Beers versus STOPP criteria in polyharmacy community-dwelling older patients

Objective: To assess potentially inappropriate prescribing (PIP) using Beers (2012 version) and STOPP (2008 version) criteria in polypharmacy, community-dwelling, older patients. Methods: From the information collected in the invoicing data of the prescriptions and the electronic medical records, a sample was selected of 223 ≥ 65-year-old patients who were taking simultaneously 10 or more drugs per day. Beers and STOPP criteria were separately applied, and the results obtained with the two methods were compared. Results: A total of 141 (63.2%) patients presented at least one Beers criterion. The two most frequently observed Beers criteria independent of diagnosis were the use of benzodiazepines and the use of non-COX-2-selective non-steroidal anti-inflammatory drugs. With regard to Beers criteria considering diagnosis, the most frequent were the use of anticholinergic drugs in patients with lower urinary tract symptoms or benign prostatic hyperplasia, and the use of benzodiazepines, antipsychotics, Zolpidem or H2-antihistamines, in patients with dementia or cognitive impairment. A total of 165 (73.9%) patients had at least one PIP according to the STOPP criteria. Duplicate drug classes and long-term use of long-acting benzodiazepines were the two most frequent STOPP criteria. Discussion: Our study identified a high frequency of PIP in poly-medicated community-dwelling older patients. Simultaneous application of Beers and STOPP criteria represents a useful tool to improve prescribing in this population group.

Bacterial communities of the specialty crop phyllosphere: response to biological soil amendment use, rainfall, and insect visitation

Microorganisms in the plant rhizosphere, the zone under the influence of roots, and phyllosphere, the aboveground plant habitat, exert a strong influence on plant growth, health, and protection. Tomatoes and cucumbers are important players in produce safety, and the microbial life on their surfaces may contribute to their fitness as hosts for foodborne pathogens such as Salmonella enterica and Listeria monocytogenes. External factors such as agricultural inputs and environmental conditions likely also play a major role. However, the relative contributions of the various factors at play concerning the plant surface microbiome remain obscure, although this knowledge could be applied to crop protection from plant and human pathogens. Recent advances in genomic technology have made investigations into the diversity and structure of microbial communities possible in many systems and at multiple scales. Using Illumina sequencing to profile particular regions of the 16S rRNA gene, this study investigates the influences of climate and crop management practices on the field-grown tomato and cucumber microbiome. The first research chapter (Chapter 3) involved application of 4 different soil amendments to a tomato field and profiling of harvest-time phyllosphere and rhizosphere microbial communities. Factors such as water activity, soil texture, and field location influenced microbial community structure more than soil amendment use, indicating that field conditions may exert more influence on the tomato microbiome than certain agricultural inputs. In Chapter 4, the impact of rain on tomato and cucumber-associated microbial community structures was evaluated. Shifts in bacterial community composition and structure were recorded immediately following rain events, an effect which was partially reversed after 4 days and was strongest on cucumber fruit surfaces. Chapter 5 focused on the contribution of insect visitors to the tomato microbiota, finding that insects introduced diverse bacterial taxa to the blossom and green tomato fruit microbiome. This study advances our understanding of the factors that influence the microbiomes of tomato and cucumber. Farms are complex environments, and untangling the interactions between farming practices, the environment, and microbial diversity will help us develop a comprehensive understanding of how microbial life, including foodborne pathogens, may be influenced by agricultural conditions.

Accuracy of ASGE criteria for the prediction of choledocholithiasis

Background/aims: Few studies have validated the performance of guidelines for the prediction of choledocholithiasis (CL). Our objective was to prospectively assess the accuracy of the American Society for Gastrointestinal Endoscopy (ASGE) guidelines for the identification of CL. Methods: A two-year prospective evaluation of patients with suspected CL was performed. We evaluated the ASGE guidelines and its component variables in predicting CL. Results: A total of 256 patients with suspected CL were analyzed. Of the 208 patients with high-probability criteria for CL, 124 (59.6%) were found to have a stone/sludge at endoscopic retrograde cholangiopancreatography (ERCP). Among 48 patients with intermediate-probability criteria, 21 (43.8%) had a stone/sludge. The performance of ASGE high- and intermediate-probability criteria in our population had an accuracy of 59.0% (85.5% sensitivity, 24.3% specificity) and 41.0% (14.4% sensitivity, 75.6% specificity), respectively. The mean ERCP delay time was 6.1 days in the CL group and 6.4 days in the group without CL, p = 0.638. The presence of a common bile duct (CBD) > 6 mm (OR 2.21; 95% CI, 1.20-4.10), ascending cholangitis (OR 2.37; 95% CI, 1.01-5.55) and a CBD stone visualized on transabdominal US (OR 3.33; 95% CI, 1.48-7.52) were stronger predictors of CL. The occurrence of biliary pancreatitis was a strong protective factor for the presence of a retained CBD stone (OR 0.30; 95% CI, 0.17-0.55). Conclusions: Irrespective of a patient's ASGE probability for CL, the application of current guidelines in our population led to unnecessary performance of ERCPs in nearly half of cases.

Publishing and impact criteria, and their bearing on Translation Studies: In search of comparability

This paper questions the current concept of quality as used in research assessment rankings and peer review, with special reference to the link often established between impact and the way this impact is measured in the form of citation counting. Taking translation studies as a case study, we will offer a two-level approach to reveal both the macro- and micro-level biases that exist in this regard. We will first review three key aspects related to the idea of the quality of publications, namely peer review, journal indexing, and journal impact factor. We will then pinpoint some of the main macro-level problems regarding current practices and criteria as applied to translation studies, such as Thomson Reuters World of Science's journal coverage, citation patterns, and publication format. Next we will provide a micro-textual and practical perspective, focusing on citation counts and suggesting a series of corrective measures to increase comparability.

Establishing IUCN red list criteria for threatened ecosystems

The potential for conservation of individual species has been greatly advanced by the International Union for Conservation of Nature's (IUCN) development of objective, repeatable, and transparent criteria for assessing extinction risk that explicitly separate risk assessment from priority setting. At the IV World Conservation Congress in 2008, the process began to develop and implement comparable global standards for ecosystems. A working group established by the IUCN has begun formulating a system of quantitative categories and criteria, analogous to those used for species, for assigning levels of threat to ecosystems at local, regional, and global levels. A final system will require definitions of ecosystems; quantification of ecosystem status; identification of the stages of degradation and loss of ecosystems; proxy measures of risk (criteria); classification thresholds for these criteria; and standardized methods for performing assessments. The system will need to reflect the degree and rate of change in an ecosystem's extent, composition, structure, and function, and have its conceptual roots in ecological theory and empirical research. On the basis of these requirements and the hypothesis that ecosystem risk is a function of the risk of its component species, we propose a set of four criteria: recent declines in distribution or ecological function, historical total loss in distribution or ecological function, small distribution combined with decline, or very small distribution. Most work has focused on terrestrial ecosystems, but comparable thresholds and criteria for freshwater and marine ecosystems are also needed. These are the first steps in an international consultation process that will lead to a unified proposal to be presented at the next World Conservation Congress in 2012.

Novel criteria for exponential stability of linear neutral time-varying differential systems

Using a novel approach, we get explicit criteria for exponential stability of linear neutral time-varying differential systems. A brief discussion to the obtained results is given. To the best of our knowledge, the results of this paper are new.

Domain-driven classification based on multiple criteria and multiple constraint-level programming for intelligent credit scoring

Extracting knowledge from the transaction records and the personal data of credit card holders has great profit potential for the banking industry. The challenge is to detect/predict bankrupts and to keep and recruit the profitable customers. However, grouping and targeting credit card customers by traditional data-driven mining often does not directly meet the needs of the banking industry, because data-driven mining automatically generates classification outputs that are imprecise, meaningless, and beyond users' control. In this paper, we provide a novel domain-driven classification method that takes advantage of multiple criteria and multiple constraint-level programming for intelligent credit scoring. The method involves credit scoring to produce a set of customers' scores that allows the classification results actionable and controllable by human interaction during the scoring process. Domain knowledge and experts' experience parameters are built into the criteria and constraint functions of mathematical programming and the human and machine conversation is employed to generate an efficient and precise solution. Experiments based on various data sets validated the effectiveness and efficiency of the proposed methods. © 2006 IEEE.

Transition to specialty practice program characteristics and professional development outcomes

BACKGROUND: Transition to Specialty Practice Programs was introduced to facilitate the transition of nurses to specialty practice, and is recognised as preparatory for emergency nurses. Emergency nursing Transition to Specialty Practice Programs and their characteristics have developed locally in response to unit needs. OBJECTIVE: The aim of this study was to examine the characteristics of emergency nursing Transition to Specialty Practice Programs in Australia, and identify which characteristics were associated with improved professional development outcomes. METHODS: An explanatory sequential design was used. Data were collected via online surveys and interviews of emergency Nurse Managers and Nurse Educators. Transition to Specialty Practice Program characteristics were compared using Mann Whitney U and Chi-Square tests. Content analysis was used to analyse qualitative data. RESULTS: Survey data were collected from 118 emergency departments, and 13 interviews were conducted. Transition to Specialty Practice Programs were offered in most emergency departments (n=80, 72.1%), with one or two intakes per year. Transition to Specialty Practice Program characteristics varied; duration ranged from 5-12months, clinical preparation time ranged from 7-22days, and the number of study days provided ranged from 2-6. When Transition to Specialty Practice Programs of 6 and 12months duration were compared, there was no difference in the content covered. Emergency departments with 12month Transition to Specialty Practice Programs had lower percentages of Clinical Specialists (9% vs 18%, p=0.03) and postgraduate qualified nurses (30.5% vs 43.8%, p=0.09). CONCLUSION: The target participants, duration and clinical preparation of Transition to Specialty Practice Programs participants varied, impeding workforce mobility and articulation to postgraduate study and there were no professional development advantages from longer programs. There is an urgent need for a nationally consistent, evidence-based and fiscally responsible approach to Transition to Specialty Practice Programs.

Heuristic approaches for multi-criteria optimisation in kidney exchange programs

The Kidney Exchange Problem (KEP) is an optimisation problem that was first discussed in Rapaport (1986) but has only more recently been the subject of much work by combinatorial optimisation re-searchers. This has been in parallel with its increased prevalence in the medical community. In the basic formulation of a KEP, each instance of the problem features a directed graph D = (V,A) . Each node i ∈ V represents an incompatible pair wherein the patient needs to trade kidneys with the patient of another incompatible pair. The goal is to find an optimal set of cycles such that as many patients as possible receive a transplant. The problem is further complicated by the imposition of a cycle-size constraint, usually considered to be 3 or 4. Kidney exchange programs around the world implement different algorithms to solve the allocation problem by matching up kidneys from potential donors to patients. In some systems all transplants are considered equally desirable, whereas in others, ranking criteria such as the age of the patient or distance they will need to travel are applied, hence the multi-criteria nature of the KEP. To address the multi-criteria aspect of the KEP, in this paper we propose a two-stage approach for the kidney exchange optimisation problem. In the first stage the goal is to find the optimal number of exchanges, and in the second stage the goal is to maximise the weighted sum of the kidney matches, subject to the added constraint that the number of exchanges must remain optimal. The idea can potentially be extended to multiple-objectives, by repeating the process in multiple runs. In our preliminary numerical experiments, we first find the maximum number of kidney matches by using an existing open source exact algorithm of Anderson et al. (2015). The solution will then be used as an initial solution for the stage two optimisation problem, wherein two heuristic methods, steepest ascent and random ascent, are implemented in obtaining good quality solutions to the objective of maximizing total weight of exchanges. The neighbourhood is obtained by two-swaps. It is our intention in the future to implement a varying neighbourhood scheme within the same two heuristic framework, or within other meta-heuristic framework.

Path independent limiting criteria in sheet metal forming

The Forming Limit Diagram (FLD) is a conventional failure diagram to estimate necking limits of sheet metal for proportional loading conditions. Previous studies reveal that the FLD is not suitable for predicting the influence of nonlinear strain paths. This paper presents methodical comparison among all common available strain path independent strain/stress based limiting criteria. All the strain path independent strain based limiting criteria (Traditional Failure Diagram (TFD), Extended Forming Limit Diagram (XFLD), Extended Stress Ratio Based Forming Limit Diagram (ESRFLD), and Polar Effective Plastic StrainDiagram (PEPSD)) and stress based limiting criteria (Traditional Stress based Failure Diagram (TFSD), Stress Based Forming Limit Diagram (FLSD), Stress Ratio and Stress Based Forming Limit Diagram (SRFLSD), Extended Stress Based Forming Limit Diagram (XFLSD), and Polar Effective Stress Diagram (PESSD)) are approximately path-independent for smaller amount of pre-straining and path dependent for large pre-straining conditions. From advance image correlation technique precisely determination of local strains near necked area is possible today. However direct determination of local stresses near necked area is not possible. Therefore, local stresses and equivalent stress are determined by employing both yield criterion and strain-hardening law. Similarly equivalent strain is calculated by the use of yield criterion. Therefore, the choice of yield criterion has an impact on the results for TFD, XFLD, ESRFLD and PEPSD. However, selections of both yield criterion and strain-hardening law have substantial influence on the results for TFSD, FLSD, SRFLSD, XFLSD and PESSD. The inherent calculation error can be minimized by generation of experimental data for each material and then selection of representable yield criterion and strain-hardening law. Improvement of experimental techniques and generation of rigorous material data bank in various strain paths may help researchers to diagnose and resolve the issue. TFD, TFSD and XFLSD have inherent variables to take care the effect of through thickness stress, however rigorous experimental verification is needed before the field application.

Multi-criteria evaluation of wave energy projects on the south-east Australian coast

In the last decade, multiple studies focusing on national-scale assessments of the ocean wave energy resource in Australia identified the Southern Margin to be one of the most energetic areas worldwide suitable for the extraction of wave energy for electricity production. While several companies have deployed single unit devices, the next phase of development will most likely be the deployment of parks with dozens of units, introducing the risk of conflicts within the marine space. This paper presents a geo-spatial multi-criteria evaluation approach to identify optimal locations to deploy a wave energy farm while minimizing potential conflicts with other coastal and offshore users. The methodology presented is based around five major criteria: ocean wave climatology, nature of the seabed, distance to key infrastructure, environmental factors and potential conflict with other users such as shipping and fisheries. A case study is presented for an area off the south-east Australian coast using a total of 18 physical, environmental and socio-economic parameters. The spatial restrictions associated with environmental factors, wave climate, as well as conflict of use, resulted in an overall exclusion of 20% of the study area. Highly suitable areas identified ranged between 11 and 34% of the study area based on scenarios with varying criteria weighting. By spatially comparing different scenarios we identified persistence of a highly suitable area of 700 km2 off the coast of Portland across all model domains investigated. We demonstrate the value of incorporation spatial information at the scale relevant to resource exploitation when examining multiple criteria for optimal site selection of Wave Energy Converters over broad geographic regions.

A Multi-Criteria GIS-Based Route Selection Tool for Hazardous Material Transport: Consideration of Environmental Consequence, Traffic Congestions and Costs

Hazardous materials are substances that, if not regulated, can pose a threat to human populations and their environmental health, safety or property when transported in commerce. About 1.5 million tons of hazardous material shipments are transported by truck in the US annually, with a steady increase of approximately 5% per year. The objective of this study was to develop a routing tool for hazardous material transport in order to facilitate reduced environmental impacts and less transportation difficulties, yet would also find paths that were still compelling for the shipping carriers as a matter of trucking cost. The study started with identification of inhalation hazard impact zones and explosion protective areas around the location of hypothetical hazardous material releases, considering different parameters (i.e., chemicals characteristics, release quantities, atmospheric condition, etc.). Results showed that depending on the quantity of release, chemical, and atmospheric stability (a function of wind speed, meteorology, sky cover, time and location of accidents, etc.) the consequence of these incidents can differ. The study was extended by selection of other evaluation criteria for further investigation because health risk as an evaluation criterion would not be the only concern in selection of routes. Transportation difficulties (i.e., road blockage and congestion) were incorporated as important factor due to their indirect impact/cost on the users of transportation networks. Trucking costs were also considered as one of the primary criteria in selection of hazardous material paths; otherwise the suggested routes would have not been convincing for the shipping companies. The last but not least criterion was proximity of public places to the routes. The approach evolved from a simple framework to a complicated and efficient GIS-based tool able to investigate transportation networks of any given study area, and capable of generating best routing options for cargos. The suggested tool uses a multi-criteria-decision-making method, which considers the priorities of the decision makers in choosing the cargo routes. Comparison of the routing options based on each criterion and also the overall suitableness of the path in regards to all the criteria (using a multi-criteria-decision-making method) showed that using similar tools as the one proposed by this study can provide decision makers insights in the area of hazardous material transport. This tool shows the probable consequences of considering each path in a very easily understandable way; in the formats of maps and tables, which makes the tradeoffs of costs and risks considerably simpler, as in some cases slightly compromising on trucking cost may drastically decrease the probable health risk and/or traffic difficulties. This will not only be rewarding to the community by making cities safer places to live, but also can be beneficial to shipping companies by allowing them to advertise as environmental friendly conveyors.

Use of flucinolone acetonide for patients with diabetic macular oedema:patient selection criteria and early outcomes in real world setting

Introduction: Fluocinolone acetonide slow release implant (Iluvien®) was approved in December 2013 in UK for treatment of eyes which are pseudophakic with DMO that is unresponsive to other available therapies. This approval was based on evidence from FAME trials which were conducted at a time when ranibizumab was not available. There is a paucity of data on implementation of guidance on selecting patients for this treatment modality and also on the real world outcome of fluocinolone therapy especially in those patients that have been unresponsive to ranibizumab therapy. Method: Retrospective study of consecutive patients treated with fluocinolone between January and August 2014 at three sites were included to evaluate selection criteria used, baseline characteristics and clinical outcomes at 3-month time point. Results: Twenty two pseudophakic eyes of 22 consecutive patients were included. Majority of patients had prior therapy with multiple intravitreal anti-VEGF injections. Four eyes had controlled glaucoma. At baseline mean VA and CRT were 50.7 letters and 631 μm respectively. After 3 months, 18 patients had improved CRT of which 15 of them also had improved VA. No adverse effects were noted. One additional patient required IOP lowering medication. Despite being unresponsive to multiple prior therapies including laser and anti-VEGF injections, switching to fluocinolone achieved treatment benefit. Conclusion: The patient level selection criteria proposed by NICE guidance on fluocinolone appeared to be implemented. This data from this study provides new evidence on early outcomes following fluocinolone therapy in eyes with DMO which had not responded to laser and other intravitreal agents.

Application of multi-criteria decision making methods to compression ignition engine efficiency and gaseous, particulate and greenhouse gas emissions

Compression ignition (CI) engine design is subject to many constraints which presents a multi-criteria optimisation problem that the engine researcher must solve. In particular, the modern CI engine must not only be efficient, but must also deliver low gaseous, particulate and life cycle greenhouse gas emissions so that its impact on urban air quality, human health, and global warming are minimised. Consequently, this study undertakes a multi-criteria analysis which seeks to identify alternative fuels, injection technologies and combustion strategies that could potentially satisfy these CI engine design constraints. Three datasets are analysed with the Preference Ranking Organization Method for Enrichment Evaluations and Geometrical Analysis for Interactive Aid (PROMETHEE-GAIA) algorithm to explore the impact of 1): an ethanol fumigation system, 2): alternative fuels (20 % biodiesel and synthetic diesel) and alternative injection technologies (mechanical direct injection and common rail injection), and 3): various biodiesel fuels made from 3 feedstocks (i.e. soy, tallow, and canola) tested at several blend percentages (20-100 %) on the resulting emissions and efficiency profile of the various test engines. The results show that moderate ethanol substitutions (~20 % by energy) at moderate load, high percentage soy blends (60-100 %), and alternative fuels (biodiesel and synthetic diesel) provide an efficiency and emissions profile that yields the most “preferred” solutions to this multi-criteria engine design problem. Further research is, however, required to reduce Reactive Oxygen Species (ROS) emissions with alternative fuels, and to deliver technologies that do not significantly reduce the median diameter of particle emissions.