Accuracy of LightCycler® SeptiFast for the detection and identification of pathogens in the blood of patients with suspected sepsis: a systematic review protocol

Background: There is growing interest in the potential utility of molecular diagnostics in improving the detection of life-threatening infection (sepsis). LightCycler® SeptiFast is a multipathogen probebased real-time PCR system targeting DNA sequences of bacteria and fungi present in blood samples within a few hours. We report here the protocol of the first systematic review of published clinical diagnostic accuracy studies of this technology when compared with blood culture in the setting of suspected sepsis. Methods/design: Data sources: the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA), the NHS Economic Evaluation Database (NHSEED), The Cochrane Library, MEDLINE, EMBASE, ISI Web of Science, BIOSIS Previews, MEDION and the Aggressive Research Intelligence Facility Database (ARIF). Study selection: diagnostic accuracy studies that compare the real-time PCR technology with standard culture results performed on a patient's blood sample during the management of sepsis. Data extraction: three reviewers, working independently, will determine the level of evidence, methodological quality and a standard data set relating to demographics and diagnostic accuracy metrics for each study. Statistical analysis/data synthesis: heterogeneity of studies will be investigated using a coupled forest plot of sensitivity and specificity and a scatter plot in Receiver Operator Characteristic (ROC) space. Bivariate model method will be used to estimate summary sensitivity and specificity. The authors will investigate reporting biases using funnel plots based on effective sample size and regression tests of asymmetry. Subgroup analyses are planned for adults, children and infection setting (hospital vs community) if sufficient data are uncovered. Dissemination: Recommendations will be made to the Department of Health (as part of an open-access HTA report) as to whether the real-time PCR technology has sufficient clinical diagnostic accuracy potential to move forward to efficacy testing during the provision of routine clinical care.

The level playing field: the impact of assessment practice on professional development

Context: The effects of assessment practice on students’ learning are unclear, particularly regarding professional development. Corralling in objective structured clinical examinations (OSCEs) is designed to reduce illicit passing of examination information. Candidates completing an examination are kept secluded until the next cohort of examinees has begun. We used the introduction of corralling as a context in which to explore social influences on examination misconduct, with the aims of improving understanding of the hidden effects of assessment, and evaluating the acceptability of corralling from the student perspective.

Methods: A questionnaire was administered to students corralled post-OSCE for the first time. Eleven semi-structured interviews were subsequently conducted. Questionnaire data were analysed for descriptive statistics and thematic analysis of interview transcripts was carried out.

Results: The questionnaire response rate was 95.4% (251/263). Before corralling, 80.9% (203/251) of students were aware of the sharing of information among peers and 78.5% (197/251) agreed that such misconduct was unprofessional. The majority were in favour of corralling (90.8%, 228/251). Four themes emerged from the semi-structured interviews: the student network versus the individual; assessment-driven culture; the deferring of professionalism, and the ‘level playing field’. Students saw interaction within the student network, on a background of assessment-driven culture, as the key driver in examination misconduct. Conforming to the rules of the social network was prioritised over individual agency, although the mismatch between the rules of the network and the dominant professional discourse caused some conflict for individuals. Deferred professionalism (described as the practice of taking on the norms of professional behaviour only when qualified) was a rationalisation used to minimise this conflict. Corralling provided a ‘level playing field’ in which the influences of the network were minimised.

Conclusions: Examination misconduct is thus a complex social construction with implications for individual learners in terms of professional development. Corralling is one mechanism for addressing misconduct that is acceptable to students, but assessment processes have important hidden effects which educators should acknowledge.

Effectiveness of in situ moisture preconditioning methods for concrete

With greater emphasis now being placed on the durability of concrete and the need for on-site characterization of concrete for durability, there is an increasing dependence on the measurement of the permeation properties of concrete. Such properties can be measured in the laboratory under controlled ambient conditions, namely, temperature and relative humidity, and comparisons made between samples not affected by testing conditions. An important factor that influences permeation measurements is the moisture state of the concrete prior to testing. Moisture gradients are known to exist in exposed concretes; therefore, all laboratory tests are generally carried out after preconditioning to a reference moisture state. This is reasonably easy to achieve in the laboratory, but more difficult to carry out on-site. Different methods of surface preconditioning in situ concrete are available; however, there is no general agreement on the suitability of any one method. Therefore, a comprehensive set of experiments was carried out with four different preconditioning methods. Results from these investigations indicated that only superficial drying could be achieved by using any of the preconditioning methods investigated and that significant moisture movement below a depth of 15 mm was not evident.

Surface treatments for concrete: assessment methods and reported performance

Several products for surface treatment are available on the market to enhance durability characteristics of concrete. For each of these materials a certain level of protection is claimed. However, there is no commonly accepted procedure to assess the effectiveness of these treatments. The inherent generic properties may be of use to the manufacturers and those responsible for specifications, however, practising engineers are interested in knowing how they improve the performance of their structures. Thus in this review an attempt is made to assess the engineering aspects of the various surface treatments so that a procedure for their selection can be proposed. (C) 1997 Elsevier Science Lid.

Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials

Background: As trials of 5 years of tamoxifen in early breast cancer mature, the relevance of hormone receptor measurements (and other patient characteristics) to long-term outcome can be assessed increasingly reliably. We report updated meta-analyses of the trials of 5 years of adjuvant tamoxifen.
Methods: We undertook a collaborative meta-analysis of individual patient data from 20 trials (n=21457) in early breast cancer of about 5 years of tamoxifen versus no adjuvant tamoxifen, with about 80% compliance. Recurrence and death rate ratios (RRs) were from log-rank analyses by allocated treatment.
Findings: In oestrogen receptor (ER)-positive disease (n=10 645), allocation to about 5 years of tamoxifen substantially reduced recurrence rates throughout the first 10 years (RR 0.53 [SE 0.03] during years 0-4 and RR 0.68 [0.06] during years 5-9 [both 2p<0.00001]; but RR 0.97 [0.10] during years 10-14, suggesting no further gain or loss after year 10). Even in marginally ER-positive disease (10-19 fmol/mg cytosol protein) the recurrence reduction was substantial (RR 0.67 [0.08]). In ER-positive disease, the RR was approximately independent of progesterone receptor status (or level), age, nodal status, or use of chemotherapy. Breast cancer mortality was reduced by about a third throughout the first 15 years (RR 0.71 [0.05] during years 0-4, 0.66 [0.05] during years 5-9, and 0.68 [0.08] during years 10-14; p<0.0001 for extra mortality reduction during each separate time period). Overall non-breast-cancer mortality was little affected, despite small absolute increases in thromboembolic and uterine cancer mortality (both only in women older than 55 years), so all-cause mortality was substantially reduced. In ER-negative disease, tamoxifen had little or no effect on breast cancer recurrence or mortality.
Interpretation: 5 years of adjuvant tamoxifen safely reduces 15-year risks of breast cancer recurrence and death. ER status was the only recorded factor importantly predictive of the proportional reductions. Hence, the absolute risk reductions produced by tamoxifen depend on the absolute breast cancer risks (after any chemotherapy) without tamoxifen.
Funding: Cancer Research UK, British Heart Foundation, and Medical Research Council.

Carotenoids and co-antioxidants in age-related maculopathy:design and methods

Age-related macular degeneration (AMD), is the leading cause of blind registration in the Western World among individuals 65 years or older. Early AMD, a clinical state without overt functional loss, is said to be present clinically when yellowish deposits known as drusen and/or alterations of fundus pigmentation are seen in the macular retina. Although the etiopathogenesis of AMD remains uncertain, there is a growing body of evidence in support of the view that cumulative oxidative damage plays a causal role. Appropriate dietary antioxidant supplementation is likely to be beneficial in maintaining visual function in patients with AMD, and preventing or delaying the progression of early AMD to late AMD. The Carotenoids in Age-Related Maculopathy (CARMA) Study is a randomized and double-masked clinical trial of antioxidant supplementation versus placebo in 433 participants with either early AMD features of sufficient severity in at least one eye or any level of AMD in one eye with late AMD (neovascular AMD or central geographic atrophy) in the fellow eye. The aim of the CARMA Study is to investigate whether lutein and zeaxanthin, in combination with co-antioxidants (vitamin C, E, and zinc), has a beneficial effect on visual function and/or prevention of progression from early to late stages of disease. The primary outcome is improved or preserved distance visual acuity at 12 months. Secondary outcomes include improved or preserved interferometric acuity, contrast sensitivity, shape discrimination ability, and change in AMD severity as monitored by fundus photography. This article outlines the CARMA Study design and methodology, including its rationale.

Assessing modern ground survey methods and airborne laser scanning for digital terrain modelling:A case study from the Lake District, England

This paper compares the applicability of three ground survey methods for modelling terrain: one man electronic tachymetry (TPS), real time kinematic GPS (GPS), and terrestrial laser scanning (TLS). Vertical accuracy of digital terrain models (DTMs) derived from GPS, TLS and airborne laser scanning (ALS) data is assessed. Point elevations acquired by the four methods represent two sections of a mountainous area in Cumbria, England. They were chosen so that the presence of non-terrain features is constrained to the smallest amount. The vertical accuracy of the DTMs was addressed by subtracting each DTM from TPS point elevations. The error was assessed using exploratory measures including statistics, histograms, and normal probability plots. The results showed that the internal measurement accuracy of TPS, GPS, and TLS was below a centimetre. TPS and GPS can be considered equally applicable alternatives for sampling the terrain in areas accessible on foot. The highest DTM vertical accuracy was achieved with GPS data, both on sloped terrain (RMSE 0.16. m) and flat terrain (RMSE 0.02. m). TLS surveying was the most efficient overall but veracity of terrain representation was subject to dense vegetation cover. Therefore, the DTM accuracy was the lowest for the sloped area with dense bracken (RMSE 0.52. m) although it was the second highest on the flat unobscured terrain (RMSE 0.07. m). ALS data represented the sloped terrain more realistically (RMSE 0.23. m) than the TLS. However, due to a systematic bias identified on the flat terrain the DTM accuracy was the lowest (RMSE 0.29. m) which was above the level stated by the data provider. Error distribution models were more closely approximated by normal distribution defined using median and normalized median absolute deviation which supports the use of the robust measures in DEM error modelling and its propagation. © 2012 Elsevier Ltd.

From bit level systolic arrays to HDTV processor chips

The initial part of this paper reviews the early challenges (c 1980) in achieving real-time silicon implementations of DSP computations. In particular, it discusses research on application specific architectures, including bit level systolic circuits that led to important advances in achieving the DSP performance levels then required. These were many orders of magnitude greater than those achievable using programmable (including early DSP) processors, and were demonstrated through the design of commercial digital correlator and digital filter chips. As is discussed, an important challenge was the application of these concepts to recursive computations as occur, for example, in Infinite Impulse Response (IIR) filters. An important breakthrough was to show how fine grained pipelining can be used if arithmetic is performed most significant bit (msb) first. This can be achieved using redundant number systems, including carry-save arithmetic. This research and its practical benefits were again demonstrated through a number of novel IIR filter chip designs which at the time, exhibited performance much greater than previous solutions. The architectural insights gained coupled with the regular nature of many DSP and video processing computations also provided the foundation for new methods for the rapid design and synthesis of complex DSP System-on-Chip (SoC), Intellectual Property (IP) cores. This included the creation of a wide portfolio of commercial SoC video compression cores (MPEG2, MPEG4, H.264) for very high performance applications ranging from cell phones to High Definition TV (HDTV). The work provided the foundation for systematic methodologies, tools and design flows including high-level design optimizations based on "algorithmic engineering" and also led to the creation of the Abhainn tool environment for the design of complex heterogeneous DSP platforms comprising processors and multiple FPGAs. The paper concludes with a discussion of the problems faced by designers in developing complex DSP systems using current SoC technology. © 2007 Springer Science+Business Media, LLC.

YIELD ENHANCEMENT OF BIT LEVEL SYSTOLIC ARRAY CHIPS USING FAULT TOLERANT TECHNIQUES.

Methods by which bit level systolic array chips can be made fault tolerant are discussed briefly. Using a simple analysis based on both Poisson and Bose-Einstein statistics authors demonstrate that such techniques can be used to obtain significant yield enhancement. Alternatively, the dimensions of an array can be increased considerably for the same initial (nonfault tolerant) chip yield.

UTILISATION OF BIT LEVEL SYSTOLIC ARRAYS IN WORD LEVEL SYSTEMS.

Bit level systolic array structures for computing sums of products are studied in detail. It is shown that these can be sub-divided into two classes and that, within each class, architectures can be described in terms of a set of constraint equations. It is further demonstrated that high performance system level functions with attractive VLSI properties can be constructed by matching data flow geometries in bit level and word level architectures.

MAPPING SYSTEM LEVEL FUNCTIONS ON TO BIT LEVEL SYSTOLIC ARRAYS.

Bit-level systolic-array structures for computing sums of products are studied in detail. It is shown that these can be subdivided into two classes and that within each class architectures can be described in terms of a set of constraint equations. It is further demonstrated that high-performance system-level functions with attractive VLSI properties can be constructed by matching data-flow geometries in bit-level and word-level architectures.

Use of data dependence graphs in the design of bit-level systolic arrays

The use of bit-level systolic array circuits as building blocks in the construction of larger word-level systolic systems is investigated. It is shown that the overall structure and detailed timing of such systems may be derived quite simply using the dependence graph and cut-set procedure developed by S. Y. Kung (1988). This provides an attractive and intuitive approach to the bit-level design of many VLSI signal processing components. The technique can be applied to ripple-through and partly pipelined circuits as well as fully systolic designs. It therefore provides a means of examining the relative tradeoff between levels of pipelining, chip area, power consumption, and throughput rate within a given VLSI design.

Optimized bit level architectures for IIR filtering

Optimized circuits for implementing high-performance bit-parallel IIR filters are presented. Circuits constructed mainly from simple carry save adders and based on most-significant-bit (MSB) first arithmetic are described. Two methods resulting in systems which are 100% efficient in that they are capable of sampling data every cycle are presented. In the first approach the basic circuit is modified so that the level of pipelining used is compatible with the small, but fixed, latency associated with the computation in question. This is achieved through insertion of pipeline delays (half latches) on every second row of cells. This produces an area-efficient solution in which the throughput rate is determined by a critical path of 76 gate delays. A second approach combines the MSB first arithmetic methods with the scattered look-ahead methods. Important design issues are addressed, including wordlength truncation, overflow detection, and saturation.

Delineation of a quick clay zone at Smørgrav, Norway, with electromagnetic methods under geotechnical constraints

In many coastal areas of North America and Scandinavia, post-glacial clay sediments have emerged above sea level due to iso-static uplift. These clays are often destabilised by fresh water leaching and transformed to so-called quick clays as at the investigated area at Smørgrav, Norway. Slight mechanical disturbances of these materials may trigger landslides. Since the leaching increases the electrical resistivity of quick clay as compared to normal marine clay, the application of electromagnetic (EM) methods is of particular interest in the study of quick clay structures.

For the first time, single and joint inversions of direct-current resistivity (DCR), radiomagnetotelluric (RMT) and controlled-source audiomagnetotelluric (CSAMT) data were applied to delineate a zone of quick clay. The resulting 2-D models of electrical resistivity correlate excellently with previously published data from a ground conductivity metre and resistivity logs from two resistivity cone penetration tests (RCPT) into marine clay and quick clay. The RCPT log into the central part of the quick clay identifies the electrical resistivity of the quick clay structure to lie between 10 and 80 O m. In combination with the 2-D inversion models, it becomes possible to delineate the vertical and horizontal extent of the quick clay zone. As compared to the inversions of single data sets, the joint inversion model exhibits sharper resistivity contrasts and its resistivity values are more characteristic of the expected geology. In our preferred joint inversion model, there is a clear demarcation between dry soil, marine clay, quick clay and bedrock, which consists of alum shale and limestone.

Signal enhancement of surface plasmon resonance immunoassay using enzyme precipitation-functionalized gold nanoparticles: A femto molar level measurement of anti-glutamic acid decarboxylase antibody

Colloidal gold nanoparticles (AuNPs) and precipitation of an insoluble product formed by HRP-biocatalyzed oxidation of 3,3'-diaminobenzidine (DAB) in the presence of H2O2 were used to enhance the signal obtained from the surface plasmon resonance (SPR) biosensor. The AuNPs were synthesized and functionalized with HS-OEG(3)-COOH by self assembling technique. Thereafter, the HS-OEG3-COOH functionalized nanoparticles were covalently conjugated with horseradish peroxidase (HRP) and anti IgG antibody to form an enzyme-immunogold complex. Characterizations were performed by several methods: UV-vis absorption, DLS, HR-TEM and Fr-IR. The Au-anti IgG-HRP complex has been applied in enhancement of SPR immunoassay using a sensor chip constructed by 1:9 molar ratio of HS-OEG(6)-COOH and HS-OEG(3)-OH for detection of anti-GAD antibody. As a result, AuNPs showed their enhancement as being consistent with other previous studies while the enzyme precipitation using DAB substrate was applied for the first time and greatly amplified the SPR detection. The limit of detection was found as low as 0.03 ng/ml of anti-GAD antibody (or 200 fM) which is much higher than that of previous reports. This study indicates another way to enhance SPR measurement, and it is generally applicable to other SPR-based immunoassays.