Modelling and simulation of ElasticSearch using CloudSim

Simulation can be a powerful technique for evaluating the performance of large-scale cloud computing services in a relatively low cost, low risk and time-sensitive manner. Largescale data indexing, distribution and management is complex to analyse in a timely manner. In this paper, we extend the CloudSim cloud simulation framework to model and simulate a distributed search engine architecture and its workload characteristics. To test the simulation framework, we develop a model based on a real-world ElasticSearch deployment on Linknovate.com. An experimental evaluation of the framework, comparing simulated and actual query response time, precision and resource utilisation, suggests that the proposed framework is capable of predicting performance at different scales in a precise, accurate and efficient manner. The results can assist ElasticSearch users to manage their scalability and infrastructure requirement

Exploring obstetricians', midwives' and general practitioners' approach to weight management in pregnant women with a BMI >= 25 kg/m(2): a qualitative study

Objective: The aim of this study was to explore healthcare professionals’ (HCPs) beliefs and attitudes towards weight management for pregnant women with a body mass index (BMI) ≥25 kg/m2. Design: Qualitative study. Setting: A public antenatal clinic in a large academic maternity hospital in Cork, Ireland, and general practice clinics in the same region. Participants: HCPs such as hospital-based midwives and consultant obstetricians and general practitioners (GPs). Method: Semistructured interviews were conducted with a purposive sample of hospital-based HCPs and a sample of GPs working in the same region. Interviews were recorded, transcribed and thematically analysed using NVivo software. Results: Seventeen HCPs were interviewed (hospital based=10; GPs=7). Four themes identified the complexity of weight management in pregnancy and the challenges HCPs faced when trying to balance the medical and psychosocial needs of the women. HCPs acknowledged weight as a sensitive conversation topic, leading to a ‘softly-softly approach’ to weight management. HCPs tried to strike a balance between being woman centred and empathetic and medicalising the conversation. HCPs described ‘doing what you can with what you have’ and shifting the focus to managing obstetric complications. Furthermore, there were unclear roles and responsibilities in terms of weight management. Conclusion: HCPs need to have standardised approaches and evidence-based guidelines that support the consistent monitoring and management of weight during pregnancy

Qualitative analysis of community pharmacists' opinions on their involvement in reducing potentially inappropriate prescribing

Purpose: Older people are at risk of potentially inappropriate prescribing (PIP) due to polypharmacy arising from multi-morbidity. Despite available explicit criteria to reduce PIP, it is highly prevalent. Whilst community pharmacists have the required knowledge to help reduce PIP, they are not currently engaged with the problem. This study explores the views of community pharmacists on their potential involvement in reducing PIP and determines the challenges to its implementation. Methods: Semi-structured interviews with pharmacists working in community pharmacies in Ireland. The theoretical domains framework (TDF) was used to develop the topic guide and to analyse the transcripts. Domains of highest relevance for PIP reduction were identified based on their frequency or whether the participants emphasised the impact of constructs within a domain. Local ethical approval was obtained. Results: Of 18 participants, 12 were female, median age was 30 years (IQR, 27–35) with a median of 6 years (IQR, 3–8) of experience. Seven TDF domains were identified as relevant to PIP reduction. Pharmacists were uncertain about their role in reducing PIP and reluctant to challenge physicians’ prescribing decisions. Challenges pertained to the environment, knowledge, social influences, professional role and identity. Conclusions: Pharmacists welcomed new responsibilities in reducing PIP as part of their daily practice but expressed a need for removal of social and environmental barriers as well as, provision of relevant guidelines and education about PIP. This study provides useful insights into the target domains for overcoming barriers of pharmacist involvement in reducing PIP

Analysing dependability and performance of a real-world Elastic Search application

—Increased complexity in IT, big data, and advanced analytical techniques are some of the trends driving demand for more sophisticated and scalable search technology. Despite Quality of Service (QoS) being a critical success factor in most enterprise software service offerings, it is often not a generic component of the enterprise search software stack. In this paper, we explore enterprise search engine dependability and performance using a real-world company architecture and associated data sourced from an ElasticSearch implementation on Linknovate.com. We propose a Fault Tree model to assess the availability and reliability of the Linknovate.com architecture. The results of the Fault Tree model are fed into a Stochastic Petri Net (SPN) model to analyze how failures and redundancy impact application performance of the use case system. Availability and MTTF were used to evaluate the reliability and throughput was used to evaluate the performance of the target system. The best results for all three metrics were returned in scenarios with high levels of redundancy

Study protocol; thyroid hormone replacement for untreated older adults with subclinical hypothyroidism - a randomised placebo controlled trial (TRUST)

Background: Subclinical hypothyroidism (SCH) is a common condition in elderly people, defined as elevated serum thyroid-stimulating hormone (TSH) with normal circulating free thyroxine (fT4). Evidence is lacking about the effect of thyroid hormone treatment. We describe the protocol of a large randomised controlled trial (RCT) of Levothyroxine treatment for SCH. Methods: Participants are community-dwelling subjects aged ≥65 years with SCH, diagnosed by elevated TSH levels (≥4.6 and ≤19.9 mU/L) on a minimum of two measures ≥ three months apart, with fT4 levels within laboratory reference range. The study is a randomised double-blind placebo-controlled parallel group trial, starting with levothyroxine 50 micrograms daily (25 micrograms in subjects <50Kg body weight or known coronary heart disease) with titration of dose in the active treatment group according to TSH level, and a mock titration in the placebo group. The primary outcomes are changes in two domains (hypothyroid symptoms and fatigue / vitality) on the thyroid-related quality of life questionnaire (ThyPRO) at one year. The study has 80% power (at p = 0.025, 2-tailed) to detect a change with levothyroxine treatment of 3.0% on the hypothyroid scale and 4.1% on the fatigue / vitality scale with a total target sample size of 750 patients. Secondary outcomes include general health-related quality of life (EuroQol), fatal and non-fatal cardiovascular events, handgrip strength, executive cognitive function (Letter Digit Coding Test), basic and instrumental activities of daily living, haemoglobin, blood pressure, weight, body mass index and waist circumference. Patients are monitored for specific adverse events of interest including incident atrial fibrillation, heart failure and bone fracture. Discussion: This large multicentre RCT of levothyroxine treatment of subclinical hypothyroidism is powered to detect clinically relevant change in symptoms / quality of life and is likely to be highly influential in guiding treatment of this common condition. Trial registration: Clinicaltrials.gov NCT01660126; registered 8th June 2012

Determinants of eWOM on hospitality CSR issues. In Facebook we trust?

Social media has emerged asa powerfuland successfultooltodisseminate information relating to corporate social responsibility (CSR) in different industries, including the hospitality context. Similarly, the media plays a major role in the domain of CSR since news media materializes corporate goals regarding CSR issues. However, no prior studies have explored the main factors that influence electronic word of mouth (eWOM) on CSR issues covered by the media through social media. This research incorporates the characteristics of information (specific) and individuals? informational predisposition (general) into an integrative model to examine the key predictors of intention to share and comment on negative CSR news covered by a specific media outlet on a particular social networking site (SNS): Facebook. To empirically test the proposed model, 208 Facebook users were surveyed in Spain. The results show that information value, Facebook trust and self-disclosure have a positive impact on eWOM intentions. It also confirmed that source credibility has a positive impact on information value. However, neither significant relationship was found between Facebook trust and privacy concerns, nor between this variable and intentions to share and comment. Finally, theoretical conclusions, managerial implications, and limitations are discussed

Investigating the perceived benefits, barriers and beliefs towards physical activity in pregnancy among women with Gestational Diabetes Mellitus

Gestational Diabetes Mellitus (GDM) is a growing concern and poses serious health risks to both mother and child1. The current study explores the psychological determinants of exercise behaviour in a sample of pregnant women with GDM. A cross-sectional survey design was employed to examine exercise behaviour, illness perceptions, perceived barriers and benefits, exercise beliefs, and exercise self-efficacy using validated questionnaires. A sample of 46 pregnant women was recruited from University College Hospital Galway, Letterkenny General Hospital, Cork University Hospital and Mayo General Hospital in Castlebar. Participant’s varied; age (22-44 years), body mass index (19-41). High mean scores for Personal Control (24.5) and Treatment Control (30.2) subscales indicated strongly held positive beliefs in relation to controllability of the illness. Total MET-min/week score was not related to any psychological variables. Analysis of the IPQ-R data revealed ‘diet’ (n=37, 80.4%) as the most referred to cause of diabetes. Exercise belief data identified “managing weight gain” (n= 21, 45.7%), and “losing baby weight” (n= 31, 67.4%) as the most frequent beliefs for engaging in physical activity during pregnancy and post pregnancy. Further research on the psychological determinants of physical activity behaviour among this population group is needed in order to create successful intervention strategies

Overtreatment and associated risk factors among multimorbid older patients with diabetes.

BACKGROUND In multimorbid older patients with type 2 diabetes mellitus (T2DM), the intensity of glucose-lowering medication (GLM) should be focused on attaining a suitable level of glycated hemoglobin (HbA1c ) while avoiding side effects. We aimed at identifying patients with overtreatment of T2DM as well as associated risk factors. METHODS In a secondary analysis of a multicenter study of multimorbid older patients, we evaluated HbA1c levels among patients with T2DM. Patients were aged ≥70 years, with multimorbidity (≥3 chronic diagnoses) and polypharmacy (≥5 chronic medications), enrolled in four university medical centers across Europe (Belgium, Ireland, Netherlands, and Switzerland). We defined overtreatment as HbA1c  < 7.5% with ≥1 GLM other than metformin, as suggested by Choosing Wisely and used prevalence ratios (PRs) to evaluate risk factors of overtreatment in age- and sex-adjusted analyses. RESULTS Among the 564 patients with T2DM (median age 78 years, 39% women), mean ± standard deviation HbA1c was 7.2 ± 1.2%. Metformin (prevalence 51%) was the most frequently prescribed GLM and 199 (35%) patients were overtreated. The presence of severe renal impairment (PR 1.36, 1.21-1.53) and outpatient physician (other than general practitioner [GP], i.e. specialist) or emergency department visits (PR 1.22, 1.03-1.46 for 1-2 visits, and PR 1.35, 1.19-1.54 for ≥3 visits versus no visits) were associated with overtreatment. These factors remained associated with overtreatment in multivariable analyses. CONCLUSIONS In this multicountry study of multimorbid older patients with T2DM, more than one third were overtreated, highlighting the high prevalence of this problem. Careful balancing of benefits and risks in the choice of GLM may improve patient care, especially in the context of comorbidities such as severe renal impairment, and frequent non-GP healthcare contacts

Social, biological, behavioural and psychological factors related to physical activity during early pregnancy in the Screening for Pregnancy Endpoints (Cork, Ireland) cohort study

Objective: The aim of this study was to identify the social, biological, behavioural and psychological factors related to physical activity (PA) in early pregnancy.Design: This is a secondary analysis of data from a prospective cohort study.Setting: The study was conducted in Cork, Ireland.Participants: Nulliparous women with singleton pregnancies were recruited and then interviewed at 15±1 weeks’ gestation.Primary and secondary outcomes: The biopsychosocial model identified factors including social (age), biological (body mass index), behavioural (diet) and psychological (anxiety) at 15±1 weeks’ gestation. PA subgroups were identified based on a latent class analysis of their responses to a set of questions about the amount and intensity of activity they were engaging in during the pregnancy. Associations were estimated with multivariable multinomial logistic regression models.Results: From a total of 2579, 1774 (69%) women were recruited; ages ranged from 17 to 45 years. Based on a combination of model fit, theoretical interpretability and classification quality, the latent class analyses identified three PA subgroups: low PA (n=393), moderate PA (n=960) and high PA (n=413). The fully adjusted model suggests non-smokers, and consumers of fruit and vegetables were more likely to be in the high PA subgroup (vs low). Women with more than 12 years of schooling and a higher socioeconomic status were more likely to be in the moderate PA subgroup (vs low).Conclusion: The findings highlight potential links between PA, a low education level and a low socioeconomic background. These factors should be considered for future interventions to improve low PA levels during pregnancy.Trial registration number: ACTRN 12607000551493

BMQ

BMQ: Boston Medical Quarterly was published from 1950-1966 by the Boston University School of Medicine and the Massachusetts Memorial Hospitals