Enhanced clinical pharmacy service targeting tools: risk-predictive algorithms

Rationale, aims and objectives: This study aimed to determine the value of using a mix of clinical pharmacy data and routine hospital admission spell data in the development of predictive algorithms. Exploration of risk factors in hospitalized patients, together with the targeting strategies devised, will enable the prioritization of clinical pharmacy services to optimize patient outcomes. 

Methods: Predictive algorithms were developed using a number of detailed steps using a 75% sample of integrated medicines management (IMM) patients, and validated using the remaining 25%. IMM patients receive targeted clinical pharmacy input throughout their hospital stay. The algorithms were applied to the validation sample, and predicted risk probability was generated for each patient from the coefficients. Risk threshold for the algorithms were determined by identifying the cut-off points of risk scores at which the algorithm would have the highest discriminative performance. Clinical pharmacy staffing levels were obtained from the pharmacy department staffing database. 

Results: Numbers of previous emergency admissions and admission medicines together with age-adjusted co-morbidity and diuretic receipt formed a 12-month post-discharge and/or readmission risk algorithm. Age-adjusted co-morbidity proved to be the best index to predict mortality. Increased numbers of clinical pharmacy staff at ward level was correlated with a reduction in risk-adjusted mortality index (RAMI). 

Conclusions: Algorithms created were valid in predicting risk of in-hospital and post-discharge mortality and risk of hospital readmission 3, 6 and 12 months post-discharge. The provision of ward-based clinical pharmacy services is a key component to reducing RAMI and enabling the full benefits of pharmacy input to patient care to be realized.

Efficient Algorithms for Answering the m-Closest Keywords Query

As an important type of spatial keyword query, the m-closest keywords (mCK) query finds a group of objects such that they cover all query keywords and have the smallest diameter, which is defined as the largest distance between any pair of objects in the group. The query is useful in many applications such as detecting locations of web resources. However, the existing work does not study the intractability of this problem and only provides exact algorithms, which are computationally expensive.

In this paper, we prove that the problem of answering mCK queries is NP-hard. We first devise a greedy algorithm that has an approximation ratio of 2. Then, we observe that an mCK query can be approximately answered by finding the circle with the smallest diameter that encloses a group of objects together covering all query keywords. We prove that the group enclosed in the circle can answer the mCK query with an approximation ratio of 2 over 3. Based on this, we develop an algorithm for finding such a circle exactly, which has a high time complexity. To improve efficiency, we propose another two algorithms that find such a circle approximately, with a ratio of 2 over √3 + ε. Finally, we propose an exact algorithm that utilizes the group found by the 2 over √3 + ε)-approximation algorithm to obtain the optimal group. We conduct extensive experiments using real-life datasets. The experimental results offer insights into both efficiency and accuracy of the proposed approximation algorithms, and the results also demonstrate that our exact algorithm outperforms the best known algorithm by an order of magnitude.

STRIBOB: Authenticated Encryption from GOST R 34.11-2012 LPS Permutation.

Authenticated encryption algorithms protect both the confidentiality and integrity of messages in a single processing pass. We show how to utilize the L◦P ◦S transform of the Russian GOST R 34.11-2012 standard hash “Streebog” to build an efficient, lightweight algorithm for Authenticated Encryption with Associated Data (AEAD) via the Sponge construction. The proposed algorithm “StriBob” has attractive security properties, is faster than the Streebog hash alone, twice as fast as the GOST 28147-89 encryption algorithm, and requires only a modest amount of running-time memory. StriBob is a Round 1 candidate in the CAESAR competition.

Anytime Algorithms for Solving Possibilistic MDPs and Hybrid MDPs

The ability of an agent to make quick, rational decisions in an uncertain environment is paramount for its applicability in realistic settings. Markov Decision Processes (MDP) provide such a framework, but can only model uncertainty that can be expressed as probabilities. Possibilistic counterparts of MDPs allow to model imprecise beliefs, yet they cannot accurately represent probabilistic sources of uncertainty and they lack the efficient online solvers found in the probabilistic MDP community. In this paper we advance the state of the art in three important ways. Firstly, we propose the first online planner for possibilistic MDP by adapting the Monte-Carlo Tree Search (MCTS) algorithm. A key component is the development of efficient search structures to sample possibility distributions based on the DPY transformation as introduced by Dubois, Prade, and Yager. Secondly, we introduce a hybrid MDP model that allows us to express both possibilistic and probabilistic uncertainty, where the hybrid model is a proper extension of both probabilistic and possibilistic MDPs. Thirdly, we demonstrate that MCTS algorithms can readily be applied to solve such hybrid models.

Paving the way for the use of the SDQ in economic evaluations of school-based population health interventions: an empirical analysis of the external validity of SDQ mapping algorithms to the CHU9D in an educational setting

Purpose
The Strengths and Difficulties Questionnaire (SDQ) is a behavioural screening tool for children. The SDQ is increasingly used as the primary outcome measure in population health interventions involving children, but it is not preference based; therefore, its role in allocative economic evaluation is limited. The Child Health Utility 9D (CHU9D) is a generic preference-based health-related quality of-life measure. This study investigates the applicability of the SDQ outcome measure for use in economic evaluations and examines its relationship with the CHU9D by testing previously published mapping algorithms. The aim of the paper is to explore the feasibility of using the SDQ within economic evaluations of school-based population health interventions.
Methods
Data were available from children participating in a cluster randomised controlled trial of the school-based roots of empathy programme in Northern Ireland. Utility was calculated using the original and alternative CHU9D tariffs along with two SDQ mapping algorithms. t tests were performed for pairwise differences in utility values from the preference-based tariffs and mapping algorithms.
Results
Mean (standard deviation) SDQ total difficulties and prosocial scores were 12 (3.2) and 8.3 (2.1). Utility values obtained from the original tariff, alternative tariff, and mapping algorithms using five and three SDQ subscales were 0.84 (0.11), 0.80 (0.13), 0.84 (0.05), and 0.83 (0.04), respectively. Each method for calculating utility produced statistically significantly different values except the original tariff and five SDQ subscale algorithm.
Conclusion
Initial evidence suggests the SDQ and CHU9D are related in some of their measurement properties. The mapping algorithm using five SDQ subscales was found to be optimal in predicting mean child health utility. Future research valuing changes in the SDQ scores would contribute to this research.

Novel Application of Genetic Sequencing algorithms to optimisation of hardware resource sharing for DSP

Field programmable gate array (FPGA) technology is a powerful platform for implementing computationally complex, digital signal processing (DSP) systems. Applications that are multi-modal, however, are designed for worse case conditions. In this paper, genetic sequencing techniques are applied to give a more sophisticated decomposition of the algorithmic variations, thus allowing an unified hardware architecture which gives a 10-25% area saving and 15% power saving for a digital radar receiver.