Progress on core outcomes sets for critical care research

Purpose of review: Appropriate selection and definition of outcome measures are essential for clinical trials to be maximally informative. Core outcome sets (an agreed, standardized collection of outcomes measured and reported in all trials for a specific clinical area) were developed due to established inconsistencies in trial outcome selection. This review discusses the rationale for, and methods of, core outcome set development, as well as current initiatives in critical care.

Recent findings: Recent systematic reviews of reported outcomes and measurement instruments relevant to the critically ill highlight inconsistencies in outcome selection, definition, and measurement, thus establishing the need for core outcome sets. Current critical care initiatives include development of core outcome sets for trials aimed at reducing mechanical ventilation duration; rehabilitation following critical illness; long-term outcomes in acute respiratory failure; and epidemic and pandemic studies of severe acute respiratory infection.

Summary: Development and utilization of core outcome sets for studies relevant to the critically ill is in its infancy compared to other specialties. Notwithstanding, core outcome set development frameworks and guidelines are available, several sets are in various stages of development, and there is strong support from international investigator-led collaborations including the International Forum for Acute Care Trialists.

The effect of AMS δ13C values on 14C ages measured on a 0.5MV NEC compact accelerator

Many AMS systems can measure 14C, 13C and 12C simultaneously thus providing δ13C values which can be used for fractionation normalization without the need for offline 13C /12C measurements on isotope ratio mass spectrometers (IRMS). However AMS δ13C values on our 0.5MV NEC Compact Accelerator often differ from IRMS values on the same material by 4-5‰ or more. It has been postulated that the AMS δ13C values account for the potential graphitization and machine induced fractionation, in addition to natural fractionation, but how much does this affect the 14C ages or F14C? We present an analysis of F14C as a linear least squares fit with AMS δ13C results for several of our secondary standards. While there are samples for which there is an obvious correlation between AMS δ13C and F14C, as quantified with the calculated probability of no correlation, we find that the trend lies within one standard deviation of the variance on our F14C measurements. Our laboratory produces both zinc and hydrogen reduced graphite, and we present our results for each type. Additionally, we show the variance on our AMS δ13C measurements of our secondary standards.

COS-STAR: a reporting guideline for studies developing core outcome sets (protocol)

BACKGROUND: Core outcome sets can increase the efficiency and value of research and, as a result, there are an increasing number of studies looking to develop core outcome sets (COS). However, the credibility of a COS depends on both the use of sound methodology in its development and clear and transparent reporting of the processes adopted. To date there is no reporting guideline for reporting COS studies. The aim of this programme of research is to develop a reporting guideline for studies developing COS and to highlight some of the important methodological considerations in the process.

METHODS/DESIGN: The study will include a reporting guideline item generation stage which will then be used in a Delphi study. The Delphi study is anticipated to include two rounds. The first round will ask stakeholders to score the items listed and to add any new items they think are relevant. In the second round of the process, participants will be shown the distribution of scores for all stakeholder groups separately and asked to re-score. A final consensus meeting will be held with an expert panel and stakeholder representatives to review the guideline item list. Following the consensus meeting, a reporting guideline will be drafted and review and testing will be undertaken until the guideline is finalised. The final outcome will be the COS-STAR (Core Outcome Set-STAndards for Reporting) guideline for studies developing COS and a supporting explanatory document.

DISCUSSION: To assess the credibility and usefulness of a COS, readers of a COS development report need complete, clear and transparent information on its methodology and proposed core set of outcomes. The COS-STAR guideline will potentially benefit all stakeholders in COS development: COS developers, COS users, e.g. trialists and systematic reviewers, journal editors, policy-makers and patient groups.

Core outcome sets and trial registries

Some reasons for registering trials might be considered as self-serving, such as satisfying the requirements of a journal in which the researchers wish to publish their eventual findings or publicising the trial to boost recruitment. Registry entries also help others, including systematic reviewers, to know about ongoing or unpublished studies and contribute to reducing research waste by making it clear what studies are ongoing. Other sources of research waste include inconsistency in outcome measurement across trials in the same area, missing data on important outcomes from some trials, and selective reporting of outcomes. One way to reduce this waste is through the use of core outcome sets: standardised sets of outcomes for research in specific areas of health and social care. These do not restrict the outcomes that will be measured, but provide the minimum to include if a trial is to be of the most use to potential users. We propose that trial registries, such as ISRCTN, encourage researchers to note their use of a core outcome set in their entry. This will help people searching for trials and those worried about selective reporting in closed trials. Trial registries can facilitate these efforts to make new trials as useful as possible and reduce waste. The outcomes section in the entry could prompt the researcher to consider using a core outcome set and facilitate the specification of that core outcome set and its component outcomes through linking to the original core outcome set. In doing this, registries will contribute to the global effort to ensure that trials answer important uncertainties, can be brought together in systematic reviews, and better serve their ultimate aim of improving health and well-being through improving health and social care.

Ultra-Compact and Robust FPGA-Based PUF Identification Generator

Physically Unclonable Functions (PUFs), exploit inherent manufacturing variations and present a promising solution for hardware security. They can be used for key storage, authentication and ID generations. Low power cryptographic design is also very important for security applications. However, research to date on digital PUF designs, such as Arbiter PUFs and RO PUFs, is not very efficient. These PUF designs are difficult to implement on Field Programmable Gate Arrays (FPGAs) or consume many FPGA hardware resources. In previous work, a new and efficient PUF identification generator was presented for FPGA. The PUF identification generator is designed to fit in a single slice per response bit by using a 1-bit PUF identification generator cell formed as a hard-macro. In this work, we propose an ultra-compact PUF identification generator design. It is implemented on ten low-cost Xilinx Spartan-6 FPGA LX9 microboards. The resource utilization is only 2.23%, which, to the best of the authors' knowledge, is the most compact and robust FPGA-based PUF identification generator design reported to date. This PUF identification generator delivers a stable range of uniqueness of around 50% and good reliability between 85% and 100%.

SN 2011dh: DISCOVERY OF A TYPE IIb SUPERNOVA FROM A COMPACT PROGENITOR IN THE NEARBY GALAXY M51

On 2011 May 31 UT a supernova (SN) exploded in the nearby galaxy M51 (the Whirlpool Galaxy). We discovered this event using small telescopes equipped with CCD cameras and also detected it with the Palomar Transient Factory survey, rapidly confirming it to be a Type II SN. Here, we present multi-color ultraviolet through infrared photometry which is used to calculate the bolometric luminosity and a series of spectra. Our early-time observations indicate that SN 2011dh resulted from the explosion of a relatively compact progenitor star. Rapid shock-breakout cooling leads to relatively low temperatures in early-time spectra, compared to explosions of red supergiant stars, as well as a rapid early light curve decline. Optical spectra of SN 2011dh are dominated by H lines out to day 10 after explosion, after which He I lines develop. This SN is likely a member of the cIIb (compact IIb) class, with progenitor radius larger than that of SN 2008ax and smaller than the eIIb (extended IIb) SN 1993J progenitor. Our data imply that the object identified in pre-explosion Hubble Space Telescope images at the SN location is possibly a companion to the progenitor or a blended source, and not the progenitor star itself, as its radius (~1013 cm) would be highly inconsistent with constraints from our post-explosion spectra.

On the numerical solution of the 2d wave equation with compact fdtd schemes

This paper discusses compact-stencil finite difference time domain (FDTD) schemes for approximating the 2D wave equation in the context of digital audio. Stability, accuracy, and efficiency are investigated and new ways of viewing and interpreting the results are discussed. It is shown that if a tight accuracy constraint is applied, implicit schemes outperform explicit schemes. The paper also discusses the relevance to digital waveguide mesh modelling, and highlights the optimally efficient explicit scheme.

Inference in Polytrees with Sets of Probabilities

Inferences in directed acyclic graphs associated with probability intervals and sets of probabilities are NP-hard, even for polytrees. We propose: 1) an improvement on Tessem’s A/R algorithm for inferences on polytrees associated with probability intervals; 2) a new algorithm for approximate inferences based on local search; 3) branch-and-bound algorithms that combine the previous techniques. The first two algorithms produce complementary approximate solutions, while branch-and-bound procedures can generate either exact or approximate solutions. We report improvements on existing techniques for inference with probability sets and intervals, in some cases reducing computational effort by several orders of magnitude.

Compact Routing Messages in Self-Healing Trees

Existing compact routing schemes, e.g., Thorup and Zwick [SPAA 2001] and Chechik [PODC 2013], often have no means to tolerate failures, once the system has been setup and started. This paper presents, to our knowledge, the first self-healing compact routing scheme. Besides, our schemes are developed for low memory nodes, i.e., nodes need only O(log2 n) memory, and are thus, compact schemes.
We introduce two algorithms of independent interest: The first is CompactFT, a novel compact version (using only O(log n) local memory) of the self-healing algorithm Forgiving Tree of Hayes et al. [PODC 2008]. The second algorithm (CompactFTZ) combines CompactFT with Thorup-Zwick’s treebased compact routing scheme [SPAA 2001] to produce a fully compact self-healing routing scheme. In the self-healing model, the adversary deletes nodes one at a time with the affected nodes self-healing locally by adding few edges. CompactFT recovers from each attack in only O(1) time and ∆ messages, with only +3 degree increase and O(log∆) graph diameter increase, over any sequence of deletions (∆ is the initial maximum degree).
Additionally, CompactFTZ guarantees delivery of a packet sent from sender s as long as the receiver has not been deleted, with only an additional O(y log ∆) latency, where y is the number of nodes that have been deleted on the path between s and t. If t has been deleted, s gets informed and the packet removed from the network.