Individual Requests Research Articles

On selecting a probabilistic classifier for appointment no-show prediction

Appointment no-shows are disruptive to healthcare clinics, and may increase patient waiting time and clinic overtime, resulting in increased clinic costs. Appointment scheduling models typically mitigate the negative effects of no-shows through appointment overbooking. Recent work has proposed a predictive overbooking framework, where a probabilisitic classifier predicts the no-show probability of individual appointment requests, and a scheduling algorithm uses those predictions to optimally schedule appointments. Because predicting no-shows is typically an imbalanced classification problem, the preferred classifier is often chosen based upon the area under the receiver operator characteristic curve (AUC), which is a commonly used metric for many other imbalanced classification problems. Contrary to intuition, in this paper we show that employing the AUC to select a classifier results in significantly lower schedule efficiency than using other metrics such as Log Loss or Brier Score. Our computational experiments, validated on large real-world appointment data, suggest that by using Log Loss or Brier Score instead of AUC, practitioners can improve the schedule quality by 3–7%.

A qualitative pilot study exploring reasons for prosthetic preference in a veteran amputee population

Background/Aims For people with transfemoral amputations, newer technology, microprocessor-controlled prosthetic limbs, offer a level of performance that exceeds that of older, non-microprocessor controlled limbs. They are often requested by members of Her Majesty's Armed Forces who have been discharged from service (veterans) during applications for replacement limbs. However, as microprocessor-controlled prosthetic limbs cost far exceeds that of non-microprocessor controlled limbs, justification for their provision is essential to ensure that they are seen as value for money for the NHS in the UK. To date, literature focuses on measures of objective performance when demonstrating the value of one limb over another, but it ignores individual lifestyles within this process. This project aims to explore the reasons underpinning individual requests for specific types of prosthetic lower limb in a population of veterans with amputations. Methods This pilot study explored secondary data, consisting of patient statements, from the evaluation process associated with applications for new microprocessor-controlled prosthetic limbs. The data referred to a sample population of non-serving veterans with amputations who attended a veteran prosthetic centre for the ongoing maintenance and replacement of their prosthetic limbs (n=15). Results Findings from the study suggest an interconnection between function, psychology and emotional context. Individual statements demonstrate that, while functional performance influences choice, it is the application of function to life and lifestyle that underpins the meaning of improvements in performance for the individual. Conclusions Further research investigating the meaning of limb performance to the life of an individual is essential to facilitate effective prescription of limbs that meet individual need, and ensuring accurate distribution of what are currently limited funds.

Redeploying Residents and Fellows in Response to COVID-19: Tensions, Guiding Principles, and Lessons From the University of Washington.

Redeploying Residents and Fellows in Response to COVID-19: Tensions, Guiding Principles, and Lessons From the University of Washington.

QoS-driven scheduling in the cloud

Priority-based scheduling policies are commonly used to guarantee that requests submitted to the different service classes offered by cloud providers achieve the desired Quality of Service (QoS). However, the QoS delivered during resource contention periods may be unfair on certain requests. In particular, lower priority requests may have their resources preempted to accommodate resources associated with higher priority ones, even if the actual QoS delivered to the latter is above the desired level, while the former is underserved. Also, competing requests with the same priority may experience quite different QoS, since some of them may have their resources preempted, while others do not. In this paper we present a new scheduling policy that is driven by the QoS promised to individual requests. Benefits of using the QoS-driven policy are twofold: it maintains the QoS of each request as high as possible, considering their QoS targets and available resources; and it minimizes the variance of the QoS delivered to requests of the same class, promoting fairness. We used simulation experiments fed with traces from a production system to compare the QoS-driven policy with a state-of-the-practice priority-based one. In general, the QoS-driven policy delivers a better service than the priority-based one. Moreover, the equity of the QoS delivered to requests of the same class is much higher when the QoS-driven policy is used, particularly when not all requests get the promised QoS, which is the most important scenario. Finally, based on the current practice of large public cloud providers, our results show that penalties incurred by the priority-based scheduler in the scenarios studied can be, on average, as much as 193% higher than those incurred by the QoS-driven one.

Network policy aware placement of tasks for elastic applications in IaaS-cloud environment

Using cloud computing as a base, new technologies like data analytics, Internet of Things, machine learning etc., have emerged. Applications that use these technologies, depend on cloud datacenters (DC) for their computing power. Performance of these applications depends on dynamic resource provisioning by DC, as there is unpredictability of rate at which data arrives for immediate processing. Cloud service providers implement this dynamism in Infrastructure-as-a-Service (IaaS) environment, using elastic virtual machines (VM). Placing these VMs onto same physical machines (PM) and/or on the network neighborhood machines is believed to increase application performance as the network latency is minimal. Deploying sub-optimal VM placement schemes creates unwanted cross network traffic resulting in poor application performance and increases the DC operating cost. This paper formulates the policy and elastic aware placement (PEAP) as an optimization problem, with additional constraints such as fixed PM, balanced PM and co-location VMs. Further, we propose PEAP algorithm which considers individual requests demanding for one or more VMs as a whole for placement along with the life-time of requests. Proposed algorithm gives optimal VM placements for increased application performance and DC efficacy. CloudSimPlus based experiments demonstrate that as compared to first fit decreasing (FFD). First fit increasing (FFI) and first come first serve (FCFS) algorithms, the proposed technique leads to reduced resource fragmentation and resource migrations. PEAP achieves placement of all the elastic VMs together with reduced network cost, thereby increasing the application performance.

Fast Scheduling in Distributed Transactional Memory

We investigate scheduling algorithms for distributed transactional memory systems where transactions residing at nodes of a communication graph operate on shared, mobile objects. A transaction requests the objects it needs, executes once those objects have been assembled, and then possibly forwards those objects to other waiting transactions. Minimizing execution time in this model is known to be NP-hard for arbitrary communication graphs, and also hard to approximate within any factor smaller than the size of the graph. Nevertheless, networks on chips, multi-core systems, and clusters are not arbitrary. Here, we explore efficient execution schedules in specialized graphs likely to arise in practice: Clique, Line, Grid, Cluster, Hypercube, Butterfly, and Star. In most cases, when individual transactions request k objects, we obtain solutions close to a factor O(k) from optimal, yielding near-optimal solutions for constant k. These execution times approximate the TSP tour lengths of the objects in the graph. We show that for general networks, even for two objects (k = 2), it is impossible to obtain execution time close to the objects’ optimal TSP tour lengths, which is why it is useful to consider more realistic network models. To our knowledge, this is the first attempt to obtain provably fast schedules for distributed transactional memory.

Text analysis of DNS queries for data exfiltration protection of computer networks

The paper proposes effective method of computer network protection from data exfiltration by the system of domain names. Data exfiltration by Domain Name System (DNS) is an approach to conceal the transfer of confidential data to remote adversary using data encapsulation into the requesting domain name. The DNS requests that transfer stolen information from a host infected by malicious software to an external host controlled by a malefactor are considered. The paper proposes a method of detecting such DNS requests based on text classification of domain names by convolutional neural network. The efficiency of the method is based on assumption that domain names exploited for data exfiltration differ from domain names formed from words of natural language. To classify the requests in convolutional neural network the use of character embedding for representing the string of a domain name is proposed. Quality evaluation of the trained neural network used for recognition of data exfiltration through domain name system using ROC-analysis is performed.The paper presents the software architecture used for deployment of trained neural network into existing infrastructure of the domain name system targeting practical computer networks protection from data exfiltration. The architecture implies creation of response policy zones for blocking of individual requests, classified as malicious.

CHANGING CUSTOMER PREFERENCES IN THE FASHION INDUSTRY AND THEIR IMPACT ON SUPPLY CHAIN CONFIGURATION

The issues related to changing customer preferences in the fashion industry have been considered. Changing consumer preferences, according to the author, can have an impact on the configuration of supply chains in the fashion industry. Among such new requirements of consumers in the fashion industry, the author have highlighted: consumer requests for the fastest possible receipt of products, production of products for specific individual requests of buyers, requests for transparency of supply chains and some others. In such situation, owners of clothing and footwear brands can cope with the new challenges of the company by re-shoring production with the organization of digital, robotic production factories.

Phase II study of concomitant radiotherapy with atezolizumab in oligometastatic soft tissue sarcomas: STEREOSARC trial protocol

IntroductionUp to 50% of soft tissue sarcoma (STS) patients develop metastases in the course of their disease. Cytotoxic therapy is a standard treatment in this setting but yields average tumour...

Fabry disease screening in high-risk populations in Japan: a nationwide study

BackgroundFabry disease (FD) is a X-linked inherited disorder caused by mutations in the GLA gene, which results in the deficiency of α-galactosidase A (α-Gal A). This leads to the progressive accumulation of metabolites, which can cause multisystemic dysfunction. A recent screening study among neonates reported an increase in the incidence of FD, and numerous FD patients remain undiagnosed or even misdiagnosed. Therefore, this study aimed to identify patients with FD by performing high-risk screening in 18,135 individuals, enrolled from October 2006 to March 2019, with renal, cardiac, or neurological manifestations from all prefectures in Japan. A total of 601 hospitals participated in this study.ResultsLow α-Gal A activity was detected in 846 individuals, with 224 of them diagnosed with FD by GLA sequencing. Cases with a family history of FD (n = 64) were also subjected to sequencing, without α-Gal A assay, as per individual request, and 12 of them were diagnosed with a variant of FD. A total of 236 patients with FD (97 males and 139 females) were identified from among 18,199 participants. A total of 101 GLA variants, including 26 novel variants, were detected in the 236 patients with FD from 143 families, with 39 amenable variants (39%) and 79 of the 236 patients (33%) suitable for migalastat treatment.ConclusionsFrom among 18,199 participants, 101 GLA variants, including 26 novel variants, were identified in the 236 patients with FD from 143 families. Migalastat was identified as a suitable treatment option in 33% of the patients with FD and 39% of the GLA variants were detected as amenable. Therefore, the simple screening protocol using dried blood spots that was performed in this study could be useful for early diagnosis and selection of appropriate treatments for FD in high-risk and underdiagnosed patients with various renal, cardiac, or neurological manifestations.

Christian Prayer and the Local Congregation: A Social Analysis of Individual Prayer Petitions

Prayer requests from members and attendees of a progressive Christian church located in a large American City was the subject of this investigation. This church serves congregants from Roman Catholic and Protestant backgrounds, and a large, but not exclusively gay, lesbian, bisexual, transgender community. ap Siôn’s study of prayer typology and subject contents from rural England influenced this investigation. This study used computer technology and document analysis to categorize 8,059 individual prayer card requests submitted between 2014-2018 from church members and attendees. Results showed the most common prayer requests were “Thanks and Thanksgiving” prayers with “Praise and Adoration” prayers among the least common. Few references to sin and forgiveness were found. The most frequently mentioned subjects of prayers were those referencing personal needs and concerns. Findings and comparison with ap Siôn and other research suggest these prayer requests demonstrate the social and theological cohesiveness of Christian prayer. Additional research is suggested comparing Christian prayer with prayers in other religions and how prayer behaviors interact with the rise of multiculturalism in society.

НЕОИНСТИТУЦИОНАЛИЗМ КАК МЕТОДОЛОГИЯ ИССЛЕДОВАНИЯ ЭФФЕКТИВНОСТИ УПРАВЛЕНИЯ ВЫСШИМ ОБРАЗОВАНИЕМ

Objective of the study is identification of the potential of the neoinstitutional approach for studying the tools of state management in improving the effectiveness of higher education. The methodological basis of the research is the neoinstitutional theory of Douglas North, which contains sufficient cognitive potential to study the effectiveness of the use of managerial tools in the management practices of higher education. Research results. The neoinstitutional paradigm has a high potential for studying the tools of state management in improving the effectiveness of higher education. This conclusion is supported by several reasons. First, general methodological issues. The theory of new institutions solves the conflict that has long been formed in sociology between the originally inherent emphasis on the search for criteria of social stability, social balance, and social stability, and the current shift in emphasis on individual requests and needs of individual actors, which potentially increase the conflict potential of society. Secondly, there is a common subject space between neoinstitutionalism and the topic of the stated problem, which is expressed in the commonality of the tasks to be solved, the similarity of methods, thematic spectra, and the commonality of the conceptual series. Prospects of the study. In the future, we plan to explore real managerial management practices aimed at improving the efficiency of higher education in Russia.

Forever young? The ethics of ongoing puberty suppression for non-binary adults

In this article, we analyse the novel case of Phoenix, a non-binary adult requesting ongoing puberty suppression (OPS) to permanently prevent the development of secondary sex characteristics, as a way...

Learning from ITIL for efficient internal services of authorities

In the following, we highlight why IT Infrastructure Library (ITIL) proposals, which have long been established for the management of IT services [8], can add value to the management of services offered by the Internal Services division of authorities.
 The Internal Service divisions of authorities offer a wide range of services that may differ from one authority to another. However, as a rule, the following services are offered as core offers:
 
 Mail processing, messenger service, document creation and management, duplication and printing, e.g. business cards.
 Facility management including winter maintenance and cleaning of buildings, access control and security, vehicle availability. However, facility management is usually a major part of provided internal services.
 Procurement and internal materials management, more and more as the implementation of decentralized activities of the consolidated processes.
 
 Adapting methods and procedures from ITIL can help to provide an overview about all offered internal services and makes the point of contact transparent for each of them. Furthermore, implementing support systems following that idea generate necessary information for keeping track of individual service requests. Hereon, even online steering mechanisms become possible as it is standard for IT services as of today.

Are high-cost drug funding mechanisms fit for purpose? A retrospective study of individual funding requests in an NHS tertiary hospital.

To report on a retrospective study of individual funding request (IFR) submissions from a large tertiary hospital and describe gaps in current mechanisms for funding of high-cost medicines in England. Data on the number and outcome of IFR submissions submitted to commissioners between 2014/15 and 2018/19 was extracted from the electronic patient health record and a local high-cost drug database. In total, 230 IFRs were submitted: 112 to NHS England and 118 to a Clinical Commissioning Group (CCG). The decline rate for IFRs was 71% for NHS England and 34% for CCGs. Lack of exceptionality was the primary reason cited for declining IFRs submitted between 2016-18 (n = 42/45; 93%). Half of the patients whose IFR was declined received treatment funded through other routes, the majority (13/23; 57%) from internal hospital budget. This was governed via a local high-cost drug panel. Positive clinical outcomes were observed in 50% (4/8) of patients who received NHS England IFR-funded treatment, 54% (19/35) who received CCG IFR-funded treatment and 91% (21/23) who were funded via other routes. The high rate of IFR decline signals inefficient use of resource expended in the IFR process. Gaps in access to high-cost medicines remain for patients with rare and refractory disease requiring urgent treatment, largely due to the demand for exceptionality from NHS commissioners. Local mechanisms address this unmet need but have limitations. An outcomes-based evaluation approach to commissioning and greater transparency of previous funding decisions by commissioners may improve efficiency and equity in the IFR system.

A judicialização do serviço de atenção domiciliar por meio de demandas coletivas

Objetivo: promover estudo de caso do processo 0004.630-73.2013.814.0133, com o intuito de analisar o uso de instrumento de tutela coletiva para finalidade exclusivamente individual no campo do serviço de atenção domiciliar. Metodologia: foi utilizado o estudo de caso para, com o enfoque baseado em direitos, fixar posicionamento sobre a utilização da ação civil pública enquanto instrumento da tutela coletiva, para respaldar exclusivamente um pedido individual. Resultado: o pedido formulado na ação, de tratamento domiciliar para a paciente, embora previsto em políticas públicas, tem como condição a prévia inscrição de agentes dos quadros do serviço público em programa federal para recebimento de treinamento e repasse de verbas, o que não ocorreu concretamente, indicando que o locus ideal para o enfrentamento da discussão seria o de âmbito coletivo, a fim de estender o benefício a todos os munícipes. Conclusão: a utilização de ações essencialmente coletivas para atendimento de casos individuais, quando se constata a irregularidade ou deficiência de uma política pública, ainda se mostra uma tônica no fenômeno da judicialização da saúde, desvirtuando a essência dessas ações e inviabilizando a concretude da universalidade no acesso ao SUS.

Making requests: Filipina/o and Latina/o immigrant claims-making and racialization

ABSTRACT Advocacy organizations have reframed immigrants as deserving, and improved their access to services and support; yet, we know little about how low-income immigrants understand organizational frames to make individual requests in public institutions and programmes. Analyzing in-depth interviews and fieldwork over multiple years, we show how Filipina/o and Latina/o immigrants become empowered to make claims through an organization's frame of low-income residents as rightful community members in San Francisco – a self-declared “sanctuary” city where residents have formal access and protections regardless of immigrant or legal status. However, despite newfound confidence and rights awareness, Latina/o participants continually anticipate racialized treatment where others construct them as inferior and illegitimate, which depresses their claims-making. In contrast, Filipina/o participants felt othered in public programmes and institutions, but not blocked by feelings of mistreatment and illegitimacy. We push for attention to how racialization differentially operates for immigrant groups and affects the claims-making process.

ERGONOMIC FACTORS THAT PROMOTE THE FORMATION OF REHABILITATION CENTERS FOR CHILDREN WITH DISABILITIES

ERGONOMIC FACTORS THAT PROMOTE THE FORMATION OF REHABILITATION CENTERS FOR CHILDREN WITH DISABILITIES

The Dementias Platform UK (DPUK) Data Portal

The Dementias Platform UK Data Portal is a data repository facilitating access to data for 3 370 929 individuals in 42 cohorts. The Data Portal is an end-to-end data management solution providing a secure, fully auditable, remote access environment for the analysis of cohort data. All projects utilising the data are by default collaborations with the cohort research teams generating the data. The Data Portal uses UK Secure eResearch Platform infrastructure to provide three core utilities: data discovery, access, and analysis. These are delivered using a 7 layered architecture comprising: data ingestion, data curation, platform interoperability, data discovery, access brokerage, data analysis and knowledge preservation. Automated, streamlined, and standardised procedures reduce the administrative burden for all stakeholders, particularly for requests involving multiple independent datasets, where a single request may be forwarded to multiple data controllers. Researchers are provided with their own secure ‘lab’ using VMware which is accessed using two factor authentication. Over the last 2 years, 160 project proposals involving 579 individual cohort data access requests were received. These were received from 268 applicants spanning 72 institutions (56 academic, 13 commercial, 3 government) in 16 countries with 84 requests involving multiple cohorts. Projects are varied including multi-modal, machine learning, and Mendelian randomisation analyses. Data access is usually free at point of use although a small number of cohorts require a data access fee.

Surgical correction for patients with port-wine stains and facial asymmetry.

The refractory port-wine stains are often associated with soft and hard tissue hypertrophy leading to facial asymmetry and psychological problems. The authors describe and illustrate a surgical strategy for the treatment of both hard and soft tissue malformations in patients with port-wine stains to restore facial symmetry. The medical records, photographs of two patients with soft and hard tissue hypertrophy were reviewed. After physical examinations, 3-dimensional computed tomography was conducted to evaluate bony asymmetry. The surgical strategy was designed according to individual malformation and requests. Both patients had congenital port-wine stains that were resistant to laser therapy. As they grew up, they developed both soft and hard tissue hypertrophy. Zygoma, maxilla, nose, and lips are involved, causing facial asymmetry, deviated nose, increased dental show and malocclusion. To correct bony malformation, orthognathic surgery, and facial bone contouring including zygomatic reduction, mandibular angles osteotomy and genioplasty were performed. After the correction of the bony factor, soft tissue symmetry was improved via resection, autologous fat grafting, liposuction, and rhinoplasty. Both patients were satisfied with the surgical result. To acquire facial symmetry, surgical correction is inevitable for patients with port-wine stains associated with soft and hard tissue hypertrophy. The authors describe the successive correction of bony and soft tissue asymmetry to achieve harmonious surgical outcomes.