As stated by Brooks, ARIMA performed well and robustly in modelin

As stated by Brooks, ARIMA performed well and robustly in modeling linear and stationary time series [7]. However, the applications of ARIMA models were limited because they assumed linear relationships among time-lagged variables and they could not capture the structure of nonlinear relationships [8]. The nonparametric purchase PS-341 regression models have been applied to forecast transportation demand. However, among these nonparametric

techniques, KNN method has been rarely adopted in forecast transportation demand. Robinson and Polak proposed the use of the KNN technique to estimate urban link travel time with single loop inductive loop detector data, and the optimized KNN model was found to provide more accurate estimates than other urban link travel time methods [9]. Neural network model has been frequently adopted to predict. In [10], the time-delay recurrent neural network for temporal correlations and prediction and multiple recurrent neural networks were described. And the best performance is attained by the time-delay recurrent neural network. In [11], a hybrid EMD-BPN forecast approach which combined empirical mode decomposition (EMD) and backpropagation neural networks (BPN) was developed to predict the short-term passenger flow in metro systems. In [12],

the forecast model of railway short-term passenger flow based on BP neural network was established based on analyzing the principle of BP neural network and time sequence characteristics of railway passenger flow. In [13], a neural network model was introduced

that combines the prediction from single neural network predictors according to an adaptive and heuristic credit assignment algorithm based on the theory of conditional probability and Bayes’ rule. In [14], Chen and Grant-Muller reported the application and performance of an alternative neural computing algorithm which involves “sequential or dynamic learning” of the traffic flow process. This indicated the potential suitability of dynamic neural networks with traffic flow data. In [15], Li and Chong-Xin employed chaos theory into forecasting. Delay time and embedding dimension are calculated to reconstruct the phase space and determine the structure of artificial neural network, and the load data of Shanxi province power grid of China is used to show that the model is more effective than classical AV-951 standard BP neural network model. Support vector machine technique has also been adopted in forecast. In [16], a modified version of a pattern recognition technique known as support vector machine for regression to forecast the annual average daily traffic was presented. Hu et al. utilized the theory and method of support vector machine regression and established the regressive model based on the least square support vector machine.

25,0 5], u7 = [0 5,0 75], and u8 = [0 75,1] The midpoints of the

25,0.5], u7 = [0.5,0.75], and u8 = [0.75,1]. The midpoints of these intervals are u1′ = −0.875, u2′ = −0.625, u3′ = −0.375, u4′ = −0.125, u5′ = 0.125, u6′ = 0.375, u7′ = 0.625, and u8′ = 0.875. Define fuzzy set Ai based on the redivided intervals; fuzzy set Ai denotes a linguistic value ALK assay of the passenger flow represented by a fuzzy set, 1 ≤ i ≤ 8. The notations A1, A2, A3, and A4 denote that passenger flow decrease is too large, larger, microlarge, and less, respectively. Also, the notations A5, A6, A7, and A8 denote that passenger flow increase is less, microlarge, larger, and too large. Eight membership functions

in this paper sufficiently reflect quasi-periodic variation of high-speed railway passenger flow, and the forecast result of FTLPFFM has better accuracy based on eight membership functions. Define the fuzzy membership function of subset Ai, namely, fA1x=1,−1≤x≤−0.75,−0.5−x0.25,−0.75−0.5,fA2x=x−−10.25,−1−0.25,fA3x=0,x≤−0.75,x−−0.750.25,−0.750,fA4x=0,x≤−0.5,x−−0.50.25,−0.50.25,fA5x=0,x≤−0.25,x−−0.250.25,−0.250.5,fA6x=0,x≤0,x0.25,00.75,fA7x=0,x≤0.25,x−0.50.25,0.25

(1) Different passenger flow change rates can be fuzzified into corresponding fuzzy sets. For example, as seen in Table 1, the passenger flow

change rate from 7:00–8:00 to 8:00–9:00 is 0.273, which is fuzzified to A6. The passenger flow change rate from 8:00–9:00 to 9:00–10:00 is 0.231, which is fuzzified to A5. The passenger flow change rate from 9:00–10:00 to 10:00–11:00 is 0.5158, which is fuzzified to A7. And the passenger flow change rate from 10:00–11:00 to 11:00–12:00 is −0.8145, which is fuzzified to A1. The fuzzification process is depicted in Figure 3. Some fuzzified passenger flow change rates are listed in Table 1. Figure 3 Fuzzified passenger flow change rate. Fuzzy logic relationships are AV-951 established by putting two consecutive fuzzy sets, as follows: Aj⟶Ap,Ap⟶Aq,…,As⟶At. (2) “Aj → Ap” denotes that “the fuzzified passenger flow change rate is Aj from period t − 1 to t and then the fuzzified passenger flow change rate is Ap from period t to t + 1”. As seen in Figure 4, the fuzzified passenger flow change rate from 7:00–8:00 to 8:00–9:00 is A6 and from 8:00–9:00 to 9:00–10:00 is A5. Hence, we can establish an fuzzy logic relationship as A6 → A5. Likewise, from Table 1, we can establish the fuzzy logic relationships as A6 → A5, A5 → A7, A7 → A1, A1 → A3, and so forth. Some fuzzy logic relationships are listed in Table 2. Figure 4 Passenger flow change rate relationships. Table 2 The fuzzy logic relationship of fuzzified passenger flow change rate. 4.

); (8) dark green leafy vegetables; (9) mangoes, papayas, other v

); (8) dark green leafy vegetables; (9) mangoes, papayas, other vitamin A fruits; (10) other fruits; (11) pumpkin, carrots, squash (yellow or orange inside); (12) liver, kidney, heart, other organs; (13) fish or shellfish (fresh or dried); (14) food made from beans, peas, lentils, nuts; (15) oils, fats, butter, products made from PDK1 them; (16) cheese, yogurt, other milk products. Details about the DDS are presented elsewhere.19 Other feeding variables were frequency of feeding solid or semisolid food and breast feeding status. The preventive health service variables included:

BCG vaccination, DPT, hepatitis B, influenza, polio and measles vaccinations, iron supplementation, and use of drugs for intestinal parasites. The CCP score was created using the results of Principal Component Analysis.20–22 We employed the regression method, with component loadings adjusted to account for the correlations between variables, and used the oblique factor rotation procedure. Component extraction was based on eigenvalues >1, and four principal

components were extracted that explained 70% of the variance. No item had a loading less than 0.4.20 Therefore, all the items were used to create the composite care practices score, treated in subsequent analyses as a continuous variable. Other variables used in the analysis: maternal age, height, weight, number of antenatal care (ANC) visits education, occupation, anaemia level and parity; method of disposal of the youngest child’s stool; empowerment variables including women’s role in household decision-making, opinion regarding wife beating, and attitudes regarding sexual relations with husband; household-level variables including the number of children under 5 years in the household, Wealth Index (WI), urban/rural place of residence, source of drinking water, religion and type of toilet facilities; the child-level

variables sex and age (child’s age was transformed into age squared and included in regression analyses to account for non-linearity of the age variable.23 Some of the variables were recoded. Source of drinking water and toilet facilities were recoded according to the WHO and UNICEF24 recommended classifications: ‘improved’ Batimastat and ‘unimproved’ water and ‘improved’ and ‘unimproved’ sanitation facilities. The disposal of the youngest child’s stool was recoded into ‘appropriate’ and ‘inappropriate’ disposal methods. Maternal occupation was recoded into ‘white collar’ and ‘agriculture/labour’, and religion into ‘Christians’ and ‘other religions’. For the empowerment variables, three indices were created based on the DHS18 recommended procedure (participation in household decision-making, opinion regarding wife beating, and justified to refuse sexual intercourse with husband).

74 visits) Breast feeding was

generally above average in

74 visits). Breast feeding was

generally above average in this population (67%). The average TNF-Alpha Pathway frequency of feeding the child with solid or semisolid food within 24 h was 2.59. Immunisation rates were high among this population. BCG, which is given at birth, was as high as 94%. Additionally, 87.7% of children older than three months had received all their DPT vaccination and 85.6% received polio 3 vaccinations. For children older than 9 months, 86.7% received their measles vaccination. Fewer children in the sample received iron supplement (29.0%). The use of drugs for intestinal parasites was low (37.2%), probably because the children in the sample were relatively young. With regard to water and sanitation, 22.2% of this population did not have access to improved source of water and 47% used unimproved sanitation facilities. Also, a high proportion of mothers (63%) used inappropriate ways to dispose of the youngest child’s

stool. Table 1 Characteristics of the sample (N=1187), continuous variables Table 2 Characteristics of the sample (N=1187), categorical variables Bivariate analysis of the association between CCP and HAZ Bivariate analysis was carried out to examine the associations between CCP and children’s nutritional status. The results show a strong positive association between care practices and child HAZ (β=0.12, t=3.73, p<0.001). Multivariate analysis of the determinants of children's nutritional status The results of the HAZ regression analyses are presented in table 3. The analysis was guided by the framework described earlier and the presentation of results in table 3 follows the framework. In models A and B, both basic and contextual factors were significant predictors of HAZ —maternal age, number of children under 5 years and place of residence were positively associated with HAZ, while child's age was negatively associated with HAZ. Model (C) tested the main effects of resources after controlling for basic and contextual factors. Only maternal weight and WI were significantly associated with HAZ. Model (D) tested for a main

effect of CCP, which was a significant predictor of HAZ after adjustment for maternal and child basic factors, context and resources. A 1-unit increase in CCP score was associated with a 0.17-unit increase in HAZ. To establish if some subgroups in the sample benefit more from CCP than others, an interaction analysis was Batimastat carried out between the CCP variable and child’s sex, WI, maternal education, maternal occupation and place of residence. No significant interactions were observed (results not shown). Table 3 Multivariate analysis of determinants of nutritional status of children in Ghana, aged 6–36 months Discussion We examined the influence of CCP on children’s HAZ, controlling for covariates and potentially confounding factors at child, maternal, household and community levels as suggested by the UNICEF framework for childcare.

This may result in an underestimation of the full extent of the a

This may result in an underestimation of the full extent of the association between COPD and subsequent suicide risk. Similarly, a contact with psychiatric hospitals and Nutlin-3a Mdm2 inhibitor specialist clinics was used as a proxy for psychiatric illness, which represents more severe psychiatric conditions, possibly leading to an underestimation of psychiatric problems. On the other hand, the data used for the study have been collected systematically and routinely without any purpose of fulfilling a particular interest

of research, which reduces plausible bias due to recall of information and ensures the precision of the data. At the same time, the study is based on the entire national population of a country where hospital treatments for physical and psychiatric illness are free of charge, which eliminates possible bias induced by a selection of access to healthcare by personal socioeconomic status. The large size of included participants also provides us opportunities to search insights on effect differences by, for example, sex and age as well as psychiatric history with reasonable statistical power. Conclusions The present study demonstrates a substantially increased risk of suicide among patients previously hospitalised for COPD

compared with individuals without such a history. The relative risk increases with frequency of hospitalisations and recency of the most recent hospitalisation for COPD treatment. The observed effect was more prominent in women, in patients above 60 years old and in individuals without a psychiatric history. The findings underline the importance of assessment of suicide risk in patients with COPD and the need of close collaboration between clinicians and clinic units with responsibilities of somatic and psychiatric treatment. Supplementary Material Author’s manuscript: Click here to view.(1.9M, pdf) Reviewer comments: Click here to view.(155K, pdf) Footnotes Contributors: PQ conceptualised and designed the study and analysed the

data. JMCS reviewed the literature, organised the writing and wrote the initial drafts. PQ and JMCS finalised the manuscript. JMCS, CFC, MO and PQ contributed the analysis and interpretation of the data, revised critically for important GSK-3 intellectual content and approved the final version to be published. Funding: This project was partly supported by the Danish Sygekassernes Helsefonden (Danish Health Insurance Research foundation; 2009B063). Competing interests: None. Ethics approval: The study has been approved by the Data Protection Agency in Denmark. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available. Statistical code and further explanation about the data set can be provided from the corresponding author on request.
An estimated 60 000–134 000 undocumented migrants (UMs) live in the Netherlands.

The promotion of health as well as the delivery of care of condit

The promotion of health as well as the delivery of care of conditions like these often occurs within the community, outside the context of University teaching hospitals, provided by professionals from several disciplines, including a significant Dovitinib Sigma input from social services. In the recently published UK government’s white paper, Equity and Excellence: Liberating the National Health Service (NHS),2 a need for a healthcare system focused on personalised

care reflecting individuals’ health and care needs was outlined. This would involve supporting carers and encouraging multidisciplinary care. These social demographic and political drivers require strong input from multiprofessional

healthcare providers in primary care and the recruitment of more general practitioners (GPs) in order to fulfil the growing need for community-based care. This concept also resonates globally and is considered important by health regulatory bodies that license medical schools. In 1987, the WHO recommended the reform of health professional curricula by incorporating methods to prepare students for providing care at all levels of healthcare settings,3 which can be achieved by, among other things, aligning education with community needs. The UK General Medical Council’s (GMC’s) document ‘Tomorrow’s Doctors’ recommend that clinical placements should reflect the changing patterns of healthcare and that they must provide experience in a variety of environments including hospitals, general practices and community medical services.4 Curricula in the UK medical schools, therefore,

currently offer community-based education (CBE) in various forms and models of teaching.5 CBE is defined as a medical education programme that may employ any variety of teaching methods to promote an understanding of health concerns at a community level. The programme is set within the community, and involves individuals within the community. Previous publications have evaluated these models of medical teaching in the community, including analyses of their advantages and drawbacks.6–28 However, a thorough literature search (as conducted in November 2013) found no existing systematic Brefeldin_A reviews on community-based teaching across all existing UK medical schools. It remains unclear what the extent of community-based teaching in UK medical schools is, the impact this had made to the standards of healthcare, and how the effectiveness of community-based teaching programmes has been measured. Knowledge of this is considered important, as it would guide the structuring of undergraduate medical curricula to adapt to changing contexts in the UK, hence effectively developing a future generation of doctors who are appropriately prepared for upcoming healthcare needs.

In addition, treatment could be considered in patients with sever

In addition, treatment could be considered in patients with severe psychological disturbances secondary to harboring an unruptured aneurysm. Symptomatic UIAs should be treated in principle. For patients at high risk Pacritinib phase 3 of treatment because of co-morbid medical conditions, old age, or location and morphology of the aneurysm, the risks and benefits of treatment should be weighed in the

treatment decision. However, the treatment decision should be determined after taking into account the patient-specific factors of age, co-morbidity, and health condition and aneurysm-specific factors of size, location, and morphology. Treatment is not generally recommended for asymptomatic extradural intracranial aneurysms. Long-term follow-up is recommended after treating an UIA. In particular, for patients managed with endovascular treatment, angiographic follow-up is recommended to detect incomplete

occlusion or recurrence. For patients with an UIA who are managed conservatively without treatment, treatment of high blood pressure, cessation of smoking, and regular noninvasive angiographic follow-up, even without symptoms, are recommended. Frequent Aspirin use may confer a protective effect for risk of intracranial aneurysm rupture. In a case-control study on the protective effect of Aspirin for patients with an untreated intracranial aneurysm, patients who used Aspirin 3 times weekly to daily had a significantly lower odds of hemorrhage (adjusted OR, 0.27; 95% CI, 0.11 – 0.67; P=0.03) compared with those who never take aspirin [56]. However, further clinical investigation is needed to confirm this effect. UIAs generally are monitored annually with MRA or CTA for 2 to 3 years and then every 2 to 5 years thereafter if the UIAs are clinically

and radiographically stable [57]. Recommendations 1. For patients with an unruptured intracranial aneurysm that are managed conservatively without treatment, treatment Drug_discovery of high blood pressure, cessation of smoking, and regular vascular imaging follow-up, even without symptoms, are recommended. 2. Treatment is not generally recommended for an asymptomatic extradural intracranial aneurysm. 3. Symptomatic UIAs should be treated in principle. 4. Considering the natural course of asymptomatic UIA, treatment might be considered for patients who have a life expectancy of more than 10-15 years and have one or more of following conditions. (1) Size of 5 mm or more (2) Size under 5 mm at high risk of rupture (3) Symptomatic intracranial aneurysm [58, 59] (4) Aneurysm located in the posterior circulation, anterior communicating artery, or posterior communicating artery [53, 54, 55].

In conclusion, in a country with a highly developed social and an

In conclusion, in a country with a highly developed social and antenatal maternity healthcare security system giving cost-free maternity and obstetric care to all pregnant women, adolescents had a decreased risk

for adverse obstetric and neonatal outcome compared with the reference group. In the same social context childbirth sellectchem at advanced maternal age was associated with a number of serious complications for the woman as well as the child. For clinicians counselling young mothers it is of great importance to highlight the positive consequences that less obstetric complications and favourable neonatal outcomes are expected. The results imply that there is a need for individualising the antenatal surveillance programmes and obstetric care based on age grouping in order to attempt to improve

the outcomes in the age groups with less favourable obstetric and neonatal outcomes. Such changes in surveillance programmes and obstetric interventions need to be evaluated in further studies. Supplementary Material Author’s manuscript: Click here to view.(3.5M, pdf) Reviewer comments: Click here to view.(279K, pdf) Footnotes Funding: The study was supported financially by grants from the County Council of Östergötland and Linköping University. Competing interests: None. Ethics approval: The study was approved by the Regional Ethical Review Board in Linköping, Sweden (Dnr 2011/479-31. Approved 25 January 2012). Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: Extra data can be accessed via the Dryad data repository at

with the doi:10.5061/dryad.nc576.
Electronic health record (EHR) systems can potentially reduce communication problems associated with paper-based transmission of test results.1 2 Computer-based test results can be transmitted securely and instantaneously to providers’ EHR inboxes as ‘alerts’, reducing turnaround time to follow-up.3 Although EHRs appear to reduce the risk of missed test results,2 4 5 they do not eliminate the problem.2 3 6 Lack of timely follow-up of test results remains a major patient safety concern in most healthcare organisations.7–9 AV-951 Previous work has shown that test result follow-up failures can be traced to ambiguity among providers about responsibility for follow-up,10–12 perceived ‘information overload’ among providers who receive large amounts of information electronically,13 and the concurrent use of paper-based and EHR systems to order and report test results.1 14 Other test result management practices may also facilitate or thwart timely follow-up. For instance, we found remarkable differences in rates of abnormal pathology result follow-up between two US Department of Veterans Affairs (VA) healthcare facilities, despite their use of a common EHR system.

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 selleck chemical 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 Batimastat 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.

It will explore several of the key issues covered in the househol

It will explore several of the key issues covered in the household survey in more depth. This will include topics in the domain of financial, physical and cultural access to health services, kinase inhibitor Dovitinib particularly access to secondary and tertiary services; healthcare-related payments; and access to domestic and overseas referrals. Interviews will be conducted by two experienced local researchers in Tetum and will be audiotaped for transcription and analysis. The survey will be piloted to test logistics and gather information to improve

the main survey. Data analysis The study will be integrated at the data analysis stage, with data from Fiji and Timor-Leste being analysed simultaneously (figure 2). Figure 2 Integration of the Fiji and Timor-Leste components of the study. BIA, benefit incidence analysis;

FIA, financing incidence analysis; NHA, National Health Accounts; HIES, Household Income and Expenditure Surveys. Analysis of the BIA and FIA data from Fiji and the data from the household survey in Timor-Leste will be undertaken using STATA version 13. The BIA data analysis will seek to ascertain whether the distribution of benefits from healthcare spending for a given provider is pro-rich or pro-poor and in line with need for services. We will construct bar charts indicating the relative share of total benefits received by each quintile of a socioeconomic group. We will then compare the distribution of benefits, depicted by the concentration curve, against the 45° line of perfect equality. Dominance tests will be carried out to ascertain whether the differences are significant.41 The gender dimension of benefit from health spending will be given specific attention given the role of women as primary caregivers in times of illness or disability.42 The FIA data analysis will assess healthcare financing equity by examining the level of contribution to healthcare (through direct payments and taxation) reported by socioeconomic quintile. We will assess the progressivity of

the health financing system by evaluating the payments made towards healthcare across different socioeconomic groups in relation to their ATP. The socioeconomic measure will be based on a household’s reported expenditure on food consumption, housing and other non-food items.43 We will adjust the total consumption variable to obtain per adult equivalent household Drug_discovery consumption using the formula: where A is the number of adults in the household, K is the number of children (0–14), α is the ‘cost of children’ (given a value of 0.5 in this study) and θ determines the degree of economies of scale (given a value of 0.75 in this study).44 Analysis of the data from the Timor-Leste household survey and other quantitative data from documents will involve running a series of regressions to determine associations between household variables and the use of hospital services.