), they contributed to the design and interpretation of data and the writing, reviewing, and approval of final version. Writing and editorial assistance was provided to the authors by Dennis Stancavish, MS, of Peloton Advantage, LLC, an OPEN Health company, Parsippany, NJ, and was funded by AbbVie. The opinions expressed in this article are those of the authors. The authors received no honorarium/fee or other form of financial support related to the development of this article. Dr Schwedt serves on the Board of Directors for the American Headache Society and the American Migraine Foundation. Within the prior 12 months he has received research support from Amgen, Henry Jackson Foundation, Mayo Clinic, National Institutes of Health, Patient-Centered Outcomes Research Institute, SPARK Neuro, and US Department of Defense. Within the past 12 months, he has received personal compensation for serving as a consultant or advisory board member for AbbVie, Allergan, Axsome, BioDelivery Science, Biohaven, Collegium, Eli Lilly, Ipsen, Linpharma, Lundbeck, and Satsuma. He holds stock options in Aural Analytics and Nocira. He has received royalties from UpToDate. Dr Lee and Ms Shah are employees of AbbVie and may hold AbbVie stock. Dr Gillard was an employee of AbbVie and may hold AbbVie stock. Dr Knievel has served as a consultant for AbbVie, Amgen, Eli Lilly, and Biohaven; conducted research for AbbVie, Amgen, and Eli Lilly; and is on speaker programs for AbbVie and Amgen. Dr McVige has served as a speaker and/or received research support from Allergan (now AbbVie Inc.), Alder, Amgen/Novartis, Avanir, Biohaven, Eli Lilly, Lundbeck, and Teva. Ms Wang and Ms Wu are employees of Genesis Research, which provides consulting services to AbbVie. Dr Blumenfeld, within the past 12 months, has served on advisory boards for Allergan, AbbVie, Aeon, Alder, Amgen, Axsome, BDSI, Biohaven, Impel, Lundbeck, Lilly, Novartis, Revance, Teva, Theranica, and Zosano; as a speaker for Allergan, AbbVie, Amgen, BDSI, Biohaven, Lundbeck, Lilly, and Teva; as a consultant for Allergan, AbbVie, Alder, Amgen, Biohaven, Lilly, Lundbeck, Novartis, Teva, and Theranica; and as a contributing author for Allergan, AbbVie, Amgen, Biohaven, Novartis, Lilly, and Teva. He has received grant support from AbbVie and Amgen. AbbVie is committed to responsible data sharing regarding the clinical trials we sponsor. This includes access to anonymized, individual, and trial-level data (analysis data sets), as well as other information (eg, protocols, clinical study reports, or analysis plans), as long as the trials are not part of an ongoing or planned regulatory submission. This includes requests for clinical trial data for unlicensed products and indications. These clinical trial data can be requested by any qualified researchers who engage in rigorous, independent scientific research, and will be provided following review and approval of a research proposal and Statistical Analysis Plan and execution of a Data Sharing Agreement. Data requests can be submitted at any time after approval in the United States and Europe and after acceptance of this manuscript for publication. The data will be accessible for 12 months, with possible extensions considered. For more information on the process, or to submit a request, visit the following link: https://www.abbvieclinicaltrials.com/hcp/data-sharing/.


Assuntos
Toxinas Botulínicas Tipo A , Transtornos de Enxaqueca , Masculino , Adulto , Humanos , Feminino , Idoso , Estados Unidos , Peptídeo Relacionado com Gene de Calcitonina , Estudos Retrospectivos , Medicare , Transtornos de Enxaqueca/tratamento farmacológico , Custos de Cuidados de Saúde
4.
J Glob Health ; 13: 04108, 2023 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-37766638

RESUMO

Background: The rising incidence of thyroid cancer (TC) has generated growing concern globally; yet there are no studies examining whether this incidence was followed by a rise in related mortality. We aimed to comprehensively quantify current trends and future projections of TC incidence and mortality, and to explore the association between the TC burden and socioeconomic inequality in different income strata. Methods: We obtained incidence and mortality data on TC and population from the 2019 Global Burden of Disease (GBD) study and the United Nations' World Population Prospects 2022. We applied an age-period-cohort (APC) model to estimate the overall annual percentage change (net drift) and age, period, and cohort effects from 1990 to 2019, and also constructed a Bayesian APC model to predict the TC burden through 2030. Results: Over a third of global TC cases belonged to the high-income group. From 1990 to 2019, net drifts of TC incidence were >0 in all income groups, while a modest reduction (net drift <0) in mortality was observed in most income groups, except for the lower-middle-income group. Unfavourable age, period, and cohort effects were most notable in Vietnam, China, and Korea. The age-standardised incidence rate (ASIR) is predicted to increase whereas the age-standardized mortality rate (ASMR) is expected to decrease globally between 2020 and 2030, with geographic heterogeneity being detected across income groups. We observed a positive correlation between ASIR and universal health coverage index and health worker density, but a negative one between ASMR and the two indicators, primarily in upper-middle-income and high-income countries. Conclusions: Opposite patterns in incidence and mortality of TC raise concerns about overdiagnosis, particularly in upper-middle-income and high-income countries. Discrepancies in the distribution of health service accessibility, including diagnostic techniques and therapeutic care, should be addressed by narrowing health inequalities in the TC burden across countries.


Assuntos
Neoplasias da Glândula Tireoide , Humanos , Incidência , Teorema de Bayes , Neoplasias da Glândula Tireoide/epidemiologia , China , Carga Global da Doença
5.
Heliyon ; 9(7): e17648, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37539296

RESUMO

The 'Ten-year Ban on Fishing' policy was designed by the Chinese government to protect the biodiversity of the Yangtze River basin. Fishermen are the ultimate implementers of the fishing ban policy. Therefore, a scientific compensation mechanism for fishers to stop fishing is the basis for ensuring the continuous implementation of the policy. First, we conducted a survey with 309 fishermen in eight cities along the Yangtze River in Jiangsu province. We also analyzed living conditions of fishermen before and after quitting fishing based on descriptive statistical analysis. Based on the theory of sustainable livelihood, a binary logistic regression model was used to analyze the relationship between fishermen's willingness to quit fishing and five types of livelihood capital (natural, material, human, financial, and social capital). The results showed that fishermen face severe livelihood sustainability issues after ceasing to fish and that their willingness to quit is closely related to the five types of livelihood capital. Based on this, and according to different age groups, this study constructed a compensation mechanism for retired fishermen from two aspects: monetary and social security compensation. The research results can provide a theoretical framework for other provinces in the Yangtze River basin to formulate a compensation system for fishermen.

6.
PLoS One ; 18(3): e0281920, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36897861

RESUMO

Whether the implementation of the water resources tax policy can stimulate the water-saving behavior of social water users is one of the important criteria for evaluating the implementation effect of the tax reform policy. Taking Hebei Province, the first tax reform pilot in China, as an example. A dynamic stochastic general equilibrium model (DSGE) with embedded water resources tax is constructed to simulate the persistent impact of water resources tax on water-saving objectives. The research shows that: (1) Water resources tax can effectively achieve the goal of water-saving and improve the utilization efficiency of water resources. (2) Levying water resources tax helps to improve the water-saving awareness of enterprises and residents. It can also encourage enterprises to optimize production structures. (3) Rational and efficient use of special water resources protection funds is the basis for ensuring the effective implementation of water resources tax. It can also improve the recycling capacity of water resources. The results show that the government should speed up formulating a reasonable water resources tax rate and accelerate the construction of water resources tax protection measures. To ensure the relatively steady state of water resources utilization and protection, and achieve the dual goals of sustainable economic development and sustainable use of water resources. The research results of this paper reveal the internal logic of the comprehensive impact of water resources tax on the economy and society and provide an important basis for the national promotion of tax reform policy.


Assuntos
Recursos Hídricos , Água , Impostos , China , Políticas , Conservação dos Recursos Naturais
7.
Environ Sci Pollut Res Int ; 30(16): 46711-46726, 2023 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-36723842

RESUMO

China faces tough challenges in the process of low-carbon transformation. To determine whether China can achieve its new 2030 carbon peaking and carbon intensity reduction commitments, accurate prediction of China's CO2 emissions is vital. In this paper, the random forest (RF) model was used to screen 26 carbon emission influencing factors, and seven indicators were selected as key variables for prediction. Subsequently, a three-layer back propagation (BP) neural network was constructed to forecast China's CO2 emissions and intensity from 2020 to 2040 under the 13th Five-Year Plan, 14th Five-Year Plan, energy optimization, technology breakthrough, and dual control scenarios. The results showed that energy structure factors have the most significant impact on China's CO2 emissions, followed by technology level, and economic development factors are no longer the main drivers. Under the 14th Five-Year Plan scenario, China can achieve its carbon peaking on time, reaching 10,434.082 Mt CO2 emissions in 2030. Although the new commitment to intensity reduction (over 65%) under this scenario cannot be achieved, the 14th Five-Year Plan can bring about 73.359 and 539.710 Mt of CO2 reduction in 2030 and 2040 respectively, compared to the 13th Five-Year Plan. Under the technology breakthrough and dual control scenarios, China will meet its new commitments ahead of schedule, with the dual control scenario being the optimal pathway for CO2 emissions to peak at 9860.08 Mt in 2025. It is necessary for Chinese policy makers to adjust their current strategic planning, such as accelerating the transformation of energy structure and increasing investment in R&D to achieve breakthroughs in green technologies.


Assuntos
Dióxido de Carbono , Carbono , Dióxido de Carbono/análise , Carbono/análise , Algoritmo Florestas Aleatórias , Redes Neurais de Computação , China , Desenvolvimento Econômico
8.
IEEE Trans Cybern ; 53(10): 6577-6587, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36215350

RESUMO

This work deals with the dynamic-memory event-triggered-based load frequency control issue for interconnected multiarea power systems (IMAPSs) associated with random abrupt variations and deception attacks. To facilitate the transient faults, a semi-Markov process is addressed to model the dynamic behavior of IMAPSs. In order to modulate transmission frequency, a novel area-dependent dynamic-memory event-triggered protocol (DMETP) is scheduled by resorting to a set of the historically released packets (HRPs), which ensures better dynamic performance. From the viewpoint of the defender, the randomly occurring deception attack is taken into account, which is regulated by a Bernoulli-distributed scalar. Benefitting from the DMETP scheduling, a novel framework of the memory-based asynchronous control strategy is formulated, in which the hidden semi-Markov model is adopted to reveal the mode mismatches. Based on the Lyapunov theory, sufficient conditions are established to ensure the stochastic stability of the resulting systems. In the end, the simulation result is presented to reveal the efficiency of the proposed dynamic-memory event-triggered-based approach.

9.
IEEE Trans Cybern ; 53(1): 151-160, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34236989

RESUMO

This article considers the security-based passivity problem for a class of discrete-time Markov jump systems in the presence of deception attacks, where the deception attacks aim to change the transmitted signal. Considering the impact of deception attacks on network disruption, it causes the existence of time-varying delays in signal transmission inevitably, which makes the controlled system and the controller work asynchronously. The asynchronous control method is employed to overcome the nonsynchronous phenomenon between the system mode and controller mode. On the other hand, to reduce the frequency of data transmission, a resilient asynchronous event-triggered control scheme taking deception attacks into account is designed to save communication resources, and the proposed controller can cover some existing ones as special examples. Moreover, different triggering conditions corresponding to different jumping modes are developed to decide whether state signals should be transferred. A new stability criterion is derived to ensure the passivity of the resultant system although there exist deception attacks. Finally, a simulation example is given to verify the theoretical analysis.

10.
IEEE Trans Cybern ; 53(11): 7095-7104, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35767506

RESUMO

In this article, we address the asynchronous H∞ control problem of a class of hidden Markov jump systems (HMJSs) subject to actuator saturation in the continuous-time domain. A bunch of convex hulls is utilized to represent the saturated nonlinearity. Considering that there is an asynchronous mode mismatch between the system and the controller, we establish a hidden Markov model (HMM) to simulate the situation. By means of the Lyapunov theory, sufficient conditions are presented to ensure that the resultant closed-loop HMJS is stochastically mean square stable within the domain of attraction with a prescribed H∞ performance index. Furthermore, the state feedback gain matrix and the estimation of the domain of attraction are given by solving an optimization problem, which is constructed via linear matrix inequality (LMI) techniques. Finally, the reliability and validity of the derived results are examined by a numerical example.

11.
IEEE Trans Cybern ; 53(11): 7342-7352, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36331644

RESUMO

This study focused on the asynchronous event-triggered output-feedback controller design problem for discrete-time singular Markov jump systems (MJSs). A hidden Markov model (HMM) was employed to estimate the system mode, which cannot always be ideally detected in practice. Because the full state is also difficult to obtain in practical scenarios, an output-feedback control scheme was used. In addition, an HMM-based event-triggered mechanism was also employed in the design of the controller to reduce the communication burden of the networked system. Sufficient conditions for the stochastic admissibility of a closed-loop singular MJS with a prescribed H∞ performance index were established using the Lyapunov functional technique. Finally, design procedures for an asynchronous event-triggered controller were summarized as a linear-matrix-inequality-based optimization algorithm. Two examples were considered to verify the effectiveness of the asynchronous event-triggered output-feedback controller design method.

12.
Transpl Int ; 35: 10422, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35692736

RESUMO

Relationships between renal function and medical costs for deceased donor kidney transplant recipients are not fully quantified post-transplant. We describe these relationships with renal function measured by estimated glomerular filtration rate (eGFR) and graft failure. The United States Renal Data System identified adults receiving single-organ deceased donor kidneys 2012-2015. Inpatient, outpatient, other facility costs and eGFRs at discharge, 6 and 12 months were included. A time-history of costs was constructed for graft failures and monthly costs in the first year post-transplant were compared to those without failure. The cohort of 24,021 deceased donor recipients had a 2.4% graft failure rate in the first year. Total medical costs exhibit strong trends with eGFR. Recipients with 6-month eGFRs of 30-59 ml/min/1.73m2 have total costs 48% lower than those <30 ml/min/1.73m2. For recipients with graft failure monthly costs begin to rise 3-4 months prior to failure, with incremental costs of over $38,000 during the month of failure. Mean annual total incremental costs of graft failure are over $150,000. Total costs post-transplant are strongly correlated with eGFR. Graft failure in the first year is an expensive, months-long process. Further reductions in early graft failures could yield significant human and economic benefits.


Assuntos
Transplante de Rim , Adulto , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Rim/fisiologia , Rim/cirurgia , Doadores de Tecidos , Estados Unidos
13.
BMC Geriatr ; 22(1): 484, 2022 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-35658904

RESUMO

BACKGROUND: Falls are the leading cause of injury-related death among older Americans. While some research has found that insomnia heightens falls, health care resource utilization (HCRU) and costs, the impact of insomnia treatments on fall risk, mortality, HCRU and costs in the elderly population, which could be of substantial interest to payers, has not been fully elucidated. This study evaluated the risk of falls and related consequences among adults ≥ 65 years of age treated with common prescription medications for insomnia compared with non-sleep disordered controls. METHODS: This was a retrospective cohort analysis of deidentified Medicare claims from January 2011 through December 2017. Medicare beneficiaries treated for insomnia receiving zolpidem extended-release, zolpidem immediate-release, trazodone, or benzodiazepines were matched with non-sleep disordered controls. The main outcomes were falls, mortality, healthcare resource utilization (HCRU), and medical costs during the 12 months following the earliest fill date for the insomnia medication of interest. Generalized linear models controlled for several key covariates, including age, race, sex, geographic region and Charlson Comorbidity Index score. RESULTS: The study included 1,699,913 Medicare beneficiaries (59.9% female, mean age 75 years). Relative to controls, adjusted analyses showed that beneficiaries receiving insomnia medication experienced over twice as many falls (odds ratio [OR] = 2.34, 95% CI: 2.31-2.36). In adjusted analyses, patients receiving benzodiazepines or trazodone had the greatest risk. Crude all-cause mortality rates were 15-times as high for the insomnia-treated as controls. Compared with controls, beneficiaries receiving insomnia treatment demonstrated higher estimated adjusted mean number of inpatient, outpatient, and emergency department visits and longer length of inpatient stay. All-cause total adjusted mean costs were higher among insomnia treated patients ($967 vs $454). CONCLUSIONS: Individuals receiving insomnia treatment had an increased risk of falls and mortality and higher HCRU and costs compared with matched beneficiaries without sleep disorders. Trazodone and benzodiazepines were associated with the greatest risk of falls. This analysis suggests that significant risks are associated with common, older generation insomnia medication treatments in the elderly. Nonetheless, these results should be interpreted with caution as the use of these medications may be indicative of underlying morbidity with potential for residual confounding.


Assuntos
Distúrbios do Início e da Manutenção do Sono , Trazodona , Acidentes por Quedas , Idoso , Benzodiazepinas/uso terapêutico , Atenção à Saúde , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Medicare , Estudos Retrospectivos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Trazodona/efeitos adversos , Estados Unidos/epidemiologia , Zolpidem/efeitos adversos
14.
J Healthc Eng ; 2022: 1463826, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35047148

RESUMO

A pressure injury is a common and painful health condition, particularly among people who are elderly or surgical patients. In order to explore how to use the information management system to optimize the pressure injury management process of surgical patients, this work establishes an integrated pressure injury management information platform for surgical patients, which can effectively control the key links in the process and realize the multistep full-process monitoring of surgical patients from admission to discharge. A total of 578 patients before the operation of the information platform were selected as the control group (CG), and after the operation of the information platform, 662 cases became the observation group (OG). Various evaluation metrics are employed to evaluate pressure injury in terms of single-pass rate, high-risk pressure injury, transfer skin condition description matching rate, hospital pressure injury incidence, and incidence of pressure injury in surgical patients at various stages. The results showed that the qualified rate of the pressure injury assessment in the OG was 99.2%, the accuracy rate of high-risk pressure injury screening and reporting was 100.0%, and the matching rate of the transfer skin description was 100.0%, which was higher than that of the CG. The integrated pressure injury management information platform for surgical patients based on the information management system realizes the full, continuous, accurate, and dynamic evaluation and monitoring of patients' skin. Furthermore, it can effectively improve the quality of pressure injury care and facilitate care management.


Assuntos
Gestão da Informação , Salas Cirúrgicas , Úlcera por Pressão , Idoso , Humanos , Incidência , Úlcera por Pressão/prevenção & controle , Úlcera por Pressão/terapia
15.
J Pharm Sci ; 111(6): 1833-1842, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35090867

RESUMO

PURPOSE: This study aimed to develop a population pharmacokinetic (PPK) model for meropenem to optimize dosing regimens for critically ill patients with pulmonary infection. PATIENTS AND METHODS: This prospective PPK study of meropenem was conducted on a pooled dataset of 236 blood samples obtained from 48 patients with pulmonary infection in the intensive care unit. Meropenem plasma concentrations were measured by a validated high-performance liquid chromatography-tandem mass spectrometry method, and the data were analyzed using NONMEM. The effect of covariates on meropenem pharmacokinetics was investigated. The probability of target attainment (PTA) to achieve the target of 100% fT>MIC at the proposed dosage regimens were investigated by Monte Carlo simulations. RESULTS: A two-compartment model adequately described the data with estimated glomerular filtration rate (eGFR) as a covariate significantly associated with the clearance (CL) from the central compartment. The typical value of CL was 7.48 L/h, with an eGFR adjustment factor of 0.0103 mL•1.73 m2/min, and the typical values of volume of the central compartment (V1), peripheral compartmental clearance (Q), and volume of the peripheral compartment (V2) were 15.9 L, 15.8 L/h, and 14.8 L, respectively. The goodness-of-fit plots, normalized prediction distribution error, and visual predictive checks showed good fitting and predictability of the final PPK model. When eGFR was >90 mL/min/1.73 m2, and there was a short duration of infusion (<60min), it was difficult for the probability target attainment (PTA) to reach >90% for MIC ≥ 2. Continuous infusion and frequent administration were necessary to achieve the target of 100% fT>MIC for critically ill patients with pulmonary infection. CONCLUSION: To achieve the optimal PTA, meropenem must be administered by frequent administration or continuously by an intravenous infusion. Our findings provide important information to optimize the meropenem regime in critically ill patients with pulmonary infection depending on eGFR values.


Assuntos
Antibacterianos , Estado Terminal , Humanos , Infusões Intravenosas , Meropeném/farmacocinética , Testes de Sensibilidade Microbiana , Método de Monte Carlo , Estudos Prospectivos
16.
IEEE Trans Cybern ; 52(9): 9219-9229, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33606651

RESUMO

This article analyzes the problem of the sliding-mode control (SMC) design for discrete-time piecewise nonhomogeneous Markov jump nonlinear systems (MJNSs) subject to an external disturbance with time-varying transition probabilities (TPs). A discrete-time asynchronous integral sliding surface is constructed, which yields matched-nonlinearity-free sliding-mode dynamics (SMDs). Then, by using the mode-dependent Lyapunov function technique, a sufficient condition is established for ensuring the stochastic stability of SMD with extended dissipation. The solution to designing controller gains is obtained. Moreover, an SMC law and an adaptive law are, respectively, derived for driving the system trajectories to move into a predetermined sliding-mode region with specified precision. Finally, the feasibility and effectiveness of the new design are verified and demonstrated by a simulation example.

17.
IEEE Trans Cybern ; 52(12): 13063-13072, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34464281

RESUMO

This article is concerned with the problem of guaranteed cost control for 2-D Markov jump Roesser systems with mismatched modes. The hidden Markov model is introduced to describe the asynchronous phenomenon caused by mismatched modes, and an asynchronous linear state-feedback control law is designed based on this model. With the help of the 2-D Lyapunov function and linear matrix inequality (LMI) techniques, sufficient conditions are established to ensure the asymptotic stability of the concerned system with a bound of the predefined guaranteed cost under three different boundary conditions, respectively. Finally, an algorithm that concludes the design processes of the optimal asynchronous guaranteed cost control law is proposed, and a numerical example is provided to verify its effectiveness.

18.
IEEE Trans Cybern ; 52(9): 9882-9892, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34554922

RESUMO

This article investigates the cooperative output regulation problem for discrete-time heterogeneous multiagent Markov jump systems. Two cases are studied: 1) output regulation quadratic control in the case where the exosystem is accessible to all agents and 2) cooperative output regulation quadratic control in the case where only a part of agents can directly communicate with the exosystem. The hidden Markov models are employed to describe the asynchronous modes of the agents and their corresponding controllers. Via the jumping regulator equation, asynchronous control laws are constructed and the algorithms to obtain control parameters are presented in terms of linear matrix inequalities. For the first case, the optimal synchronous/mode-dependent control law, which is a special case of the asynchronous control protocol, is also given via the stochastic dynamic programming approach. Finally, an example is given to illustrate the effectiveness of the proposed approaches.

19.
IEEE Trans Cybern ; 52(10): 10177-10186, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33878001

RESUMO

Mode information is of great significance when investigating the Markov jump systems (MJSs). However, it is common in practical scenarios that the mode information is not completely accessible, which probably induces nonsynchronization problems. Taking this into consideration, in this article, we study nonsynchronous H∞ model order reduction for 2-D MJSs with model uncertainty. The considered 2-D system and reduced-order model are characterized by the Roesser model. The nonsynchronization phenomenon between the original system and the reduced-order model is dealt with under the framework of the hidden Markov model. By appropriately selecting the Lyapunov function, the asymptotic mean-square stability and the H∞ performance of the error system are analyzed, and sufficient conditions are proposed. Based on this, an efficient design method for nonsynchronous model order reduction is further proposed with the help of a projection lemma. Finally, the correctness and effectiveness of the designed reduced-order model are verified through some simulations.

20.
IEEE Trans Cybern ; 52(4): 2543-2552, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32721908

RESUMO

In this article, asynchronous sliding-mode control (SMC) is investigated for 2-D discrete-time Markov jump systems. As the system modes are not always accessible to the controller, the hidden Markov model is employed to describe the asynchronization between the system modes and controller. A new 2-D sliding surface is constructed and the corresponding asynchronous SMC law is designed under the framework of the hidden Markov model. By Lyapunov function and linear matrix inequality (LMI) approaches, the reachability of system dynamics to the predefined sliding surface is investigated, and sufficient conditions are established to guarantee that the underlying 2-D system is asymptotically mean-square stable (AMSS) with an H∞ disturbance attenuation performance. Then, an algorithm is provided to derive the asynchronous 2D-SMC law. Finally, an example is given to verify the validity and effectiveness of the new SMC law design algorithm.

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