Definition.

Orgel's terminology.

The term "specified complexity" was originally coined by origin of life researcher Leslie Orgel in his 1973 book "The Origins of Life: Molecules and Natural Selection", which proposed that RNA could have evolved through Darwinian natural selection. Orgel used the phrase in discussing the differences between life and non-living structures:  In brief, living organisms are distinguished by their "specified" complexity. Crystals are usually taken as the prototypes of simple well-specified structures, because they consist of a very large number of identical molecules packed together in a uniform way. Lumps of granite or random mixtures of polymers are examples of structures that are complex but not specified. The crystals fail to qualify as living because they lack complexity; the mixtures of polymers fail to qualify because they lack specificity.  The phrase was taken up by the creationists Charles Thaxton and Walter L Bradley in a chapter they contributed to the 1994 book "The Creation Hypothesis" where they discussed "design detection" and redefined "specified complexity" as a way of measuring information. Another contribution to the book was written by William A. Dembski, who took this up as the basis of his subsequent work.  The term was later employed by physicist Paul Davies to qualify the complexity of living organisms:  Living organisms are mysterious not for their complexity per se, but for their tightly specified complexity

Dembski's definition.

Dembski describes specified complexity as a property in living things which can be observed by intelligent-design proponents. However, whereas Orgel used the term for biological features which are considered in science to have arisen through a process of evolution, Dembski says that it describes features which cannot form through "undirected" evolution—and concludes that it allows one to infer intelligent design. While Orgel employed the concept in a qualitative way, Dembski's use is intended to be quantitative. Dembski's use of the concept dates to his 1998 monograph "The Design Inference". Specified complexity is fundamental to his approach to intelligent design, and each of his subsequent books has also dealt significantly with the concept. He has stated that, in his opinion, "if there is a way to detect design, specified complexity is it".  Dembski asserts that specified complexity is present in a configuration when it can be described by a pattern that displays a large amount of independently specified information and is also complex, which he defines as having a low probability of occurrence. He provides the following examples to demonstrate the concept: "A single letter of the alphabet is specified without being complex. A long sentence of random letters is complex without being specified. A Shakespearean sonnet is both complex and specified."  In his earlier papers Dembski defined "complex specified information" (CSI) as being present in a specified event whose probability did not exceed 1 in 10, which he calls the universal probability bound. In that context, "specified" meant what in later work he called "pre-specified", that is specified by the unnamed designer before any information about the outcome is known. The value of the universal probability bound corresponds to the inverse of the upper limit of "the total number of [possible] specified events throughout cosmic history", as calculated by Dembski. Anything below this bound has CSI. The terms "specified complexity" and "complex specified information" are used interchangeably. In more recent papers Dembski has redefined the universal probability bound, with reference to another number, corresponding to the total number of bit operations that could possibly have been performed in the entire history of the universe.  Dembski asserts that CSI exists in numerous features of living things, such as in DNA and in other functional biological molecules, and argues that it cannot be generated by the only known natural mechanisms of physical law and chance, or by their combination. He argues that this is so because laws can only shift around or lose information, but do not produce it, and because chance can produce complex unspecified information, or simple specified information, but not CSI; he provides a mathematical analysis that he claims demonstrates that law and chance working together cannot generate CSI, either. Moreover, he claims that CSI is holistic, with the whole being greater than the sum of the parts, and that this decisively eliminates Darwinian evolution as a possible means of its "creation". Dembski maintains that by process of elimination, CSI is best explained as being due to intelligence, and is therefore a reliable indicator of design.

Law of conservation of information.

Dembski formulates and proposes a law of conservation of information as follows:  This strong proscriptive claim, that natural causes can only transmit CSI but never originate it, I call the Law of Conservation of Information.  Immediate corollaries of the proposed law are the following: Dembski notes that the term "Law of Conservation of Information" was previously used by Peter Medawar in his book The Limits of Science (1984) "to describe the weaker claim that deterministic laws cannot produce novel information." The actual validity and utility of Dembski's proposed law are uncertain; it is neither widely used by the scientific community nor cited in mainstream scientific literature. A 2002 essay by Erik Tellgren provided a mathematical rebuttal of Dembski's law and concludes that it is "mathematically unsubstantiated."

Specificity.

In a more recent paper, Dembski provides an account which he claims is simpler and adheres more closely to the theory of statistical hypothesis testing as formulated by Ronald Fisher. In general terms, Dembski proposes to view design inference as a statistical test to reject a chance hypothesis P on a space of outcomes Ω.  Dembski's proposed test is based on the Kolmogorov complexity of a pattern "T" that is exhibited by an event "E" that has occurred. Mathematically, "E" is a subset of Ω, the pattern "T" specifies a set of outcomes in Ω and "E" is a subset of "T". Quoting Dembski Thus, the event "E" might be a die toss that lands six and "T" might be the composite event consisting of all die tosses that land on an even face. Kolmogorov complexity provides a measure of the computational resources needed to specify a pattern (such as a DNA sequence or a sequence of alphabetic characters). Given a pattern "T", the number of other patterns may have Kolmogorov complexity no larger than that of "T" is denoted by φ("T"). The number φ("T") thus provides a ranking of patterns from the simplest to the most complex. For example, for a pattern "T" which describes the bacterial flagellum, Dembski claims to obtain the upper bound φ("T") ≤ 10.  Dembski defines specified complexity of the pattern "T" under the chance hypothesis P as  where P("T") is the probability of observing the pattern "T", "R" is the number of "replicational resources" available "to witnessing agents". "R" corresponds roughly to repeated attempts to create and discern a pattern. Dembski then asserts that "R" can be bounded by 10. This number is supposedly justified by a result of Seth Lloyd in which he determines that the number of elementary logic operations that can have been performed in the universe over its entire history cannot exceed 10 operations on 10 bits.  Dembski's main claim is that the following test can be used to infer design for a configuration: There is a target pattern "T" that applies to the configuration and whose specified complexity exceeds 1. This condition can be restated as the inequality

Dembski's explanation of specified complexity.

Dembski's expression σ is unrelated to any known concept in information theory, though he claims he can justify its relevance as follows: An intelligent agent "S" witnesses an event "E" and assigns it to some reference class of events Ω and within this reference class considers it as satisfying a specification "T". Now consider the quantity φ("T") × P("T") (where P is the "chance" hypothesis):  Think of S as trying to determine whether an archer, who has just shot an arrow at a large wall, happened to hit a tiny target on that wall by chance. The arrow, let us say, is indeed sticking squarely in this tiny target. The problem, however, is that there are lots of other tiny targets on the wall. Once all those other targets are factored in, is it still unlikely that the archer could have hit any of them by chance?  In addition, we need to factor in what I call the replicational resources associated with "T", that is, all the opportunities to bring about an event of "T"'s descriptive complexity and improbability by multiple agents witnessing multiple events. According to Dembski, the number of such "replicational resources" can be bounded by "the maximal number of bit operations that the known, observable universe could have performed throughout its entire multi-billion year history", which according to Lloyd is 10.  However, according to Elsberry and Shallit, "[specified complexity] has not been defined formally in any reputable peer-reviewed mathematical journal, nor (to the best of our knowledge) adopted by any researcher in information theory."

Calculation of specified complexity.

Thus far, Dembski's only attempt at calculating the specified complexity of a naturally occurring biological structure is in his book "No Free Lunch", for the bacterial flagellum of E. coli. This structure can be described by the pattern "bidirectional rotary motor-driven propeller". Dembski estimates that there are at most 10 patterns described by four basic concepts or fewer, and so his test for design will apply if  However, Dembski says that the precise calculation of the relevant probability "has yet to be done", although he also claims that some methods for calculating these probabilities "are now in place".  These methods assume that all of the constituent parts of the flagellum must have been generated completely at random, a scenario that biologists do not seriously consider. He justifies this approach by appealing to Michael Behe's concept of "irreducible complexity" (IC), which leads him to assume that the flagellum could not come about by any gradual or step-wise process. The validity of Dembski's particular calculation is thus wholly dependent on Behe's IC concept, and therefore susceptible to its criticisms, of which there are many.  To arrive at the ranking upper bound of 10 patterns, Dembski considers a specification pattern for the flagellum defined by the (natural language) predicate "bidirectional rotary motor-driven propeller", which he regards as being determined by four independently chosen basic concepts. He furthermore assumes that English has the capability to express at most 10 basic concepts (an upper bound on the size of a dictionary). Dembski then claims that we can obtain the rough upper bound of  for the set of patterns described by four basic concepts or fewer.  From the standpoint of Kolmogorov complexity theory, this calculation is problematic. Quoting Ellsberry and Shallit "Natural language specification without restriction, as Dembski tacitly permits, seems problematic. For one thing, it results in the Berry paradox". These authors add: "We have no objection to natural language specifications per se, provided there is some evident way to translate them to Dembski's formal framework. But what, precisely, is the space of events Ω here?"

Criticisms.

The soundness of Dembski's concept of specified complexity and the validity of arguments based on this concept are widely disputed. A frequent criticism (see Elsberry and Shallit) is that Dembski has used the terms "complexity", "information" and "improbability" interchangeably. These numbers measure properties of things of different types: Complexity measures how hard it is to describe an object (such as a bitstring), information is how much the uncertainty about the state of an object is reduced by knowing the state of another object or system, and improbability measures how unlikely an event is given a probability distribution.  On page 150 of "No Free Lunch" Dembski claims he can demonstrate his thesis mathematically: ""In this section I will present an in-principle mathematical argument for why natural causes are incapable of generating complex specified information."" When Tellgren investigated Dembski's "Law of Conservation of Information” using a more formal approach, he concluded it is mathematically unsubstantiated. Dembski responded in part that he is not "in the business of offering a strict mathematical proof for the inability of material mechanisms to generate specified complexity". Jeffrey Shallit states that Demski's mathematical argument has multiple problems, for example; a crucial calculation on page 297 of "No Free Lunch" is off by a factor of approximately 10.  Dembski's calculations show how a simple smooth function cannot gain information. He therefore concludes that there must be a designer to obtain CSI. However, natural selection has a branching mapping from one to many (replication) followed by pruning mapping of the many back down to a few (selection). When information is replicated, some copies can be differently modified while others remain the same, allowing information to increase. These increasing and reductional mappings were not modeled by Dembski. In other words, Dembski's calculations do not model birth and death. This basic flaw in his modeling renders all of Dembski's subsequent calculations and reasoning in "No Free Lunch" irrelevant because his basic model does not reflect reality. Since the basis of "No Free Lunch" relies on this flawed argument, the entire thesis of the book collapses.  According to Martin Nowak, a Harvard professor of mathematics and evolutionary biology "We cannot calculate the probability that an eye came about. We don't have the information to make the calculation".  Dembski's critics note that specified complexity, as originally defined by Leslie Orgel, is precisely what Darwinian evolution is supposed to create. Critics maintain that Dembski uses "complex" as most people would use "absurdly improbable". They also claim that his argument is circular: CSI cannot occur naturally because Dembski has defined it thus. They argue that to successfully demonstrate the existence of CSI, it would be necessary to show that some biological feature undoubtedly has an extremely low probability of occurring by any natural means whatsoever, something which Dembski and others have almost never attempted to do. Such calculations depend on the accurate assessment of numerous contributing probabilities, the determination of which is often necessarily subjective. Hence, CSI can at most provide a "very high probability", but not absolute certainty.  Another criticism refers to the problem of "arbitrary but specific outcomes". For example, if a coin is tossed randomly 1000 times, the probability of any particular outcome occurring is roughly one in 10. For any particular specific outcome of the coin-tossing process, the "a priori" probability (probability measured before event happens) that this pattern occurred is thus one in 10, which is astronomically smaller than Dembski's universal probability bound of one in 10. Yet we know that the "post hoc" probability (probabilitly as observed after event occurs) of its happening is exactly one, since we observed it happening. This is similar to the observation that it is unlikely that any given person will win a lottery, but, eventually, a lottery will have a winner; to argue that it is very unlikely that any one player would win is not the same as proving that there is the same chance that no one will win. Similarly, it has been argued that "a space of possibilities is merely being explored, and we, as pattern-seeking animals, are merely imposing patterns, and therefore targets, after the fact."  Apart from such theoretical considerations, critics cite reports of evidence of the kind of evolutionary "spontanteous generation" that Dembski claims is too improbable to occur naturally. For example, in 1982, B.G. Hall published research demonstrating that after removing a gene that allows sugar digestion in certain bacteria, those bacteria, when grown in media rich in sugar, rapidly evolve new sugar-digesting enzymes to replace those removed. Another widely cited example is the discovery of nylon eating bacteria that produce enzymes only useful for digesting synthetic materials that did not exist prior to the invention of nylon in 1935.  Other commentators have noted that evolution through selection is frequently used to design certain electronic, aeronautic and automotive systems which are considered problems too complex for human "intelligent designers". This contradicts the argument that an intelligent designer is required for the most complex systems. Such evolutionary techniques can lead to designs that are difficult to understand or evaluate since no human understands which trade-offs were made in the evolutionary process, something which mimics our poor understanding of biological systems.  Dembski's book "No Free Lunch" was criticised for not addressing the work of researchers who use computer simulations to investigate artificial life. According to Shallit:  The field of artificial life evidently poses a significant challenge to Dembski's claims about the failure of evolutionary algorithms to generate complexity. Indeed, artificial life researchers regularly find their simulations of evolution producing the sorts of novelties and increased complexity that Dembski claims are impossible.

Specified complexity is a concept proposed by William Dembski and used by him and others to promote intelligent design. According to Dembski, the concept can formalize a property that singles out patterns that are both "specified" and "complex", where in Dembski's terminology, a "specified" pattern is one that admits short descriptions, whereas a "complex" pattern is one that is unlikely to occur by chance. Proponents of intelligent design use specified complexity as one of their two main arguments, alongside irreducible complexity.

特殊复杂性(Specified complexity)是一种由威廉·登布斯基所提出的、用以支持智能设计的理论,与不可化约的复杂性同为支持智能设计论者常提出的核心理论之一。登布斯基认为,当一个信号模式具有足够的特殊性与复杂性的时候就不可能是自然的随机过程下的产物,而生物的基因具有前述的性质,因此只能是透过智能设计所导致。特殊复杂性的概念广泛地在数学与其他科学领域上被认为是不正确的,一方面几率低并不等同于必定不会发生,另一方面生物学家也已经提出证据显示演化的确可以在自然的随机过程下发生


History.

The triangle-shaped tortilla chip was popularized by Rebecca Webb Carranza in the 1940s as a way to make use of misshapen tortillas rejected from the automated tortilla manufacturing machine that she and her husband used at their Mexican delicatessen and tortilla factory in southwest Los Angeles. Carranza found that the discarded tortillas, cut into triangles and fried, were a popular snack, and she sold them for a dime a bag at the El Zarape Tortilla Factory. In 1994, Carranza received the Golden Tortilla award for her contribution to the Mexican food industry.

Tex-Mex and Mexican cuisine.

Tortilla chips are the quintessential and often complimentary appetizer in Tex-Mex and Mexican restaurants in the U.S. and elsewhere. Their popularity outside of California saw a steady rise in the late 1970s when they began to compete with corn chips, the dipping chip of choice during the first three quarters of the 20th century. They are typically served with a dip, such as salsa, chile con queso, or guacamole. When not served with a dip, the chips are often seasoned with herbs and spices. Although they are now available worldwide, the United States is one of the main markets for tortilla chips. Commercial brand names for tortilla chips include Phileas Fogg snacks, Tostitos, Doritos, and Don Tacos (in Japan).  A more elaborate dish utilizing tortilla chips is nachos. First created circa 1943 by Ignacio "Nacho" Anaya, nachos are tortilla chips served with melted or shredded cheese, although often other toppings are added or substituted, such as meat, salsa (such as pico de gallo), refried beans, guacamole, sour cream, diced onions, olives, and pickled jalapeños. More elaborate nachos are often baked for a short period of time to warm the tortillas and melt shredded cheese.

Corn chips.

A similar fried corn snack is the corn chip, which is not made from a tortilla, but from corn meal which has been processed into a particular shape, typically a small scoop. Fritos are an example of this. The principal difference between the corn in tortilla and corn chips is that the corn in a tortilla chip has undergone a process known as nixtamalization, which involves processing the raw corn with quicklime.

A tortilla chip is a snack food made from corn tortillas, which are cut into triangles and then fried—or baked (alternatively they may be discs pressed out of corn masa then fried or baked). Corn tortillas are made of corn, vegetable oil, salt and water. Although first mass-produced commercially in the U.S. in Los Angeles in the late 1940s, tortilla chips grew out of Mexican cuisine, where similar items were well known, such as totopos and tostadas.

墨西哥玉米片、玉米饼、或墨西哥脆饼(tortilla chips)是由墨西哥薄饼(tortilla)翻制的零食。一般是将整块由玉米、蔬菜油、糖、盐和水做成的墨西哥薄饼切成楔形小片、或直接从揉制阶段的玉米面团马萨压切,再经油炸或烘烤后而得。虽然玉米饼是在1940年代末期于洛杉矶首先被大量生产,但还是普遍被认为是墨西哥食物。玉米饼的原料通常是黄玉米,但也可以是白玉米、蓝玉米或是红玉米。


History.

Accident services were already provided by workmen's compensation plans, railway companies, and municipalities in Europe and the United States by the late mid-nineteenth century, but the first specialized trauma care center in the world was opened in 1911 in the United States at the University of Louisville Hospital in Louisville, Kentucky, and was developed by surgeon Arnold Griswold during the 1930s. Griswold also equipped police and fire vehicles with medical supplies and trained officers to give emergency care while en route to the hospital.  Today, a typical hospital has its emergency department in its own section of the ground floor of the grounds, with its own dedicated entrance. As patients can arrive at any time and with any complaint, a key part of the operation of an emergency department is the prioritization of cases based on clinical need. This process is called triage.  Triage is normally the first stage the patient passes through, and consists of a brief assessment, including a set of vital signs, and the assignment of a "chief complaint" (e.g. chest pain, abdominal pain, difficulty breathing, etc.). Most emergency departments have a dedicated area for this process to take place and may have staff dedicated to performing nothing but a triage role. In most departments, this role is fulfilled by a triage nurse, although dependent on training levels in the country and area, other health care professionals may perform the triage sorting, including paramedics and physicians. Triage is typically conducted face-to-face when the patient presents, or a form of triage may be conducted via radio with an ambulance crew; in this method, the paramedics will call the hospital's triage center with a short update about an incoming patient, who will then be triaged to the appropriate level of care.  Most patients will be initially assessed at triage and then passed to another area of the department, or another area of the hospital, with their waiting time determined by their clinical need. However, some patients may complete their treatment at the triage stage, for instance, if the condition is very minor and can be treated quickly, if only advice is required, or if the emergency department is not a suitable point of care for the patient. Conversely, patients with evidently serious conditions, such as cardiac arrest, will bypass triage altogether and move straight to the appropriate part of the department.  The resuscitation area, commonly referred to as "Trauma" or "Resus", is a key area in most departments. The most seriously ill or injured patients will be dealt with in this area, as it contains the equipment and staff required for dealing with immediately life-threatening illnesses and injuries. Typical resuscitation staffing involves at least one attending physician, and at least one and usually two nurses with trauma and Advanced Cardiac Life Support training. These personnel may be assigned to the resuscitation area for the entirety of the shift or may be "on call" for resuscitation coverage (i.e. if a critical case presents via walk-in triage or ambulance, the team will be paged to the resuscitation area to deal with the case immediately). Resuscitation cases may also be attended by residents, radiographers, ambulance personnel, respiratory therapists, hospital pharmacists and students of any of these professions depending upon the skill mix needed for any given case and whether or not the hospital provides teaching services.  Patients who exhibit signs of being seriously ill but are not in immediate danger of life or limb will be triaged to "acute care" or "majors", where they will be seen by a physician and receive a more thorough assessment and treatment. Examples of "majors" include chest pain, difficulty breathing, abdominal pain and neurological complaints. Advanced diagnostic testing may be conducted at this stage, including laboratory testing of blood and/or urine, ultrasonography, CT or MRI scanning. Medications appropriate to manage the patient's condition will also be given. Depending on underlying causes of the patient's chief complaint, he or she may be discharged home from this area or admitted to the hospital for further treatment.  Patients whose condition is not immediately life-threatening will be sent to an area suitable to deal with them, and these areas might typically be termed as a "prompt care" or "minors" area. Such patients may still have been found to have significant problems, including fractures, dislocations, and lacerations requiring suturing.  Children can present particular challenges in treatment. Some departments have dedicated pediatrics areas, and some departments employ a play therapist whose job is to put children at ease to reduce the anxiety caused by visiting the emergency department, as well as provide distraction therapy for simple procedures.  Many hospitals have a separate area for evaluation of psychiatric problems. These are often staffed by psychiatrists and mental health nurses and social workers. There is typically at least one room for people who are actively a risk to themselves or others (e.g. suicidal).  Fast decisions on life-and-death cases are critical in hospital emergency departments. As a result, doctors face great pressures to overtest and overtreat. The fear of missing something often leads to extra blood tests and imaging scans for what may be harmless chest pains, run-of-the-mill head bumps, and non-threatening stomach aches, with a high cost on the health care system.

Nomenclature in English.

"Emergency department" became commonly used when emergency medicine was recognised as a medical specialty, and hospitals and medical centres developed departments of emergency medicine to provide services. Other common variations include 'emergency ward,' 'emergency centre' or 'emergency unit'.  'Accident and Emergency' or 'A&E' is still the accepted term in the United Kingdom, and some Commonwealth countries, as are earlier terms such as 'Casualty' or 'casualty ward', which continue to be used informally. The same applies to 'emergency room' or 'ER' in North America, originating when emergency facilities were provided in a single room of the hospital by the department of surgery.

Signage.

Regardless of naming convention, there is a widespread usage of directional signage in white text on a red background across the world, which indicates the location of the emergency department, or a hospital with such facilities.  Signs on emergency departments may contain additional information. In some American states, there is close regulation of the design and content of such signs. For example, California requires wording such as "Comprehensive Emergency Medical Service" and "Physician On Duty", to prevent persons in need of critical care from presenting to facilities that are not fully equipped and staffed.  In some countries, including the United States and Canada, a smaller facility that may provide assistance in medical emergencies is known as a clinic. Larger communities often have walk-in clinics where people with medical problems that would not be considered serious enough to warrant an emergency department visit can be seen. These clinics often do not operate on a 24-hour basis. Very large clinics may operate as "free-standing emergency centres", which are open 24 hours and can manage a very large number of conditions. However, if a patient presents to a free-standing clinic with a condition requiring hospital admission, he or she must be transferred to an actual hospital, as these facilities do not have the capability to provide inpatient care.

United States.

The Centers for Medicare and Medicaid Services (CMS) classified emergency departments into two types: Type A, the majority, which are open 24 hours a day, 7 days a week, 365 days a year; and those who are not, Type B. Many US emergency departments are exceedingly busy. A study found that in 2009, there were an estimated 128,885,040 ED encounters in US hospitals. Approximately one-fifth of ED visits in 2010 were for patients under the age of 18 years. In 2009–2010, a total of 19.6 million emergency department visits in the United States were made by persons aged 65 and over. Most encounters (82.8 percent) resulted in treatment and release; 17.2 percent were admitted to inpatient care.  The 1986 Emergency Medical Treatment and Active Labor Act is an act of the United States Congress, that requires emergency departments, if the associated hospital receives payments from Medicare, to provide appropriate medical examination and emergency treatment to all individuals seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay. Like an unfunded mandate, there are no reimbursement provisions.  Rates of ED visits rose between 2006 and 2011 for almost every patient characteristic and location. The total rate of ED visits increased 4.5% in that time. However, the rate of visits for patients under one year of age declined 8.3%.  A survey of New York area doctors in February 2007 found that injuries and even deaths have been caused by excessive waits for hospital beds by ED patients. A 2005 patient survey found an average ED wait time from 2.3 hours in Iowa to 5.0 hours in Arizona.  One inspection of Los Angeles area hospitals by Congressional staff found the EDs operating at an average of 116% of capacity (meaning there were more patients than available treatment spaces) with insufficient beds to accommodate victims of a terrorist attack the size of the 2004 Madrid train bombings. Three of the five Level I trauma centres were on "diversion", meaning ambulances with all but the most severely injured patients were being directed elsewhere because the ED could not safely accommodate any more patients. This controversial practice was banned in Massachusetts (except for major incidents, such as a fire in the ED), effective 1 January 2009; in response, hospitals have devoted more staff to the ED at peak times and moved some elective procedures to non-peak times.  In 2009, there were 1,800 EDs in the country. In 2011, about 421 out of every 1,000 people in the United States visited the emergency department; five times as many were discharged as were admitted. Rural areas are the highest rate of ED visits (502 per 1,000 population) and large metro counties had the lowest (319 visits per 1,000 population). By region, the Midwest had the highest rate of ED visits (460 per 1,000 population) and Western States had the lowest (321 visits per 1,000 population).  Most Common Reasons for Discharged Emergency Department Visits in the United States, 2011

Freestanding.

In addition to the normal hospital based emergency departments a trend has developed in some states (including Texas and Colorado) of emergency departments not attached to hospitals. These new emergency departments are referred to as free standing emergency departments. The rationale for these operations is the ability to operate outside of hospital policies that may lead to increased wait times and reduced patient satisfaction.  These departments have attracted controversy due to consumer confusion around their prices and insurance coverage. In 2017, the largest operator, Adeptus Health, declared bankruptcy.

Overuse and utilization management.

Patients may visit the emergency room for non-emergencies, which typically costs the patient and the managed care insurance company more, and therefore the insurance company may apply utilization management to deny coverage. In 2004, a study found that emergency room visits were the most common reason for appealing disputes over coverage after receiving service. In 2017, Anthem expanded this denial coverage more broadly, provoking public policy reactions.

United Kingdom.

All A&E departments throughout the United Kingdom are financed and managed publicly by the NHS of each constituent country (England, Scotland, Wales and Northern Ireland). As with most other NHS services, emergency care is provided to all, both resident citizens and those not ordinarily resident in the UK, free at the point of need and regardless of any ability to pay.  In England departments are divided into three categories:  Historically, waits for assessment in A&E were very long in some areas of the UK. In October 2002, the Department of Health introduced a four-hour target in emergency departments that required departments in England to assess and treat patients within four hours of arrival, with referral and assessment by other departments if deemed necessary. It was expected that the patients would have physically left the department within the four hours. Present policy is that 95% of all patient cases do not "breach" this four-hour wait. The busiest departments in the UK outside London include University Hospital of Wales in Cardiff, The North Wales Regional Hospital in Wrexham, the Royal Infirmary of Edinburgh and Queen Alexandra Hospital in Portsmouth.  In July 2014, the QualityWatch research programme published in-depth analysis which tracked 41 million A&E attendances from 2010 to 2013. This showed that the number of patients in a department at any one time was closely linked to waiting times, and that crowding in A&E had increased as a result of a growing and ageing population, compounded by the freezing or reduction of A&E capacity. Between 2010/11 and 2012/13 crowding increased by 8%, despite a rise of just 3% in A&E visits, and this trend looks set to continue. Other influential factors identified by the report included temperature (with both hotter and colder weather pushing up A&E visits), staffing and inpatient bed numbers.  A&E services in the UK are often the focus of a great deal of media and political interest, and data on A&E performance is published weekly. However, this is only one part of a complex urgent and emergency care system. Reducing A&E waiting times therefore requires a comprehensive, coordinated strategy across a range of related services.  Many A&E departments are crowded and confusing. Many of those attending are understandably anxious, and some are mentally ill, and especially at night are under the influence of alcohol or other substances. Pearson Lloyd's redesign – 'A Better A&E' – is claimed to have reduced aggression against hospital staff in the departments by 50 per cent. A system of environmental signage provides location-specific information for patients. Screens provide live information about how many cases are being handled and the current status of the A&E department. Waiting times for patients to be seen at A&E have been rising.

Critical conditions handled.

Cardiac arrest.

Cardiac arrest may occur in the ED/A&E or a patient may be transported by ambulance to the emergency department already in this state. Treatment is basic life support and advanced life support as taught in advanced life support and advanced cardiac life support courses.

Heart attack.

Patients arriving to the emergency department with a myocardial infarction (heart attack) are likely to be triaged to the resuscitation area. They will receive oxygen and monitoring and have an early ECG; aspirin will be given if not contraindicated or not already administered by the ambulance team; morphine or diamorphine will be given for pain; sub lingual (under the tongue) or buccal (between cheek and upper gum) glyceryl trinitrate (nitroglycerin) (GTN or NTG) will be given, unless contraindicated by the presence of other drugs.  An ECG that reveals ST segment elevation suggests complete blockage of one of the main coronary arteries. These patients require immediate reperfusion (re-opening) of the occluded vessel. This can be achieved in two ways: thrombolysis (clot-busting medication) or percutaneous transluminal coronary angioplasty (PTCA). Both of these are effective in reducing significantly the mortality of myocardial infarction. Many centers are now moving to the use of PTCA as it is somewhat more effective than thrombolysis if it can be administered early. This may involve transfer to a nearby facility with facilities for angioplasty.

Trauma.

Major trauma, the term for patients with multiple injuries, often from a motor vehicle crash or a major fall, is initially handled in the Emergency Department. However, trauma is a separate (surgical) specialty from emergency medicine (which is itself a medical specialty, and has certifications in the United States from the American Board of Emergency Medicine).  Trauma is treated by a trauma team who have been trained using the principles taught in the internationally recognized Advanced Trauma Life Support (ATLS) course of the American College of Surgeons. Some other international training bodies have started to run similar courses based on the same principles.  The services that are provided in an emergency department can range from x-rays and the setting of broken bones to those of a full-scale trauma centre. A patient's chance of survival is greatly improved if the patient receives definitive treatment (i.e. surgery or reperfusion) within one hour of an accident (such as a car accident) or onset of acute illness (such as a heart attack). This critical time frame is commonly known as the "golden hour".  Some emergency departments in smaller hospitals are located near a helipad which is used by helicopters to transport a patient to a trauma centre. This inter-hospital transfer is often done when a patient requires advanced medical care unavailable at the local facility. In such cases the emergency department can only stabilize the patient for transport.

Mental illness.

Some patients arrive at an emergency department for a complaint of mental illness. In many jurisdictions (including many U.S. states), patients who appear to be mentally ill and to present a danger to themselves or others may be brought against their will to an emergency department by law enforcement officers for psychiatric examination. The emergency department conducts medical clearance rather than treats acute behavioral disorders. From the emergency department, patients with significant mental illness may be transferred to a psychiatric unit (in many cases involuntarily).

Asthma and COPD.

Acute exacerbations of chronic respiratory diseases, mainly asthma and chronic obstructive pulmonary disease (COPD), are assessed as emergencies and treated with oxygen therapy, bronchodilators, steroids or theophylline, have an urgent chest X-ray and arterial blood gases and are referred for intensive care if necessary. Noninvasive ventilation in the ED has reduced the requirement for tracheal intubation in many cases of severe exacerbations of COPD.

Special facilities, training, and equipment.

An ED requires different equipment and different approaches than most other hospital divisions. Patients frequently arrive with unstable conditions, and so must be treated quickly. They may be unconscious, and information such as their medical history, allergies, and blood type may be unavailable. ED staff are trained to work quickly and effectively even with minimal information.  ED staff must also interact efficiently with pre-hospital care providers such as EMTs, paramedics, and others who are occasionally based in an ED. The pre-hospital providers may use equipment unfamiliar to the average physician, but ED physicians must be expert in using (and safely removing) specialized equipment, since devices such as military anti-shock trousers ("MAST") and traction splints require special procedures. Among other reasons, given that they must be able to handle specialized equipment, physicians can now specialize in emergency medicine, and EDs employ many such specialists.  ED staff have much in common with ambulance and fire crews, combat medics, search and rescue teams, and disaster response teams. Often, joint training and practice drills are organized to improve the coordination of this complex response system. Busy EDs exchange a great deal of equipment with ambulance crews, and both must provide for replacing, returning, or reimbursing for costly items.  Cardiac arrest and major trauma are relatively common in EDs, so defibrillators, automatic ventilation and CPR machines, and bleeding control dressings are used heavily. Survival in such cases is greatly enhanced by shortening the wait for key interventions, and in recent years some of this specialized equipment has spread to pre-hospital settings. The best-known example is defibrillators, which spread first to ambulances, then in an automatic version to police cars and fire apparatus, and most recently to public spaces such as airports, office buildings, hotels, and even shopping malls.  Because time is such an essential factor in emergency treatment, EDs typically have their own diagnostic equipment to avoid waiting for equipment installed elsewhere in the hospital. Nearly all have radiographic examination rooms staffed by dedicated Radiographer, and many now have full radiology facilities including CT scanners and ultrasonography equipment. Laboratory services may be handled on a priority basis by the hospital lab, or the ED may have its own "STAT Lab" for basic labs (blood counts, blood typing, toxicology screens, etc.) that must be returned very rapidly.

Non-emergency use.

Metrics applicable to the ED can be grouped into three main categories, volume, cycle time, and patient satisfaction. Volume metrics including arrivals per hour, percentage of ED beds occupied, and age of patients are understood at a basic level at all hospitals as an indication for staffing requirements. Cycle time metrics are the mainstays of the evaluation and tracking of process efficiency and are less widespread since an active effort is needed to collect and analyze this data. Patient satisfaction metrics, already commonly collected by nursing groups, physician groups, and hospitals, are useful in demonstrating the impact of changes in patient perception of care over time. Since patient satisfaction metrics are derivative and subjective, they are less useful in primary process improvement. Health information exchanges can reduce nonurgent ED visits by supplying current data about admissions, discharges, and transfers to health plans and accountable care organizations, allowing them to shift ED use to primary care settings.  In all primary care trusts there are out of hours medical consultations provided by general practitioners or nurse practitioners.  In the United States, high costs are incurred by non-emergency use of the emergency room. The National Hospital Ambulatory Medical Care Survey looked at the ten most common symptoms for which giving rise to emergency room visits (cough, sore throat, back pain, fever, headache, abdominal pain, chest pain, other pain, shortness of breath, vomiting) and made suggestions as to which would be the most cost-effective choice among virtual care, retail clinic, urgent care, or emergency room. Notably, certain complaints may also be addressed by a telephone call to a person's primary care provider.  In the United States, and many other countries, hospitals are beginning to create areas in their emergency rooms for people with minor injuries. These are commonly referred as "Fast Track" or "Minor Care" units. These units are for people with non-life-threatening injuries. The use of these units within a department have been shown to significantly improve the flow of patients through a department and to reduce waiting times. Urgent care clinics are another alternative, where patients can go to receive immediate care for non-life-threatening conditions. To reduce the strain on limited ED resources, American Medical Response created a checklist that allows EMTs to identify intoxicated individuals who can be safely sent to detoxification facilities instead.

Overcrowding.

Emergency department overcrowding is when function of a department is hindered by an inability to treat all patients in an adequate manner. This is a common occurrence in emergency departments worldwide. Overcrowding causes inadequate patient care which leads to poorer patient outcomes. To address this problem, escalation policies are used by emergency departments when responding to an increase in demand (e.g., a sudden inflow of patients) or a reduction in capacity (e.g., a lack of beds to admit patients). The policies aim to maintain the ability to deliver patient care, without compromising safety, by modifying "normal" processes.

Emergency department waiting times.

Emergency department (ED) waiting times have a serious impact on patient mortality, morbidity with readmission in less than 30 days, length of stay, and patient satisfaction. A review of the literature bears out the logical premise that since the outcome of treatment for all diseases and injuries is time-sensitive, the sooner treatment is rendered, the better the outcome. Various studies reported significant associations between waiting times and higher mortality and morbidity among those who survived. It is clear from the literature that untimely hospital deaths and morbidity can be reduced by reductions in ED waiting times.

Exit block.

While a significant proportion of people attending emergency departments are discharged home after treatment, many require admission for ongoing observation or treatment, or to ensure adequate social care before discharge is possible. If people requiring admission are not able to be moved to inpatient beds swiftly, "exit block" or "access block" occurs. This often leads to crowding and impairs flow to the point that it can lead to delays in appropriate treatment for newly presenting cases ("arrival access block"). This phenomenon is more common in densely populated areas, and affects pediatric departments less than adults ones.  Exit block can lead to delays in care both in the people awaiting inpatient beds ("boarding") and those who newly present to an exit blocked department. Various solutions have been proposed, such as changes in staffing or increasing inpatient capacity.

Frequent presenters.

Frequent presenters are persons who will present themselves at a hospital multiple times, usually those with complex medical requirements or with psychological issues complicating medical management. These persons contribute to overcrowding and typically require more hospital resources although they do not account for a significant number of visits. To help prevent inappropriate emergency department use and return visits, some hospitals offer care coordination and support services such as at-home and in-shelter transitional primary care for frequent presenters and short-term housing for homeless patients recovering after discharge.

In the military.

Emergency departments in the military benefit from the added support of enlisted personnel who are capable of performing a wide variety of tasks they have been trained for through specialized military schooling. For example, in United States Military Hospitals, Air Force Aerospace Medical Technicians and Navy Hospital Corpsmen perform tasks that fall under the scope of practice of both doctors (i.e. sutures, staples and incision and drainages) and nurses (i.e. medication administration, foley catheter insertion, and obtaining intravenous access) and also perform splinting of injured extremities, nasogastric tube insertion, intubation, wound cauterizing, eye irrigation, and much more. Often, some civilian education and/or certification will be required such as an EMT certification, in case of the need to provide care outside the base where the member is stationed. The presence of highly trained enlisted personnel in an Emergency Departments drastically reduces the workload on nurses and doctors.

Violence against health care workers.

According to a survey at an urban inner-city tertiary care centre in Vancouver, 57% of health care workers were physically assaulted in 1996. 73% were afraid of patients as a result of violence, almost half, 49%, hid their identities from patients, 74% had reduced job satisfaction. Over one-quarter of the respondents took days off because of violence. Of respondents no longer working in the emergency department, 67% reported that they had left the job at least partly owing to violence. Twenty-four-hour security and a workshop on violence prevention strategies were felt to be the most useful potential interventions. Physical exercise, sleep and the company of family and friends were the most frequent coping strategies cited by those surveyed.

Medication errors.

Medication errors are issues that lead to incorrect medication distribution or potential for patient harm. As of 2014, around 3% of all hospital-related adverse effects were due to medication errors in the emergency department (ED); between 4% and 14% of medications given to patients in the ED were incorrect and children were particularly at risk.  Errors can arise if the doctor prescribes the wrong medication, if the prescription intended by the doctor is not the one actually communicated to the pharmacy due to an illegibly-written prescription or misheard verbal order, if the pharmacy dispenses the wrong medication, or if the medication is then given to the wrong person.  The ED is a riskier environment than other areas of the hospital due to medical practitioners not knowing the patient as well as they know longer term hospital patients, due to time pressure caused by overcrowding, and due to the emergency-driven nature of the medicine that is practiced there.

An emergency department (ED), also known as an accident & emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care centre.

急诊室(英语:Accident & Emergency、英语:Emergency department、英语:Emergency room等,缩写为英语:A&E或英语:ER),是医院的其中一个部门,但不是每间医院都有提供急诊服务。相对于有预约的门诊部,使用急诊室的病人,他们的求诊需要多数是突发的,例如交通事故、中风、孕妇早产等。


Name.

The island is named for Chongming, an early settlement on the island of Xisha that was named for its placement on relatively high and clear ground.

History.

Present-day Chongming first developed as two separate shoals—Xisha and Dongsha—during the Wude Era ( 618–626) of the Tang dynasty. These were initially about apart and located south of the larger island of Dongbuzhou (,, "Dōngbùzhōu"), which came to form part of the peninsula of Qidong in Jiangsu. Xisha was also known as Gujunsha. By the first year of Shenlong (705), a town was established on Xisha which was known as "Chongming". The number, size, and shapes of the islands fluctuated repeatedly over time and with the floods of the Yangtze: In the 3rd year of Tiansheng (1025), a new island arose a little to the northwest of Dongsha which became known as Yaoliusha from the surnames of its early settlers. In the first year of Jiangzhong Jingguo (1101), Sansha rose for the third time, stabilizing 50 Chinese miles northwest of Yaoliusha. During the 12th- and 13th-century Yuan dynasty, Yingqiansha, Matuosha, Zhangpusha, and around six other islands also formed. The early settlers of these islands were mostly fishermen and salt collectors, with their principal saltern at Tianci.  In the 14th year of Zhiyuan (1277) under Kublai Khan of the Yuan, was organized within Yangzhou. Owing to the shifting sands of the islands, however, the county seat needed to be repeatedly moved. During the late Yuan and early Ming, the sparsely-inhabited shoals of the area began to fill with migrants from Pudong and other areas of Songjiang Prefecture. These immigrants introduced cotton cultivation, which spread widely prior to China's opening to international trade in the later Qing. There was small-scale textile production in the area, but most of the cotton was exported for use in Songjiang, Hangzhou, and other more developed areas of Jiangnan. In the 2nd year of Hongwu (1396) under the Ming, the prefecture was downgraded to a county but, shortly afterwards, a major subsidence—sinking the entirety of Dongsha and most of Xisha—provoked a mass emigration back to the mainland. Around the same time, however, Sansha expanded towards the north while Yaoliusha simultaneously eroded in the south while building up in the north, "migrating" it towards Sansha.  Chongming County was later placed in Suzhou and then Taicang Prefectures. Over the course of the Ming, numerous shoals arose in succession: Ma'ansha, Chen'ensha, Gaomingsha, Xiaoyinsha, Changsha, Yuanjiasha, Xiangsha, Gaotousha, and around 20 others. Over the two hundred years from the beginning of Jiajing (1522) under the Ming to the end of Kangxi (1722) under the Qing, these shoals frequently flooded or collapsed back into the river. Yaoliusha and Sansha eroded away; Xisha, Chenensha, Fanliansha, and others sank. In the west, Pingyangsha arose, then sank, then finally merged with nearby Yuanjiasha, Wujiasha, Xiangsha, and Nansha. Around the end of the Ming dynasty in 1644, these islands were merged all the way to Gaotousha in the west, forming a single mass 200 Chinese miles east to west by 40 north to south. Their unification with remaining nearby islands by 1681 effectively created present-day Chongming, although it remained much smaller at the time. Between the Shunzhi and Kangxi Eras (1644–1722), Rilongsha, Yongansha, Ping'ansha, Dongsansha, and around 25 others arose without sinking.  Under the Republic, it was organized first under the Nantong and then Songjiang Special Administration District. During the Second World War, Chongming was administered first by a separate pacification team, then as part of Shanghai's Great Way Government, and finally as a county of the Japanese-allied Nationalists in Nanjing. Nine years after the establishment of the People's Republic of China, it was placed under the municipality of Shanghai in December 1958. During the Down to the Countryside Movement, many of the "sent-down youth" from Shanghai travelled no further than Chongming. Reclamation, particularly large-scale work on the island's northern and eastern tidal flats in the 1960s and ’90s, doubled the size of the island between 1950 and 2010. It began to absorb the separate island of Yonglongsha—creating an enclave of Jiangsu on the northern shore of the island—in 1972.  Dongtan was a proposed ecocity which was planned to open along with the 2010 World Expo in Shanghai but stalled following the 2006 ouster of the Communist Party Chief Chen Liangyu.

Geography.

Chongming is about running east and west and generally between north to south, covering. The island has an average elevation of above sea level, with the northwest and central areas somewhat higher than the southwest and eastern ones.

Location.

Chongming is located in the Yangtze River, dividing the river into northern and southern channels immediately prior to its entrance into the East China Sea. The island forms the northernmost part of the municipality of Shanghai, separated by the Yangtze from Baoshan and Pudong New Area, which face each other across the mouth of the Huangpu. In Jiangsu, most of Haimen and Qidong are separated from Chongming by the northern channel of the Yangtze; Taicang County, meanwhile, lies across the southern channel next to Shanghai's Baoshan District.  Chongming is about two hours' distance from central Shanghai.

Enclaves.

Owing to the continuous expansion of the island, there are two pene-exclaves of Jiangsu present on the north shore of Chongming Island. The island of Yonglongsha appeared in the north channel of the Yangtze most recently in 1937 and was stabilized and expanded by workers from Nantong in Jiangsu during the late 1960s. Administration of the island was divided between Nantong's cities of Haimen and Qidong. Farms and then townships were established in both areas. Qidong's community of Qilong was connected in 1972 and Haimen's Haiyong township joined separately in 1975. Haiyong is now around while Qilong now stretches along of the north shore of the island. As it is usually only about wide, however, its area is only around.

Environment.

Efforts to improve water quality in local areas successfully resulted in notable recoveries. Furthermore, stable numbers of endangered finless porpoises, have been discovered along the island where two subspecies may occur.

Landmarks.

Under its poetic name of "Yingzhou", various locales around the island were treated as its "8 views" during the Ming and Qing dynasties.  Today, Dongping National Forest Park is located in the central part of the island. Dongping Forest Farm was established in 1959, opened to the public in 1989, and became a nationally protected area in 1993. It is Shanghai's largest forest park, with artificially-planted trees covering. The island is also home to the Dongtan Nature Reserve and the Chongxi Wetland Park, as well as the Chongming National Geological Park.

Tour.

The county runs two 4A-class attractions and four 3A-class attractions. The tourism of the island focuses on three zones - East Chongming, Central Chongming and West Chongming. East Chongming features Dongtan Wetland Park and agritainment options in Yingdong Village and Nanjiang Village. Central Chongming features Dongping National Forest Park, agritainment options at Qianwei Village, Gaojia Zhuangyuan and Ruihua Orchard, Genbao Football Base, Chongming Xuegong (Chongming Museum), Jinaoshan Park, Shou’an Temple and Sanmin Cultural Village. West Chongming offers Mingzhu Lake Park, Xiling Resort, Xisha Wetland and agritainment at Lugang Village.

Economy.

Chengqiao's Chongming Industrial Zone was established in March 1994 and promoted to municipal status in February 1996. It lies west of the town center and north of Nanmen Port.  Chongming is also a center of Shanghai's shipbuilding and maritime equipment industries, whose main base is on nearby Changxing.

Culture.

Chongming boasts one of Shanghai's three Confucian temples, along with Shou'an and Hanshan Temples, Mount Jin'ao, and the tomb of Tang Yicen.  Annual festivals on Chongming include the Shanghai Chongming Forest Travel Festival, Chongming Hairy Crab Festival, the Mingzhu Lake Cup Fishing Competition, the Qianwei Autumn Ecological and Cultural Festival, the Shanghai Fishermen Fun Festival, and the Chongming Cook Stove Painting Festival. The Yu Sheng Cup, a national cricket fighting tournament, is held annually outside the Xilai Ranch in Lühua during the National Day holiday in early October, with a purse of.  The Tour of Chongming Island is an annual elite international women's cycling race consisting of a one-day race and a stage race.

Government.

Administratively, the Shanghai side of Chongming Island is divided among 15 towns and 1 township of Chongming County. The township of Xincun occupies the northernmost corner of the island. From northwest to southeast, the towns are Xinhai Lühua Sanxing Miaozhen Dongping Gangxi Jianshe Chengqiao Xinhe Shuxin Gangyan Buzhen Xianghua Zhongxing and Chenjia The Jiangsu side of the island is divided into Haiyong Township and Qilong Township.

Infrastructure.

Whereas the island was previously only connected to the mainland by ferry service, the Shanghai Yangtze Bridge and Tunnel now connects Chenjia in southeastern Chongming with Shanghai via Changxing and the Chongqi Bridge connects Chenjia to Qidong in southeastern Jiangsu. The Chonghai Bridge under construction will link Xinhai at the west end of the island with Haimen in Jiangsu, while the proposed S7 (Huchong) Expressway would connect Chengqiao directly with Baoshan across the Yangtze.  The new bridges form part of the G40 (Hushan) Expressway connecting Shanghai and Xi'an. Chongming is also spanned by another 38 highways. The two major highways of the island run along its length, Beiyan Highway to the north and Chenhai Highway to the south. There are 41 bus lines in Chongming County, accessing over 98% of its 227 communities.  18 ferries still connect the island. Chengqiao's Nanmen Port offers service to Shidongkou and Baoyang Rd in Baoshan and to Liuhegang in southern Jiangsu; Xinhai's Niupeng Harbor to Qinglonggang in Haimen; and other ports offer connections with Wusong and the two other islands of the county, Changxing and Hengsha.

Chongming, formerly known as Chungming, is an alluvial island at the mouth of the Yangtze River in eastern China covering as of 2010. Together with the islands Changxing and Hengsha, it forms Chongming County, the northernmost area of the provincial-level municipality of Shanghai. At the time of the 2010 Chinese census, its population was.

崇明岛位于西太平洋沿岸中国海岸线的中点地区,为中华人民共和国实控岛屿中的第二大的岛屿(仅次于海南岛),地处中国最大河流长江入海口,是世界面积最大的河口冲积岛。明清以来,崇明岛属崇明县管辖,目前崇明岛大部分地区属于上海市崇明区管辖,常住人口66万,区政府驻城桥镇,但是有极少一部分(约28平方公里)分属江苏省海门市海永镇和启东市启隆镇管辖。


Terminology.

There are many variations in terminology, in which one or more of "artery", "bypass" or "graft" is left out. The most frequently used acronym for this type of surgery is "CABG" (pronounced 'cabbage'), pluralized as "CABGs" (pronounced 'cabbages'). Initially the term "aortocoronary" "bypass" (ACB) was more popularly used to describe this procedure. "CAGS" (coronary artery graft surgery, pronounced phonetically) should not be confused with coronary angiography (CAG).

Number of arteries bypassed.

The terms "single bypass", "double bypass", "triple bypass", "quadruple bypass" and "quintuple bypass" refer to the number of coronary arteries bypassed in the procedure. In other words, a double bypass means two coronary arteries are bypassed (e.g., the left anterior descending (LAD) coronary artery and right coronary artery (RCA)); a triple bypass means three vessels are bypassed (e.g., LAD, RCA and left circumflex artery (LCX)); a quadruple bypass means four vessels are bypassed (e.g., LAD, RCA, LCX and first diagonal artery of the LAD) while quintuple means five. Left main coronary artery obstruction requires two bypasses, one to the LAD and one to the LCX.  A coronary artery may be unsuitable for bypass grafting if it is small (< 1 mm or < 1.5 mm), heavily calcified, or located within the heart muscle rather than on the surface. A single obstruction of the left main coronary artery is associated with a higher risk for a cardiac death and usually receives a double bypass.  The surgeon reviews the coronary angiogram prior to surgery and identifies the number of obstructions, the percent obstruction of each, and the suitability of the arteries beyond the obstruction(s) as targets. The presumed number of bypass grafts needed as well as the location for graft attachment is determined in a preliminary fashion prior to surgery, but the final decision as to number and location is made during surgery by direct examination of the heart.

Efficacy.

Age "per se" is not a factor in determining risk vs benefit of CABG.  Prognosis following CABG depends on a variety of factors, and successful grafts typically last 8–15 years. In general, CABG improves the chances of survival of patients who are at high risk (generally triple or higher bypass), though statistically after about five years the difference in survival rate between those who have had surgery and those treated by drug therapy diminishes. Age at the time of CABG is critical to the prognosis, younger patients with no complicating diseases doing better, while older patients can usually be expected to suffer further blockage of the coronary arteries.  Veins that are used either have their valves removed or are turned around so that the valves in them do not occlude blood flow in the graft. External support may be placed on the vein prior to grafting into the coronary circulation of the patient. LITA grafts are longer-lasting than vein grafts, both because the artery is more robust than a vein and because, being already connected to the arterial tree, the LITA need only be grafted at one end. The LITA is usually grafted to the left anterior descending coronary artery (LAD) because of its superior long-term patency when compared to saphenous vein grafts.

Results compared to stent placement.

CABG or stent placement is indicated when medical management - anti-angina medications, statins, antihypertensives, smoking cessation, and/or tight blood sugar control in diabetics - do not satisfactorily relieve ischemic symptoms.  A 2018 meta-analysis with over 4000 patient cases found hybrid coronary revascularization (LIMA-to-LAD anastomosis combined with percutaneous stents at other atherosclerotic sites) to have significant advantages compared with conventional CABG. Reduced incidence of blood transfusion, reduced hospital stay duration and reduced intubation duration were all reported. In contrast, HCR was found to be significantly more expensive compared to CABG.

Procedure.

Minimally invasive technique.

Alternate methods of minimally invasive coronary artery bypass surgery have been developed. Off-pump coronary artery bypass (OPCAB) is a technique of performing bypass surgery without the use of cardiopulmonary bypass (the heart-lung machine). Avoidance of aortic manipulation may be achieved through the "anaortic" or no-touch OPCAB technique, which has been shown to reduce stroke and mortality compared to on-pump CABG. Further refinements to OPCAB have resulted in minimally invasive direct coronary artery bypass surgery (MIDCAB), a technique of performing bypass surgery through a 5 to 10 cm incision.  Hybrid Coronary Revascualrisation, where the LIMA-to-LAD anastomosis is combined with percutaneous stents in other atherosclerotic sites, has been shown to have significant advantages compared to conventional CABG, including a decrease in the incidence of blood transfusion, and a reduced intubation time. A 2018 meta-analysis has however demonstrated a greater financial cost when compared to conventional CABG.

Choice of source of grafts.

The choice of vessel(s) is highly dependent upon the particular surgeon and institution. Typically, the left internal thoracic artery (LITA) (previously referred to as "left internal mammary artery" or "LIMA") is grafted to the left anterior descending artery and a combination of other arteries and veins is used for other coronary arteries. The great saphenous vein from the leg is used approximately in 80% of all grafts for CABG. The right internal thoracic (mammary) artery (RITA or RIMA) and the radial artery from the forearm are frequently used as well; in the U.S., these vessels are usually harvested either endoscopically, using a technique known as endoscopic vessel harvesting (EVH), or with the open-bridging technique, employing two or three small incisions. The right gastroepiploic artery from the stomach is infrequently used given the difficult mobilization from the abdomen.

Number performed.

CABG is one of the most common procedures performed during U.S. hospital stays; it accounted for 1.4% of all operating room procedures performed in 2011. Between 2001 and 2011, however, its volume decreased by 46%, from 395,000 operating procedures performed in 2001 to 213,700 procedures in 2011.  Between 2000 and 2012, the number of CABG procedures carried out decreased across the majority of OECD countries. However, there remained substantial variation in the rate of procedures, with the U.S. carrying out four times as many CABG operations per 100,000 people as Spain. These differences do not appear to be closely related to the incidence of heart disease, but may be due to variation in financial resources, capacity, treatment protocols and reporting methods.

Cost.

According to the CDC, the average cost of hospitalization (only) associated with a coronary bypass operation in the United States in 2013 was $38,707, for an aggregate hospitalization cost of $6.4 billion. The International Federation of Healthcare Plans has estimated the average cost of hospitalization and physician fees for a coronary bypass operation in various countries as shown in the Table below.

Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure to restore normal blood flow to an obstructed coronary artery. A normal coronary artery transports blood to the heart muscle itself, not through the main circulatory system.

冠状动脉旁路移植(英语:Coronary artery bypass graft,常缩写为CABG)或心脏绕道手术,俗称冠脉搭桥或搭桥,即冠状动脉旁路移植术,是一项缓解心绞痛和减少冠心病死亡风险的手术。搭桥所用的动脉或静脉均来自患者自身(乳内动脉、桡动脉、胃网膜右动脉、大隐静脉)。将血管桥接于冠状动脉,以绕过冠脉粥样硬化狭窄部,从而提高冠脉灌注,增加心肌氧供。这项手术通常在心脏停搏下进行,需使用体外循环支持; 而搭桥手术也可在跳动的心脏上进行,所谓的“非体外循环(off-pump)”手术。


Origins.

The Shanghai Five grouping was created 26 April 1996 with the signing of the Treaty on Deepening Military Trust in Border Regions in Shanghai, China by the heads of states of China, Kazakhstan, Kyrgyzstan, Russia and Tajikistan.  On 24 April 1997, the same countries signed the Treaty on Reduction of Military Forces in Border Regions in a meeting in Moscow, Russia. On 20 May 1997, President of Russia Boris Yeltsin and President of China Jiang Zemin signed a declaration on a "multipolar world".  Subsequent annual summits of the Shanghai Five group occurred in Almaty, Kazakhstan in 1998, in Bishkek, Kyrgyzstan in 1999, and in Dushanbe, Tajikistan in 2000. At the Dushanbe summit, members agreed to "oppose intervention in other countries' internal affairs on the pretexts of 'humanitarianism' and 'protecting human rights;' and support the efforts of one another in safeguarding the five countries' national independence, sovereignty, territorial integrity, and social stability."  In 2001, the annual summit returned to Shanghai. There the five member nations first admitted Uzbekistan in the Shanghai Five mechanism (thus transforming it into the Shanghai Six). Then all six heads of state signed on 15 June 2001 the "Declaration of Shanghai Cooperation Organisation", praising the role played thus far by the Shanghai Five mechanism and aiming to transform it to a higher level of cooperation.  In June 2002, the heads of the SCO member states met in Saint Petersburg, Russia. There they signed the "SCO Charter" which expounded on the organisation's purposes, principles, structures and forms of operation, and established it in international law.  In July 2005, at the summit in Astana, Kazakhstan, with representatives of India, Iran, Mongolia and Pakistan attending an SCO summit for the first time, the president of the host country, Nursultan Nazarbayev, greeted the guests in words that had never been used before in any context: "The leaders of the states sitting at this negotiation table are representatives of half of humanity".  By 2007 the SCO had initiated over twenty large-scale projects related to transportation, energy and telecommunications and held regular meetings of security, military, defence, foreign affairs, economic, cultural, banking and other officials from its member states.  In July 2015 in Ufa, Russia, the SCO decided to admit India and Pakistan as full members. Both signed the memorandum of obligations in June 2016 in Tashkent, Uzbekistan, thereby starting the formal process of joining the SCO as full members. On 9 June 2017, at a summit in Astana, India and Pakistan officially joined SCO as full members.  The SCO has established relations with the United Nations in 2004 (where it is an observer in the General Assembly), Commonwealth of Independent States in 2005, Association of Southeast Asian Nations (ASEAN) in 2005, the Collective Security Treaty Organization in 2007, the Economic Cooperation Organization in 2007, the United Nations Office on Drugs and Crime in 2011, the Conference on Interaction and Confidence-Building Measures in Asia (CICA) in 2014, and the United Nations Economic and Social Commission for Asia and the Pacific in 2015, African Union in 2018.  The SCO is widely regarded as the "alliance of the East", due to its growing centrality in Asia-Pacific, and has been the primary security pillar of the region. In 2017, SCO's eight full members account for approximately half of the world's population, a quarter of the world's GDP, and about 80% of Eurasia's landmass.

Organisational structure.

The Council of Heads of State is the top decision-making body in the SCO. This council meets at the SCO summits, which are held each year in one of the member states' capital cities. The current Council of Heads of State consists of:  The Council of Heads of Government is the second-highest council in the organisation. This council also holds annual summits, at which time members discuss issues of multilateral cooperation. The council also approves the organisation's budget. The current Council of Heads of Government consists of:  The Council of Foreign Ministers also hold regular meetings, where they discuss the current international situation and the SCO's interaction with other international organisations.  The Council of National Coordinators coordinates the multilateral cooperation of member states within the framework of the SCO's charter.  The Secretariat of the SCO is the primary executive body of the organisation. It serves to implement organisational decisions and decrees, drafts proposed documents (such as declarations and agendas), function as a document depository for the organisation, arranges specific activities within the SCO framework, and promotes and disseminates information about the SCO. It is located in Beijing. The current SCO Secretary-General is Rashid Alimov of Tajikistan, appointed to the office of Shanghai Cooperation Organisation Secretary-General in January 2016.  The Regional Anti-Terrorist Structure (RATS), headquartered in Tashkent, Uzbekistan, is a permanent organ of the SCO which serves to promote cooperation of member states against the three evils of terrorism, separatism and extremism. The Head of RATS is elected to a three-year term. Each member state also sends a permanent representative to RATS.  The official working languages of the Shanghai Cooperation Organisation are Chinese and Russian.  Afghanistan received observer status at the 2012 SCO summit in Beijing, China on 6 June 2012.

Membership.

Observer states.

In 2008, Belarus applied for partner status in the organisation and was promised Kazakhstan's support towards that goal. However, Russian Defence Minister Sergei Ivanov voiced doubt on the probability of Belarus' membership, saying that Belarus was a purely European country. Despite this, Belarus was accepted as a Dialogue Partner at the 2009 SCO Summit in Yekaterinburg, and after applying in 2012, was granted observer status in 2015. Iran has observer status in the organisation, and applied for full membership on 24 March 2008. However, because it was under sanctions levied by the United Nations at the time, it was blocked from admission as a new member. The SCO stated that any country under UN sanctions could not be admitted. After the UN sanctions were lifted, Chinese president Xi Jinping announced its support for Iran's full membership in SCO during a state visit to Iran in January 2016. Mongolia became the first country to receive observer status at the 2004 Tashkent Summit. Pakistan, India and Iran received observer status at the 2005 SCO summit in Astana, Kazakhstan on 5 July 2005.

Dialogue partners.

The position of Dialogue Partner was created in 2008. Nepal was granted dialogue partner status at the group's 2015 summit in Ufa, Russia. Sri Lanka was granted dialogue partner status at the group's 2009 summit in Yekaterinburg. Turkey, a member of NATO, was granted dialogue partner status in the Shanghai Cooperation Organisation (SCO) at the group's 2012 summit in Beijing. Turkish Prime Minister Recep Tayyip Erdoğan has stated that he has discussed the possibility of abandoning Turkey's European Union membership candidacy in return for full membership in the Shanghai Cooperation Organisation. This was reinforced again on 21 November 2016, after the European Parliament voted unanimously to suspend accession negotiations with Turkey. Two days later, on 23 November 2016, Turkey was granted the chairmanship of the energy club of SCO for the 2017 period. That made Turkey the first country to chair a club in the organisation without full membership status.

Future membership possibilities.

In June 2010, the SCO approved a procedure of admitting new members. Several states additionally participate as observers, some of whom have expressed interest in becoming full members in the future. The implications of Iran joining the organisation has been given much thought academically. In early September 2013 Armenian Prime Minister Tigran Sargsyan said during his meeting with his Chinese counterpart that Armenia would like to obtain an observer status in the SCO.  Meanwhile, in 2012 Armenia, Azerbaijan, Bangladesh, Nepal and Sri Lanka applied for observer status within the organisation. Egypt and Syria have also submitted applications for observer status, while Israel, Maldives, Ukraine, Iraq, and Saudi Arabia have applied for dialogue partner status. Bahrain and Qatar have also officially applied to join the SCO.  Turkmenistan has previously declared itself a permanently neutral country, which was recognised by a resolution adopted by the United Nations General Assembly, thus precluding its membership in a military alliance like the Shanghai Cooperation Organisation.

Activities.

Cooperation on security.

The SCO is primarily centered on its member nations' Central Asian security-related concerns, often describing the main threats it confronts as being terrorism, separatism and extremism. However evidence is growing that its activities in the area of social development of its member states is increasing fast.  At SCO summit, held in Tashkent, Uzbekistan, on 16–17 June 2004, the Regional Anti-Terrorist Structure (RATS) was established. On 21 April 2006, the SCO announced plans to fight cross-border drug crimes under the counter-terrorism rubric.  In October 2007, the SCO signed an agreement with the Collective Security Treaty Organization (CSTO), in the Tajik capital Dushanbe, to broaden cooperation on issues such as security, crime, and drug trafficking.  The organisation is also redefining cyberwarfare, saying that the dissemination of information "harmful to the spiritual, moral and cultural spheres of other states" should be considered a "security threat". An accord adopted in 2009 defined "information war", in part, as an effort by a state to undermine another's "political, economic, and social systems". "The Diplomat" reported in 2017 that SCO has foiled 600 terror plots and extradited 500 terrorists through RATS.

Military activities.

Over the past few years, the organisation's activities have expanded to include increased military cooperation, intelligence sharing, and counterterrorism.  Military exercises are regularly conducted among members to promote cooperation and coordination against terrorism and other external threats, and to maintain regional peace and stability. There have been a number of SCO joint military exercises. The first of these was held in 2003, with the first phase taking place in Kazakhstan and the second in China. Since then China and Russia have teamed up for large-scale war games in 2005 (Peace Mission 2005), 2007 and 2009, under the auspices of the Shanghai Cooperation Organisation. More than 4,000 soldiers participated at the joint military exercises in 2007 (known as "Peace Mission 2007") which took place in Chelyabinsk Russia near the Ural Mountains, as was agreed upon in April 2006 at a meeting of SCO Defence Ministers. Russian Defence Minister Sergei Ivanov said that the exercises would be transparent and open to media and the public. Following the war games' successful completion, Russian officials began speaking of India joining such exercises in the future and the SCO taking on a military role. Peace Mission 2010, conducted 9–25 September at Kazakhstan's Matybulak training area, saw over 5,000 personnel from China, Russia, Kazakhstan, Kyrgyzstan and Tajikistan conduct joint planning and operational maneuvers.  The SCO has served as a platform for larger military announcements by members. During the 2007 war games in Russia, with leaders of SCO member states in attendance including Chinese President Hu Jintao, Russia's President Vladimir Putin used the occasion to take advantage of a captive audience. Russian strategic bombers, he said, would resume regular long-range patrols for the first time since the Cold War. "Starting today, such tours of duty will be conducted regularly and on the strategic scale", Putin said. "Our pilots have been grounded for too long. They are happy to start a new life".  On 4 June 2014, in the Tajik capital Dushanbe, the idea was brought up to merge the SCO with the Collective Security Treaty Organization. It is still being debated.

Economic cooperation.

Russia, Kazakhstan and Kyrgyzstan are also members of the Eurasian Economic Union. A Framework Agreement to enhance economic cooperation was signed by the SCO member states on 23 September 2003. At the same meeting the Premier of China, Wen Jiabao, proposed a long-term objective to establish a free trade area in the SCO, while other more immediate measures would be taken to improve the flow of goods in the region. A follow up plan with 100 specific actions was signed one year later, on 23 September 2004.  On 26 October 2005, during the Moscow Summit of the SCO, the Secretary General of the Organisation said that the SCO will prioritise joint energy projects; including in the oil and gas sector, the exploration of new hydrocarbon reserves, and joint use of water resources. The creation of the SCO Interbank Consortium was also agreed upon at that summit in order to fund future joint projects. The first meeting of the SCO Interbank Association was held in Beijing on 21–22 February 2006. On 30 November 2006, at "The SCO: Results and Perspectives", an international conference held in Almaty, the representative of the Russian Foreign Ministry announced that Russia is developing plans for an SCO "Energy Club". The need for this "club" was reiterated by Moscow at an SCO summit in November 2007. Other SCO members, however, have not committed themselves to the idea. However, during the 2008 summit it was stated that "Against the backdrop of a slowdown in the growth of world economy pursuing a responsible currency and financial policy, control over the capital flowing, ensuring food and energy security have been gaining special significance".  At the 2007 SCO summit Iranian Vice President Parviz Davoodi addressed an initiative that had been garnering greater interest and assuming a heightened sense of urgency when he said, "The Shanghai Cooperation Organisation is a good venue for designing a new banking system which is independent from international banking systems".  The address by President Putin also included these comments:  We now clearly see the defectiveness of the monopoly in world finance and the policy of economic selfishness. To solve the current problem Russia will take part in changing the global financial structure so that it will be able to guarantee stability and prosperity in the world and to ensure progress.  The world is seeing the emergence of a qualitatively different geo-political situation, with the emergence of new centers of economic growth and political influence.  We will witness and take part in the transformation of the global and regional security and development architectures adapted to new realities of the 21st century, when stability and prosperity are becoming inseparable notions.  On 16 June 2009, at the Yekaterinburg Summit, China announced plans to provide a US$10 billion loan to SCO member states to shore up the struggling economies of its members amid the global financial crisis. The summit was held together with the first BRIC summit, and the China–Russia joint statement said that they want a bigger quota in the International Monetary Fund.  At the occasion of Bishkek summit June 2019, Pakistani Prime Minister, Imran Khan also gave a statement to build a market of local currency instead of US Dollars among the members of Shanghai Cooperation Organisation (SCO).

Cultural cooperation.

Cultural cooperation also occurs in the SCO framework. Culture ministers of the SCO met for the first time in Beijing on 12 April 2002, signing a joint statement for continued cooperation. The third meeting of the Culture Ministers took place in Tashkent, Uzbekistan, on 27–28 April 2006.  An SCO Arts Festival and Exhibition was held for the first time during the Astana Summit in 2005. Kazakhstan has also suggested an SCO folk dance festival to take place in 2008, in Astana.

Summits.

According to the Charter of the SCO, summits of the Council of Heads of State shall be held annually at alternating venues. The locations of these summits follow the alphabetical order of the member state's name in Russian. The charter also dictates that the Council of Heads of Government (that is, the Prime Ministers) shall meet annually in a place decided upon by the council members. The Council of Foreign Ministers is supposed to hold a summit one month before the annual summit of Heads of State. Extraordinary meetings of the Council of Foreign Ministers can be called by any two member states.

Analysis.

Relations with the West.

The United States applied for observer status in the SCO, but was rejected in 2005.  At the Astana summit in July 2005, with the wars in Afghanistan and Iraq foreshadowing an indefinite presence of U.S. forces in Uzbekistan and Kyrgyzstan, the SCO requested the U.S. to set a clear timetable for withdrawing its troops from SCO member states. Shortly afterwards, Uzbekistan requested the U.S. to leave the K2 air base.  The SCO has made no direct comments against the U.S. or its military presence in the region; however, some indirect statements at the past summits have been viewed by Western media outlets as "thinly veiled swipes at Washington".  A European Parliament researcher expressed her view that "institutional weaknesses, a lack of common financial funds for the implementation of joint projects and conflicting national interests have prevented the SCO from achieving a higher level of regional cooperation".

Geopolitical aspects.

There have been many discussions and commentaries about the geopolitical nature of the Shanghai Cooperation Organisation. Matthew Brummer, in the Journal of International Affairs, tracks the implications of SCO expansion into the Persian Gulf. Also, according to political scientist Thomas Ambrosio, one aim of SCO was to ensure that liberal democracy could not gain ground in these countries.  Iranian writer Hamid Golpira had this to say on the topic: "According to Zbigniew Brzezinski's theory, control of the Eurasian landmass is the key to global domination and control of Central Asia is the key to control of the Eurasian landmass...Russia and China have been paying attention to Brzezinski's theory, since they formed the Shanghai Cooperation Organisation in 2001, ostensibly to curb extremism in the region and enhance border security, but most probably with the real objective of counterbalancing the activities of the United States and NATO in Central Asia".  At a 2005 summit in Kazakhstan the SCO issued a Declaration of Heads of Member States of the Shanghai Cooperation Organisation which addressed their "concerns" and contained an elaboration of the organisation's principles. It included: "The heads of the member states point out that, against the backdrop of a contradictory process of globalisation, multilateral cooperation, which is based on the principles of equal right and mutual respect, non-intervention in internal affairs of sovereign states, non-confrontational way of thinking and consecutive movement towards democratisation of international relations, contributes to overall peace and security, and call upon the international community, irrespective of its differences in ideology and social structure, to form a new concept of security based on mutual trust, mutual benefit, equality and interaction."  In November 2005 Russian Foreign Minister Sergey Lavrov reiterated that the "Shanghai Cooperation Organisation (SCO) is working to establish a rational and just world order" and that "The Shanghai Cooperation Organisation provides us with a unique opportunity to take part in the process of forming a fundamentally new model of geopolitical integration".  The "People's Daily" expressed the matter in these terms: "The Declaration points out that the SCO member countries have the ability and responsibility to safeguard the security of the Central Asian region, and calls on Western countries to leave Central Asia. That is the most noticeable signal given by the Summit to the world".  A 2010 analysis in "American Legion Magazine" said that 'Chinese Premier Wen Jiabao... has concluded that the United States is maneuvering "to preserve its status as the world's sole superpower and will not allow any country the chance to pose a challenge to it."'

The Shanghai Cooperation Organisation (SCO), or Shanghai Pact, is a Eurasian political, economic, and security alliance, the creation of which was announced on 15 June 2001 in Shanghai, China by the leaders of China, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, and Uzbekistan; the Shanghai Cooperation Organisation Charter, formally establishing the organisation, was signed in June 2002 and entered into force on 19 September 2003. The original five nations, with the exclusion of Uzbekistan, were previously members of the Shanghai Five group, founded on 26 April 1996. Since then, the organisation has expanded its membership to eight countries when India and Pakistan joined SCO as full members on 9 June 2017 at a summit in Astana, Kazakhstan. The Heads of State Council (HSC) is the supreme decision-making body in the SCO, it meets once a year and adopts decisions and guidelines on all important matters of the organisation. Military exercises are also regularly conducted among members to promote cooperation and coordination against terrorism and other external threats, and to maintain regional peace and stability. The SCO is the largest regional organisation in the world in terms of geographical coverage and population, covering three-fifths of the Eurasian continent and nearly half of the human population.

上海合作组织(简称上合组织;,缩写为 ;英语:Shanghai Cooperation Organization,缩写为 英语:SCO)是中华人民共和国、俄罗斯、哈萨克斯坦、吉尔吉斯、塔吉克斯坦斯坦、乌兹别克、巴基斯坦和印度等8个国家组成的一个国际组织,另有四个观察员国:蒙古、白俄罗斯、伊朗、阿富汗,以及六个对话伙伴国:亚美尼亚、阿塞拜疆、柬埔寨、尼泊尔、斯里兰卡、土耳其。工作语言为汉语和俄语。成员国总面积为3435.7万平方公里,即亚欧大陆总面积的3/5,人口30亿,为世界总人口的43%。这是在中国境内成立的第2个政府间国际组织,及首次以其城市命名,宣称以“上海精神”解决各成员国间的边境问题。