Project Hydra: Designing & Building a Reusable Framework for Multipurpose, Multifunction, Multi-institutional Repository-Powered Solutions

4th International Conference on Open RepositoriesThis presentation was part of the session : Fedora User Group PresentationsDate: 2009-05-20 03:30 PM – 05:00 PMThere is a clear business need in higher education for a flexible, reusable application framework that can support the rapid development of multiple systems tailored to distinct needs, but powered by a common underlying repository. Recognizing this common need, Stanford University, the University of Hull and the University of Virginia are collaborating on "Project Hydra", a three-year effort to create an application and middleware framework that, in combination with an underlying Fedora repository, will create a reusable environment for running multifunction, multipurpose repository-powered solutions. This paper details the collaborators' functional and technical design for such a framework, and will demonstrate the progress made to date on the initiative.JIS

Hydra: A Technical and Community Framework For Customized, Reusable, Repository Solutions

While repositories provide obvious benefits in hosting and managing content, it is equally clear that there is no "one size fits all" solution to the range of digital asset management needs at a typical institution, much less across institutions. A system that supports the submission, approval and dissemination of electronic theses and dissertations, for example, has demonstrably different requirements than a digitization workflow solution, an e-science data repository, or media preservation and access system. There is a clear need in the repository community to readily develop and deploy content-, domain-, and institution-specific solutions that integrate the flexibility and richness of customized applications and workflows with the underlying power of repositories for content management, access and preservation. Hydra is a multi-institutional, multi-functional, multi-purpose framework that addresses this need on twin fronts. As a technical framework, it provides a toolkit of reusable components that can be combined and configured in different arrays to meet a diversity of content management needs. As a community framework, Hydra provides like-minded institutions with the mechanism to combine their individual development efforts, resources and priorities into a collective solution with breadth and depth that exceeds the capacity of any single institution to create, maintain or enhance on its own

Hydra: A Technical and Community Framework For Customized, Reusable, Repository Solutions

While repositories provide obvious benefits in hosting and managing content, it is equally clear that there is no "one size fits all" solution to the range of digital asset management needs at a typical institution, much less across institutions. A system that supports the submission, approval and dissemination of electronic theses and dissertations, for example, has demonstrably different requirements than a digitization workflow solution, an e-science data repository, or media preservation and access system. There is a clear need in the repository community to readily develop and deploy content-, domain-, and institution-specific solutions that integrate the flexibility and richness of customized applications and workflows with the underlying power of repositories for content management, access and preservation. Hydra is a multi-institutional, multi-functional, multi-purpose framework that addresses this need on twin fronts. As a technical framework, it provides a toolkit of reusable components that can be combined and configured in different arrays to meet a diversity of content management needs. As a community framework, Hydra provides like-minded institutions with the mechanism to combine their individual development efforts, resources and priorities into a collective solution with breadth and depth that exceeds the capacity of any single institution to create, maintain or enhance on its own

Clinical and cost-effectiveness of contingency management for cannabis use in early psychosis: the CIRCLE randomised clinical trial

Background Cannabis is the most commonly used illicit substance among people with psychosis. Continued cannabis use following the onset of psychosis is associated with poorer functional and clinical outcomes. However, finding effective ways of intervening has been very challenging. We examined the clinical and cost-effectiveness of adjunctive contingency management (CM), which involves incentives for abstinence from cannabis use, in people with a recent diagnosis of psychosis. Methods CIRCLE was a pragmatic multi-centre randomised controlled trial. Participants were recruited via Early Intervention in Psychosis (EIP) services across the Midlands and South East of England. They had had at last one episode of clinically diagnosed psychosis (affective or non-affective); were aged 18 to 36; reported cannabis use in at least 12 out of the previous 24 weeks; and were not currently receiving treatment for cannabis misuse, or subject to a legal requirement for cannabis testing. Participants were randomised via a secure web-based service 1:1 to either an experimental arm, involving 12 weeks of CM plus a six-session psychoeducation package, or a control arm receiving the psychoeducation package only. The total potential voucher reward in the CM intervention was £240. The primary outcome was time to acute psychiatric care, operationalised as admission to an acute mental health service (including community alternatives to admission). Primary outcome data were collected from patient records at 18 months post-consent by assessors masked to allocation. The trial was registered with the ISRCTN registry, number ISRCTN33576045. Results: 551 participants were recruited between June 2012 and April 2016. Primary outcome data were obtained for 272 (98%) in the CM (experimental) group and 259 (95%) in the control group. There was no statistically significant difference in time to acute psychiatric care (the primary outcome) (HR 1.03, 95% CI 0.76, 1.40) between groups. By 18 months, 90 (33%) of participants in the CM group, and 85 (30%) of the control groups had been admitted at least once to an acute psychiatric service. Amongst those who had experienced an acute psychiatric admission, the median time to admission was 196 days (IQR 82, 364) in the CM group and 245 days (IQR 99,382) in the control group. Cost-effectiveness analyses suggest that there is an 81% likelihood that the intervention was cost-effective, mainly resulting from higher mean inpatient costs for the control group compared with the CM group, however the cost difference between groups was not statistically significant. There were 58 adverse events, 27 in the CM group and 31 in the control group. Conclusions Overall, these results suggest that CM is not an effective intervention for improving the time to acute psychiatric admission or reducing cannabis use in psychosis, at least at the level of voucher reward offered

A randomised controlled trial of the clinical and cost-effectiveness of a contingency management intervention for reduction of cannabis use and of relapse in early psychosis (CIRCLE): a study protocol for a randomised controlled trial

Background: Around 35–45 % of people in contact with services for a first episode of psychosis are using cannabis. Cannabis use is associated with delays in remission, poorer clinical outcomes, significant increases in the risk of relapse, and lower engagement in work or education. While there is a clear need for effective interventions, so far only very limited benefits have been achieved from psychological interventions. Contingency management (CM) is a behavioural intervention in which specified desired behavioural change is reinforced through financial rewards. CM is now recognised to have a substantial evidence base in some contexts and its adoption in the UK is advocated by the National Institute for Health and Care Excellence (NICE) guidance as a treatment for substance or alcohol misuse. However, there is currently little published data testing its effectiveness for reducing cannabis use in early psychosis. Methods: CIRCLE is a two-arm, rater-blinded randomised controlled trial (RCT) investigating the clinical and cost-effectiveness of a CM intervention for reducing cannabis use among young people receiving treatment from UK Early Intervention in Psychosis (EIP) services. EIP service users (n = 544) with a recent history of cannabis use will be recruited. The experimental group will receive 12 once-weekly CM sessions, and a voucher reward if urinalysis shows that they have not used cannabis in the previous week. Both the experimental and the control groups will be offered an Optimised Treatment as Usual (OTAU) psychoeducational package targeting cannabis use. Assessment interviews will be performed at consent, at 3 months, and at 18 months. The primary outcome is time to relapse, defined as admission to an acute mental health service. Secondary outcomes include proportion of cannabis-free urine samples during the intervention period, severity of positive psychotic symptoms, quality-adjusted life years, and engagement in work or education. Discussion: CIRCLE is a RCT of CM for cannabis use in young people with a recent history of psychosis (EIP service users) and recent cannabis use. It is designed to investigate whether the intervention is a clinically and cost-effective treatment for cannabis use. It is intended to inform future treatment delivery, particularly in EIP settings

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Case Studies in Repository Workflows: Three Approaches

4th International Conference on Open RepositoriesThis presentation was part of the session : Fedora User Group PresentationsDate: 2009-05-21 10:30 AM – 12:00 PM"Lightweight workflow" is both an oxymoron, and a continual aspiration of the many stakeholders in the repository community. As part of the Hydra Project, the University of Hull, University of Virginia and Stanford University are collaboratively developing a reusable application framework that will sit on top of Fedora. Developing support for workflow (defined here as orchestrating multistep processes that may include human interaction) is integral to the project. The partners consciously chose to take three different paths in implementing and integrating workflow into the overall solution. This paper briefly details the three different workflow approaches the collaborators are taking, why they chose them, and the apparent pro's and cons of each.JIS