A pilot process to identify and switch high-risk warfarin patients to direct oral anticoagulants

Objective: To pilot a process for identifying and switching high-risk warfarin patients to direct oral anticoagulants (DOACs) in nonvalvular atrial fibrillation (AF) or venous thromboembolism (VTE).Methods: A pharmacy resident identified high-risk warfarin patients using three criteria. The resident reviewed medical charts, communicated recommendations to the primary care physician (PCP), and scheduled patients for appointments to switch to DOACs. Patients were followed every 1 to 3 months after initiating DOACs. The primary outcome of the study was the percentage of high-risk warfarin patients before and after process implementation. Secondary outcomes at 6 months included bleeding or thrombotic events, patient-reported side effects, recommendation acceptance rates, adherence rates, clinic time in therapeutic range (TTR), and patient satisfaction.Results: Out of 76 patients evaluated, 22.4% were identified as high-risk using the pre-specified criteria. After program implementation, this percentage was reduced to 9.2%. No significant adverse events occurred by 3-month follow-up, and 100% of recommendations were accepted by physicians. Adherence rates and clinic TTR also improved after implementation (87.5% to 94% and 60.9% to 81.1%, respectively). Overall, patients reported satisfaction with switching from warfarin to DOAC.Conclusions: A pilot process was successful in reducing the percentage of high-risk warfarin patients by switching to DOAC therapy.</jats:p

Disabled Beggars in Addis Ababa

This study brings together qualitative and quantitative data to better understand the lives of people with disabilities who beg in Ethiopia. It sets out to provide an initial understanding of the lives of disabled beggars with particular emphasis on determining social and economic factors, and sequences of events or patterns of behaviour that are common to people with disabilities who now work as beggars. Chapter 3 provides an overview of the demographic characteristics of the survey respondents, including their education and vocational training levels and work history. Additional attention was directed to identifying possible areas of intervention that might sever the links between disability and poverty. The study yielded an intriguing set of results that identify: the complex set of issues with which disabled beggars grapple; a series of points where targeted intervention by governments, UN agencies, NGOs and disabled people's organizations could help break the on-going cycle of disability and poverty; and choices that lead some men and women with disabilities to beg. The study contains recommendations for policy, programming and areas for further research

Disabled women’s attendance at community women’s groups in rural Nepal

There is strong evidence that participatory approaches to health and participatory women’s groups hold great potential to improve the health of women and children in resource poor settings. It is important to consider if interventions are reaching the most marginalized, and therefore we examined disabled women’s participation in women’s groups and other community groups in rural Nepal. People with disabilities constitute 15% of the world’s population and face high levels of poverty, stigma, social marginalization and unequal access to health resources, and therefore their access to women’s groups is particularly important. We used a mixed methods approach to describe attendance in groups among disabled and non-disabled women, considering different types and severities of disability. We found no significant differences in the percentage of women that had ever attended at least one of our women’s groups, between non-disabled and disabled women. This was true for women with all severities and types of disability, except physically disabled women who were slightly less likely to have attended. Barriers such as poverty, lack of family support, lack of self-confidence and attendance in many groups prevented women from attending groups. Our findings are particularly significant because disabled people’s participation in broader community groups, not focused on disability, has been little studied. We conclude that women’s groups are an important way to reach disabled women in resource poor communities. We recommend that disabled persons organizations help to increase awareness of disability issues among organizations running community groups to further increase their effectiveness in reaching disabled women

Disability status, intimate partner violence and perceived social support among married women in three districts of the Terai region of Nepal

INTRODUCTION: Women living with disabilities are disproportionately vulnerable to intimate partner violence (IPV). Existing research on the topic largely takes place in high-income settings and treats disability as a dichotomous experience-an individual either has a disability or does not. Disability experiences, however, are diverse such that some individuals face minimal impairment, while for others impairment can be severe. With this spectrum in mind, this study sought to examine the associations between severity of disability impairment, past-year IPV, past-year in-law violence and perceived social support among married women in Nepal. METHODS: Baseline data (2016) from a randomised controlled trial aiming to reduce IPV among women aged 18-49 (n=1800) were analysed using generalised estimating equations logistic regressions to assess associations. RESULTS: Women with severe impairment reported higher levels of physical and/or sexual, emotional, economic and in-law violence than women without a disability (adjusted OR (AOR)=1.68, 95%  CI 1.04 to 2.72; AOR=1.65, 95%  CI 1.03 to 2.65; AOR=1.75, 95%  CI 1.02 to 3.02; AOR=2.80, 95%  CI 2.53 to 5.11, respectively). Differences in IPV between women reporting some impairment versus no disability were observed for economic (AOR=1.47, 95%  CI 1.11 to 1.94) and in-law violence (AOR=1.50, 95%  CI 1.07 to 2.10). Women with severe or some impairment versus no disability were less likely to perceive their in-laws as supportive. CONCLUSION: Disability status was associated with increased vulnerability to IPV. A gradient was observed; the highest levels of IPV were experienced by women with severe impairment, followed by some impairment. Future research should examine the mechanisms driving such observations

Disabled women's maternal and newborn health care in rural Nepal: a qualitative study.

OBJECTIVE: there is little evidence about disabled women's access to maternal and newborn health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and care seeking. Our study explores disabled women׳s experiences of maternal and newborn care in rural Nepal. DESIGN: we used a qualitative methodology, using semi-structured interviews. SETTING: rural Makwanpur District of central Nepal. PARTICIPANTS: we purposively sampled married women with different impairments who had delivered a baby in the past 10 years from different topographical areas of the district. We also interviewed maternal health workers. We compared our findings with a recent qualitative study of non-disabled women in the same district to explore the differences between disabled and non-disabled women. FINDINGS: married disabled women considered pregnancy and childbirth to be normal and preferred to deliver at home. Issues of quality, cost and lack of family support were as pertinent for disabled women as they were for their non-disabled peers. Health workers felt unprepared to meet the maternal health needs of disabled women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: integration of disability into existing Skilled Birth Attendant training curricula may improve maternal health care for disabled women. There is a need to monitor progress of interventions that encourage institutional delivery through the use of disaggregated data, to check that disabled women are benefiting equally in efforts to improve access to maternal health care

Software Model Checking with Explicit Scheduler and Symbolic Threads

In many practical application domains, the software is organized into a set of threads, whose activation is exclusive and controlled by a cooperative scheduling policy: threads execute, without any interruption, until they either terminate or yield the control explicitly to the scheduler. The formal verification of such software poses significant challenges. On the one side, each thread may have infinite state space, and might call for abstraction. On the other side, the scheduling policy is often important for correctness, and an approach based on abstracting the scheduler may result in loss of precision and false positives. Unfortunately, the translation of the problem into a purely sequential software model checking problem turns out to be highly inefficient for the available technologies. We propose a software model checking technique that exploits the intrinsic structure of these programs. Each thread is translated into a separate sequential program and explored symbolically with lazy abstraction, while the overall verification is orchestrated by the direct execution of the scheduler. The approach is optimized by filtering the exploration of the scheduler with the integration of partial-order reduction. The technique, called ESST (Explicit Scheduler, Symbolic Threads) has been implemented and experimentally evaluated on a significant set of benchmarks. The results demonstrate that ESST technique is way more effective than software model checking applied to the sequentialized programs, and that partial-order reduction can lead to further performance improvements.Comment: 40 pages, 10 figures, accepted for publication in journal of logical methods in computer scienc

Encoding conformance checking artefacts in SAT

Conformance checking strongly relies on the computation of artefacts, which enable reasoning on the relation between observed and modeled behavior. This paper shows how important conformance artefacts like alignments, anti-alignments or even multi-alignments, defined over the edit distance, can be computed by encoding the problem as a SAT instance. From a general perspective, the work advocates for a unified family of techniques that can compute conformance artefacts in the same way. The prototype implementation of the techniques presented in this paper show capabilities for dealing with some of the current benchmarks, and potential for the near future when optimizations similar to the ones in the literature are incorporated.Peer ReviewedPostprint (author's final draft

Encoding conformance checking artefacts in SAT

Conformance checking strongly relies on the computation of artefacts, which enable reasoning on the relation between observed and modeled behavior. This paper shows how important conformance artefacts like alignments, anti-alignments or even multi-alignments, defined over the edit distance, can be computed by encoding the problem as a SAT instance. From a general perspective, the work advocates for a unified family of techniques that can compute conformance artefacts in the same way. The prototype implementation of the techniques presented in this paper show capabilities for dealing with some of the current benchmarks, and potential for the near future when optimizations similar to the ones in the literature are incorporated.Peer ReviewedPostprint (author's final draft

Responsibility Analysis by Abstract Interpretation

Given a behavior of interest in the program, statically determining the corresponding responsible entity is a task of critical importance, especially in program security. Classical static analysis techniques (e.g. dependency analysis, taint analysis, slicing, etc.) assist programmers in narrowing down the scope of responsibility, but none of them can explicitly identify the responsible entity. Meanwhile, the causality analysis is generally not pertinent for analyzing programs, and the structural equations model (SEM) of actual causality misses some information inherent in programs, making its analysis on programs imprecise. In this paper, a novel definition of responsibility based on the abstraction of event trace semantics is proposed, which can be applied in program security and other scientific fields. Briefly speaking, an entity ER is responsible for behavior B, if and only if ER is free to choose its input value, and such a choice is the first one that ensures the occurrence of B in the forthcoming execution. Compared to current analysis methods, the responsibility analysis is more precise. In addition, our definition of responsibility takes into account the cognizance of the observer, which, to the best of our knowledge, is a new innovative idea in program analysis.Comment: This is the extended version (33 pages) of a paper to be appeared in the Static Analysis Symposium (SAS) 201