Automated Monitoring of Online News Streams: Topic Detection and Tracking Considerations

This paper describes the term frequency patterns found in online news summaries published over a seven-week period. The patterns are analyzed qualitatively and quantitatively to facilitate the refinement of algorithms used for the automatic detection and tracking of important topics appearing in streams of text. It is shown that a term's importance cannot be measured in raw frequency counts or significant increases in volume alone. The impact of these findings on existing algorithms is discussed, and new approaches for automated story detection and presentation are considered

Automated telephone communication systems for preventive healthcare and management of long-term conditions

Background Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone’s touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. Objectives To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. Search methods We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. Selection criteria Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. Data collection and analysis We used standard Cochrane methods to select and extract data and to appraise eligible studies. Main results We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome reporting to be unclear. For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty). For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462; high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care. It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36, 95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR (RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening. Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions (25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS, compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage) related to adherence, but only a small number of studies contributed clinical outcome data. The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS varied, including by the type of ATCS intervention in use. Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity, weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure, hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/ substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia, obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers. Only four trials (3%) reported adverse events, and it was unclear whether these were related to the intervention

Trends in Insulin Initiation and Treatment Intensification Among Patients with Type 2 Diabetes

BACKGROUND: Many patients with type 2 diabetes eventually require insulin, yet little is known about the patterns and quality of pharmacologic care received following insulin initiation. Guidelines from the American Diabetes Association and the European Association for the Study of Diabetes recommend that insulin secretagogues such as sulfonylureas be discontinued at the time of insulin initiation to reduce the risk of hypoglycemia, and that treatment be intensified if HbA1c levels remain above-target 3 months after insulin initiation. OBJECTIVE: To describe pharmacologic treatment patterns over time among adults initiating insulin and/or intensifying insulin treatment. DESIGN: Observational study. SUBJECTS: A large commercially insured population of adult patients without recorded type 1 diabetes who initiated insulin. MAIN MEASURES: We evaluated changes in non-insulin antidiabetic medication use during the 120 days immediately following insulin initiation, rates of increase in insulin dose and/or dosing frequency during the 270 days following an insulin initiation treatment period of 90 days, and rates of insulin discontinuation. KEY RESULTS: Seven thousand, nine hundred and thirty-two patients initiated insulin during 2003-2008, with the majority (61 %) initiating basal insulin only. Metformin (55 %), sulfonylureas (39 %), and thiazolidinediones (30 %) were commonly used prior to insulin initiation. Metformin was continued by 64 % of patients following mixed or mealtime insulin initiation; the continuation rate was nearly as high for sulfonylureas (58 %). Insulin dose and/or dosing frequency increased among 22.9 % of patients. Insulin was discontinued by 27 % of patients. CONCLUSIONS: We found evidence of substantial departures from guideline-recommended pharmacotherapy. Insulin secretagogues were frequently co-prescribed with insulin. The majority of patients had no evidence of treatment intensification following insulin initiation, although this finding is difficult to interpret without HbA1c levels. While each patient's care should be individualized, our data suggest that the quality of care following insulin initiation can be improved.Statistic

From Yellow to Black: Dramatic Changes between Cerium(IV) and Plutonium(IV) Molybdates

Hydrothermal reactions of CeCl3 and PuCl3 with MoO3 and Cs2CO3 yield surprisingly different results. Ce3Mo6O24(H2O)4 crystallizes as bright yellow plates (space group C2/c, a = 12.7337(7) Å, b = 22.1309(16) Å, c = 7.8392(4) Å, β = 96.591(4)°, V = 2194.6(2) Å3), whereas CsPu3Mo6O24(H2O) crystallizes as semiconducting black-red plates (space group C2/c, a = 12.633(5) Å, b = 21.770(8) Å, c = 7.743(7) Å, β = 96.218(2)°, V = 2117(2) Å3). The topologies of the two compounds are similar, with channel structures built from disordered Mo(VI) square pyramids and (RE)O8 square antiprisms (RE = Ce(IV), Pu(IV)). However, the Pu(IV) compound contains Cs+ in its channels, while the channels in Ce3Mo6O24(H2O)4 contain water molecules. Disorder and an ambiguous oxidation state of Mo lead to the formula CsPu3Mo6O24(H2O), where one Mo site is Mo(V) and the rest are Mo(VI). X-ray absorption near-edge structure (XANES) experiments were performed to investigate the source of the black color of CsPu3Mo6O24(H2O). These experiments revealed Pu to be tetravalent, while the strong pre-edge absorption from the distorted molybdate anions leaves the oxidation state ambiguous between Mo(V) and Mo(VI)

The effect of free health care on polypharmacy: a comparison of propensity score methods and multivariable regression to account for confounding

Purpose: Differing healthcare access has implications for public health. In Ireland, eligibility for free public health care is means tested. Here, we examine the association between healthcare access and polypharmacy while accounting for underlying socio-economic and health status differences. Methods: Self-reported regular medication use, history of diagnosed health conditions, disability, socio-demographics, and objective measures of depression and anxiety for adults aged 50–69 years (n = 5796) were ascertained from the population-representative Irish Longitudinal Study on Ageing. Objective measures of frailty, cognition, hypertension, and body mass index were also assessed for 4241 participants. The associations between free healthcare access and polypharmacy and use of 15 medication classes were estimated using multivariable modified Poisson regression, adjustment for the propensity score, and inverse probability of treatment weighting by the propensity score. Results: Polypharmacy was reported by 22% and 7% of the 1932 and 3864 participants with and without public healthcare coverage. Public patients had a 21–38% greater risk of polypharmacy depending on the method used to account for confounding. Results were less robust using propensity score weighting. There was evidence that classes of cardiovascular drugs, drugs for acid-related disorders, and analgesics were used more commonly in public patients. Associations were mostly unaffected after also accounting for objective health measures but were significantly attenuated after accounting for frequency of healthcare visits. Conclusions: Publically funded health care in Ireland leads to greater medication use in people aged 50–69 years. This may reflect over-prescribing to public patients or restricted use among those who pay out of pocket. Copyright © 2014 John Wiley & Sons, Ltd

From Yellow to Black: Dramatic Changes between Cerium(IV) and Plutonium(IV) Molybdates

Hydrothermal reactions of CeCl₃ and PuCl₃ with MoO₃ and Cs₂CO₃ yield surprisingly different results. Ce₃Mo₆O₂₄(H₂O)₄ crystallizes as bright yellow plates (space group <i>C</i>2<i>/c, a</i> = 12.7337(7) Å, <i>b</i> = 22.1309(16) Å, <i>c</i> = 7.8392(4) Å, β = 96.591(4)°, <i>V</i> = 2194.6(2) ų), whereas CsPu₃Mo₆O₂₄(H₂O) crystallizes as semiconducting black-red plates (space group <i>C</i>2<i>/c</i>, <i>a</i> = 12.633(5) Å, <i>b</i> = 21.770(8) Å, <i>c</i> = 7.743(7) Å, β = 96.218(2)°, <i>V</i> = 2117(2) ų). The topologies of the two compounds are similar, with channel structures built from disordered Mo­(VI) square pyramids and (RE)­O₈ square antiprisms (RE = Ce­(IV), Pu­(IV)). However, the Pu­(IV) compound contains Cs⁺ in its channels, while the channels in Ce₃Mo₆O₂₄(H₂O)₄ contain water molecules. Disorder and an ambiguous oxidation state of Mo lead to the formula CsPu₃Mo₆O₂₄(H₂O), where one Mo site is Mo­(V) and the rest are Mo­(VI). X-ray absorption near-edge structure (XANES) experiments were performed to investigate the source of the black color of CsPu₃Mo₆O₂₄(H₂O). These experiments revealed Pu to be tetravalent, while the strong pre-edge absorption from the distorted molybdate anions leaves the oxidation state ambiguous between Mo­(V) and Mo­(VI)

From Yellow to Black: Dramatic Changes between Cerium(IV) and Plutonium(IV) Molybdates

Hydrothermal reactions of CeCl₃ and PuCl₃ with MoO₃ and Cs₂CO₃ yield surprisingly different results. Ce₃Mo₆O₂₄(H₂O)₄ crystallizes as bright yellow plates (space group <i>C</i>2<i>/c, a</i> = 12.7337(7) Å, <i>b</i> = 22.1309(16) Å, <i>c</i> = 7.8392(4) Å, β = 96.591(4)°, <i>V</i> = 2194.6(2) ų), whereas CsPu₃Mo₆O₂₄(H₂O) crystallizes as semiconducting black-red plates (space group <i>C</i>2<i>/c</i>, <i>a</i> = 12.633(5) Å, <i>b</i> = 21.770(8) Å, <i>c</i> = 7.743(7) Å, β = 96.218(2)°, <i>V</i> = 2117(2) ų). The topologies of the two compounds are similar, with channel structures built from disordered Mo­(VI) square pyramids and (RE)­O₈ square antiprisms (RE = Ce­(IV), Pu­(IV)). However, the Pu­(IV) compound contains Cs⁺ in its channels, while the channels in Ce₃Mo₆O₂₄(H₂O)₄ contain water molecules. Disorder and an ambiguous oxidation state of Mo lead to the formula CsPu₃Mo₆O₂₄(H₂O), where one Mo site is Mo­(V) and the rest are Mo­(VI). X-ray absorption near-edge structure (XANES) experiments were performed to investigate the source of the black color of CsPu₃Mo₆O₂₄(H₂O). These experiments revealed Pu to be tetravalent, while the strong pre-edge absorption from the distorted molybdate anions leaves the oxidation state ambiguous between Mo­(V) and Mo­(VI)