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 Cilengitide 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.

We surveyed 450 respondents in central business districts, outlet

We surveyed 450 respondents in central business districts, outlets, transportation hubs, office buildings, and large enterprises in Tangshan. Out of the total of 424 questionnaires received, 419 are qualified. The calculation is executed by SPSS ATM activity software. 4.2. Utility Function The MNL model is used to model the individual travel mode choice. It is assumed that all the factors are independent from each other and obey the Gumbel distribution with zero mean. Equation (4) is the utility function: Vin=θiXin=θi0+∑k=1KθikXink, i∈An.

(4) In (5), Pin is the probability of traveler n selecting travel mode i: Pin=exp⁡Vin∑j∈Anexp⁡Vjn=exp⁡θiXin∑j∈Anexp⁡θXjn, i∈An, (5) where Vin is the utility function when traveler n chooses travel mode i; Xin = [Xin0, Xin1,…, Xink,…, XinK] is an eigenvector of traveler n choosing travel mode i; the component Xink is the value of variable k when traveler n chooses mode i, Xin0 = 1; θi = [θi0, θi1,…, θik,…, θiK] is the vector

of utility coefficients; and θik is the impact coefficient of variable k on travel mode i. 4.3. Results and Model Validation SPSS17.0 is used to process the data. The results of the MNL model are shown in Table 2. Table 2 The calculated parameters of the MNL model. The calculated parameters in Table 2 and the variable values in Table 1 are put into (4) and (5) to calculate the utility value and choice probability. Therefore, it is possible to forecast the sample individuals’ choice. The observed and forecasted choices are presented in Table 3. Table 3 Comparison of predicted and observed selection. There are different tests for model validation, the main ones of which are the goodness-of-fit test, F-test, and t-test. These three methods are fitted to test the linear model. Because the MNL model is a nonlinear

exponential model and the unbiased estimate of the error variance cannot be obtained from the estimated residuals, the t-test or F-test cannot be used here to test the significance either for the individual or for the population [27]. Furthermore, the model residuals do not necessarily sum to zero and ESS and RSS do not necessarily add up to TSS; therefore, R2 = ESS/TSS may not be a meaningful descriptive statistic for this model. Consequently, an alternative to pseudo R-square is proposed to estimate the goodness Drug_discovery of fit. It can be seen as a rough approximation of model prediction accuracy [28]. Three pseudo R-squares calculated by SPSS are shown in Table 4. Generally, the pseudo R-squared value falls in [0, 1]. When the independent variable is completely unrelated to the dependent variable, the pseudo R-squared value will be close to zero; otherwise, it will be close to 1, which indicates that the model perfectly predicts the objective. The results listed in Table 4 show that the model is acceptable. Table 4 Pseudo R-square. 5. Analysis and Implication 5.1.

In both trials, progression by independent review as well as inve

In both trials, progression by independent review as well as investigator assessment appeared to have consistent negative impact on all three HRQoL measures, as indicated

by the negative coefficients for progression. Table 2 Estimates of the effects of disease progression on HRQoL from mixed-effects longitudinal Transforming Growth Factor β models for LUX-Lung 1 and LUX-Lung 3 Estimates of the effects of progression in each treatment group separately, obtained from mixed-effects longitudinal models for LUX-Lung 1 and LUX-Lung 3, showed no significant differences between treatment groups in either study (table 3). In all analyses, PEs were consistently numerically higher when evaluated by investigator assessment than when evaluated by independent review. Table 3 Effects of disease progression from mixed-effects longitudinal models for LUX-Lung

1 and LUX-Lung 3 by randomised treatment Model diagnostics Diagnostic tests confirmed that statistical methods were appropriate for the data in the two studies. Discussion Results from the two analyses reported here suggest that tumour progression in patients with NSCLC is associated with statistically significant worsening in HRQoL, as measured using the EORTC QLQ-C30 Global Health/QoL measure and EQ-5D UK Utility and VAS scores. These findings are in agreement with previous studies in patients with breast, colorectal and renal cell cancer7–10; however, to our knowledge, this is the first study to show an association between tumour progression and HRQoL in patients with NSCLC. Previous studies claiming an association between HRQoL and disease progression have been criticised for failing to apply quality assessment criteria developed to avoid potential bias when evaluating this type of association.4 Specifically, failure of analyses to censor patients at the time of progression, inadequate adjustment for confounding factors where necessary, inadequate description of whether participants were aware of their PFS status leading to potential performance bias and failure to define an a priori hypothesis regarding

the relationship between PFS and HRQoL.4 In the analysis reported here, HRQoL Brefeldin_A assessments up to and beyond the time of PFS were included, confounding factors (baseline covariates) were included in the ANCOVA and analysis objectives and methods were clearly defined. In order to avoid potential performance bias, it was mandatory that patients completed HRQoL questionnaires before receiving test results, although it is possible that deviations from this may have occurred in practice. Our results are strengthened by the use of validated assessment tools for the evaluation of HRQoL and the use of two separate analyses methods, which showed consistent findings in two trials. The longitudinal model analyses have several additional strengths over the ANCOVA, and allow for within-patient comparison of HRQoL and progression states, whereas ANCOVA only considers between-patient comparisons.


is particularly relevant for new treatments that ser


is particularly relevant for new treatments that serve as add-ons to existing chemotherapy regimens, when it is often difficult to show a HRQoL benefit compared with chemotherapy alone, GS-1101 PI3K inhibitor or where OS benefits are not shown. This analysis validates the clinical meaningfulness of PFS as a clinical trial end point. Conclusion The association between PFS and HRQoL reported here supports the use of PFS as a primary endpoint in clinical trials in patients with NSCLC, as it confirms the value of PFS as a patient-relevant endpoint associated with tangible improvements in HRQoL. Supplementary Material Author’s manuscript: Click here to view.(2.1M, pdf) Reviewer comments: Click here to view.(139K, pdf) Acknowledgments Medical writing assistance, supported financially by Boehringer Ingelheim, was provided by Suzanne Patel during the preparation of this article. Footnotes Contributors: IG, MP, PMF and SE contributed to the conception and design of the analysis. MP, PMF and SE conducted the analyses and all authors contributed to the interpretation of data. The first draft of the manuscript was written by IG. All authors contributed to critically revising the text for

important intellectual content. All authors provided final approval of this submitted version. Funding: This study was supported by Boehringer Ingelheim. Competing interests: MP, PMF and SE have received consultancy fees from Boehringer Ingelheim. IG is an employee of Boehringer Ingelheim. Provenance and peer review: Not commissioned; externally peer reviewed. Data sharing statement: No additional data are available.
Tricyclic antidepressants have no benefit over placebos in the treatment of adolescent depression1 and are not recommended for treatment in this group by the National Institute for Health and Care Excellence (NICE) guidelines.2 At the time of ethical approval for this study, the European Medicines Agency3 4 recommended that SSRIs in general should not be used for the

treatment of depression in young people, with the exception of fluoxetine where there was some evidence, although limited, of its efficacy. There are additional concerns about the addictive potential of antidepressants AV-951 and many young people and parents would prefer a ‘talking’ therapy in the first instance.5 6 The argument against using medication early is further strengthened by the finding of a large study showing that 21% of moderate to severely depressed adolescents improved with a brief psychosocial intervention before being randomised between medication and treatment as usual.7 There is thus a climate of caution about antidepressant use in general and particularly in adolescents, due to evidence of poor efficacy and high side effects.

65 We will evaluate sequence generation, allocation sequence conc

65 We will evaluate sequence generation, allocation sequence concealment; blinding of participants and study personnel; and incomplete outcome data.66

We will resolve any disagreements between reviewers by discussion. We will contact study authors if limitations in reporting lead to uncertainties in eligibility, risk of bias, or outcome. Direct comparisons meta-analyses In comparison to fixed Vandetanib mechanism of action effect models, random effect models are conservative in that they consider the within-study as well as the among-study variability. Recent methodological research has shown that while popular, the DerSimonian-Laird method67 can produce narrow CIs when the number of studies is small or when they are substantively heterogeneous.68 69 Therefore, to pool outcome data for trials that make direct comparisons between interventions and alternatives, we will use the likelihood profile approach.70 We will pool cross-over trials with parallel design RCTs using methods outlined in the Cochrane handbook to derive effect estimates.66

Specifically, we will perform a paired t test for each cross-over trial if any of the following are available: (1) the individual participant data; (2) the mean and SD or SE of the participant-specific differences, and between the intervention and control measurement; (3) the mean difference (MD) and one of the following: (a) a t-statistic from a paired t test; (b) a p value from a paired t-test; (c) a CI from a paired analysis; or (4)

a graph of measurements of the intervention arm and control arm from which we can extract individual data values, so long as the matched measurement for each individual can be identified.66 If these data are not available, we will approximate paired analyses by calculating the MDs and the corresponding SEs for the paired analyses.66 If the SE or SD of within-participant differences are not available, we will impute the SD using the methods outlined in the Cochrane Handbook.66 Ensuring interpretable results We will use a number of approaches to provide interpretable results from our meta-analyses. Batimastat For studies that provide binary outcome measures, we will calculate relative risks (RRs) to inform relative effectiveness. To generate measures of absolute effect (risk differences), we will use estimates of baseline risk from the control arm of eligible RCTs. When pooling across studies reporting continuous endpoints that use the same instrument, we will calculate the weighted mean difference (WMD), which maintains the original unit of measurement and represents the average difference between groups. Once the WMD has been calculated, we will contextualise this value by noting the corresponding MID—the smallest change in instrument score that patients perceive is important. We will prioritise use of anchor-based MIDs when they are available, and calculate distribution-based MIDs when they are not.

7 12 19 20 Overt censure from strangers who do not condone smokin

7 12 19 20 Overt censure from strangers who do not condone smoking during pregnancy may also trigger strong guilt that stimulates either quit never attempts or reactance, or both.17 20 Women unable or unwilling to quit may rationalise their continued smoking by discounting the risks they face or asserting their invulnerability to these.25 27 28 For example, they may interpret their own perceived well-being as a sign they do not face the risks others face, while the apparent health of other smokers’ babies may reinforce beliefs that smoking is not inevitably harmful.22 27 However, while these approaches might counter cognitive dissonance, affective

dissonance may be less easily resolved. Arousal of negative emotions such as shock, horror and fear could increase the affective element of risk perception, reduce feelings of immunity, and heighten the urgency of behaviour change.29 Research to date suggests cessation messages that elicit strong emotional reactions provoke fewer counter-arguments

than more informational approaches,30 and have stronger effects on lower socioeconomic smokers, where smoking prevalence is higher.29 31 We used this emotion-dissonance framework to explore how women who are pregnant and smoking (or who gave birth within the past year and smoked while pregnant) resolve the tensions they face. Specifically, we sought to identify messages that would promote smoke-free behaviour during and following pregnancy. We began by exploring the metaphors participants used to interpret smoking and quitting. Next, we translated these metaphors into cessation messages that included strong negative affect-arousing themes as well as more informational

approaches, and explored responses to these. Specifically, we addressed the following research questions: RQ1: What metaphors do pregnant smokers use to interpret smoking and quitting? RQ2: How do women who are pregnant and smoking interpret and respond to cessation messages that challenge these metaphors AV-951 and the rationalizations they support? Methods Phase 1 involved in-depth interviews with 13 pregnant women and/or women who had given birth within the past year. In-depth interviews recognised the stigma associated with smoking during pregnancy and so provided participants with privacy. In addition, this approach allows detailed probing of responses, which was important to test interpretations of the alternative messages tested. The second phase comprised in-depth interviews with a new sample of 22 women. For both phases, we recruited a convenience volunteer sample using community advertising, via affinity groups, and through advertising at an antenatal clinic.

Parents and guardians were interviewed by trained interviewers to

Parents and guardians were interviewed by trained interviewers to capture sociodemographic and health information when their children were 9 months old, with subsequent follow-up at 3, 5 and 7 years. This study

was a cross-sectional inhibitor purchase survey using the baseline questionnaire (9 months postnatally) of the Millennium Cohort Study. Time spent in care as a child The definition of a looked-after child or a child in care varies between countries due to national legislation. In this cohort, mothers were asked the question: “Before the age of 17, did you spend any time living away from both of your parents?” If they answered yes, they were asked to indicate the nature of the time spent away from home and the amount of time they had spent away. Parents who had spent time in a children’s home or with foster parents, run by either a local authority or a charitable organisation, were coded as having been in care. This group included women who were not sure whether

their placement was managed by the local authority or any another organisation. Although children’s homes and foster placements can be run by voluntary societies, the responsibility for the child still lies with the local authority.27 We classed mothers who had spent some amount of time in foster care or a children’s home under the ‘exposed’ group. The comparison (‘unexposed’) group consisted of all mothers who had answered ‘no’ to the question: “Before the age of 17, did you spend any time living

away from both of your parents?”, or who had only spent time in a boarding school, prison or young-offenders’ institution, or with relatives. Mothers who did not answer the question or who indicated that they were unsure of their answer were excluded. Breastfeeding Mothers were asked if they ever tried to breastfeed their cohort baby. If they answered yes, they were asked when they had last given their baby breast milk. Their answer was converted into breastfeeding duration, and then categorised into: ‘never’, ‘less than 2 months’ ‘over 2 and less than 4 months’ and ‘over 4 months’. The information was also coded into a binary category of ‘never breastfed’ and ‘ever breastfed’. Smoking during pregnancy Maternal smoking was Cilengitide coded as ‘current non-smoker’, ‘smoked during pregnancy’ or ‘gave up smoking during pregnancy’. These categories were recoded as a binary outcome of ‘smoked during pregnancy’ and ‘did not smoke during pregnancy’. Symptoms of depression Symptoms of depression were measured using 9 questions of the validated Malaise Inventory,28 29 a tool used within the Millennium Cohort Study, to provide a measure of depression or psychological distress.30 It is a self-report tool phrased in plain language. There is no specified time frame over which participants are asked to report their symptoms, but the emphasis is on the recent past. Birth outcomes Information on a baby’s birth weight, gestation and delivery method was obtained by self-reporting.

Some of the physicians used the electronic health records as a me

Some of the physicians used the electronic health records as a means for collaboration to share the

screen with their patients. They showed them some pictures to illustrate and explain concerns. System-dependent factors A summary of the advantages and barriers highlighted by physicians using the EMR is discussed in the text below. The kinase inhibitor Tofacitinib quality of documentation Physicians believed that the EMR improved the quality and clarity of the documentation, for example, “it is very helpful, very readable, better than the handwriting”; another example, “previously they were usually write their own abbreviations ‘LE’, ‘RE’ not sure what they mean is it LEFT EYE or the disease itself but now because of the system coding they tend to write” (FG2). However, some physicians described the system as complex and less informative, for example, “if the doctor is free texting he will say the real thing and when you read

it you will know what is the meaning exactly (overlapping talk) but if you tick tick, tick sometime you lose” (FG3). Participants in all focus groups agreed that the current EMR was designed mainly for the hospitals and not for the primary care centres, for example, “The system was not designed for primary care (all agree) it is designed for hospitals this is the main issue for us” (FG3). Physicians had difficulties finding a diagnosis for some of the common conditions like skin laceration or skin abrasion seen in daily practices. System complexity and interconnectivity A common theme was the complexity of the system. Participants explained that they had difficulty at the beginning of implementation of the system to find the proper coding for the diagnosis. They also reported that sometimes they had to duplicate and repeat notes in several locations because there was no link, for example, between the notification system and the patient notes, for example, “Notification system, there must be a connection between Health Authority Abu Dhabi and cerner (EMR) another thing some cases…if anyone experience how to notify a case of syphilis he will hate himself

(laughing). Four pages you must fulfill four (4) pages” (FG3). Participants were very satisfied with the pre-completed notes in the system. They mentioned that it helped them save time and was very useful in the GSK-3 specialty clinics, for example, “Definitely, it saves a lot of time” (FG1); another example, “Helpful, especially in the clinics, the specialized clinics like the well-baby clinic, in antenatal clinic, in chronic clinic” (FG1). They also emphasised that in the long run the review of accumulated documentation will be challenging by asserting that visual scanning is impossible without highlights, for example, “Accumulation over the year will be a problem because you cannot go through all the note to find something” (FG1).

Large differences in PA scores

between the two administra

Large differences in PA scores

between the two administrations would indicate that at least one of the two measurements is not accurate. However, similar to the finding of a Mexican study,38 scores on the Hausa IPAQ-LF were consistently lower during the second administration of the questionnaire compared to the first administration. useful handbook Since familiarity with the IPAQ questions may improve over multiple exposures to the questionnaire, it is possible that participants in our study might have over-reported their PA levels during the first administration of the Hausa IPAQ-LF. These kind of findings may have implications for the utility of IPAQ for surveillance. Generally, due to issues of social desirability phenomenon and over-reporting of PA that has been associated with the IPAQ,39 40 it may be necessary to start considering the need for multiple measurements when using the IPAQ for evaluating PA, especially in developing African countries. However, patterns of PA as measured by the modified IPAQ-LF during both administrations were consistently similar, and both administrations were able to discriminate PA in the expected direction

between subgroups of our sample. For example, at both measurement time points, and consistent with hypothesis, men reported more time in active transportation, occupational PA and leisure PA than women, while women reported more time in domestic PA and sedentary activity than men. In the absence of objective criterion standards for evaluating an absolute estimate of PA, the consistency of items on IPAQ with variables known to be related to PA, such as BMI, blood pressure, heart rate, indicators of lipid and glucose metabolism, and fitness index have been

used as important construct validity measures.7 10 21 24 In the present study, the correlations of the PA domains and intensities with biological and anthropometric variables were mostly significant in the expected direction, but they were low, suggesting a modest evidence of construct validity for the modified IPAQ-LF in Nigeria. However, observed correlations were comparable with the values in other studies that AV-951 have evaluated the IPAQ-LF.5 7 8 24 30 33 39 Since better validity coefficients have been reported for other PA measures above those of the IPAQ,39 41 with the present African finding, it is possible that the IPAQ-LF only has modest evidence of construct validity. However, our findings on the relationships between PA and biological and anthropometric variables should be interpreted in the light of an important caution. Since hypertensive and obese people may get oriented to exercise,3 cross-sectional associations of PA and blood pressure or BMI could also occur in the opposite direction and may not represent much information as indicators of construct validity of PA measures.

Table 2 Test–reliability based on intraclass correlation coeffici

Table 2 Test–reliability based on intraclass correlation coefficient for Hausa IPAQ-LF, overall and apply for it by gender Similarly, socioeconomic status differences were observed in the reliability coefficients of the modified

IPAQ-LF (table 3). Across all domains of PA, reliability coefficients were substantially higher among participants with less than secondary school education (ICC from 0.77 (sitting activity) to 0.92 (leisure activity)) compared to those with secondary school education (ICC from 0.28 (active transport) to 0.58 (occupational activity)) and those with higher than secondary school education (ICC from 0.23 (sitting activity) to 0.67 (active transport)). While reliability coefficients were higher for overall PA (ICC=0.80, 95% CI 0.71 to 0.86), active transport (ICC=0.83, 95% CI 0.74 to 0.88), occupational PA (ICC=0.79, 95% CI 0.70 to 0.86) and leisure-time PA (ICC=0.79, 95% CI 0.69 to 0.85) among participants who were employed compared to their unemployed counterparts, it was higher for domestic PA (ICC=0.65, 95% CI 0.43 to 0.79) and sitting time (ICC=0.68, 95% CI 0.36 to 0.83) among participants who were unemployed than

in the employed subgroup. Table 3 Socioeconomic status differences in test–retest reliability of the Hausa IPAQ-LF (N=180) Figures 1–3 (Bland-Altman plots) illustrate the agreement in the scores (min/week) of total PA, MVPA and sitting between the first and second administrations of Hausa IPAQ-LF. For total PA, the mean difference was 106.7 min/week, with wide 95% limits of agreement (−762.2 to 965.6 min/week). For MVPA, the mean difference was about one and half hours per week (91.6 min/week), and also demonstrating wide 95% limits of agreement (−744.5 to 927.7 min/week). For sitting time, the mean difference was small (26 min/week) and the 95% limits of agreement ranged from −2178.1 to 2230.9 min/week. Figure 1 Bland-Altman plot min/week reported

in total physical activity (PA) for the first and second administrations of Hausa IPAQ-LF. Mean difference: 106.7±2 SD=−762.2 to 965.6. Figure 2 Bland-Altman plot min/week reported in moderate-to-vigorous physical activity (MVPA) for the first and second administrations Anacetrapib of Hausa IPAQ-LF. Mean difference: 91.6±2 SD=−744.5 to 927. Figure 3 Bland-Altman plot min/week reported in sitting for the first and second administrations of Hausa IPAQ-LF. Mean difference: 26.4=±2 SD=−2178.1 to 2230.9. Table 4 shows the patterns of PA across sociodemographic subgroups during the first (IPAQ1) and second (IPAQ2) administrations of the modified IPAQ-LF. Overall and across all stratified variables, time spent in PA reported during the first administration tends to be higher than that reported during the second administration. At both time points, men reported significantly (p<0.05) higher mean time (min/week) in active transportation, occupational PA and leisure-time PA than women.