5 research outputs found
Optimasi Rute Pengiriman Gas Medis dan Industri Menggunakan Algoritma Nearest Neighbor di PT RSG
Get PDFPT RSG (Rezeki Surya Gasindo) merupakan perusahaan swasta yang menjual produk gas medis dan gas industri serta menyediakan layanan pengiriman kepada pelanggan. Namun, layanan pengiriman tersebut belum sepenuhnya optimal sehingga sering terjadi keterlambatan pengantaran gas yang berdampak pada menurunnya tingkat kepuasan pelanggan. Oleh karena itu, diperlukan solusi untuk mengoptimalkan rute pengiriman agar dapat meminimalkan jarak tempuh dan meningkatkan efisiensi layanan. Salah satu metode yang dapat digunakan adalah Algoritma Nearest Neighbor, yaitu metode heuristik yang sederhana dan cepat dalam menyelesaikan permasalahan Traveling Salesman Problem (TSP), dengan memilih jarak terdekat dari posisi awal tanpa mempertimbangkan jarak lainnya. Penelitian menunjukkan terdapat dua kondisi awal yang memiliki jarak terdekat yang sama dari Perusahaan yaitu kondisi Perusahaan ke Bagan Pete dan kondisi Perusahaan ke Mayang. Hasil penelitian menunjukkan bahwa kondisi Perusahaan ke Bagan Pete menghasilkan rute optimal karena berhasil mengunjungi seluruh pelanggan dan kembali ke Perusahaan dengan total jarak km. sementara itu, kondisi Perusahaan ke Mayang tidak mampu mengunjungi seluruh pelanggan. Dengan demikian, algoritma nearest neighbor terbukti efektif digunakan untuk menyusun rute pengiriman yang optimal dan praktis di PT. Rezeki Surya Gasindo
Interpreting the clinical utility of a pharmacogenomic marker based on observational association studies
No full textThe author accepted manuscript (post print) is made available in accordance with with publisher copyright policy.It is increasingly recognized that the clinical utility of a pharmacogenomic marker is a fundamental characteristic influencing the likelihood of successful clinical translation. Although appropriately designed and executed randomized controlled trials generally provide the most valid evidence for the clinical utility of a pharmacogenomic marker, such evidence may not always be available. Observational pharmacogenomic association studies are a common form of evidence available, but the assessment of clinical utility based on such evidence is often not straightforward. This paper aims to provide insight into this issue using a range of illustrative examples
Indirect Estimation of the Comparative Treatment Effect in Pharmacogenomic Subgroups
Get PDF2013 Sorich et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Evidence of clinical utility is a key issue in translating pharmacogenomics into clinical practice. Appropriately designed
randomized controlled trials generally provide the most robust evidence of the clinical utility, but often only data from a
pharmacogenomic association study are available. This paper details a method for reframing the results of
pharmacogenomic association studies in terms of the comparative treatment effect for a pharmacogenomic subgroup
to provide greater insight into the likely clinical utility of a pharmacogenomic marker, its’ likely cost effectiveness, and the
value of undertaking the further (often expensive) research required for translation into clinical practice. The method is
based on the law of total probability, which relates marginal and conditional probability. It takes as inputs: the prevalence of
the pharmacogenomic marker in the patient group of interest, prognostic effect of the pharmacogenomic marker based on
observational association studies, and the unstratified comparative treatment effect based on one or more conventional
randomized controlled trials. The critical assumption is that of exchangeability across the included studies. The method is
demonstrated using a case study of cytochrome P450 (CYP) 2C19 genotype and the anti-platelet agent clopidogrel. Indirect
subgroup analysis provided insight into relationship between the clinical utility of genotyping CYP2C19 and the risk ratio of
cardiovascular outcomes between CYP2C19 genotypes for individuals using clopidogrel. In this case study the indirect and
direct estimates of the treatment effect for the cytochrome P450 2C19 subgroups were similar. In general, however, indirect
estimates are likely to have substantially greater risk of bias than an equivalent direct estimate
The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis.
No full textBackground
Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI.
Purpose
We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI.
Data source
We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI.
Study selection
Two authors independently reviewed the studies for eligibility.
Data extraction
Data about studies characteristics, adjusted effect estimates and quality were extracted.
Data synthesis
Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22–1.7), I2 = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15–1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097).
Conclusion
In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics
Teenage Pregnancy and Fertility in English Communities: Neighbourhood, Family and Peer Influences on Behaviour
No full textPhDThe British government established the Teenage Pregnancy Unit in 1999 to
reduce early pregnancy. Current policy initiatives have a significant geographic
dimension: specific English neighbourhoods have been identified as the sites
where most early pregnancy occurs and have been targeted for intervention.
The aim of this thesis is to explore the factors that influence teenage sexual and
reproductive behaviour by drawing on the neighbourhoods effects literature.
Within this body of research, teenage reproduction is believed to be affected by a
multiplicity of factors operating within different domains. The analysis (of survey
data and qualitative material collected in three locations) was guided by two
research questions: which factors within neighbourhoods, family and peer
contexts are the most important in elucidating the causal pathways to teenage
sex, pregnancy and fertility; and do the importance of these factors vary between
neighbourhoods?
Overall, factors within neighbourhood and peer contexts were found to be less
significant than family and individual-level factors. The analysis of British Cohort
Study data showed that, for example, women who experience teenage
pregnancy or birth lived in deprived areas at age 16, but other neighbourhood
variables were not significant in multivariate analysis. There were some
differences between neighbourhoods, but the cohort member's attitude to school
was, generally, the most important factor associated with teenage sexual and
reproductive behaviour. The qualitative data supported these statistical results.
There was little evidence that women had been influenced by either their friends
or others within their neighbourhoods (though some women reported knowing
high numbers of teenage mothers), and nearly all the young mothers had low
educational attainment. In conclusion, individual and family-level influences on
sexual and reproductive outcomes are paramount, but behaviour is also subtly
informed by wider social factors
