Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study)

PURPOSE Potentially inappropriate prescribing (PIP) is common in older people and can result in increased morbidity, adverse drug events, and hospitalizations. The OPTI-SCRIPT study (Optimizing Prescribing for Older People in Primary Care, a cluster-randomized controlled trial) tested the effectiveness of a multifaceted intervention for reducing PIP in primary care.

METHODS We conducted a cluster-randomized controlled trial among 21 general practitioner practices and 196 patients with PIP. Intervention participants received a complex, multifaceted intervention incorporating academic detailing; review of medicines with web-based pharmaceutical treatment algorithms that provide recommended alternative-treatment options; and tailored patient information leaflets. Control practices delivered usual care and received simple, patient-level PIP feedback. Primary outcomes were the proportion of patients with PIP and the mean number of potentially inappropriate prescriptions. We performed intention-to-treat analysis using random-effects regression.

RESULTS All 21 practices and 190 patients were followed. At intervention completion, patients in the intervention group had significantly lower odds of having PIP than patients in the control group (adjusted odds ratio = 0.32; 95% CI, 0.15–0.70; P = .02). The mean number of PIP drugs in the intervention group was 0.70, compared with 1.18 in the control group (P = .02). The intervention group was almost one-third less likely than the control group to have PIP drugs at intervention completion, but this difference was not significant (incidence rate ratio = 0.71; 95% CI, 0.50–1.02; P = .49). The intervention was effective in reducing proton pump inhibitor prescribing (adjusted odds ratio = 0.30; 95% CI, 0.14–0.68; P = .04).

CONCLUSIONS The OPTI-SCRIPT intervention incorporating academic detailing with a pharmacist, and a review of medicines with web-based pharmaceutical treatment algorithms, was effective in reducing PIP, particularly in modifying prescribing of proton pump inhibitors, the most commonly occurring PIP drugs nationally.

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.

Workload Schedulers - Genesis, Algorithms and Comparisons

In this article we provide brief descriptions of three classes of schedulers: Operating Systems Process Schedulers, Cluster Systems, Jobs Schedulers and Big Data Schedulers. We describe their evolution from early adoptions to modern implementations, considering both the use and features of algorithms. In summary, we discuss differences between all presented classes of schedulers and discuss their chronological development. In conclusion, we highlight similarities in the focus of scheduling strategies design, applicable to both local and distributed systems.

Optimal virtual cluster-based multiprocessor scheduling

Scheduling of constrained deadline sporadic task systems on multiprocessor platforms is an area which has received much attention in the recent past. It is widely believed that finding an optimal scheduler is hard, and therefore most studies have focused on developing algorithms with good processor utilization bounds. These algorithms can be broadly classified into two categories: partitioned scheduling in which tasks are statically assigned to individual processors, and global scheduling in which each task is allowed to execute on any processor in the platform. In this paper we consider a third, more general, approach called cluster-based scheduling. In this approach each task is statically assigned to a processor cluster, tasks in each cluster are globally scheduled among themselves, and clusters in turn are scheduled on the multiprocessor platform. We develop techniques to support such cluster-based scheduling algorithms, and also consider properties that minimize total processor utilization of individual clusters. In the last part of this paper, we develop new virtual cluster-based scheduling algorithms. For implicit deadline sporadic task systems, we develop an optimal scheduling algorithm that is neither Pfair nor ERfair. We also show that the processor utilization bound of us-edf{m/(2m−1)} can be improved by using virtual clustering. Since neither partitioned nor global strategies dominate over the other, cluster-based scheduling is a natural direction for research towards achieving improved processor utilization bounds.

An adaptive cluster based routing scheme for mobile wireless sensor networks

Clustering schemes improve energy efficiency of wireless sensor networks. The inclusion of mobility as a new criterion for the cluster creation and maintenance adds new challenges for these clustering schemes. Cluster formation and cluster head selection is done on a stochastic basis for most of the algorithms. In this paper we introduce a cluster formation and routing algorithm based on a mobility factor. The proposed algorithm is compared with LEACH-M protocol based on metrics viz. number of cluster head transitions, average residual energy, number of alive nodes and number of messages lost

Parallel genetic algorithms for the tuning of a fuzzy AQM controller

This paper presents the results of the application of a parallel Genetic Algorithm (GA) in order to design a Fuzzy Proportional Integral (FPI) controller for active queue management on Internet routers. The Active Queue Management (AQM) policies are those policies of router queue management that allow the detection of network congestion, the notification of such occurrences to the hosts on the network borders, and the adoption of a suitable control policy. Two different parallel implementations of the genetic algorithm are adopted to determine an optimal configuration of the FPI controller parameters. Finally, the results of several experiments carried out on a forty nodes cluster of workstations are presented.

Parallel Monte Carlo algorithms for information retrieval

In any data mining applications, automated text and text and image retrieval of information is needed. This becomes essential with the growth of the Internet and digital libraries. Our approach is based on the latent semantic indexing (LSI) and the corresponding term-by-document matrix suggested by Berry and his co-authors. Instead of using deterministic methods to find the required number of first "k" singular triplets, we propose a stochastic approach. First, we use Monte Carlo method to sample and to build much smaller size term-by-document matrix (e.g. we build k x k matrix) from where we then find the first "k" triplets using standard deterministic methods. Second, we investigate how we can reduce the problem to finding the "k"-largest eigenvalues using parallel Monte Carlo methods. We apply these methods to the initial matrix and also to the reduced one. The algorithms are running on a cluster of workstations under MPI and results of the experiments arising in textual retrieval of Web documents as well as comparison of the stochastic methods proposed are presented. (C) 2003 IMACS. Published by Elsevier Science B.V. All rights reserved.

On merging gradient estimation with mean-tracking techniques for cluster identification

This paper discusses how numerical gradient estimation methods may be used in order to reduce the computational demands on a class of multidimensional clustering algorithms. The study is motivated by the recognition that several current point-density based cluster identification algorithms could benefit from a reduction of computational demand if approximate a-priori estimates of the cluster centres present in a given data set could be supplied as starting conditions for these algorithms. In this particular presentation, the algorithm shown to benefit from the technique is the Mean-Tracking (M-T) cluster algorithm, but the results obtained from the gradient estimation approach may also be applied to other clustering algorithms and their related disciplines.

THE VORONOI TESSELLATION CLUSTER FINDER IN 2+1 DIMENSIONS

We present a detailed description of the Voronoi Tessellation (VT) cluster finder algorithm in 2+1 dimensions, which improves on past implementations of this technique. The need for cluster finder algorithms able to produce reliable cluster catalogs up to redshift 1 or beyond and down to 10(13.5) solar masses is paramount especially in light of upcoming surveys aiming at cosmological constraints from galaxy cluster number counts. We build the VT in photometric redshift shells and use the two-point correlation function of the galaxies in the field to both determine the density threshold for detection of cluster candidates and to establish their significance. This allows us to detect clusters in a self-consistent way without any assumptions about their astrophysical properties. We apply the VT to mock catalogs which extend to redshift 1.4 reproducing the ACDM cosmology and the clustering properties observed in the Sloan Digital Sky Survey data. An objective estimate of the cluster selection function in terms of the completeness and purity as a function of mass and redshift is as important as having a reliable cluster finder. We measure these quantities by matching the VT cluster catalog with the mock truth table. We show that the VT can produce a cluster catalog with completeness and purity > 80% for the redshift range up to similar to 1 and mass range down to similar to 10(13.5) solar masses.

Towards improving cluster-based feature selection with a simplified silhouette filter

This paper proposes a filter-based algorithm for feature selection. The filter is based on the partitioning of the set of features into clusters. The number of clusters, and consequently the cardinality of the subset of selected features, is automatically estimated from data. The computational complexity of the proposed algorithm is also investigated. A variant of this filter that considers feature-class correlations is also proposed for classification problems. Empirical results involving ten datasets illustrate the performance of the developed algorithm, which in general has obtained competitive results in terms of classification accuracy when compared to state of the art algorithms that find clusters of features. We show that, if computational efficiency is an important issue, then the proposed filter May be preferred over their counterparts, thus becoming eligible to join a pool of feature selection algorithms to be used in practice. As an additional contribution of this work, a theoretical framework is used to formally analyze some properties of feature selection methods that rely on finding clusters of features. (C) 2011 Elsevier Inc. All rights reserved.

Multidimensional cluster stability analysis from a Brazilian Bradyrhizobium sp RFLP/PCR data set

The taxonomy of the N(2)-fixing bacteria belonging to the genus Bradyrhizobium is still poorly refined, mainly due to conflicting results obtained by the analysis of the phenotypic and genotypic properties. This paper presents an application of a method aiming at the identification of possible new clusters within a Brazilian collection of 119 Bradryrhizobium strains showing phenotypic characteristics of B. japonicum and B. elkanii. The stability was studied as a function of the number of restriction enzymes used in the RFLP-PCR analysis of three ribosomal regions with three restriction enzymes per region. The method proposed here uses Clustering algorithms with distances calculated by average-linkage clustering. Introducing perturbations using sub-sampling techniques makes the stability analysis. The method showed efficacy in the grouping of the species B. japonicum and B. elkanii. Furthermore, two new clusters were clearly defined, indicating possible new species, and sub-clusters within each detected cluster. (C) 2008 Elsevier B.V. All rights reserved.

QK-Means: A clustering technique based on community detection and K-Means for deployment of cluster head nodes

Wireless Sensor Networks (WSN) are a special kind of ad-hoc networks that is usually deployed in a monitoring field in order to detect some physical phenomenon. Due to the low dependability of individual nodes, small radio coverage and large areas to be monitored, the organization of nodes in small clusters is generally used. Moreover, a large number of WSN nodes is usually deployed in the monitoring area to increase WSN dependability. Therefore, the best cluster head positioning is a desirable characteristic in a WSN. In this paper, we propose a hybrid clustering algorithm based on community detection in complex networks and traditional K-means clustering technique: the QK-Means algorithm. Simulation results show that QK-Means detect communities and sub-communities thus lost message rate is decreased and WSN coverage is increased. © 2012 IEEE.

Collaborative fuzzy clustering algorithms: some refinements and design guidelines

There are some variants of the widely used Fuzzy C-Means (FCM) algorithm that support clustering data distributed across different sites. Those methods have been studied under different names, like collaborative and parallel fuzzy clustering. In this study, we offer some augmentation of the two FCM-based clustering algorithms used to cluster distributed data by arriving at some constructive ways of determining essential parameters of the algorithms (including the number of clusters) and forming a set of systematically structured guidelines such as a selection of the specific algorithm depending on the nature of the data environment and the assumptions being made about the number of clusters. A thorough complexity analysis, including space, time, and communication aspects, is reported. A series of detailed numeric experiments is used to illustrate the main ideas discussed in the study.

Large-scale coupled-cluster calculations

Coupled-cluster theory provides one of the most successful concepts in electronic-structure theory. This work covers the parallelization of coupled-cluster energies, gradients, and second derivatives and its application to selected large-scale chemical problems, beside the more practical aspects such as the publication and support of the quantum-chemistry package ACES II MAB and the design and development of a computational environment optimized for coupled-cluster calculations. The main objective of this thesis was to extend the range of applicability of coupled-cluster models to larger molecular systems and their properties and therefore to bring large-scale coupled-cluster calculations into day-to-day routine of computational chemistry. A straightforward strategy for the parallelization of CCSD and CCSD(T) energies, gradients, and second derivatives has been outlined and implemented for closed-shell and open-shell references. Starting from the highly efficient serial implementation of the ACES II MAB computer code an adaptation for affordable workstation clusters has been obtained by parallelizing the most time-consuming steps of the algorithms. Benchmark calculations for systems with up to 1300 basis functions and the presented applications show that the resulting algorithm for energies, gradients and second derivatives at the CCSD and CCSD(T) level of theory exhibits good scaling with the number of processors and substantially extends the range of applicability. Within the framework of the ’High accuracy Extrapolated Ab initio Thermochemistry’ (HEAT) protocols effects of increased basis-set size and higher excitations in the coupled- cluster expansion were investigated. The HEAT scheme was generalized for molecules containing second-row atoms in the case of vinyl chloride. This allowed the different experimental reported values to be discriminated. In the case of the benzene molecule it was shown that even for molecules of this size chemical accuracy can be achieved. Near-quantitative agreement with experiment (about 2 ppm deviation) for the prediction of fluorine-19 nuclear magnetic shielding constants can be achieved by employing the CCSD(T) model together with large basis sets at accurate equilibrium geometries if vibrational averaging and temperature corrections via second-order vibrational perturbation theory are considered. Applying a very similar level of theory for the calculation of the carbon-13 NMR chemical shifts of benzene resulted in quantitative agreement with experimental gas-phase data. The NMR chemical shift study for the bridgehead 1-adamantyl cation at the CCSD(T) level resolved earlier discrepancies of lower-level theoretical treatment. The equilibrium structure of diacetylene has been determined based on the combination of experimental rotational constants of thirteen isotopic species and zero-point vibrational corrections calculated at various quantum-chemical levels. These empirical equilibrium structures agree to within 0.1 pm irrespective of the theoretical level employed. High-level quantum-chemical calculations on the hyperfine structure parameters of the cyanopolyynes were found to be in excellent agreement with experiment. Finally, the theoretically most accurate determination of the molecular equilibrium structure of ferrocene to date is presented.