Physical activity changes and related factors in chronic heart failure patients during the postdischarge transition period: a longitudinal study.

BACKGROUND: Physical activity (PA) is essential and effective for chronic heart failure (CHF) patients. A greater understanding of the longitudinal change in PA and its influencing factors during the postdischarge transition period may help create interventions for improving PA. The aims of this study were (1) to compare the change in PA, (2) to examine the influencing factors of PA change, and (3) to verify the mediating pathways between influencing factors and PA during the postdischarge transition period in CHF patients. METHODS: A total of 209 CHF patients were recruited using a longitudinal study design. The Chinese version of the International Physical Activity Questionnaire (IPAQ), Patient-reported Outcome Measure for CHF (CHF-PRO), and the Chinese version of the Tampa Scale for Kinesiophobia Heart (TSK-Heart) were used to assess PA, CHF-related symptoms, and kinesiophobia. The IPAQ score was calculated (1) at admission, (2) two weeks after discharge, (3) two months after discharge, and (4) three months after discharge. Two additional questionnaires were collected during admission. Generalized estimating equation (GEE) models were fitted to identify variables associated with PA over time. We followed the STROBE checklist for reporting the study. RESULTS: The PA scores at the four follow-up visits were 1039.50 (346.50-1953.00) (baseline/T1), 630.00 (1.00-1260.00) (T2), 693.00 (1-1323.00) (T3) and 693.00 (160.88-1386.00) (T4). The PA of CHF patients decreased unevenly, with the lowest level occurring two weeks after discharge, and gradually improving at two and three months after discharge. CHF-related symptoms and kinesiophobia were significantly associated with changes in PA over time. Compared with before hospitalization, an increase in CHF-related symptoms at two weeks and two months after discharge was significantly associated with decreased PA. According to our path analysis, CHF-related symptoms were positively and directly associated with kinesiophobia, and kinesiophobia was negatively and directly related to PA. Moreover, CHF-related symptoms are indirectly related to PA through kinesiophobia. CONCLUSION: PA changed during the postdischarge transition period and was associated with CHF-related symptoms and kinesiophobia in CHF patients. Reducing CHF-related symptoms helps improve kinesiophobia in CHF patients. In addition, the reduction in CHF-related symptoms led to an increase in PA through the improvement of kinesiophobia. TRIAL REGISTRATION: The study was registered in the Chinese Clinical Trial Registry (11/10/2022 ChiCTR2200064561 retrospectively registered).

Noma in a boy with septic shock: a case report.

BACKGROUND: Noma is a rare disease, which is characterized by rapid progression and a high rate of mortality; however, relatively few cases of noma infection accompanied by septic shock in children have been described. Further, most health care professionals have no knowledge of this disease or of its clinical significance. CASE PRESENTATION: Herein, we present a case report of a six-year-old male patient who was diagnosed with noma infection at a Chinese pediatric medical intensive care unit (PMICU), at which time, it was discovered that he had septic shock. Following treatment by continuous renal replacement therapy (CRRT) for septic shock arising from noma, the patient was in generally good condition, and the local wound was seen to be essentially healed five weeks post-admission. CONCLUSION: Noma is an opportunistic infectious disease condition. Treatment of the acute phase of noma predominantly focuses on controlling the infection and improving systemic conditions. In addition, CRRT could be considered as a treatment option for cases that present with noma accompanied by septic shock.

The sedation practices of paediatric intensive care unit nurses and the influencing factors in China.

Nurses play a key role in administering sedation to mechanically ventilated children, which impacts children's psychological, physiological and cognitive changes in the paediatric intensive care unit. This study aimed to survey the sedation practices of paediatric intensive care unit nurses on mechanically ventilated children in China and explored the influencing factors. A cross-sectional survey was conducted based on electronic questionnaires comprised of the Nurse Sedation Practices Scale (Chinese version) in 14 different types of paediatric intensive care units of 11 academic hospitals in China from 15 February to 15 April 2017. A convenience sample of 495 nurses [73·4% response rate, (674)] completed the survey. Seven units applied Ramsay Sedation Scale as a sedative assessment tool. The majority of the nurses used observed behaviours and physiological changes of the ventilated children as indicators to assess the sedation level, and they had a positive attitude and intention, which may influence practice positively, whereas high clinical workload and the lack of communication between the nurses and families might hinder practice. The practice of sedation varied greatly in different regions, and the respondents of the northwest region scored lower. Paediatric nurses in China rarely used a validated paediatric instrument to assess sedation, and most nurses relied on physiological and behavioural cues. The quality of sedation training, nursing workload and regional economic disparity affected the sedation practice. The restricted visiting policy and lack of clearly defined nursing responsibilities around sedation may hinder effective sedation assessment and management. This study found that there was no paediatric-validated tool popularized in paediatric intensive care units in China and explored influencing factors. We suggest that a validated tool, high-quality training and hospital's policy, such as visiting regulation, should be promoted to improve the sedation practice.

Core competencies for nurses in Chinese intensive care units: a cross-sectional study.

BACKGROUND: Core competencies of intensive care unit (ICU) nurses were defined as the essential capability to influence patient safety and interdisciplinary collaboration; however, there has been no research conducted that relates to core competencies of ICU nurses at Chinese tertiary-A hospitals in Shanghai. AIMS AND OBJECTIVES: To investigate the current state of core competencies and the factors that influence this key capability in ICU nurses in Chinese tertiary-A hospitals. DESIGN: This was a multicentre, cross-sectional study. METHODS: A convenient sampling method was used to investigate 451 ICU nurses at five tertiary-A hospitals in Shanghai. Data were collected using self-administered questionnaires. RESULTS: The core competencies of ICU nurses were above average, and the scores of seven dimensions, ranked from first to last, were medical ethics, clinical practice, nurse-nurse co-operation, assessment and decision-making, personal and professional development, teaching and research and nurse-physician co-operation. Multivariate linear regression analysis showed that the factors exerting an influence on the core competencies of ICU nurses were title, role incumbent and ICU department. CONCLUSION: This study showed an above-average level of core competencies among ICU nurses in tertiary-A hospitals in Shanghai; however, competencies related to nurse-physician co-operation and the translation of research into practice were underdeveloped. RELEVANCE TO CLINICAL PRACTICE: Nursing managers should implement targeted interventions to improve nurse-physician co-operation and translate research into practice competencies, such as high-fidelity simulation, inter-professional education, scientific research training and innovative skills tutorials. Moreover, this study demonstrated the influencing factors that can be used to improve core competences of ICU nurses.

Psychometric analysis of subjective sedation scales used for critically ill paediatric patients.

AIMS: This study evaluated the psychometric properties of subjective sedation scales using one psychometric scoring system to identify the appropriate scale that is most suitable for clinical care practice. BACKGROUND: A number of published sedation assessment scales for paediatric patients are currently used to attempt to achieve a moderate depth of sedation to avoid the undesirable effects caused by over- or undersedation. However, there has been no systematic review of these scales. SEARCH STRATEGY: We searched the Cochrane Library, PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, etc., to obtain relevant articles. The quality of the selected studies was evaluated according to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. INCLUSION CRITERIA: Articles that had been published or were in press and discussed the psychometric properties of sedation scales were included. The population comprised critically ill infants and non-verbal children ranging in age from 0 to 18 years who underwent sedation in an intensive care unit. FINDINGS: Data were independently extracted by two investigators using a standard data extraction checklist: 43 articles were included in this review, and 13 sedation scales were examined. The quality of the psychometric evidence for the Comfort Scale and Comfort Behaviour Scale was 'very good', with the Comfort Scale having a higher quality (total weighted scores, Comfort Scale = 17·3 and Comfort Behaviour Scale = 15·5). CONCLUSIONS: We suggest that the scales be systematically and comprehensively tested in terms of development method, reliability, validation, feasibility and correlation with clinical outcome. The Comfort Scale and Comfort Behaviour Scale are useful tools for measuring sedation in paediatric patients. RELEVANCE TO CLINICAL PRACTICE: Nursing staff should choose one subjective sedation scale that is suitable for assessing paediatric patients' depth of sedation. We recommend the Comfort Scale and Comfort Behaviour Scale as optimal choices if the clinical environment permits.

Delay-Variation-Dependent Criteria on Extended Dissipativity for Discrete-Time Neural Networks With Time-Varying Delay.

This article is concerned with the extended dissipativity of discrete-time neural networks (NNs) with time-varying delay. First, the necessary and sufficient condition on matrix-valued polynomial inequalities reported recently is extended to a general case, where the variable of the polynomial does not need to start from zero. Second, a novel Lyapunov functional with a delay-dependent Lyapunov matrix is constructed by taking into consideration more information on nonlinear activation functions. By employing the Lyapunov functional method, a novel delay and its variation-dependent criterion are obtained to investigate the effects of the time-varying delay and its variation rate on several performances, such as H∞ performance, passivity, and l2-l∞ performance, of a delayed discrete-time NN in a unified framework. Finally, a numerical example is given to show that the proposed criterion outperforms some existing ones.

A retrospective analysis of coping competence among community health centers during the COVID-19 pandemic in Shanghai, China: Coping strategies for future public health emergency events.

This study aims to investigate the coping competence of 12 community health centers through nursing workforce, emergency preparation, emergency response training, and emergency support in a district of Shanghai during the coronavirus disease 2019 (COVID-19) pandemic in 2022 to propose coping strategies and implication for Future Public Health Emergency Events for community health centers. A cross-sectional survey was conducted on June 2022, and 12 community health centers (servicing a population of 104,472.67 ± 41,421.18, with 125 ± 36 health care providers per center) were then divided into group A (n = 5, medical care ratio ≥ 1:1) and group B (n = 7, medical care ratio < 1:1) according to collected data, and the nursing human resources management and coping competence of the centers with COVID-19 of both groups were retrospectively analyzed. Nursing shortages were obvious across all 12 centers. Certain deficiencies in the coping competence of community health centers with emergencies must be addressed (possession rate < 70% in both groups, p > 0.05). Community health centers need to enhance hospital-to-hospital collaboration and the ability to transport emergency staff to the post promptly during outbreaks. Emergency coping assessments, emergency drills at different levels, and mental health support need to be implemented regularly among community health centers, and effective donation management should be pursued as well. We expect that this study could support efforts by leaders of community health centers to conclude coping strategies including increasing nursing workforce, optimizing human recourse management, and identifying areas of improvement of centers for emergency coping during public health events.

Dynamic Event-Triggered Platooning Control of Automated Vehicles Under Random Communication Topologies and Various Spacing Policies.

This article addresses the problem of dynamic event-triggered platooning control of automated vehicles over a vehicular ad-hoc network (VANET) subject to random vehicle-to-vehicle communication topologies. First, a novel dynamic event-triggered mechanism is developed to determine whether or not the sampled data packets of each vehicle should be released into the VANET for intervehicle cooperation. More specifically, the threshold parameter in the triggering condition is dynamically adjusted over time according to the vehicular data variations, the dynamic threshold updating laws, and the bandwidth occupancy indication. Second, a unified platooning control framework is established to account for various spacing policies, randomly switching communication topologies, unknown leader control input, and external disturbances. Then, a new scheduling and platooning control co-design approach is presented such that the controlled vehicular platoon can successfully track the leader vehicle under random communication topologies and different spacing policies, including constant spacing, constant time headway spacing, and variable time headway spacing, meanwhile maintaining efficient bandwidth-aware resource management. Finally, comparative studies are provided to substantiate the effectiveness and merits of the proposed co-design approach.

Supplementary Control for Quantized Discrete-Time Nonlinear Systems Under Goal Representation Heuristic Dynamic Programming.

This article is concerned with supplementary control of discrete-time nonlinear systems with multiple controllers in the framework of goal representation heuristic dynamic programming (GrHDP), where a logarithmic quantizer is used to govern the network communication. For the addressed problem, a neural network (NN)-based observer is first proposed to estimate the unknown system state in the simultaneous presence of quantized influence. In light of the estimated states and the ideal control inputs via a zero-sum game, a GrHDP algorithm with a reinforced term is developed to implement the supplementary control task, where some novel weight updating rules are constructed by virtue of an additional tunable parameter to improve the system performance. Furthermore, a set of conditions about the stability of estimated error dynamics of both observer states and updated NNs' weights are derived by resorting to the Lyapunov stability theory. Finally, the effectiveness of the developed method is verified by a power system and a numerical experiment.

Event-Triggered Cluster Consensus of Multi-Agent Systems via a Modified Genetic Algorithm.

This article is concerned with the event-triggered output feedback cluster consensus of leader-following multi-agent systems (MASs) under limited communication resources. Specifically, the distributed agents are divided into several clusters to accomplish different collective tasks under diverse intracluster and intercluster communications. First, to alleviate excessive communication resource consumption, two sampled-data-based event-triggered schemes are developed to distinguish agent-to-agent communications within clusters and between clusters. Based on these schemes, an event-based cluster consensus control protocol is proposed to solve the problem. Then, sufficient criteria on asymptotic stability of the resulting closed-loop system are derived and expressed in terms of matrix inequalities. It is noteworthy that the derived criteria for controller design are nonlinear and nonconvex with respect to the output feedback control gains and triggering parameters. To handle this issue, a modified genetic algorithm (MGA) with multiple subpopulations is proposed, where the subpopulations are independent of each other. The key feature of the designed MGA lies in that the fitness value is described as an accumulation of initial value and weighing value of each matrix inequality. Finally, an application of satellite formation flying is exemplified to demonstrate the effectiveness of the derived theoretical results.

Secure Distributed Adaptive Platooning Control of Automated Vehicles Over Vehicular Ad-Hoc Networks Under Denial-of-Service Attacks.

This article deals with the problem of secure distributed adaptive platooning control of automated vehicles over vehicular ad-hoc networks (VANETs) in the presence of intermittent denial-of-service (DoS) attacks. The platoon, which is wirelessly connected via directed vehicle-to-vehicle (V2V) communication, is composed of a group of following vehicles subject to unknown heterogeneous nonlinearities and external disturbance inputs, and a leading vehicle subject to unknown nonlinearity and external disturbance as well as an unknown control input. Under such a platoon setting, this article aims to accomplish secure distributed platoon formation tracking with the desired longitudinal spacing and the same velocities and accelerations guided by the leader regardless of the simultaneous presence of nonlinearities, uncertainties, and DoS attacks. First, a new logical data packet processor is developed on each vehicle to identify the intermittent DoS attacks via verifying the time-stamps of the received data packets. Then, a scalable distributed neural-network-based adaptive control design approach is proposed to achieve secure platooning control. It is proved that under the established design procedure, the vehicle state estimation errors and platoon tracking errors can be regulated to reside in small neighborhoods around zero. Finally, comparative simulation studies are provided to substantiate the effectiveness and merits of the proposed control design approach on maintaining the desired platooning performance and attack tolerance.

The effects of early exercise on cardiac rehabilitation-related outcome in acute heart failure patients: A systematic review and meta-analysis.

BACKGROUND: Heart failure can be classified into chronic heart failure and acute heart failure. Rapid onsets or worsening symptoms characterize acute heart failure, while progressive symptoms characterize chronic heart failure. Exercise-based cardiac rehabilitation is recommended for chronic heart failure patients, yet controversies on whether early exercise is safe and advantageous for acute heart failure patients remain unclear. OBJECTIVES: We performed a systematic review and meta-analysis to explore the effects of early exercise on cardiac rehabilitation-related outcome in acute heart failure patients. METHODS: We searched PubMed, Web Of Science, Embase, the Cochrane Library, CINAHL, PsycINFO, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang Dataset and SinoMed Dataset (from the earliest date available to August 2021) for randomized controlled trials that evaluated the effects of early exercise in acute heart failure patients. Studies were selected according to inclusion and exclusion criteria. Data synthesis was performed with Review Manager 5.2. RESULTS: 13 studies met the study criteria, including 1466 patients. Compared to the control group [routine care], early exercise improved 6 min walk distance[mean difference = 33.10, 95% CI (31.43, 34.77), P < 0.001], short physical performance battery scores[mean difference = 1.40, 95% CI (1.36, 1.44), P < 0.001], N-terminal pro-B-type natriuretic peptide[mean difference = -58.84, 95% CI (-89.25, -28.43), P < 0.001], quality of life assessed by Minnesota heart failure quality of life questionnaire [mean difference = -6.55, 95% CI (-9.99, -3.11), P = 0.0002], quality of life assessed by Kansas city cardiomyopathy questionnaire [mean difference = 7.00, 95% CI (6.58, 7.42), P < 0.001], activities of daily living [mean difference = 4.43, 95% CI (2.20, 6.65), P < 0.001], and all-cause related readmission rate [mean difference = 0.69, 95% CI (0.51, 0.94), P = 0.02]. No significant difference in left ventricular ejection fraction [mean difference = 1.93, 95% CI (-2.19, 6.05), P = 0.36], heart failure-related readmission rate [mean difference = 0.76, 95% CI (0.50, 1.17), P = 0.21] and all-cause mortality [mean difference = 0.63, 95% CI (0.18, 2.24), P = 0.47] was found between early exercise group and control group. No adverse events occurred during the intervention. CONCLUSION: Compared to routine care, early exercise could significantly improve the effect of physical capacity, physiological outcomes and clinical outcomes in acute heart failure patients, and appeared to be safe.

[LAMTOR2 deficiency exacerbates Klebsiella pneumoniae-induced liver sepsis in mice].

Objective To explore the biological function and mechanisms of LAMTOR2 during Klebsiella pneumoniae(K. pneumoniae) induced liver sepsis by establishing late endosomal/lysosomal adaptor 2(LAMTOR2) gene liver conditional knockout mouse model infected by K. pneumoniae. Methods LAMTOR2 gene liver conditional knockout mice (LAMTOR2flox/flox; Alb-Cre+) and littermate controls (LAMTOR2flox/flox) were generated and bred. LAMTOR2 gene knockout efficiency in liver was determined by real-time quantitative PCR (RT-qPCR) and Western blot analysis. Then, both group mice were infected with K. pneumoniae, and survival rates and liver pathological changes were determined. The expression levels of liver TNF-α, IL-1ß and CXCL1 mRNA were detected by RT-qPCR. Results LAMTOR2 gene liver conditional knockout mice were generated and bred successfully; compared to the littermate controls, LAMTOR2flox/flox, Alb-Cre+ mice showed lower survival rates and more severe liver injury. The expression levels of TNF-α, IL-1ß and CXCL1 mRNA were reduced in LAMTOR2flox/flox and the ability of immune response was decreased in mice. Alb-Cre+ mice liver compared to these of littermate controls post K. pneumoniae infections. Conclusion LAMTOR2 plays a protective role during K. pneumoniae-induced liver sepsis.

Prediction Model for Urinary Tract Infection in Pediatric Urological Surgery Patients.

Background: Urinary tract infection (UTI) is a common complication in pediatric urological surgery patients and is associated with long-term sequelae, including subsequent recurrent infections and renal scarring. In this study, we aimed to explore the risk factors for UTI in pediatric urological surgery patients and construct a predictive model for UTI. Materials and Methods: A total of 2,235 pediatric patients who underwent urological surgery at a tertiary hospital between February 2019 and January 2020 were included. A multivariate logistic regression model was applied to identify the predictive factors, and a predictive model was constructed using a receiver operating characteristic curve. A multifactorial predictive model was used to categorize the risk of UTI based on the weight of the evidence. Results: A total of 341 patients with UTI were identified, which corresponded to a prevalence of 15.26% in pediatric urological surgery patients. Multivariate analysis identified six significant risk factors for UTI, including age <12.0 months, upper urinary tract disease, not using an indwelling drainage tube, hospital stay ≥10 days, administration of two or more types of antibiotics, and stent implantation. A combination of the aforementioned factors produced an area under the curve value of 88.37% for preventing UTI in pediatric urological surgery patients. A multifactorial predictive model was created based on the combination of these factors. Conclusions: The constructed multifactorial model could predict UTI risk in pediatric urological surgery patients with a relatively high predictive value.

Distributed Resilient Estimator Design for Positive Systems Under Topological Attacks.

This article is concerned with the distributed resilient estimation of a positive system over a sensor network. First, a heterogeneous sensor interaction framework, where each sensor is capable of sharing its local information of measurement as well as state estimate with its underlying neighbors via distinct interaction topologies, is proposed to account for different sensor communication capacities. During the information exchanges among the sensors, topological attacks are suitably modeled in such a way to incorporate the random and intermittent disruption of the heterogeneous sensor interaction topologies. Second, two sets of distributed resilient estimators are delicately constructed to cope with the resulting random denial of information exchanges within the specific repaired periods and compromised periods caused by the topological attacks. Third, the resilience performance analysis with a prescribed l1 -gain attenuation level is carried out, and a linear programming approach is then developed to achieve the design of the desired distributed estimators. Finally, the effectiveness of the proposed design method is verified through a vehicle formation monitoring system.

Finite-Horizon H∞ Bipartite Consensus Control of Cooperation-Competition Multiagent Systems With Round-Robin Protocols.

This article focuses on the finite-horizon H∞ bipartite consensus control problem for a class of discrete time-varying cooperation-competition multiagent systems (DTV-CCMASs) with the round-robin (RR) protocol. The cooperation-competition relationship among agents is characterized by a signed graph, whose edges are with positive or negative connection weights. Specifically, a positive weight corresponds to an allied relationship between two agents and a negative one means an adversary relationship. The data exchange between each agent and its neighbors is orchestrated by an RR protocol, where only one neighboring agent is authorized to transmit the data packet at each time instant, and therefore, the data collision is prevented. This article aims to design a bipartite consensus controller for DTV-CCMASs with the RR protocol such that the predetermined H∞ bipartite consensus is satisfied over a given finite horizon. A sufficient condition is first established to guarantee the desired H∞ bipartite consensus by resorting to the completing square method. With the help of an auxiliary cost combined with the Moore-Penrose pseudoinverse method, a design scheme of the bipartite consensus controller is obtained by solving two coupled backward recursive Riccati difference equations (BRRDEs). Finally, a simulation example is given to verify the effectiveness of the proposed scheme of the bipartite consensus controller.

Resilient Tracking Control of Networked Control Systems Under Cyber Attacks.

This article is concerned with the resilient tracking control of a networked control system under cyber attacks. The attacker is an active adversary whose aim is to severely degrade the tracking performance of the system by launching deception attacks on the sensor-to-controller communication channels and denial-of-service attacks on the controller-to-plant channels, respectively. First, a concept of resilient set-membership tracking control is presented, through which the system's true state is guaranteed to reside in a bounding ellipsoidal set of the reference state regardless of the existence of attacks and unknown-but-bounded (UBB) noises. Second, in the case that full information of the system's state is not implicitly trusted in the presence of attacks, a resilient set-membership estimation strategy is provided to secure the state estimates against the deception attacks. Furthermore, based on a recursive computation of a reference state ellipsoid and confidence state estimation ellipsoids, a convex optimization algorithm in terms of recursive linear matrix inequalities is proposed to obtain the gain parameters for both the desired resilient state estimator and the tracking controller. Finally, the effectiveness of the proposed method is illustrated through an Internet-based three-tank system.

On Designing Distributed Prescribed Finite-Time Observers for Strict-Feedback Nonlinear Systems.

This article is concerned with the problem of distributed prescribed finite-time observer design for a strictfeedback nonlinear system with external disturbance. The purpose is to reconstruct the unavailable system state based on a group of distributed observers, where each of them can only receive at most 1-D output measurement from the system. First, in the absence of disturbance, a new distributed prescribed finite-time observer featuring time-varying gains is constructed and designed under the assumption of joint observability. It is analytically proved that for any prescribed instant independent of system initial conditions and other design parameters, the obtained distributed observer can guarantee not only the asymptotic convergence to zero of the state error between each observer state and the system state at this prescribed instant but also the definite zero-state error after this prescribed instant. Second, a distributed prescribed finite-time bounded observer is delicately proposed to account for the presence of external disturbance in the system dynamics. It is shown that the state error can be bounded by an arbitrarily positive constant after a prescribed instant. Finally, a numerical example and an electromechanical system are presented to demonstrate the effectiveness of the proposed results.

Analysis of risk factor for pediatric intensive care unit delirium in children: a case-control study.

OBJECTIVE: This study aimed to survey the prevalence of delirium in the pediatric intensive care unit (PICU) and explore the associated risk factors. DESIGN: A retrospective case-control study. SETTING: Two PICUs within a tertiary-A general hospital. PATIENTS: Patients aged from 1 month to 7 years who stayed in either PICU for at least 1 day were included. METHODS: A total of 639 patients admitted to PICU of a tertiary-A general hospital from December 2018 to August 2019 were enrolled. Demographic, clinical, laboratory data and length of stay in the PICU were collected. The patients were screened twice a day with the Chinese version of Cornell Assessment of Pediatric Delirium (CAPD), and were divided into the delirium group and the non-delirium group. A risk factor analysis was conducted, with ICU pediatric delirium as primary outcome, by performing a multivariable logistic regression analysis. RESULTS: Of the 639 patients, the prevalence of ICU pediatric delirium was 31.30%. Of the 200 children with delirium across 3703 study days, 36% children were hyperactive, 41% were hypoactive, and 23% displayed the mixed type of delirium. Univariate analysis and multivariate logistic regression analysis showed that age, PRISM IV score (OR, 2.20; 95% CI, 1.42-3.41), hypoxia (OR, 2.69; 95% CI, 1.53-4.71), metabolic dis-function (OR, 3.73; 95% CI, 2.08-6.71), duration of infection (OR, 1.22; 95% CI, 1.10-1.36), and mechanical ventilation (OR, 3.78; 95% CI, 2.25-6.35) were statistically correlated with ICU pediatric delirium. The ROC curve analysis shows the combination CRP with duration of infection has good predictive performance. CONCLUSIONS: Age, PRISM IV score, ICU retention time, metabolic dis-function, duration of infection, hypoxia, CRP and mechanical ventilation were the independent risk factors for ICU pediatric delirium. We suggest that active preventive measures should be taken to reduce the occurrence of ICU pediatric delirium.

Resilient Control Design Based on a Sampled-Data Model for a Class of Networked Control Systems Under Denial-of-Service Attacks.

This article is concerned with designing resilient state feedback controllers for a class of networked control systems under denial-of-service (DoS) attacks. The sensor samples system states periodically. The DoS attacks usually prevent those sampled signals from being transmitted through a communication network. A logic processor embedded in the controller is introduced to not only receive sampled signals but also capture information on the duration time of each DoS attack. Note that the duration time of DoS attacks is usually both lower and upper bounded. Then the closed-loop system is modeled as an aperiodic sampled-data system closely related to both lower and upper bounds of duration time of DoS attacks. By introducing a novel looped functional, which caters for the N -order canonical Bessel-Legendre inequalities, some N -dependent stability criteria are presented for the resultant closed-loop system. It is worth pointing out that a number of identity formulas are uncovered, which enable us to apply the notable free-weighting matrix approach to derive less conservative stability criteria. A linear-matrix-inequality-based criterion is provided to design stabilizing state-feedback controllers against DoS attacks. A satellite control system is given to demonstrate the effectiveness of the proposed method.