Efficacy of a standard meticillin-resistant Staphylococcus aureus decolonisation protocol in routine clinical practice

Summary

Decolonisation may reduce the risk of meticillin-resistant Staphylococcus aureus (MRSA) infection in individual carriers and prevent transmission to other patients. The aims of this prospective cohort study were to determine the long-term efficacy of a standardised decolonisation regimen and to identify factors associated with failure. Patients colonised with MRSA underwent decolonisation, which was considered to be successful if there was no growth in three consecutive sets of site-specific screening swabs obtained weekly post treatment. If patients were successfully decolonised, follow-up cultures were performed 6 and 12 months later. Of 137 patients enrolled, 79 (58%) were successfully decolonised. Of these 79, 53 (67%) and 44 (56%) remained decolonised at 6 and 12 months respectively. Therefore only 44/137 (32%) patients who completed decolonisation were MRSA negative 12 months later. Outcome was not associated with a particular strain of MRSA. Successful decolonisation was less likely in patients colonised with a mupirocin-resistant isolate (adjusted odds ratio: 0.08; 95% confidence interval: 0.02–0.30), in patients with throat colonisation (0.22; 0.07–0.68) and in patients aged >80 years (0.30; 0.10–0.93) compared with those aged 60–80 years. These findings suggest that although initially successful in some cases, the protocol used did not result in long-term clearance of MRSA carriage for most patients.

A distributed contention-vector division multiple access (D-CVDMA) protocol for wireless networks

Traditional Time Division Multiple Access (TDMA) protocol provides deterministic periodic collision free data transmissions. However, TDMA lacks flexibility and exhibits low efficiency in dynamic environments such as wireless LANs. On the other hand contention-based MAC protocols such as the IEEE 802.11 DCF are adaptive to network dynamics but are generally inefficient in heavily loaded or large networks. To take advantage of the both types of protocols, a D-CVDMA protocol is proposed. It is based on the k-round elimination contention (k-EC) scheme, which provides fast contention resolution for Wireless LANs. D-CVDMA uses a contention mechanism to achieve TDMA-like collision-free data transmissions, which does not need to reserve time slots for forthcoming transmissions. These features make the D-CVDMA robust and adaptive to network dynamics such as node leaving and joining, changes in packet size and arrival rate, which in turn make it suitable for the delivery of hybrid traffic including multimedia and data content. Analyses and simulations demonstrate that D-CVDMA outperforms the IEEE 802.11 DCF and k-EC in terms of network throughput, delay, jitter, and fairness.

Synchrophasor Broadcast over Internet Protocol for Distributed Generator Synchronization

Synchronous islanded operation involves continuously holding an islanded power network in virtual synchronism with the main power system to aid paralleling and avoid potentially damaging out-of-synchronism reclosure. This requires phase control of the generators in the island and the transmission of a reference signal from a secure location on the main power system. Global positioning system (GPS) time-synchronized phasor measurements transmitted via an Internet protocol (IP) are used for the reference signal. However, while offering low cost and a readily available solution for distribution networks, IP communications have variable latency and are susceptible to packet loss, which can make time-critical control applications difficult. This paper investigates the ability of the phase-control system to tolerate communications latency. Phasor measurement conditioning algorithms that can tolerate latency are used in the phase-control loop of a 50-kVA diesel generator. © 2010 IEEE.

On the Study of Network Coded AF Transmission Protocol for Wireless Multiple Access Channels

In this paper, the performance of the network coded amplify-forward cooperative protocol is studied. The use of network coding can suppress the bandwidth resource consumed by relay transmission, and hence increase the spectral efficiency of cooperative diversity. A distributed strategy of relay selection is applied to the cooperative scheme, which can reduce system overhead and also facilitate the development of the explicit expressions of information metrics, such as outage probability and ergodic capacity. Both analytical and numerical results demonstrate that the proposed protocol can achieve large ergodic capacity and full diversity gain simultaneously.

Performance Analysis of Novel Randomly Shifted Certification Authority Authentication Protocol for MANETs

The provision of security in mobile ad hoc networks is of paramount importance due to their wireless nature. However, when conducting research into security protocols for ad hoc networks it is necessary to consider these in the context of the overall system. For example, communicational delay associated with the underlying MAC layer needs to be taken into account. Nodes in mobile ad hoc networks must strictly obey the rules of the underlying MAC when transmitting security-related messages while still maintaining a certain quality of service. In this paper a novel authentication protocol, RASCAAL, is described and its performance is analysed by investigating both the communicational-related effects of the underlying IEEE 802.11 MAC and the computational-related effects of the cryptographic algorithms employed. To the best of the authors' knowledge, RASCAAL is the first authentication protocol which proposes the concept of dynamically formed short-lived random clusters with no prior knowledge of the cluster head. The performance analysis demonstrates that the communication losses outweigh the computation losses with respect to energy and delay. MAC-related communicational effects account for 99% of the total delay and total energy consumption incurred by the RASCAAL protocol. The results also show that a saving in communicational energy of up to 12.5% can be achieved by changing the status of the wireless nodes during the course of operation. Copyright (C) 2009 G. A. Safdar and M. P. O'Neill (nee McLoone).

Standardisation of a coproantigen reduction test (CRT) protocol for the diagnosis of resistance to triclabendazole in Fasciola hepatica

A sheep trial was performed to standardise a coproantigen reduction test (CRT) protocol for the diagnosis of resistance to triclabendazole (TCBZ) in Fasciola hepatica). The CRT employs the BIO K201 Fasciola coproantigen ELISA (Bio-X Diagnostics, Jemelle, Belgium) to test for the presence of F. hepatica coproantigens in a faecal sample. If it is coproantigen-positive, the CRT protocol recommends that faecal samples are re-tested for coproantigens at 14 days post-treatment (dpt), with negative testing at this point indicating TCBZ success.

Protocolized versus non-protocolized weaning for reducing the duration of invasive mechanical ventilation in critically ill paediatric patients (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows:

To assess the effects of weaning by protocol for invasively ventilated critically ill children.

To compare the total duration of invasive mechanical ventilation of critically ill children who are weaned using protocols versus usual (non-protocolized) practice.
To ascertain any differences between protocolized weaning and usual care in terms of mortality, adverse events, ICU length of stay, and quality of life.

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.