The study protocol of: 'initiating end of life care in stroke: clinical decision- making around prognosis'

 Background: The initiation of end of life care in an acute stroke context should be focused on those patients and families with greatest need. This requires clinicians to synthesise information on prognosis, patterns (trajectories) of dying and patient and family preferences. Within acute stroke, prognostic models are available to identify risks of dying, but variability in dying trajectories makes it difficult for clinicians to know when to commence palliative interventions. This study aims to investigate clinicians’ use of different types of evidence in decisions to initiate end of life care within trajectories typical of the acute stroke population.
Methods/design: This two-phase, mixed methods study comprises investigation of dying trajectories in acute stroke (Phase 1), and the use of clinical scenarios to investigate clinical decision-making in the initiation of palliative care (Phase 2). It will be conducted in four acute stroke services in North Wales and North West England. Patient and public involvement is integral to this research, with service users involved at each stage.
Discussion: This study will be the first to examine whether patterns of dying reported in other diagnostic groups are transferable to acute stroke care. The strengths and limitations of the study will be considered. This research will produce comprehensive understanding of the nature of clinical decision-making around end of life care in an acute stroke context, which in turn will inform the development of interventions to further build staff knowledge, skills and confidence in this challenging aspect of acute stroke care.

General approach for electrochemical functionalization of glassy carbon surface by in situ generation of diazonium ion under acidic and non-acidic condition with a cascade protocol

Immobilization of catechol derivatives on GC electrode surfaces can be performed by in situ generation and reduction of nitrocatechol. We present the oxidative nitration of catechol in the presence of nitrous acid followed by electrochemically reduction of the generated nitro aromatic group to the corresponding amine group and its conversion to diazonium cation at the electrode surface to yield a surface covalently modified with catechol. In this manner, some derivatives of catechol can be immobilized on the electrode surface. Whole of the process is carried out in Triethylammonium acetate ionic liquid as an inert and neutral medium (pH∼7.0). Surface coverage can be easily controlled by the applied potential, time and concentration of catechol. After modification, the electrochemical features of modified surface have been studied. Also modified GC electrode exhibited remarkable catalytic activity in the oxidation of NADH. The catalytic currents were proportional to the concentration of NADH over the range 0.01-0.80 mM. This condition can be used for modification of GC surfaces by various aromatic molecules for different application such as design of sensors and biosensors. © 2014 Elsevier Ltd. All rights reserved.

Robust nonlinear distributed controller design for active and reactive power sharing in islanded microgrids

This paper presents a robust nonlinear distributed controller design for islanded operation of microgrids in order to maintain active and reactive power balance. In this paper, microgrids are considered as inverter-dominated networks integrated with renewable energy sources (RESs) and battery energy storage systems (BESSs), where solar photovoltaic generators act as RESs and plug-in hybrid electric vehicles as BESSs to supply power into the grid. The proposed controller is designed by using partial feedback linearization and the robustness of this control scheme is ensured by considering structured uncertainties within the RESs and BESSs. An approach for modeling the uncertainties through the satisfaction of matching conditions is also provided in this paper. The proposed distributed control scheme requires information from local and neighboring generators to communicate with each other and the communication among RESs, BESSs, and control centers is developed by using the concept of the graph theory. Finally, the performance of the proposed robust controller is demonstrated on a test microgrid and simulation results indicate the superiority of the proposed scheme under different operating conditions as compared to a linear-quadratic-regulator-based controller.

Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: protocol for a randomised controlled trial

Many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy so breast milk is available after birth, given (1) infants of these women are at increased risk of hypoglycaemia in the first 24 h of life; and (2) the delay in lactogenesis II compared with women without diabetes that increases their infant's risk of receiving infant formula. The Diabetes and Antenatal Milk Expressing (DAME) trial will establish whether advising women with diabetes in pregnancy (pre-existing or gestational) to express breast milk from 36 weeks gestation increases the proportion of infants who require admission to special or neonatal intensive care units (SCN/NICU) compared with infants of women receiving standard care. Secondary outcomes include birth gestation, breastfeeding outcomes and economic impact.

Robust nonlinear controller design for three-phase grid-connected photovoltaic systems under structured uncertainties

This paper presents a robust nonlinear controller design for a three-phase grid-connected photovoltaic (PV) system to control the current injected into the grid and the dc-link voltage for extracting maximum power from PV units. The controller is designed based on the partial feedback linearization approach, and the robustness of the proposed control scheme is ensured by considering structured uncertainties within the PV system model. An approach for modeling the uncertainties through the satisfaction of matching conditions is provided. The superiority of the proposed robust controller is demonstrated on a test system through simulation results under different system contingencies along with changes in atmospheric conditions. From the simulation results, it is evident that the robust controller provides excellent performance under various operating conditions. © 2014 IEEE.

My road ahead study protocol: a randomised controlled trial of an online psychological intervention for men following treatment for localised prostate cancer

There is a need for psychosocial interventions for men with prostate cancer to promote adaptive coping with the challenges and distress associated with diagnosis, treatment and recovery. In addition, interventions are needed that help to overcome barriers to psychosocial treatment such as limited face-to-face psychosocial support services, a shortage of adequately trained professionals, geographical distance, perceived and personal stigma and a preference for consumer-centric and self-directed learning. My Road Ahead is an online cognitive behaviour therapy (CBT) intervention for prostate cancer. This protocol describes a randomised controlled trial (RCT) that will evaluate the efficacy of this online intervention alone, the intervention in combination with a moderated online forum, and the moderated online forum alone.

Dealing with alcohol-related problems in the night-time economy: a study protocol for mapping trends in harm and stakeholder views surrounding local community level interventions

This project will provide a comprehensive investigation into the prevalence of alcohol-related harms and community attitudes in the context of community-based interventions being implemented to reduce harm in two regional centres of Australia. While considerable experimentation and innovation to address these harms has occurred in both Geelong and Newcastle, only limited ad-hoc documentation and analysis has been conducted on changes in the prevalence of harm as a consequence, leaving a considerable gap in terms of a systematic, evidence-based analysis of changes in harm over time and the need for further intervention. Similarly, little evidence has been reported regarding the views of key stakeholder groups, industry, government agencies, patrons or community regarding the need for, and the acceptability of, interventions to reduce harms. This project will aim to provide evidence regarding the impact and acceptability of local initiatives aimed at reducing alcohol-related harms.

A randomised controlled trial of an intervention to increase the implementation of a healthy canteen policy in Australian primary schools: study protocol

Background: The implementation of healthy school canteen policies has been recommended as a strategy to help prevent unhealthy eating and excessive weight gain. Internationally, research suggests that schools often fail to implement practices consistent with healthy school canteen policies. Without a population wide implementation, the potential benefits of these policies will not be realised. The aim of this trial is to assess the effectiveness of an implementation intervention in increasing school canteen practices consistent with a healthy canteen policy of the New South Wales (NSW), Australia, government known as the 'Fresh Tastes @ School NSW Healthy School Canteen Strategy'.Methods/design: The parallel randomised trial will be conducted in 70 primary schools located in the Hunter region of New South Wales, Australia. Schools will be eligible to participate if they are not currently meeting key components of the healthy canteen policy. Schools will be randomly allocated after baseline data collection in a 1:1 ratio to either an intervention or control group using a computerised random number function in Microsoft Excel. Thirty-five schools will be selected to receive a multi-component intervention including implementation support from research staff, staff training, resources, recognition and incentives, consensus and leadership strategies, follow-up support and implementation feedback. The 35 schools allocated to the control group will not receive any intervention support as part of the research trial. The primary outcome measures will be i) the proportion of schools with a canteen menu that does not contain foods or beverages restricted from regular sale ('red' and 'banned' items) and ii) the proportion of schools where healthy canteen items ('green' items) represent the majority (>50%) of products listed on the menu. Outcome data will be collected via a comprehensive menu audit, conducted by dietitians blind to group allocation. Intervention effectiveness will be assessed using logistic regression models adjusting for baseline values.Discussion: The proposed trial will represent a novel contribution to the literature, being the first randomised trial internationally to examine the effectiveness of an intervention to facilitate implementation of a healthy canteen policy.

ANFIS traffic signal controller for an isolated intersection

Traffic signal controlling is one of the solutions to reduce the traffic congestion in cities. To set appropriate green times for traffic signal lights, we have applied Adaptive Neuro-Fuzzy Inference System (ANFIS) method in traffic signal controllers. ANFIS traffic signal controller is used for controlling traffic congestion of a single intersection with the purpose of minimizing travel delay time. The ANFIS traffic controller is an intelligent controller that learns to set an appropriate green time for each phase of traffic signal lights at the start of the phase and based on the traffic information. The controller uses genetic algorithm to tune ANFIS parameters during learning time. The results of the experiments show higher performance of the ANFIS traffic signal controller compared to three other traffic controllers that are developed as benchmarks. One of the benchmarks is GA-FLC (Araghi et al., 2014), next one is a fixed-FLC, and a fixed-time controller with three different values for green phase. Results show the higher performance of ANFIS controller.

A sliding-mode-control-based adaptive cruise controller

This paper presents an alternative solution to the conventional cruise controller of a hybrid electric vehicle based on the sliding mode control approach. The mathematical model of a hybrid electric vehicle cruise control system is developed. Then, the sliding mode control approach is applied as the controller. The sliding mode control stability is investigated and demonstrated. Thereafter, the system is simulated and the results are presented. © 2014 IEEE.

A robust grouping proof protocol for RFID EPC C1G2 tags

Several grouping proof protocols for RFID systems have been proposed over the years but they are either found to be vulnerable to certain attacks or do not comply with the EPC class-1 gen-2 (C1G2) standard because they use hash functions or other complex encryption schemes. Among other requirements, synchronization of keys, simultaneity, dependence, detecting illegitimate tags, eliminating unwanted tag processing, and denial-of-proof attacks have not been fully addressed by many. Our protocol addresses these important gaps by taking a holistic approach to grouping proofs and provides forward security, which is an open research issue. The protocol is based on simple (XOR) encryption and 128-bit pseudorandom number generators, operations that can be easily implemented on low-cost passive tags. Thus, our protocol enables large-scale implementations and achieves EPC C1G2 compliance while meeting the security requirements.

An RCT to evaluate the utility of a clinical protocol for staff in the management of behavioral and psychological symptoms of dementia in residential aged-care settings

Objectives: Behavioral and psychological symptoms of dementia (BPSD) cause significant stress and distress to both aged-care residents and staff. This study evaluated a training program to assist staff to manage BPSD in residential care. Method: A randomised controlled trial (RCT) was employed. The study was included in the Australian and New Zealand Clinical Trial Register residential care facilities. Staff (n = 204) and residents (n = 187) were from 16 residential care facilities. Facilities were recruited and randomly assigned to four staff training conditions: (1) training in the use of a BPSD-structured clinical protocol, plus external clinical support, (2) a workshop on BPSD, plus external clinical support, (3) training in the use of the structured clinical protocol alone, and (4) care as usual. Staff and resident outcome measures were obtained pre-intervention, three months and six months post-intervention. The primary outcome was changes in BPSD, measured using the Cohen-Mansfield Agitation Inventory (CMAI) as well as frequency and duration of challenging behaviors. Secondary outcomes were changes in staff adjustment. Results: There were improvements in challenging behaviors for both intervention conditions that included training in the BPSD instrument, but these were not maintained in the condition without clinical support. The training/support condition resulted in sustained improvements in both staff and resident variables, whereas the other conditions only led to improvement in some of the measured variables. Conclusion: These results demonstrate the effectiveness of the BPSD protocol in reducing BPSD and improving staff self-efficacy and stress.

Low cost MPPT controller for a photovoltaic-based microgrid

 Photovoltaic based microgrid have been increasingly investigated in recent years, ascribable to their fundamental advantages such as the infinite energy source, environmentally friendly aspect and low upkeep cost. However, in practice, they are still considered as an expensive and low output option of renewable energy resources. To extract the maximum possible power from the output of the PV system, a reliable maximum power point tracker (MPPT) is required. Numerous studies have been conducted to introduce the best MPPT techniques suitable for different types of PV systems. However, they are mostly able to track the MPP from the PV system when the output signals (Voltage and Current) of individual array are available. In this study, a meta-heuristic method, based on particle swarm optimization theory, is used to determine the actual MPP of PV system, including several PV arrays, by only single current sensor at the output terminal. The results of the proposed PSO based technique, for tracking the global MPP in a multidimensional search space, have been presented at the end of this paper.

Developing an instrumental activities of daily living tool as part of the low vision assessment of daily activities protocol

To determine the validity, reliability, and measurement characteristics using factor and Rasch analysis of the Very Low Vision Instrumental Activities of Daily Living (IADL-VLV) in persons with severe vision loss.

Optimal design of traffic signal controller using neural networks and fuzzy logic systems

This paper aims at optimally adjusting a set of green times for traffic lights in a single intersection with the purpose of minimizing travel delay time and traffic congestion. Neural network (NN) and fuzzy logic system (FLS) are two methods applied to develop intelligent traffic timing controller. For this purpose, an intersection is considered and simulated as an intelligent agent that learns how to set green times in each cycle based on the traffic information. The training approach and data for both these learning methods are similar. Both methods use genetic algorithm to tune their parameters during learning. Finally, The performance of the two intelligent learning methods is compared with the performance of simple fixed-time method. Simulation results indicate that both intelligent methods significantly reduce the total delay in the network compared to the fixed-time method.