In the following, we will analyze the result of our NILP algorith

In the following, we will analyze the result of our NILP algorithm on a real DBLP coauthorship

network. Since the network DBLP does not provide a standard result which can be used kinase inhibitor to compare, we assess the correctness of the obtained communities by referring to the data source of the network. The proposed method detected 3,466 communities of different sizes in this network. Table 3 lists the five real communities detected. Due to the limitation of space of our paper, only seven members are listed for each community. As can be seen from Table 3, the Community [1] and Community [2] are experts and scholars in the field of data mining in which Philip S. Yu and Jiawei Han are regarded as their leading figures, respectively. Community [8] is composed of the experts and scholars in database who are from InfoLab laboratory at Stanford University. Community [188] comprises experts and scholars from CMU in the field of machine learning and Community [346] is constituted by experts and scholars in the field of information retrieval. It can be observed that scientists from one community, detected by our algorithm, are often in the same realm of research, which accounts for their frequent academic collaboration. In the same field, usually there are multiple communities which are formed from different work teams. In a team, often there is a common

or similar research direction and long-term cooperation, while different work teams will rarely have chance to collaborate. Consequently, the community detection result obtained from DBLP via the proposed algorithm is sound and accurate. Table 3 The accuracy comparison of various label propagation algorithms in networks with ground truth of community structure. 4.4. Evaluation on Synthetic Networks We also evaluate the performance of our algorithm on synthetic networks. Figure 6 illustrates the comparison of accuracy for community detection of four label propagation

based algorithms LPA, LPAm, LHLC, and 2-NILP. The mixing coefficients of the 1000-node synthetic networks in Figure 6(a) and 10000-node networks in Figure 6(b) both range from 0.1 to 0.8. It can be observed that the accuracy of LHLC is relatively low compared with the other three algorithms. Algorithms LPA, LPAm, and NILP have higher values of NMI. When the number of GSK-3 nodes is 1000, as shown in Figure 6(a), the accuracy of 2-NILP is obviously better than that of the algorithm LPA. When mixing coefficient is less than 0.55, 2-NILP has equal accuracy with the algorithm LPAm, while when mixing coefficient is greater than 0.55, 2-NILP is significantly better than LPAm. When the number of nodes is 10000, as shown in Figure 6(b), the accuracy of our algorithm 2-NILP is superior to the other three algorithms. Figure 6 The NMI values varying with the mixing coefficient achieved by four label propagation algorithms on the synthetic networks. 4.5.

Yet fatigue, reduced out-of-hours

Yet fatigue, reduced out-of-hours PI3K activation resources and more limited access to senior obstetric support are factors that prevail when performing OVDs at night. Several studies have reported higher levels of morbidity and mortality in relation to operative interventions performed outside routine working hours.13–15 Few studies to date have addressed OVD outcomes in relation to time of birth. The purpose of this study was to evaluate maternal and neonatal outcomes associated with OVDs performed by day and at night. The findings will contribute to the debate on safe obstetric care and workforce planning and have important implications for all surgical specialties where emergency care is required at

night. Methods The Coombe Women and Infants University Hospital, Dublin is a consultant-led university teaching hospital with between

8500 and 9000 deliveries annually. The OVD rate in 2012 was 15% (30% in nulliparae) and the CS rate was 27%. Maternal and neonatal care is provided by an interdisciplinary team of midwives, obstetricians, anaesthetists and paediatricians. Routine care on the labour ward is provided by midwives with medical rounds taking place twice daily at 08:00 and 17:00. Obstetricians in training are allocated to the labour ward and receive direct or indirect supervision depending on their level of experience and expertise. Consultant support is readily available between the hours of 08:00 and 20:00 when consultants are usually on-site. Consultants are likely to be off-site between the hours of 20:00 and 08:00 and provide an on-call service to the labour ward. In addition, consultants attend the delivery of private patients (approximately 15% of the overall caseload),16 and any consultant who is on the premises at the time of an emergency will provide immediate assistance. At night, there are either one or two obstetric trainees resident on-call, depending on experience, and one on-call consultant who is non-resident. Labour ward protocols for OVDs are in accordance with the RCOG Guidelines.3 The on-call consultant is expected to attend for all second stage CSs, all OVDs conducted in an operating theatre (complex procedures usually involving

a malposition or mid-cavity station) and whenever the obstetric trainee (or senior midwife) requests support. Cohort All women who required an OVD were eligible for inclusion in the Carfilzomib study if they were nulliparous (no previous delivery ≥24 weeks of gestation), with a live singleton pregnancy and a cephalic presentation at term (gestation of ≥37 weeks). A team of research midwives and obstetricians identified participants from daily labour ward records and the electronic maternity database. The recruitment period took place from 1 February 2013 to 19 November 2013. We recorded detailed data on each mother and baby up until the time of hospital discharge. The study was non-interventional and required no direct patient contact, and no request for follow-up information.

Interpretation We found no significant associations between time

Interpretation We found no significant associations between time of OVD and maternal and neonatal morbidities. This is consistent with two previous studies.20 21 The US Maternal-Fetal Medicine Units Network Cesarean Registry found no association between change of shift for physicians

and maternal or neonatal morbidity following an unscheduled ATM inhibitor clinical trial CS.20 Another US study found no difference in timing of birth and resident duty-hour restrictions on outcomes for small preterm infants.21 However, a recent retrospective cohort study in the Netherlands found that evening (18:00–22:59) and night-time (23:00–07:59) deliveries requiring obstetric interventions or labour augmentation were associated with increased perinatal morbidity and mortality.13 Another retrospective study evaluating neonatal morbidity in an unselected population found increased rates of emergency CS and NICU admission during the hours of 23:00 and 03:00.14 Varying study designs, obstetric environments and limited ability to control for confounding factors may have contributed to the conflicting findings. We found a higher rate of shoulder dystocia during the day, which was unexpected but may reflect our policy of prioritising

inductions of labour for pregnancies with suspected macrosomia and diabetes early in the day. Operator inexperience has been linked to excessive number of pulls at OVD, use of multiple instruments and CS for failed OVD, all of which increase the risk of trauma to the mother and neonate.8 22–25 It was perhaps surprising that there was no evidence of excess morbidity at night, even though a greater proportion of deliveries were performed by mid-grade operators with access to a consultant but in most cases no direct supervision. It was also notable that the mean decision-to-delivery intervals were under 15 min in both time periods.26 Our findings suggest that consultant support was available when necessary

and that the travel time associated with attendance from home did not compromise patient care. Fewer OVDs were completed by mid-grade operators during the day, which was directly related to a higher proportion of daytime deliveries performed by junior operators. From a training perspective, it GSK-3 is essential that obstetricians have opportunities for both direct and indirect supervision in order to develop clinical decision-making skills and this appears to happen for mid-grade operators more often at night. The overall complement of staff available at night is another important consideration. The obstetric staffing for a unit of this size falls below the recommended levels described by the RCOG.27 This is probably the case for many units in the UK and Ireland.

They even felt unwilling

They even felt unwilling selleck bio to discuss

their treatment plan with their physicians because they believed that whatever physicians said was right and patients should always obey their physicians. On some occasions, they admitted they could not openly communicate with their physicians due to unwillingness to challenge their authority. I will follow whatever the doctor tells me. It would be strange if the doctor discusses the treatment plan with me, and it is unnecessary for the doctor to do that. I have never accused the doctor for anything wrong. Just like a child and his father—the doctor is like our parent, and whatever he says is correct. If … the doctor has said something wrong, and I notice it … then I know more than the doctor. That’s impossible! (Participant 16, male) The strong sense of respect for doctors seemed to hinder the development of Chinese immigrants’ capacity to obtain additional information about their treatment regime (HL1), communicate their needs and preferences with professionals (HL2), and process information about treatment plans (HL3). Desire to avoid being burdensome to others Participants stated that they tried to avoid burdening people around them, especially their families. Most of the participants shared common experiences. Some felt uncomfortable affecting

the dietary habits of their family members. They believed that low-sugar and low-fat diets for people with diabetes were neither appetising nor of high quality. Therefore, they did not want their family members to suffer because of

their own dietary restrictions. “I do not want the whole family to have less tasty food. … Shanghai people like sweet stuff. I do not want to ask them to put less sugar [in the food]” (Participant 16, male). Most of the participants also stated they felt embarrassed about taking time and energy away from healthcare providers to address their health concerns. They considered the key responsibility of physicians and nurses to be curing or treating diseases. They did not expect physicians and nurses to take an active role in health education via discussions. Many of the participants felt it was impractical Anacetrapib for nurses to provide extra services, such as conducting patient support groups, during non-office hours. The participants stated that health professionals were busy enough and they did not want to bother them. Because the nurses should have the weekends off. … It is impossible for the clinic to provide us with nurse-led support groups in a frequent manner, such as weekly or monthly. In fact, there is an alternative way to do this: all of us can exchange our phone numbers and we will contact with each other if we have time.

12 AYUSH doctors contracted to Medical Officer posts in PHCs in t

12 AYUSH doctors contracted to Medical Officer posts in PHCs in the southern Indian state of Andhra Pradesh report numerous lacunae in the implementation of the mainstreaming initiatives in the NRHM:13 job perquisites are not indicated; no benefits or allowances are

provided for health, housing or education, and compensation packages are much lower than those of allopathic doctors. Support for AYUSH practice is also inadequate (lack of infrastructure, trained assistants and drug supply) and unethical practices have also been reported (documenting attendance of absentees, and non-cooperation from non-AYUSH personnel). Evidence from NRHM suggests that reshuffled AYUSH providers practise forms of medicine beyond the scope of their training.14 Paradoxically, moreover, some Indian states prohibit cross-system prescription, adding ethical dilemmas for TCA practitioners who serve as the only medical practitioners in resource-poor areas.14 On

a larger scale, current practices of integration (as in NRHM) have been described as substitution and replacement; which tend to ignore the merits of TCAM and present more barriers than facilitators of integration.7 In particular, given the strong push towards co-location and other strategies of integration as part of India’s move towards Universal Health Coverage, the integration of AYUSH practitioners could result in a doubling of the health workforce. Yet there are strong fears that such an emphasis on quantitative aspects of integration, that is, having the right number of practitioners placed at facilities, is inadequate. There is a need to critically and qualitatively appraise the government infrastructure to support TCA, identify barriers and facilitators to integration that have emerged from this rapid placement of these practitioners, and how these TCA practitioners, allopathic practitioners and health system

actors are reacting and adapting to each factor. Methods This analysis draws from a larger mixed-methods implementation research study aimed at understanding operational and ethical challenges in integration of TCA providers for delivery of essential health services in three Indian states. The study looked at the contents and Brefeldin_A implementation of TCA provider integration policies in three states, and at the national level it examined the understanding and interpretations of integration from the perspectives of different health system actors. These, coupled with their experiences in the actual processes of integration of TCA providers, were studied using qualitative interview methods to help identify systemic and ethical challenges. Based on this, the study sought to derive strategies to augment the integration of TCA providers in the delivery of essential health services. Our study was based on action-centred frameworks15 with a focus on policy actors and processes.16 We have therefore sought to understand the implementation of integration policies empirically.

Provenance and peer

Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available.
The late 20th and early 21st centuries have been marked by rapidly increasing interest in and provision of humanitarian work. The number of organisations with expertise in disaster and emergency relief

increased fivefold in the early 2000s.1 Currently, there are between 3000 and 4000 non-governmental organisations (NGOs) in the Northern industrialised states operating internationally, including development, relief and social organisations.2 Worldwide, around 19 million people are employed by some kind of NGO and engaged in humanitarian efforts.3 There is greater public visibility of humanitarian emergencies, natural and manmade alike; coverage of events such as the Sri Lankan tsunami, Hurricane Katrina, the earthquake in Haiti and Arab Spring highlights the immense human cost of humanitarian crises, increasing awareness and interest in relief work.4–6 While international health experience was once a fringe element in medical practice and education, it is now more widespread and acknowledged for its valuable contribution of increasing understanding of international health issues, and diversifying practitioners’ capabilities

and contributions to this field.7–9 Limited literature exists to characterise, define and describe the population of medical aid workers, and assess their experiences and the conflicts they face with potential impact on the overall aid community.3 10–12 The humanitarian field itself is heterogeneous, with organisations varying widely in affiliations and philosophies.

Potential discordant interests—among different aid organisations and/or individual aid workers—due to differing motivations, perspectives, training and competencies may contribute to high turnover and burnout rate. These have critical implications for the nature and quality of humanitarian interventions, as well as the prospects and expectations of the profession itself seeking to retain professional aid workers and maintain expertise,13 14 and may impede proper interagency and intra-agency collaboration and coordination, and adversely impact the overall Batimastat effectiveness of aid operations.15 16 Characterising shared understanding, attitudes and experience provides an opportunity to reinforce collective motives and efforts, and enhance synergy, human resource support and overall humanitarian efforts. Using qualitative data is one of the best ways to elicit relevant information from participants’ perspectives, especially regarding philosophical and ideological underpinnings of their work.

Work absenteeism For England, the HSE 2010 question “Over the las

Work absenteeism For England, the HSE 2010 question “Over the last 12 months, how many days has your wheezing/whistling in your chest, shortness of breath or difficulty in breathing caused you to be absent from work?” will be used among asthma respondents. Sickness-leave data from the Northern Ireland civil service from the Department of Finance and Personnel will be used on workdays lost due to asthma.33 We were unable to find any suitable data sources for Scotland and Wales. Workdays lost due to occupational asthma will be obtained from 2005 onwards from The Health and Occupation Research Network, which collates data from a research

network of over 2000 specialist physicians and specially trained GPs throughout the UK.34 Care-at-home We have been unable to identify any suitable data to estimate costs of care-at-home for asthma from England, Scotland and Northern Ireland.

The only data we have identified come from a recent project undertaken by the Swansea Centre for Health Economics in collaboration with the Swansea Social Services available in SAIL, detailing home-care service packages and costs to people aged 50 years and above and living within the city and county of the Swansea council area.35 Disability living allowance There are aggregated data available from DWP on a number of people receiving DLA, total DLA amount and expenditure on people receiving DLA due to asthma for England, Scotland and Wales for 2011–2012.9 For Northern Ireland, there are data available from the Department for Social Development on the number of people with asthma receiving DLA and total amount by age group, gender and SES from 2008.36 Premature retirement So far, no data source has

been identified. Mortality Mortality data with a primary or secondary cause of asthma from death certificates, coded using ICD-10, are available from the Office of National Statistics for England and Wales,37 the Northern Ireland Statistics and the Research Agency and General Register Office for Scotland.38 39 Covariates We aim to present the estimates of incidence, prevalence and healthcare utilisation by age, gender, SES and ethnicity, where data for these covariates are available, provided risks of individuals’ Cilengitide identity being disclosed is not compromised. For cost estimates, the covariates will be limited to the primary covariates of age and gender. For age, estimates will be given for children (aged under 15 years) and adults (15 years and above). In addition, to facilitate comparisons of prevalence estimates with results from the International Study of Asthma and Allergies in Childhood, we will also present estimates of prevalence by age groups 6–7 and 13–14 years.1 Gender will be classified as male and female.

Laboratory detections of rotavirus from Public Health England Lab

Laboratory detections of rotavirus from Public Health England Laboratory surveillance covering Merseyside residents will be included in the analysis. Other causative agents of AGE identified thing through laboratory testing including, for example, norovirus, adenovirus and astrovirus will also be extracted for analysis. Each data set will cover at least 3 years either side of vaccine introduction. All data will be pseudoanonymised to allow distinction of records but no linking

of data sets or identification of individuals will be undertaken. All data will be either geocoded from postcode to small statistical geographical community units termed Lower Super Output Areas (LSOAs) or sourced with this geography. LSOAs consist of approximately 1500 persons and denominator populations will be derived from the Office of National Statistics (ONS) mid-year population estimates by LSOA.29 Indicators of socioeconomic deprivation at LSOA level will be measured using the English Indices of Deprivation.

The UK Department for Communities and Local Government produce the English Indices of Deprivation using census and other local administrative data.28 Rotavirus vaccination uptake data will be sourced from the Child Health Information System (CHIS) which is held by community NHS health Trusts in Merseyside. Records of doses of vaccinations given as part of the UK childhood vaccine schedule are recorded in CHIS for each child. Quality control Data sources

such as HES and laboratory detections will be influenced by testing practices; for instance, testing of some organisms is more likely to occur at certain times of the year. In the hospital admission data set, it is possible that some cases of RVGE will not be coded as rotaviral enteritis (ICD10: A08.0) and may be classified as other unspecified either due to an absence of laboratory confirmation or misclassification/miscoding. In order to attempt to quantify this information bias, the investigator team will perform quality control on hospital admissions and laboratory detections at the lead NHS Trust hospital site (Alder Hey). Using a sample of cases from at least 3 years, those cases with a laboratory confirmation will be checked against clinical records and clinic coding and Brefeldin_A those coded as ICD10 A08.0 rotaviral enteritis will be cross-matched against laboratory detections. Based on the results of this assessment, it may be necessary to adjust the recorded number of hospital admissions for any ascertainment bias identified. Ethical considerations The study has been approved by NHS Research Ethics Committee, South Central-Berkshire REC Reference: 14/SC/1140. Data sharing agreement will be obtained between PHE, participating NHS Trusts and the University of Liverpool. Research governance approval will be sought form all participating NHS Trusts and Clinical Commissioning Groups.

18 In the UK, the burden of RVGE in older children and adults is

18 In the UK, the burden of RVGE in older children and adults is difficult to estimate but admissions for AGE are 2 per 1000 population in 5–14-year-olds and 7 per 1000 in those 15+ years.19 Hence monitoring changes

in AGE incidence in non-vaccinated older children and adults is critical to assess indirect jq1 impact. Ecological rotavirus vaccine effectiveness studies have primarily focused on mortality, hospitalisations and laboratory detections as a measure of burden.20–27 Severe cases of rotavirus infection will often end up in hospital and receive full diagnostic evaluation. However, many cases of rotavirus infection, particularly in older children and adults, will not attend hospital but will be seen by primary and community healthcare providers. Therefore, in order to better understand the burden of RVGE and AGE on all ages and the impact of routine immunisation on the health system, it is crucial to

examine routine data sources for all health service providers in a defined study area. Taking advantage of a range of regional healthcare facilities in Merseyside, UK, we describe a protocol for an ecological study which will use a ‘before and after’ approach allowing comprehensive evaluation of the direct and indirect vaccine impact following the introduction of the monovalent rotavirus vaccine into the UK’s routine childhood immunisation programme. We will investigate the relationship between socioeconomic deprivation, and vaccine uptake and disease burden. These data will provide evidence to support future rotavirus vaccination in the UK and will inform rotavirus immunisation

policy in other Western European countries.6 Methods Study aim Routine data sources will be used to estimate the direct and indirect effects of monovalent rotavirus vaccination on gastroenteritis indicators in the population of Merseyside, UK, and their relationship to vaccine coverage and sociodemographic indicators. We also hope to identify the key areas that require extended and improved data collection tools to maximise the usefulness of this surveillance approach. The main outcome measures are: Laboratory detections of rotavirus in faecal samples; Admissions to hospital for RVGE or AGE; Attendances to EDs for AGE; Number of nosocomially acquired cases of RVGE; GP and community consultations for diarrhoea and AGE in children less than 5 and in all Batimastat ages; Routine rotavirus vaccine coverage mapping by small area geography; Relative contribution of direct (those vaccinated) and indirect (not vaccinated) effects to overall vaccine benefit in health system usage for both RVGE and AGE; Relationship between socioeconomic deprivation, vaccine uptake and RVGE/AGE incidence. Study setting and location The study will be conducted in the large metropolitan area of Merseyside in North West England which contains the city of Liverpool. Merseyside has a population of nearly 1.

Further improvements in VO2max with longer periods of training ar

Further improvements in VO2max with longer periods of training are due to peripheral changes of enhanced oxygen extraction with an increased capillary density of skeletal muscle (Ekblom, 1968). In the presence of improved stroke volume, the increased filling time requirement between each heart beat selleck bio (i.e., a longer diastolic phase) results in a lower HRrest (Powers and Howley, 2012). Since a change in HRmax following training is not typical, it could be theorized that the difference between resting and maximal HR would increase after a period of chronic

endurance training. If this occurred, then a larger HRindex (i.e., HRmax – HRrest) and a greater pVO2max derived by the equation would have resulted. However, a change in the HRindex following training was not demonstrated in the current study mainly because neither the prediction variables (i.e., HRrest and HRmax) changed from pre to post. Therefore, pVO2max did not increase following the training program despite an increase in aVO2max. As noted previously, the HR is a parameter of Q that increases or decreases in response to a respective decrease or increase in stroke volume. As a result of no change in the HR parameters, we can conclude no subsequent

change in stroke volume took place in the studied sample. Therefore, perhaps the improvement in aVO2max following the training program was primarily due to an improvement in peripheral oxygen extraction (i.e., increased a-vO2diff), which was not accounted for in the HRindex equation. Though this is a reasonable explanation of the findings, it is only speculative as blood gases were not analyzed in this investigation. At any rate, the HRindex equation did not reflect improvements in observed VO2max in the group of competitive

female collegiate athletes. Another explanation of the findings may be due to how the HRrest was determined in the current study. Among the 60 studies reviewed by Wicks et al. (2011) that were used to develop Batimastat the HRindex equation, only 12 documented how the HRrest was recorded. Therefore, comparing how the HRrest was determined in the current study to all of the studies reviewed by Wicks et al. (2011) is impossible. Currently, there are no accepted standard recommendations for recording the HRrest, despite its importance as a prognostic variable related to cardiovascular disease risks (Fox et al., 2007). Standardization of methods could possibly decrease prediction error associated with the HRindex equation and enhance the utility of the HRrest for predicting VO2max. Future research in this area is needed. Although aerobic power is an important contributor to soccer performance, it should not be the exclusive focus when testing athletes from this population.