PERC rule to exclude the diagnosis of pulmonary embolism in emergency low-risk patients: study protocol for the PROPER randomized controlled study.

BACKGROUND: The diagnosis of Pulmonary Embolism (PE) in the emergency department (ED) is crucial. As emergency physicians fear missing this potential life-threatening condition, PE tends to be over-investigated, exposing patients to unnecessary risks and uncertain benefit in terms of outcome. The Pulmonary Embolism Rule-out Criteria (PERC) is an eight-item block of clinical criteria that can identify patients who can safely be discharged from the ED without further investigation for PE. The endorsement of this rule could markedly reduce the number of irradiative imaging studies, ED length of stay, and rate of adverse events resulting from both diagnostic and therapeutic interventions. Several retrospective and prospective studies have shown the safety and benefits of the PERC rule for PE diagnosis in low-risk patients, but the validity of this rule is still controversial. We hypothesize that in European patients with a low gestalt clinical probability and who are PERC-negative, PE can be safely ruled out and the patient discharged without further testing. METHODS/DESIGN: This is a controlled, cluster randomized trial, in 15 centers in France. Each center will be randomized for the sequence of intervention periods: a 6-month intervention period (PERC-based strategy) followed by a 6-month control period (usual care), or in reverse order, with 2 months of "wash-out" between the 2 periods. Adult patients presenting to the ED with a suspicion of PE and a low pre test probability estimated by clinical gestalt will be eligible. The primary outcome is the percentage of failure resulting from the diagnostic strategy, defined as diagnosed venous thromboembolic events at 3-month follow-up, among patients for whom PE has been initially ruled out. DISCUSSION: The PERC rule has the potential to decrease the number of irradiative imaging studies in the ED, and is reported to be safe. However, no randomized study has ever validated the safety of PERC. Furthermore, some studies have challenged the safety of a PERC-based strategy to rule-out PE, especially in Europe where the prevalence of PE diagnosed in the ED is high. The PROPER study should provide high-quality evidence to settle this issue. If it confirms the safety of the PERC rule, physicians will be able to reduce the number of investigations, associated subsequent adverse events, costs, and ED length of stay for patients with a low clinical probability of PE. TRIAL REGISTRATION: NCT02375919 .

Corruption, income, and rule of law: empirical evidence from developing and developed economies

This article presents an empirical analysis based on cross-country data concerned with two points regarding corruption: (i) its effects on income; and (ii) how to mitigate corruption. The findings can be highlighted in two points. Firstly the idea that corruption is intrinsically connected with income is confirmed. Secondly, the traditional argument that an increase in rule of law represents a good strategy in the fight against corruption is valid for developing countries. Furthermore, this study reveals that the search for increasing the human development index represents a rule of thumb for high levels of income and to control corruption.

In Search for the European solidarity: The rule of law within the European Union in the framework of constitutional pluralism

The dissertation examines the rule of law within the European Union in the theoretical framework of constitutional pluralism. The leading lines of constitutional pluralism are examined with relation to the traditional and prevailing, monistic and hierarchical conceptions on how to perceive legal orders in Europe. The theoretical part offers also historical perspective by highlighting some of the turning points for the Union constitutional legal order in the framework of European integration. The concept of rule of law is examined in legal terms and its meaning to the Union constitutional constellation as a constitutional principle and a common value is observed. The realization of the rule of law at supranational and national level is explored with a view to discover that recent developments in some of the Member States give rise to concern about the viability of the rule of law within the European Union. It is recognized that the inobservance of the rule of law at national level causes a threat to the supranational constitutional legal order. The relationship between the supranational and national legal orders is significant in this respect and therefore particularly the interaction between the Court of Justice of the European Union (hereinafter the ECJ) and the Member States’ (constitutional/supreme) courts takes focus. It is observed that functioning dialogue between the supranational and national courts based on mutual respect and judicial deference is an important prerequisite for the realization of the rule of law within Europe. In order to afford a concrete example, a recent case C-62/14 Gauweiler v Deutscher Bundestag is introduced and analysed in relation to the notorious relationship between the Federal Constitutional Court of Germany and the ECJ. The implications of the ECJ’s decision in Gauweiler v Deutscher Bundestag is assessed with reference to some of the pressing issues of constitutionalism within Europe and some institutional aspects are also brought forward. Lastly, the feasibility of constitutional pluralism as a theoretical setting is measured against the legal reality of today’s Europe and its many constitutions. The hierarchical idea of one ultimate source of power, stemming from the traditional approaches to legal systems, is then assessed with relation to the requirement of the realization of the rule of law within the European Union from the supranational and national point of view.

Efficient data mining based on formal concept analysis

Formal Concept Analysis is an unsupervised learning technique for conceptual clustering. We introduce the notion of iceberg concept lattices and show their use in Knowledge Discovery in Databases (KDD). Iceberg lattices are designed for analyzing very large databases. In particular they serve as a condensed representation of frequent patterns as known from association rule mining. In order to show the interplay between Formal Concept Analysis and association rule mining, we discuss the algorithm TITANIC. We show that iceberg concept lattices are a starting point for computing condensed sets of association rules without loss of information, and are a visualization method for the resulting rules.

Efficient mining of association rules based on formal concept analysis

Association rules are a popular knowledge discovery technique for warehouse basket analysis. They indicate which items of the warehouse are frequently bought together. The problem of association rule mining has first been stated in 1993. Five years later, several research groups discovered that this problem has a strong connection to Formal Concept Analysis (FCA). In this survey, we will first introduce some basic ideas of this connection along a specific algorithm, TITANIC, and show how FCA helps in reducing the number of resulting rules without loss of information, before giving a general overview over the history and state of the art of applying FCA for association rule mining.

UNITRAN: A Principle-Based Approach to Machine Translation

Machine translation has been a particularly difficult problem in the area of Natural Language Processing for over two decades. Early approaches to translation failed since interaction effects of complex phenomena in part made translation appear to be unmanageable. Later approaches to the problem have succeeded (although only bilingually), but are based on many language-specific rules of a context-free nature. This report presents an alternative approach to natural language translation that relies on principle-based descriptions of grammar rather than rule-oriented descriptions. The model that has been constructed is based on abstract principles as developed by Chomsky (1981) and several other researchers working within the "Government and Binding" (GB) framework. Thus, the grammar is viewed as a modular system of principles rather than a large set of ad hoc language-specific rules.

Ownership rights in performance-based contracting: A case study of English law

Clients and contractors need to be aware of the project’s legal environment because the viability of a procurement strategy can be vitiated by legal rules. This is particularly true regarding Performance-Based Contracting (PBC) whose viability may be threatened by rules of property law: while the PBC concept does not require that the contractor transfers the ownership in the building materials used to the client, the rules of property law often lead to an automatic transfer of ownership. But does the legal environment really render PBC unfeasible? In particular, is PBC unfeasible because contractors lose their materials as assets? These questions need to be answered with respect to the applicable property law. As a case study, English property law has been chosen. Under English law, the rule which governs the automatic transfer of ownership is called quicquid plantatur solo, solo credit (whatever is fixed to the soil belongs to the soil). An analysis of this rule reveals that not all materials which are affixed to land become part of the land. This fate only occurs in relation to materials which have been affixed with the intention of permanently improving the land. Five fictitious PBC cases have been considered in terms of the legal status of the materials involved, and several subsequent legal questions have been addressed. The results suggest that English law does actually threaten the feasibility of PBC in some cases. However, it is also shown that the law provides means to circumvent the unwanted results which flow from the rules of property law. In particular, contractors who are interested in keeping their materials as assets can insist on agreeing a property right in the client’s land, i.e. a contractor’s lien. Therefore, the outcome is that English property law does not render the implementation of the PBC concept unfeasible. At a broader level, the results contribute to the theoretical framework of PBC as an increasingly used procurement strategy.

Characterisation of blends based on hydroxyethylcellulose and maleic acid-alt-methyl vinyl ether

Hydrophilic polymeric films based on blends of hydroxyethylcellulose and maleic acid-co-methyl vinyl ether were produced by casting from aqueous solutions. The physicochemical properties of the blends have been assessed using Fourier transform infrared spectroscopy, thermal gravimetric analysis, differential scanning calorimetry, dielectric spectroscopy, etc. The pristine films exhibit complete miscibility due to the formation of intermacromolecular hydrogen bonding. The thermal treatment of the blend films leads to cross-linking via intermacromolecular esterification and anhydride formation. The cross-linked materials are able to swell in water and their swelling degree can be easily controlled by temperature and thermal treatment time. The formation of the crosslinks is apparent in the dynamic properties of the blends as observed through the mechanical relaxation and dielectric relaxation spectra. The dielectric characteristics of the material are influenced by the effects of change in the local structure of the blend on the ionic conduction processes and the rate of dipolar relaxation. Separation of these processes is attempted using the dielectric modulus method. Significant deviations from a simple additive rule of mixing on the activation energy are observed consistent with hydrogen bonding and crosslinking of the matrix. This paper indicates a method for the creation of films with good mechanical and physical characteristics by exposing the blends to a relatively mild thermal treatment.

The relative success of recognition-based inference in multichoice decisions

The utility of an "ecologically rational" recognition-based decision rule in multichoice decision problems is analyzed, varying the type of judgment required (greater or lesser). The maximum size and range of a counterintuitive advantage associated with recognition-based judgment (the "less-is-more effect") is identified for a range of cue validity values. Greater ranges of the less-is-more effect occur when participants are asked which is the greatest of to choices (m > 2) than which is the least. Less-is-more effects also have greater range for larger values of in. This implies that the classic two-altemative forced choice task, as studied by Goldstein and Gigerenzer (2002), may not be the most appropriate test case for less-is-more effects.

An overview of domestic energy models and a new approach with agent based modelling

Government targets for CO2 reductions are being progressively tightened, the Climate Change Act set the UK target as an 80% reduction by 2050 on 1990 figures. The residential sector accounts for about 30% of emissions. This paper discusses current modelling techniques in the residential sector: principally top-down and bottom-up. Top-down models work on a macro-economic basis and can be used to consider large scale economic changes; bottom-up models are detail rich to model technological changes. Bottom-up models demonstrate what is technically possible. However, there are differences between the technical potential and what is likely given the limited economic rationality of the typical householder. This paper recommends research to better understand individuals’ behaviour. Such research needs to include actual choices, stated preferences and opinion research to allow a detailed understanding of the individual end user. This increased understanding can then be used in an agent based model (ABM). In an ABM, agents are used to model real world actors and can be given a rule set intended to emulate the actions and behaviours of real people. This can help in understanding how new technologies diffuse. In this way a degree of micro-economic realism can be added to domestic carbon modelling. Such a model should then be of use for both forward projections of CO2 and to analyse the cost effectiveness of various policy measures.

P-Prism: a computationally efficient approach to scaling up classification rule induction

Top Down Induction of Decision Trees (TDIDT) is the most commonly used method of constructing a model from a dataset in the form of classification rules to classify previously unseen data. Alternative algorithms have been developed such as the Prism algorithm. Prism constructs modular rules which produce qualitatively better rules than rules induced by TDIDT. However, along with the increasing size of databases, many existing rule learning algorithms have proved to be computational expensive on large datasets. To tackle the problem of scalability, parallel classification rule induction algorithms have been introduced. As TDIDT is the most popular classifier, even though there are strongly competitive alternative algorithms, most parallel approaches to inducing classification rules are based on TDIDT. In this paper we describe work on a distributed classifier that induces classification rules in a parallel manner based on Prism.

J-measure based hybrid pruning for complexity reduction in classification rules

Prism is a modular classification rule generation method based on the ‘separate and conquer’ approach that is alternative to the rule induction approach using decision trees also known as ‘divide and conquer’. Prism often achieves a similar level of classification accuracy compared with decision trees, but tends to produce a more compact noise tolerant set of classification rules. As with other classification rule generation methods, a principle problem arising with Prism is that of overfitting due to over-specialised rules. In addition, over-specialised rules increase the associated computational complexity. These problems can be solved by pruning methods. For the Prism method, two pruning algorithms have been introduced recently for reducing overfitting of classification rules - J-pruning and Jmax-pruning. Both algorithms are based on the J-measure, an information theoretic means for quantifying the theoretical information content of a rule. Jmax-pruning attempts to exploit the J-measure to its full potential because J-pruning does not actually achieve this and may even lead to underfitting. A series of experiments have proved that Jmax-pruning may outperform J-pruning in reducing overfitting. However, Jmax-pruning is computationally relatively expensive and may also lead to underfitting. This paper reviews the Prism method and the two existing pruning algorithms above. It also proposes a novel pruning algorithm called Jmid-pruning. The latter is based on the J-measure and it reduces overfitting to a similar level as the other two algorithms but is better in avoiding underfitting and unnecessary computational effort. The authors conduct an experimental study on the performance of the Jmid-pruning algorithm in terms of classification accuracy and computational efficiency. The algorithm is also evaluated comparatively with the J-pruning and Jmax-pruning algorithms.

Rule Type Identification using TRCM for trend analysis in Twitter

This paper considers the use of Association Rule Mining (ARM) and our proposed Transaction based Rule Change Mining (TRCM) to identify the rule types present in tweet’s hashtags over a specific consecutive period of time and their linkage to real life occurrences. Our novel algorithm was termed TRCM-RTI in reference to Rule Type Identification. We created Time Frame Windows (TFWs) to detect evolvement statuses and calculate the lifespan of hashtags in online tweets. We link RTI to real life events by monitoring and recording rule evolvement patterns in TFWs on the Twitter network.

Towards expressive rule induction on IP network event streams

In order to gain insights into events and issues that may cause errors and outages in parts of IP networks, intelligent methods that capture and express causal relationships online (in real-time) are needed. Whereas generalised rule induction has been explored for non-streaming data applications, its application and adaptation on streaming data is mostly undeveloped or based on periodic and ad-hoc training with batch algorithms. Some association rule mining approaches for streaming data do exist, however, they can only express binary causal relationships. This paper presents the ongoing work on Online Generalised Rule Induction (OGRI) in order to create expressive and adaptive rule sets real-time that can be applied to a broad range of applications, including network telemetry data streams.

Texture analysis based on maximum contrast walker

Recently, the deterministic tourist walk has emerged as a novel approach for texture analysis. This method employs a traveler visiting image pixels using a deterministic walk rule. Resulting trajectories provide clues about pixel interaction in the image that can be used for image classification and identification tasks. This paper proposes a new walk rule for the tourist which is based on contrast direction of a neighborhood. The yielded results using this approach are comparable with those from traditional texture analysis methods in the classification of a set of Brodatz textures and their rotated versions, thus confirming the potential of the method as a feasible texture analysis methodology. (C) 2010 Elsevier B.V. All rights reserved.