Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units : cost effectiveness evaluation

Objective: To assess the cost-effectiveness of screening, isolation and decolonisation strategies in the control of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs). Design: Economic evaluation. Setting: England and Wales. Population: ICU patients. Main outcome measures: Infections, deaths, costs, quality adjusted life years (QALYs), incremental cost-effectiveness ratios for alternative strategies, net monetary benefits (NMBs). Results: All strategies using isolation but not decolonisation improved health outcomes but increased costs. When MRSA prevalence on admission to the ICU was 5% and the willingness to pay per QALY gained was between £20,000 and £30,000, the best such strategy was to isolate only those patients at high risk of carrying MRSA (either pre-emptively or following identification by admission and weekly MRSA screening using chromogenic agar). Universal admission and weekly screening using polymerase chain reaction (PCR)-based MRSA detection coupled with isolation was unlikely to be cost-effective unless prevalence was high (10% colonised with MRSA on admission to the ICU). All decolonisation strategies improved health outcomes and reduced costs. While universal decolonisation (regardless of MRSA status) was the most cost-effective in the short-term, strategies using screening to target MRSA carriers may be preferred due to reduced risk of selecting for resistance. Amongst such targeted strategies, universal admission and weekly PCR screening coupled with decolonisation with nasal mupirocin was the most cost-effective. This finding was robust to ICU size, MRSA admission prevalence, the proportion of patients classified as high-risk, and the precise value of willingness to pay for health benefits. Conclusions: MRSA control strategies that use decolonisation are likely to be cost-saving in an ICU setting provided resistance is lacking, and combining universal PCR-based screening with decolonisation is likely to represent good value for money if untargeted decolonisation is considered unacceptable. In ICUs where decolonisation is not implemented there is insufficient evidence to support universal MRSA screening outside high prevalence settings.

A conditional retransmission enabled transport protocol for real-time networked control systems

Real-time networked control systems (NCSs) over data networks are being increasingly implemented on a massive scale in industrial applications. Along with this trend, wireless network technologies have been promoted for modern wireless NCSs (WNCSs). However, popular wireless network standards such as IEEE 802.11/15/16 are not designed for real-time communications. Key issues in real-time applications include limited transmission reliability and poor transmission delay performance. Considering the unique features of real-time control systems, this paper develops a conditional retransmission enabled transport protocol (CRETP) to improve the delay performance of the transmission control protocol (TCP) and also the reliability performance of the user datagram protocol (UDP) and its variants. Key features of the CRETP include a connectionless mechanism with acknowledgement (ACK), conditional retransmission and detection of ineffective data packets on the receiver side.

Modelling and performance evaluation of the IEEE 802.11 DCF for real-time control

Popular wireless networks, such as IEEE 802.11/15/16, are not designed for real-time applications. Thus, supporting real-time quality of service (QoS) in wireless real-time control is challenging. This paper adopts the widely used IEEE 802.11, with the focus on its distributed coordination function (DCF), for soft-real-time control systems. The concept of the critical real-time traffic condition is introduced to characterize the marginal satisfaction of real-time requirements. Then, mathematical models are developed to describe the dynamics of DCF based real-time control networks with periodic traffic, a unique feature of control systems. Performance indices such as throughput and packet delay are evaluated using the developed models, particularly under the critical real-time traffic condition. Finally, the proposed modelling is applied to traffic rate control for cross-layer networked control system design.

Borders, mobility and technologies of control

Territorial borders are taking on a new significance, the implications of which are relatively unexplored within the discipline of criminology. This book presents the first systematic attempt to develop a critical criminology of the border and offers a unique treatment of the impact of globalisation and mobility. It focuses on borders and the significance of the activities which take place on and around them. For many the border is an everyday reality, a space in which to live, a land necessary to cross. For states the border space increasingly requires protection and defence; is at the centre of state ideology and performance; is the site for investing significant political and material resources, and is ultimately ungovernable. Providing a wealth of case material from Australia, Europe and North America, it is for students, academics, and practitioners working in the areas of criminology, migration, human geography, international law and politics, globalisation, sociology and cultural anthropology.

Development of an autonomous unmanned aerial system to collect time-stamped samples from the atmosphere and localize potential pathogen sources

This paper presents the hardware development and testing of a new concept for air sampling via the integration of a prototype spore trap onboard an unmanned aerial system (UAS).We propose the integration of a prototype spore trap onboard a UAS to allow multiple capture of spores of pathogens in single remote locations at high or low altitude, otherwise not possible with stationary sampling devices.We also demonstrate the capability of this system for the capture of multiple time-stamped samples during a single mission.Wind tunnel testing was followed by simulation, and flight testing was conducted to measure and quantify the spread during simulated airborne air sampling operations. During autonomous operations, the onboard autopilot commands the servo to rotate the sampling device to a new indexed location once the UAS vehicle reaches the predefined waypoint or set of waypoints (which represents the region of interest). Time-stamped UAS data are continuously logged during the flight to assist with analysis of the particles collected. Testing and validation of the autopilot and spore trap integration, functionality, and performance is described. These tools may enhance the ability to detect new incursions of spores

Promoting rural and remote teacher education in Australia through the Over the Hill project

Attracting quality teachers to rural areas is an ongoing international concern. Teacher education institutions have been criticised for contributing to this problem by failing to raise an awareness of teaching in rural areas in their teacher education programs. This study investigates preservice teachers’ perceptions towards teaching in rural areas after participating in a rural experience through the Over the Hill project. A self-selected group of second and third year preservice teachers from a regional campus of an urban Queensland university participated in a six-day rural experience, which included being billeted with local families, attending local community events and observing and teaching in rural primary and secondary schools. Data collected from the preservice teachers before and after the rural teaching experience were analysed to reveal positive perceptions towards teaching and living in rural communities. The findings revealed that even a brief immersion into rural schooling communities can positively influence preservice teachers’ attitudes towards seeking rural teaching placements. These findings have implications for the ways in which teacher education institutions can promote rural teaching opportunities in their teacher education programs.

Vision based control for fixed wing UAVs inspecting locally linear infrastructure using skid-to-turn maneuvers

The following paper proposes a novel application of Skid-to-Turn maneuvers for fixed wing Unmanned Aerial Vehicles (UAVs) inspecting locally linear infrastructure. Fixed wing UAVs, following the design of manned aircraft, traditionally employ Bank-to-Turn maneuvers to change heading and thus direction of travel. Commonly overlooked is the effect these maneuvers have on downward facing body fixed sensors, which as a result of bank, point away from the feature during turns. By adopting Skid-to-Turn maneuvers, the aircraft is able change heading whilst maintaining wings level flight, thus allowing body fixed sensors to maintain a downward facing orientation. Eliminating roll also helps to improve data quality, as sensors are no longer subjected to the swinging motion induced as they pivot about an axis perpendicular to their line of sight. Traditional tracking controllers that apply an indirect approach of capturing ground based data by flying directly overhead can also see the feature off center due to steady state pitch and roll required to stay on course. An Image Based Visual Servo controller is developed to address this issue, allowing features to be directly tracked within the image plane. Performance of the proposed controller is tested against that of a Bank-to-Turn tracking controller driven by GPS derived cross track error in a simulation environment developed to simulate the field of view of a body fixed camera.

Distribution feeder voltage support and power factor control by distributed multiple inverters

The potential of distributed reactive power control to improve the voltage profile of radial distribution feeders has been reported in literature by few authors. However, the multiple inverters injecting or absorbing reactive power across a distribution feeder may introduce control interactions and/or voltage instability. Such controller interactions can be alleviated if the inverters are allowed to operate on voltage droop. First, the paper demonstrates that a linear shallow droop line can maintain the steady state voltage profile close to reference, up to a certain level of loading. Then, impacts of the shallow droop line control on line losses and line power factors are examined. Finally, a piecewise linear droop line which can achieve reduced line losses and close to unity power factor at the feeder source is proposed.

Estimation and control for an open-source quadcopter

This paper describes modelling, estimation and control of the horizontal translational motion of an open-source and cost effective quadcopter — the MikroKopter. We determine the dynamics of its roll and pitch attitude controller, system latencies, and the units associated with the values exchanged with the vehicle over its serial port. Using this we create a horizontal-plane velocity estimator that uses data from the built-in inertial sensors and an onboard laser scanner, and implement translational control using a nested control loop architecture. We present experimental results for the model and estimator, as well as closed-loop positioning.

Editoral : Correspondence regarding Anker SD, Koehler F, Abraham WT. Telemedicine and remote management of patients with heart failure. The Lancet 2011; 378: 731–39. Published 20 August 2011.

We read the excellent review of telemonitoring in chronic heart failure (CHF)1 with interest and commend the authors on the proposed classification of telemedical remote management systems according to the type of data transfer, decision ability and level of integration. However, several points require clarification in relation to our Cochrane review of telemonitoring and structured telephone support2. We included a study by Kielblock3. We corresponded directly with this study team specifically to find out whether or not this was a randomised study and were informed that it was a randomised trial, albeit by date of birth. We note in our review2 that this randomisation method carries a high risk of bias. Post-hoc metaanalyses without these data demonstrate no substantial change to the effect estimates for all cause mortality (original risk ratio (RR) 0·66 [95% CI 0·54, 0·81], p<0·0001; revised RR 0·72 [95% CI 0·57, 0·92], p=0·008), all-cause hospitalisation (original RR 0·91 [95% CI 0·84, 0·99] p=0·02; revised RR 0.92 [95% CI 0·84, 1·02], p=0·10 ) or CHF-related hospitalisation (original RR 0·79 [95% CI 0·67, 0·94] p=0·008; revised RR 0·75 [95% CI 0·60, 0·94] p=0·01). Secondly, we would classify the Tele-HF study4, 5 as structured telephone support, rather than telemonitoring. Again, inclusion of these data alters the point-estimate but not the overall result of the meta-analyses4. Finally, our review2 does not include invasive telemonitoring as the search strategy was not designed to capture these studies. Therefore direct comparison of our review findings with recent studies of these interventions is not recommended.

Learning multidimensional joint control of a robot using receding horizon locally weighted regression

In this paper we explore the ability of a recent model-based learning technique Receding Horizon Locally Weighted Regression (RH-LWR) useful for learning temporally dependent systems. In particular this paper investigates the application of RH-LWR to learn control of Multiple-input Multiple-output robot systems. RH-LWR is demonstrated through learning joint velocity and position control of a three Degree of Freedom (DoF) rigid body robot.

Comparing the cost-effectiveness of MRSA control strategies between ICU and non-ICU settings

Introduction / objectives Many strategies are used to control MRSA in hospitals. Only a few have been assessed in clinical trials and it is not obvious how findings should be generalised between settings. Uncertainty remains about which strategies represent the most appropriate use of scarce resources. We assess the cost-effectiveness of alternative MRSA screening and infection control strategies in England and Wales and discuss international relevance. Methods Models of MRSA transmission in ICUs and general medical (GM) wards were developed and used to evaluate different screening methods combined with decolonisation or isolation. Strategies were compared in terms of costs and health benefits (quality adjusted life years, QALYs). Different prevalences, proportions of high risk patients and ward sizes were investigated, and probabilistic sensitivity analyses (PSA) conducted. Results Decolonisation strategies were cost-saving in ICUs at a 5% admission prevalence, with admission and weekly PCR screening the most cost-effective (£3,929/QALY). In ICUs, screening and isolation reduced infection rates by ~10%. With admission prevalence ≤5%, targeting screening and isolation to high risk patients was optimal. In GM wards decolonisation and isolation strategies, though able to reduce MRSA infection rates up to ~50%, were not cost-effective. Conclusion The largest reductions in MRSA infection were achieved by screening and decolonisation strategies, and were cost-effective in ICU settings. In comparison, there is limited potential for screening and control strategies to be cost-effective in GM wards due to lower infection and mortality rates.

A taint marking approach to confidentiality violation detection

This article presents a novel approach to confidentiality violation detection based on taint marking. Information flows are dynamically tracked between applications and objects of the operating system such as files, processes and sockets. A confidentiality policy is defined by labelling sensitive information and defining which information may leave the local system through network exchanges. Furthermore, per application profiles can be defined to restrict the sets of information each application may access and/or send through the network. In previous works, we focused on the use of mandatory access control mechanisms for information flow tracking. In this current work, we have extended the previous information flow model to track network exchanges, and we are able to define a policy attached to network sockets. We show an example application of this extension in the context of a compromised web browser: our implementation detects a confidentiality violation when the browser attempts to leak private information to a remote host over the network.