Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.

MPJ express: Towards thread safe Java HPC

MPJ Express is a thread-safe Java messaging library that provides a full implementation of the mpiJava 1.2 API specification. This specification defines a MPI-like bindings for the Java language. We have implemented two communication devices as part of our library, the first, called niodev is based on the Java New I/O package and the second, called mxdev is based on the Myrinet eXpress library MPJ Express comes with an experimental runtitne, which allows portable bootstrapping of Java Virtual Machines across a cluster or network of computers. In this paper we describe the implementation of MPJ Express. Also, we present a performance comparison against various other C and Java messaging systems. A beta version of MPJ Express was released in September 2005.

Parallel and distributed computing with Java

The Java language first came to public attention in 1995. Within a year, it was being speculated that Java may be a good language for parallel and distributed computing. Its core features, including being objected oriented and platform independence, as well as having built-in network support and threads, has encouraged this view. Today, Java is being used in almost every type of computer-based system, ranging from sensor networks to high performance computing platforms, and from enterprise applications through to complex research-based.simulations. In this paper the key features that make Java a good language for parallel and distributed computing are first discussed. Two Java-based middleware systems, namely MPJ Express, an MPI-like Java messaging system, and Tycho, a wide-area asynchronous messaging framework with an integrated virtual registry are then discussed. The paper concludes by highlighting the advantages of using Java as middleware to support distributed applications.

Building collaborative environments for advanced computing

Synchronous collaborative systems allow geographically distributed users to form a virtual work environment enabling cooperation between peers and enriching the human interaction. The technology facilitating this interaction has been studied for several years and various solutions can be found at present. In this paper, we discuss our experiences with one such widely adopted technology, namely the Access Grid [1]. We describe our experiences with using this technology, identify key problem areas and propose our solution to tackle these issues appropriately. Moreover, we propose the integration of Access Grid with an Application Sharing tool, developed by the authors. Our approach allows these integrated tools to utilise the enhanced features provided by our underlying dynamic transport layer.

Autonomous execution of tasks by swarm carrier agents in swarm-array computing

How can a bridge be built between autonomic computing approaches and parallel computing system? The work reported in this paper is motivated towards bridging this gap by proposing swarm-array computing, a novel technique to achieve autonomy for distributed parallel computing systems. Among three proposed approaches, the second approach, namely 'Intelligent Agents' is of focus in this paper. The task to be executed on parallel computing cores is considered as a swarm of autonomous agents. A task is carried to a computing core by carrier. agents and can be seamlessly transferred between cores in the event of a pre-dicted failure, thereby achieving self-ware objectives of autonomic computing. The feasibility of the proposed approach is validated on a multi-agent simulator.

Intelligent agents: are they feasible in swarm-array computing?

The work reported in this paper proposes 'Intelligent Agents', a Swarm-Array computing approach focused to apply autonomic computing concepts to parallel computing systems and build reliable systems for space applications. Swarm-array computing is a robotics a swarm robotics inspired novel computing approach considered as a path to achieve autonomy in parallel computing systems. In the intelligent agent approach, a task to be executed on parallel computing cores is considered as a swarm of autonomous agents. A task is carried to a computing core by carrier agents and can be seamlessly transferred between cores in the event of a predicted failure, thereby achieving self-* objectives of autonomic computing. The approach is validated on a multi-agent simulator.

Intelligent cores and intelligent agents: two approaches to achieve autonomy in swarm-array computing

How can a bridge be built between autonomic computing approaches and parallel computing systems? How can autonomic computing approaches be extended towards building reliable systems? How can existing technologies be merged to provide a solution for self-managing systems? The work reported in this paper aims to answer these questions by proposing Swarm-Array Computing, a novel technique inspired from swarm robotics and built on the foundations of autonomic and parallel computing paradigms. Two approaches based on intelligent cores and intelligent agents are proposed to achieve autonomy in parallel computing systems. The feasibility of the proposed approaches is validated on a multi-agent simulator.

Building reliable systems for space applications using swarm-array computing

Space applications demand the need for building reliable systems. Autonomic computing defines such reliable systems as self-managing systems. The work reported in this paper combines agent-based and swarm robotic approaches leading to swarm-array computing, a novel technique to achieve self-managing distributed parallel computing systems. Two swarm-array computing approaches based on swarms of computational resources and swarms of tasks are explored. FPGA is considered as the computing system. The feasibility of the two proposed approaches that binds the computing system and the task together is simulated on the SeSAm multi-agent simulator.

Building reliable systems for space applications using swarm-array computing

Space applications demand the need for building reliable systems. Autonomic computing defines such reliable systems as self-managing systems. The work reported in this paper combines agent-based and swarm robotic approaches leading to swarm-array computing, a novel technique to achieve self-managing distributed parallel computing systems. Two swarm-array computing approaches based on swarms of computational resources and swarms of tasks are explored. FPGA is considered as the computing system. The feasibility of the two proposed approaches that binds the computing system and the task together is simulated on the SeSAm multi-agent simulator.

Parallel performance and scalability experiments with the Danish Eulerian Model on the EPCC supercomputers

The Danish Eulerian Model (DEM) is a powerful air pollution model, designed to calculate the concentrations of various dangerous species over a large geographical region (e.g. Europe). It takes into account the main physical and chemical processes between these species, the actual meteorological conditions, emissions, etc.. This is a huge computational task and requires significant resources of storage and CPU time. Parallel computing is essential for the efficient practical use of the model. Some efficient parallel versions of the model were created over the past several years. A suitable parallel version of DEM by using the Message Passing Interface library (AIPI) was implemented on two powerful supercomputers of the EPCC - Edinburgh, available via the HPC-Europa programme for transnational access to research infrastructures in EC: a Sun Fire E15K and an IBM HPCx cluster. Although the implementation is in principal, the same for both supercomputers, few modifications had to be done for successful porting of the code on the IBM HPCx cluster. Performance analysis and parallel optimization was done next. Results from bench marking experiments will be presented in this paper. Another set of experiments was carried out in order to investigate the sensitivity of the model to variation of some chemical rate constants in the chemical submodel. Certain modifications of the code were necessary to be done in accordance with this task. The obtained results will be used for further sensitivity analysis Studies by using Monte Carlo simulation.

Investigating the feasibility of a swarm-array computing approach

The work reported in this paper proposes a novel synergy between parallel computing and swarm robotics to offer a new computing paradigm, 'swarm-array computing' that can harness and apply autonomic computing for parallel computing systems. One approach among three proposed approaches in swarm-array computing based on landscapes of intelligent cores, in which the cores of a parallel computing system are abstracted to swarm agents, is investigated. A task is executed and transferred seamlessly between cores in the proposed approach thereby achieving self-ware properties that characterize autonomic computing. FPGAs are considered as an experimental platform taking into account its application in space robotics. The feasibility of the proposed approach is validated on the SeSAm multi-agent simulator.

An autonomic approach in swarm-array computing

Can autonomic computing concepts be applied to traditional multi-core systems found in high performance computing environments? In this paper, we propose a novel synergy between parallel computing and swarm robotics to offer a new computing paradigm, `Swarm-Array Computing' that can harness and apply autonomic computing for parallel computing systems. One approach among three proposed approaches in swarm-array computing based on landscapes of intelligent cores, in which the cores of a parallel computing system are abstracted to swarm agents, is investigated. A task gets executed and transferred seamlessly between cores in the proposed approach thereby achieving self-ware properties that characterize autonomic computing. FPGAs are considered as an experimental platform taking into account its application in space robotics. The feasibility of the proposed approach is validated on the SeSAm multi-agent simulator.