Researching effective approaches to cleaning in hospitals: Protocol of the REACH study, a multi-site stepped-wedge randomised trial

Background The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. Methods/design The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Discussion Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12615000325​505

Nonlocal scale effects on wave propagation in multi-walled carbon nanotubes

This paper represents the effect of nonlocal scale parameter on the wave propagation in multi-walled carbon nanotubes (MWCNTs). Each wall of the MWCNT is modeled as first order shear deformation beams and the van der Waals interactions between the walls are modeled as distributed springs. The studies shows that the scale parameter introduces certain band gap region in both flexural and shear wave mode where no wave propagation occurs. This is manifested in the wavenumber plots as the region where the wavenumber tends to infinite (or group speed tends to zero). The frequency at which this phenomenon occurs is called the ``Escape frequency''. The analysis shows that, for a given N-walled carbon nanotube (CNT). the nonlocal scaling parameter has a significant effect on the shear wave modes of the N - 1 walls. The escape frequencies of the flexural and shear wave modes of the N-walls are inversely proportionl to the nonlocal scaling parameter. It is also shown that the cut-off frequencies are independent of the nonlocal scale parameter. (C) 2009 Elsevier B.V. All rights reserved.

A multi-centre open-label randomised non-inferiority trial comparing watchful waiting to antibiotic treatment for acute otitis media without perforation in low-risk urban Aboriginal and Torres Strait Islander children (the WATCH trial): study protocol for a randomised controlled trial

Background Treatment guidelines recommend watchful waiting for children older than 2 years with acute otitis media (AOM) without perforation, unless they are at high risk of complications. The high prevalence of chronic suppurative otitis media (CSOM) in remote Aboriginal and Torres Strait Islander communities leads these children to be classified as high risk. Urban Aboriginal and Torres Strait Islander children are at lower risk of complications, but evidence to support the subsequent recommendation for watchful waiting in this population is lacking. Methods/Design This non-inferiority multi-centre randomised controlled trial will determine whether watchful waiting is non-inferior to immediate antibiotics for urban Aboriginal and Torres Strait Islander children with AOM without perforation. Children aged 2 − 16 years with AOM who are considered at low risk for complications will be recruited from six participating urban primary health care services across Australia. We will obtain informed consent from each participant or their guardian. The primary outcome is clinical resolution on day 7 (no pain, no fever of at least 38 °C, no bulging eardrum and no complications of AOM such as perforation or mastoiditis) as assessed by general practitioners or nurse practitioners. Participants and outcome assessors will not be blinded to treatment. With a sample size of 198 children in each arm, we have 80 % power to detect a non-inferiority margin of up to 10 % at a significance level of 5 %, assuming clinical improvement of at least 80 % in both groups. Allowing for a 20 % dropout rate, we aim to recruit 495 children. We will analyse both by intention-to-treat and per protocol. We will assess the cost- effectiveness of watchful waiting compared to immediate antibiotic prescription. We will also report on the implementation of the trial from the perspectives of parents/carers, health professionals and researchers. Discussion The trial will provide evidence for the safety and effectiveness of watchful waiting for the management of AOM in Aboriginal and Torres Strait Islander children living in urban settings who are considered to be at low risk of complications.

Using multi-label classification for acoustic pattern detection and assisting bird species surveys

Acoustics is a rich source of environmental information that can reflect the ecological dynamics. To deal with the escalating acoustic data, a variety of automated classification techniques have been used for acoustic patterns or scene recognition, including urban soundscapes such as streets and restaurants; and natural soundscapes such as raining and thundering. It is common to classify acoustic patterns under the assumption that a single type of soundscapes present in an audio clip. This assumption is reasonable for some carefully selected audios. However, only few experiments have been focused on classifying simultaneous acoustic patterns in long-duration recordings. This paper proposes a binary relevance based multi-label classification approach to recognise simultaneous acoustic patterns in one-minute audio clips. By utilising acoustic indices as global features and multilayer perceptron as a base classifier, we achieve good classification performance on in-the-field data. Compared with single-label classification, multi-label classification approach provides more detailed information about the distributions of various acoustic patterns in long-duration recordings. These results will merit further biodiversity investigations, such as bird species surveys.

Recent progress on synthesis, multi-scale structure, and properties of Y-Si-O oxides

Yttrium silicates (Y-Si-O oxides), including Y2Si2O7, Y2SiO5, and Y4·67(SiO4)3O apatite, have attracted wide attentions from material scientists and engineers, because of their extensive polymorphisms and important roles as grain boundary phases in improving the high-temperature mechanical/thermal properties of Si3N4and SiC ceramics. Recent interest in these materials has been renewed by their potential applications as high-temperature structural ceramics, oxidation protective coatings, and environmental barrier coatings (EBCs). The salient properties of Y-Si-O oxides are strongly related to their unique chemical bonds and microstructure features. An in-depth understanding on the synthesis - multi-scale structure-property relationships of the Y-Si-O oxides will shine a light on their performance and potential applications. In this review, recent progress of the synthesis, multi-scale structures, and properties of the Y-Si-O oxides are summarised. First, various methods for the synthesis of Y-Si-O ceramics in the forms of powders, bulks, and thin films/coatings are reviewed. Then, the crystal structures, chemical bonds, and atomic microstructures of the polymorphs in the Y-Si-O system are summarised. The third section focuses on the properties of Y-Si-O oxides, involving the mechanical, thermal, dielectric, and tribological properties, their environmental stability, and their structure-property relationships. The outlook for potential applications of Y-Si-O oxides is also highlighted.

Architecture of a polymorphic ASIC for interoperability across multi-mode H.264 decoders

Run-time interoperability between different applications based on H.264/AVC is an emerging need in networked infotainment, where media delivery must match the desired resolution and quality of the end terminals. In this paper, we describe the architecture and design of a polymorphic ASIC to support this. The H.264 decoding flow is partitioned into modules, such that the polymorphic ASIC meets the design goals of low-power, low-area, high flexibility, high throughput and fast interoperability between different profiles and levels of H.264. We demonstrate the idea with a multi-mode decoder that can decode baseline, main and high profile H.264 streams and can interoperate at run.time across these profiles. The decoder is capable of processing frame sizes of up to 1024 times 768 at 30 fps. The design synthesized with UMC 0.13 mum technology, occupies 250 k gates and runs at 100 MHz.

CAE-based prediction of projectile residual velocity for impact on single and multi-layered metallic armour plates

The present, paper deals with the CAE-based study Of impact of jacketed projectiles on single- and multi-layered metal armour plates using LS-DYNA. The validation of finite element modelling procedure is mainly based on the mesh convergence study using both shell and solid elements for representing single-layered mild steel target plates. It, is shown that the proper choice of mesh density and the strain rate-dependent material properties are essential for all accurate prediction of projectile residual velocity. The modelling requirements are initially arrived at by correlating against test residual velocities for single-layered mild steel plates of different depths at impact velocities in the ran.-c of approximately 800-870 m/s. The efficacy of correlation is adjudged, in terms of a 'correlation index', defined in the paper: for which values close to unity are desirable. The experience gained for single-layered plates is next; used in simulating projectile impacts on multi-layered mild steel target plates and once again a high degree of correlation with experimental residual velocities is observed. The study is repeated for single- and multi-layered aluminium target plates with a similar level of success in test residual velocity prediction. TO the authors' best knowledge, the present comprehensive study shows in particular for the first time that, with a. proper modelling approach, LS-DYNA can be used with a great degree of confidence in designing perforation-resistant single and multi-layered metallic armour plates.

A blind indic script recognizer for multi-script documents

We report a hierarchical blind script identifier for 11 different Indian scripts. An initial grouping of the 11 scripts is accomplished at the first level of this hierarchy. At the subsequent level, we recognize the script in each group. The various nodes of this tree use different feature-classifier combinations. A database of 20,000 words of different font styles and sizes is collected and used for each script. Effectiveness of Gabor and Discrete Cosine Transform features has been independently, evaluated using nearest neighbor linear discriminant and support vector machine classifiers. The minimum and maximum accuracies obtained, using this hierarchical mechanism, are 92.2% and 97.6%, respectively.

Multi-GNSS precise point positioning with raw single-frequency and dual-frequency measurement models

The emergence of multiple satellite navigation systems, including BDS, Galileo, modernized GPS, and GLONASS, brings great opportunities and challenges for precise point positioning (PPP). We study the contributions of various GNSS combinations to PPP performance based on undifferenced or raw observations, in which the signal delays and ionospheric delays must be considered. A priori ionospheric knowledge, such as regional or global corrections, strengthens the estimation of ionospheric delay parameters. The undifferenced models are generally more suitable for single-, dual-, or multi-frequency data processing for single or combined GNSS constellations. Another advantage over ionospheric-free PPP models is that undifferenced models avoid noise amplification by linear combinations. Extensive performance evaluations are conducted with multi-GNSS data sets collected from 105 MGEX stations in July 2014. Dual-frequency PPP results from each single constellation show that the convergence time of undifferenced PPP solution is usually shorter than that of ionospheric-free PPP solutions, while the positioning accuracy of undifferenced PPP shows more improvement for the GLONASS system. In addition, the GLONASS undifferenced PPP results demonstrate performance advantages in high latitude areas, while this impact is less obvious in the GPS/GLONASS combined configuration. The results have also indicated that the BDS GEO satellites have negative impacts on the undifferenced PPP performance given the current “poor” orbit and clock knowledge of GEO satellites. More generally, the multi-GNSS undifferenced PPP results have shown improvements in the convergence time by more than 60 % in both the single- and dual-frequency PPP results, while the positioning accuracy after convergence indicates no significant improvements for the dual-frequency PPP solutions, but an improvement of about 25 % on average for the single-frequency PPP solutions.

Developing an Unmanned Aerial Vehicle (UAV) multi-sensor payload carrier for air quality monitoring

Emissions of gases and particles from sea-faring ships have been shown to impact on the atmospheric chemistry and climate. To efficiently monitor and report these emissions found from a ship’s plume, the concept of using a multi-rotor or UAV to hover inside or near the exhaust of the ship to actively record the data in real time is being developed. However, for the required sensors obtain the data; their sensors must face into the airflow of the ships plume. This report presents an approach to have sensors able to read in the chemicals and particles emitted from the ship without affecting the flight dynamics of the multi-rotor UAV by building a sealed chamber in which a pump can take in the surrounding air (outside the downwash effect of the multi-rotor) where the sensors are placed and can analyse the gases safely. Results show that the system is small, lightweight and air-sealed and ready for flight test.

Introducing the multi-faceted teaching experiment

A mathematics classroom is comprised of many mathematicians with varying understanding of mathematics knowledge, including the teacher, students and sometimes researchers. To align with this conceptualisation of knowledge and understanding, the multi-faceted teaching experiment will be introduced as an approach to study all classroom participants’ interactions with the shared knowledge of mathematics. Drawing on the experiences of a large curriculum project, it is claimed that, unlike a multi-tiered teaching experiment, the multi-faceted teaching experiment provides a research framework that allows for the study of mathematicians’ building of knowledge in a classroom without privileging the experience of any one participant.

Performance evaluation of elitist-mutated multi-objective particle swarm optimization for integrated water resources management

Optimal allocation of water resources for various stakeholders often involves considerable complexity with several conflicting goals, which often leads to multi-objective optimization. In aid of effective decision-making to the water managers, apart from developing effective multi-objective mathematical models, there is a greater necessity of providing efficient Pareto optimal solutions to the real world problems. This study proposes a swarm-intelligence-based multi-objective technique, namely the elitist-mutated multi-objective particle swarm optimization technique (EM-MOPSO), for arriving at efficient Pareto optimal solutions to the multi-objective water resource management problems. The EM-MOPSO technique is applied to a case study of the multi-objective reservoir operation problem. The model performance is evaluated by comparing with results of a non-dominated sorting genetic algorithm (NSGA-II) model, and it is found that the EM-MOPSO method results in better performance. The developed method can be used as an effective aid for multi-objective decision-making in integrated water resource management.

DMT of Multi-hop Cooperative Networks-Part II: Layered and Multi-Antenna Networks

We consider single-source, single-sink (ss-ss) multi-hop relay networks, with slow-fading Rayleigh links. This two part paper aims at giving explicit protocols and codes to achieve the optimal diversity-multiplexing tradeoff (DMT) of two classes of multi-hop networks: K-parallel-path (KPP) networks and Layered networks. While single-antenna KPP networks were the focus of the first part, we consider layered and multi-antenna networks in this second part. We prove that a linear DMT between the maximum diversity d(max). and the maximum multiplexing gain of 1 is achievable for single-antenna fully-connected layered networks under the half-duplex constraint. This is shown to be equal to the optimal DMT if the number of relaying layers is less than 4. For the multiple-antenna case, we provide an achievable DMT, which is significantly better than known lower bounds for half duplex networks. Along the way, we compute the DMT of parallel MIMO channels in terms of the DMT of the component channel. For arbitrary ss-ss single-antenna directed acyclic networks with full-duplex relays, we prove that a linear tradeoff between maximum diversity and maximum multiplexing gain is achievable using an amplify-and-forward (AF) protocol. Explicit short-block-length codes are provided for all the proposed protocols. Two key implications of the results in the two-part paper are that the half-duplex constraint does not necessarily entail rate loss by a factor of two as previously believed and that simple AN protocols are often sufficient to attain the best possible DMT.

DMT of Multi-hop Cooperative Networks-Part I: K-Parallel-Path Networks

We consider single-source, single-sink multi-hop relay networks, with slow-fading Rayleigh fading links and single-antenna relay nodes operating under the half-duplex constraint. While two hop relay networks have been studied in great detail in terms of the diversity-multiplexing tradeoff (DMT), few results are available for more general networks. In this two-part paper, we identify two families of networks that are multi-hop generalizations of the two hop network: K-Parallel-Path (KPP) networks and Layered networks. In the first part, we initially consider KPP networks, which can be viewed as the union of K node-disjoint parallel paths, each of length > 1. The results are then generalized to KPP(I) networks, which permit interference between paths and to KPP(D) networks, which possess a direct link from source to sink. We characterize the optimal DMT of KPP(D) networks with K >= 4, and KPP(I) networks with K >= 3. Along the way, we derive lower bounds for the DMT of triangular channel matrices, which are useful in DMT computation of various protocols. As a special case, the DMT of two-hop relay network without direct link is obtained. Two key implications of the results in the two-part paper are that the half-duplex constraint does not necessarily entail rate loss by a factor of two, as previously believed and that, simple AF protocols are often sufficient to attain the best possible DMT.

Efficient computation of volume fractions for multi-material cell complexes in a grid by slicing

The paper presents a novel slicing based method for computation of volume fractions in multi-material solids given as a B-rep whose faces are triangulated and shared by either one or two materials. Such objects occur naturally in geoscience applications and the said computation is necessary for property estimation problems and iterative forward modeling. Each facet in the model is cut by the planes delineating the given grid structure or grid cells. The method, instead of classifying the points or cells with respect to the solid, exploits the convexity of triangles and the simple axis-oriented disposition of the cutting surfaces to construct a novel intermediate space enumeration representation called slice-representation, from which both the cell containment test and the volume-fraction computation are done easily. Cartesian and cylindrical grids with uniform and non-uniform spacings have been dealt with in this paper. After slicing, each triangle contributes polygonal facets, with potential elliptical edges, to the grid cells through which it passes. The volume fractions of different materials in a grid cell that is in interaction with the material interfaces are obtained by accumulating the volume contributions computed from each facet in the grid cell. The method is fast, accurate, robust and memory efficient. Examples illustrating the method and performance are included in the paper.