With the rapid development of society and continuous improvement

With the rapid development of society and continuous improvement of domestic economy in our nation, the occupations of the dangerous goods transport accounted in the entire transport system have been constantly raised. The dangerous StemRegenin 1 solubility goods refer to a kind of materials and goods which is flammable, explosive, toxic, strongly corrosive and heavily radioactive, and so

forth [1]. Any links may easily cause accidents which can endanger people’s life and property and pollute the environment in the process of transportation. Just for these special characteristics, it is extremely important to make safety assessment of dangerous goods transport enterprise. At present, there are few available studies on safety assessment of dangerous goods transport enterprise in our country. For instance, Xiu and Zhang established the evaluation index system and fuzzy synthetic evaluation model used for safety management of dangerous goods transport and then assessed the safety of dangerous goods transport enterprise [2]. Huo et al. applied Likert-type scale based on Matter Element Analysis theory to assess the safety of dangerous goods transport enterprise [3]. While Yan and his partners integrated the Fuzzy Decision theory, group decision making, and

TOPSIS, put forward a method to make safety assessment of dangerous goods transport enterprise based on Fuzzy TOPSIS [4]. In foreign countries, they focused on the dangerous goods transport routes

optimization, risk assessment, emergency tube principle, and the development of decision support system research [5–9]. Above studies have provided a theoretical reference to assess the safety of dangerous goods transport enterprise, but they still need further improvement in aspects of index value and weight assignment. For instance, a certain index value in index system of safety assessment of dangerous goods transport enterprise may change with the passage of time, change of environment, affection of inner or outer factors, and shift of personal subjective wishes. It will not be accurate enough on assessment result in certain degree if they are assessed as static indexes. Moreover, because of the existing diversity on knowledge, experience, and preference among the experts, giving the same weight value may not be objective. Therefore, this paper researches on the safety assessment GSK-3 of dangerous goods transport enterprise using optimization model based on relative entropy in group decision making. 2. The Safety Assessment Model of Multiobjective Dangerous Goods Transport Enterprise Based on Entropy Suppose A = a j, j = 1,2,…, n is a dangerous goods transport enterprise set to be assessed, wherein a j is the enterprise j; and B = b i, i = 1,2,…, m is a set of assessment indexes from experts, wherein b i represents index i. Namely, there are total n experts to make an assessment on m indexes in an assessment program.

18 19 A medical diagnosis was considered to exist if a participan

18 19 A medical diagnosis was considered to exist if a participant answered ‘yes’ when asked supplier Olaparib whether a doctor had ever told them they had the condition of interest. For arthritis, a follow-up question asked whether they had been told they had osteoarthritis, rheumatoid or other arthritis. Treatment for depression and diabetes was defined by reported achievement of quality of care indicators, derived through a robust process of literature reviews, expert panel assessment and piloting.20 21 For depression, the quality indicator was about receipt of treatment since the previous wave:

“if a person is diagnosed with clinical depression, then antidepressive treatment, talking treatment or electroconvulsive treatment should be offered within 2 weeks after diagnosis unless within that period the patient has improved, or unless the patient has substance abuse or dependence, in which case treatment may wait until 8 weeks after

the patient is in a drug-or alcohol-free state.” For diabetes, treatment was measurement of HbA1c or fructosamine levels in the preceding 12 months. Treatment for angina was defined as ever being offered or currently taking β-blockers (ELSA variables hebeta or hebetb). Treatment for osteoarthritis and cataract was defined as reporting ever having had surgery for the condition. For osteoarthritis, this excluded those with hips or knees replaced due to fracture. Data on hip and knee replacements were only available for respondents aged 60 and over, and so respondents aged less than 60 years (n=3186) were excluded from the analysis of osteoarthritis. Wealth was defined as

the sum of financial, physical and housing wealth plus state and private pension income. Age was categorised into three groups: 50–59, 60–74 and 75 years and older. Analysis We used two approaches to analysis, a main analysis using serial cross-sectional data and then a subsidiary analysis using longitudinal data. Multivariable logistic regression analysis was used, with the outcome variables defined as one of illness burden, self-reported medical diagnosis or treatment for each of the five conditions in each cross-sectional wave (STATA statistical software V.12.1). This regression analysis was repeated for each of the four waves Entinostat of ELSA from 2004 to 2011 separately and then ‘overall’ for all four waves combined. For the ‘overall’ analysis, the data were reshaped into ‘long’ format in Stata statistical software, with each participant having a separate record for each wave. Intraperson correlation of outcomes was accounted for using robust adjustment with Stata, with each participant’s unique identifier included in the regression equation as a cluster variable. Missing data were excluded from the analyses. The independent variables were age group, sex and slope order of inequality.

2 to 15 1; table 3) The least wealthy participant also had highe

2 to 15.1; table 3). The least wealthy participant also had higher odds of diagnosis (ORs 1.1–4.5) and either no different or relatively small odds of treatment (ORs 0.9–2.6; table 3 and figure 1). Table 3 supplier Adriamycin Illness burden, self-reported medical diagnosis and treatment of angina, cataract, depression, diabetes and osteoarthritis, comparing the least wealthy with the most wealthy: logistic regression Figure 1

Illness burden (in blue), self-reported medical diagnosis (in green) and treatment (in red) of angina, cataract, depression, diabetes and osteoarthritis, comparing the least wealthy with the most wealthy: Overall ORs (adjusted for age and sex) and 95% … For angina, the overall OR for meeting the criteria for ‘illness burden’ was 7.6, indicating that the hypothetically least wealthy individual was seven times more likely to have angina symptoms (defined by the Rose Angina scale) than the wealthiest. The OR for self-reported medical diagnosis was 4.5, suggesting that some less wealthy people with angina symptoms had not received a diagnosis of angina, as the expected OR for equitably distributed diagnosis would have been 7.6. The OR for treatment was

3.2, and again the expected ORs for equitably distributed treatment would have been 7.6. For depression, the overall OR for illness burden was 6.4, for medical diagnosis was 3.3 and for treatment was 2.6, again suggesting that some poorer people with symptoms of depression were less likely to have received a diagnosis or indicated healthcare, as the expected ORs for equitably distributed treatment would have been 6.4. For diabetes, the overall OR for illness burden was 4.2 and 4.0 for diagnosis, suggesting that for diabetes, diagnosis was distributed equitably. However, the OR for treatment was 0.9 and not statistically significantly different from 1, again suggesting that some less wealthy people with medically diagnosed diabetes had not received treatment, as the expected OR for equitably distributed treatment would have been 4.2. The subsidiary analysis calculated the OR of receiving a diagnosis by a subsequent

wave only for those who had met the criteria for ‘illness burden’ for the relevant long-term condition in a previous wave, and then the likelihood of receiving GSK-3 treatment only for those who had received a medical diagnosis in a previous wave. The substantial inequalities in the illness burden of conditions by wealth are identical to table 3, as expected, and subsequently the numbers of eligible participants dwindle rapidly due to the nested nature of the analysis, with some wide CI and 9 out of 10 results not statistically significant (see online supplemental file 1). Discussion We found that while there were strong inverse associations between wealth and the burden of illness (based on validated scales, symptoms and biomarker) of a long-term condition, there were smaller or absent inequalities in receipt of self-reported medical diagnosis or treatment for the conditions considered.

05), but there were no significant differences for other cardiova

05), but there were no significant differences for other cardiovascular

risk factors (all Crizotinib ROS1 p>0.05). The proportions of male sex, overweight, obesity, dyslipidaemia, DM, IFG, hyperuricaemia and BMI, and levels of TC, LDL-C, TG, FPG and UA were higher in the high-range prehypertension group than in the optimal BP group (all p<0.05). Compared with low-range prehypertension, the proportions of overweight, dyslipidaemia and IFG were higher in the high-range prehypertension (all p<0.05; table 3). Table 3 Cardiovascular risk factors in different subranges of prehypertension Risk factors associated with prehypertension The multivariable-adjusted risk factors associated with prehypertension are presented in table 4. High BMI (overweight/obesity) was the most important risk factor for prehypertension (OR=2.84, 95% CI 1.55 to 5.20, p<0.001). Age (per 10 years, OR=1.21, 95% CI 1.02 to 1.44, p=0.03), male sex (OR=2.19, 95% CI 1.39 to 3.45, p<0.001) and hyperuricaemia (OR=1.70, 95% CI 1.14 to 2.54, p=0.009) were also significantly associated with prehypertension. Furthermore, collinearity statistics were >0.4

for tolerance and <2.5 for the variance inflation factor, suggesting that multicollinearity was not a concern among the independent variables. Table 4 Multivariate logistic regression analysis for risk factors of prehypertension Discussion In this study, we found that prehypertension is highly prevalent in the Shunde District, Guangdong Province. Prehypertensive individuals presented with other risk factors associated with CVD, such as overweight, dyslipidaemia, impaired glucose and hyperuricaemia. Furthermore, combined cardiovascular risk factors were more significant in people with high-range prehypertension. To the best of our knowledge, this is the first study to show that there was a significant heterogeneity of combined risk factors within the prehypertensive subgroups. Many epidemiological studies have demonstrated that prehypertension is an important public health problem. However, the prevalence GSK-3 of prehypertension

in different countries and districts differs significantly, and may be influenced by different regional factors, such as climate and lifestyle, as well as ethnicity. At the beginning of this century (2000–2001), a cross-sectional survey found that the prevalence of prehypertension was 21.9% among Chinese participants aged between 35 and 74 years.3 However, in other subsequent studies, the prevalence of prehypertension was significantly higher than this ratio. In rural northeastern China, the prevalence of prehypertension was 35.1% in men and 32.5% in women,15 and up to 40% in the whole population from urban areas of northeastern China,16 which may be associated with the cold climate and high sodium diet.

Literature review of studies evaluating community-based teaching

Literature review of studies evaluating community-based teaching A summary of the studies evaluated in the systematic literature review are outlined in table 4. The main methods of evaluation employed in the studies were questionnaires, interviews and focus groups of the key stakeholders in CBE—students, patients, tutors inhibitor price and other staff in the community setting. Table 4 Summary of systematic review Needs assessment of CBE Studies of student expectations of CBE highlighted

that students valued experiential patient-centred learning and tutor supervision in the community setting.14 30 In a Sheffield study,14 students also recognised that CBE was a powerful vehicle for changing their approach to medicine and illness, where the patient as a person is given emphasis over the disease. Implementation assessment of CBE All forms of community-based teaching were generally well-received by medical students, patients and participating healthcare professionals, supporting the continuation of existing community-based teaching programmes in the future. This included community-based teaching which was incorporated into specialty modules such as Obstetrics and Gynaecology,31 Psychiatry22 and Surgery.27 The

unique approach of incorporating primary healthcare in an intercalated Bachelor of Science medical research year also received positive feedback.23 Three studies found that students preferred the implementation of practice-based teaching over hospital-based teaching. Hastings et al11 found that students in Leicester preferred practice-based teaching on the grounds of both teaching method and content. O’Sullivan et al12 had similar findings among students from University College London, where practice-based teaching bore qualities of better

teaching attitudes, teaching methods and course organisation. Interestingly, these findings were consistent with Powell and Easton’s27 investigation on Imperial College students undertaking their surgery module. These students preferred surgical teaching within general practices due to the learner-centred approach in teaching, more protected teaching time and regular access to suitable patients for acquiring clinical skills. The success of community teaching in Leicester was analysed by Hastings et al.11 It was found that the improved quality of teaching by GP tutors was attributed to a higher proportion of GP tutors attending teacher-training courses. General practices Drug_discovery were also found to have greater resource availability and NHS funding specifically allocated to support the teaching of medical undergraduates. All these factors placed hospital doctors at a disadvantage in preparing good-quality clinical teaching sessions in comparison to GPs. Impact assessment of CBE Studies of CBE impact on students bore the following themes: (1) Learning outcomes, (2) Behavioural changes to primary care and (3) Traits of future doctors.

*National Coordinator ISAAC Phase Three National Coordinators no

*National Coordinator. ISAAC Phase Three National Coordinators not identified above—Brazil: D Solé; Canada: M Sears; Chile: V Aguirre; Fiji: L Waqatakirewa; India: J Shah; Indonesia: PF-2341066 K Baratawidjaja;

Japan: S Nishima; Mexico: M Baeza-Bacab; New Zealand: MI Asher; Singapore: B-W Lee. Contributors: AWS had access to all the data on the study and takes responsibility for the integrity of the data and accuracy of the data analysis; he was also involved in statistical analysis. All authors were involved in the study concept and design; critical revision of the manuscript for important intellectual content; and administrative, technical and material support. The

ISAAC steering committee was involved in the acquisition of data. IB contributed to the drafting of the manuscript. EAM obtained funding and was involved in study supervision. Funding: EAM and IB are supported by Cure-Kids NZ. Competing interests: None. Ethics approval: Ethical approval was obtained for the original ISAAC Phase Three study, and permission was gained to use the data from ISAAC Phase Three through agreement with the ISAAC Phase Three Steering Committee. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: Information with respect to all ISAAC studies, including methods, data gathering and results is available on the ISAAC website: isaac.auckland.ac.nz/.
Alcohol use disorders (AUD) have been associated with excessive all-cause mortality in three meta-analyses1–3 and

this has further been corroborated in recent population-based cohort studies.4 5 Important causes of death are injuries and suicide; these are highlighted in patients presenting with AUDs.2 3 6 Mental disorders, other than AUDs, are associated with increased all-cause mortality1 3 and suicide.3 6 7 Whereas alcohol dependence is significantly associated with all types of substance and psychiatric disorders,8 the co-occurrence of mental disorders and AUDs should be taken into account when studying outcomes in patients with these disorders. Alcohol-related problems or AUDs have Anacetrapib been described as a substantial burden on emergency departments (EDs.),9–12 and the increase in alcohol-related visits and suboptimal management at the ED calls for action.12 The imminent and long-term mortality risks of drunken patients in the ED have only rarely been studied,13 although mortality investigations have been undertaken repeatedly on patients with a clinical diagnosis of AUDs or persons with AUDs identified in general population surveys.1–5 Increased all-cause mortality of AUD patients from the ED was found in a small study13 with excess death from injuries and suicide.

In order

to facilitate deeper exploration of the known ke

In order

to facilitate deeper exploration of the known key themes and assumed barriers/facilitators selleck chemicals llc to help-seeking, the interviews use probes designed to ensure rich data are collected. However, the overarching interview topics are general to encourage the participant to tell their story and share their experience to ensure new themes are not missed. Investigating gender, help-seeking decisions and cardiac symptoms is complex, and few larger quantitative studies have produced convincing statistical results. Many studies have criticised the lack of inclusion of a specific valid instrument for gender, help-seeking and cardiac symptoms. Studies used generalised non-specific response-to-symptoms. In order to facilitate further study—a large quantitative trial with generalisable results—the qualitative data elicited in this study will be used to construct and undertake preliminary validation testing for a gender and help-seeking questionnaire with a specific focus on cardiac symptoms. Feedback and dissemination The investigators will send a written summary to participants at the end of the study to thank them for their involvement, let them know the study is concluded and provide key study findings. In addition, investigators will disseminate findings to the scientific community via publication

in peer journals, presentations and the creation of patient advice leaflet for chest pain clinics. Supplementary Material Author’s manuscript: Click here to view.(979K, pdf) Reviewer comments: Click here to view.(134K, pdf) Acknowledgments The University of Westminster for sponsoring this study and Dr Bob Odle for his help in obtaining sponsorship. Queen Mary’s Roehampton Cardiology Department for agreeing to be host site for this study, with special gratitude to Mona Chauhan for her assistance. Dr Beth Unsworth for helping us conceptualise this study. Adam Russell for help with editing the manuscript.

Footnotes Contributors: NS designed the study protocol with guidance from DR and AC. NS drafted the manuscript. DR and AC edited and gave feedback on multiple drafts of the manuscript. All authors Dacomitinib read and approved the final manuscript. Competing interests: None. Ethics approval: IRAS. Provenance and peer review: Not commissioned; externally peer reviewed.
According to a recent scenario, diabetes is becoming a global public health problem, especially in India. Obesity, especially central obesity, and increased visceral fat due to physical inactivity and consumption of high-calorie/high-fat and high-sugar diets are major contributing factors for it.1 In India, as urbanisation and economic growth occur, there are major deviations in the dietary pattern that are influenced by varied cultural and social customs.

Data analysis plan The analysis will be conducted on an intention

Data analysis plan The analysis will be conducted on an intention-to-treat selleck screening library (ITT) basis.

Exploratory analysis will be conducted first for outcome and patient background variables; descriptive statistics of each variable will be presented separately for each group at each follow-up point, with means and SD for normally distributed variables, medians (IQR) for skewed variables and frequency (percentage) for categorical variables. Missing values will be checked and reported. Multiple imputation will be used to hand missing values, based on a multilevel modelling approach. To compare the number of visits needed to achieve an ADHD diagnosis (either confirmed or excluded) between groups, Poisson regression with binary group status as the explanatory variable will be implemented. To compare clinician’s confidence in their diagnostic decisions, multilevel modelling with patient as a level

2 unit will be used to take into account the non-independence within patient data due to repeated measures.41 κ Statistics will be used to reflect the stability of diagnosis between first confirmed diagnosis and diagnosis rerated at 6-month follow-up time. κ Statistics will be reported for each group and the stability of diagnosis will be compared between arms using logistic regression. The same analysis approach will be implemented to explore the stability of diagnosis confidence between time of first confirmed diagnosis and 6-month follow-up. To assess the diagnosis accuracy, the sensitivity, specificity, likelihood ratio (LR) ve+, LR ve−, positive predictive value (PPV) and negative predictive

value (NPV) will be reported for each group and the test performance will be compared between QbO and QbB arms.42 43 Receiver operating characteristic curve analyses will be used to obtain the best predictive model based on QbTest scores that discriminates between ADHD ‘positive’ and ADHD ‘negative’ gold standard DAWBA diagnoses. For treatment related outcomes (phase 2) outcome measures such as SNAP-IV, side effects scale, SDQ and C-GAS scores, multilevel modelling with patient as a level 2 unit will be again Batimastat applied to quantify the difference between QbO and QbB arms. For time to event variables such as time to diagnosis (in days), survival analysis using log-rank test will be performed for group comparison and Kaplan-Meier survival curves will be displayed for each group. Logistic regression will be used to compare the proportion of normalisation between two groups at 6-month follow-up time. For all regression modelling to explore the difference between arms, group status will be included as explanatory variables. Data transformation would be needed for skewed outcome variables. Health economic evaluation Economic evaluation will be completed primarily from a health service perspective but in addition from a societal perspective. A cost-effectiveness and cost utility analysis of the treatment options will be conducted.

The search strategy for MEDLINE (Ovid MEDLINE In-Process & Other

The search strategy for MEDLINE (Ovid MEDLINE In-Process & Other Non-Indexed Citations 1946 to 20 January 2012) is shown: Circumcision, Female/ ((female$ or wom#n or girl$1) adj3 (mutilation$ or circumcis$ or cutting$)).tw. Crizotinib ROS1 “fgm/c”.tw. ((removal$ or alteration$ or

excision$) adj6 female genital$).tw. pharaonic circumcision$.tw. sunna.tw. (clitoridectom$ or clitorectom$).tw. (infibulat$ or reinfibulat$ or deinfibulat$).tw. or/1–8 One reviewer (RCB) manually screened the bibliographies of published reviews on FGM/C and all included studies for additional qualifying studies. RCB did additional searches for the relevant grey literature and unpublished studies in OpenGrey, OpenSigle, OAIster, browsed websites of six international organisations that are engaged in projects regarding FGM/C, and communicated with experts

in the field. Selection of studies and extraction of data Studies retrieved were eligible for inclusion if they satisfied all our criteria: Be an empirical quantitative study with or without a comparison group published in any language that presented original quantitative data for physical health outcomes in women who had undergone any type of FGM/C as defined by the WHO.1 All physical health outcomes were eligible, including but not limited to death, infections, infertility, fistula, pain, urinary complications, shock (primary outcomes), and bleeding/haemorrhage, menstrual complications, obstetric complications, vaginal calculus formation, cysts, tissue injury,

fractured/displaced bones, urethral meatal stenosis/ urethral stricture, abscesses, keloid and other scarring (secondary outcomes). We applied the following exclusion criteria: Qualitative studies, studies without a quantitative measure of a physical consequence of FGM/C, and all genital modifications not captured by the WHO stated FGM/C definition. Screening, quality appraisal and data extraction were independently undertaken by two investigators (RCB and VU), with discrepancies resolved by consensus. The two investigators confirmed the eligibility of first titles and Drug_discovery abstracts and then full texts. Quality assessment of the identified studies was undertaken as recommended in the Cochrane Handbook, using design specific checklists based on the User’s Guide framework.16 This was done at the study level. The investigators extracted study information and data onto a standardised data collection form, which had been piloted. Data extracted included publication details, study design, sample characteristics, FGM/C characteristics, methods of outcome measurement and health consequences. We contacted authors for additional data or clarification where needed. Statistical analysis We grouped the data according to outcomes across the studies, keeping the outcome categories or labels as reported in each individual study.

The other variants of PG are less common and usually respond well

The other variants of PG are less common and usually respond well to immunosuppressive treatments exactly [3]. In our study, the lesions were more commonly localised to the lower limbs (56.5%) but this proportion was lower than other studies which reported a proportion of 70% to 80% [3, 12, 13, 15]. Pathergy was a precipitating factor in almost half the cases. One of the main causes of pathergy was surgery. It is therefore critical for clinicians to be aware and vigilant in diagnosing this complication as delayed diagnosis can potentially lead to poorer prognosis.

Many studies have reported that, in 50 to 70% of the cases, PG is associated with an underlying disease such as IBD, inflammatory arthritis, haematological disorders, and solid malignancies [11–15]. In our study, 47.8% of patients had associated systemic diseases. Most patients presented with known systemic disorders. Only one patient was newly diagnosed with an associated systemic disease during the acute admission. He was diagnosed with monoclonal gammopathy on serum protein electrophoresis. This highlights the importance of screening patients with PG for associated systemic diseases. 4.3. Investigations It is not uncommon for PG to occur with wound infection. We observed that

CRP alone is not specific for wound infection [6, 19, 20]. An elevated CRP can indicate either a concomitant bacterial infection or active inflammatory process associated with PG. However, an abnormally high level of CRP more than 50mg/L, a positive wound culture, and clinical signs such as erythema and swelling indicate a wound infection which should prompt treatment with antibiotics. Immunosuppression should still be continued to prevent progression of PG [6, 19, 20] except in the presence of systemic sepsis. CRP is a valuable investigation and has been shown in previous studies to be useful in monitoring progression of PG [11]. Histology findings are nonspecific but can serve to exclude infection, malignancy, and vasculitis [2]. Neutrophilic infiltration into

dermis is the histological hallmark of PG [2] and is consistent with the Brefeldin_A results of our study. Other histological findings of leukocytoclasia, abscess, and vasculitis are also seen in our patients. 4.4. Treatment Systemic therapy is the mainstay of treatment for severe, progressive PG which is commonly seen in patients requiring hospital treatment for PG [7, 8]. Twenty-one patients received systemic therapy. Only two patients with mild PG received topical therapy and were discharged after a relatively short hospital stay. One patient was admitted as she was also suffering from community acquired pneumonia while the other had peristomal PG and required admission to monitor his underlying Crohn’s disease. Systemic corticosteroids have been shown to be effective in a number of studies and are therefore considered as first-line therapy [7, 8].