Interventions to control nosocomial infections : study designs and statistical issues

There is a wide range of potential study designs for intervention studies to decrease nosocomial infections in hospitals. The analysis is complex due to competing events, clustering, multiple timescales and time-dependent period and intervention variables. This review considers the popular pre-post quasi-experimental design and compares it with randomized designs. Randomization can be done in several ways: randomization of the cluster [intensive care unit (ICU) or hospital] in a parallel design; randomization of the sequence in a cross-over design; and randomization of the time of intervention in a stepped-wedge design. We introduce each design in the context of nosocomial infections and discuss the designs with respect to the following key points: bias, control for nonintervention factors, and generalizability. Statistical issues are discussed. A pre-post-intervention design is often the only choice that will be informative for a retrospective analysis of an outbreak setting. It can be seen as a pilot study with further, more rigorous designs needed to establish causality. To yield internally valid results, randomization is needed. Generally, the first choice in terms of the internal validity should be a parallel cluster randomized trial. However, generalizability might be stronger in a stepped-wedge design because a wider range of ICU clinicians may be convinced to participate, especially if there are pilot studies with promising results. For analysis, the use of extended competing risk models is recommended.

A Hybrid Queue-based Bayesian Network framework for passenger facilitation modelling

This paper presents a novel framework for the modelling of passenger facilitation in a complex environment. The research is motivated by the challenges in the airport complex system, where there are multiple stakeholders, differing operational objectives and complex interactions and interdependencies between different parts of the airport system. Traditional methods for airport terminal modelling do not explicitly address the need for understanding causal relationships in a dynamic environment. Additionally, existing Bayesian Network (BN) models, which provide a means for capturing causal relationships, only present a static snapshot of a system. A method to integrate a BN complex systems model with stochastic queuing theory is developed based on the properties of the Poisson and exponential distributions. The resultant Hybrid Queue-based Bayesian Network (HQBN) framework enables the simulation of arbitrary factors, their relationships, and their effects on passenger flow and vice versa. A case study implementation of the framework is demonstrated on the inbound passenger facilitation process at Brisbane International Airport. The predicted outputs of the model, in terms of cumulative passenger flow at intermediary and end points in the inbound process, are found to have an R2 goodness of fit of 0.9994 and 0.9982 respectively over a 10 h test period. The utility of the framework is demonstrated on a number of usage scenarios including causal analysis and ‘what-if’ analysis. This framework provides the ability to analyse and simulate a dynamic complex system, and can be applied to other socio-technical systems such as hospitals.

Modeling and control of a CLC resonant dual active bridge

This paper proposes a linear large signal state-space model for a phase controlled CLC (Capacitor Inductor Capacitor) Resonant Dual Active Bridge (RDAB). The proposed model is useful for fast simulation and for the estimation of state variables under large signal variation. The model is also useful for control design because the slow changing dynamics of the dq variables are relatively easy to control. Simulation results of the proposed model are presented and compared to the simulated circuit model to demonstrate the proposed model's accuracy. This proposed model was used for the design of a Proportional-Integral (PI) controller and it has been implemented in the circuit simulation to show the proposed models usefulness in control design.

The effect of using different regions of interest on local and mean skin temperature

The dynamic nature of tissue temperature and the subcutaneous properties, such as blood flow, fatness, and metabolic rate, leads to variation in local skin temperature. Therefore, we investigated the effects of using multiple regions of interest when calculating weighted mean skin temperature from four local sites. Twenty-six healthy males completed a single trial in a thermonetural laboratory (mean ± SD): 24.0 (1.2) °C; 56 (8%) relative humidity; < 0.1 m/s air speed). Mean skin temperature was calculated from four local sites (neck, scapula, hand and shin) in accordance with International Standards using digital infrared thermography. A 50 x 50 mm square, defined by strips of aluminium tape, created six unique regions of interest, top left quadrant, top right quadrant, bottom left quadrant, bottom right quadrant, centre quadrant and the entire region of interest, at each of the local sites. The largest potential error in weighted mean skin temperature was calculated using a combination of a) the coolest and b) the warmest regions of interest at each of the local sites. Significant differences between the six regions interest were observed at the neck (P < 0.01), scapula (P < 0.001) and shin (P < 0.05); but not at the hand (P = 0.482). The largest difference (± SEM) at each site was as follows: neck 0.2 (0.1) °C; scapula 0.2 (0.0) °C; shin 0.1 (0.0) °C and hand 0.1 (0.1) °C. The largest potential error (mean ± SD) in weighted mean skin temperature was 0.4 (0.1) °C (P < 0.001) and the associated 95% limits of agreement for these differences was 0.2 to 0.5 °C. Although we observed differences in local and mean skin temperature based on the region of interest employed, these differences were minimal and are not considered physiologically meaningful.

Co-optimisation of indoor environmental quality and energy consumption within urban office buildings

This study aimed to develop a multi-component model that can be used to maximise indoor environmental quality inside mechanically ventilated office buildings, while minimising energy usage. The integrated model, which was developed and validated from fieldwork data, was employed to assess the potential improvement of indoor air quality and energy saving under different ventilation conditions in typical air-conditioned office buildings in the subtropical city of Brisbane, Australia. When operating the ventilation system under predicted optimal conditions of indoor environmental quality and energy conservation and using outdoor air filtration, average indoor particle number (PN) concentration decreased by as much as 77%, while indoor CO2 concentration and energy consumption were not significantly different compared to the normal summer time operating conditions. Benefits of operating the system with this algorithm were most pronounced during the Brisbane’s mild winter. In terms of indoor air quality, average indoor PN and CO2 concentrations decreased by 48% and 24%, respectively, while potential energy savings due to free cooling went as high as 108% of the normal winter time operating conditions. The application of such a model to the operation of ventilation systems can help to significantly improve indoor air quality and energy conservation in air-conditioned office buildings.

A survey: Error control methods used in bio-cryptography

Integration of biometrics is considered as an attractive solution for the issues associated with password based human authentication as well as for secure storage and release of cryptographic keys which is one of the critical issues associated with modern cryptography. However, the widespread popularity of bio-cryptographic solutions are somewhat restricted by the fuzziness associated with biometric measurements. Therefore, error control mechanisms must be adopted to make sure that fuzziness of biometric inputs can be sufficiently countered. In this paper, we have outlined such existing techniques used in bio-cryptography while explaining how they are deployed in different types of solutions. Finally, we have elaborated on the important facts to be considered when choosing appropriate error correction mechanisms for a particular biometric based solution.

Investigation of pedestrian crashes on two-way two-lane rural roads in Ethiopia

Understanding pedestrian crash causes and contributing factors in developing countries is critically important as they account for about 55% of all traffic crashes. Not surprisingly, considerable attention in the literature has been paid to road traffic crash prediction models and methodologies in developing countries of late. Despite this interest, there are significant challenges confronting safety managers in developing countries. For example, in spite of the prominence of pedestrian crashes occurring on two-way two-lane rural roads, it has proven difficult to develop pedestrian crash prediction models due to a lack of both traffic and pedestrian exposure data. This general lack of available data has further hampered identification of pedestrian crash causes and subsequent estimation of pedestrian safety performance functions. The challenges are similar across developing nations, where little is known about the relationship between pedestrian crashes, traffic flow, and road environment variables on rural two-way roads, and where unique predictor variables may be needed to capture the unique crash risk circumstances. This paper describes pedestrian crash safety performance functions for two-way two-lane rural roads in Ethiopia as a function of traffic flow, pedestrian flows, and road geometry characteristics. In particular, random parameter negative binomial model was used to investigate pedestrian crashes. The models and their interpretations make important contributions to road crash analysis and prevention in developing countries. They also assist in the identification of the contributing factors to pedestrian crashes, with the intent to identify potential design and operational improvements.

Rate Control State-of-the-art Survey

The majority of Internet traffic use Transmission Control Protocol (TCP) as the transport level protocol. It provides a reliable ordered byte stream for the applications. However, applications such as live video streaming place an emphasis on timeliness over reliability. Also a smooth sending rate can be desirable over sharp changes in the sending rate. For these applications TCP is not necessarily suitable. Rate control attempts to address the demands of these applications. An important design feature in all rate control mechanisms is TCP friendliness. We should not negatively impact TCP performance since it is still the dominant protocol. Rate Control mechanisms are classified into two different mechanisms: window-based mechanisms and rate-based mechanisms. Window-based mechanisms increase their sending rate after a successful transfer of a window of packets similar to TCP. They typically decrease their sending rate sharply after a packet loss. Rate-based solutions control their sending rate in some other way. A large subset of rate-based solutions are called equation-based solutions. Equation-based solutions have a control equation which provides an allowed sending rate. Typically these rate-based solutions react slower to both packet losses and increases in available bandwidth making their sending rate smoother than that of window-based solutions. This report contains a survey of rate control mechanisms and a discussion of their relative strengths and weaknesses. A section is dedicated to a discussion on the enhancements in wireless environments. Another topic in the report is bandwidth estimation. Bandwidth estimation is divided into capacity estimation and available bandwidth estimation. We describe techniques that enable the calculation of a fair sending rate that can be used to create novel rate control mechanisms.

Factors Affecting Knowledge Sharing in Strategic Alliances: The Role of Knowledge Sharing as Strategic Control Behavior among Multinational Enterprises

International strategic alliances (ISAs) have become increasingly important for the stability, growth, and long-term viability of modern business organizations. Alliance partnerships as inter-firm cooperative ventures represent an influential mechanism for asserting corporate strategic control among autonomous multinational enterprises. These different cooperative arrangements are made of equity investments or contractually-based partnerships. Different alliance forms represent different approaches that partner firms adopt to control their mutual dependence on the alliance and on other partners. Earlier research shows that the partner characteristics could provide an explanation for alliance strategic behavior and see alliances as alternative forms to markets or hierarchies for addressing specific strategic needs linked to partners’ characteristics and their subsequent strategic motives. These characteristics of the partners’ and subsequent strategic motives are analyzed as knowledge sharing factors and how these influence inter-firm control in alliances within the context of the focal-firm STMicroelectronics and its alliance partners Nokia, Ericsson and IBM. This study underline that as contracts are incomplete, they are therefore required to maintain mutual dependence based control mechanisms in addition to a contract. For example, mutual dependence based control mechanisms could be joint financial investments and the building of an ownership structure between the parties (e.g., JVs). However, the present study clarifies that subsequent inter-firm control is also exercised through inter-firm knowledge sharing. The present study contributes by presenting a dynamic interplay between competitive and cooperative rent seeking behavior. Such coopetition behavior describes the firm's strategic orientation to achieve a dynamic balance between competitive and cooperative strategies. This balance is seen in knowledge sharing based cooperation and competition behavior. Thus this study clarifies coopetition strategies by introducing the role of inter-firm cooperation and the competitive nature of knowledge sharing. Simultaneous cooperative and competitive behavior is also seen as synergetic rent-seeking behavior. Therefore, this study extends the perspective of previous studies on competitive and cooperative seeking behavior.

Unsteady laminar compressible swirling flow with massive blowing

THE study of swirling boundary layers is of considerable importance in many rotodynamic machines such as rockets, jet engines, swirl generators, swirl atomizers, arc heaters, etc. For example, the introduction of swirl in a flow acceleration device such as a nozzle in a rocket engine promises efficient mass flow control. In nuclear rockets, swirl is used to retain the uranium atoms in the rocket chamber. With these applications in mind, Back1 and Muthanna and Nath2 have obtained the similarity solutions for a low-speed three-dimensional steady laminar compressible boundary layer with swirl inside an axisymmetric surface of variable cross section. The aim of the present analysis is to study the effect of massive blowing rates on the unsteady laminar swirling compressible boundary-layer flow of an axisymmetric body of arbitrary cross section when the freestream velocity and blowing rate vary with time. The type of swirl considered here is that of a free vortex superimposed on the longitudinal flow of a compressible fluid with variable properties. The analysis is applicable to external flow over a body as well as internal flow along a surface. For the case of external flow, strong blowing can have significant use in cooling the surface of hypervelocity vehicles, particularly when ablation occurs under large aerodynamic or radiative heating, but there may not be such an important application of strong blowing in the case of internal flow. The governing partial differential equations have been solved numerically using an implicit finite difference scheme with a quasilinearization technique.3 High temperature gas effects, such as radiation, dissociation, and ionization, etc., are not investigated. The nomenclature is usually that of Ref. 4 and is listed in the full paper.

Micro-ramp control for oblique shock wave / boundary layer interactions

Supersonic engine intakes operating supercritically feature shock wave / boundary layer interactions (SBLIs), which are conventionally controlled using boundary layer bleed. The momentum loss of bleed flow causes high drag, compromising intake performance. Micro-ramp sub-boundary layer vortex generators (SBVGs) have been proposed as an alternative form of flow control for oblique SBLIs in order to reduce the bleed requirement. Experiments have been conducted at Mach 2.5 to characterise the flow details on such devices and investigate their ability to control the interaction between an oblique shock wave and the naturally grown turbulent boundary layer on the tunnel floor. Micro-ramps of four sizes with heights ranging from 25% to 75% of the uncontrolled boundary layer thickness were tested. The flow over all sizes of microramp was found to be similar, featuring streamwise counter-rotating vortices which entrain high momentum fluid, locally reducing the boundary layer displacement thickness. When installed ahead of the shock interaction it was found that the positioning of the micro-ramps is of limited importance. Micro-ramps did not eliminate flow separation. However, the previously two-dimensional separation was broken up into periodic three-dimensional separation zones. The interaction length was reduced and the pressure gradient across the interaction was increased.

Behaviour of unsteady transonic shock / boundary layer interactions with three-dimensional effects

An experimental investigation into the response of transonic SBLIs to periodic down-stream pressure perturbations in a parallel walled duct has been conducted. Tests have been carried out with a shock strength of M ∞ = 1.5 for pressure perturbation frequencies in the range 16-90 Hz. Analysis of the steady interaction at M∞ = 1.5 has also been made. The principle measurement techniques were high speed schlieren photography and laser Doppler anemometry. The structure of the steady SBLI was found to be highly three-dimensional, with large corner flows and sidewall SBLIs. These aspects are thought to influence the upstream transmission of pressure information through the interaction by affecting the post-shock flow field, including the extent of regions of secondary supersonic flow. At low frequency, the dynamics of shock motion can be predicted using an inviscid analytical model. At increased frequencies, viscous effects become significant and the shock exhibits unexpected dynamic behaviour, due to a phase lag between the upstream transmission of pressure information in the core flow and in the viscous boundary layers. Flow control in the form of micro-vane vortex generators was found to have a small impact on shock dynamics, due to the effect it had on the post-shock flow field outside the viscous boundary layer region. The relationship between inviscid and viscous effects is developed and potential destabilising mechanisms for SBLIs in practical applications are suggested. Copyright © 2009 by Paul Bruce and Holger Babinsky.

Different mechanisms involved in adaptation to stable and unstable dynamics.

Recently, we demonstrated that humans can learn to make accurate movements in an unstable environment by controlling magnitude, shape, and orientation of the endpoint impedance. Although previous studies of human motor learning suggest that the brain acquires an inverse dynamics model of the novel environment, it is not known whether this control mechanism is operative in unstable environments. We compared learning of multijoint arm movements in a "velocity-dependent force field" (VF), which interacted with the arm in a stable manner, and learning in a "divergent force field" (DF), where the interaction was unstable. The characteristics of error evolution were markedly different in the 2 fields. The direction of trajectory error in the DF alternated to the left and right during the early stage of learning; that is, signed error was inconsistent from movement to movement and could not have guided learning of an inverse dynamics model. This contrasted sharply with trajectory error in the VF, which was initially biased and decayed in a manner that was consistent with rapid feedback error learning. EMG recorded before and after learning in the DF and VF are also consistent with different learning and control mechanisms for adapting to stable and unstable dynamics, that is, inverse dynamics model formation and impedance control. We also investigated adaptation to a rotated DF to examine the interplay between inverse dynamics model formation and impedance control. Our results suggest that an inverse dynamics model can function in parallel with an impedance controller to compensate for consistent perturbing force in unstable environments.

Impedance control and internal model use during the initial stage of adaptation to novel dynamics in humans.

This study investigated the neuromuscular mechanisms underlying the initial stage of adaptation to novel dynamics. A destabilizing velocity-dependent force field (VF) was introduced for sets of three consecutive trials. Between sets a random number of 4-8 null field trials were interposed, where the VF was inactivated. This prevented subjects from learning the novel dynamics, making it possible to repeatedly recreate the initial adaptive response. We were able to investigate detailed changes in neural control between the first, second and third VF trials. We identified two feedforward control mechanisms, which were initiated on the second VF trial and resulted in a 50% reduction in the hand path error. Responses to disturbances encountered on the first VF trial were feedback in nature, i.e. reflexes and voluntary correction of errors. However, on the second VF trial, muscle activation patterns were modified in anticipation of the effects of the force field. Feedforward cocontraction of all muscles was used to increase the viscoelastic impedance of the arm. While stiffening the arm, subjects also exerted a lateral force to counteract the perturbing effect of the force field. These anticipatory actions indicate that the central nervous system responds rapidly to counteract hitherto unfamiliar disturbances by a combination of increased viscoelastic impedance and formation of a crude internal dynamics model.