Control strategies to prevent total hip replacement-related infections : a systematic review and mixed treatment comparison

OBJECTIVE: To synthesise the available evidence and estimate the comparative efficacy of control strategies to prevent total hip replacement (THR)-related surgical site infections (SSIs) using a mixed treatment comparison. DESIGN: Systematic review and mixed treatment comparison. SETTING: Hospital and other healthcare settings. PARTICIPANTS: Patients undergoing THR. PRIMARY AND SECONDARY OUTCOME MEASURES: The number of THR-related SSIs occurring following the surgical operation. RESULTS: 12 studies involving 123 788 THRs and 9 infection control strategies were identified. The strategy of 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation' significantly reduced the risk of THR-related SSI compared with the referent strategy (no systemic antibiotics+plain cement+conventional ventilation), OR 0.13 (95% credible interval (CrI) 0.03-0.35), and had the highest probability (47-64%) and highest median rank of being the most effective strategy. There was some evidence to suggest that 'systemic antibiotics+antibiotic-impregnated cement+laminar airflow' could potentially increase infection risk compared with 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation', 1.96 (95% CrI 0.52-5.37). There was no high-quality evidence that antibiotic-impregnated cement without systemic antibiotic prophylaxis was effective in reducing infection compared with plain cement with systemic antibiotics, 1.28 (95% CrI 0.38-3.38). CONCLUSIONS: We found no convincing evidence in favour of the use of laminar airflow over conventional ventilation for prevention of THR-related SSIs, yet laminar airflow is costly and widely used. Antibiotic-impregnated cement without systemic antibiotics may not be effective in reducing THR-related SSIs. The combination with the highest confidence for reducing SSIs was 'systemic antibiotics+antibiotic-impregnated cement+conventional ventilation'. Our evidence synthesis underscores the need to review current guidelines based on the available evidence, and to conduct further high-quality double-blind randomised controlled trials to better inform the current clinical guidelines and practice for prevention of THR-related SSIs.

Ghrelin and the brain-gut axis as a pharmacological target for appetite control

Appetite regulation is highly complex and involves a large number of orexigenic and anorexigenic peptide hormones. These are small, processed, secreted peptides derived from larger prepropeptide precursors. These peptides are important targets for the development of therapeutics for obesity, a global health epidemic. As a case study, we consider the ghrelin axis. The ghrelin axis is likely to be a particularly useful drug target, as it also plays a role in energy homeostasis, adipogenesis, insulin regulation and reward associated with food intake. Ghrelin is the only known circulating gut orexigenic peptide hormone. As it appears to play a role in diet-induced obesity, blocking the action of ghrelin is likely to be effective for treating and preventing obesity. The ghrelin peptide has been targeted using a number of approaches, with ghrelin mirror-image oligonucleotides (Spiegelmers) and immunotherapy showing some promise. The ghrelin receptor, the growth hormone secretagogue receptor, may also provide a useful target and a number of antagonists and inverse agonists have been developed. A particularly promising new target is the enzyme which octanoylates ghrelin, ghrelin O-acyltransferase (GOAT), and drugs that inhibit GOAT are likely to circumvent pharmacological issues associated with approaches that directly target ghrelin or its receptor.

An overview of the marine systems simulator (MSS) : a Simulink toolbox for marine control systems

The Marine Systems Simulator (MSS) is an environment which provides the necessary resources for rapid implementation of mathematical models of marine systems with focus on control system design. The simulator targets models¡Xand provides examples ready to simulate¡Xof different floating structures and its systems performing various operations. The platform adopted for the development of MSS is Matlab/Simulink. This allows a modular simulator structure, and the possibility of distributed development. Openness and modularity of software components have been the prioritized design principles, which enables a systematic reuse of knowledge and results in efficient tools for research and education. This paper provides an overview of the structure of the MSS, its features, current accessability, and plans for future development.

Sensor fault-resilient control of interior permanent-magnet synchronous motor drives

In a conventional ac motor drive using field-oriented control, a dc-link voltage, speed, and at least two current sensors are required. Hence, in the event of sensor failure, the performance of the drive system can be severely compromised. This paper presents a sensor fault-tolerant control strategy for interior permanent-magnet synchronous motor (IPMSM) drives. Three independent observers are proposed to estimate the speed, dc-link voltage, and currents of the machine. If a sensor fault is detected, the drive system isolates the faulty sensor while retaining the remaining functional ones. The signal is then acquired from the corresponding observer in order to maintain the operation of the drive system. The experimental results provided verify the effectiveness of the proposed approach.

Power buffer with model predictive control for stability of vehicular power systems with constant power loads

Electrification of vehicular systems has gained increased momentum in recent years with particular attention to constant power loads (CPLs). Since a CPL potentially threatens system stability, stability analysis of hybrid electric vehicle with CPLs becomes necessary. A new power buffer configuration with battery is introduced to mitigate the effect of instability caused by CPLs. Model predictive control (MPC) is applied to regulate the power buffer to decouple source and load dynamics. Moreover, MPC provides an optimal tradeoff between modification of load impedance, variation of dc-link voltage and battery current ripples. This is particularly important during transients or starting of system faults, since battery response is not very fast. Optimal tradeoff becomes even more significant when considering low-cost power buffer without battery. This paper analyzes system models for both voltage swell and voltage dip faults. Furthermore, a dual mode MPC algorithm is implemented in real time offering improved stability. A comprehensive set of experimental results is included to verify the efficacy of the proposed power buffer.

Five-level current-source inverters with buck-boost and inductive-current balancing capabilities

This paper presents new five-level current-source inverters (CSIs) with voltage/current buck-boost capability, unlike existing five-level CSIs where only voltage-boost operation is supported. The proposed inverters attain self-inductive-current-balancing per switching cycle at their dc front ends without having to include additional balancing hardware or complex control manipulation. The inverters can conveniently be controlled by using the well-established phase-shifted carrier modulation scheme with only two additional linear references and a mapping logic table needed. Existing modulators can therefore be conveniently retrofitted for controlling the presented inverters. By appropriately coordinating the inverter gating signals, their implementations can be realized by using the least number of components without degrading performance. These enhanced features of the inverters have already been verified in simulation and experimentally using a scaled-down laboratory platform.

Integrated access control for smart buildings using building information models

This thesis investigates the use of building information models for access control and security applications in critical infrastructures and complex building environments. It examines current problems in security management for physical and logical access control and proposes novel solutions that exploit the detailed information available in building information models. The project was carried out as part of the Airports of the Future Project and the research was modelled based on real-world problems identified in collaboration with our industry partners in the project.

Control of ion density distribution by magnetic traps for plasma electrons

The effect of a magnetic field of two magnetic coils on the ion current density distribution in the setup for low-temperature plasma deposition is investigated. The substrate of 400 mm diameter is placed at a distance of 325 mm from the plasma duct exit, with the two magnetic coils mounted symmetrically under the substrate at a distance of 140 mm relative to the substrate centre. A planar probe is used to measure the ion current density distribution along the plasma flux cross-sections at distances of 150, 230, and 325 mm from the plasma duct exit. It is shown that the magnetic field strongly affects the ion current density distribution. Transparent plastic films are used to investigate qualitatively the ion density distribution profiles and the effect of the magnetic field. A theoretical model is developed to describe the interaction of the ion fluxes with the negative space charge regions associated with the magnetic trapping of the plasmaelectrons. Theoretical results are compared with the experimental measurements, and a reasonable agreement is demonstrated.

Experiences with control of evaporators using extensive vapour bleeding

FOR SUGAR factories with cogeneration plants major changes to the process stations have been undertaken to reduce the consumption of exhaust steam from the turbines and maximise the generated power. In many cases the process steam consumption has been reduced from greater than 52% on cane to ~40% on cane. The main changes have been to install additional evaporation area at the front of the set, operate the pan stages on vapour from No 1 or No 2 effects and undertake juice heating using vapour bleed from evaporators as far down the set as the penultimate stage. Operationally, one of the main challenges has been to develop a control system for the evaporators that addresses the objectives of juice processing rate (throughput) and steam economy, while producing syrup consistently at the required brix and providing an adequate and consistent vapour pressure for the pan stage operations. The cyclic demand for vapour by batch pans causes process disturbances through the evaporator set and these must be regulated in an effective manner to satisfy the above list of objectives for the evaporator station. The impact of the cyclic pan stage vapour demand has been modelled to define the impact on juice rate, steam economy, syrup brix and head space pressures in the evaporators. Experiences with the control schemes used at Pioneer and Rocky Point Mills are discussed. For each factory the paper provides information on (a) the control system used, the philosophy behind the control system and experiences in reaching the current system for control (b) the performance of the control system to handle the disturbances imposed by the pan stage and operate within other constraints of the factory (c) deficiencies in the current system and plans for further improvements. Other processing changes to boost the performance of the evaporators are also discussed.

Mathematical modeling of the cancer cell’s control circuitry : paving the way to individualized therapeutic strategies

Cancer is a disease of signal transduction in which the dysregulation of the network of intracellular and extracellular signaling cascades is sufficient to thwart the cells finely-tuned biochemical control mechanisms. A keen interest in the mathematical modeling of cell signaling networks and the regulation of signal transduction has emerged in recent years, and has produced a glimmer of insight into the sophisticated feedback control and network regulation operating within cells. In this review, we present an overview of published theoretical studies on the control aspects of signal transduction, emphasizing the role and importance of mechanisms such as ‘ultrasensitivity’ and feedback loops. We emphasize that these exquisite and often subtle control strategies represent the key to orchestrating ‘simple’ signaling behaviors within the complex intracellular network, while regulating the trade-off between sensitivity and robustness to internal and external perturbations. Through a consideration of these apparent paradoxes, we explore how the basic homeostasis of the intracellular signaling network, in the face of carcinogenesis, can lead to neoplastic progression rather than cell death. A simple mathematical model is presented, furnishing a vivid illustration of how ‘control-oriented’ models of the deranged signaling networks in cancer cells may enucleate improved treatment strategies, including patient-tailored combination therapies, with the potential for reduced toxicity and more robust and potent antitumor activity.

A control theoretic paradigm for cell signaling networks : a simple complexity for a sensitive robustness

The fields of molecular biology and cell biology are being flooded with complex genomic and proteomic datasets of large dimensions. We now recognize that each molecule in the cell and tissue can no longer be viewed as an isolated entity. Instead, each molecule must be considered as one member of an interacting network. Consequently, there is an urgent need for mathematical models to understand the behavior of cell signaling networks in health and in disease.

Effective control of ion fluxes over large areas by magnetic fields : from narrow beams to highly uniform fluxes

An effective control of the ion current distribution over large-area (up to 103 cm2) substrates with the magnetic fields of a complex structure by using two additional magnetic coils installed under the substrate exposed to vacuum arc plasmas is demonstrated. When the magnetic field generated by the additional coils is aligned with the direction of the magnetic field generated by the guiding and focusing coils of the vacuum arc source, a narrow ion density distribution with the maximum current density 117 A m-2 is achieved. When one of the additional coils is set to generate the magnetic field of the opposite direction, an area almost uniform over the substrate of 103 cm2 ion current distribution with the mean value of 45 A m-2 is achieved. Our findings suggest that the system with the vacuum arc source and two additional magnetic coils can be effectively used for the effective, high throughput, and highly controllable plasma processing.

Evaluation of resonant damping techniques for Z-source current-type inverter

For the renewable energy sources whose outputs vary continuously, a Z-source current-type inverter has been proposed as a possible buck-boost alternative for grid-interfacing. With a unique X-shaped LC network connected between its dc power source and inverter topology, Z-source current-type inverter is however expected to suffer from compounded resonant complications in addition to those associated with its second-order output filter. To improve its damping performance, this paper proposes the careful integration of Posicast or three-step compensators before the inverter pulse-width modulator for damping triggered resonant oscillations. In total, two compensators are needed for wave-shaping the inverter boost factor and modulation ratio, and they can conveniently be implemented using first-in first-out stacks and embedded timers of modern digital signal processors widely used in motion control applications. Both techniques are found to damp resonance of ac filter well, but for cases of transiting from current-buck to boost state, three-step technique is less effective due to the sudden intermediate discharging interval introduced by its non-monotonic stepping (unlike the monotonic stepping of Posicast damping). These findings have been confirmed both in simulations and experiments using an implemented laboratory prototype.

Robust control scheme for a microgrid with PFC capacitor connected

Capacitors are widely used for power-factor correction (PFC) in power systems. When a PFC capacitor is installed with a certain load in a microgrid, it may be in parallel with the filter capacitor of the inverter interfacing the utility grid and the local distributed-generation unit and, thus, change the effective filter capacitance. Another complication is the possibility of occurrence of resonance in the microgrid. This paper conducts an in-depth investigation of the effective shunt-filter-capacitance variation and resonance phenomena in a microgrid due to a connection of a PFC capacitor. To compensate the capacitance-parameter variation, an Hinfin controller is designed for the voltage-source- inverter voltage control. By properly choosing the weighting functions, the synthesized Hinfin controller would exhibit high gains at the vicinity of the line frequency, similar to traditional high- performance P+ resonant controller and, thus, would possess nearly zero steady-state error. However, with the robust Hinfin controller, it will be possible to explicitly specify the degree of robustness in face of parameter variations. Furthermore, a thorough investigation is carried out to study the performance of inner current-loop feedback variables under resonance conditions. It reveals that filter-inductor current feedback is more effective in damping the resonance. This resonance can be further attenuated by employing the dual-inverter microgrid conditioner and controlling the series inverter as a virtual resistor affecting only harmonic components without interference with the fundamental power flow. And finally, the study in this paper has been tested experimentally using an experimental microgrid prototype.

miR-126 in human cancers : clinical roles and current perspectives

miR-126 has been implicated in the processes of inflammation and angiogenesis. Through these processes, miR-126 is implicated in cancer biology, but its role there has not been well reviewed. The aim of this review is to examine the molecular mechanisms and clinicopathological significance of miR-126 in human cancers. miR-126 was shown to have roles in cancers of the gastrointestinal tract, genital tracts, breast, thyroid, lung and some other cancers. Its expression was suppressed in most of the cancers studied. The molecular mechanisms that are known to cause aberrant expression of miR-126 include alterations in gene sequence, epigenetic modification and alteration of dicer abundance. miR-126 can inhibit progression of some cancers via negative control of proliferation, migration, invasion, and cell survival. In some instances, however, miR-126 supports cancer progression via promotion of blood vessel formation. Downregulation of miR-126 induces cancer cell proliferation, migration, and invasion via targeting specific oncogenes. Also, reduced levels of miR-126 are a significant predictor of poor survival of patients in many cancers. In addition, miR-126 can alter a multitude of cellular mechanisms in cancer pathogenesis via suppressing gene translation of numerous validated targets such as PI3K, KRAS, EGFL7, CRK, ADAM9, HOXA9, IRS-1, SOX-2, SLC7A5 and VEGF. To conclude, miR-126 is commonly down-regulated in cancer, most likely due to its ability to inhibit cancer cell growth, adhesion, migration, and invasion through suppressing a range of important gene targets. Understanding these mechanisms by which miR-126 is involved with cancer pathogenesis will be useful in the development of therapeutic targets for the management of patients with cancer.