General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial

Background There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice. Methods/design This is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization. This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient testing with C-reactive protein. In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing. The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed after the completion of the intervention phase. They include the number of antibiotic prescriptions and the number of patient visits per general practitioner for periods before and during the intervention. The incidence of antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and other factors as explanatory variables. Results will compare the change in prescription rates before and during the intervention in the two groups of practices. Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the feasibility and uptake of the interventions. An economic evaluation will be conducted to estimate the costs of implementing the package, and its cost-effectiveness in terms of cost per unit reduction in prescribing. Discussion The results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of interventions will inform the policy for any national implementation.

A Novel Construction of Complex Orthogonal Designs with Maximal Rate and Low-PAPR

Space-time block codes based on orthogonal designs are used for wireless communications with multiple transmit antennas which can achieve full transmit diversity and have low decoding complexity. However, the rate of the square real/complex orthogonal designs tends to zero with increase in number of antennas, while it is possible to have a rate-1 real orthogonal design (ROD) for any number of antennas.In case of complex orthogonal designs (CODs), rate-1 codes exist only for 1 and 2 antennas. In general, For a transmit antennas, the maximal rate of a COD is 1/2 + l/n or 1/2 + 1/n+1 for n even or odd respectively. In this paper, we present a simple construction for maximal-rate CODs for any number of antennas from square CODs which resembles the construction of rate-1 RODs from square RODs. These designs are shown to be amenable for construction of a class of generalized CODs (called Coordinate-Interleaved Scaled CODs) with low peak-to-average power ratio (PAPR) having the same parameters as the maximal-rate codes. Simulation results indicate that these codes perform better than the existing maximal rate codes under peak power constraint while performing the same under average power constraint.

From Bathymetry to Bioshields: A Review of Post-Tsunami Ecological Research in India and its Implications for Policy

More than half a decade has passed since the December 26th 2004 tsunami hit the Indian coast leaving a trail of ecological, economic and human destruction in its wake. We reviewed the coastal ecological research carried out in India in the light of the tsunami. In addition, we also briefly reviewed the ecological research in other tsunami affected countries in Asia namely Sri Lanka, Indonesia, Thailand and Maldives in order to provide a broader perspective of ecological research after tsunami. A basic search in ISI Web of Knowledge using keywords ``tsunami'' and ``India'' resulted in 127 peer reviewed journal articles, of which 39 articles were pertaining to ecological sciences. In comparison, Sri Lanka, Indonesia, Thailand and Maldives had, respectively, eight, four, 21 and two articles pertaining to ecology. In India, bioshields received the major share of scientific interest (14 out of 39) while only one study (each) was dedicated to corals, seagrasses, seaweeds and meiofauna, pointing to the paucity of research attention dedicated to these critical ecosystems. We noted that very few interdisciplinary studies looked at linkages between pure/applied sciences and the social sciences in India. In addition, there appears to be little correlation between the limited research that was done and its influence on policy in India. This review points to gap areas in ecological research in India and highlights the lessons learnt from research in other tsunami-affected countries. It also provides guidance on the links between science and policy that are required for effective coastal zone management.

2-Dimensional Linear-Stability of Premixed Laminar Flames Under Zero-Gravity

This paper reports on the numerical study of the linear stability of laminar premixed flames under zero gravity. The study specifically addresses the dependence of stability on finite rate chemistry with low activation energy and variable thermodynamic and transport properties. The calculations show that activation energy and details of chemistry play a minor role in altering the linear neutral stability results from asymptotic analysis. Variable specific heat makes a marginal change to the stability. Variable transport properties on the other hand tend to substantially enhance the stability from critical wave number of about 0.5 to 0.20. Also, it appears that the effects of variable properties tend to nullify the effects of non-unity Lewis number. When the Lewis number of a single species is different from unity, as will happen in a hydrogen-air premixed flame, the stability results remain close to that of unity Lewis number.

Constitutive modeling of ice in the high strain rate regime

The objective of the present work is to propose a constitutive model for ice by considering the influence of important parameters such as strain rate dependence and pressure sensitivity on the response of the material. In this regard, the constitutive model proposed by Carney et al. (2006) is considered as a starting basis and subsequently modified to incorporate the effect of brittle cracking within a continuum damage mechanics framework. The damage is taken to occur in the form of distributed cracking within the material during impact which is consistent with experimental observations. At the point of failure, the material is assumed to be fluid-like with deviatoric stress almost dropping down to zero. The constitutive model is implemented in a general purpose finite element code using an explicit formulation. Several single element tests under uniaxial tension and compression, as well as biaxial loading are conducted in order to understand the performance of the model. Few large size simulations are also performed to understand the capability of the model to predict brittle damage evolution in un-notched and notched three point bend specimens. The proposed model predicts lower strength under tensile loading as compared to compressive loading which is in tune with experimental observations. Further the model also asserts the strain rate dependency of the strength behavior under both compressive as well as tensile loading, which also corroborates well with experimental results. (C) 2010 Elsevier Ltd. All rights reserved.

Reactivation kinetics of boron acceptors in hydrogenated silicon during zero bias anneal

The reactivation kinetics of passivated boron accepters in hydrogenated silicon during zero bias annealing in the temperature range of 65-130 degrees C are reported, For large annealing times and high annealing temperatures, the reactivation process follows second-order kinetics and is rate limited by a thermally activated <(H)over tilde (2)> complex formation process, For short annealing times and low annealing temperatures, the reactivation rate is found to be larger than that due to <(H)over tilde (2)> complex formation alone. We conclude that the faster reactivation is caused by the diffusion of the liberated hydrogen atoms into the bulk as well as <(H)over tilde (2)> complex formation. The effective diffusion coefficient of hydrogen is measured and found to obey the Arrhenius relation with an activation energy (1.41 +/- 0.1) eV. (C) 1997 American Institute of Physics.

On the achievable rates of sources having a group alphabet in a distributed source coding setting

We consider the problem of compression via homomorphic encoding of a source having a group alphabet. This is motivated by the problem of distributed function computation, where it is known that if one is only interested in computing a function of several sources, then one can at times improve upon the compression rate required by the Slepian-Wolf bound. The functions of interest are those which could be represented by the binary operation in the group. We first consider the case when the source alphabet is the cyclic Abelian group, Zpr. In this scenario, we show that the set of achievable rates provided by Krithivasan and Pradhan [1], is indeed the best possible. In addition to that, we provide a simpler proof of their achievability result. In the case of a general Abelian group, an improved achievable rate region is presented than what was obtained by Krithivasan and Pradhan. We then consider the case when the source alphabet is a non-Abelian group. We show that if all the source symbols have non-zero probability and the center of the group is trivial, then it is impossible to compress such a source if one employs a homomorphic encoder. Finally, we present certain non-homomorphic encoders, which also are suitable in the context of function computation over non-Abelian group sources and provide rate regions achieved by these encoders.

On the diversity and complexity of Zero Forcing receivers for MIMO Zero Padded systems

Zero padded systems with linear receivers are shown to be robust and amenable to fast implementations in single antenna scenarios. In this paper, properties of such systems are investigated when multiple antennas are present at both ends of the communication link. In particular, their diversity and complexity are evaluated for precoded transmissions. The linear receivers are shown to exploit multipath and receive diversities, even in the absence of any coding at the transmitter. Use of additional redundancy to improve performance is considered and the effect of transmission rate on diversity order is analyzed. Low complexity implementations of Zero Forcing receivers are devised to further enhance their applicability.

On optimal timer-based distributed selection for rate-adaptive multi-user diversity systems

We develop an optimal, distributed, and low feedback timer-based selection scheme to enable next generation rate-adaptive wireless systems to exploit multi-user diversity. In our scheme, each user sets a timer depending on its signal to noise ratio (SNR) and transmits a small packet to identify itself when its timer expires. When the SNR-to-timer mapping is monotone non-decreasing, timers of users with better SNRs expire earlier. Thus, the base station (BS) simply selects the first user whose timer expiry it can detect, and transmits data to it at as high a rate as reliably possible. However, timers that expire too close to one another cannot be detected by the BS due to collisions. We characterize in detail the structure of the SNR-to-timer mapping that optimally handles these collisions to maximize the average data rate. We prove that the optimal timer values take only a discrete set of values, and that the rate adaptation policy strongly influences the optimal scheme's structure. The optimal average rate is very close to that of ideal selection in which the BS always selects highest rate user, and is much higher than that of the popular, but ad hoc, timer schemes considered in the literature.

Groundwater Management in India:Physical, Institutional and Policy Alternatives

Groundwater constitutes a vital natural resource for sustaining India’s agricultural economy and meeting the country’s social, ecological and environmental goals. It is a unique resource, widely available, providing security against droughts and yet it is closely linked to surface-water resources and the hydrological cycle. Its availability depends on geo-hydrological conditions and characteristics of aquifers, from deep to alluvium, sediment crystalline rocks to basalt formations; and agro-climate from humid to subhumid and semi-arid to arid. Its reliable supply, uniform quality and temperature, relative turbidity, pollution-safe, minimal evaporation losses, and low cost of development are attributes making groundwater more attractive compared to other resources. It plays a key role in the provision of safe drinking water to rural populations. For example, already almost 80% of domestic water use in rural areas in India is groundwater-supplied, and much of it is being supplied to farms, villages and small towns. Inadequate control of the use of groundwater, indiscriminate application of agrochemicals and unrestrained pollution of the rural environment by other human activities make groundwater usage unsustainable, necessitating proper management in the face of the twin demand for water of good quality for domestic supply and adequate supply for irrigation, ensuring equity, efficiency and sustainability of the resource. Groundwater irrigation has overtaken surface irrigation in the early 1980s, supported by well energization. It is estimated that there are about 24 million energised wells and tube wells now and it is driven by demand rather than availability, evident through the greater occurrence of wells in districts with high population densities. Apart from aquifer characteristics, land fragmentation and landholding size are the factors that decide the density of wells. The ‘rise and fall’ of local economies dependent on groundwater can be summarized as: the green revolution of 1980s, groundwaterbased agrarian boom, early symptoms of groundwater overdraft, and decline of the groundwater socio-ecology. The social characteristics and policy interventions typical of each stage provide a fascinating insight into the human-resource dynamics. This book is a compilation of nine research papers discussing various aspects of groundwater management. It attempts to integrate knowledge about the physical system, the socio-economic system, the institutional set-up and the policy environment to come out with a more realistic analysis of the situation with regard to the nature, characteristics and intensity of resource use, the size of the economy the use generates, and the negative socioeconomic consequences. Complex variables addressed in this regard focusing on northern Gujarat are the stock of groundwater available in the region, its hydrodynamics, its net outflows against inflows, the economics of its intensive use (particularly irrigation in semi-arid and arid regions), its criticality in the regional hydroecological regime, ethical aspects and social aspects of its use. The first chapter by Dinesh Kumar and Singh, dwells on complex groundwater socio-ecology of India, while emphasizing the need for policy measures to address indiscriminate over-exploitation of dwindling resources. The chapter also explores the nature of groundwater economy and the role of electricity prices on it. The next chapter on groundwater issue in north Gujarat provides a description of groundwater resource characteristics followed by a detailed analysis of the groundwater depletion and quality deterioration problems in the region and their undesirable consequences on the economy, ecosystem health and the society. Considering water-buyers and wellowning farmers individually, a methodology for economic valuation of groundwater in regions where its primary usage is in agriculture, and as assessment of the groundwater economy based on case studies from north Gujarat is presented in the fourth chapter. The next chapter focuses on the extent of dependency of milk production on groundwater, which includes the water embedded in green and dry fodder and animal feed. The study made a realistic estimate of irrigation water productivity in terms of the physics and economics of milk production. The sixth chapter analyses the extent of reduction in water usage, increase in yield and overall increase in physical productivity of alfalfa with the use of the drip irrigation system. The chapter also provides a detailed synthesis of the costs and benefits associated with the use of drip irrigation systems. A linear programmingbased optimization model with the objective to minimize groundwater use taking into account the interaction between two distinct components – farming and dairying under the constraints of food security and income stability for different scenarios, including shift in cropping pattern, introduction of water-efficient crops, water- saving technologies in addition to the ‘business as usual’ scenario is presented in the seventh chapter. The results show that sustaining dairy production in the region with reduced groundwater draft requires crop shifts and adoption of water-saving technologies. The eighth chapter provides evidences to prove that the presence of adequate economic incentive would encourage farmers to adopt water-saving irrigation devices, based on the findings of market research with reference to the level of awareness among farmers of technologies and the factors that decide the adoption of water-saving technologies. However, now the marginal cost of using electricity for agricultural pumping is almost zero. The economic incentives are strong and visible only when the farmers are either water-buyers or have to manage irrigation with limited water from tube-well partnerships. The ninth chapter explores the socio-economic viability of increasing the power tariff and inducing groundwater rationing as a tool for managing energy and groundwater demand, considering the current estimate of the country’s annual economic loss of Rs 320 billion towards electricity subsidy in the farm sector. The tenth chapter suggests private tradable property rights and development of water markets as the institutional tool for achieving equity, efficiency and sustainability of groundwater use. It identifies the externalities for local groundwater management and emphasizes the need for managing groundwater by local user groups, supported by a thorough analysis of groundwater socio-ecology in India. An institutional framework for managing the resource based on participatory approach that is capable of internalizing the externalities, comprising implementation of institutional and technical alternatives for resource management is also presented. Major findings of the analyses and key arguments in each chapter are summarized in the concluding chapter. Case studies of the social and economic benefits of groundwater use, where that use could be described as unsustainable, are interesting. The benefits of groundwater use are outlined and described with examples of social and economic impacts of groundwater and the negative aspects of groundwater development with the compilation of environmental problems based on up-to-date research results. This publication with a well-edited compilation of case studies is informative and constitutes a useful publication for students and professionals.

Biofuel production and implications for land use, food production and environment in India

There is a large interest in biofuels in India as a substitute to petroleum-based fuels, with a purpose of enhancing energy security and promoting rural development. India has announced an ambitious target of substituting 20% of fossil fuel consumption by biodiesel and bioethanol by 2017. India has announced a national biofuel policy and launched a large program to promote biofuel production, particularly on wastelands: its implications need to be studied intensively considering the fact that India is a large developing country with high population density and large rural population depending upon land for their livelihood. Another factor is that Indian economy is experiencing high growth rate, which may lead to enhanced demand for food, livestock products, timber, paper, etc., with implications for land use. Studies have shown that area under agriculture and forest has nearly stabilized over the past 2-3 decades. This paper presents an assessment of the implications of projected large-scale biofuel production on land available for food production, water, biodiversity, rural development and GHG emissions. The assessment will be largely focused on first generation biofuel crops, since the Indian program is currently dominated by these crops. Technological and policy options required for promoting sustainable biofuel production will be discussed. (C) 2010 Elsevier Ltd. All rights reserved.

Optimal maintenance policy of a machine subject to failure

Optimal maintenance policies for a machine with degradation in performance with age and subject to failure are derived using optimal control theory. The optimal policies are shown to be, normally, of bang-coast nature, except in the case when probability of machine failure is a function of maintenance. It is also shown, in the deterministic case that a higher depreciation rate tends to reverse this policy to coast-bang. When the probability of failure is a function of maintenance, considerable computational effort is needed to obtain an optimal policy and the resulting policy is not easily implementable. For this case also, an optimal policy in the class of bang-coast policies is derived, using a semi-Markov decision model. A simple procedure for modifying the probability of machine failure with maintenance is employed. The results obtained extend and unify the recent results for this problem along both theoretical and practical lines. Numerical examples are presented to illustrate the results obtained.

High Rate Capability Lithium Iron Phosphate Wired by Carbon Nanotubes and Galvanostatic Transformed to Graphitic Carbon

Lithium iron phosphate (LiFePO4) electronically wired by multi-walled carbon nanotubes (MWCNTs) and in-situ transformed graphitic carbon for lithium-ion batteries are discussed here. Presence of MWCNTs up to a maximum of 0.5% in porous LiFePO4 (abbreviated as LFP-CNT) resulted in remarkable reversible cyclability and rate capability compared to LFP coated with highly disordered carbon (abbreviated as LFP-C). In the current range (30-1500) mAg(-1), specific capacity of LFP-CNT (approximate to 150-50 mAhg(-1)) is observed to be always higher compared to LFP-C (approximate to 120-0 mAhg(-1)). At higher currents of 250-1500 mAg(-1) LFP-C performed poorly compared to LFP-CNT. LFP-C showed considerable decay in capacity with increase in cycle number at intermediate high currents (approximate to 250 mAg(-1)) whereas at very high currents (approximate to 750 mAg(-1)) it is nearly zero. The LFP-CNT showed no such detrimental behavior in battery performance. The exemplary performance of the LFP-CNT is attributed to combination of both enhanced LFP structural stability, as revealed by Raman spectra and formation of an efficient percolative network of carbon nanotubes which during the course of galvanostatic cycling gets gradually transformed to graphitic carbon. (C) 2012 The Electrochemical Society. [DOI: 10.1149/2.015204jes] All rights reserved.

New Insights into Optimal Discrete Rate Adaptation for Average Power Constrained Single and Multi-Node Systems

The throughput-optimal discrete-rate adaptation policy, when nodes are subject to constraints on the average power and bit error rate, is governed by a power control parameter, for which a closed-form characterization has remained an open problem. The parameter is essential in determining the rate adaptation thresholds and the transmit rate and power at any time, and ensuring adherence to the power constraint. We derive novel insightful bounds and approximations that characterize the power control parameter and the throughput in closed-form. The results are comprehensive as they apply to the general class of Nakagami-m (m >= 1) fading channels, which includes Rayleigh fading, uncoded and coded modulation, and single and multi-node systems with selection. The results are appealing as they are provably tight in the asymptotic large average power regime, and are designed and verified to be accurate even for smaller average powers.

Effect of strain rate and temperature on the plastic deformation behaviour of a bulk metallic glass composite

The composites consisting of amorphous matrix reinforced with crystalline dendrites offer extraordinary combinations of strength, stiffness, and toughness and can be processed in bulk. Hence, they have been receiving intense research interest, with a primary focus to study their mechanical properties. In this paper, the temperature and strain rate effects on the uniaxial compression response of a tailored bulk metallic glass (BMG) composite has been investigated. Experimental results show that at temperatures ranging between ambient to 500 K and at all strain rates; the onset of plastic deformation in the composite is controlled by that in the dendrites. As the temperature is increased to the glass transition temperature of the matrix and beyond, flow in the amorphous matrix occurs readily and hence it dictates the composite's response. The role of the constituent phases in controlling the deformation mechanism of the composite has been verified by assessing the strain rate sensitivity and the activation volume for deformation. The composite is rate sensitive at room temperature with values of strain rate sensitivity and activation volume being similar to that of the dendrites. At test temperatures near to the glass transition temperature, the composite however becomes rate-insensitive corresponding to that of the matrix phase. At low strain rates, serrated flow akin to that of dynamic strain ageing in crystalline alloys was observed and the serration magnitude decreases with increasing temperature. Initiation of the shear bands at the dendrite/matrix interface and propagation of them through the matrix ligaments until their arrest at another interface is the responsible mechanism for this. (C) 2011 Elsevier B.V. All rights reserved.