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This study reports the performance of an Archimedean spiral antenna, which exhibits unidirectional circularly polarized radiation patterns with a peak gain >8 dBic in the lower (2.4–2.485 GHz) and upper (5.15–5.35 and 5.725–5.875 GHz) Wireless local area network frequency bands. The required backlobe suppression and impedance match are obtained by placing a multiresonant high impedance surface (HIS) in close proximity to the radiating aperture. Simulated and measured radiation patterns are shown at the center frequency of all three channels and a comparison of the key performance metrics is made with free space and metal backed antenna arrangements to demonstrate the enhancements which are attributed to the HIS reflector.

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Background: Skeletal muscle wasting and weakness are significant complications of critical illness, associated with the degree of illness severity and periods of reduced mobility during mechanical ventilation. They contribute to the profound physical and functional deficits observed in survivors. These impairments may persist for many years following discharge from the intensive care unit (ICU) and may markedly influence health-related quality of life. Rehabilitation is a key strategy in the recovery of patients following critical illness. Exercise based interventions are aimed at targeting this muscle wasting and weakness. Physical rehabilitation delivered during ICU admission has been systematically evaluated and shown to be beneficial. However its effectiveness when initiated after ICU discharge has yet to be established. Objectives: To assess the effectiveness of exercise rehabilitation programmes, initiated after ICU discharge, on functional exercise capacity and health-related quality of life in adult ICU survivors who have been mechanically ventilated for more than 24 hours. Search methods:We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), OvidSP MEDLINE, Ovid SP EMBASE, and CINAHL via EBSCO host to 15th May 2014. We used a specific search strategy for each database. This included synonyms for ICU and critical illness, exercise training and rehabilitation. We searched the reference lists of included studies and contacted primary authors to obtain further information regarding potentially eligible studies. We also searched major clinical trials registries (Clinical Trials and Current Controlled Trials) and the personal libraries of the review authors. We applied no language or publication restriction. We reran the search in February 2015. We will deal with any studies of interest when we update the review.  Selection criteria:We included randomized controlled trials (RCTs), quasi-RCTs, and controlled clinical trials (CCTs) that compared an exercise interventioninitiated after ICU discharge to any other intervention or a control or ‘usual care’ programme in adult (≥18years) survivors ofcritical illness. Data collection and analysis:We used standard methodological procedures expected by The Cochrane Collaboration. Main results:We included six trials (483 adult ICU participants). Exercise-based interventions were delivered on the ward in two studies; both onthe ward and in the community in one study; and in the community in three studies. The duration of the intervention varied according to the length of stay in hospital following ICU discharge (up to a fixed duration of 12 weeks).Risk of bias was variable for all domains across all trials. High risk of bias was evident in all studies for performance bias, although blinding of participants and personnel in therapeutic rehabilitation trials can be pragmatically challenging. Low risk of bias was at least 50% for all other domains across all trials, although high risk of bias was present in one study for random sequence generation (selection bias), incomplete outcome data (attrition bias) and other sources. Risk of bias was unclear for remaining studies across the domains.All six studies measured effect on the primary outcome of functional exercise capacity, although there was wide variability in natureof intervention, outcome measures and associated metrics, and data reporting. Overall quality of the evidence was very low. Only two studies using the same outcome measure for functional exercise capacity, had the potential for pooling of data and assessment of heterogeneity. On statistical advice, this was considered inappropriate to perform this analysis and study findings were therefore qualitatively described. Individually, three studies reported positive results in favour of the intervention. A small benefit (versus. control)was evident in anaerobic threshold in one study (mean difference, MD (95% confidence interval, CI), 1.8 mlO2/kg/min (0.4 to 3.2),P value = 0.02), although this effect was short-term, and in a second study, both incremental (MD 4.7 (95% CI 1.69 to 7.75) Watts, P value = 0.003) and endurance (MD 4.12 (95% CI 0.68 to 7.56) minutes, P value = 0.021) exercise testing demonstrated improvement.Finally self-reported physical function increased significantly following a rehabilitation manual (P value = 0.006). Remaining studies found no effect of the intervention.Similar variability in with regard findings for the primary outcome of health-related quality of life were also evident. Only two studies evaluated this outcome. Following statistical advice, these data again were considered inappropriate for pooling to determine overall effect and assessment of heterogeneity. Qualitative description of findings was therefore undertaken. Individually, neither study reported differences between intervention and control groups for health-related quality of life as a result of the intervention. Overall quality of the evidence was very low.Mortality was reported by all studies, ranging from 0% to 18.8%. Only one non-mortality adverse event was reported across all patients in all studies (a minor musculoskeletal injury). Withdrawals, reported in four studies, ranged from 0% to 26.5% in control groups,and 8.2% to 27.6% in intervention groups. Loss to follow-up, reported in all studies, ranged from 0% to 14% in control groups, and 0% to 12.5% in intervention groups. Authors’ conclusions:We are unable, at this time, to determine an overall effect on functional exercise capacity, or health-related quality of life, of an exercise based intervention initiated after ICU discharge in survivors of critical illness. Meta-analysis of findings was not appropriate. This was due to insufficient study number and data. Individual study findings were inconsistent. Some studies reported a beneficial effect of the intervention on functional exercise capacity, and others not. No effect was reported on health-related quality of life. Methodological rigour was lacking across a number of domains influencing quality of the evidence. There was also wide variability in the characteristics of interventions, outcome measures and associated metrics, and data reporting.If further trials are identified, we may be able to determine the effect of exercise-based interventions following ICU discharge, on functional exercise capacity and health-related quality of life in survivors of critical illness.

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Background: There is growing interest in the potential utility of real-time polymerase chain reaction (PCR) in diagnosing bloodstream infection by detecting pathogen deoxyribonucleic acid (DNA) in blood samples within a few hours. SeptiFast (Roche Diagnostics GmBH, Mannheim, Germany) is a multipathogen probe-based system targeting ribosomal DNA sequences of bacteria and fungi. It detects and identifies the commonest pathogens causing bloodstream infection. As background to this study, we report a systematic review of Phase III diagnostic accuracy studies of SeptiFast, which reveals uncertainty about its likely clinical utility based on widespread evidence of deficiencies in study design and reporting with a high risk of bias. 

Objective: Determine the accuracy of SeptiFast real-time PCR for the detection of health-care-associated bloodstream infection, against standard microbiological culture. 

Design: Prospective multicentre Phase III clinical diagnostic accuracy study using the standards for the reporting of diagnostic accuracy studies criteria. 

Setting: Critical care departments within NHS hospitals in the north-west of England. 

Participants: Adult patients requiring blood culture (BC) when developing new signs of systemic inflammation. 

Main outcome measures: SeptiFast real-time PCR results at species/genus level compared with microbiological culture in association with independent adjudication of infection. Metrics of diagnostic accuracy were derived including sensitivity, specificity, likelihood ratios and predictive values, with their 95% confidence intervals (CIs). Latent class analysis was used to explore the diagnostic performance of culture as a reference standard. 

Results: Of 1006 new patient episodes of systemic inflammation in 853 patients, 922 (92%) met the inclusion criteria and provided sufficient information for analysis. Index test assay failure occurred on 69 (7%) occasions. Adult patients had been exposed to a median of 8 days (interquartile range 4–16 days) of hospital care, had high levels of organ support activities and recent antibiotic exposure. SeptiFast real-time PCR, when compared with culture-proven bloodstream infection at species/genus level, had better specificity (85.8%, 95% CI 83.3% to 88.1%) than sensitivity (50%, 95% CI 39.1% to 60.8%). When compared with pooled diagnostic metrics derived from our systematic review, our clinical study revealed lower test accuracy of SeptiFast real-time PCR, mainly as a result of low diagnostic sensitivity. There was a low prevalence of BC-proven pathogens in these patients (9.2%, 95% CI 7.4% to 11.2%) such that the post-test probabilities of both a positive (26.3%, 95% CI 19.8% to 33.7%) and a negative SeptiFast test (5.6%, 95% CI 4.1% to 7.4%) indicate the potential limitations of this technology in the diagnosis of bloodstream infection. However, latent class analysis indicates that BC has a low sensitivity, questioning its relevance as a reference test in this setting. Using this analysis approach, the sensitivity of the SeptiFast test was low but also appeared significantly better than BC. Blood samples identified as positive by either culture or SeptiFast real-time PCR were associated with a high probability (> 95%) of infection, indicating higher diagnostic rule-in utility than was apparent using conventional analyses of diagnostic accuracy. 

Conclusion: SeptiFast real-time PCR on blood samples may have rapid rule-in utility for the diagnosis of health-care-associated bloodstream infection but the lack of sensitivity is a significant limiting factor. Innovations aimed at improved diagnostic sensitivity of real-time PCR in this setting are urgently required. Future work recommendations include technology developments to improve the efficiency of pathogen DNA extraction and the capacity to detect a much broader range of pathogens and drug resistance genes and the application of new statistical approaches able to more reliably assess test performance in situation where the reference standard (e.g. blood culture in the setting of high antimicrobial use) is prone to error.

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Re-imagining of the aerial transportation system has become increasingly important as the need for significant environmental and economic efficiency gains has become ever more prevalent. A number of studies have highlighted the benefits of the adoption of air to air refuelling within civil aviation. However, it also opens up the potential for increased flexibility in operations through smaller aircraft, shifting emphasis away from the traditional hub and spoke method of operation towards the more flexible Point to Point operations. It is proposed here that one technology can act as an enabler for the other, realising benefits that neither can realise as a standalone. The impact of an air-toair refuelling enabled point to point system is discussed, and the affect on economic and environmental cost metrics relative to traditional operations evaluated. An idealised airport configuration study shows the difference in fuel burn for point to point networks to vary from -23% to 28% from that of Hub and Spoke depending on the configuration. The sensitive natures of the concepts are further explored in a second study based on real airport configurations. The complex effect of the choice of a Point to Point or Hub and Spoke system on fuel burn, operating cost and revenue potential is highlighted. Fuel burn savings of 15% can be experienced with AAR over traditional refuelling operations, with point to point networks increasing the available seat miles (by approximately 20%) without a proportional increase in operating cost or fuel.

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As a post-CMOS technology, the incipient Quantum-dot Cellular Automata technology has various advantages. A key aspect which makes it highly desirable is low power dissipation. One method that is used to analyse power dissipation in QCA circuits is bit erasure analysis. This method has been applied to analyse previously proposed QCA binary adders. However, a number of improved QCA adders have been proposed more recently that have only been evaluated in terms of area and speed. As the three key performance metrics for QCA circuits are speed, area and power, in this paper, a bit erasure analysis of these adders will be presented to determine their power dissipation. The adders to be analysed are the Carry Flow Adder (CFA), Brent-Kung Adder (B-K), Ladner-Fischer Adder (L-F) and a more recently developed area-delay efficient adder. This research will allow for a more comprehensive comparison between the different QCA adder proposals. To the best of the authors' knowledge, this is the first time power dissipation analysis has been carried out on these adders.

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Very high speed and low area hardware architectures of the SHACAL-1 encryption algorithm are presented in this paper. The SHACAL algorithm was a submission to the New European Schemes for Signatures, Integrity and Encryption (NESSIE) project and it is based on the SHA-1 hash algorithm. To date, there have been no performance metrics published on hardware implementations of this algorithm. A fully pipelined SHACAL-1 encryption architecture is described in this paper and when implemented on a Virtex-II X2V4000 FPGA device, it runs at a throughput of 17 Gbps. A fully pipelined decryption architecture achieves a speed of 13 Gbps when implemented on the same device. In addition, iterative architectures of the algorithm are presented. The SHACAL-1 decryption algorithm is derived and also presented in this paper, since it was not provided in the submission to NESSIE. © Springer-Verlag Berlin Heidelberg 2003.

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Quantum-dot cellular automata (QCA) is potentially a very attractive alternative to CMOS for future digital designs. Circuit designs in QCA have been extensively studied. However, how to properly evaluate the QCA circuits has not been carefully considered. To date, metrics and area-delay cost functions directly mapped from CMOS technology have been used to compare QCA designs, which is inappropriate due to the differences between these two technologies. In this paper, several cost metrics specifically aimed at QCA circuits are studied. It is found that delay, the number of QCA logic gates, and the number and type of crossovers, are important metrics that should be considered when comparing QCA designs. A family of new cost functions for QCA circuits is proposed. As fundamental components in QCA computing arithmetic, QCA adders are reviewed and evaluated with the proposed cost functions. By taking the new cost metrics into account, previous best adders become unattractive and it has been shown that different optimization goals lead to different “best” adders.

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Directional modulation (DM) is an emerging technology for securing wireless communications at the physical layer. This promising technology, unlike the conventional key-based cryptographic methods and the key-based physical layer security approaches, locks information signals without any requirements of keys. The locked information can only be fully recovered by the legitimate receiver(s) priory known by DM transmitters. This paper reviews the origin of the DM concept and, particularly, its development in recent years, including its mathematical model, assessment metrics, synthesis approaches, physical realizations, and finally its potential aspects for future studies.

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Cloud data centres are critical business infrastructures and the fastest growing service providers. Detecting anomalies in Cloud data centre operation is vital. Given the vast complexity of the data centre system software stack, applications and workloads, anomaly detection is a challenging endeavour. Current tools for detecting anomalies often use machine learning techniques, application instance behaviours or system metrics distribu- tion, which are complex to implement in Cloud computing environments as they require training, access to application-level data and complex processing. This paper presents LADT, a lightweight anomaly detection tool for Cloud data centres that uses rigorous correlation of system metrics, implemented by an efficient corre- lation algorithm without need for training or complex infrastructure set up. LADT is based on the hypothesis that, in an anomaly-free system, metrics from data centre host nodes and virtual machines (VMs) are strongly correlated. An anomaly is detected whenever correlation drops below a threshold value. We demonstrate and evaluate LADT using a Cloud environment, where it shows that the hosting node I/O operations per second (IOPS) are strongly correlated with the aggregated virtual machine IOPS, but this correlation vanishes when an application stresses the disk, indicating a node-level anomaly.

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AIMS: To determine the incidence and predictive factors of rib fracture and chest wall pain after lung stereotactic ablative radiotherapy (SABR).

MATERIALS AND METHODS: Patients were treated with lung SABR of 48-60 Gy in four to five fractions. The treatment plan and follow-up computed tomography scans of 289 tumours in 239 patients were reviewed. Dose-volume histogram (DVH) metrics and clinical factors were evaluated as potential predictors of chest wall toxicity.

RESULTS: The median follow-up was 21.0 months (range 6.2-52.1). Seventeen per cent (50/289) developed a rib fracture, 44% (22/50) were symptomatic; the median time to fracture was 16.4 months. On univariate analysis, female gender, osteoporosis, tumours adjacent (within 5 mm) to the chest wall and all of the chest wall DVH metrics predicted for rib fracture, but only tumour location adjacent to the chest wall remained significant on the multivariate model (P < 0.01). The 2 year fracture-free probability for those adjacent to the chest wall was 65.6%. Among those tumours adjacent to the chest wall, only osteoporosis (P = 0.02) predicted for fracture, whereas none of the chest wall DVH metrics were predictive. Eight per cent (24/289) experienced chest wall pain without fracture.

CONCLUSIONS: None of the chest wall DVH metrics independently predicted for SABR-induced rib fracture when tumour location is taken into account. Patients with tumours adjacent (within 5 mm) to the chest wall are at greater risk of rib fracture after lung SABR, and among these, an additional risk was observed in osteoporotic patients.

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Power, and consequently energy, has recently attained first-class system resource status, on par with conventional metrics such as CPU time. To reduce energy consumption, many hardware- and OS-level solutions have been investigated. However, application-level information - which can provide the system with valuable insights unattainable otherwise - was only considered in a handful of cases. We introduce OpenMPE, an extension to OpenMP designed for power management. OpenMP is the de-facto standard for programming parallel shared memory systems, but does not yet provide any support for power control. Our extension exposes (i) per-region multi-objective optimization hints and (ii) application-level adaptation parameters, in order to create energy-saving opportunities for the whole system stack. We have implemented OpenMPE support in a compiler and runtime system, and empirically evaluated its performance on two architectures, mobile and desktop. Our results demonstrate the effectiveness of OpenMPE with geometric mean energy savings across 9 use cases of 15 % while maintaining full quality of service.

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Bridge construction responds to the need for environmentally friendly design of motorways and facilitates the passage through sensitive natural areas and the bypassing of urban areas. However, according to numerous research studies, bridge construction presents substantial budget overruns. Therefore, it is necessary early in the planning process for the decision makers to have reliable estimates of the final cost based on previously constructed projects. At the same time, the current European financial crisis reduces the available capital for investments and financial institutions are even less willing to finance transportation infrastructure. Consequently, it is even more necessary today to estimate the budget of high-cost construction projects -such as road bridges- with reasonable accuracy, in order for the state funds to be invested with lower risk and the projects to be designed with the highest possible efficiency. In this paper, a Bill-of-Quantities (BoQ) estimation tool for road bridges is developed in order to support the decisions made at the preliminary planning and design stages of highways. Specifically, a Feed-Forward Artificial Neural Network (ANN) with a hidden layer of 10 neurons is trained to predict the superstructure material quantities (concrete, pre-stressed steel and reinforcing steel) using the width of the deck, the adjusted length of span or cantilever and the type of the bridge as input variables. The training dataset includes actual data from 68 recently constructed concrete motorway bridges in Greece. According to the relevant metrics, the developed model captures very well the complex interrelations in the dataset and demonstrates strong generalisation capability. Furthermore, it outperforms the linear regression models developed for the same dataset. Therefore, the proposed cost estimation model stands as a useful and reliable tool for the construction industry as it enables planners to reach informed decisions for technical and economic planning of concrete bridge projects from their early implementation stages.

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This paper addresses the representation of landscape complexity in stated preferences research. It integrates landscape ecology and landscape economics and conducts the landscape analysis in a three-dimensional space to provide ecologically meaningful quantitative landscape indicators that are used as variables for the monetary valuation of landscape in a stated preferences study. Expected heterogeneity in taste intensity across respondents is addressed with a mixed logit model in Willingness to Pay space. The results suggest that the integration of landscape ecology metrics in a stated preferences model provides useful insights for valuing landscape and landscape changes

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We present the Coordinated Synoptic Investigation of NGC 2264, a continuous 30 day multi-wavelength photometric monitoring campaign on more than 1000 young cluster members using 16 telescopes. The unprecedented combination of multi-wavelength, high-precision, high-cadence, and long-duration data opens a new window into the time domain behavior of young stellar objects. Here we provide an overview of the observations, focusing on results from Spitzer and CoRoT. The highlight of this work is detailed analysis of 162 classical T Tauri stars for which we can probe optical and mid-infrared flux variations to 1% amplitudes and sub-hour timescales. We present a morphological variability census and then use metrics of periodicity, stochasticity, and symmetry to statistically separate the light curves into seven distinct classes, which we suggest represent different physical processes and geometric effects. We provide distributions of the characteristic timescales and amplitudes and assess the fractional representation within each class. The largest category (>20%) are optical "dippers" with discrete fading events lasting ~1-5 days. The degree of correlation between the optical and infrared light curves is positive but weak; notably, the independently assigned optical and infrared morphology classes tend to be different for the same object. Assessment of flux variation behavior with respect to (circum)stellar properties reveals correlations of variability parameters with Hα emission and with effective temperature. Overall, our results point to multiple origins of young star variability, including circumstellar obscuration events, hot spots on the star and/or disk, accretion bursts, and rapid structural changes in the inner disk. Based on data from the Spitzer and CoRoT missions. The CoRoT space mission was developed and is operated by the French space agency CNES, with participation of ESA's RSSD and Science Programmes, Austria, Belgium, Brazil, Germany, and Spain.

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Software-programmable `soft' processors have shown tremendous potential for efficient realisation of high performance signal processing operations on Field Programmable Gate Array (FPGA), whilst lowering the design burden by avoiding the need to design fine-grained custom circuit archi-tectures. However, the complex data access patterns, high memory bandwidth and computational requirements of sliding window applications, such as Motion Estimation (ME) and Matrix Multiplication (MM), lead to low performance, inefficient soft processor realisations. This paper resolves this issue, showing how by adding support for block data addressing and accelerators for high performance loop execution, performance and resource efficiency over four times better than current best-in-class metrics can be achieved. In addition, it demonstrates the first recorded real-time soft ME estimation realisation for H.263 systems.