Urban-Rural Disparity of Generics Prescription in Taiwan: The Example of Dihydropyridine Derivatives

The aim of the current study was to investigate the urban-rural disparity of prescribing generics, which were usually cheaper than branded drugs, within the universal health insurance system in Taiwan. Data sources were the cohort datasets of National Health Insurance Research Database with claims data in 2010. The generic prescribing ratios of dihydropyridine (DHP) derivatives (the proportion of DHP prescribed as generics to all prescribed DHP) of medical facilities were examined against the urbanization levels of the clinic location. Among the total 21,606,914 defined daily doses of DHP, 35.7% belonged to generics. The aggregate generic prescribing ratio rose from 6.7% at academic medical centers to 15.3% at regional hospitals, 29.4% at community hospital, and 66.1% at physician clinics. Among physician clinics, the generic prescribing ratio in urban areas was 63.9 ± 41.0% (mean ± standard deviation), lower than that in suburban (69.6 ± 38.7%) and in rural (74.1% ± 35.3%). After adjusting the related factors in the linear regression model, generic prescribing ratios of suburban and rural clinics were significantly higher than those of urban clinics (β=0.043 and 0.077; P=0.024 and 0.008, resp.). The generic prescribing ratio of the most popular antihypertensive agents at a clinic was reversely associated with the urbanization level

Endoscopic Treatment of Vesicoureteral Reflux in Children with Dextranomer/Hyaluronic Acid—A Single Surgeon's 6-Year Experience

Endoscopic treatment for vesicoureteral reflux (VUR) has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. We present the outcome of endoscopic treatment with dextranomer/hyaluronic acid copolymer (Deflux) for VUR in children by a single surgeon at our institute from October 2003 to October 2009. We reviewed the cases of 150 patients (total 239 ureters), 56 girls (37%) and 94 boys (63%), with a mean age of 2.2 years and a median followup of 2.5 years (range 3–68 months). Among the 239 ureters treated, 67.4% (161/239) were cured with a single injection, and a second and third injection raised the cure rate to 86.6% (207/239) and 88.3% (211/239), respectively. None had postoperative ureteral obstruction

Condensation of the atomic relaxation vibrations in lead-magnesium-niobate at T=T∗T=T^*

We present neutron diffraction, dielectric permittivity and photoconductivity measurements, evidencing that lead-magnesium niobate experiences a diffuse phase transformation between the spherical glass and quadrupole glass phases, in the temperature interval between 400 K and 500 K, with the quadrupole phase possessing extremely high magnitudes of dielectric permittivity. Our analysis shows that the integral diffuse scattering intensity may serve as an order parameter for this transformation. Our experimental dielectric permittivity data support this choice. These data are important for the aplications desiring giant dielectric responses, in a wide temperature intervals and not related to electron's excitations.Comment: 6 figure

Revisiting the problem of audio-based hit song prediction using convolutional neural networks

Being able to predict whether a song can be a hit has impor- tant applications in the music industry. Although it is true that the popularity of a song can be greatly affected by exter- nal factors such as social and commercial influences, to which degree audio features computed from musical signals (whom we regard as internal factors) can predict song popularity is an interesting research question on its own. Motivated by the recent success of deep learning techniques, we attempt to ex- tend previous work on hit song prediction by jointly learning the audio features and prediction models using deep learning. Specifically, we experiment with a convolutional neural net- work model that takes the primitive mel-spectrogram as the input for feature learning, a more advanced JYnet model that uses an external song dataset for supervised pre-training and auto-tagging, and the combination of these two models. We also consider the inception model to characterize audio infor- mation in different scales. Our experiments suggest that deep structures are indeed more accurate than shallow structures in predicting the popularity of either Chinese or Western Pop songs in Taiwan. We also use the tags predicted by JYnet to gain insights into the result of different models.Comment: To appear in the proceedings of 2017 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP

Results of one-stage urethroplasty for hypospadias in pediatrics – single surgeon’s experience

Introduction: Hypospadias repair is a challenging technique in pediatric urology with a long learning curve. This study presents the results of urethroplasty performed by a single surgeon to repair hypospadias in children and compares the surgical outcomes at different periods. Materials and Methods: From January 2009 to February 2016, patients who were less than 18 years old and were operated for hypospadias were retrospectively reviewed and divided into two groups: group I (from January 2009 to February 2012) and group II (from March 2012 to February 2016). All operations were performed by the same pediatric surgeon, andsurgical outcomes of the two periods were compared. Results: This study considered150 patients (69 in group I/81 in group II). The Mean operative age was 30.4±32.7 months in group I and 33.6±43.3 months in group II(p=0.309). The selected procedures mainly depended on the subjective anatomical analysis in the operating room and the surgeon’s preference. The mean follow-up duration was 21.7±28.31 months in group I and 13.6±16.6 months in group II (p=0.033).The overall complication rate was 44.9% in group Iand 35.8% in group II (p=0.316). The incidence of glanular disruption significantly decreased from 21.7% to 6.2% (p=0.007) because of the wide dissection of the glanular wings and the deep incision of the urethral plate, which led to tension-free sutures for glanular reconstruction. Conclusions: One-stage repair of hypospadias may achieve satisfactory outcomes in cosmetic appearance and voiding function. Surgical outcomes could be improved by increasing practice

Prescription opioids: regional variation and socioeconomic status: evidence from primary care in England

Background: This study aimed to quantify dispensed opioid prescriptions among primary care practices throughout England and investigate its association with socioeconomic status (SES).Methods: This cross-sectional study used publicly available data in 2015, including practice-level dispensing data and characteristics of registrants from the United Kingdom (UK) National Health Service Digital, and Index of Multiple Deprivation (IMD) data from Department of Communities and Local Government. Practices in England which had opioid prescriptions that could be assigned a defined daily dose (DDD) in the claim-based dispensing database were included. The total amount of dispensed opioid prescriptions (DDD/1000 registrants/day) was calculated for each practice. The association between dispensed opioid prescriptions and IMD was analyzed by multi-level regression and adjusted for registrants' characteristics and the clustered effect of Clinical Commissioning Groups. Subgroup analysis was conducted for practices in London, Birmingham, Manchester and Newcastle.Results: Of the 7856 included practices in England, the median and interquartile range (IQR) of prescription opioids dispensed was 36.9 (IQR: 23.1, 52.5) DDD/1000 registrants/day. The median opioid utilization (DDD/1000 registrants/day) amongst practices varied between Manchester (53.1; IQR: 36.8, 71.4), Newcastle (48.9; IQR: 38.8, 60.1), Birmingham (35.3; IQR: 23.1, 49.4) and London (13.9; IQR: 8.1, 18.8). Lower SES, increased prevalence of patients aged more than 65 years, female gender, smoking, obesity and depression were significantly associated with increased dispensed opioid prescriptions. For every decrease in IMD decile (lower SES), there was a significant increase of opioid utilization by 1.0 (95% confidence interval: 0.89, 1.2, P less than 0.001) DDD/1000 registrants/day.Conclusion: There was a variation in prescription opioids dispensed among practices from Northern and Eastern England to Southern England. A significant association between increased opioid prescriptions and greater deprivation at a population level was observed. Further longitudinal studies using individual patient data are needed to validate this association and identify the potential mechanisms

The Evaluation And Using Intention For Digital Teaching Materials Of Penghu Basalt

The Bureau of Culture of Penghu County produced the Penghu Basalt Digital Teaching Materials, which are supplementary teaching materials for local curriculums in elementary and middle schools in Penghu County. But just what are the teachers’ and students’ opinions of the said teaching materials? Are they willing to use them? Are they suitable? These questions are, indeed, worth further research. The questionnaire survey was conducted to gather the opinions of 142 teachers and 151 students of elementary and middle schools in Penghu County. In addition, using the quasi-experimental and experimental teaching methods, after comparing the pre-test and post-test results to the control group, the learning effectiveness was determined. The results indicate that teachers and students have the highest evaluation for the interface design aspect of this teaching material. The teachers’ evaluation for the teaching materials is significantly higher than the students’. Furthermore, the teaching materials are evaluated highly in terms of attracting attention, generating interest and willingness to use, indicating that the digital teaching materials have potential for promotion in Penghu. After the experimental teaching, only the vocational high school students’ scores before and after the experiment showed significantly improvement, while the scores of the students in the other levels of schools did not. &nbsp