Natriuretic peptide-based screening and collaborative care for heart failure:the STOP-HF randomized trial

IMPORTANCE: Prevention strategies for heart failure are needed.

OBJECTIVE: To determine the efficacy of a screening program using brain-type natriuretic peptide (BNP) and collaborative care in an at-risk population in reducing newly diagnosed heart failure and prevalence of significant left ventricular (LV) systolic and/or diastolic dysfunction.

DESIGN, SETTING, AND PARTICIPANTS: The St Vincent's Screening to Prevent Heart Failure Study, a parallel-group randomized trial involving 1374 participants with cardiovascular risk factors (mean age, 64.8 [SD, 10.2] years) recruited from 39 primary care practices in Ireland between January 2005 and December 2009 and followed up until December 2011 (mean follow-up, 4.2 [SD, 1.2] years).

INTERVENTION: Patients were randomly assigned to receive usual primary care (control condition; n=677) or screening with BNP testing (n=697). Intervention-group participants with BNP levels of 50 pg/mL or higher underwent echocardiography and collaborative care between their primary care physician and specialist cardiovascular service.

MAIN OUTCOMES AND MEASURES: The primary end point was prevalence of asymptomatic LV dysfunction with or without newly diagnosed heart failure. Secondary end points included emergency hospitalization for arrhythmia, transient ischemic attack, stroke, myocardial infarction, peripheral or pulmonary thrombosis/embolus, or heart failure.

RESULTS: A total of 263 patients (41.6%) in the intervention group had at least 1 BNP reading of 50 pg/mL or higher. The intervention group underwent more cardiovascular investigations (control, 496 per 1000 patient-years vs intervention, 850 per 1000 patient-years; incidence rate ratio, 1.71; 95% CI, 1.61-1.83; P<.001) and received more renin-angiotensin-aldosterone system-based therapy at follow-up (control, 49.6%; intervention, 56.5%; P=.01). The primary end point of LV dysfunction with or without heart failure was met in 59 (8.7%) of 677 in the control group and 37 (5.3%) of 697 in the intervention group (odds ratio [OR], 0.55; 95% CI, 0.37-0.82; P = .003). Asymptomatic LV dysfunction was found in 45 (6.6%) of 677 control-group patients and 30 (4.3%) of 697 intervention-group patients (OR, 0.57; 95% CI, 0.37-0.88; P = .01). Heart failure occurred in 14 (2.1%) of 677 control-group patients and 7 (1.0%) of 697 intervention-group patients (OR, 0.48; 95% CI, 0.20-1.20; P = .12). The incidence rates of emergency hospitalization for major cardiovascular events were 40.4 per 1000 patient-years in the control group vs 22.3 per 1000 patient-years in the intervention group (incidence rate ratio, 0.60; 95% CI, 0.45-0.81; P = .002).

CONCLUSION AND RELEVANCE: Among patients at risk of heart failure, BNP-based screening and collaborative care reduced the combined rates of LV systolic dysfunction, diastolic dysfunction, and heart failure.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00921960.

A Preliminary Case Study for Collaborative Quality Enhancement

Eight universities have collaborated in an Erasmus+ funded project to create a lean process to enhance self-evaluation and accreditation through peer alliance and cooperation. Central to this process is the partnering of two institutions as critical friends, based on prior selfevaluations of specific programmes to identify particular criteria for improvement. A pairing algorithm matches two institutions based on their respective self-evaluation scores. It ensures there are significant differences in key criteria that are mutually beneficial for future programme development and enhancement. The ensuing meetings between critical friends have been designated as ‘cross-sparring’. This paper focuses on a case-study of the crosssparring and resulting enhancement outcomes between Umeå University and Queen’s University Belfast, and their respective Masters programmes in Software Engineering and Mechanical Engineering. The collaborative experiences of the process are evaluated, reported, discussed and conclusions provided on the efficacy of this particular application of cross-sparring.

Shared Education in contested spaces: How collaborative networks improve communities and schools

Societies which suffer from ethnic and political divisions are often characterised by patterns of social and institutional separation, and sometimes these divisions remain even after political conflict has ended. This has occurred in Northern Ireland where there is, and remains, a long-standing pattern of parallel institutions and services for the different communities. A socially significant example lies in the education system where a parallel system of Catholic and Protestant schools has been in place since the establishment of a national school system in the 1830s. During the years of political violence in Northern Ireland a variety of educational interventions were implemented to promote reconciliation, but most of them failed to create any systemic change. This paper describes a post-conflict educational initiative known as Shared Education which aims to promote social cohesion and school improvement by encouraging sustained and regular shared learning between students and broader collaboration between teachers and school leaders from different schools. The paper examines the background to work on Shared Education, describes a ‘sharing continuum’ which emerged as an evaluation and policy tool from this work and considers evidence from a case study of a Shared Education school partnership in a divided city in Northern Ireland. The paper will conclude by highlighting some of the significant social and policy impact of the Shared Education work.

A Validation Study of Vascular Cognitive Impairment Genetics Meta-Analysis Findings in an Independent Collaborative Cohort

Vascular cognitive impairment (VCI), including its severe form, vascular dementia (VaD), is the second most common form of dementia. The genetic etiology of sporadic VCI remains largely unknown. We previously conducted a systematic review and meta-analysis of all published genetic association studies of sporadic VCI prior to 6 July 2012, which demonstrated that APOE (ɛ4, ɛ2) and MTHFR (rs1801133) variants were associated with susceptibility for VCI. De novo genotyping was conducted in a new independent relatively large collaborative European cohort of VaD (nmax = 549) and elderly non-demented samples (nmax = 552). Where available, genotype data derived from Illumina's 610-quad array for 1210 GERAD1 control samples were also included in analyses of genes examined. Associations were tested using the Cochran-Armitage trend test: MTHFR rs1801133 (OR = 1.36, 95% CI 1.16-1.58, p = <0.0001), APOE rs7412 (OR = 0.62, 95% CI 0.42-0.90, p = 0.01), and APOE rs429358 (OR = 1.59, 95% CI 1.17-2.16, p = 0.003). Association was also observed with APOE epsilon alleles; ɛ4 (OR = 1.85, 95% CI 1.35-2.52, p = <0.0001) and ɛ2 (OR = 0.67, 95% CI 0.46-0.98, p = 0.03). Logistic Regression and Bonferroni correction in a subgroup of the cohort adjusted for gender, age, and population maintained the association of APOE rs429358 and ɛ4 allele.

A Two-Stage Online Approach for Collaborative Multi-Agent Planning under Uncertainty

In a team of multiple agents, the pursuance of a common goal is a defining characteristic. Since agents may have different capabilities, and effects of actions may be uncertain, a common goal can generally only be achieved through a careful cooperation between the different agents. In this work, we propose a novel two-stage planner that combines online planning at both team level and individual level through a subgoal delegation scheme. The proposal brings the advantages of online planning approaches to the multi-agent setting. A number of modifications are made to a classical UCT approximate algorithm to (i) adapt it to the application domains considered, (ii) reduce the branching factor in the underlying search process, and (iii) effectively manage uncertain information of action effects by using information fusion mechanisms. The proposed online multi-agent planner reduces the cost of planning and decreases the temporal cost of reaching a goal, while significantly increasing the chance of success of achieving the common goal. 

A Collaborative Multiagent Framework based on Online Risk-Aware Planning and Decision-Making

Planning is an essential process in teams of multiple agents pursuing a common goal. When the effects of actions undertaken by agents are uncertain, evaluating the potential risk of such actions alongside their utility might lead to more rational decisions upon planning. This challenge has been recently tackled for single agent settings, yet domains with multiple agents that present diverse viewpoints towards risk still necessitate comprehensive decision making mechanisms that balance the utility and risk of actions. In this work, we propose a novel collaborative multi-agent planning framework that integrates (i) a team-level online planner under uncertainty that extends the classical UCT approximate algorithm, and (ii) a preference modeling and multicriteria group decision making approach that allows agents to find accepted and rational solutions for planning problems, predicated on the attitude each agent adopts towards risk. When utilised in risk-pervaded scenarios, the proposed framework can reduce the cost of reaching the common goal sought and increase effectiveness, before making collective decisions by appropriately balancing risk and utility of actions. 

Iowa Rural Health IT Collaborative "It Worker", December 19, 2012

The purpose of this paper is to share information about the Iowa Rural HIT Collaborative efforts to help rural hospitals and providers attain electronic medical records meaningful use status. Information from this paper can be helpful to others who are pursuing solutions related to integration of health information technology in rural areas.

Collaborative Filtering with Data Classification : A Combined Approach to Hotel Recommendation Systems

Recommendation systems aim to help users make decisions more efficiently. The most widely used method in recommendation systems is collaborative filtering, of which, a critical step is to analyze a user's preferences and make recommendations of products or services based on similarity analysis with other users' ratings. However, collaborative filtering is less usable for recommendation facing the "cold start" problem, i.e. few comments being given to products or services. To tackle this problem, we propose an improved method that combines collaborative filtering and data classification. We use hotel recommendation data to test the proposed method. The accuracy of the recommendation is determined by the rankings. Evaluations regarding the accuracies of Top-3 and Top-10 recommendation lists using the 10-fold cross-validation method and ROC curves are conducted. The results show that the Top-3 hotel recommendation list proposed by the combined method has the superiority of the recommendation performance than the Top-10 list under the cold start condition in most of the times.

Basi di conoscenza collaborative: il progetto Wikidata

Il lavoro svolto è motivato dall'esigenza di utilizzare strumenti per la gestione di grandi quantità di dati, disponibili in seguito alla diffusione del Web. Si sono analizzate le basi di conoscenza, definendone le caratteristiche comuni e presentando poi un confronto fra alcune delle più significative. Infine si è analizzato più dettagliatamente il progetto Wikidata.

“It’s the People That Drive It”: Motivating and Supporting Collaborative Data Use Practices in Three Teacher Education Programs

Thesis (Ph.D.)--University of Washington, 2016-08