(11) Step 5 Calculate distance between dangerous goods transport

(11) Step 5. Calculate distance between dangerous goods transport enterprise and its ideal points. Suppose the distance between each enterprise under assessment and its positive ideal point and negative ideal point is d j + and GDC-0068 FGFR Inhibitors d j −, respectively, described as follows: dj+=∑i=1mbij∗−pi+2, j=1,2,…,n,dj−=∑i=1mbij∗−pi−2, j=1,2,…,n.

(12) Step 6. Calculate closeness between dangerous goods transport enterprise and its ideal points. The closeness between dangerous goods transport enterprise and ideal points is described as follows: Tj=dj−dj−+dj+, j=1,2,…,n. (13) Step 7. Rank the closeness order of all enterprises according to the value of T j. The bigger the value of T j, the safer

the enterprise j and less safe in opposite [11]. 3. The Safety Assessment Optimization Model of Dangerous Goods Transport Enterprise Based on the Relative Entropy Aggregation in Group Decision Making Through the above-mentioned model of safety assessment of multiobjective dangerous goods transport enterprise based on entropy [12, 13], each expert had calculated the value of T j for all enterprises in A. Suppose D = d k, k = 1,2,…, q is a group decision set, wherein d k stands for expert k. Let L = l k, k = 1,2,…, q be the weight vector of D; then use it to reflect the authority that experts have in group decision set, wherein l k ∈ [0,1], and ∑k=1 q l k = 1; the bigger the value of l k, the more authoritative the expert k. The method to calculate weight given by experts [14] is shown as follows. (1) Generate a set of preferences vector for enterprises T = T j, j = 1,2,…, n, where T j

= T kj, k = 1,2,…, q, T j stands for preference vector of the q experts preferring enterprise j, while T kj stands for preference of the expert k preferring enterprise j, and T kj can be calculated as we described above. (2) Make a cluster analysis [15] on data T 1j, T 2j,…, T qj in T j(j = 1,2,…, n). Taking T j, for example, suppose data T 1j, T 2j,…, T qj are finally clustered into x j sorts Cilengitide (x j ≤ q); y j is the total number in the same sort. Namely, the number of sort 1 is y 1j and y i j for sort i. Let λ ij be the weight coefficient of expert in sort i; then there will be an existing constant d j which can make formula (14) valid: yij=dj·λij. (14) According to the definition of weight coefficient ∑i=1xjλij·yij=1. (15) From formulas (14) and (15) we can know λij=yij∑i=1xyij2. (16) (3) Calculate weight coefficient λ kj(k = 1,2,…, q, j = 1,2,…, n) of expert k on safety assessment of dangerous goods transport enterprises j using the above-mentioned method. Let λ k = ∑j=1 n λ kj(k = 1,2,…, q) be the sum of expert k’s authority on safety assessment of total n dangerous goods transport enterprises.


Provenance DNA-PK inhibitor in vivo and peer review: Not commissioned; externally peer reviewed. Data sharing statement: Extra data can be accessed via the Dryad data repository at http://datadryad.org/ with the doi:10.5061/dryad.pd670.

is associated with poor health, poor access to healthcare and poor health outcomes in many countries and across different healthcare systems.1–3 Much of this variation is caused by recognised broad social determinants of health.4 Considerable political effort has been directed at attempts to narrow health inequalities by reducing poverty and social exclusion. However, as healthcare has become more effective at improving health, its potential contribution to ameliorating health inequalities has increased. McKeown demonstrated in the 1970s that health services had contributed little to health improvement,5 but the same claim could not be made today. The past 30 years have seen the introduction of a wide range of effective interventions, particularly for the prevention and management of chronic disease.6 Yet although these new interventions improve health, they are not necessarily applied equally across the population.

Health inequalities will widen if effective services are offered, or taken up, with greater frequency by wealthier than less wealthy people. The reverse is also true, however, and there is an opportunity for healthcare to reduce social inequalities if it reaches those most in need.7 Little is known about pathways into poor health. The National Health Service provides medical

care free at point-of-need to all UK residents, but there is scope for inequalities to occur in the pathway from identification of early symptoms through diagnosis and on to effective treatment. Individuals in more deprived social groups may be more reluctant to present to doctors with their symptoms and so may not receive a diagnosis.8 9 Diagnosis is a key step that has meaning for both patient and physician in all health systems, and ‘diagnostic confusion’ may act as a barrier to healthcare for vulnerable populations.8 10 11 Previous studies have found socioeconomic variation in either diagnosis Batimastat or treatment rates, but have not been able to compare inequalities in illness burden, rates of diagnosis and treatment modalities in the same population.12–14 The English Longitudinal Study of Ageing (ELSA) provides new data that can be used to identify barriers to equitable receipt of healthcare, and constitutes a unique source of information on illness burden, self-reported medical diagnosis and treatment. Other data sources cover symptoms or diagnosis or treatment, but no other single source covers all three. ELSA collects data on symptoms and validated markers of common health conditions, as well as diagnosis and treatment.

18 19 A medical diagnosis was considered to exist if a participan

18 19 A medical diagnosis was considered to exist if a participant answered ‘yes’ when asked selleckchem whether a doctor had ever told them they had the condition of interest. For arthritis, a follow-up question asked whether they had been told they had osteoarthritis, rheumatoid or other arthritis. Treatment for depression and diabetes was defined by reported achievement of quality of care indicators, derived through a robust process of literature reviews, expert panel assessment and piloting.20 21 For depression, the quality indicator was about receipt of treatment since the previous wave:

“if a person is diagnosed with clinical depression, then antidepressive treatment, talking treatment or electroconvulsive treatment should be offered within 2 weeks after diagnosis unless within that period the patient has improved, or unless the patient has substance abuse or dependence, in which case treatment may wait until 8 weeks after

the patient is in a drug-or alcohol-free state.” For diabetes, treatment was measurement of HbA1c or fructosamine levels in the preceding 12 months. Treatment for angina was defined as ever being offered or currently taking β-blockers (ELSA variables hebeta or hebetb). Treatment for osteoarthritis and cataract was defined as reporting ever having had surgery for the condition. For osteoarthritis, this excluded those with hips or knees replaced due to fracture. Data on hip and knee replacements were only available for respondents aged 60 and over, and so respondents aged less than 60 years (n=3186) were excluded from the analysis of osteoarthritis. Wealth was defined as

the sum of financial, physical and housing wealth plus state and private pension income. Age was categorised into three groups: 50–59, 60–74 and 75 years and older. Analysis We used two approaches to analysis, a main analysis using serial cross-sectional data and then a subsidiary analysis using longitudinal data. Multivariable logistic regression analysis was used, with the outcome variables defined as one of illness burden, self-reported medical diagnosis or treatment for each of the five conditions in each cross-sectional wave (STATA statistical software V.12.1). This regression analysis was repeated for each of the four waves AV-951 of ELSA from 2004 to 2011 separately and then ‘overall’ for all four waves combined. For the ‘overall’ analysis, the data were reshaped into ‘long’ format in Stata statistical software, with each participant having a separate record for each wave. Intraperson correlation of outcomes was accounted for using robust adjustment with Stata, with each participant’s unique identifier included in the regression equation as a cluster variable. Missing data were excluded from the analyses. The independent variables were age group, sex and slope order of inequality.

Conclusion In conclusion, our study showed that spine specialty h

Conclusion In conclusion, our study showed that spine specialty hospitals have higher per day inpatient charges and much shorter LOS than other types of hospitals due to their specialty volume and experience. Specialty hospitals endeavour to be more efficient after

governmental ‘specialty’ designation. In addition, phosphatase inhibitor the patient readmission rate was lower for specialty hospitals than general hospitals. To promote a successful specialty hospital system, a broader discussion that includes patient satisfaction and the real cost of care should be initiated. Supplementary Material Author’s manuscript: Click here to view.(1.2M, pdf) Reviewer comments: Click here to view.(311K, pdf) Footnotes Contributors: SJK designed the study, researched data, performed statistical analyses and wrote the manuscript. JWY, SGL, THK, K-TH and E-CP contributed to the discussion, and reviewed and edited the manuscript. E-CP

is the guarantor. Competing interests: None. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available.
In 2003, the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) proposed a new blood pressure (BP) category, including 120–139 mm Hg systolic BP (SBP) or 80–89 mm Hg diastolic BP (DBP), designated as ‘prehypertension’.1 The prevalence of prehypertension is up to 30–50% worldwide, as well as in many districts of China.2–4 It is known that in China the prevalence of hypertension is significantly higher in the northern area than in the southern area because of the colder climate and high sodium intake.5 Such regional factors may also affect the prevalence of prehypertension. However, the prevalence of prehypertension in Guangdong Province, southern China has been rarely reported. Prehypertensive individuals are prone to progress into frank hypertension, and most of them present with clustering of other cardiovascular

risk factors.6–8 However, the use of the term ‘prehypertension’ is still controversial. Most of the arguments against using this term consist of the possible public anxiety and Anacetrapib overtreatment it may cause. Further, there is a high heterogeneity within this category because the risk of progressing to hypertension and developing cardiovascular disease (CVD) is higher among people with BP 130–139/85–89 mm Hg than among those with BP 120–129/80–84 mm Hg.6 9 Furthermore, the question of whether the concurrent cardiovascular risk factors in subgroups of prehypertension are different remains unanswered. Given these inconsistent results, we conducted a retrospective analysis to explore the prevalence of prehypertension, and the cardiovascular risk factors in the subgroups of prehypertension in Guangdong Province, southern China.

A systemic review was also conducted to comprehensively evaluate

A systemic review was also conducted to comprehensively evaluate community-based teaching in UK medical curricula on the domains of programme needs, implementation, impact, and cost. Methods Online survey An online survey of the current neverless provision of community-based teaching in UK medical curricula was completed by NC through

accessing official online material of medical schools between 31 November 2013 and 8 December 2013. An up-to-date list of all the registered medical schools was obtained from the Medical Schools Council (MSC) website on 31 November 2013.29 All graduate-entry courses were excluded. This was due to the wide variations of graduate-entry course structure, as well as the lack of literature on postgraduate community-based medical education. This was a prerequisite in order for the results of both the online survey and systematic review to be evaluated in parallel. Online material of the undergraduate medical curriculum was sourced using the Google search engine, and included content from university websites or online course prospectuses for the 2014 intake. The information search was specific to descriptions of both mandatory and elective components of the curriculum relating to ‘primary care’, ‘general practice’, or ‘community

medicine’. Systematic review: data sources A systematic literature review was conducted using the electronic databases PubMed and Web of Science to source for papers published on undergraduate community-based medical education. With the understanding that community-based education has evolved over the years, only publications published within the past 15 years, from November 1998 to 2013, were included in this study. The search criteria was (‘community-based’, ‘community-oriented’, ‘community involvement’, or; ‘primary health care’) and (‘medical curriculum’, ‘medical students’, ‘undergraduate medical education’ or ‘undergraduate medical school’).

Systematic review: selection criteria and data extraction The relevance of the articles was screened by the title and abstract, based on the inclusion and exclusion criteria. Articles were selected if Batimastat they described undergraduate medical education within the UK. Papers that included healthcare professionals apart from medical students were excluded. Any articles that were duplicated, not available in full text, or not published in English were also regarded as unsuitable for the review. In total, 29 peer-reviewed articles were identified as relevant, and were selected for further qualitative content analysis by SL and NT (see figure 1). Data on the following were extracted from each article: (1) Format of CBE; (2) Type of evaluation used to assess the programme; (3) Findings of this evaluation; and (4) Method of data collection. Rossi, Lipsey and Freeman’s (2004) approach to programme evaluation was adopted to systematically categorise the evaluation findings on CBE (see table 1).

Cohort studies have demonstrated that high consumption of fast-fo

Cohort studies have demonstrated that high consumption of fast-food at first assessment is associated with higher BMIs later in childhood or adult life.12 24 If this is Tipifarnib the case, despite an apparently lower BMI with more frequent fast-food consumption in the adolescent group, the high proportion of adolescents eating fast-food frequently is a matter of concern, as fast-food

consumption has been directly linked with insulin resistance, hypertension and other health sequelae.31 Strengths and limitations The major strengths of this study were its size and multicentre structure, with 199 135 adolescents from 36 countries and 72 900 children from 17 countries surveyed. Many of the centres were from middle-income and low-income countries from which previous data on the association between fast-food consumption and BMI had not been reported. The main limitation to this study is the cross-sectional design which allows identification

of associations, but not of temporal sequence or causality. The assessment of participants’ heights and weights and their fast-food consumption was primarily undertaken by a questionnaire which raises the possibility of misclassification error, particularly with respect to the parent-reported weights of their children and self-reported weights of the adolescents, thereby influencing the calculated BMI. It is also possible that parents and adolescents may have misreported fast-food consumption. A further consideration is the interpretation of the question about the consumption of burgers/fast-foods. While a ‘burger’ is almost universally understood, a ‘fast-food’ can be interpreted in a number of ways, including foodstuffs from global restaurant

chains, smaller non-franchised food stores, street vendors and even frozen meals heated and served at home. Without knowing the exact kind of fast-food consumed, we can make no assessment of the nutritional content or energy density of the food in question. Additionally, while the questionnaire asked about the frequency of burgers/fast-food consumption, we have no indication of portion sizes, Batimastat or if it was accompanied by other items such as sugar-sweetened beverages. Finally, centres that objectively measured heights and weights received no standardised instructions for doing this. We have controlled for GNI, centre, measurement type and sex in our analysis; however, we have no data available on individual socioeconomic status or parental BMI which could potentially affect young peoples’ BMI, and nor did we control for physical activity/inactivity of the participants. Conclusions This cross-sectional study has found that one-quarter of children and half of the adolescents consume fast-food frequently or very frequently.

2 Barring a few smaller studies3 4 from the southern part of Indi

2 Barring a few smaller studies3 4 from the southern part of India, we do not have any studies that document the dietary contents of patients with T2DM from across India. There was a need to conduct a dietary survey considering

antagonist FTY720 the diverse dietary food habits in various parts of India. The objective of this study (STARCH: Study To Assess the dietaRy CarboHydrate content of Indian type-2 diabetes population) was to assess the total and complex carbohydrate (CHO) contents in the daily diet of T2DM participants. Our study not only provides preliminary information on the dietary carbohydrate, fat and protein contribution in food consumed by T2DM participants but also shows how it compares with non-T2DM participants from pan India. Research design and methods Study design and study participants Our study was an exploratory cross-sectional, single-visit, two-arm, multicentre, single-country survey. Study participants were enrolled (from March 2012 to September 2012) from 10 sites across all regions of India, viz; East, North, West, South and central, considering different dietary patterns. Participants were enrolled from endocrinology/diabetology clinics/hospitals with clinical research facilities during routine outpatient visits. Study participants were not provided with any incentives for participation

in the study. Participants aged ≥18 years of either sex, diagnosed with T2DM for at least 12 months, were eligible in the T2DM group, whereas participants not on any diet plan or dietary advice and who visited for acute illnesses/conditions that do not affect inclusion in the survey were included in the non-T2DM group. Moreover, non-T2DM participants were matched to T2DM participants with respect to age, sex and centre. Patients with specific comorbidities that may impact daily diet, with chronic diseases, or a weight management plan that includes

dietary modifications or dietary alterations were excluded from the study. All participants provided written informed consent. Dietary survey methodology A dietary survey form, a 3-day dietary recall, and a validated Food Frequency Drug_discovery Questionnaire (FFQ) were completed by a qualified dietitian or trained study coordinator. Dietary assessment included general dietary information (vegetarian or mixed), status of diet plan advised by the physician, and information about dietary patterns for both groups with the help of the dietary survey form, which included questions about the diet consumed during two typical working days and during one typical weekend day (usually Sunday). The final dietary assessment was done using the 3-day dietary recall data. Primary and secondary outcomes Primary outcome variables were the percentage of total energy intake as total CHO and complex CHO intake from total CHO in the T2DM group.

While attending the clinic, the participant will be asked to comp

While attending the clinic, the participant will be asked to complete the QbTest at some point during the diagnostic process. inhibitor purchase Participants will also be asked to complete baseline outcome measures (see measures section). Phase 2, Treatment: Patients who receive a clinic diagnosis of ADHD and are allocated by clinicians to receive ADHD

medication initiated within 3 months of their baseline assessment will be asked to complete a second QbTest (Qb2) 4–8 weeks after medication initiation. This timeframe was chosen to ensure that all participants can complete their second QbTest before the 6-month follow-up. All participants will stay in the trial for 6 months and will be asked to complete outcome measures at 3 and 6-month follow-up, regardless of their diagnosis or whether they receive medication. With the aim of promoting participant retention and completion

of follow-up measures, participants will be compensated for their time with a £15 high-street voucher if they remain in the trial until 6 months. Measures Blinded members of the research team (CLH, GMW, AZV,) will be fully trained in all trial assessments and responsible for monitoring the distribution, completion and collection of all outcome measures. Primary outcome The primary outcome is the number of consultations until a confirmed clinical diagnosis is reached, as recorded on a short pro-forma. The pro-forma will be completed by clinicians after each consultation with the young person and/or

family and documents information about appointment duration, diagnosis and medication/treatment. The pro-forma can be provided by contacting the corresponding author. Secondary outcomes The secondary outcomes obtained from the pro-forma are: Number of days and duration of visits (in minutes) until a confirmed diagnosis is reached. Clinical confidence in diagnostic decision. Clinicians will be required to rate the confidence of their decision on a 7-point Likert scale (Definitely ADHD-Definitely not ADHD). Stability in diagnosis. Clinicians will be required to re-rate their diagnostic decision and confidence at 6 months. Other measures Development and Well-being Assessment (DAWBA29): Entinostat The DAWBA is a semistructured, investigator-based diagnostic interview for child mental health problems, including ADHD, which includes the (Strengths and Difficulties Questionnaire; SDQ30) as an initial screen. The parent and teacher DAWBA will be completed to compare the accuracy of clinic diagnosis (in QbO and QbB arms of the trial) to that of an independent clinical consensus diagnosis made using the DAWBA. Two experienced clinicians, blind to allocation, will review the DAWBA and arrive at a clinical consensus diagnosis.

There were 13 studies from

There were 13 studies from click this the Middle East, 43 from a Western country, and 129 from Africa. Twenty different African countries were represented. The FGM/C participants in studies from a Western country originated in the majority of cases from Somalia, and in the remaining cases they originated from another African country where FGM/C is commonly practised. Overall, the 185 studies involved 3.17 million female participants, from infants to women in their 70s, with a mean age

of approximately 30. With respect to the FGM/C characteristics, the majority of women had genital alteration that involved the cutting and removal of portions of the external female genitalia, without stitching, corresponding to either type I or type II. The procedure had in the absolute majority of cases been undertaken in early childhood, usually before the age of 10, by a traditional circumciser. A total of 75 different outcomes were extracted. In this overview, we present key physical health complications of FGM/C in a

life course perspective. Except for some immediate outcomes, these key outcomes derive from comparative studies, that is, women with FGM/C are compared to women without FGM/C with respect to an outcome in a cohort, case–control or cross-sectional study (table 1). We prioritise the presentation of studies with clinically measured and adjusted outcome data, but note also the best available

evidence for additional key outcomes, largely immediate complications. Table 1 shows the 57 studies with the best available evidence regarding the physical health sequelae of FGM/C (comparative cohort, case–control, cross-sectional studies).19–72 About 40% of the outcomes were self-reported primarily by adult women, although the great majority of the obstetric and some genitourinary outcomes were clinically measured. The meta-analytical results that are based on unadjusted estimates are presented in figure 3, and those based on adjusted estimates are shown in figure 4. Table 1 Summary of included comparative studies (N=57) Figure 3 Meta-analyses of urinary tract infection, dyspareunia, Cilengitide sexually transmitted infections, episiotomy (unadjusted effect estimates). Figure 4 Meta-analyses of bacterial vaginosis, HIV, prolonged labour, obstetric tears, caesarean section, instrumental delivery, obstetric haemorrhage, difficult delivery (adjusted effect estimates). Immediate complications In most cases of FGM/C, a girl’s clitoris and labia are cut away, often with a crude unsterile instrument and without anaesthetics by a traditional practitioner who has little knowledge of female anatomy.2 Thus, it is reasonable to assume that physiological harms such as bleeding ensue during the cutting process and the short-term postprocedure period.

Seven patients underwent surgical interventions while on immunosu

Seven patients underwent surgical interventions while on immunosuppressive therapy. Five patients had minor debridement of their wounds, one patient had split skin grafts (SSG), and another

had both SSG and minor debridement. None of the patients had exacerbation after these procedures. Intravenous antibiotics were administered to 18 patients http://www.selleckchem.com/products/MLN8237.html based on clinical suspicion of infected PG wound. 3.5. Patient Outcomes 3.5.1. Length of Stay (LOS) Mean length of hospital stay (LOS) till discharge or death was 47 days (range 5 to 243 days). Three patients were hospitalised for more than three months. All three suffered from concomitant wound infections during their hospital stay. Two of them grew Staphylococcus aureus and one grew Extended-spectrum beta-lactamase (ESBL) Escherichia coli. All three patients had abnormally high CRP levels (range 53mg/L–178mg/L) and one patient

who also suffered from colorectal cancer died during the initial hospital admission. 3.5.2. Death Five patients (21.7%) died during their initial hospital stay (see Table 2). Their mean age at time of admission was 78.8 years (range 72 to 85 years). The mean LOS till death was 50.6 days (range 15 to 151 days). All had lower limb PG. The cause of death was sepsis in four patients while one patient died of multiorgan failure secondary to hypovolemia. Four patients had ulcerative and one had vegetative PG. All patients had positive wound cultures and all had highly elevated CRP levels above 50mg/L. Four patients had associated systemic disease. All underwent systemic therapy: three had combination therapy while two had monotherapy. Table 2 Characteristics of patients who died during initial admission. 3.5.3. Recurrence Seven patients had recurrence of PG requiring readmission (see Table 3). The mean number of readmissions for PG was three (range 1 to 7). Three patients died during their subsequent admissions. The mean age at diagnosis of the patients who died during subsequent admissions was 68 years. Of those who died, two patients had concomitant

gastrointestinal disorders. Table 3 Characteristics of patients who survived initial admission. 4. Discussion 4.1. Patient Demographics We retrospectively reviewed 23 patients diagnosed with PG and treated at our hospital over a 10-year period. The mean age of onset was 62.8 years which was similar to that reported in two recent studies [11, 12]. Three earlier studies reported an earlier mean age of onset with Anacetrapib peak incidence in the fifth to sixth decade [13–15]. It is widely known that PG has a predilection for females [3] and our study has shown a similar result. 4.2. Clinical Features Four variants have been described in the literature, namely, ulcerative [2], vegetative [16], bullous [6], and pustular [17]. Ulcerative PG, which is the classical variant, is the commonest form in our study as well as previous studies [11–15, 18].