Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care:a cluster randomized trial (OPTI-SCRIPT study protocol)

Potentially inappropriate prescribing in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. In Ireland, 36% of those aged 70 years or over received at least one potentially inappropriate medication, with an associated expenditure of over €45 million.The main objective of this study is to determine the effectiveness and acceptability of a complex, multifaceted intervention in reducing the level of potentially inappropriate prescribing in primary care.

Towards an Emancipatory International Law: the Bolivarian reconstruction

In this article, we argue that a unique South American treaty known as ALBA—the Bolivarian Alliance for the Americas—puts forward a cohesive counter-vision of international law rooted in notions of complementarity and human solidarity. We further argue that Third World Approaches to International Law (TWAIL) scholars might use this initiative as a springboard to push forward a long-overdue reform of the international legal regime. While, on its own, ALBA is unlikely to pose much of a challenge to the structural imbalances that permeate global society, when juxtaposed alongside the many initiatives of the Bolivarian Revolution, it appears to possess signi?cant democratic potential. With both scholarly and popular support, ALBA may even have the capability of sparking a renewal of a united Third World movement.

Personalized medicine: Has it started yet? A reconstruction of the early history

Within the last few years the field personalized medicine entered the stage. Accompanied with great hopes and expectations it is believed that this field may have the potential to revolutionize medical and clinical care by utilizing genomics information about the individual patients themselves. In this paper, we reconstruct the early footprints of personalized medicine as reflected by information retrieved from PubMed and Google Scholar. That means we are providing a data-driven perspective of this field to estimate its current status and potential problems.

Analysis of Dependence Tracking Algorithms for Task Dataflow Execution

Processor architectures has taken a turn towards many-core processors, which integrate multiple processing cores on a single chip to increase overall performance, and there are no signs that this trend will stop in the near future. Many-core processors are harder to program than multi-core and single-core processors due to the need of writing parallel or concurrent programs with high degrees of parallelism. Moreover, many-cores have to operate in a mode of strong scaling because of memory bandwidth constraints. In strong scaling increasingly finer-grain parallelism must be extracted in order to keep all processing cores busy.

Task dataflow programming models have a high potential to simplify parallel program- ming because they alleviate the programmer from identifying precisely all inter-task de- pendences when writing programs. Instead, the task dataflow runtime system detects and enforces inter-task dependences during execution based on the description of memory each task accesses. The runtime constructs a task dataflow graph that captures all tasks and their dependences. Tasks are scheduled to execute in parallel taking into account dependences specified in the task graph.

Several papers report important overheads for task dataflow systems, which severely limits the scalability and usability of such systems. In this paper we study efficient schemes to manage task graphs and analyze their scalability. We assume a programming model that supports input, output and in/out annotations on task arguments, as well as commutative in/out and reductions. We analyze the structure of task graphs and identify versions and generations as key concepts for efficient management of task graphs. Then, we present three schemes to manage task graphs building on graph representations, hypergraphs and lists. We also consider a fourth edge-less scheme that synchronizes tasks using integers. Analysis using micro-benchmarks shows that the graph representation is not always scalable and that the edge-less scheme introduces least overhead in nearly all situations.

Algorithms for Self-Healing Networks

Many modern networks are \emph{reconfigurable}, in the sense that the topology of the network can be changed by the nodes in the network. For example, peer-to-peer, wireless and ad-hoc networks are reconfigurable. More generally, many social networks, such as a company's organizational chart; infrastructure networks, such as an airline's transportation network; and biological networks, such as the human brain, are also reconfigurable. Modern reconfigurable networks have a complexity unprecedented in the history of engineering, resembling more a dynamic and evolving living animal rather than a structure of steel designed from a blueprint. Unfortunately, our mathematical and algorithmic tools have not yet developed enough to handle this complexity and fully exploit the flexibility of these networks. We believe that it is no longer possible to build networks that are scalable and never have node failures. Instead, these networks should be able to admit small, and maybe, periodic failures and still recover like skin heals from a cut. This process, where the network can recover itself by maintaining key invariants in response to attack by a powerful adversary is what we call \emph{self-healing}. Here, we present several fast and provably good distributed algorithms for self-healing in reconfigurable dynamic networks. Each of these algorithms have different properties, a different set of gaurantees and limitations. We also discuss future directions and theoretical questions we would like to answer. %in the final dissertation that this document is proposed to lead to.

‘Emergent reconstruction’ in grounded theory: learning from team-based interview research

Constructivist grounded theory (CGT) methods render an interpretive portrayal, a construction of reality, strengthened when the process of construction is acknowledged. An Irish team study uses CGT to explore intergenerational solidarity at individual, familial and societal levels, and their interface. The study data comprise interviews with 100 people from diverse socio-economic and
age groups. The article contributes insights on applying CGT in team-based interview research on a topic with such breadth of scope. This contrasts with the more usual focused inquiry with a defined population. Adapting the method’s guidelines to the specific inquiry involved challenges in: framing the topic conceptually; situating research participants in contrasting social contexts to
provide interpretive depth; and generating interview data with which to construct theory. We argue that interrogating the very premise of the inquiry allowed for emergent reconstruction, a goal at the heart of the method.

Skin-reducing mastectomy and one-stage implant reconstruction with a myodermal flap: A safe and effective technique in risk-reducing and therapeutic mastectomy

Introduction: Immediate reconstruction following mastectomy for breast cancer has been shown to be oncologically safe and associated with improved psychosocial outcomes for patients. Bostwick described a technique for one-stage implant based reconstruction, combining skin-sparing mastectomy with concurrent reduction of the skin envelope. This report reviews the experience of a single centre using skin-reducing mastectomy and one-stage implant reconstruction in both early stage breast cancer and risk-reducing mastectomy, with specific reference to frequency of complications, implant loss and oncological outcomes.

Methods and results: A retrospective review was undertaken to identify women who had undergone skin-reducing mastectomy and one-stage implant reconstruction using a de-epithelialised dermal flap, between October 2008 and October 2012. One hundred and four consecutive mastectomies, with reconstruction, were performed by two surgeons on 64 patients. No complications were seen in 43.8% of patients. At three months, four implants were lost (3.8% of breast reconstructions, 6.3% of patients), due to either peri-implant infection or mastectomy skin flap necrosis. One patient required unplanned return to theatre for evacuation of a haematoma. Minor mastectomy skin flap necrosis was seen in 10 breasts (9.6% of reconstructed breasts) and superficial wound infection in 8 breasts (7.7% of reconstructed breasts). All of these complications were managed conservatively and none required operative intervention. At a median follow up of 35 months (4-53 months) there had been one episode of ipsilateral axillary nodal recurrence.

Conclusion: One-stage implant reconstruction using a myo-dermal flap technique following skin-reducing mastectomy is safe and should be considered in selected patients. Most complications are minor and will resolve with conservative management. Major complications such as implant failure or immediate reoperation, were relatively uncommon (6.3% patients, 3.8% of reconstructed breasts). Early follow-up suggests that oncological outcomes are satisfactory, but longer follow-up is required to substantiate this. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Immediate breast reconstruction after mastectomy for cancer

Background: Immediate breast reconstruction after mastectomy has increased over the past decade following the unequivocal demonstration of its oncological safety and the availability of reliable methods of reconstruction. Broadly, it is undertaken in the treatment of breast cancer, after prophylactic mastectomy in high-risk patients, and in the management of treatment failure after breast-conserving surgery and radiotherapy. Immediate breast reconstruction can be achieved reliably with a variety of autogenous tissue techniques or prosthetic devices. Careful discussion and evaluation remain vital in choosing the correct technique for the individual patient.

Methods: This review is based primarily on an English language Medline search with secondary references obtained from key articles.

Results and conclusion: Immediate breast reconstruction is a safe and acceptable procedure after mastectomy for cancer; there is no evidence that it has untoward oncological consequences. In the appropriate patient it can be achieved effectively with either prosthetic or autogenous tissue reconstruction. Patient selection is important in order to optimize results, minimize complications and improve quality of life, while simultaneously treating the malignancy. Close cooperation and collaboration between the oncological breast and reconstructive achieve these objectives.