Analysis of social barriers to sustainable innovation and digitisation in supply chain.

Organisations are consistently becoming more and more conscious about sustainability issues that are being raised on various platforms by regulatory bodies and other social activists. Digitisation of supply chains and other technologies like recycling has emerged as one solution that helps achieve sustainability goals by bringing more transparency into the system regarding emissions. Adopting these sustainability and digitisation-related technologies in the supply chain is a major issue, and there are many social issues related to their implementation and adoption. This study aims to identify social barriers to sustainable innovations and digitisation in the supply chain. A total of eight barriers are identified and analysed using BWM and DEMATEL methodologies. The results indicate that work-related circumstances and employment disruptions are the most prominent social barriers, which also influence other barriers. Organisations need to hire and train manpower in skills related to sustainable and digitisation technologies to secure their jobs and facilitate the adoption of these technologies in the supply chain.

Volume-outcome relationships in open and endovascular repair of abdominal aortic aneurysm: administrative data 2006-2018.

BACKGROUND: The aim of this study was to use recent evidence to investigate and update volume-outcome relationships after open surgical repair (OSR) and endovascular repair (EVAR) of abdominal aortic aneurysm in England. METHODS: Hospital Episode Statistics (HES) data from April 2006 to March 2018 were obtained. The primary outcome was in-hospital death. Other outcomes included duration of hospital stay, readmissions within 30 days, and critical care requirements. Case-mix adjustment included age, sex, HES year, deprivation index, weekend admission, mode of admission, type of procedure and co-morbidities. RESULTS: Annual volume of all repairs combined appeared to be an appropriate measure of volume. After case-mix adjustment, a significant relationship between volume and in-hospital mortality was seen for OSR (P < 0·001) but not for EVAR (P = 0·169 for emergency and P = 0·363 for elective). The effect appeared to extend beyond 60 repairs per year to volumes above 100 repairs per year. There was no significant relationship between volume and duration of hospital stay or 30-day readmissions. In patients receiving emergency OSR, higher volume was associated with longer stay in critical care. CONCLUSION: Higher annual all-procedure volumes were associated with significantly lower in-hospital mortality for OSR, but such a relationship was not significant for EVAR. There was not enough evidence for a volume effect on other outcomes.

Sex differences in national rates of repair of emergency abdominal aortic aneurysm.

BACKGROUND: The aim of this study was to assess the sex differences in both the rate and type of repair for emergency abdominal aortic aneurysm (AAA) in England. METHODS: Hospital Episode Statistics (HES) data sets from April 2002 to February 2015 were obtained. Clinical and administrative codes were used to identify patients who underwent primary emergency definitive repair of ruptured or intact AAA, and patients with a diagnosis of AAA who died in hospital without repair. These three groups included all patients with a primary AAA who presented as an emergency. Sex differences between repair rates and type of surgery (endovascular aneurysm repair (EVAR) versus open repair) over time were examined. RESULTS: In total, 15 717 patients (83·3 per cent men) received emergency surgical intervention for ruptured AAA and 10 276 (81·2 per cent men) for intact AAA; 12 767 (62·0 per cent men) died in hospital without attempted repair. The unadjusted odds ratio for no repair in women versus men was 2·88 (95 per cent c.i. 2·75 to 3·02). Women undergoing repair of ruptured AAA were older and had a higher in-hospital mortality rate (50·0 versus 41·0 per cent for open repair; 30·9 versus 23·5 per cent for EVAR). After adjustment for age, deprivation and co-morbidities, the odds ratio for no repair in women versus men was 1·34 (1·28 to 1·40). The in-hospital mortality rate after emergency repair of an intact AAA was also higher among women. CONCLUSION: Women who present as an emergency with an AAA are less likely to undergo repair than men. Although some of this can be explained by differences in age and co-morbidities, the differences persist after case-mix adjustment.

Efficient Framework for Identifying, Locating, Detecting and Classifying MRI Brain Tumor in MRI Images.

Image processing has plays vital role in today's technological world. It can be applied in numerous application areas such as medical, remote sensing, computer vision etc. Brain tumor is caused due to formation of abnormal tissues within human brain. Therefore, it is necessary to remove affected tumor part from the brain securely. Among various medical imaging techniques Magnetic Resonance Imaging (MRI) employs a vital role to generate images of internal parts of human body. Image segmentation is one of the challenging tasks in today's medical field. An effective segmentation using MRI slices can help to identifying the tumor with its actual size and shape. To meet this requirement, a novel method called Adaptive Convex Region Contour (ACRC) algorithm is presented. Here, Support Vector Machine (SVM) is utilized for slice classification whether it is normal or abnormal. After obtaining SVM results, abnormal slices are involved in segmentation process. Since, human body is having complicated 3D anatomical structure naturally. Unfortunately, MRI slices are yields only 2Dimensional images. The actual shape of tumor cannot be clearly visualized in 2D form. Hence, transformation from 2D to 3D is essential which helps the doctors during surgery. The Rapid Mode Image Matching (RMIM) algorithm has to be followed for 3D reconstruction modeling. After building 3D model, the original volume of the tumor is estimated. The precise experimentation was implemented in MATLAB simulation environment. The obtained results are confirmed that proposed method has better accurate results compared to existing methods.

Increasing inequality in childhood obesity in primary schools in a northern English town.

OBJECTIVE: To undertake an analysis of National Child Measurement Programme (NCMP) data to quantify the obesity prevalence gap over time between children in primary schools in the most and least deprived areas of Doncaster. STUDY DESIGN: The research design for this study was retrospective quantitative analysis of secondary data. METHODS: The study undertook secondary analysis of NCMP data on obesity prevalence in children in Reception Year and Year 6 in primary schools in Doncaster for the period 2006-2007 to 2014-2015. Data were combined into three 3-year periods (2006-2007 to 2008-2009; 2009-2010 to 2011-2012; and 2012-2013 to 2014-2015), and schools were grouped by deprivation based on the national Indices of Multiple Deprivation 2015. Analysis was undertaken to assess whether there is a difference in obesity prevalence for Reception Year and Year 6 children in schools in the most deprived areas compared with the least deprived (prevalence gap), over time. RESULTS: The difference in obesity prevalence between children attending schools in the most and least deprived areas has increased over time. For Reception Year children, the prevalence gap has widened from a difference of 1.01% higher in the most deprived schools in 2006-2007 to 2008-2009 to 3.64% higher in 2012-2013 to 2014-2015. In the same time periods, for Year 6 children, the obesity prevalence gap has also increased over time from 2.82% to 5.08%. CONCLUSIONS: There is inequality in relation to obesity in primary school children in Doncaster with those in schools in the most deprived areas carrying the greatest burden. Research is needed to understand why the plateau seen nationally is not reaching the most deprived children.

Associations between neighbourhood environmental factors and the uptake and effectiveness of a brief intervention to increase physical activity: findings from deprived urban communities in an English city.

Background: Evidence suggests behavioural interventions may exacerbate health inequalities, potentially due to differences in uptake or effectiveness. We used a physical activity intervention targeting deprived communities to identify neighbourhood-level factors that might explain differences in programme impact. Methods: Individuals aged 40-65 were sent a postal invitation offering a brief intervention to increase physical activity. We used postcodes linkage to determine whether neighbourhood indicators of deprivation, housing, crime and proximity to green spaces and leisure facilities predicted uptake of the initial invitation or an increase in physical activity level in those receiving the brief intervention. Results: A total of 4134 (6.8%) individuals responded to the initial invitation and of those receiving the intervention and contactable after 3 months, 486 (51.6%) reported an increase in physical activity. Area deprivation scores linked to postcodes predicted intervention uptake, but not intervention effectiveness. Neighbourhood indicators did not predict either uptake or intervention effectiveness. Conclusions: The main barrier to using brief intervention invitations to increase physical activity in deprived, middle-aged populations was the low uptake of an intervention requiring significant time and motivation from participants. Once individuals have taken up the intervention offer, neighbourhood characteristics did not appear to be significant barriers to successful lifestyle change.

A study on the use of Gumbel approximation with the Bernoulli spatial scan statistic.

The Bernoulli version of the spatial scan statistic is a well established method of detecting localised spatial clusters in binary labelled point data, a typical application being the epidemiological case-control study. A recent study suggests the inferential accuracy of several versions of the spatial scan statistic (principally the Poisson version) can be improved, at little computational cost, by using the Gumbel distribution, a method now available in SaTScan(TM) (www.satscan.org). We study in detail the effect of this technique when applied to the Bernoulli version and demonstrate that it is highly effective, albeit with some increase in false alarm rates at certain significance thresholds. We explain how this increase is due to the discrete nature of the Bernoulli spatial scan statistic and demonstrate that it can affect even small p-values. Despite this, we argue that the Gumbel method is actually preferable for very small p-values. Furthermore, we extend previous research by running benchmark trials on 12 000 synthetic datasets, thus demonstrating that the overall detection capability of the Bernoulli version (i.e. ratio of power to false alarm rate) is not noticeably affected by the use of the Gumbel method. We also provide an example application of the Gumbel method using data on hospital admissions for chronic obstructive pulmonary disease.

Development of value-added sustainable products from paper mill sludge: An experimental approach.

The disposal of paper mill sludge waste generated by the paper industry is a tough and challenging task. In this work, an attempt is made to develop various value-added products namely bricks, briquettes, ground chakra base, and eco-friendly composites from the secondary paper mill sludge (PMS). The secondary PMS was initially dewatered to remove the moisture content, ground to powder, and mixed with cement, MSand. quarry dust, and fly ash to produce bricks. The brick specimens were tested for compressive strength, water absorption, and efflorescence as per the standards and found to be 5.29 ± 0.11 N/mm2, 3.84 ± 0.13% respectively, and have NIL efflorescence. The PMS is mixed with paraffin wax and compressed in a squeeze moulding to form briquettes and observed that the percentage of ash content in the briquette is 66.6% which is less than that of the PMS. Further, a ground chakra base is produced using a slurry of starch and dried in a heater at 60° exhibiting better properties. An eco-friendly composite pottery product was developed by mixing PMS, clay, and starch and tested for breakage.

The health benefits of urban green spaces: a review of the evidence.

BACKGROUND: Urban development projects can be costly and have health impacts. An evidence-based approach to urban planning is therefore essential. However, the evidence for physical and non-physical health benefits of urban green space is unclear. METHODS: A literature search of academic and grey literature was conducted for studies and reviews of the health effects of green space. Articles found were appraised for their relevance, critically reviewed and graded accordingly. Their findings were then thematically categorized. RESULTS: There is weak evidence for the links between physical, mental health and well-being, and urban green space. Environmental factors such as the quality and accessibility of green space affects its use for physical activity. User determinants, such as age, gender, ethnicity and the perception of safety, are also important. However, many studies were limited by poor study design, failure to exclude confounding, bias or reverse causality and weak statistical associations. CONCLUSION: Most studies reported findings that generally supported the view that green space have a beneficial health effect. Establishing a causal relationship is difficult, as the relationship is complex. Simplistic urban interventions may therefore fail to address the underlying determinants of urban health that are not remediable by landscape redesign.

Repeat attenders at National Health Service walk-in centres - a descriptive study using routine data.

OBJECTIVES: Whilst numerous studies have examined repeat attendance at general practices or emergency departments, little is known about repeat attenders at walk-in centres. The aim of this study was to examine age, gender, socio-economic status, distance from walk-in centre, day and time of attendance in relation to repeat attendance at walk-in centres. STUDY DESIGN: Descriptive study using routine data from four walk-in centres in England, two of which were located in London and were accessible to local and commuter populations. METHODS: Data for 2 years (2003-2004) were examined. Age, gender, day and time of attendance were obtained from administrative records. Distance was calculated from the census output area of residence to walk-in centre attended. The Index of Multiple Deprivation (Income Domain) was used as an indicator of socio-economic deprivation at the small-area level. RESULTS: Thirty-nine percent of 272,701 attendances by 166,486 patients were repeat attendances. Seventy percent of patients attended once, 27.9% attended two to five times, and 2.2% attended on over five occasions over the 2-year study period. Patients attending the two London walk-in centres lived closer than those attending the two walk-in centres outside London (percentage living 6 km or more from walk-in centre: 9% and 12% compared with 18% and 22%). The London walk-in centres had a higher percentage of single attenders (74.1% and 78%) compared with the other two walk-in centres (63.3% and 64.7%). Repeat attenders lived closer to walk-in centres than single attenders. Adjusted odds ratios for patients living within 3 km of the walk-in centre relative to patients living 6 km or more from the walk-in centre ranged from 1.59 [95% confidence interval (CI) 1.42-1.78] to 3.34 (95% CI 3.12-3.57) for patients attending two to five times, and from 2.37 (95% CI 1.36-4.11) to 14.99 (95% CI 11.30-19.88) for patients with over five attendances. There was substantial variation with significant contrasting patterns in odds ratios across walk-in centres in relation to the other variables. Repeat attenders were older than single attenders at three of the four walk-in centres. Repeat attenders tended to be more likely to be male at two walk-in centres, and less likely to be male at the other two walk-in centres. Socio-economic deprivation tended to be associated with repeat attendance at one of the walk-in centres. There were also significant and contrasting patterns in relation to day and, to a lesser extent, time of attendance. CONCLUSIONS: Users living near walk-in centres are more likely to be repeat attenders. Age, gender, socio-economic deprivation, day and time of attendance had significantly higher or lower odds ratios for repeat attendance at different walk-in centres, suggesting that organizational and other factors may determine patterns of repeat attendance.

Effectiveness of advice to reduce alcohol consumption in hypertensive patients.

The relation between alcohol consumption and blood pressure is well recognized, and advice to reduce alcohol plays an important part in the management of hypertensive patients. We have evaluated the effectiveness of this advice in a randomized, controlled, single-blind clinical study. After a 2-week run-in period, hypertensive men regularly consuming more than 20 units/wk (1 unit = 10 g) of alcohol were randomly assigned either to the "advice" or control group and were seen at 2-week intervals over an 8-week study period. The outcome measures were: reported alcohol consumption (1-week retrospective diary), markers of alcohol consumption (serum gamma-glutamyl transpeptidase, aspartate aminotransferase, uric acid, mean corpuscular volume), and blood pressure (sitting and standing). Over 18 months, 67 men who drank more than 20 units/wk of alcohol were seen. Twenty-six either were excluded, refused to participate, or dropped out due to nonattendance. Forty-one patients completed the study. After intervention, reported alcohol consumption fell from 60 units/wk to around 30 units/wk in the advice group, whereas it remained between 50 and 60 units/wk in the control group (analysis of variance [ANOVA] F = 7.1, p less than 0.05). This was accompanied by falls in gamma-glutamyl transpeptidase (20.9%) and aspartate aminotransferase (18.1%), but no significant changes were seen in the control group. Standing diastolic blood pressure fell significantly in the advice group (from 101.5 mm Hg to 96.3 mm Hg) compared with the control group (ANOVA F = 4.8, p less than 0.05). The results suggest that advice to reduce alcohol consumption is a useful form of treatment for hypertensive patients who drink excessively.

High blood pressure due to alcohol. A rapidly reversible effect.

The hypothesis that the action of alcohol on blood pressure is rapidly reversible and that its effect is therefore mainly due to very recent alcohol consumption was examined in this study. Five hundred and seventy-seven subjects were screened in an occupational survey. Alcohol consumption, documented with a 1-week retrospective diary was divided into two categories: "recent" and "previous" intake. Recent intake was defined as the amount consumed on days 1, 2, and 3 immediately preceding blood pressure measurement. Previous intake was defined as the amount consumed on days 4, 5, and 6 preceding blood pressure measurement. High recent alcohol intake significantly raised systolic and diastolic blood pressure in both men and women. Previous alcohol intake, however, did not appear to influence blood pressure. We conclude that the effect of alcohol on blood pressure appears to be predominantly due to alcohol consumed in the few days immediately preceding blood pressure measurement, with alcohol consumption before those few days exerting little effect on blood pressure.

Socioeconomic deprivation, ethnicity, and stroke mortality in Greater London and south east England.

OBJECTIVE AND SETTING: To examine geographical variation in stroke mortality in Greater London compared with the surrounding South East Region of England. DESIGN: Cross sectional, ecological analysis based on electoral wards. SUBJECTS: Resident population aged 45 years or more. MAIN OUTCOME MEASURE: Age specific stroke mortality rates in five age bands, 1986-92. MAIN OUTCOME MEASURE: Age specific stroke mortality rates in five age bands, 1986-92. MAIN RESULTS: In the 45-54 years age band, stroke mortality rate ratios (95% confidence intervals) relative to the surrounding south east were 2.09 (1.81, 2.4) for Inner London and 1.31 (1.15, 1.5) for Outer London for men and 1.64 (1.4, 1.93) and 1.13 (0.98, 1.31) respectively for women. This gradient diminished and reversed with increasing age. In the 85+ age band, rate ratios were 0.82 (0.76, 0.89) for Inner London and 0.89 (0.84, 0.94) for Outer London for men and 0.8 (0.75, 0.85) and 0.88 (0.84, 0.92) respectively for women. Carstairs deprivation index and the percentages of Afro-Caribbean men and women and Irish born men were significantly and positively correlated with stroke mortality at the ward level. The Carstairs effect diminished with increasing age. Adjustment for these variables diminished or abolished the higher stroke mortality risks in London for younger people but had little effect on the lower risks for older Londoners. CONCLUSIONS: Higher rates of stroke mortality among middle aged adults in Greater London, compared with the surrounding South East Region, are associated with socioeconomic deprivation and ethnicity. These factors do not explain the relatively lower stroke mortality among older Londoners.

Trends in stroke mortality in Greater London and south east England--evidence for a cohort effect?

OBJECTIVE AND SETTING: To examine time trends in stroke mortality in Greater London compared with the surrounding South East Region of England. DESIGN: Age-cohort analysis based on routine mortality data. SUBJECTS: Resident population aged 45 years or more. MAIN OUTCOME MEASURE: Age specific stroke mortality rates, 1951-92. MAIN RESULTS: In 1951, stroke mortality was lower in Greater London than the surrounding South East Region in all age bands over 45. It has been declining in both areas but the rate of decline has been significantly slower in Greater London (p < 0.0001). The differences in rates of decline were such that stroke mortality is now higher in Greater London for people under 75. The crossover of age specific stroke mortality rates occurred at different periods in different age bands and is consistent with a cohort effect, with similar rates in Greater London and the surrounding south east for men and women born around 1916-21. This cohort effect does not appear to be consistent with past maternal and neonatal mortality rates in these areas, nor, within the limitations of the data, with the ethnic composition of cohorts. CONCLUSIONS: There seems to be a cohort effect on stroke mortality which is not explained by past maternal and neonatal mortality. If the decline in stroke mortality continues at its current rate, the Health of the Nation stroke target is unlikely to be achieved in Greater London.

Clinical evaluation of the Pollenex BP-850 automatic sphygmomanometer.

Eighty subjects were assigned to two conditions in which readings of blood pressure were taken simultaneously by an observer using a Hawkesley Random Zero Sphygmomanometer and by a Pollenex BP-850 Automatic Sphygmomanometer either in its standard form or silenced to stop it bleeping whilst recording blood pressure. Forty subjects were assigned to a comparison group, where simultaneous readings by two observers were taken from one Hawkesley. Analyses performed included correlations, t-tests, and Bland and Altman's (Lancet, 1986, i: 307-310) differences against the mean method. Cues from observer behaviours or the bleeping Pollenex resulted in higher concordance between measures in the standard condition and the Hawkesley comparison condition. However, even in the silent condition the Pollenex proved to be as reliable a monitor of blood pressure as the Hawkesley.

A strategy for vascular services--testing the 600,000 population model.

BACKGROUND: Vascular services' delivery has been criticised, and re-organisation based on a 600,000 population model suggested. We assessed the feasibility of this model in three geographically disparate English regions. METHODS: Surgical arterial activity by Trust was analyzed using 1994/95 data from Hospital Episode Statistics. A postal survey of acute Trusts was used to assess vascular facilities and personnel. Distances between hospitals and enumeration districts were mapped using a Geographical Information System. MAIN OUTCOME MEASURES: Number (proportion) of Trusts performing over 100 arterial procedures a year. Number (proportion) of Trusts with a vascular on-call rota. Proportion of population likely to live more than 40 km away (equivalent to 1 h blue-light ambulance travel time) from a vascular unit under the proposed model. RESULTS: Twelve of the 32 Trusts (38%) performed over 100 arterial procedures annually; 23 Trusts completed the survey. Of these, five (22%) had a vascular on-call rota. Under the 600,000 model, in East Anglia a further 16.5% of the population would live > 40 km from a vascular unit. In Wessex, a further 0.4% of the population would live > 40 km from a vascular unit. Impact on access in North West Thames was negligible. CONCLUSIONS: A 600,000 population model could be feasible in urbanized regions, but not in geographically remote ones.

Clinical evaluation of the Copal UA-251 and the Dinamap 1848 automatic blood-pressure monitors.

The Copal UA-251 is a small automatic blood-pressure monitor, which relies on a piezo-electric microphone for detection of Korotkoff sounds. The Dinamap 1848 automatic monitor uses the oscillometric method for blood-pressure determination. When compared with the Hawksley random-zero sphygmomanometer, the Copal UA-251 recorded higher systolic blood-pressure, with this discrepancy widening at the upper end of the systolic pressure range. The agreement between these machines was reasonable for diastolic blood-pressure. The Dinamap 1848 had a tendency to consistently over-read systolic and under-read diastolic blood-pressure compared with the Hawksley sphygmomanometer, with median differences of 7 mmHg and -2.5 mmHg respectively.

Clinical correlates in parathyroid hypertension.

There is a known association between hypertension and hyperparathyroidism but the mechanism remains unclear. A total of 115 patients with hyperparathyrodism were examined in a retrospective study, and 54.8% were hypertensive. Serum urea and creatinine levels were higher in the hypertensive patients compared with the normotensive patients. Parathyroidectomy had little effect on blood pressure, suggesting that hypertension alone is not an indication for surgery in these patients.

Hospital characteristics affecting potentially avoidable emergency admissions: national ecological study.

Some emergency admissions can be avoided if acute exacerbations of health problems are managed by emergency and urgent care services without resorting to admission to a hospital bed. In England, these services include hospitals, emergency ambulance, and a range of primary and community services. The aim was to identify whether characteristics of hospitals affect potentially avoidable emergency admission rates. An age-sex adjusted rate of admission for 14 conditions rich in avoidable emergency admissions was calculated for 129 hospitals in England for 2008-2011. Twenty-two per cent (3,273,395/14,998,773) of emergency admissions were classed as potentially avoidable, with threefold variation between hospitals. Explanatory factors of this variation included those which hospital managers could not control (demand for hospital emergency departments) and those which they could control (supply in terms of numbers of acute beds in the hospital, and management of non-emergency and emergency patients within the hospital). Avoidable admission rates were higher for hospitals with higher emergency department attendance rates, higher numbers of acute beds per 1000 catchment population and higher conversion rates from emergency department attendance to admission. Hospital managers may be able to reduce avoidable emergency admissions by reducing supply of acute beds and conversion rates from emergency department attendance.