The objective of this paper is to use the SOM to study the PR-171 structure heterogeneities of vehicle-following behavior. We use a trained SOM to show that when presented with similar stimuli (i) different car drivers respond with different magnitudes of acceleration when following cars; that is, car drivers have interdriver heterogeneity; (ii) the same car driver responds with different magnitudes of acceleration when following the same car; that is, the same driver has intradriver heterogeneity; and (iii) car drivers respond with different magnitudes of acceleration when the leaders are of different vehicle types. We called this phenomenon inter-vehicle-type heterogeneity.
In additional to proposing the SOM as a nonparametric vehicle-following model, the findings of interdriver heterogeneity, intradriver heterogeneity, and inter-vehicle-type heterogeneity serve as complements to limited earlier studies. After this introduction, the next section of this paper reviews the vehicle-following models and SOM. This is followed by a description of the data used in this research. The next section presents the SOM training. Subsequently, we present the results of using the trained SOM to analyze the interdriver, intradriver and inter-vehicle-type heterogeneities. The
findings are summarized towards the end of this paper. 2. Literature Review 2.1. Vehicle-Following Models A vehicle-following model is an equation (or a set of equations) that describes the movement of a driver-vehicle in response to the dynamics of the driver-vehicle immediately ahead,
when both vehicles are traveling in the same direction in the same lane. As a fundamental building block of microscopic traffic simulation, the realism of a vehicle-following model improves the accuracy of the simulation outcome, which in turn enables better transportation decision making. The historical development of vehicle-following models from 1958 to 1999 has been summarized in . Many vehicle-following models have been proposed, tested, and used in microscopic simulation models over the years . Carfilzomib The deterministic model proposed by Gazis, Herman, and Rothery , often known simply as the GHR model, is one of the earliest and the most well-known models. The GHR model, also known as the General Motors (GM) model, takes the following form: x¨ft+Δt=λfx˙ft+Δtmx˙lt−x˙ftxlt−xftk, (1) where x¨ft is the acceleration of the follower f at time t; x˙ft is the velocity of the follower f at time t; x˙lt is the velocity of the leader l at time t; xf(t) is the position of the follower f at time t; xl(t) is the position of the leader l at time t; λf is the follower’s sensitivity constant; Δt is the time lag in the follower’s response; and m and k are calibration constants. The GHR model equates the follower’s response to the follower’s sensitivity multiplied by the external stimulus.
(2.4M, pdf) Acknowledgments Dave Stott and Amander Wellings, representatives of Public and Patient Involvement Tie-2 in Research (PPIRes), brought a helpful lay perspective to this research. Footnotes Contributors: NS contributed to the study design, oversaw data analysis and interpretation, and drafted the paper. NS is the guarantor. ACH undertook data preparation, analysis and interpretation, and contributed to drafting the paper. LTAM undertook data preparation and analysis. MOB and AC advised on statistical techniques. SHR, JC and IL advised on data analysis and interpretation. DM contributed to the study design
and advised on data analysis and interpretation. All authors contributed to data interpretation and revised the paper critically. Funding: This article presents independent research commissioned by the UK National Institute for Health Research (NIHR) under the Health Services Research programme: HSR Project 10/2002/06—‘The dynamics of
quality: a national panel study of evidence-based standards’. IL’s work was supported by the NIHR Collaboration for Applied Health Research and Care (CLAHRC) for the South West Peninsula. Competing interests: All authors had financial support from the National Institute for Health Research for the submitted work. DM had financial support from Age UK. Ethics approval: The English Longitudinal Study of Ageing received ethics approval from the National Research Ethics Service: 09/H0505/124 and the London Multi-Centre Research Ethics Committee. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: The ELSA data set and technical documentation are available from the UK Data Service at: http://discover.ukdataservice.ac.uk/catalogue?sn=5050.
From international reviews and reports of adverse drug events,
incorrect doses account for up to one-third of the events.1–3 Many health professionals find drug dose calculations difficult. The majority of medical students are unable to calculate the mass of a drug in solution correctly, and around half the doctors are unable Carfilzomib to convert drug doses correctly from a percentage concentration or dilution to mass concentration.4 5 Nurses carry out practical drug management after the physicians’ prescriptions both in hospitals and primary healthcare. In Norway, a faultless test in drug dose calculations during nursing education is required to become a registered nurse.6 Both nursing students and experienced nurses have problems with drug dose calculations, and nursing students early in the programme showed limited basic skills in arithmetic.7–10 We have shown a high risk of error in conversion of units in 10% of registered nurses in an earlier study.11 E-learning was introduced with the internet in the early 1990s, and has been increasingly used in medical and healthcare education.
14 Two to four weeks after the course, the nurses protein inhibitor were retested
in drug dose calculations with a similar MCQ test as the pretest. Sample size Studies testing drug dose calculations in nurses have shown a mean score of 75% (SD 15%).15–17 In a study with 14 questions, this is equivalent to a score of 10.5 (SD 2.1). To detect a difference of one correct answer between the two didactic methods with a strength of 0.8 and α<0.05, it was necessary to include 74 participants in each group. Owing to the likely dropouts, the aim was to randomise 180 participating nurses. Randomisation At inclusion, each nurse was stratified according to five workplaces: internal medicine, surgery or psychiatric wards in hospitals, and nursing home or ambulatory care in primary healthcare. Immediately after
submission of the pretest, the participants were randomised to one of the two didactic methods by predefined computer-generated lists for each stratum. Data collection Participant characteristics The following background characteristics were recorded: age; gender; childhood and education as a nurse in or outside of Norway; length of work experience as a nurse in at least a 50% part-time job; part-time job percentage in the past 12 months; present workplace in a specific hospital department (surgery, internal medicine or psychiatry) or primary healthcare (nursing home or ambulatory care); and frequency of drug dose calculation tasks at work, score 0–3: 0=less than monthly, 1=monthly, 2=weekly, 3=every working day. Further educational background was recorded (yes/no): mathematics beyond the first mandatory year at upper secondary school; other education prior to nursing; postgraduate specialisation and
courses in drug dose calculations during the past 3 years. The participants registered motivation for the courses in drug dose calculations, rated as 1=very unmotivated, 2=relatively unmotivated, 3=relatively motivated, 4=very motivated. In addition, the participants were asked to consider statements from GHQ 30, in the context of performing medication tasks: five regarding coping (finding life a struggle; being able to enjoy normal activities; feeling reasonably happy; getting scared or panicky for no good reason and being capable Brefeldin_A of making decisions), and four regarding self-esteem/well-being (overall doing things well; satisfied with the way they have carried out their task; managing to keep busy and occupied; and managing as well as most people in the same situation). The ratings of these statements were 0–3: 0=more/better than usual, 1=as usual, 2=less/worse than usual and 3=much less/worse than usual; ‘as usual’ was defined as the normal state. Outcomes Drug dose calculation test and certainty in calculations A drug dose calculation test was performed before and after the course: 14 MCQs with four alternative answers.
Different kinds of acupuncture methods such as fire needling, electroacupuncture, surrounding needling, pyonex, pricking blood and cupping are in use for the treatment of PHN in hospitals in China. In the past selleck chem Erlotinib 5 years, acupuncture for treating PHN has been used in more than 137 studies. The benefit of the treatment group was reported between 84.1% and 97.5%.22–24 The clinical trials indicate that acupuncture could reduce pain and discomfort among most patients and also remove pain and discomfort among some patients. However, there is a lack of high-quality current evidence for acupuncture
in the treatment of PHN. Thus, this systematic review is conducted to assess the efficacy and safety of acupuncture for PHN in pain relieving and pain removing. Methods and analysis Criteria for considering
studies for this review Type of studies Randomised controlled trials (RCTs) will be included without restriction of language or publication type. Moreover, the trials using open label, single blind and double blind design will all be included, while crossover designs and quasi-RCTs will be excluded. Type of participants Participants who had been diagnosed as PHN defined as pain persisting over 3 months after resolution of the rush will be all focused on. No restrictions on age, gender or race. Types of interventions Any form of acupuncture therapy used in an experimental group will be included, involving acupuncture, electroacupuncture, an elongated needle, a three-edged needle, fire needling, auricular acupuncture, pyonex, moxibustion, pricking blood and cupping. Control interventions with no treatment control, sham acupuncture control (non-point acupuncture, minimal acupuncture), placebo control and drug
therapy control will be included. Studies with the following comparisons will be included: Acupuncture versus another therapy. Acupuncture with another therapy versus the same other therapy. Acupuncture versus no active intervention. Acupuncture versus sham acupuncture. Types of outcome measures Primary outcomes Pain intensityStudies which applied scales such as the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), the Faces Pain Scale-Revised (FPS-R), etc Cilengitide that were used to measure the intensity of pain will be included. Secondary outcomes Global impression (the proportion of participants whose symptoms improved after treatments); Quality of life; Safety as measured by the incidence and severity of adverse effects; Costs. Search methods for identification of studies A search strategy will be designed and conducted according to the guidance of the Cochrane handbook.25 Electronic searches We will search the following databases: The Cochrane Skin Group Trials Register (the inception to 2014.1); MEDLINE (the inception to 2014.1); EMBASE (the inception to 2014.1); The Cochrane Central Register of Controlled Trials (CENTRAL; the inception to 2014.
The cost-feasibility implied in this study is consistent with Murray et al’s40 1993 study of the University College London teaching programme, where community teaching cost £60 per student session,
comparing well with the SIFT provision of £64 per student session. However, Oswald Imatinib price et al discusses that the national formula for SIFT funds is inappropriate for community teaching due to a mismatch in the 2:1 ratio of placement costs and facilities costs in community teaching, versus the traditionally allotted 1:4 SIFT ratio between placement costs and facilities costs. SIFT funding to medical education institutions is traditionally divided to cater for the costs of clinical placements (about 20%) and the costs of facilities (80%). The 1995 Winyard Report specified that the use of SIFT funding would support teaching conducted in settings other than the main university hospital, such as in general practices and community settings.41 This report unfortunately failed to realise the inappropriateness of applying the 1:4 formula (for facilities and placement costs) in the context of primary care. The allocation of 80% SIFT funding to facilities would
be disadvantageous to community-based teaching since this money will be retained for usage within the hospital setting. It is important that the provision of SIFT funding is reconsidered so that it suits a growing emphasis of community-based education in the medical curriculum and therefore help develop these settings as centres of education. The strengths of our study are that it provides the most up-to-date picture of the UK landscape of community-based teaching in medical schools’ and the fact that the literature review was conducted in a systematic way. The use of Rossi, Lipsey and Freeman’s widely accepted approach to programme evaluation also ensured that programme evaluations in the literature were
analysed comprehensively. The weaknesses of the online survey are that it relied on data provided on the websites of medical schools which can occasionally be out of date and incomplete. The online survey also had the disadvantage of inconsistency in the extent of details provided Batimastat online. For example, the online sources may not have mentioned details on clinical placements which are primarily hospital-based, but also provide supplementary clinical teaching within the community setting, (eg, shadowing of a community midwife in an Obstetrics and Gynaecology placement). To address these weaknesses, the method of information collection may be improved by contacting course administrators to obtain detailed and focused information on any community-based teaching that is offered to students in all the course modules. A weakness of the literature review is publication bias. The majority of the papers included in the review were written in support of CBE, and there are very few publications which focused on the disadvantages of CBE.
The cohort comprised 57 181 men, and 50 056 women. Those in the AUD group differed from those in
the comparison group with regard to age and gender. In the AUD group, there were 63.7% men and 36.3% women, while in comparison group comprised 53.2% men and 46.8% women. The mean age for the selleckbio AUD group was 41.5 years while it was 43.5 years for the comparison group. Table 1 Baseline characteristics at the emergency department 2002–2008 among the AUD group (mental and behavioural disorders (MBD), F10) and the comparison group Selected discharge diagnoses (other than AUD at the ED) are shown in table 2. The AUD group had a higher percentage in all the selected discharged diagnoses. Table 2 Selected diagnosis at discharge from the emergency department after the first visit among the
AUD group and the comparison group Figure 1 shows the survival function adjusted for age, gender, number of visits, year of entrance and mental or behavioural disorders at discharge from the ED among those in the AUD group (dashed line) and the comparison group (black line) for all causes of death. A greater proportion of those in the AUD group died during the study period compared with those in the comparison group. Figure 1 Survival function at mean of covariates, adjusted for gender, age, number of visits, year of entrance and mental and behavioural disorders at discharge. Dashed line indicates the alcohol use disorder group, and black line the comparison group, p<0.0001. ... The HR and 95% CI of all causes of death and selected causes of death are shown in table 3, for both genders combined.
The HR for all causes of death was 1.91 (95% CI 1.51 to 2.42), for mental and behavioural disorders 7.62 (95% CI 2.76 to 21.07); for mental and behavioural disorders due to alcohol 47.68 (95% CI 11.56 to 196.59); for diseases of the circulatory system 2.52 (95% CI 1.73 to 3.68); for diseases of the digestive system 4.58 (95% CI 1.95 to 10.81); for chronic liver disease 14.69 (95% CI 4.99 to 43.28); and for an alcoholic liver disease 19.06 (95% CI 6.07 to 59.87; for external causes of injury and poisoning 4.02 (95% CI 2.48 to 6.53); for accidental poisoning 13.64 (95% CI 3.98 to 46.73; for suicide and intentional self-harm 2.72 (95% CI 1.08 to Drug_discovery 6.83); for events of undetermined intent 10.89 (95% CI 4.53 to 26.16). The HR for all causes of death was significantly associated with gender, age, year of entry, mental diseases and frequency of visits to the ED. The HR was 1.55 (95 CI 1.23 to 1.96) when adjusted for age and gender only. Table 3 Number of all causes and selected causes of death among the AUD group, and the comparison group, HR, 95% CIs adjusted for age, gender, number of visits, year of entrance and mental and behavioural disorders at discharge Table 4 shows the number of deaths, HR and 95% CI for all causes of death and selected causes of death among men and women separately. In the AUD group, 57 men and 15 women had died.
8%) followed by sulfonylurea (72.6%), α-glucosidase inhibitors (26.4%), thiazolidinedione (24.0%), insulin (20.6%) and dipeptidyl peptidase-IV inhibitors (13.6%). A similar pattern LDC000067? of drug use was reported earlier in a small study from northern India.15 Our study shows that T2DM participants consume high CHO in their diet, which has a direct effect on postprandial blood glucose and insulin response.7 In addition to dietary and lifestyle modifications, multiple therapeutic strategies like AGIs, SU, Insulin, DPP4-I and glucagon-like-peptide—1
analogues may benefit T2DM participants. Metformin was the most commonly used antidiabetic agent in our study. It is a hypoglycaemic agent that has been widely used in clinical practice for more than half a decade to treat diabetes. It is as safe and effective as monotherapy and can also be used in combination with any other hypoglycaemic agent for treatment of diabetes. Furthermore, it is cost-effective, reduces weight and is weight neutral. It has less incidence of hypoglycaemia as compared to sulfonylurea and insulin and exerts beneficial effects on lipids.16 17
The second most commonly used medication was sulfonylurea. Among sulfonylureas, glimepiride was the one most commonly used. The higher usage of sulfonylurea is probably due to the need to rapidly control the glucose levels and the preference for glimepiride could be due to its lower propensity to cause hypoglycaemia. The next commonly used agents were AGIs (acarbose and voglibose) in our study. AGIs such as acarbose seem to be particularly useful in newly diagnosed T2DM with excessive PPBG, because of their unique mode of action,
that is, to delay digestion and absorption of complex CHO and reduce postprandial rise in blood glucose levels.18 19 Usage of AGIs seems to be more in our study compared to that reported previously (26.4% in our study vs 7.6% in Sultana et al15). In an editorial published in the November 2010 issue of the Journal of Association of Physicians of India,20 the author expressed the need for therapeutic agents like AGIs that reduce postprandial hyperglycaemia and hyperinsulinaemia and also increase incretin levels (glucagon-like peptide-1) early in the course of T2DM. This strategy Entinostat may have a more prominent role in an Indian setting where the role of AGIs is even more significant as meal component is rich in CHO as seen in this study.20 However, we need to investigate further the benefit of various therapeutic interventions in high CHO-consuming Indian T2DM participants in a prospective randomised controlled study to examine this hypothesis. Limitation This study has some limitations; the cross-sectional design of the study does not allow us to make inferences about the cause (consumption of high CHO) and effect (glycaemic control, rise in PPBG). Another possible limitation of the study includes the small sample size, the possibility of measurement error of diet and covariates.
5 Consequently, in order to enhance the utility of IPAQ and to further evaluate its psychometrics worldwide, efforts have been made to translate and adapt the IPAQ in many other countries, but most of the research in this context were from developed Western countries.7–14 In Africa, the psychometric www.selleckchem.com/products/17-DMAG,Hydrochloride-Salt.html properties of IPAQ have only been tested in South Africa as part of the initial development process of the questionnaire,5 and in older adults.15 Since the largest increases and burden
of non-communicable diseases (NCDs) are in low-income countries where the understanding of evidence-based strategies for increasing PA remains poor,16–19 improving PA research is a top priority for them.20 However, to advance PA research in Africa, it is important to first develop or tailor standardised measures to be culturally sensitive to PA behaviours of people in the region’s countries. Since Nigeria is the most populous country in Africa with culture and languages similar to most of the other West
African countries, it is a good choice to evaluate the IPAQ for cultural and psychometric relevance in this country. Recently, a cultural adaptation study of the IPAQ-SF was conducted among adults in Nigeria,21 with good evidence of test–retest reliability similar to findings in some other studies.10 22–24 However, because the IPAQ-SF is not domain specific and does not provide context-specific information on PA behaviour, it is important to evaluate the IPAQ-LF for relevance in Nigeria. Psychometric evaluation of a culturally modified version of the IPAQ-LF in sub-Saharan African
countries can impact PA research and surveillance in the African region where the prevalence of inactivity related NCDs is on the increase.20 25 The aim of the present study was to investigate the reliability and an aspect of validity of a modified version of the IPAQ-LF among adults in Nigeria. Methods Participants A purposive sample of 180 adults from eight neighbourhoods that varied in socioeconomic status and walkability in Maiduguri city were recruited for the study. The sampling and neighbourhood selection strategy have been described in detail elsewhere.26 Maiduguri, with an estimated population of 749 123 people, is the capital and largest city of Borno State in North-Eastern Dacomitinib Nigeria.27 The city attracts immigrants from neighbouring countries of Cameroon, Niger and Chad Republic and the Hausa language is the common means of communication for commercial activities among the diverse inhabitants of Maiduguri.27 28 Participants were eligible for this study if they were willing to self-complete a written survey twice in either Hausa or English language. However, researchers (UMB and STP) were in attendance to provide translation and interpretation assistance to participants (n=11) who required help to complete the survey.
100 Owing to gaps in the evidence towards base, precise estimation of frequency and risk of complications is not possible. However, irrespective of the exact size of the greater risk from FGM/C, the consistency of results with increased risk of several physical harms in women with genital modification is robust, and even the lowest increase in risk of complications is undesirable from a woman’s health perspective. Conclusion The evidence base on the physical health complications of FGM/C, which covers over half a century of research from more than 20 countries in Africa and beyond, shows that FGM/C is associated
with an increased risk of health complications, especially urinary tract infections, bacterial vaginosis, painful sexual intercourse and obstetric difficulties. Further research into this question is unlikely to produce practical value. Rather, efforts should be expended
in safeguarding girls and women against the physical risks of FGM/C and caring for those who suffer from its consequences. Supplementary Material Author’s manuscript: Click here to view.(6.1M, pdf) Reviewer comments: Click here to view.(137K, pdf) Acknowledgments The authors gratefully acknowledge the support and financial assistance received from Norad and the WHO. They are also grateful to librarian Sari S. Ormstaad who designed and conducted the literature search and to the experts who reviewed early versions of our technical reports. Footnotes Contributors: RCB planned the study; collected, analysed, and synthesised the data; and wrote the article. VU assisted in data collection and synthesis; and contributed to the writing of the article. GEV and AF assisted in data synthesis and contributed to the writing of the article. JO-J assisted in data analysis and contributed to the writing of the article. Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Competing interests: None. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: Three technical reports available for all at http://www.kunnskapssenteret.no/publikasjoner.
AV-951 health (SRH) is an important health status indicator. It has been consistently found to be associated with socioeconomic and demographic indicators,1 2 use of health services,3 4 morbidity5 6 and mortality7–9 in various populations. Unlike objective health indicators (eg, medical diagnoses, laboratory examination results), SRH is a subjective measure that reflects an individual’s perception of health, including its biological, psychological and social dimensions.10 Many epidemiological studies suggest a socioeconomic gradient related to SRH in which low educational attainment,1 2 low income11 12 and low-paying occupations13 14 are strongly associated with poor perceived health.
Most of the previously reported cases in premature and also full-term infants were associated with low zinc levels in the maternal milk, although in some cases maternal zinc level
was normal. A low zinc level in the maternal milk is an important cofactor. Breast milk may be low in zinc because of a rare abnormality of zinc secretion by the mammary normally gland . This may be the cause of symptomatic zinc deficiency, which is more severe and more common in premature infants because of the increased zinc requirements in this group. Symptomatic zinc deficiency can also appear from a combination of the SLC39A4 mutation in the infant and low milk zinc concentration from the mother who has the same heterozygous mutation .
All our patients had an excellent clinical improvement and discontinued the treatment after 2-3 months with no relapses. This indicates the diagnosis of TNZD and made us exclude AE, which requires lifelong treatment. Breast feeding, partial or total, was also a supporting factor for the diagnosis. Zinc deficiency may also be secondary to a poor intestinal absorption or an increased urinary and intestinal secretion . Disorders of intestinal malabsorption are other possible etiologic factors. None of the children reported here had clinical evidence of intestinal disease. It was not possible to measure urinary zinc levels. In our patients, we were not able to demonstrate any increased demand for zinc or any decreased ability of zinc storage. In fact, none of them was evidently preterm, had burns, had parenteral nutrition, or had any other evident reason to require increased zinc supplementation. We could not rule out whether mother and child presented heterozygosity
for a SLC39A4 or SLC30A2 gene mutation or whether the clinical features could be due to a dietary zinc deficiency of the mothers and/or increased zinc requirements of the infants. All the mothers were asymptomatic and had no skin abnormalities. As reported in previous studies from different regions of Ethiopia [17–19], they could also probably have a primary dietary asymptomatic zinc deficiency. Since sophisticated diagnostic techniques are not generally available in developing countries, our diagnosis was clinical and confirmed by the prompt and remarkable healing of the lesions after treatment with oral zinc supplement. Most GSK-3 probably, an association of both heterozygosity for SLC30A2 gene mutation and dietary zinc deficiency in the mothers was contributing to the clinical manifestations in the infants. Zinc is essential for growth, as it is involved in the development of the immune system, the muscles, and the bones, as well as the skin. In developing countries, diets often do not contain zinc in sufficient quantity or of sufficient bioavailability [18, 19].