Since the problem was introduced, high-speed railway passenger flow forecast is vitally important to the organization of high-speed railway. However, several studies have focused on forecasting short-term high-speed railway passenger flow on the basis of the regularity and randomness of the passenger flow rate. A new DNA-PK pathway method is, therefore, very much needed. Fuzzy

temporal logic based passenger flow forecast model (FTLPFFM) is proposed in this paper. Quasi-periodic variation of high-speed railway passenger flow is sufficiently reflected and nonlinear fluctuation of high-speed railway passenger flow is processed using fuzzy logic relationship recognition techniques in the searching process. The proposed model has explicit physical meaning, which reflects variation of high-speed railway passenger flow and has sufficient comprehensibility and interpretability. The characteristics of short-term high-speed railway passenger flow are vitally important to forecast model which is used to improve predictive performance

of fuzzy k-nearest neighbor by comparing with other predictive methods in short-term high-speed railway passenger flow forecast. The remainder of this paper is organized as follows. In Section 2, passenger flow characteristics of the high-speed railway and passenger flow variation in adjacent period are summarized. In Section 3, the change degree of passenger flow is divided into eight grades according to cognitive habit and passenger flow change rate is fuzzified. FTLPFFM is proposed in Section 4. In Section 5, the experiment result for the application of FTLPFFM is compared with ARIMA and KNN models when using three statistics: mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean square error (RMSE). And FTLPFFM appears to be more robust and universally fitting. The last section is the conclusion and future work. 2. Passenger Flow Feature Extraction In short-term passenger flow forecast, the characteristics of high-speed railway passenger flow are summarized based on time variable because passenger flow has strong correlation to time variable. The data of high-speed

railway passenger flow were collected Drug_discovery from Beijingnan Railway Station to Jinanxi Railway Station, which is passenger flow in per hour from 26 March to 4 April 2012 (see Figure 1) and daily passenger flow from 14 May to 31 July 2012 (see Figure 2). Figure 1 Daily variation of high-speed railway passenger flow. Figure 2 Weekly variation of high-speed railway passenger flow. Two characteristics of high-speed railway passenger flow are taken into account in FTLPFFM. The first significant characteristic is quasi-periodic which imposes a great impact on passenger flow forecast. The running time of high-speed train is between 6:00 and 24:00 and the passenger flow in morning peak and evening peak is more than other periods, which is revealed in Figure 1.

Since the problem was introduced, high-speed railway passenger flow forecast is vitally important to the organization of high-speed railway. However, several studies have focused on forecasting short-term high-speed railway passenger flow on the basis of the regularity and randomness of the passenger flow rate. A new gamma secretase structure method is, therefore, very much needed. Fuzzy

temporal logic based passenger flow forecast model (FTLPFFM) is proposed in this paper. Quasi-periodic variation of high-speed railway passenger flow is sufficiently reflected and nonlinear fluctuation of high-speed railway passenger flow is processed using fuzzy logic relationship recognition techniques in the searching process. The proposed model has explicit physical meaning, which reflects variation of high-speed railway passenger flow and has sufficient comprehensibility and interpretability. The characteristics of short-term high-speed railway passenger flow are vitally important to forecast model which is used to improve predictive performance

of fuzzy k-nearest neighbor by comparing with other predictive methods in short-term high-speed railway passenger flow forecast. The remainder of this paper is organized as follows. In Section 2, passenger flow characteristics of the high-speed railway and passenger flow variation in adjacent period are summarized. In Section 3, the change degree of passenger flow is divided into eight grades according to cognitive habit and passenger flow change rate is fuzzified. FTLPFFM is proposed in Section 4. In Section 5, the experiment result for the application of FTLPFFM is compared with ARIMA and KNN models when using three statistics: mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean square error (RMSE). And FTLPFFM appears to be more robust and universally fitting. The last section is the conclusion and future work. 2. Passenger Flow Feature Extraction In short-term passenger flow forecast, the characteristics of high-speed railway passenger flow are summarized based on time variable because passenger flow has strong correlation to time variable. The data of high-speed

railway passenger flow were collected Carfilzomib from Beijingnan Railway Station to Jinanxi Railway Station, which is passenger flow in per hour from 26 March to 4 April 2012 (see Figure 1) and daily passenger flow from 14 May to 31 July 2012 (see Figure 2). Figure 1 Daily variation of high-speed railway passenger flow. Figure 2 Weekly variation of high-speed railway passenger flow. Two characteristics of high-speed railway passenger flow are taken into account in FTLPFFM. The first significant characteristic is quasi-periodic which imposes a great impact on passenger flow forecast. The running time of high-speed train is between 6:00 and 24:00 and the passenger flow in morning peak and evening peak is more than other periods, which is revealed in Figure 1.

DBP variations have an impact on the metabolite of vitamin D, thereby affecting the amount and activity of vitamin D in the β cell which play an important role in insulin secretion. Another possibility is that the association might be Rapamycin not due to the vitamin D metabolite. Fatty acids, as one of the ligands of DBP, may also induce β cell abnormalities when it is at a high

level in the pancreas islet.19 As a macrophage-activating factor, DBP is also critical to the immune system. Several cytokines, such as the tumour necrosis factor, could play important roles in insulin sensitivity.4 It is also possible that the association of the DBP polymorphism with T2DM does not result from functional variations in DBP, but is derived from a variation in a closely linked gene on chromosome 4q12.11 Strengths and limitations To the best of our knowledge, this is the first systematic review and meta-analysis to evaluate the association of DBP polymorphisms with T2DM. In this meta-analysis, sensitivity analysis and meta-regression were conducted. In addition, several limitations of this study should also be addressed. First, the sample size was relatively small for stratified analyses, which weakened our conclusions. Therefore, more studies need to be conducted to obtain a more reliable result. Second, T2DM is a complex metabolic disorder caused

by the interaction of multiple genetic and environmental factors; so gene-gene and gene-environment interactions should also be taken into account to conclude a true effect if possible. Third, detailed information at an individual level was lacking in previous studies, so some stratified analyses were not able to be performed. If individual raw data were available, effect induced by age, gender, medication use and other environmental factors (sun exposure, dietary vitamin D intake, etc.) could also be investigated. Fourth, we are unable to control

against publication bias for such a small number of studies. Additionally, results of Genome-wide association study (GWAS) studies were not included because the raw data had not been published. Conclusions In conclusion, this meta-analysis had pooled all the available data related to the DBP polymorphism and T2DM, and indicated that the DBP polymorphism was only moderately associated with an increased susceptibility to T2DM in Asians but not in Caucasians. Dacomitinib Therefore, more well-designed and large sample studies are warranted to confirm this conclusion, and to fully understand the mechanism of T2DM. Additionally, prospective cohort studies in combination with analyses of other gene and environment factors are also necessary to explore the true effect of the DBP polymorphism on the risk of T2DM. Supplementary Material Author’s manuscript: Click here to view.(5.6M, pdf) Reviewer comments: Click here to view.

DBP variations have an impact on the metabolite of vitamin D, thereby affecting the amount and activity of vitamin D in the β cell which play an important role in insulin secretion. Another possibility is that the association might be Rho-associated protein kinase not due to the vitamin D metabolite. Fatty acids, as one of the ligands of DBP, may also induce β cell abnormalities when it is at a high

level in the pancreas islet.19 As a macrophage-activating factor, DBP is also critical to the immune system. Several cytokines, such as the tumour necrosis factor, could play important roles in insulin sensitivity.4 It is also possible that the association of the DBP polymorphism with T2DM does not result from functional variations in DBP, but is derived from a variation in a closely linked gene on chromosome 4q12.11 Strengths and limitations To the best of our knowledge, this is the first systematic review and meta-analysis to evaluate the association of DBP polymorphisms with T2DM. In this meta-analysis, sensitivity analysis and meta-regression were conducted. In addition, several limitations of this study should also be addressed. First, the sample size was relatively small for stratified analyses, which weakened our conclusions. Therefore, more studies need to be conducted to obtain a more reliable result. Second, T2DM is a complex metabolic disorder caused

by the interaction of multiple genetic and environmental factors; so gene-gene and gene-environment interactions should also be taken into account to conclude a true effect if possible. Third, detailed information at an individual level was lacking in previous studies, so some stratified analyses were not able to be performed. If individual raw data were available, effect induced by age, gender, medication use and other environmental factors (sun exposure, dietary vitamin D intake, etc.) could also be investigated. Fourth, we are unable to control

against publication bias for such a small number of studies. Additionally, results of Genome-wide association study (GWAS) studies were not included because the raw data had not been published. Conclusions In conclusion, this meta-analysis had pooled all the available data related to the DBP polymorphism and T2DM, and indicated that the DBP polymorphism was only moderately associated with an increased susceptibility to T2DM in Asians but not in Caucasians. GSK-3 Therefore, more well-designed and large sample studies are warranted to confirm this conclusion, and to fully understand the mechanism of T2DM. Additionally, prospective cohort studies in combination with analyses of other gene and environment factors are also necessary to explore the true effect of the DBP polymorphism on the risk of T2DM. Supplementary Material Author’s manuscript: Click here to view.(5.6M, pdf) Reviewer comments: Click here to view.

The Netherlands are known to have legislation to guarantee generous healthcare provision for UMs who cannot afford to pay the bills. In practice, however, the provision mostly of this care is limited as legislation is complex and ineffectively implemented. Service providers are often not aware of their obligations to provide care for UMs; they are uncertain about the definition of ‘necessary care’ or unaware of the provision

of reimbursement, resulting in denials of UMs particularly in hospitals.9 Because ‘proof of inability to pay’ is nowhere defined, there are great variations in billing UMs for services. The limited—and often variable—group of service providers in secondary care who are entitled reimbursement of costs of care of UMs also creates problems of accessibility. Although in principle every general practice

is available, UMs tend to cluster in a limited number of practices known for rendering this type of services, leading to a high (administrational) workload for a small group of GPs.10 Several of these practices do not keep patient records of UMs which hampers continuity of care and adequate registration of medical histories.10 Besides these barriers on the side of the care providers, UMs themselves have difficulty seeking help due to obstacles such as shame, fear of deportation and worries over bills.11 Various studies have shown that a large percentage of migrants are unaware of their medical rights and lack knowledge of the Dutch healthcare system.9 11 These problems are not exclusive to the Netherlands and have been reported in other countries as well.2 Additionally, factors such as a lack of knowledge of informal networks of local citizens and healthcare professionals, administrative obstacles, social exclusion and indirect or direct discrimination are also mentioned.12 13 Language barriers and cultural differences add to the

risk of inequity in healthcare access and quality.11 13 Studies on the accessibility of healthcare with a focus on UMs with mental health problems are scarce. Literature does exist on the perceptions of mental health, healthcare utilisation and accessibility of mental healthcare services at both national as well as international Drug_discovery level but these concentrate on migrants in general and often exclude UMs.14–18 Mental health problems Studies conducted in the Netherlands reveal that refugees and asylum seekers experience more physical and psychological problems compared to native Dutch and other Western migrants.19 20 In turn, concordant with international literature asylum seekers report more health problems than refugees who have been granted asylum.21 Among studies reporting health status of UMs in the European Union, psychological issues appear most widespread.

Literature review of studies evaluating community-based teaching A summary of the studies evaluated in the systematic literature review are outlined in table 4. The main methods of evaluation employed in the studies were questionnaires, interviews and focus groups of the key stakeholders in CBE—students, patients, tutors selleck catalog and other staff in the community setting. Table 4 Summary of systematic review Needs assessment of CBE Studies of student expectations of CBE highlighted

that students valued experiential patient-centred learning and tutor supervision in the community setting.14 30 In a Sheffield study,14 students also recognised that CBE was a powerful vehicle for changing their approach to medicine and illness, where the patient as a person is given emphasis over the disease. Implementation assessment of CBE All forms of community-based teaching were generally well-received by medical students, patients and participating healthcare professionals, supporting the continuation of existing community-based teaching programmes in the future. This included community-based teaching which was incorporated into specialty modules such as Obstetrics and Gynaecology,31 Psychiatry22 and Surgery.27 The

unique approach of incorporating primary healthcare in an intercalated Bachelor of Science medical research year also received positive feedback.23 Three studies found that students preferred the implementation of practice-based teaching over hospital-based teaching. Hastings et al11 found that students in Leicester preferred practice-based teaching on the grounds of both teaching method and content. O’Sullivan et al12 had similar findings among students from University College London, where practice-based teaching bore qualities of better

teaching attitudes, teaching methods and course organisation. Interestingly, these findings were consistent with Powell and Easton’s27 investigation on Imperial College students undertaking their surgery module. These students preferred surgical teaching within general practices due to the learner-centred approach in teaching, more protected teaching time and regular access to suitable patients for acquiring clinical skills. The success of community teaching in Leicester was analysed by Hastings et al.11 It was found that the improved quality of teaching by GP tutors was attributed to a higher proportion of GP tutors attending teacher-training courses. General practices Dacomitinib were also found to have greater resource availability and NHS funding specifically allocated to support the teaching of medical undergraduates. All these factors placed hospital doctors at a disadvantage in preparing good-quality clinical teaching sessions in comparison to GPs. Impact assessment of CBE Studies of CBE impact on students bore the following themes: (1) Learning outcomes, (2) Behavioural changes to primary care and (3) Traits of future doctors.

Aneurysmal clipping has been the standard method for treatment. However, with the technological Sirolimus advances in devices, endovascular treatment has been used with increasing frequency. The selection of a treatment method for an unruptured intracranial aneurysm should be individualized based on patient’s factors, aneurysmal factors, and facility and performance of centers. In 2013, Greving et al. presented the PHASES score for prediction of risk of rupture of intracranial aneurysms [52]. The scoring system was developed from a pooled analysis of individual patient data from 8382 participants in six prospective cohort studies. Predictors included age, hypertension, history of SAH,

aneurysm size, aneurysm location, and geographical region, and were independently associated with the rupture risk of an intracranial aneurysm. According to the PHASES score, a high PHASES score corresponds to a great 5-year risk of aneurysm rupture (Table 1). It is not yet complete, but this study is the first proposal to reliably predict the long-term risk of aneurysm rupture and a risk prediction chart could serve as a valuable aid for treatment of an UIA. Table 1 PHASES Aneurysm Risk Score General principles Aneurysm size was an important predictor of rupture risk and could be considered preferentially in determining whether to treat. In ISUIA (International Study of

UIAs) published in 2003, calculating the total risk of rupture for patients demonstrates that for aneurysms 7 to 12

mm, 13 to 24 mm, and greater than 25 mm in diameter, the yearly rupture rates are 1.2, 3.1, and 8.6%, respectively [53]. Small, single incidental aneurysms less than 5 mm in diameter should be managed conservatively. However, treatment of a small aneurysm would be considered a relative rupture risk according to risk factors like location, history of SAH, symptomatic intracranial aneurysm, family history of aneurysm, and aneurysm with a multilobule or bleb. SUAVe (Small Unruptured Aneurysm Verification), published in 2010, was a prospective study to assess the annual risk of rupture of UIAs less than 5 mm in diameter [54]. In SUAVe, the overall annual risk rate of rupture was demonstrated to be 0.54%/year (single unruptured aneurysms: 0.34%/year, multiple unruptured Carfilzomib aneurysms: 0.95%/year). And patients <50 years of age (P=0.046; hazard ratio, 5.23; 95% CI,1.03 to 26.52), aneurysm diameter of ≥4.0 mm (P=0.023; hazard ratio, 5.86; 95% CI, 1.27 to 26.95), hypertension (P=0.023; hazard ratio, 7.93; 95% CI, 1.33 to 47.42), and aneurysm multiplicity (P=0.0048; hazard ratio, 4.87; 95% CI, 1.62 to 14.65) were found to be significant predictive factors for rupture of small aneurysms. Results of this study showed that the rupture risk of a small cerebral aneurysm in Japan was higher compared with that of ISUIA. And, in UCAS (Unruptured Cerebral Aneurysm Study of Japan), reported in 2011, the overall rate of rupture of cerebral aneurysms was 0.

Only primiparous women were included in order to avoid the confounding effects of factors associated with subsequent deliveries. There www.selleckchem.com/products/BAY-73-4506.html are limitations that should be considered. The external validity is reduced to facilities with similar socioeconomic and demographic characteristics and healthcare systems with comparable standards. The drawback is obvious given the large size of the study and the numbers of healthcare units involved so the criteria for diagnosis (ICD codes) to define outcomes may not be uniform across the study population, but the variation is most likely not related to maternal age. The MBR contains a large

body of information concerning the mother and child, which made it possible to adjust the results for confounding factors. At the same time this is a limitation as only the data available in the register could be used for adjustments. The register lacks information on ethnicity and socioeconomic status. Our effort was to evaluate obstetric and neonatal outcomes in different maternal age groups compared with women aged 25–29 overall. The only stratifications made were for year of birth, maternal BMI and smoking in early pregnancy. The data on year of birth showed that there is variability in the existence

of obstetric and neonatal diagnoses during the observation period. This may be due to true changes but may also be a result of changes in recording, including the expanding use of computerised medical records. It was therefore necessary to adjust for year of birth. Maternal BMI, maternal smoking and gestational age (for some relevant outcomes) were included in the adjusted analyses based on their well-known association with maternal and fetal outcome.26 27 Putative confounders and intermediaries were not identified with statistical analysis. To demonstrate causality between

the different outcomes evaluated in the analyses and maternal age a great number of putative intermediaries could have been considered such as the use of fertility treatment, fetal size, gestational weight gain, etc, but that was not the purpose of the study. There may be other variables (which are not intermediaries) but we have not been able to identify them. The proportion of missing data concerning the included confounders could have affected the results. The youngest age group had the highest frequency Dacomitinib of missing data on BMI (20.7%) and smoking (7.7%) compared with the reference group (13.1% and 4.9%, respectively). The distribution of BMI in the youngest age group was almost equal to the other maternal age groups. One explanation for a higher proportion of missing data in the youngest age group could be later detection of their pregnancies and attendance to the antenatal care, and questions concerning exposure in early pregnancy were not raised. Gestational age could be calculated for more than 99% of individuals in this study with only minimal variations between maternal age groups.

Patients Ruxolitinib solubility were excluded if they switched antiplatelet therapy between aspirin and clopidogrel during the follow-up period to make the analyses straightforward. The Taiwan National Health Insurance Bureau provides reimbursement for the use of clopidogrel in patients with ischaemic stroke who are allergic to aspirin or have peptic ulcer (the latter confirmed by prior or current pan-endoscopy results). Although ‘aspirin treatment failure’ is not one of the prespecified criteria for clopidogrel use, the Bureau typically provides reimbursement in these circumstances. As such, physicians generally have broad latitude to prescribe clopidogrel

or aspirin based on their personal preferences. Patients were excluded if their medication possession ratio (number of days drug supplied divided by the number of days in the follow-up period) was <80% or clopidogrel or aspirin was not prescribed within 30 days before an end point to reduce bias from poor drug adherence or antiplatelet-discontinuation

effects.11 12 Main outcome measures The primary end point was the first event of a new-onset major adverse cardiovascular event (MACE: composite of any stroke (ischaemic or haemorrhagic) or myocardial infarction). The leading secondary end point was the first event of any recurrent stroke (ischaemic or haemorrhagic) alone. Additional secondary end points were ischaemic stroke, intracranial haemorrhage (codes 430–432), fatal stroke, myocardial infarction (code 410) and all-cause

mortality. Follow-up was from time of the index stroke to admission for the first event of recurrent stroke (codes 430–434, 436) or myocardial infarction, death, or the end of 2010. National Health Insurance is a compulsory programme in Taiwan, and moving out of the country, which is supposed to be scarce among patients with stroke, is almost the only reason, besides death, for being withdrawn from this programme. A previous study from the Taiwan NHIRD also used ‘withdrawn’ from this programme to define death.13 Therefore, we defined death as in-hospital death or withdrawal of the patient from the National Health Insurance programme. Statistical analysis The baseline characteristics of two treatment groups were compared using student t test for continuous variables and χ2 test for categorical variables. Kaplan-Meier plots were generated, Dacomitinib and the log-rank test was used to evaluate the difference between curves. We employed Cox’s proportional hazard model to estimate the unadjusted and adjusted HRs and 95% CIs, which considered the aspirin group as the reference group. The model was adjusted for baseline age, gender, hypertension, diabetes, prior stroke, prior ischaemic heart disease, hyperlipidaemia, gastrointestinal bleeding or peptic ulcer, Charlson index, statin use, other antiplatelet drugs use, ACE inhibitors or angiotensin receptor blockers use, calcium channel blockers use and diuretics use during the follow-up period.

gs.unsw.edu.au/policy/documents/researchdataproc.pdf. Quality assurance procedures will be built into the data management system and implemented alongside other data management activities to ensure timely detection and resolution of errors in the data. A central project database that is password protected selleckchem 17-DMAG will be established using the UNSW research data portal. This will be the ultimate home of the data and will be established in advance of data collection. Access to the database will be given only to members of the study team and country institutions collaborating on the project such as the MoH. The use of e-data

collection method means that data can be transferred directly from the field to the project central database immediately after collection. There will be a dedicated staff member to receive all data and prepare it for analysis.

The data will be archived using the UNSW long-term data archiving system. Discussion This study seeks to support country efforts towards achieving UHC by providing policymakers in Fiji and Timor-Leste with evidence on the equity of their current health financing arrangements. In Fiji, this involves the application of internationally accepted methods for measuring health financing equity, namely BIA and FIA.49 In Timor-Leste, it makes advances on these standard methods to explore the reasons for the inequitable distribution of healthcare benefits using qualitative and quantitative approaches. Regionally, the timing of the study is ideal. There is growing interest in ‘pro poor’ reforms across the Asia-Pacific region particularly in view of the targets established by the MDGs. The comprehensiveness of this study in terms of covering both the public and private sectors will also mean our findings are relevant to a growing number of countries in the region with a thriving private sector. For Fiji and Timor-Leste the potential benefits from this

study are significant. In Fiji, the study represents the first attempt to undertake a nationally representative household survey on utilisation of healthcare services. Cilengitide It is also the first attempt to use an electronic data collection system in a household survey in Fiji. The recommendations made will assist the FBoS to improve national surveys by capturing essential parameters of healthcare utilisation, health expenditure by households and socioeconomic stratifiers necessary for estimating household wealth indexes. The introduction of e-data collection may also help mobilise support within FBoS for a move from paper-based to electronic data collection, improving further the overall efficiency of data gathering and analysis in the country.