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Environmental tobacco smoke exposure and heart disease:A systematic review

World Journal of Meta-Analysis 2017年第2期5卷 14-40页

作者： Peter N Lee Barbara A Forey Jan S Hamling Alison J Thornton P.N.Lee statistics and Computing Ltd. Independent consultant in statistics

AIM To review evidence relating passive smoking to heart disease risk in never smokers. METHODS Epidemiological studies were identified providing estimates of relative risk(RR) of ischaemic heart disease and 95%CI for never smokers for various indices of exposure to environmental tobacco smoke(ETS). "Never smokers" could include those with a minimal smoking experience. The database set up included the RRs and other study details. Unadjusted and confounderadjusted RRs were entered, derived where necessary using standard methods. The fixed-effect and randomeffects meta-analyses conducted for each exposure index included tests for heterogeneity and publication bias. For the main index(ever smoking by the spouse or nearest equivalent, and preferring adjusted to unadjusted data), analyses investigated variation in the RR by sex, continent, period of publication, number of cases, study design, extent of confounder adjustment, availability of dose-response results and biomarkerdata, use of proxy respondents, definitions of exposure and of never smoker, and aspects of disease definition. Sensitivity analyses were also run, preferring current to ever smoking, or unadjusted to adjusted estimates, or excluding certain *** Fifty-eight studies were identified, 20 in North America, 19 in Europe, 11 in Asia, seven in other countries, and one in 52 countries. Twenty-six were prospective, 22 case-control and 10 cross-sectional. Thirteen included 100 cases or fewer, and 11 more than 1000. For the main index, 75 heterogeneous(P < 0.001) RR estimates gave a combined random-effects RR of 1.18(95%CI: 1.12-1.24), which was little affected by preferring unadjusted to adjusted RRs, or RRs for current ETS exposure to those for ever exposure. Estimates for each level of each factor considered consistently exceeded 1.00. However, univariate analyses revealed significant(P < 0.001) variation for some factors. Thus RRs were lower for males, and in North American, larger and prospecti

关键词： Passive smoking Heart disease Dose-response Meta-Analysis Review

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Management of patients with a short bowel

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World Journal of Gastroenterology 2001年第6期7卷 741-751页

作者： Jeremy M D Nightingale consultant Gastroenterologist Gastroenterology CentreLeicester Royal InfirmaryUnited Kingdom

There are two common types of adult patient with a short bowel, those with jejunum in continuity with a functioning colon and those with a jejunostomy. Both groups have potential problems of undernutrition, but this is a greater problem in those without a colon, as they do not derive energy from anaerobic bacterial fermentation of carbohydrate to short chain fatty acids in the colon. Patients with a jejunostomy have major problems of dehydration, sodium and magnesium depletion all due to a large volume of stomal output. Both types of patient have lost at least 60 cm of terminal ileum and so will become deficient of vitamin B(12). Both groups have a high prevalence of gallstones (45%) resulting from periods of biliary stasis. Patients with a retained colon have a 25% chance of developing calcium oxalate renal stones and they may have problems with D(-) lactic acidosis. The survival of patients with a short bowel, even if they need long-term parenteral nutrition, is good.

关键词： Colon Digestive System Humans Jejunostomy Nutrition Disorders Risk Factors Short Bowel Syndrome

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Clinicopathological differences and correlations between right and left colon cancer

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World Journal of Clinical Cases 2020年第8期8卷 1424-1443页

作者： Ioannis Kalantzis Afroditi Nonni Kitty Pavlakis Eumorphia-Maria Delicha Konstantinos Miltiadou Christos Kosmas Nikolaos Ziras Konstantinos Gkoumas Harikleia Gakiopoulou Department of Gastroenterology Korgialenio-Mpenakeio Hellenic Red Cross HospitalAthens 11526Greece Department of Oncology Metaxa Anticancer HospitalPiraeus 18537Greece First Department of Pathology National and Kapodistrian University of AthensMedical SchoolAthens 11527Greece Independent Biostatistical consultant ASTATStatistics in Clinical ResearchGlyfada 16675Greece Hepatogastroenterology Unit Second Department of Internal MedicineAttikon University General HospitalAthens 12462Greece

BACKGROUND The differences in histopathology and molecular biology between right colon cancer(RCC)and left colon cancer(LCC)were first reported in the literature by Bufill in *** then,a large number of studies have confirmed their differences in epidemiology,clinical presentation,comorbidities and biological behaviours,which may be related to the difference in prognosis and overall survival(OS)between the two *** To investigate statistically significant differences between Greek patients with LCC and *** The present observational study included 144 patients diagnosed with colon cancer of any stage who received chemotherapy in a Greek tertiary oncology hospital during a 2.5-year *** information,comorbidities,histopathologic characteristics and molecular biomarkers were collected from the patients’medical records retrospectively,while administered chemotherapy regimens,targeted agents,progression-free survival(PFS)periods with first-and second-line chemotherapy and OS were recorded retroactively and *** analysis was performed with the SPSS statistical *** Eighty-six males and 58 females participated in the *** hundred(69.4%)patients had a primary lesion in the left colon,and 44(30.6%)patients had a primary lesion in the right *** with RCC were more likely to display anaemia than patients with LCC[odds ratio(OR)=3.09],while LCC patients were more likely to develop rectal bleeding(OR=3.37)and a feeling of incomplete evacuation(OR=2.78)than RCC *** comorbidities,RCC patients were more likely to suffer from diabetes(OR=3.31)and coronary artery disease(P=0.056)than LCC *** mucinous differentiation rate was higher in the right-sided group than in the left-sided group(OR=4.49),as was the number of infiltrated lymph nodes(P=0.039),while the percentage of high-grade differentiation was higher in the group of patients with left-sided colon cancer than in RCC patients(OR=2.78)

关键词： Colorectal neoplasm Epidermal growth factor Vascular endothelial growth factor Histology Molecular biology Metabolic syndrome

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ANALYSIS OF AUTOMATIC ASSEMBLY SYSTEMS WITH REPAIR LOOPS

ANALYSIS OF AUTOMATIC ASSEMBLY SYSTEMS WITH REPAIR LOOPS

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第二届系统科学与系统工程国际会议

作者： K K Lai W K Leung Associate Head Department of Applied statistics and Operational research City Polytechnic of Hong Kong Senior consultant Yourdon Inc.Raleigh North Carolina U.S.A

＜正＞ An automatic assembly system,a valuable tool for mass production,is generally composed of a number of workstations and a transport *** the workstations perform some preplanned operations,the transport system moves the assemblies from one station to another.A typical example is a dishwasher assembly system that composes of more than forty stations and a conveyor system which moves the assemblies by specially designed pallets.

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Environmental tobacco smoke exposure and lung cancer:A systematic review

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World Journal of Meta-Analysis 2016年第2期4卷 10-43页

作者： Peter N Lee John S Fry Barbara A Forey Jan S Hamling Alison J Thornton P.N. Lee statistics and Computing Ltd. Sutton Surrey SM2 5DA United Kingdom Independent consultant in statistics Okehampton EX20 1SG United Kingdom

AIM： To review evidence relating passive smoking to lung cancer risk in never smokers, considering various major sources of ***： Epidemiological prospective or case-control studies were identifed which provide estimates of relative risk （RR） and 95%CI for never smokers for one or more of seven different indices of exposure to environmental tobacco smoke （ETS）： The spouse; household; workplace; childhood; travel; social and other; and total. A wide range of study details were entered into a database, and the RRs for each study, including descriptions of the comparisons made, were entered into a linked database. RRs were derived where necessary. Results were entered, where available, for all lung cancer, and for squamous cell cancer and adenocarcinoma. “Most adjusted” results were entered based on results available, adjusted for the greatest number of potential confounding variables. “Least adjusted” results were also entered, with a preference for results adjusted at least for age for prospective studies. A pre-planned series of fxed-effects and random-effects meta-analyses were conducted. Overall analyses and analyses by continent were run for each exposure index,with results for spousal smoking given by sex, and results for childhood exposure given by source of ETS exposure. For spousal exposure, more extensive analyses provide results by various aspects of study design and defnition of the RR. For smoking by the husband （or nearest equivalent）, additional analyses were carried out both for overall risk, and for risk per 10 cigarettes per day smoked by the husband. These adjusted for uncontrolled confounding by four factors （fruit, vegetable and dietary fat consumption, and education）, and corrected for misclassification of smoking status of the wife. For the confounding adjustment, estimates for never smoking women were derived from publications on the relationship of the four factors to both lung cancer risk and at home ETS exposure, and on the correlati

关键词： Passive smoking Lung neoplasms Dose-response Meta-analysis Review Confounding factors (epidemiology) Misclassifcation

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Issues with Philippines Road Transport Energy Consumption

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Open Journal of Energy Efficiency 2014年第1期3卷 14-24页

作者： Sudhir Gota Independent consultant Bangalore India

Department of Energy of Philippines statistics reveal that from 2000 to 2010, the road transport fuel consumption and corresponding CO2 emissions have grown modestly with an annual growth rate of 0.5%. This modest growth is in contrast to the rapid increase in vehicle numbers, economic activity and in absence of implementation of comprehensive sustainable transport policies and options. The main objective of this research is to correlate official fuel consumption data (i.e. top-down) with bottom up quantifications and provide relevant policy recommendations. Based on the assessment of transport demand variables and review of policies and strategies, fuel consumption in transport sector was found to be growing at a much faster rate when compared to official estimates. Use of official data on fuel consumption in road transport sector may lead to serious errors. This has huge implications on policies and investments.

关键词： Philippines Fuel Economy ASIF MRT Transport Emissions

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Supporting nurse practitioner education:Preceptorship recruitment and retention

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International Journal of Nursing Sciences 2018年第2期5卷 115-120页

作者： Eric Staples Esther Sangster-Gormley Independent Nursing Practice consultant AncasterONCanada Faculty of Human and Social Development University of VictoriaVictoriaBCCanada

Objectives:Clinical experience is an essential component of nurse practitioner(NP)education that relies heavily on *** and retention of preceptors is challenging due to many variables that can affect NP education and *** surveyed Canadian NP programs to understand their preceptorship structures,how they support preceptorship,and to identify gaps and challenges to recruitment and retention of ***:An 18-item survey,developed by the NP Education Interest Group,was distributed to 24 universities across 10 Canadian *** validity and reliability was assessed by experienced NPs and NP *** were analyzed using relative frequency statistics and thematic *** consisted of administrative staff and/or faculty designated as responsible for recruitment and retention of NP ***:Seventeen returned surveys were analyzed and demonstrated more similarities than differences across Canada's NP programs,particularly related to barriers affecting recruitment and retention of *** findings identified NP programs have too many students for the number of available clinical sites/preceptors,resulting in overutilization,burnout,or refusal to take *** with other health disciplines for clinical placements was identified as a challenge to *** commented they lack time to recruit,provide follow-up,offer support,or seek preceptors'feedback due to competing work *** identified the need for standardized funding for preceptor remuneration and recognition across the ***:The findings suggest the need for exploring a wider intraprofessional collaboration among graduate NP programs/faculty,clinical placement sites,and NPs to facilitate the recruitment and retention of preceptors.

关键词： nurse Canada retention

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Quality Appraisal of Clinical Guidelines in Obstetrics and Gynecology in India

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Open Journal of Obstetrics and Gynecology 2019年第10期9卷 1419-1428页

作者： A. G. Radhika Denny John consultant Department of Obstetrics & Gynecology University College of Medical Sciences & Guru Teg Bahadur Hospital Delhi India Evidence Synthesis Specialist Campbell South Asia New Delhi India Adjunct Scientist ICMR-National Institute of Medical Statistics New Delhi India.

Background: Clinical practice guidelines are important for standard of care. This study was undertaken to assess the quality of Obstetrics and Gynecology guidelines in India. Objective Systematic appraisal of clinical practice guidelines (CPG) in obstetrics and gynecology in India uses Appraisal of Guidelines for research and Evaluation II (AGREE II) instrument. Methods: All reported Indian guidelines in obstetrics and gynecology from 1st Jan. 2000 to 1st April 2018 were identified and subjected to inclusion using 3-point assessment criteria (relevance, clarity of intervention/outcome, and appropriate use of healthcare resources) using WHO AGREE-II instrument. Separate scores for the mean item, domain, and standardized were calculated by averaging the scores across two appraisers. Results & Discussion: Of 47 Clinical Practice Guidelines in Obstetrics and Gynecology (CPG) from India, 8 met the inclusion criteria. These were assessed using AGREE II checklist. Overall scores ranged from 8% to 22% (median 5%). No guideline received “Yes” for clinical use by either of the appraisers. Scores for scope and purpose and clarity were high but were very low for all the other domains. Only 1 review had identified cost as one of the focus areas as part of the guideline. Conclusion: Though being clinically relevant the clinical practice guidelines related to obstetrics and gynecology in India score poorly. There is a need for sensitization and capacity building of clinicians and public health professionals on the development of CPG related to obstetrics and gynecology in India.

关键词： Quality Improvement Implementation Healthcare Evidence-Based Practice AGREE II Tool

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Comparison of Transvaginal Ultrasound, Saline Infusion Sonohysterography versus Diagnostic Hysteroscopy in Evaluation of Endometrial Cavity Pathology amongst Women with Abnormal Uterine Bleeding in Low Resource Setting

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Open Journal of Obstetrics and Gynecology 2020年第5期10卷 644-656页

作者： Jayni Dedhia Gichuhi J.Wanyoike Ojwang B.Shadrack Madadi M.Obimbo Rafique B.Parkar Elijah Kwasa Department of Obstetrics&Gynaecology University of NairobiNairobiKenya Department of Anatomy University of NairobiNairobiKenya consultant Obstetrician&Gynecologist NairobiKenya consultant Radiologist NairobiKenya

Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The inc

关键词： Abnormal Uterine Bleeding Transvaginal Sonography Saline Infusion Sonohysterography Hysteroscopy

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Silvicultural alternatives to conventional even-aged forest man-agement-what limits global adoption?

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Forest Ecosystems 2015年第2期2卷 123-138页

作者： Klaus J Puettmann Scott McG Wilson Susan C Baker Pablo J Donoso Lars Dr?ssler Girma Amente Brian D Harvey Thomas Knoke Yuanchang Lu Susanna Nocentini Francis E Putz Toshiya Yoshida Jürgen Bauhus Department of Forest Ecosystems and Society Oregon State University consultant Forester and Forest Ecologist School ofBiological Sciences University of Tasmania Department of Forests and Society Faculty of Forest Sciences and Natural Resources Universidad Austral de Chile Southern Swedish Forest research Centre Swedish Agricultural University Haramaya University Institut de recherche sur les forêts Université du Québec en Abitibi-Témiscamingue 445 Boulevard de l’Université Institute of Forest Management TUMSchool of Life Sciences Weihenstephan Technische Universit?t München Department of Forest Management and statistics IFRIT Chinese Academy of Forestry Department of Agricultural Food and Forestry Systems University of Florence Department of Biology University of Florida Uryu Experimental Forest Field Science Center for Northern Biosphere Hokkaido University Chair of Silviculture Faculty of Environment and Natural Resources University of FreiburgTennenbacherstr

Background： The development of forestry as a scientific and management discipline over the last two centuries has mainly emphasized intensive management operations focused on increased commodity production, mostly wood. This conventionar＇ forest management approach has typically favored production of even-aged, single-species stands. While alternative management regimes have generally received less attention, this has been changing over the last three decades, especially in countries with developed economies. Reasons for this change include a combination of new information and concerns about the ecological consequences of intensive forestry practices and a willingness on the part of many forest owners and society to embrace a wider set of management objectives. Alternative silvicultural approaches are characterized by a set of fundamental principles, including avoidance of clearcutting, an emphasis on structural diversity and small-scale variability, deployment of mixed species with natural regeneration, and avoidance of intensive site-preparation methods. Methods： Our compilation of the authors＇ experiences and perspectives from various parts of the world aims to initiate a larger discussion concerning the constraints to and the potential of adopting alternative silvicultural practices. Results： The results suggest that a wider adoption of alternative silvicultural practices is currently hindered by a suite of ecological, economic, logistical, informational, cultural, and historical constraints. Individual contexts display their own unique combinations and relative significance of these constraints, and accordingly, targeted efforts, such as regulations and incentives, may help to overcome specific challenges. Conclusions： In a broader context, we propose that less emphases on strict applications of principles and on stand structures might provide additional flexibility and facilitate the adoption of alternative silvicultural regimes in a broader set of circumstanc

关键词： Natural Regeneration Forest Owner Stand Structure Commodity Production Private Landowner

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