With reference to the average radio coverage of BTS and the required spatial scale in traffic analysis, the size of cells was set as 500 meters by 500 meters. All the BTSs in the same cell were replaced by one equivalent BTS coordinated at the cell’s centroid. Figure 3 Illustration of raster data structure. The calculation Gemcitabine of the four critical parameters and the transformation of BTSs’ geographical coordinates were described in Algorithm 2. Algorithm 2 Transformation of geographic coordinates. The city territory of Shanghai was covered by the raster with 245 rows and 348 columns. In the output of the algorithm, the 23,918 actual BTSs throughout Shanghai were reduced to 10,303 equivalent
BTSs. 3.2. Identification of Activity Points The original mobile phone data describes the individual’s virtual activities and provides the basic information of time, location, and
frequency. The synthesis and summarization of this basic information enable the inference of physical activities and the accessibility to the individual behavior patterns. In this study, the activity point was defined as the location at which a certain mobile subscriber continuously stayed for no less than 30 minutes. Activity points act as critical anchor points in people’s daily trajectories, incorporating home and workplace as two particular kinds of activity points. A set of activity points arranged in chronological order formed the activity chain of a certain mobile subscriber. The identification of activity points can be carried out as Algorithm 3. Algorithm 3 Identification of activity points. 3.3. Measurement of Spatial Interaction The macroscopic zonal interaction can be obtained
through the aggregate analysis of activity chains. In the existing models, the spatial interaction is analyzed based on the concept of trips. However, as for mobile phone data, the extraction of single trips from the continuous daily trajectories is not easily accessible. Though the particular data processing may contribute to the relatively accurate trip identification, the extra operation is doomed to lower the efficiency GSK-3 of mass data mining. In this study, the novel approach for spatial interaction analysis was proposed based on frequent pattern mining. The correlations and associations between different areas were applied to measure the spatial interaction. Frequent pattern is item sets that appear in a dataset with frequency no less than a user-specified threshold. In this study, identities of areas acted as item sets; and each transaction was a sequence of area identities obtained from the activity chain of a certain mobile subscriber. Concretely speaking, let M = m1, m2,…, mN be an item set, where mi, i = 1,2,…, N, represent the identity of the ith area. With the specific mapping relation between areas and geographical coordinates, the activity chain A could be converted to a sequence of area identities AI.
In the following sections, the three stages in the framework were discussed in detail
and their specific procedures were described by pseudocode, respectively. Finally, the overall structure of the three-stage framework was given in the last section. 3.1. Reorganization of Original Mobile Phone Data Since the EGFR inhibitor drugs mobile phone data was collected for communication industry, it was not primarily designed for modeling purposes and not in an easy-to-use format. Particularly, the peculiarity of mobile phone data collection makes it unfit for the spatial and statistical analysis as well as the visualization of data mining results. To make up the deficiencies, binning method and raster data structure were introduced in this study. 3.1.1. Binning Method Overlaps exist in the coverage areas of two adjacent BTSs. In particular, coverage radius of BTS in the central city of Shanghai is only 500~800 meters on average. Frequent handover may occur as the MS enters the overlaps of the serving cell and the adjacent cells.
The frequently gratuitous handovers lead to the data noise and the waste of system resources. Binning method was used in this study to smooth the location information and reduce the volume of data. The chronologically sorted logs were distributed into bins of equal width in the temporal dimension. All the logs in the same bin were replaced by one equivalent log. The timestamp of the equivalent log was the bin median; and the location information was replaced by the weighted average of the original coordinates in the same bin. Let the width of each bin be 10 minutes; the specific procedure was described in Algorithm 1. Algorithm 1 Binning method of original mobile phone data. Since the frequent handover was represented in the original data as a cluster of logs in an incredibly short period of time, the negative
effect of frequent handover was eliminated by assigning small weights to logs with small intervals. What is more, with one equivalent log acting as alternative for all the actual logs in a certain bin, the volume of data was Cilengitide reduced sharply. The selections of bin width value as well as the accuracy of mining results obtained with the binned data are to be discussed in the forthcoming articles. 3.1.2. Raster Data Structure By 2011, 23,918 BTSs distributed unevenly and irregularly throughout Shanghai. The data structure was unfit for the spatial and statistical analysis, the mining results visualization, and the further data fusion with other data sources. The raster data structure was applied for the transformation of BTS’s geographical coordinates. In this study, a raster was constructed to cover the city territory of Shanghai. For the facility of calculation, cells of the raster were delimited with meridians and parallels in fixed intervals.
2±3.6 vs 13.3±3.1, p=0.001) or ≥25 (6.7±4.5 vs 8.3±4.7, p=0.023). Table 2 GCS and injury-related Estrogen Receptor Pathway characteristics of the patients who had and had not undergone an alcohol test as well as of the patients with positive and negative BAC On stratification of patients according to ISS (<16, 16–24 and ≥25), an ISS of <16 was more common among patients with positive BAC (68.0 vs 60.6, p=0.001) and an ISS of 16–24 (26.2 vs 22.0, p=0.033) or ≥25 (13.2 vs 10.0, p=0.024) was more common among patients with negative BAC (table 3). Alcohol use was associated with a shorter LOS (8.6 vs 11.4 days, p=0.000) among patients with an ISS of <16. LOS
did not differ significantly between patients with positive and negative BAC in the subgroup of more severely injured patients (ISS of 16–24 or ≥25). In addition, fewer patients with positive BAC were admitted to the ICU among patients with an ISS of <16 (9.6% vs 11.9%, p=0.009) or ≥25 (9.1% vs 10.7%, p=0.033). Alcohol use was not associated with LICUS, regardless of injury severity. Patients with positive and negative BAC
did not have significantly different mortality rates, again, regardless of injury severity. Table 3 LOS and mortality rates in patients stratified by the ISS Brain CT was performed in 496 of 793 (62.5%) patients with positive BAC and in 891 of 1399 (63.7%) patients with negative BAC (table 4). The rate of brain CT performance was not significantly different between the two groups, irrespective of injury severity. Brain CT showed positive findings in 164 of the 496 (33.1%) patients with positive BAC and in 389 of the 891 (43.7%) patients with negative BAC. The percentage of positive findings was lower for patients with positive BAC (p=0.000). This difference was attributed to the lower percentage of positive
findings among patients with positive BAC who had an ISS of <16 (18.0% vs 28.8%, p=0.001). Consequently, the percentage of positive brain CT findings did not differ significantly between the two groups among more severely injured patients (ISS of 16–24 or ≥25). Further, the proportion of patients with positive brain CT findings for the final diagnosis (subarachnoid Cilengitide haemorrhage, subdural haemorrhage, epidural haemorrhage and intracranial haemorrhage) did not differ between patients with positive and negative BAC. Binary logistic regression analysis was performed to evaluate the relationship between BAC and the performance of brain CT among patients with positive BAC. According to receiver operating characteristic curve analysis (figure 1), a BAC of 156 mg/dL was identified as the cut-off for the decision to perform brain CT, with an area under the curve of 0.562±0.021 (95% CI 0.521 to 0.603; p=0.003). However, the discriminating power was only slightly better than would be expected if left to chance.
In this study, the rate of brain CT performance did not differ significantly between patients with positive or negative BAC and was not related to the final diagnosis (subarachnoid haemorrhage, subdural haemorrhage, epidural haemorrhage and intracranial haemorrhage), irrespective of injury severity. CH5424802 ic50 However, the percentage of patients with positive
findings was lower among patients with positive BAC, particularly among those with an ISS of <16. Similar results have been reported, noting a relative risk of performing brain CT of 1.18 when trauma patients with an ISS of <16 are intoxicated.23 The results of this study also imply that alcohol intoxication in trauma patients may be associated with an unacceptable burden on hospital resources as well as an increased cost of healthcare. This study has some limitations. First, the combination of psychoactive drugs and alcohol may further increase the risk of having an accident,24 25 and potential drug users may have refused to undertake drug tests, which may have led to a selection bias. However, in our study, this analytical bias is thought to be random. Second, although BAC measurement is the most commonly used method to determine whether trauma patients have consumed alcohol and all drivers involved in traffic accidents were compelled by law to undergo a test
to estimate BAC, a few patients may have refused to undergo an actual BAC test after a breathalyser confirmed the presence of alcohol. Accordingly, such patients may be entered and analysed with the wrong group because the breathalyser results would not have been noted in the medical records; however, in our experience, such patients are rare. In addition, the lack of exact time from the injury to an alcohol test
may result in a bias of the acquired data; however, according to Taiwan government data from January 2009 to June 2009, the average transport time was about 12 min26 and from our yet published study, which demonstrated that the mean transport time of the patients transported by emergency medical service (EMS) to our hospital was 18.3±7.9 min, the bias may be minimal. Brefeldin_A Finally, the lack of clear and strict indication for performing a brain CT examination in these intoxicated patients by the on-duty physicians in the emergency department may result in some bias in this study. Conclusion This study revealed that patients who consumed alcohol tended to have a lower GCS score and less severe injuries. Among those with an ISS of <16, alcohol intoxication was associated with a shorter LOS. Given the significantly low percentage of positive findings for alcohol consumption, brain CT may be overused in less severely injured patients. Supplementary Material Author’s manuscript: Click here to view.(1.2M, pdf) Reviewer comments: Click here to view.
This means that the distribution of patients selleck catalog over the various contexts is at least partly selective in character. This is reflected in the actual risk profiles of the distinct context related patient groups (figure 2). It is plausible that a high percentage of patients at higher actual risk
(in the absence of professional intervention) correlates with a high relative incidence of adverse outcomes. This implies that the same actual risks that influence the choice of the professional organisational context also influence the incidence of adverse outcomes in the related patient group. Hence, a professional organisational context-category cannot be considered as an independent determinant. It is important to note that the risk profile of a context related patient group can also be affected
by the exclusion of patients (records) because of the design of a study. Figure 2 Factors influencing the relative incidence of adverse outcomes in context related patient groups. Distribution of deliveries over the 24 h day The distribution of patients (records) over the distinct context-categories is not only determined by professional choices. This is especially true for patients with a spontaneous onset of labour (ie, without professional intervention). We base this claim on a twofold assumption: (1) Under natural conditions the deliveries are randomly spread and, therefore, in a population of sufficient size, (approximately) equally distributed over the 24 h day; (2) Under these conditions, the actual and potential risks in this population are also (approximately) equally distributed over the 24 h day. The reverse side of this basic assumption is that, in case of an unequal distribution of deliveries, we cannot assume that the
risks are equally distributed over those 24 h.12 In this way we therefore ignore the smaller peaks and troughs in the distribution of births over the day that have been described.13 14 A responsible comparison of context-categories If the objective is to gain insight into the performance of a professional organisational context-category, Entinostat the conventional method is to compare the (adverse) outcomes of births in the related patient group (transversal) with those in a reference category.5–10 To complicate matters, the relative incidence of adverse outcomes in a context related patient group is not only affected by contextual factors, but also by patient-related factors (figure 2). A difference in the incidence of adverse outcomes between two context related patient groups can therefore only be attributed (exclusively) to a difference in performance of the relevant professional organisational contexts if it can be established that this difference in incidence is not caused by a difference in actual risk profiles.
In recent decades, healthcare has become more and more expensive, triggering calls for cost-effective care in an increasingly cost-conscious www.selleckchem.com/products/MLN8237.html and quality-conscious environment. Intensive care unit (ICU) beds are scarce hospital resources reserved for a select subset of hospital patients. Underlying the scarcity of ICU beds is the high start-up and operating cost of the unit as well as the highly specialised training required of the staff. While the total cost of ICU admission varies widely, the daily cost of ICU care per patient is approximately three to four times more
than that in the general ward.1–4 Despite ICU beds comprising only between 1.2–6.3% of all hospital beds, ICU services are estimated to take up 15–20% of the total hospital budget.5 Given the scarcity of ICU beds, priority is given to patients with serious but potentially reversible conditions who may benefit from more intensive observation and treatment than is provided in the general ward.4 6 To a certain extent, guidelines can reduce the arbitrariness of triaging patients to the ICU. However, the ultimate decision to admit a patient
to the ICU depends largely on the individual physician’s preference, professional judgement and experience. A benchmarking study found a wide variation across ICUs in the proportion of critical care patients admitted for active critical care treatment versus monitoring alone.7 Depending on the institution, between 20% and 98% of patients admitted to the ICU required active treatment.7 The benefits gained from the ICU as a scarce resource can be maximised not just through the right siting of care, but also by ensuring that critically ill patients are admitted without delay. Numerous factors have been cited for delays in admitting
critically ill patients from the emergency department (ED) to the ICU. Commonly implicated factors include the lack of available ICU beds,8–12 the underlying disease itself,8 13 organisational issues9 and frontline health professionals’ inability to recognise the seriousness of the condition.14 15 Regardless of the cause, delayed ICU admissions may ultimately have the same detrimental effect on the patient. Carfilzomib This study aimed to determine if severely ill patients indirectly admitted from the ED to the general wards and subsequently to the medical ICU (MICU) or high dependency unit (HDU) have a greater risk of adverse outcomes than those who were admitted directly from the ED to the MICU or HDU. The main outcomes of interest included in-hospital and 60-day mortality, ICU as well as total hospital length of stay. Methods Plan of investigation This was a retrospective cohort study conducted in a tertiary level acute care public hospital in Singapore. In this hospital, after assessing the patient’s need for ICU care, the ED physician refers the patient to the intensivist on-call.
These changes might be caused by local factors such as an increased intramural hematoma or extended intimal flap. Hemodynamic stress may also play an important role in repeated dissection, resulting in chronically enlarging dissecting aneurysms with multilayered intramural hematomas in some cases and extensive damage all targets to the internal elastic lamina .
A systemic factor, such as increased blood pressure might aggravate the natural course of the VBD. Both MRA and CT angiography offer potential advantages for noninvasive assessment of vascular disease, and they have been previously shown useful in the detection of VBD. Sequential neuroimaging examinations can indicate recanalization or normalization of the blood flow and thus are helpful for the decision to discontinue antithrombotic therapy, but the appropriate timing for follow-up examinations has not yet been defined . In this case report, we showed that MRI and MRA are useful in evaluating an asymptomatic rapid progression of intracranial VBD. Our case suggests that intracranial VBD can progress
rapidly in a short time period, and those changes can be detected with MRI and MRA successfully.
Axial spondyloarthritis (AxSpA) is characterised by chronic inflammation of the spine and affects millions of people.1 Spondyloarthritis (SpA) has been classified into axial (AxSpA) and peripheral SpA depending on the major clinical presentation.2 3 Ankylosing spondylitis (AS) is the prototype AxSpA with characteristic radiographic changes in the sacroiliac joints. The disease starts predominantly
in young adults and in addition to chronic pain and disability, it causes significant morbidity and risk of mortality.4 AS poses a huge financial burden to the healthcare and public welfare systems by costing billions of dollars on treatment, disability and loss of productivity.5 6 The prevalence of AxSpA has been reported to be as high as that of rheumatoid arthritis, with estimates ranging from 1.0% Carfilzomib to 1.4%.7 Yet, until recently, AxSpA has received relatively less attention and is often overlooked in the initial stages due to the non-specific nature of the back pain.8 Large-scale studies of the incidence and prevalence of AS are scant. Studies examining epidemiological trends in AS have yielded variable results, some of which may be explained by differences in study design, geographic location, age, ethnicity, background prevalence of HLA-B27, genetic susceptibility and disease ascertainment.9–13 Some authors have reported AS incidence rates, but these studies were mainly in Europe.13–19 Documenting disease trends may improve our understanding of the pathogenesis of disease and aid in the planning of health services.
Table 3 Frequency of presenting symptoms not accounted for FAST With increasing stroke severity signs included in the FAST scheme were more prevalent (table 4). FAST signs were less frequent in TIA than in strokes (62.3% vs 81.5%). Severe strokes were nearly completely covered by FAST signs when a selleck NIH score of at least 6 was present. FAST signs occurred in 96.7% of patients who received thrombolysis. Table 4 Sings included in the FAST scheme depending on stroke severity, TIA or stroke and eligibility for thrombolysis Association between presenting symptoms and MRI lesions A
total of 1419 patients had no infarct in MRI, more than half of those patients (56.5%) had a TIA. From those 1419 patients only 65.1% were detected by the FAST items. For 252 patients no information about lesions in MRI was available. For patients with definite infarct lesions in MRI (n=2865) we tested
the differences in occurrence of symptoms included in the FAST scheme regarding vascular territories: FAST symptoms were less frequent in patients with strokes in the posterior circulation, where only 65.2% of all cases with an apparent MRI lesion could be identified, whereas 92.4% of anterior circulation strokes matched symptoms included in the FAST criteria. There was no difference between left and right hemispheric stroke (82.9% vs 82.1%). Hierarchy of presenting symptoms The item ‘arm/paresis’ was by far the most frequent sign in all patients with stroke (aged 18–55 years), and ‘speech’ the second (figure 2). Both items together were covering almost 75% of all recruited stroke and patients with TIA. Under hierarchic perspective the frequency of the ‘face’ item (0.2%) becomes irrelevant if the four most common signs of stroke ‘arm/paresis’ (57.7%), ‘speech’ (16.9%), ‘vertigo’
(10.6%) and ‘somatosensory deficit’ (6.8%) were prior sequentially used as selection criteria.13 14 Hemianopia occurred in general with a frequency of 14.4% but only 3.2% of the cases experienced this symptom Carfilzomib independent from arm/paresis, speech, vertigo or somatosensory deficits. Common stroke signs in young patients such as headache, leg paresis and diplopia were seldom or not independently differentiated from other stroke signs. Figure 2 Initial presenting symptoms (shown as a percentage of all cases). Discussion Principal findings Frequency of presenting symptoms In our cohort the FAST symptoms could be traced in 76.5% of all cases. This is notably less than in a previously reported study in which study nurses screened retrospectively the medical records of 3498 stroke cases who presented in an acute care hospital.4 The ‘capture rate’ in this study was 88.
CEACs enable a probabilistic visual interpretation of the health economic analysis that can be used by decision-makers to assist in their choice of health service delivery. Implementation To assess feasibility and acceptability we shall look at scores on the sellectchem QbTest feedback questionnaires. High scores will be taken to indicate high acceptability and feasibility. Mean scores for individual items on each questionnaire will be assessed to determine which aspects of QbTest are perceived negatively or positively by clinicians and service users. Data from clinicians and patients
who participate in interviews will be thematically analysed according to the principles of Braun and Clarke44 to assess themes on the acceptability of QbTest, including patients’ opinion on reduced length or number of clinic visits. Data monitoring No interim analysis or analyses for safety or efficacy are planned. Access to data will be restricted to trial team members and associated regulatory authorities as indicated in the sponsor agreement between sites and individual participant information sheets.
The chief investigator (CH) shall oversee study management, with oversight from the rest of the research team. A sample (10% of the data) will be checked on a regular basis for verification of all entries made. Where corrections are required these will carry a full audit trail and justification, independent from the research team. There are no anticipated adverse
effects of the QbTest, all adverse events will be recorded and monitored and the CH will determine seriousness and causality and report the event to the ethics committee. The trial is overseen by an independent CLAHRC East Midlands Scientific Committee. The members of the committee are drawn externally from outside the institutions of the research team members and the trial sponsor. Study limitations The diagnosis and management of ADHD is inconsistent, as such the ‘assessment as usual’ practice will vary across sites. In order to document this difference each site completed a questionnaire prior to their participation in the trial detailing their ‘assessment as usual’ procedure. Furthermore, basic descriptions of ‘assessment as usual’ will be recorded in the pro-forma (such as number and length of appointments, decision-making and medication). Given this is a pragmatic trial conducted in real-world settings we are interested in the impact of adding QbTest Drug_discovery feedback to ‘assessment as usual’—without changing other aspects of practice. In order to minimise the trial results being influenced by practice in any one site, we are recruiting participants across multiple sites in different regions of the country and include both CAMHS and community paediatrics. In our design, we have attempted to control for variations between sites by stratification of randomisation by site.
Side-effects scale:31 Side-effects scale will be completed as a control check in medicated participants to ensure greater speed to diagnosis/medication normalisation is not off-set by greater side effects. SNAP-IV:32 The proportion of patients achieving Tenatoprazole? symptom normalisation assessed via the SNAP-IV. If the young person receives a QbTest on medication (Qb2), the timing on the 3-month SNAP-IV will be moved to coincide with Qb2 to provide a direct comparison of subjective (SNAP-IV) and objective (QbTest) measures. The SNAP-IV is a rating scale designed to assess ADHD symptoms. SDQ:30 The SDQ is a brief behavioural screening questionnaire
which can be used as part of a clinical assessment. C-GAS (Children’s Global Assessment
Scale33): Clinician opinion of patient outcome will be assessed via the C-GAS. The C-GAS is a 0–100 scale which that integrates psychological, social and academic functioning in children. EQ-5D-Y (EuroQol Five Dimensions Heath Questionnaire-Youth34): Child health-related quality of life will be assessed using the EQ-5D-Y. A resource collection profile tool will be used. It will encompass elements of a CSRI (Client Service Receipt Inventory35) often used in mental health studies but will be a specifically designed economic collection pro-forma for the purpose of this study. It will collect demographic details as well as information on all the services used by the child and family borne costs to be estimated. Indirect costs such as time lost from work incurred by the child’s parents or carers will further be recorded. This measure will enable a societal wide perspective for a cost-effectiveness analysis of the QbTest. The DAWBA29 QbTest22 SDQ30 Side-effects scale,31 SNAP-IV32 C-GAS33 EQ-5D-Y34 and CSRI35 all have established reliability, validity and history of use in
clinical and research settings. Feasibility and acceptability QbTest opinion questionnaire and interview: Clinician and patient opinion of the QbTest will be assessed via a questionnaire, developed by CLH and currently used to assess QbTest opinion in on-going studies at the Queens Medical Centre, Nottingham. This will provide information on the acceptability of QbTest in routine NHS settings. A subsample (n=20) of families and clinicians will be invited to participate in qualitative interviews to further Batimastat explore acceptability and feasibility of the QbTest. The subsample will be chosen at random from each participating site, using a random number generator. Table 1 displays a summary of measures, the informant and the time point of completion. All measures will have a 1-month window for completion, with the exception of the clinic pro-forma which must be completed during or just after the clinic appointment and the QbTest which must form part of the diagnostic or medication assessment.