Context Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain Objective To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States Design Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 85 years) in which 16608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998 Interventions Participants received conjugated equine estrogens, 0625 mg/d, plus medroxyprogesterone acetate, 25 mg/d, in 1 tablet (n = 8506) or placebo (n = 8102) Main outcomes measures The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes Results On May 31, 2002, after a mean of 52 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits This report includes data on the major clinical outcomes through April 30, 2002 Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 129 (102-163) with 286 cases; breast cancer, 126 (100-159) with 290 cases; stroke, 141 (107-185) with 212 cases; PE, 213 (139-325) with 101 cases; colorectal cancer, 063 (043-092) with 112 cases; endometrial cancer, 083 (047-147) with 47 cases; hip fracture, 066 (045-098) with 106 cases; and death due to other causes, 092 (074-114) with 331 cases Corresponding HRs (nominal 95% CIs) for composite outcomes were 122 (109-136) for total cardiovascular disease (arterial and venous disease), 103 (090-117) for total cancer, 076 (069-085) for combined fractures, 098 (082-118) for total mortality, and 115 (103-128) for the global index Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures The absolute excess risk of events included in the global index was 19 per 10 000 person-years Conclusions Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 52-year follow-up among healthy postmenopausal US women All-cause mortality was not affected during the trial The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD

/pdf/risks-and-benefits-of-estrogen-plus-progestin-in-healthy-4glim99n2t.pdf

Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial

Global strategy for asthma management and prevention

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Data Mining Practical Machine Learning Tools and Techniques

Context.—Observational studies have found lower rates of coronary heart disease
(CHD) in postmenopausal women who take estrogen than in women who do not,
but this potential benefit has not been confirmed in clinical trials.Objective.—To determine if estrogen plus progestin therapy alters the risk for
CHD events in postmenopausal women with established coronary disease.Design.—Randomized, blinded, placebo-controlled secondary prevention trial.Setting.—Outpatient and community settings at 20 US clinical centers.Participants.—A total of 2763 women with coronary disease, younger than 80 years,
and postmenopausal with an intact uterus. Mean age was 66.7 years.Intervention.—Either 0.625 mg of conjugated equine estrogens plus 2.5 mg of medroxyprogesterone
acetate in 1 tablet daily (n=1380) or a placebo of identical appearance (n=1383).
Follow-up averaged 4.1 years; 82% of those assigned to hormone treatment were
taking it at the end of 1 year, and 75% at the end of 3 years.Main Outcome Measures.—The primary outcome was the occurrence of nonfatal myocardial infarction
(MI) or CHD death. Secondary cardiovascular outcomes included coronary revascularization,
unstable angina, congestive heart failure, resuscitated cardiac arrest, stroke
or transient ischemic attack, and peripheral arterial disease. All-cause mortality
was also considered.Results.—Overall, there were no significant differences between groups in the
primary outcome or in any of the secondary cardiovascular outcomes: 172 women
in the hormone group and 176 women in the placebo group had MI or CHD death
(relative hazard [RH], 0.99; 95% confidence interval [CI], 0.80-1.22). The
lack of an overall effect occurred despite a net 11% lower low-density lipoprotein
cholesterol level and 10% higher high-density lipoprotein cholesterol level
in the hormone group compared with the placebo group (each P<.001). Within the overall null effect, there was a statistically
significant time trend, with more CHD events in the hormone group than in
the placebo group in year 1 and fewer in years 4 and 5. More women in the
hormone group than in the placebo group experienced venous thromboembolic
events (34 vs 12; RH, 2.89; 95% CI, 1.50-5.58) and gallbladder disease (84
vs 62; RH, 1.38; 95% CI, 1.00-1.92). There were no significant differences
in several other end points for which power was limited, including fracture,
cancer, and total mortality (131 vs 123 deaths; RH, 1.08; 95% CI, 0.84-1.38).Conclusions.—During an average follow-up of 4.1 years, treatment with oral conjugated
equine estrogen plus medroxyprogesterone acetate did not reduce the overall
rate of CHD events in postmenopausal women with established coronary disease.
The treatment did increase the rate of thromboembolic events and gallbladder
disease. Based on the finding of no overall cardiovascular benefit and a pattern
of early increase in risk of CHD events, we do not recommend starting this
treatment for the purpose of secondary prevention of CHD. However, given the
favorable pattern of CHD events after several years of therapy, it could be
appropriate for women already receiving this treatment to continue.

https://jamanetwork.com/journals/jama/articlepdf/187879/JOC80678.pdf

Randomized Trial of Estrogen Plus Progestin for Secondary Prevention of Coronary Heart Disease in Postmenopausal Women

The X-MatchPRO 100 Mbytes/second FPGA-based lossless data compressor

Background: ‘Failure to rescue’ - death after a treatable complication - is used as a nursing sensitive quality indicator in the USA. It is associated with the size of the nursing workforce relative to patient load, for example patient to nurse ratio, although assessments of nurse sensitivity have not previously considered other staff groups. This study aims to assess the potential to derive failure to rescue and a proxy measure, based on long length of stay, from English hospital administrative data. By exploring change in coding practice over time and measuring associations between failure to rescue and factors including staffing, we assess whether these are useful nurse sensitive indicators. Design: Cross sectional observational study of routinely collected administrative data. Participants: Discharge data from 66,100,672 surgical admissions to 146 general acute hospital trusts in England (1997 to 2009). Results: Median percentage of surgical admissions with at least one secondary diagnosis recorded increased from 26% in 1997/8 to 40% in 2008/9. Regression analyses showed that mortality based failure to rescue was significantly associated (p Conclusion: Failure to rescue can be derived from English administrative data and may be a valid quality indicator. This is the first study to assess the association between failure to rescue and medical staffing. The suggestion that it is particularly sensitive to nursing is not clearly supported, nor is the suggestion that the number of patients with an extended hospital stay is a good proxy.

An assessment of “failure to rescue” derived from routine NHS data as a nursing sensitive patient safety indicator for surgical inpatient care

What abstractions should a reusable code generator, such as C–, provide to make it easy for a language implementor to compile a highly concurrent language? The implementation of concurrency is typically tightly interwoven with the code generator and run-time system of the high-level language. Our contribution is to tease out the tricky low-level concurrency mechanisms and to package them in an elegant way, so they can be reused by many front ends. (This paper was rejected by PLDI’01 and is still awaiting a New Life.)

/pdf/featherweight-concurrency-in-a-portable-assembly-language-j5l3ozo5mt.pdf

Featherweight concurrency in a portable assembly language

Purpose




The purpose of this paper is to propose an inter-disciplinary approach to the ethics of social networking services (SNS) that connects critical analysis with the doing of ethics in terms of both pedagogic and technological practice.




Design/methodology/approach




Primarily conceptual and discursive, drawing on theoretical concepts from a broad, inter-disciplinary field. These concepts are integrated into a multi-dimensional framework that proceeds through four sequential stages: socio-economic, ethical, legal and practical/professional. Particular instances of SNS are used as illustrative examples.




Findings




The evaluation of ethical issues can be enriched by broader, holistic approaches that take account of the socio-economic, technical and legal contexts in which SNS technologies are designed, deployed and used. Inter-disciplinary approaches have the potential to generate new connections and possibilities for both the teaching and the professional practice of ethics.




Practical implications




Applied ethics are used to consider practical solutions that explore regulatory measures and envision alternative models of social networking. The approach proposed has practical value for teachers and students of computer ethics, as well as for IT practitioners.




Originality/value




This paper synthesises elements from media, communication and cultural studies, science and technology, information systems and computer science. The paper offers a strategy of inquiry to understand various aspects of SNS ethics – legal, socio-economic and technical. It presents a methodology for thinking about and doing ethics which can be used by IT practitioners.

/pdf/doing-social-network-ethics-a-critical-interdisciplinary-1znqj4ouai.pdf

Doing social network ethics: a critical, interdisciplinary approach

Neural networks are valuable tools for the support of a wide range of image processing applications. For video-rate operation, special-purpose parallel hardware is often necessary. One of the most common architectures used for this purpose is the linear systolic array. The design and implementation of multi-layer neural networks in linear systolic arrays can be complex, however. This paper demonstrates that the smallest network is not necessarily the best in terms of learning or recall times. Furthermore, this paper shows that the manner in which networks are mapped into a particular hardware structure affects both the performance of the application and the efficiency with which the hardware resources are used. We analyze and identify how to best structure neural networks to optimize network performance for throughput, latency and the efficiency with which the hardware is used. We use the HANNIBAL neural network processor as a research vehicle for these investigations and demonstrate the value of the proposed techniques by a number of example applications. >

Simon Jones

Papers

The X-MatchPRO 100 Mbytes/second FPGA-based lossless data compressor

An assessment of “failure to rescue” derived from routine NHS data as a nursing sensitive patient safety indicator for surgical inpatient care

Featherweight concurrency in a portable assembly language

Doing social network ethics: a critical, interdisciplinary approach

Backpropagation in linear arrays-a performance analysis and optimization