Incident duration, which can be defined as the

time diffe

Incident duration, which can be defined as the

time difference between incident occurrence and incident site clearance [3–5], includes four time intervals or phases [6]: (1) incident detection/reporting time, (2) incident preparation/dispatching time, (3) travel time, and (4) clearance/treatment FAK kinase inhibitor time. This study investigates the influences of various traffic incident characteristics, such as temporal, road, incident-related, and environmental characteristics, on incident duration time using parametric hazard-based models and flexible parametric hazard-based duration models, to provide more suitable distribution for the base hazard function. The dataset used in this study was extracted from the Incident Reporting and Dispatching System in Beijing, and it contains the characteristics and duration times of incidents that occurred on the 3rd Ring expressway mainline in 2008. This paper begins with a literature review about previous research on incident duration analysis and prediction. This review is followed by details on flexible parametric hazard-based

model development. Next, the used data is described with the use of descriptive analyses of incident duration time and incident characteristics. The model estimation results and model parameter interpretation are then presented. This paper concludes with a summary of findings and directions for future research. 2. Literature Review Over the past few decades, many studies have been conducted to investigate appropriate approaches and techniques

for the estimation and prediction of traffic incident duration time, mainly on freeways. The most typical approaches include (1) regression methods [3, 7–9], (2) Bayesian classifier [10–12], (3) Decision trees and Classification trees [13, 14], (4) neural networks [15–17], (5) the discrete choice model [18], (6) the structure equation model [19], (7) probabilistic distribution analyses [20, 21], (8) support/relevance vector machines [22], and (9) hybrid methods [23]. These studies on traffic incident duration modeling have been summarized elsewhere [24, 25]. Several kinds of hazard-based models have been recently used to estimate the factors affecting traffic incident Carfilzomib duration/clearance time or predict traffic incident duration/clearance time. The majority of studies on incident duration analysis have used parametric hazard-based models, that is, accelerated failure time (AFT) models, because of the following reasons: (1) the baseline hazard rate contributes to the understanding of the natural history of the incident through the manner in which the hazard rate changes over time; and (2) the AFT model allows for the estimation of an acceleration factor that can capture the direct effect of a specific factor on survival time [26].

Our surveys show that most people are willing to choose a proenvi

Our surveys show that most people are willing to choose a proenvironmental travel mode when they are traveling a short distance and that they are more concerned about the efficiency and travel cost over a longer distance. Consequently, if the quality of the public transportation service (speed, punctuality, comfort, and accessibility) is satisfactory kinase inhibitors of signaling pathways even at peak hours, it has the potential to enhance the proportion of proenvironmental travel. Therefore, various strategies under the guidance of the public transit priority strategy, BRT, subsidies for public transportation, and bicycle sharing systems all stimulate proenvironmental travel. Although the promoting

effects may be different for different individuals, they help to create a premise for proenvironmental travel. The biggest challenge in promoting proenvironmental travel is how to make people who own a private car reduce their car use as much as possible. At present in China, both the family income and the private car ownership rate are undergoing a period of rapid growth. People have strong material consumption values at this stage. Additionally, there is a dual difficulty for the whole society in promoting proenvironmental travel. Many people without cars tend to choose a proenvironmental mode, but their travel mode choice may change once they have a car as the car ownership will change the situation of the travel decision. With an increase in

the percentage of private car travel, the roads will become more crowded and the public transport service quality will decrease rapidly. Consequently, some people will gradually abandon public transport again. This will form a vicious circle, which can only be broken when people choose a proenvironmental travel mode based on their attitudes. However, according to the surveys, men with a high income who

travel for business have a closer correlation with carbon-intensive travel, while women with a medium income accept proenvironmental travel modes relatively easily. Changing the travel mode of the men with a high income needs a more powerful influence of social norms and the elimination of material consumption values. As a matter of fact, more and more researchers are focusing on how to educate and intervene in people’s decisions Anacetrapib to reduce car use and choose a proenvironmental travel mode. Acknowledgment This work was supported by the National Natural Science Foundation of China (NSFC) under Grant no. 61203162. Conflict of Interests The authors declare that there is no conflict of interests regarding the publication of this paper.
Traffic incidents are the primary causes of nonrecurrent traffic congestion on intercity expressways and arterial networks in cities [1, 2]. Many Advanced Traffic Incident Management (ATIM) systems have been deployed all over the world in the past two decades to reduce traffic incident duration and congestion level.

20 In both trials, the HRQoL assessments were


20 In both trials, the HRQoL assessments were

comprehensive, providing a strong basis for evaluating the relationship between HRQoL and disease progression. Differences in the findings of the ANCOVA results between LUX-Lung 1 and LUX-Lung 3 may reflect the fact that clinically meaningful Rucaparib PF-01367338 changes in HRQoL may be harder to achieve in heavily pretreated patients such as those included in LUX-Lung 1. While the findings reported here indicate that disease progression is accompanied by a statistically significant worsening of HRQoL, it should also be considered whether the results represent a clinically meaningful change in HRQoL. There is continued debate as to what constitutes a meaningful change in oncology HRQoL scores, with data suggesting that patients are more responsive to improvement than decline,22 and that the thresholds for clinically significant improvement and decline are not always uniform.23 While a 10-point change in an individual patient’s EORTC QLQ-C30 item or domain is an accepted threshold for clinically meaningful improvement,24 different thresholds have been proposed for intergroup changes for individual QLQ-C30 QOL scales.25 For the QLQ-C30 Global health status/QoL scale, a mean difference of 0–4 points represents a trivial effect, 4–10 point difference represents a small but clinically

important effect and a 10–15 difference represents a moderate effect.25 These thresholds for QLQ-C30 Global health status/QoL imply that most of the findings reported here are clinically meaningful. For the EQ-5D UK Utility and EQ VAS scores, changes of 0.06–0.11 and 7–12 points, respectively, have been suggested to represent a minimally important difference,26 27 although there is no established consensus on how best to determine the minimally important difference in HRQoL measures.26 Using these values as a guide, some of the changes observed in our study should be considered

clinically meaningful. GSK-3 Limitations should be considered. As more HRQoL assessments were conducted up to the time of progression, and fewer at follow-up visit(s) following progression, limited data were available on the health state of patients with progression; this is a common limitation of this type of analysis.4 Further evaluation of HRQoL in these patients may have revealed more pronounced differences in HRQoL between patients with and without progression. Of the two trials, LUX-Lung 3 had more HRQoL data after progression than LUX-Lung 1, indicating that the results from analysis of LUX-Lung 3 data are potentially more robust. Accounting for, and minimising the impact of missing data (which are often not missing at random as assumed here) is an important factor in analyses such as ours.

Reviews of cognitive

behavioural therapy (CBT) for adoles

Reviews of cognitive

behavioural therapy (CBT) for adolescent depression have shown that it is effective and currently one of the main treatment options recommended in adolescents.2 8 Trials comparing CBT to either family therapy or supportive psychotherapy show that it is better at both improving mood and achieving remission.9 enzalutamide price It has also been shown to prevent depression in high-risk adolescent groups including the offspring of depressed adults.10 Since it has a low side effect profile it is an attractive alternative option for the treatment of adolescent depression. However, some studies have questioned its efficacy in young people with moderate to severe depression, questioning how powerful a treatment it is.7 11 The 1 year prevalence of depression in adolescents is about 2%.12 An area with a population of 300 000, such as that served by the York and Selby Community Adolescent Mental Health Service (CAMHS), would be expected to have at least 450 young people

with depression. Delivering CBT to this number of young people is far more resource intensive in terms of time than using medication. Many primary care doctors are referring all young people directly in to CAMHS rather than managing them in primary care, as they are reluctant to use medication and do not have the time or experience to deliver psychological therapy. Most primary care counsellors are not trained to counsel adolescents. This creates an additional pressure in CAMHS. Together with other service pressures, this leads to long waiting

lists in CAMH services in some areas. As a result, it is unlikely that individual CBT needs can be met from existing therapist resources.13 This therefore presents a number of challenges to services, including demands on clinical time, the potential development of waiting lists and issues about prioritisation of services. Given the affinity young people have with information technology, it may be that young people could be treated effectively and more widely using CCBT and at an Carfilzomib earlier stage in the evolution of their illness. The Improving Access to Psychological Therapies (IAPT) programme was introduced to improve availability of therapies and specifically mentions the use of CCBT in relation to depression. CCBT represents an alternative form of therapy delivery, which has the potential to enhance access to CBT and to provide a realistic alternative therapy or potentially a preventive intervention early in the course of depressive illness. Some argue that many adolescents, often reluctant to engage one to one with a therapist, may be more comfortable accessing computerised material or therapy. CCBT comes in many forms and can be directed at a range of conditions and age groups, but adequate research needs to be conducted to capture this broad range of possible new therapies.

However, contextualising the WMD through the MID can be misleadin

However, contextualising the WMD through the MID can be misleading; clinicians neither may mistakenly interpret any effect in MID units smaller than 1 as suggesting no patient

obtains an important benefit, and any effect estimate greater than 1 as suggesting that all patients benefit, which is not accurate. Therefore, we will also calculate the proportion of patients who have benefited, that is, demonstrated improvement greater than or equal to the MID in each trial, then aggregate the results across all studies.71 Further, we will convert the proportion data to probabilities of experiencing benefit to calculate pooled RRs and numbers needed to treat (NNTs). For trials using different continuous outcome measures that address the same underlying construct, we will calculate the between-group difference in change scores (change from baseline) and divide this difference by the SD of the change. This calculation creates a measure of the effect (quantifying its magnitude in SD units), called the standardised mean difference (SMD), which allows for comparison and pooling across trials.66 However, the SMD is difficult to interpret and is vulnerable to the heterogeneity of patients who are enrolled: trials that enrol homogeneous study populations and thus have smaller SDs will generate

a larger SMD than studies with more heterogeneous patient populations. To address this issue, we will calculate the effect estimates in MID units by dividing between-group difference in change scores by the MID. However, as with WMDs, contextualising the SMD in MID units can be misleading; therefore, we will, for each trial, calculate the probability of experiencing a treatment

effect greater than or equal to the MID in the control and intervention groups, then pool the results to calculate RRs and NNTs.71 Patients may be interested in the ability of a given intervention to provide more than an MID—to produce improvement that allows patients to feel much better (ie, substantially greater than the MID). Thus, for our analyses, where studies report percentage reduction in pain we will also use thresholds of ≥20%, ≥30% and ≥50% reduction GSK-3 of pain from baseline to calculate the proportion of patients who have benefited in each trial, and derive RRs and risk differences. Assessment of heterogeneity and subgroup analyses We will conduct conventional meta-analyses (see above) for each paired comparison. For each of these comparisons, we will examine heterogeneity using a χ2 test and the I2 statistic—the percentage of variability that is due to true differences between studies (heterogeneity) rather than sampling error (chance).

I’m gonna do what I wanna do when I wanna do it and no one can te

I’m gonna do what I wanna do when I wanna do it and no one can tell me otherwise.” Despite asserting their ‘choice’, many participants struggled to maintain this privileged position of control because nearly all had tried but failed to quit while pregnant. While some women had made a quit attempt because they were advised to do so by their midwife, Sunitinib PDGFR others had tried to stop smoking because they recognised the harms continued smoking presented to their unborn child.

Women in this latter group had to contend with ongoing complications and the guilt these caused: “ I always blame myself because I know it was my smoking… I don’t want to have another sick baby” and all felt the stigma of smoking while pregnant: “you know …it just looks wrong. You know, you feel bad. You feel really

bad and you feel guilty.” The resulting dissonance weighed heavily as women wanted the best outcomes for their children, even though their continued smoking conflicted with this goal. While a minority acknowledged their smoking was controlled by an addiction, the general dominance of control and choice metaphors in participants’ discourse suggested three potential cessation message themes that we developed and tested in phase 2. The first two used affect-laden approaches to challenge the reasoned positions smokers had constructed. Specific messages illustrated the effects of smoking on babies who had

no choice in being exposed to toxins, and the consequences children face when their parents are harmed by smoking. The final theme used a rational approach to support smoke-free behaviours; messages recognised smokers’ autonomy and promoted children’s right to a smoke-free life. Phase 2: Affect, responsibility and reason The first two themes depicted unwell babies and showed the distress of children who could become tobacco orphans; these messages elicited strong emotional reactions from participants. Comments focused on how smoking would harm unborn children, and participants often used words such as ‘suffer’, ‘affect’ and ‘feel’: “no matter who you hide it from, the child will still suffer for it”, and “your baby’s always going to feel it so he’ll know you’re smoking.” These emotionally-laden responses recognised that children lacked choice and would AV-951 bear the consequences of their mothers’ actions: “for something so little and small that hasn’t even entered this world yet, already they have chances taken from them.” The strong emotional engagement with the messages meant very few advanced counter-arguments. Feelings of fear and shame elicited directly challenged participants’ behaviour: “I think that’s so sad….It’s like you’re responsible… like they can’t make choices for themselves… Like you’ve gotta make the right ones for them.

31–33 Birth weight was classified as ≥2 5 kg (‘normal’) or <2 5 k

31–33 Birth weight was classified as ≥2.5 kg (‘normal’) or <2.5 kg (‘low’). Gestation was recorded in weeks and classified as <28, 28–32, 33–36 or ≥37 weeks. The mode of Gemcitabine DNA Synthesis delivery was categorised as ‘normal’, ‘instrumental’ or ‘caesarean’. Sociodemographic factors Ethnicity was analysed as ‘white’ or ‘other ethnic group’. Parity was the number of children the mother

had (including the cohort member) and was coded as 1, 2, 3 or >3 children. Family status was categorised as ‘lone parent’, ‘cohabiting’ or ‘married’. Household socioeconomic class was measured by taking the occupation of the parent with the highest socioeconomic position according to the four UK National Statistics socioeconomic categories. Household income was calculated from the self-reported data on the questionnaire. Mother’s education was determined by the highest attainment of a National Vocational Qualification or equivalent group. These qualifications were grouped as follows: ‘higher’ (bachelor’s degree or equivalent),

‘medium’ (end of schooling at age 18, A Level or equivalent), ‘lower’ (end of compulsory schooling at age 16, General Certificate of Secondary Education (GCSE) or equivalent) or others. Inclusion and exclusion criteria The Millennium Cohort Study did not recruit families if the child had been taken into care at the time of initial assessment. One study participant, who withdrew consent after the study began, was excluded. For this analysis, mothers were included if they were the birth mother of the Millennium Cohort Study participant. Mothers who did not answer the question of whether they lived away from home were excluded, as were mothers who answered the question as “I don’t know”. Statistical analysis First, we compared the following characteristics of the ‘exposed’ with ‘unexposed’ groups using the χ2 statistic: age at delivery, ethnic group, social class, household income, education, family status, parity, smoking during pregnancy, symptoms of depression, mode of delivery, gestational age, birth weight and duration of feeding. We then used logistic

regression to estimate ORs for a history of time spent in care and the outcomes of smoking during pregnancy, birth weight, breastfeeding initiation and symptoms of depression, with adjustment for potential confounding Cilengitide factors. A plausible model was developed based on background literature and included the following potential confounders: age at delivery, ethnic group, social class, household income and education. Previous evidence suggests that these factors are associated with poor perinatal outcomes,34 although there has been very little previous evidence on how factors relating to time in care manifest in maternal and neonatal outcomes. All of these potential confounders were significantly associated with the outcome (indicated by Wald, p<0.

They mentioned that it is the strongest part in the EMR system an

They mentioned that it is the strongest part in the EMR system and the results are available on the same day, for example, “The stronger point on cerner (EMR) is lab’s and x-rays” (FG3). Participants Ganetespib HSP (e.g. HSP90) inhibitor found that online orders from the Cerner tick list were easier than the written ones, for example, “If you are comparing writing an order with ticking order, ticking order is easier” (FG3). The EMR viewing capability was considered to be useful information for patient management because it helped with continuity

of care and to follow progression of many chronic diseases, for example, “For example, if you have a patient with renal failure you can see the results (creatinine) for one year which is very useful” (FG2). Participants believed that X-ray orders are very helpful because the radiologist has access to the history of the patient, for example, “It was really miserable because there is no history for the doctor to read from x-ray. When I sit with the doctor the radiologist, I feel what he is feeling because there is nothing just X-ray. Okay for what? What are you thinking? What are your

differential, it is nothing” (FG3). Regarding the electronic prescription, participants were very excited since it helps in reducing the errors. “It is easy and safe also” (FG1). They indicated that the prescription refill system saved time. Participants stated that they liked the drug reference text that appeared with each medication order. Participants suggested agreeing on uniformity in the use of metric units deciding on either reporting

in milligram or millimol. Several participants agreed that the EMR referral is much easier and patients could be traced and followed up through the system. Feedback about patient referral and management was a major improvement according to participants. The previous paper system did not support Dacomitinib continuity of care or feedback, for example, “Before we don’t know any feedback about the patient but now I refer one patient suspecting bronchiolitis or something after one hour I can open the cerner(EMR) and I can see what they did for him” (FG1). According to some participants, the referral and feedback system enhances continuity of care of the patients; it provides them with a complete picture of post referral management and progress, for example, “I think referred for us as Family medicine for continuity of case is better” (FG2). Regarding the disadvantages of the EMR, participants reported that the system was time-consuming and required too much detailed documentation, for example, “Previously documentation was not such detail when using file.

This is the first study in an African country to explore the cult

This is the first study in an African country to explore the cultural adaptation and translation of the IPAQ-LF, and its findings selleck chemical demonstrated the feasibility of using the IPAQ-LF to reliably collect PA data in a diverse segment of the Nigerian population. In the Africa region, the importance of a valid and established PA scale such as the modified IPAQ-LF is not only important to monitoring the domain in which activity is performed, but also very critical to understanding studies of ecological models of health behaviours

that emphasise the importance of multiple levels of influence on health behaviours including PA.18 42 In Nigeria, emerging evidence from studies using ecological models indicate that favourable built environmental attributes are promising for improving total and moderate-to-vigorous PA and controlling obesity among adults.26 43–45 However, built environment characteristics are expected to be strongly related to specific PA types rather than overall PA.46 47 For example, different environmental variables can be related to walking for leisure or transportation and to moderate PA for household, occupation, recreation or transportation. Thus, a study of adaptation of the IPAQ-LF is very important to understanding the domain-specific nature of ecological model research in the African region. One additional strength was the exploration

of PA patterns by gender, educational level and employment status, the findings of which were consistent with general hypothesis on social patterns of inactivity in low-income countries.20 48 However, the findings of

this study should be interpreted in the light of some important limitations. Direct comparison of our validity findings with previous studies should be made with caution, because unlike in our study, the accelerometer or PA diary were utilised as a common objective criterion standard to validate the IPAQ in the majority of the studies.5 7 8 24 30 33 39 Thus, examining the construct validity through the relationships of PA with BMI and resting blood pressure was an important limitation of our study. The choice and availability of appropriate criterion measures are particular issues of concern for the validation of PA questionnaires in low-income countries of Africa.5 49 50 Despite these issues, the validity coefficients in our study were remarkably similar to those reported in other studies,5 7 8 24 30 33 39 and the consistency of items on IPAQ with variables GSK-3 known to be related to PA, such as BMI, blood pressure, heart rate, indicators of lipid and glucose metabolism and fitness index have previously been used as important construct validity measures.7 10 21 24 Another limitation of the study is the use of non-probability sampling technique. The study finding may have limited generalisability to other samples of Nigerians that have different characteristics from this sample.

001) more time (min/week) in domestic PA than men (IPAQ1=236 9 vs

001) more time (min/week) in domestic PA than men (IPAQ1=236.9 vs 82.3, IPAQ2=195.5 vs 52.4). For educational status, participants who had lower than secondary school education compared to those with at least secondary school education reported statistically significant higher mean time (min/week) at both time points for total PA, active transport, occupational PA, walking and vigorous intensity activity compared to those with at least secondary school education. While participants who were employed reported statistically significant (p<0.05) greater time (min/week) in total PA

(IPAQ1=441.1 vs 285.1, IPAQ2=359.4 vs 141.0), active transportation (IPAQ1=43.8 vs 21.1, IPAQ2=36.9 vs 18.3) and work PA (IPAQ1=195.5 vs 41.8, IPAQ2=164.1 vs 40.1) than those who were unemployed, the unemployed reported statistically significant (p<0.05) higher time in domestic activity (IPAQ1=210.6 vs 132.1, IPAQ2=205.0 vs 112.6) compared to the employed. Table 4 Differences in time spent in physical activity overall, and by gender and socioeconomic status subgroups Construct validity Overall, correlations between energy expenditure (MET-min/week) according to the modified IPAQ-LF and anthropometric and biological measures were statistically significant

in the expected direction for all domains and intensities of PA, except for occupation and active transport domains, and walking (table 5). In the full sample, domestic PA was mainly related with SBP (r=−0.27, p<0.01) and DBP (r=−0.17, p< 0.05), while leisure PA and total PA were only related with SBP (r=−0.16, p<0.05) and BMI (r=−0.29, p<0.01), respectively. Similarly, moderate-intensity PA was mainly related with SBP (r=−0.16, p<0.05) and DBP (r=−0.21, p<0.01), but vigorous-intensity PA was only related with BMI (r=−0.11, p<0.05). In the gender-based analyses, total PA, domestic PA and sedentary time were more consistently related with anthropometric and biological variables. The strongest r value (−0.41) was found for the relationship between total PA and BMI for the male subgroup. The r value of −0.23 was reached between total PA and DBP for the women subgroup. Only

in women was domestic PA significantly related with BMI (r=−0.23), Anacetrapib DBP (r=−0.20) and SBP (r=−0.31). Leisure-time PA (r=−0.39) and occupational PA (r=−0.22) were significantly related with BMI only in men. The rho value for the relationship between sitting time and BMI was slightly higher in women (r=0.19) than in men (r=0.15). Table 5 Construct validity of Hausa IPAQ-LF: Spearman correlations between energy expenditure (MET×min/week) from Hausa IPAQ-LF, and anthropometric and biological variables (N=180) Discussion This study examined the reliability and an aspect of validity of a modified version of the IPAQ-LF in Nigeria. The findings generally indicated acceptable test–retest reliability and modest construct validity for items of the modified IPAQ-LF among Nigerian adults.