Degrees of tenant isolation for cloud-hosted software services : a cross-case analysis

A challenge, when implementing multi-tenancy in a cloud-hosted software service, is how to ensure that the performance and resource consumption of one tenant does not adversely affect other tenants. Software designers and architects must achieve an optimal degree of tenant isolation for their chosen application requirements. The objective of this research is to reveal the trade-offs, commonalities, and differences to be considered when implementing the required degree of tenant isolation. This research uses a cross-case analysis of selected open source cloud-hosted software engineering tools to empirically evaluate varying degrees of isolation between tenants. Our research reveals five commonalities across the case studies: disk space reduction, use of locking, low cloud resource consumption, customization and use of plug-in architecture, and choice of multi-tenancy pattern. Two of these common factors compromise tenant isolation. The degree of isolation is reduced when there is no strategy to reduce disk space and customization and plug-in architecture is not adopted. In contrast, the degree of isolation improves when careful consideration is given to how to handle a high workload, locking of data and processes is used to prevent clashes between multiple tenants and selection of appropriate multi-tenancy pattern. The research also revealed five case study differences: size of generated data, cloud resource consumption, sensitivity to workload changes, the effect of the software process, client latency and bandwidth, and type of software process. The degree of isolation is impaired, in our results, by the large size of generated data, high resource consumption by certain software processes, high or fluctuating workload, low client latency, and bandwidth when transferring multiple files between repositories. Additionally, this research provides a novel explanatory framework for (i) mapping tenant isolation to different software development processes, cloud resources and layers of the cloud stack; and (ii) explaining the different trade-offs to consider affecting tenant isolation (i.e. resource sharing, the number of users/requests, customizability, the size of generated data, the scope of control of the cloud application stack and business constraints) when implementing multi-tenant cloud-hosted software services. This research suggests that software architects have to pay attention to the trade-offs, commonalities, and differences we identify to achieve their degree of tenant isolation requirements

Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling

Background: Various lipid measurements in monitoring/screening programmes can be used, alone or in cardiovascular risk scores, to guide treatment for prevention of cardiovascular disease (CVD). Because some changes in lipids are due to variability rather than true change, the value of lipid-monitoring strategies needs evaluation. Objective: To determine clinical value and cost-effectiveness of different monitoring intervals and different lipid measures for primary and secondary prevention of CVD. Data sources: We searched databases and clinical trials registers from 2007 [including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Clinical Trials Register, the Current Controlled Trials (CCT) register, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)] to update and extend previous systematic reviews. Patient-level data from the Clinical Practice Research Datalink (CPRD) and St Luke’s Hospital, Japan, were used in statistical modelling. Utilities and health-care costs were drawn from the literature. Methods: In two meta-analyses, we used prospective studies to examine associations of lipids with CVD and mortality, and randomised controlled trials to estimate lipid-lowering effects of atorvastatin doses. Patient-level data were used to estimate progression and variability of lipid measurements over time, and hence to model lipid-monitoring strategies. Results are expressed as rates of true-/false-positive and true-/false-negative tests for high lipid or high CVD risk. We estimated incremental costs per quality-adjusted life-year. Results: A total of 115 publications reported strength of association between different lipid measures and CVD events in 138 data sets. The summary adjusted hazard ratio (HR) per standard deviation of total cholesterol (TC) to high-density lipoprotein (HDL) cholesterol ratio was 1.25 [95% confidence interval 1.15 to 1.35] for CVD in a primary prevention population but heterogeneity was high (I 2 = 98%); similar results were observed for non-HDL cholesterol, apolipoprotein B and other ratio measures. Associations were smaller for other single lipid measures. Across 10 trials, low-dose atorvastatin (10 and 20 mg) effects ranged from a TC reduction of 0.92 mmol/l to 2.07 mmol/l, and low-density lipoprotein reduction of between 0.88 mmol/l and 1.86 mmol/l. Effects of 40 mg and 80 mg were reported by one trial each. For primary prevention, over a 3-year period, we estimate annual monitoring would unnecessarily treat 9 per 1000 more men (28 vs. 19 per 1000) and 5 per 1000 more women (17 vs. 12 per 1000) than monitoring every 3 years. However, annual monitoring would also undertreat 9 per 1000 fewer men (7 vs. 16 per 1000) and 4 per 1000 fewer women (7 vs. 11 per 1000) than monitoring at 3-year intervals. For secondary prevention, over a 3-year period, annual monitoring would increase unnecessary treatment changes by 66 per 1000 men and 31 per 1000 women, and decrease undertreatment by 29 per 1000 men and 28 per 1000 men, compared with monitoring every 3 years. In cost-effectiveness, strategies with increased screening/monitoring dominate. Exploratory analyses found that any unknown harms of statins would need utility decrements as large as 0.08 (men) to 0.11 (women) per statin user to reverse this finding in primary prevention. Limitation: Heterogeneity in meta-analyses. Conclusions: While acknowledging known and potential unknown harms of statins, we find that more-frequent monitoring strategies are cost-effective compared with others. Regular lipid monitoring in those with and without CVD is likely to be beneficial to patients and to the health service. Future research should include trials of the benefits and harms of atorvastatin 40 and 80 mg, large-scale surveillance of statin safety, and investigation of the effect of monitoring on medication adherence