Application of Incident Command Structure to clinical trial management in the academic setting: principles and lessons learned

Background Clinical trial success depends on appropriate management, but practical guidance to trial organisation and planning is lacking. The Incident Command System (ICS) is the ‘gold standard’ management system developed for managing diverse operations in major incident and public health arenas. It enables effective and flexible management through integration of personnel, procedures, resources, and communications within a common hierarchical organisational structure. Conventional ICS organisation consists of five function modules: Command, Planning, Operations, Logistics, and Finance/Administration. Large clinical trials will require a separate Regulatory Administrative arm, and an Information arm, consisting of dedicated data management and information technology staff. We applied ICS principles to organisation and management of the Prehospital Use of Plasma in Traumatic Haemorrhage (PUPTH) trial. This trial was a multidepartmental, multiagency, randomised clinical trial investigating prehospital administration of thawed plasma on mortality and coagulation response in severely injured trauma patients. We describe the ICS system as it would apply to large clinical trials in general, and the benefits, barriers, and lessons learned in utilising ICS principles to reorganise and coordinate the PUPTH trial. Results Without a formal trial management structure, early stages of the trial were characterised by inertia and organisational confusion. Implementing ICS improved organisation, coordination, and communication between multiple agencies and service groups, and greatly streamlined regulatory compliance administration. However, unfamiliarity of clinicians with ICS culture, conflicting resource allocation priorities, and communication bottlenecks were significant barriers. Conclusions ICS is a flexible and powerful organisational tool for managing large complex clinical trials. However, for successful implementation the cultural, psychological, and social environment of trial participants must be accounted for, and personnel need to be educated in the basics of ICS

The Octopus switch

This chapter1 discusses the interconnection architecture of the Mobile Digital Companion. The approach to build a low-power handheld multimedia computer presented here is to have autonomous, reconfigurable modules such as network, video and audio devices, interconnected by a switch rather than by a bus, and to offload as much as work as possible from the CPU to programmable modules placed in the data streams. Thus, communication between components is not broadcast over a bus but delivered exactly where it is needed, work is carried out where the data passes through, bypassing the memory. The amount of buffering is minimised, and if it is required at all, it is placed right on the data path, where it is needed. A reconfigurable internal communication network switch called Octopus exploits locality of reference and eliminates wasteful data copies. The switch is implemented as a simplified ATM switch and provides Quality of Service guarantees and enough bandwidth for multimedia applications. We have built a testbed of the architecture, of which we will present performance and energy consumption characteristics

The Design of a System Architecture for Mobile Multimedia Computers

This chapter discusses the system architecture of a portable computer, called Mobile Digital Companion, which provides support for handling multimedia applications energy efficiently. Because battery life is limited and battery weight is an important factor for the size and the weight of the Mobile Digital Companion, energy management plays a crucial role in the architecture. As the Companion must remain usable in a variety of environments, it has to be flexible and adaptable to various operating conditions. The Mobile Digital Companion has an unconventional architecture that saves energy by using system decomposition at different levels of the architecture and exploits locality of reference with dedicated, optimised modules. The approach is based on dedicated functionality and the extensive use of energy reduction techniques at all levels of system design. The system has an architecture with a general-purpose processor accompanied by a set of heterogeneous autonomous programmable modules, each providing an energy efficient implementation of dedicated tasks. A reconfigurable internal communication network switch exploits locality of reference and eliminates wasteful data copies

Computing infrastructure issues in distributed communications systems : a survey of operating system transport system architectures

The performance of distributed applications (such as file transfer, remote login, tele-conferencing, full-motion video, and scientific visualization) is influenced by several factors that interact in complex ways. In particular, application performance is significantly affected both by communication infrastructure factors and computing infrastructure factors. Several communication infrastructure factors include channel speed, bit-error rate, and congestion at intermediate switching nodes. Computing infrastructure factors include (among other things) both protocol processing activities (such as connection management, flow control, error detection, and retransmission) and general operating system factors (such as memory latency, CPU speed, interrupt and context switching overhead, process architecture, and message buffering). Due to a several orders of magnitude increase in network channel speed and an increase in application diversity, performance bottlenecks are shifting from the network factors to the transport system factors.This paper defines an abstraction called an "Operating System Transport System Architecture" (OSTSA) that is used to classify the major components and services in the computing infrastructure. End-to-end network protocols such as TCP, TP4, VMTP, XTP, and Delta-t typically run on general-purpose computers, where they utilize various operating system resources such as processors, virtual memory, and network controllers. The OSTSA provides services that integrate these resources to support distributed applications running on local and wide area networks.A taxonomy is presented to evaluate OSTSAs in terms of their support for protocol processing activities. We use this taxonomy to compare and contrast five general-purpose commercial and experimental operating systems including System V UNIX, BSD UNIX, the x-kernel, Choices, and Xinu

Octopus - an energy-efficient architecture for wireless multimedia systems

Multimedia computing and mobile computing are two trends that will lead to a new application domain in the near future. However, the technological challenges to establishing this paradigm of computing are non-trivial. Personal mobile computing offers a vision of the future with a much richer and more exciting set of architecture research challenges than extrapolations of the current desktop architectures. In particular, these devices will have limited battery resources, will handle diverse data types, and will operate in environments that are insecure, dynamic and which vary significantly in time and location. The approach we made to achieve such a system is to use autonomous, adaptable modules, interconnected by a switch rather than by a bus, and to offload as much as work as possible from the CPU to programmable modules that is placed in the data streams. A reconfigurable internal communication network switch called Octopus exploits locality of reference and eliminates wasteful data copies

Dispelling the myths of online education: learning via the information superhighway

There continues to be a perception that online education is inferior to traditional education. In the U.S. online learning is more developed than in the U.K. This paper provides insights into a U.S. provision and takes a close look at what are perceived as weaknesses of on line learning and argues that these are not necessarily inherent weaknesses of this form of educational delivery. Then, results of two major studies, undertaken in the U.S. are provided comparing the effectiveness of online education to traditional education as perceived by current MBA students and past graduates. Results of these studies suggest that students of MBA modules and MBA graduates perceive the quality and effectiveness of online education to be similar to, if not higher than, the quality and effectiveness of traditional modules and programmes

Design techniques for low-power systems

Portable products are being used increasingly. Because these systems are battery powered, reducing power consumption is vital. In this report we give the properties of low-power design and techniques to exploit them on the architecture of the system. We focus on: minimizing capacitance, avoiding unnecessary and wasteful activity, and reducing voltage and frequency. We review energy reduction techniques in the architecture and design of a hand-held computer and the wireless communication system including error control, system decomposition, communication and MAC protocols, and low-power short range networks