Sometimes, some particular condition attributes cannot be used to distinguish objects; they are redundant. The condition attributes excluding redundant attributes are called reduct in rough sets theory. A reduct is the essential part of an information table which can selleck product discern all objects discernible by the original table. The performance of the specified condition attributes can be described with two indicators:
accuracy of the approximation and quality of approximation. Accuracy of approximation represents the percentage of the associated objects definable with the specified condition attributes. It is defined as follows: αpX=cardA_XcardA¯X, (2) where cardrefers to cardinality. The value of accuracy ranges from 0 to 1. The closer to 1 is the accuracy, the more discernible is the condition attribute, that is, travel mode. It implies that the associated travel mode does exist unambiguously. On the other hand, quality of approximation represents what percentage of the universe is definable. Let X = X1, X2,…, Xn be a classification of U;
that is to say, Xi∩Xj = ∅, ∀i, j ≤ n, i ≠ j and i=1nXi = U. Xi is called class of X. Quality of approximation of classification X by a set of attributes can be defined as follows: γpX=∑i=1rcardA_XicardU. (3) The value of quality ranges from 0 to 1. The closer to 1 is the quality, the more objects of the universe clearly belong to a single class of X. It implies that all travel modes can be clearly identified. To recognize further details of mode choices, rules need to be extracted. Using reduced information table (without redundant attributes), the rules could be found through determining the decision attributes value based on condition attributes values. Therefore, the rules are presented in an “IF condition(s) THEN decision(s)” format. If the condition(s) in the IF part matches with the given fact(s), the decision(s) in the THEN part will be performed. Unlike mathematical functions or statistical models in traditional travel demand forecasting analysis, decision rules induced from a set of raw data can capture and represent both numeric and
nonnumeric variables. In addition, the modular nature of decision rules makes it easy for researchers to insert new decisions rules or to modify/delete existing decision rules without affecting the overall system. Once a set of rules have been derived, it is then that the training stage of the Drug_discovery knowledge discovery finishes and the rules are then tested. 4.2. Theory of Testing The testing stage is relatively straight forward and involves the application of rules to a previously unseen set of data in order to predict mode choice. Fortunately the actual mode choice is known so it is therefore possible to evaluate the predictive ability. This information is usually presented in a confusion matrix  which contains the actual mode choices as rows and the predicted mode choices as columns.
21 We aim to establish the most up to date description of the order innovativeness of new drugs launched in the UK, and to understand whether the recent increase in drug launches represents increasing numbers of highly innovative new drugs being made available, or whether the apparent recovery in launch volumes is due to increasing numbers of drugs of limited additional therapeutic value. We adopted the criteria proposed by Aronson et al1 to define the degree of innovation based on an assessment of clinical usefulness and the nature of the innovation (table 1). Table 1 Criteria for determining clinical
usefulness and nature of pharmaceutical innovation, adapted from Aronson et al1 and Ferner et al10 Methods Data collection and definition of new drugs We obtained data on the numbers and characteristics of new drugs (NCEs and new biological agents) launched in
the UK each year from relevant editions of the British National Formulary (BNF). The BNF lists all preparations available for prescribing and/or dispensing in the UK, including prescription only and over-the-counter medicines. Information on the active ingredient and BNF chapter heading (organised into broad therapeutic areas) for every item in the ‘new preparations’ section of each BNF from edition 41 in 2001 to edition 64 in 2012 was obtained and entered onto a spreadsheet. The BNF also includes non-drug products (nutraceutical and medical foods, natural products, devices and diagnostic products), new salts and esters of existing chemical compounds, and generic or biosimilar preparations; these products
were excluded to leave only new drugs (full details given in online supplementary file 1).19 In addition, active and passive immunisations were excluded from the data as these typically follow different development and National Health Service (NHS) market access pathways to other drugs. Commercial pharmaceutical databases (Pharmaprojects, Informa Healthcare; and Adis R&D Insight, Springer International Publishing) were also used to determine whether a substance was a new drug at the date of UK launch. Different dosages of the same product were counted only once; different formulations of the same product, Entinostat for example, oral tablet and intramuscular injection, were counted once if they contained the same active ingredients, and multiple times if they contained different active ingredients. Different indications for the same product were counted once. Determination of innovation level The criteria proposed by Aronson et al1 (table 1) were used to determine the degree of innovation at the time of launch for all new drugs identified as entering the UK market between 2001 and 2012 (inclusive). Clinical usefulness and the process through which the innovation arose (nature of the innovation) were determined by simple searches of online sources, including the NHS Evidence web portal (http://www.evidence.nhs.
67, R2=0.44, y=1.03×year−2062.0 (p=0.051)) and total new drugs (r=0.81, R2=0.65, y=1.20×year−2385.5 (p=0.009)). In contrast, no linear trends were apparent in moderately innovative or highly innovative new drugs for the purchase ABT-869 same time period (r=0.19 and 0.04, respectively). Table 2 Numbers of new drug launches in the UK and degree of innovativeness by BNF chapter heading, 2001–2012 Figure 1 Numbers of new drug launches in the UK and degree of innovativeness by year, 2001–2012. Considering BNF chapter headings, 6 of the 15 broad therapeutic areas represented over three-quarters of all new drugs, namely malignant disease and immunosuppression; infections; cardiovascular system; endocrine system; central nervous
system; and nutrition and blood (table 2). Each of these provided at least 9% of all new drugs during the study time period, with malignant disease and immunosuppression making up
19.7% of the total. A statistically significantly greater proportion of drugs were coded as highly innovative in two broad therapeutic areas (malignant disease and immunosuppression (p=0.0003, one-tailed χ2 test); and skin (p=0.028)) when compared with the total proportion coded as highly innovative (table 2). In addition, almost 40% of drugs in the nutrition and blood chapter were coded as highly innovative, though the difference from the overall proportion was not statistically significant (p=0.062). In contrast, a statistically significantly greater proportion of drugs were coded as slightly innovative in the chapters for eye disease (p=0.013) and immunological products and vaccines (p=0.014). In addition, 80% of new drugs in the obstetrics, gynaecology and urinary-tract disorders chapter, and all new drugs in the ear, nose and oropharynx
chapters, were coded as slightly innovative, though these results were not statistically significantly different from the overall proportion (p=0.59 and 0.10, respectively), and the latter group included only two drugs. Discussion This is the most up to date study that considers the innovativeness of new drug introductions into the UK. The BNF includes all medicinal products available for dispensing in the UK, and the printed editions were updated every 6 months, providing an accurate and reliable account of Drug_discovery new drugs launched in the UK each year. We identified an upward linear trend in the annual numbers of slightly innovative new drugs launched in the UK since 2004, which aligns closely with the recovery in total numbers of new drug launches seen since that time.19 No apparent similar increase in moderately innovative or highly innovative new drugs was observed. Just six broad therapeutic areas accounted for over three-quarters of new drug introductions, and of these, drugs for malignant disease and immunosuppression, and nutrition and blood disorders were also more likely to be categorised as highly innovative.
Patient claims data were matched to the hospitals where each patient was admitted.
Hospital-level data included fty720 PP2a characteristics of the hospital, such as hospital type (specialty, tertiary, large, small), number of beds (in 100 bed increments), specialists per 100 beds, nurses per 100 beds, hospital location (metropolitan if located in cities with a population of more than one million), teaching status and bed occupancy rate. According to the Korean Hospital Association, Korean hospitals are categorised into three groupings based on bed size: (1) hospitals with over 1000 beds: tertiary research university hospitals, (2) hospitals with 300–1000 beds: mid-sized general hospitals and (3) hospitals with 100–300 beds: small general hospitals. The specialty hospitals and the small general hospitals in our study both fell within category 3 (small general hospitals).21 The hospital level data were obtained from the Agency for Health Insurance Review and Assessment Services. In order to investigate the post
policy designation effect, we included the interaction term of type of hospital and year, which we named designation effect. We also included data envelopment analysis (DEA) using efficiency as the dummy variable (1=efficient, 0=non-efficient) to determine whether hospitals were operated efficiently using a conventional technical efficiency measuring technique.22 It is derived from microeconomics methodology where input and output combinations are depicted
using a production function to measure the efficiency of multiple decision-making units (in this case hospitals) when the production process presents a structure of multiple inputs and outputs.22 Input variables included number of beds, surgical beds, recovery beds, specialists, residents, nurses, physical therapists and pharmacists; and positron emission tomography, CT and MRI units of each hospital. Output variables included total number of inpatient cases and AV-951 sum of charges in 2011 and 2012 study periods for each hospital. Hospital-level statistics were collected based on their first quarter of 2012 status, which was the only available data set at the time of this study. Analytical approach Mean and SD were analysed for continuous variables; frequency and per cent were analysed for categorical variables. Univariate analysis of inpatient charges, LOS, readmission within 30 days of discharge and mortality within 30 days of admission was performed to investigate the unadjusted effects of hospital types on these measures. Analysis of variance and χ2 tests were performed for identification of group differences.
The six exercise sessions presented within the other two DVDs are comprised of an orchestrated sequencing of progressions (ie, beginning with simpler, more basic AZD9291 movements, and then building on exercises learned to ultimately engage in more complex movements). Delivering the exercise programme in such a manner helps to ensure that new challenges are built on a previous foundation and to help minimise the risk of injury. Participants will be instructed to inform research staff of any adverse events that might occur as a result of participation. This information will be documented, reported to the Institutional Review Board, and discussed in future publications regarding study outcomes. Furthermore, each
of the exercises presented within the DVDs will include two additional versions that vary in difficulty to make the exercises more attainable or challenging for individuals of varying functional capabilities and to further reduce the risk of injury. Using the standing military press exercise as an example, the exercise leader will instruct participants to stand straight with their feet in a staggered position while placing the centre of an exercise band directly between the front foot and the floor. She will then instruct them to grab the handles of the bands and position their hands so that the palms face forward/outward (ie,
towards the direction of the TV for those doing the exercise at home). Next, participants will be told to form a ‘goal post’ type position with their arms (ie, elbows in line with shoulders and forearms perpendicular with the ground). From this starting position, participants will be told to extend their elbows and press/raise their hands straight up over their head in a slow and controlled manner and up to the point where their thumbs almost touch. They will then be instructed to slowly lower the band back to starting position to complete one repetition. To modify the military
press, participants will be encouraged to use light hand weights as opposed to standing on an exercise band, as this will provide less resistance and greater range of motion. To make the exercise more challenging, participants will be instructed to stand with both feet evenly spaced on the band while performing the movement, which will considerably increase the level of resistance. Participants in the FlexToBa group will be instructed to exercise with the DVDs on a regular basis (ie, Carfilzomib every other day or at least three times per week) and to complete and mail in the exercise logs on a monthly basis via previously provided self-addressed stamped envelopes. These logs will be collected and entered by select, unblinded research personnel, who will also be responsible for generating and mailing personalised programme feedback to the corresponding participants for each of the six monthly exercise sessions.
Further high-quality prospective clinical trials are urgently needed in demonstrating the safety, benefits
and optimal modes of deprescribing, especially in relation to multimorbid older people.61 64 The fog of polypharmacy else clouds a prescriber’s capacity and confidence to identify PIMs which, to be overcome, requires complete and accurate clinical information and decision support. Professional organisations and colleges have an important role in encouraging the necessary cultural and attitudinal shifts towards ‘less can be more’ in appropriate patients. The push for guideline adherence and intensification of therapy needs to be counterbalanced by the view that judicious reduction, discontinuation or non-initiation of medication, in the context of shared decision-making and agreed care goals, is an affirmation of highest quality, individualised care.65 This view needs to be embraced in the education and training of all health professionals, not just doctors, who influence the prescribing process. Prescribers are making decisions in the face of immense clinical and health system complexity. Appropriate deprescribing needs to be regarded as equally important and achievable as appropriate initiation of new medications. Understanding how
prescribers perceive and react to prescribing and deprescribing contexts is the first step to designing policy initiatives and health system reforms that will minimise inappropriate overprescribing. Supplementary Material Author’s manuscript: Click here to view.(2.4M, pdf) Reviewer comments: Click here to view.(147K, pdf) Acknowledgments The authors thank the University of Queensland librarians Mr Lars Eriksson and Ms Jill McTaggart for their assistance in developing the search strategy
and Ms Debra Rowett for her invaluable insights when scoping the search and developing the manuscript. Footnotes Contributors: IS conceived the paper, the scope of which was refined by all authors. KA searched the literature, led AV-951 the data analysis and drafted the manuscript. IS and DS read articles and assessed the data analysis for comprehensiveness and reliability. IS, DS and CF provided critical comments and contributed to the interpretation of the analysed results and framework development. All authors read, revised and accepted the final draft. Funding: KA and IS are funded through a National Health and Medical Research Council grant under the Centre of Research Excellence Quality & Safety in Integrated Primary/Secondary Care (Grant ID, GNT1001157). Competing interests: KA received a speaker honorarium for an Australian Association of Consultant Pharmacy presentation. DS reports personal fees from the National Prescribing Service, outside the submitted work.
Theoretical framework The study will take a social constructionist approach to understand patients’ meaning-making in relation to non-emergency cardiac symptoms.46 This approach starts from the view that individuals and groups construct or create their realities, influenced
by multiple factors including sex, culture, www.selleckchem.com/products/ABT-888.html ethnicity and expected social behaviours. It also considers the consequences of these social constructions, for example, a belief that women do not get heart disease is likely to impact on help-seeking. Semistructured interviews using an interview guide will be used to ensure we uncover the meaning patients attribute to their circumstances, and cover topics considered important to the project. Sampling Maximum variation sampling will be used in order to
capture a wide range of perspectives within the phenomena being studied.47 The sampling dimensions are sex, age and ethnicity to ensure the recruitment of a heterogeneous sample and will include at least: Four male patients >50 years of age and include a mixture of white and ethnic minority participants. Four female patients >60 years of age and include a mixture of ethnic minority and white participants. Four male patients <50 years of age and will include a mixture of ethnic minority and white participants. Four female patients <60 years of age and include a mixture of ethnic minority and white participants. The sample will be drawn from referrals to the rapid access chest pain clinic (RACPC), which specialises in the assessment of non-emergency cardiac symptoms (stable angina), at Queen Mary's Hospital, Roehampton. The RACPC operates on Mondays and Thursdays and sees over 80 patients a month. The service covers a large and highly diverse catchment area, making
it the ideal centre to capture the maximum variation required. Recruitment Recruitment will last approximately 12 months, starting February 2014 and continue until data saturation, that is, no new themes important to the project are being elaborated on. It is envisaged a sample of 20–30 participants will be recruited. Although this sample might be considered Entinostat too small for quantitative research, in qualitative research it is considered that this sample is large enough to reach saturation of concepts. Indeed, Baker and Edwards expert discussion paper suggests saturation can be achieved with as low as 12 participants with the average being 30 participants.48 Similar studies in gender comparison work have shown concept density (saturation) at around 20 participants.19 43 Referrals, medical records and the Patient Administration System (PAS) system will be used to identify candidates who meet the inclusion/exclusion criteria, as detailed in table 1.
48 Supplementary Material Reviewer comments: Click here to view.(6.9K, pdf) Acknowledgments The authors thank Susie Bernier for the translation and Isabelle
Gaumond for the final revision of the manuscript. Footnotes Contributors: concerning CH, M-CC and MC initiated the project and designed the study. AB (implementation analysis), EMC (health literacy), M-FD (statistical analysis), MF (multimorbidity), TF (case management), CL (poverty), JM (healthcare database), PP (participatory research), PR (mental healthcare) and CR (case study) provided specific expertise. All authors contributed to the redaction and approved the final version of the manuscript. Funding: This work is supported by the Canadian Institutes of Health Research (CIHR) grant number 318771. Competing interests: None. Ethics approval: The research protocol was approved by the Ethics Research Boards of the four HSSCs involved (Chicoutimi, Jonquière, Alma and La Baie). Provenance and peer review: Not commissioned; internally peer reviewed.
Attention deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder and affects 3–5% of children and young people.1 The core symptoms of ADHD include poor attention,
hyperactivity and impulsivity. National Institute for Health and Care Excellence (NICE)1 guidelines provide a blueprint for the diagnosis and management of ADHD in England and Wales and indicate the need for young people with ADHD to have access to the best evidence-based care in order to fulfil their potential and prevent poor outcome. However, in practice, delivery and quality of care is ad hoc, with little consistency in assessment,
diagnosis or management.2 ADHD frequently coexists with other neurodevelopmental and psychiatric disorders and is a risk factor for major educational, social and occupational impairment, placing a huge burden on the National Health Service (NHS), social care and criminal justice systems. There has been a rapid growth in diagnosis over the past 30 years with the number of children recognised and treated for ADHD in the UK increasing almost 10-fold from the early 1980s1 and spending Entinostat on medication for ADHD increasing sevenfold between 1998 and 2005.3 The cost of initial specialist assessment for ADHD is estimated at £23 million annually in England and Wales4 and drug costs for ADHD in England during 2012 was expected to exceed £78 million3 while indirect costs to families include parental mental ill health, time off work and loss of earnings are even higher.5 Increasing recognition of ADHD as a lifespan condition is placing a new demand on the NHS to provide diagnostic and treatment services for children, adolescents and adults, exposing serious limitations in existing methods of assessment and management. There is no single test, or biomarker used to diagnose the disorder.
74). The grades were totalled to create a composite score: the lower the score, the better the knowledge. The scores were dichotomised by the median score to those who demonstrated reasonable knowledge and those whose knowledge was insufficient. In order to enough measure negative affective status, the ULCA Loneliness Scale21 and the Sexual Sensation Seeking Scale22 were used.
Statistical methods Analyses were performed using χ2 or Fisher’s exact tests for associating the categorical variables. Continuous variables were analysed by Student’s t test or by the Mann–Whitney non-parametric test for variables distributed abnormally. Logistic analysis identifying variables predicting high-risk sexual behaviour or excessive anaerobic training included variables with p<0.05 after assessment for collinearity and normal distribution
in backwards fashion. The model generated ORs and 95% CIs. Confounding between IAT, sexual risk and sexual orientation, as well as interaction between sexual orientation and IAT, among high-risk participants were assessed using 2-by-2 tables. Analysis was conducted using the SPSS V.17.0 package for Windows software. The study was approved by the E Wolfson Medical Centre Institutional Review Board (WOMC-0058-09). Results Of approximately 600 men who were approached in five gyms in central Tel Aviv, 379 who were older than 18 years of age and reported more than one act of sexual intercourse in the preceding 6 months completed the questionnaire. Of these 379 men, 182 (48%) were MSM (154 reported sex exclusively with men and 28 engaged in sex with both men
and women), while 197 (52%) were heterosexual. The mean±SD age of all the participants was 31.9±6 (range 18–60) years. MSM versus heterosexual men In comparison with heterosexual men, MSM were more likely to be Israeli-born, have lower BMI, have followed a dietary regimen, and used protein supplement powders or anabolic steroids (table 1). They also reported a greater number of casual sex partners and more commonly used drugs before or during sex. MSM demonstrated a Anacetrapib stronger desire to become muscular (OR for preferring to be muscular than rich 3.0, 95% CI 1.9 to 4.9, p=0.01), and a greater percentage reported performing IAT than heterosexual men. Body shaping and improving self-confidence were the main reasons of MSM for training, while losing weight and improving health were more predominant reasons among heterosexual men. The threat of HIV perceived by MSM was lower than that perceived by heterosexual men, yet MSM considered themselves to be at higher risk of acquiring HIV/STI and had higher sexual desire scores than heterosexual men.
There was also a correlation between traffic volume within 100 m of a residence and a modest increase in the rate of lung cancer (HR 1.09 (CI 0.99 to 1.21)). No similar correlation was found with NOx air pollution. This suggests that long-term exposure to higher levels of particulate matter air pollution may increase the incidence of lung cancer in a
population. Another study published selleck catalog in the USA in 2004 looked at the long-term effect of exposure to particulate matter air pollution and the mortality attributed to different cardiovascular and respiratory diseases in different areas of the USA.4 A good correlation was found between the degree of long-term exposure to Pm air pollution and increases in mortality from cardiovascular diseases, including heart failure.
Interestingly, this was not found to be the case for most respiratory diseases. There was also an element of the study that looked at the effect of a person’s smoking status on the mortality statistics. This found, as expected, a strong link between mortality and smoking. However, it also found that air pollution contributed additional cardiovascular mortality risk on top of that attributed to smoking. This was at least an additive, if not a synergistic effect. Methods Study data In order to carry out this project, data were collected on the geographical distribution of air pollution within Warwickshire. These data included information about each of four individual components of air pollution (NOx, sulfur dioxide, particulate matter and benzene), which could then be united into a combined index (all of the contributions added together). A single recorded level from 2010 of each air pollutant for each ward was used in the study. This was then compared to collected data about: The geographical distribution of home addresses of patients who were admitted to hospital because of heart failure or a complication of heart failure. Hospital admission rate in an area due to heart failure was used as a proxy indicator for the level of heart
failure morbidity within that area. The geographical distribution of home addresses of patients who died from heart failure, or whose death was contributed to by heart failure. These data were collected by the Warwickshire Anacetrapib Observatory, which is part of the Warwickshire County Council in charge of collecting and handling statistics relating to the county. Mortality data for the analysis were supplied via the Warwickshire Public Health Intelligence Team and was sourced from the Public Health Mortality Files, Office for National Statistics. Hospital admissions data were accessed via the Ventris Business Intelligence System, Arden Commissioning Support Unit. Ward level population data were obtained from the 2011 census. Warwickshire is divided into 105 wards. Data from all of the 105 current Warwickshire County wards were collected.