Therefore, the fluctuation cycle of high-speed railway passenger

Therefore, the fluctuation cycle of high-speed railway passenger flow is one day and one week. The second one is nonlinear fluctuation which also imposes a great impact buy Ganetespib on passenger flow forecast. Specifically, the change rate of passenger flow is instable with nonlinear fluctuation for a short time because of many effect

factors, such as passengers’ income, travel cost, and service quality of transportation, which is revealed in Figures ​Figures11 and ​and22. 3. Regularity of Passenger Flow Notation: p(t): the passenger flow in period t, n: the total number of points of the historical passenger flow series, p(n): the current passenger flow state, v(t): the passenger flow change rate from p(t) to p(t+1), ui: the interval of passenger flow change rate, ui′: the intermediate value

of ui,i = 1,2,…, 8. The history passenger flow series is denoted by p(1), p(2),…, p(t − 1), p(t), p(t + 1),…, p(n − 1), p(n). The passenger flow change rates v(1), v(2),…, v(t − 1), v(t), v(t + 1),…, v(n − 2), v(n − 1) between adjacent periods are taken into account, and then the passenger flow change rates are analyzed and variation of passenger flow in adjacent period is summed up. 3.1. Change Rate of Passenger Flow In order to express passenger flow trend in adjacent period clearly and more accurately, passenger flow change rate is normalized. Define standardized passenger flow change rate v(t) = (p(t + 1) − p(t))/pmax ∈ [−1,1], and pmax = max (|p(2) − p(1)|, |p(3) − p(2)|,…, |p(n) − p(n − 1)|). For p(t + 1)

− p(t) < 0, the passenger flow descends from period t to t + 1; for p(t + 1) − p(t) > 0, the passenger flow increases from period t to t + 1; for p(t + 1) − p(t) = 0, the passenger flow does not change from period t to t + 1. In Table 1, the data are collected from Beijingnan Railway Station to Jinanxi Railway Station in Beijing-Shanghai high-speed railway. For example, the maximum value of the passenger flow change in adjacent periods is calculated as pmax = max (|p(2) − p(1)|, |p(3) − p(2)|,…, |p(n) − p(n − 1)|) = 857; the passenger flow change rate from 8:00–8:30 to 8:30–9:00 on October 10th is calculated as v(1) = (p(2) − p(1))/pmax = (304 − 70)/857 = 0.273. Similarly, we can calculate the passenger flow change rates, which are 0.231, 0.5158, −0.8145, and so forth, as shown in Table 1. Table 1 The value of passenger flow, passenger flow change degree, passenger flow change Anacetrapib rate, and fuzzy set. 3.2. Variation of Passenger Flow In order to reveal the regularity of the passenger flow trend clearly and express varying degrees of passenger flow change, respectively, we divide passenger flow change rate into eight intervals applying Zadeh’s fuzzy set theory [18]. Define the universe of discourse U = u1, u2, u3, u4, u5, u6, u7, u8 and partition it into equal length intervals u1 = [−1, −0.75], u2 = [−0.75, −0.5], u3 = [−0.5, −0.25], u4 = [−0.25,0], u5 = [0,0.

71401156 and 71171089), the Specialized Research Fund for the Doc

71401156 and 71171089), the Specialized Research Fund for the Doctoral selleck product Program of Higher Education of China (Grant no. 20130142110051), Humanity and Sociology Foundation of Ministry of Education of China (Grant no. 11YJC630019), as well as Contemporary Business and Trade Research Center and Center for Collaborative Innovation Studies of Modern Business of Zhejiang Gongshang University of China (Grant no. 14SMXY05YB). Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper.
High-speed railway as a kind of large volume passenger transportation mode has been well developed in Europe and Japan and has been

developing in China in an even larger scale

and has been planned to develop in American continent. In these areas, high-speed railway plays the role of backbone of passenger transportation systems. How to raise operation of the efficiency and how to make the passenger service decision-making more demand-responsive have been the most important focus to the research concerned. As one of the most important basics for the decision-making on high-speed railway transportation pattern and train operation planning, passenger flow forecast is of essential importance, and short-term passenger flow forecast is the key to the success of daily operation management. Recently, many forecast techniques have been used to solve the prediction problems. Lin and Yang applied the grey forecasting model to forecast the output value of Taiwan’s optoelectronics industry accurately from 2000 to 2005 [1]. In [2], four models were developed and tested for the freeway traffic flow forecasting problem. They were the historical average, time-series, neural network, and nonparametric regression models. The nonparametric regression model significantly outperformed

the other models. Du and Ren [3] proposed a prediction model of train passenger flow volume to help the railway administration’s analysis of running strategies. The model was analysed based on industrial GSK-3 economic indexes and Cobb-Douglas theory to make the prediction. Particularly, ARIMA model has become one of the most common approaches of parametric forecast since the 1970s. The ARIMA model is a linear combination of time-lagged variables and error terms, which has been widely applied in forecasting short-term traffic data such as traffic flow, travel time, and speed. In [4], time series of traffic flow data are characterized by definite periodic cycles. Seasonal autoregressive integrated moving average (ARIMA) and Winters exponential smoothing models were developed. In [5], it was presented that the theoretical basis for modeling univariate traffic condition data streams as seasonal ARIMA process. In [6], Hamed et al.

This can be seen in most of the nutrition intervention programmes

This can be seen in most of the nutrition intervention programmes in Ghana.8 Yet food security alone is not enough to improve children’s nutritional status, and the significance of care practices to Taxol solubility improving children’s nutritional status has been documented repeatedly.6 9–16 Despite the fact that quality of childcare has a demonstrated role in alleviating child undernutrition in resource-constrained settings such as Ghana, there have been only two Ghanaian studies (of which we are aware) that have examined the role of childcare in relation to children’s nutritional status. The pioneering

study of Ruel et al6 in urban Accra used a composite care practices variable (care practice index) to examine the importance of care for healthy child nutrition. The other study, by Nti and Lartey,16 was conducted in one rural area; both studies found a significant association between care practices and children’s nutritional status. However, the setting specificity of these two studies limits the generalisability of their findings. Addressing this limitation, this paper presents an analysis of the relationship between care practices and children’s nutritional status in Ghana, using a national representative sample. The primary objective of this analysis was to examine the influence of CCP on children’s

height-for-age Z-scores (HAZ), controlling for covariates and potentially confounding factors at child, maternal, household and community

levels. The secondary objective was to establish whether care practices were more important to growth in some sociodemographic subgroups of children compared with others. Methods Data sources The Ghana Demographic and Health Survey (DHS) data collected in 2008 were used for the analysis. These data are in the public domain and available from the MEASURE DHS website.17 The Ghana Statistical Service and the Ghana Health Service collected the data, using the 2000 national population census as a sampling frame. The participants were 1187 children aged 6–36 months (393 urban and 794 rural) AV-951 from whom anthropometry data were obtained. This excluded 224 children in the survey from whom complete and in-range anthropometry data could not be obtained. The weight measurements were undertaken using electronic Seca scales. Height measurements were obtained using a measuring board. Children younger than 24 months were measured lying on the board, while standing height was measured for older children.18 Outcome variable The outcome variable for this analysis was HAZ. CCP measurement The variables used in creating the CCP score were feeding practices variables and use of preventive health service.

The authors also wish to thank Dr Mark Dickson and Dr Fatiha Kara

The authors also wish to thank Dr Mark Dickson and Dr Fatiha Karam for their critical reading of the manuscript. Footnotes Contributors: CW, WL, GW and YL contributed to the conception

and design, acquisition of selleck the data, analysis and interpretation of the data, and the drafting of the articles. LL, FY, LC and YB were involved in the collection and analysis of the data. All authors approved the final version of the manuscript. Funding: This work was supported by the National Natural Science Foundation of China (Grant no: U1204823 and U1304821), National Key Basic Research Program of China (Grant no: 2012CB526709), High-level Personnel Special Support Project of Zhengzhou University (no: ZDGD13001), China Postdoctoral Science Foundation (Grant no: 20100471003 and 201104401), and Medical Scientific Research Foundation of Health

Department of Henan Province (Grant no: 201004042 and 201204051). Competing interests: None. Ethics approval: Ethics approval was granted by the Zhengzhou University Medical Ethics Committee. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available.
The foundational UNICEF framework for child health emphasises that childcare practices (CCP) are vitally important in promoting child nutrition and health.1 Sociodemographic factors (eg, parental education and income) are also emphasised in the UNICEF framework, and are consistently found to have a graded relationship with health.2 However, little is known about the degree to which CCP are consistently related to child health in the face of the widely differing sociodemographic backgrounds that characterise societies. Childcare is a complex concept including a range of behaviours and practices of caregivers that provide the food, healthcare, stimulation, and emotional support necessary for children’s healthy survival, growth and development.3 As part of CCP, feeding and healthcare underlie dietary sufficiency and protection from disease, which in turn impacts

child health, for which physical growth is a critical marker.4 A robust finding in public health research is that of a graded relationship between sociodemographic status (SDS) and health.5 Low SDS translates predictably into lessened food security and reduced access to healthcare. However, AV-951 even in households with food insecurity due to poverty and poor access to healthcare, families can optimise the use of the existing resources to promote health.3 6 This calls for further research to illuminate the relationship between childcare and child health in economically vulnerable as well as secure households and communities. An ecological approach to such research calls for specification of proximal influences on child health such as feeding practices, as well as consideration of more distal factors such as caregivers’ health literacy, availability of resources such as clean water and sanitary living conditions and accessible healthcare.

2 These migrants often suffer from mental health problems In a s

2 These migrants often suffer from mental health problems. In a study of 100 female UMs in the Netherlands, psychological problems such as anxiety, sleeplessness and agitation were selleck chem Dovitinib mentioned by more than 70% of the women.3 In a European survey among UMs, more than one-third of 177 UMs in the Netherlands perceived their mental health as bad or very bad.4 Their limited access to healthcare services may impede adequate treatment of these problems by healthcare providers, usually general practitioners (GPs) who are in the Netherlands their

first contact with healthcare.3–5 Accessibility problems In 1998 a Dutch law named Linking Act was passed making it impossible for UMs to obtain healthcare insurance.6 At the same time, however—in accordance with various universal covenants—they are entitled to free ‘medically necessary

care’.7 From 1998 to 2009 the care was regulated by the Linking Act and financed by a special fund called ‘Koppelingsfonds’. In this period ‘medically necessary care’ and care to protect public health could be reimbursed, but it became apparent that service providers used different interpretations of these concepts. Therefore efforts were made to formulate a uniform system for reimbursement, and in 2009 a new law came into force with the following legislation:8 The definition of ‘medically necessary care’ is equated with ‘basic health

coverage’ as defined by the 2006 Health Insurance Act. UMs should be treated according to the same standards and guidelines as of other patients, unless they are expected to leave the country soon. Costs can be reimbursed by a special fund from the National Health Care Institute to healthcare providers if they have failed in their efforts to let the UM pay his own bill. With the exception of care for pregnant women and childbirth (for which 100% reimbursement is possible), only 80% of the costs of directly accessible care (general practice and emergency department) can be reimbursed. ‘For non-directly accessible’ plannable Dacomitinib care (eg, other hospital departments, pharmacies, nursing homes, dispensaries) 100% reimbursement is possible, but only for a selected group of healthcare providers appointed in each region by the National Health Care Institute. For this care, UMs need a referral or prescription. UMs are therefore entitled to receive primary care delivered by GPs which they have to pay for themselves. However, if UMs are unable to pay for these services, GPs can get a reimbursement from the aforementioned fund. After referral by the GP, UMs have access to all secondary care services but will be referred mostly to those hospitals, mental healthcare institutions and pharmacies that are appointed by the National Health Care Institute.

However, future studies will be needed to determine the effective

However, future studies will be needed to determine the effectiveness of delivering such an exercise programme without the regular contact and support of a research team. Nevertheless, this innovative mode of programme delivery possesses the meanwhile potential for broad-scale dissemination and should be well-received by those affected by chronic disabling diseases due to its progressive and modifiable nature. Supplementary Material Author’s manuscript: Click here to view.(3.7M, pdf) Reviewer comments: Click here to view.(162K, pdf) Acknowledgments The authors express their appreciation to: Ruth Franklin Sosnoff,

PhD, and Julia Balto, project coordinators; Bill Yauch of RiellyBoy Productions; Erica Urrego, FlexToBa DVD exercise leader; and Grant Henry, Lynda Matejkowski, Joyce O’Donnell,

Bernard Puglisi, Paula Smith, and Peter Tan, FlexToBa DVD exercise models. The authors also extend their thanks to Andrew Weil, MD, for the generous contribution of the Healthy Aging DVDs. Footnotes Contributors: TRW contributed to the conception and design of the study, led programme orientation sessions, assisted with the acquisition of data, and drafted and revised the manuscript. SAR led programme orientation sessions, assisted with the acquisition of data, and helped to draft and revise the manuscript. YCL assisted with the acquisition of data, designed and will conduct the qualitative assessments, and contributed to the writing and revision of the manuscript. EAH and DK-H assisted with the acquisition of data, were responsible for conducting onsite assessments and interviews, and helped to draft and revise the manuscript. RWM contributed to the conception and design of the study, assisted with the acquisition of data, and helped to draft and revise the manuscript. EM conceived the study, made substantial contributions to its design, and contributed to the drafting and revision of the manuscript. All authors read and approved the final version of the submitted

AV-951 manuscript. Funding: This project is supported by grant number IL0009 from the National Multiple Sclerosis Society. Competing interests: None. Patient consent: Obtained. Ethics approval: The study protocol was approved by the University of Illinois at Urbana-Champaign’s Institutional Review Board (Urbana, Illinois, USA; Protocol No. 14163). Provenance and peer review: Not commissioned; externally peer reviewed.
The context of healthcare in the UK is changing, with an increasingly aging population and a growing focus on the prevention and management of disease.1 This has prompted the need to ensure that medical graduates are adequately prepared to address these evolving healthcare needs, rather than maintaining a reactive approach to illness in the UK.

We also present pathologic findings

of the retrieved clot

We also present pathologic findings

of the retrieved clots and we review currently available literature on this issue. CASE REPORT A 40-year-old right-handed woman presented with fever and general malaise for a few days. During her hospital stay, she was found to be aphasic and right hemiparetic by her husband, and he notified our on-call Neurology reference 4 resident. She was febrile (37.6℃), blood pressure was 140/80 mm Hg, and her pulse was regular (120 bpm). The initial neurological examination revealed expressive aphasia, right homonymous hemianopia, and right hemiparesis including facial paresis with a National Institutes of Health Stroke Scale (NIHSS) score of 15. An electrocardiogram showed sinus tachycardia without T wave changes. The white blood cell count was 15,410/µL, the erythrocyte sedimentation rate was 48 mm/hr and the C-reactive protein level was 3.93 mg/dL. Systolic murmur could be heard in the apex area. A diffusion-weighted image revealed subtle early ischemic changes in the periinsular area, and a perfusion-weighted image showed mean transition time delays on the left MCA M2 inferior trunk territory (Fig. 1A, B), and magnetic resonance angiography showed a left MCA M1 cut-off sign (Fig. 1C). IA mechanical thrombectomy

using the FAST technique was performed on the left MCA occlusion after 5 hours from symptom onset (Fig. 1E). The procedure was initiated by placing the coaxialguiding system into the internal carotid artery, and then the 041 F Penumbra reperfusion catheter (Penumbra Inc., Alameda, CA, USA) was advanced to the area of occlusion over a 1.7 F microcatheter (Excelsior SL-10; Boston Scientific, Fremont, CA, USA) and microwire (synchro 14; Boston Scientific, Natick, MA, USA). After removal of the microcatheter and microwire, manual aspiration was performed with a 50 ml syringe. The

Penumbra reperfusion catheter was slowly withdrawn, while maintaining pulling forces [6]. A complete recanalization was achieved, and multiple fragmented clots were retrieved through the reperfusion catheter tip (Fig. 1F, G). Fig. 1 Summary of brain images and angiographic findings in a 40-year-old woman. A-C. Initial magnetic resonance image and angiography showed acute ischemic change in the left peri-insula area, delayed mean transition time Drug_discovery of the left MCA partial territory and … Pathologic analysis of the retrieved clots revealed septic thrombi containing gram-positive cocci (Fig. 1H). Diagnosis of an infective endocarditis was confirmed thereafter using transthoracic echocardiography. It showed mitral valve vegetation and severe mitral valve regurgitation with valve perforation. Blood cultures were positive for streptococcus mitis. Intravenous antibiotic treatment was started with ceftriaxone and gentamicin. She recovered to mild right hemiparesis and mild expressive aphasia with an NIHSS score of 3 at 2 days after onset.

Phase I: quantitative study Facility selection Because we were in

Phase I: quantitative study Facility selection Because we were interested primarily in facility-level differences in alert management practices, we used a three-step process to select facilities from which to recruit participants. Step 1: Calculating perceived vulnerability. We conducted Temsirolimus FDA a cross-sectional, web-based survey of all VA PCPs (N=5290) from June 2010 through November 2010. The survey content was guided by our eight-dimensional

sociotechnical model16 and assessed PCPs’ perceptions of multiple facets of EHR-based test-result notifications. The survey was developed by a multidisciplinary team who wrote and refined items using input from subject-matter experts and then pilot testing the survey for readability, clarity and ease of completion. Details of the survey development are published elsewhere.17 We classified facilities on the basis of PCPs’ responses to two items in this survey17: “I missed alerts that led to delayed care” and “The alert system

makes it possible for providers to miss alerts.” Both survey items were rated on a five-point Likert scale from ‘strongly agree’ to ‘strongly disagree’. Responses to these two questions were positively correlated13 with responses pertaining to information overload,11 22 23 which itself is related to safety, system performance,24 and organisational and communication practices.25 We calculated the mean of the two question scores to create an aggregate score of perceived

vulnerability to missed test results. We sorted facilities by perceived vulnerability score and designated those with a score in the top 30% (3.315 or above on a five-point scale) and bottom 30% (2.947 or lower) as low and high perceived risk, respectively. Step 2: Adjusting for site characteristics. We controlled for facility-level structural characteristics using the ‘nearest neighbour’ methodology for creating peer groups for healthcare facilities.26 Our criteria for peer grouping by facility complexity included patient volume, academic affiliation, disease burden and patient reliance on VA for healthcare, care delivery structures, medical centre infrastructure and community Brefeldin_A environment.26 Step 3: Prioritizing facility pairs. We generated a list of potential pairs of high and low perceived risk facilities with otherwise relatively similar structures (ie, for each facility pair, the structural difference score was small), attempting to maximise contrasts between structural similarity and differences in perceived vulnerability. We contacted 48 facilities for participation in this order of prioritisation. Participants We separately interviewed one patient safety manager (PSM, n=40) and one IT/EHR staff member (designated in the VA as clinical application coordinator (CAC, n=40)) at each facility.

In Timor-Leste and Fiji the study will build local capacity for h

In Timor-Leste and Fiji the study will build local capacity for health financing equity analysis within the MoH and collaborating universities by providing practical training in BIA and FIA. A user-friendly toolkit on how to analyse health financing equity will be developed for use by policymakers and development partners in the region. The results will be disseminated through further info stakeholder meetings, targeted multidisciplinary workshops, seminars, journal publications, policy briefs, podcasts and the use of other electronic and web-based technologies

appropriate to the audiences to maximise awareness and utilisation of the findings. Supplementary Material Reviewer comments: Click here to view.(5.2K, pdf) Footnotes Contributors: ADA contributed to the design of this study and drafted the manuscript. JP contributed to the drafting of the manuscript. AH contributed

to the design of the study and reviewed the manuscript. WI and JM provided the local contents for Fiji and Timor-Leste. LG, JEA, AM and SJ contributed to the design of the study and reviewed the manuscript. VW conceived and designed the study, and oversaw the preparation of the manuscript. All authors read and approved the final manuscript. Funding: Funding for this study is provided by the Australian Aid through the Australian Development Research Awards (ADRAs) scheme. Competing interests: None. Ethics approval: The study is approved by the Human Research Ethics Committee of University of New South Wales, Australia (Approval number: HC13269); the Fiji National Health Research Committee (Approval # 201371); and the Timor-Leste Ministry of Health (Ref MS/UNSW/VI/218). Provenance and peer review: Not commissioned; peer reviewed for ethical and funding approval prior to submission. Data sharing statement: No additional data are available.
The term ‘aspirin resistance’ has been used to describe the

failure of aspirin to produce an expected response on one or more laboratory measures of platelet activation and aggregation.1 Mechanistic approaches to investigating aspirin resistance have relied mostly on ex vivo evaluations Dacomitinib of platelet function.2 However, while platelet aggregability is a major contributor to occlusive vascular events,3 other factors, such as vascular endothelial dysfunction,4 clotting protein cascades5 and flow stasis6 are also relevant. This multifactorial complexity, along with differing methods for making ex vivo assessments of platelet function, have made linkage between abnormal platelet function on laboratory indices and hard clinical events inconsistent. As a result, defining ‘aspirin resistance’ primarily based on currently available laboratory measures may not necessarily be the most appropriate way of discriminating people at high risk for future vascular events while on aspirin.

7 The diagnosis of aspirin treatment failure is simpler to diagno

7 The diagnosis of aspirin treatment failure is simpler to diagnose on a consistent basis in everyday routine clinical practice. However, the term ‘aspirin failure’ can be conceptually misleading when recurrent events occur through except mechanisms that aspirin is not expected to influence, such as collateral failure, and when the failure is actually due to non-adherence to prescribed aspirin rather than pharmacological ineffectiveness. Although alternative antiplatelet agents are often considered,

as mentioned in prevailing expert consensus clinical practice guidelines, there is insufficient evidence on which to base a recommendation for optimal antiplatelet therapy following a stroke while on aspirin.8 The objective of this

study was to compare the effectiveness of clopidogrel vs aspirin for vascular risk reduction among patients with ischaemic stroke who were on aspirin treatment at the time of their index stroke. Methods Study design and dataset We conducted a nationwide cohort study by retrieving all hospitalised patients (≥18 years) with a primary diagnosis of ischaemic stroke between 2003 and 2009 from Taiwan National Health Insurance Research Database (NHIRD). Taiwan has launched a compulsory National Health Insurance programme since 1995, which covers 99% of the population and reimburses for outpatients, inpatient services as well as prescription drugs. All contracted institutions must file claims according to standard formats, which later transform into the NHIRD. The accuracy of diagnosis of major diseases in the NHIRD, such as stroke, has been validated.9 Study population We identified all hospitalised patients who were admitted with a primary diagnosis of ischaemic stroke (International Classification

of Diseases, Ninth Revision (ICD-9) codes 433, 434, 436) among subjects (≥18 years) encountered between 2003 and 2009. This is a nationwide study that included all available and eligible patients. We defined the first ischaemic stroke during study period as the index stroke. We retrieved the information of medications prescribed by physicians prior to index stroke among these patients from the pharmacy prescription database. Only patients with ischaemic stroke who received continuous aspirin treatment ≥30 days before the index stroke were included in our study cohort. The Charlson index was used as AV-951 a measure for overall severity of comorbidities for index stroke.10 Comorbidities were confirmed by ICD-9 codes based on the diagnoses of hospitalisation for index stroke. We excluded patients with atrial fibrillation, valvular heart disease or coagulopathy, since anticoagulants, rather than antiplatelet agents, are generally more suitable for secondary stroke prevention among these patients. Information regarding patients’ medications during the follow-up period was retrieved from the pharmacy prescription database.