Lower Index Scores Research Articles

Impact of Education on the Korean Wechsler Memory Scale IV Performances

본 연구에서는 한국판 웩슬러 기억검사 4판(K-WMS-IV)의 수행에 미치는 교육의 영향을 확인하고자 하였다. K-WMS-IV 표준화 자료를이용하여 교육 집단 별 소검사 및 지수점수를 비교하였고, 각 집단에 대해 특정 절단점 아래의 기저율 및 다변량 기저율을 산출하여 임상적 유용성을 증가시켰다. 또한 교육의 영향이 연령이 증가함에 따라 더 크게 나타나는지를 확인하기 위하여 교육과 연령의 상호작용 효과도 분석하였다. 결과는 다음과 같다. 첫째, K-WMS-IV 소검사 및 지수 점수의 평균은 교육 수준이 증가할수록 상승하는 경향이 있었다. 8 년 이하 교육 집단의 지수점수는 90.69-92.49인 데 반해, 16년 이상 교육 집단의 지수점수는 104.58-106.10으로, 두 집단 간에 1SD에 상당하는 점수 차이가 나고 있었다. 둘째, 교육 수준이 낮아질수록 기저율이 증가하였다. 8년 이하 교육 집단에서는 19.77-30.23%의 사람들이각 지수점수에서 M-1SD 미만의 점수를 받은 반면, 16년 이상 교육 집단에서는 5.23-8.14%가 이에 해당하였다. 또한 교육 수준이 낮아질수록 다변량 기저율이 증가하였다. 8년 이하의 교육 집단에서는 55%가 하나 이상의 지수 점수에서 M-1SD 미만의 점수를 받은 반면, 16년 이상 교육 집단에서는 18%가 이에 해당하였다. 마지막으로, 교육의 영향은 연령이 증가할수록 커지는 것으로 나타났다. 본 연구의 결과는 학력에 따른 점수 차이로 인해 고학력자에서는 인지손상을 과소 추정하고 저학력에서는 인지 손상을 과대 추정할 수 있으며, 이러한 효과는특히 고연령 집단에서 두드러지게 나타날 수 있음을 시사한다.

“I feel good and I am not overweight” – A qualitative study of considerations underlying lay people's self-assessments of unhealthy diets

It has been suggested that optimistic self-assessments of unhealthy diets constitute a barrier to the promotion of healthier eating practices. In order to discuss possible reasons for such optimistic assessments, knowledge about the considerations underlying self-assessments of unhealthy diets is needed. The aim of this qualitative study is to explore this issue by comparing considerations underlying the assessments of people who overestimate the healthiness of their unhealthy diets with those of people who express more realistic assessments. Interviewees were recruited among those respondents to the Danish National Survey of Diet and Physical Activity 2011–2013, who had been accorded a low diet index score. A thematic analysis of qualitative interviews is undertaken (N = 16). When interviewees are asked to assess the healthiness of their diets, they draw upon their nutritional knowledge and their perceptions of healthy eating practices. However, these considerations tend to be overruled by more decisive criteria. Thus, diets are assessed as being not exactly healthy, but nevertheless healthy enough – so long as interviewees feel good. Moreover, a personal history of weight status and weight concerns emerge as decisive criteria in self-assessments. Those who experience problems in these areas tend to be realistic about the unhealthy character of their diets, while optimistic assessments appear to be linked to tendencies to perceive oneself as not being overweight, not having experienced weight gain or loss, or not being concerned about weight. This study concludes that decisive criteria in lay people's self-assessments of unhealthy diets – with regard to feeling and looking good – differ markedly from the criteria employed in food-based dietary guidelines. These broader criteria of assessment should be recognized by professionals engaged in planning health promotion strategies with reference to dietary health.

Impact of pulmonary exacerbations and lung function on generic health-related quality of life in patients with cystic fibrosis.

BackgroundThe analysis aimed to examine the impact of pulmonary exacerbations (PEs) and lung function on generic measures of HRQL in patients with cystic fibrosis (CF) using trial-based data.MethodsIn a 48-week randomized, placebo-controlled study of ivacaftor in patients ≥12 years with CF and a G551D-CFTR mutation the relationship between PEs, PE-related hospitalizations and percent predicted forced expiratory volume in one second (ppFEV1) with EQ-5D measures (index and visual analog scale [VAS]) was examined in post-hoc analyses. Multivariate mixed-effects models were employed to describe the association of PEs, PE-related hospitalizations, and ppFEV1 on EQ-5D measures.ResultsOne hundred sixty one patients (age: mean 25.5 [SD 9.5] years; baseline ppFEV1: 63.6 [16.4]) contributed 1,214 observations (ppFEV1: no lung dysfunction [n = 157], mild [n = 419], moderate [n = 572], severe [n = 66]). Problems were most frequently reported on pain/discomfort, anxiety/depression, and usual activities EQ-5D items. The mean (SE) EQ-5D index nominally decreased (worsened) with worsening severity of lung dysfunction (P = 0.070): 0.931 (0.023); mild: 0.923 (0.021); moderate: 0.904 (0.018); severe: 0.870 (0.020). 146 PEs were experienced by 72 patients, including 52 PEs (35.6 %) that required hospitalization. Mean EQ-5D index and VAS scores were lowest (worst) within 1 week (before or after PE start) for PEs requiring hospitalization. Pulmonary exacerbations, PE-related hospitalizations, and ppFEV1 were significant predictors of EQ-5D index and VAS.ConclusionsIn a clinical study of patients with CF (≥12 years of age and a G551D-CFTR mutation), PEs, primarily those requiring hospitalization, were associated with low EQ-5D index and VAS scores. The impact of ppFEV1 was relatively smaller. Reducing PEs, in particular those requiring hospitalization, would likely improve HRQL among these patients.Trial registrationClinicalTrials.gov, NCT00909532; URL: clinicaltrials.gov, May 26, 2009Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-016-0465-z) contains supplementary material, which is available to authorized users.

Prediction of Remission in a French Early Arthritis Cohort by RAPID3 and other Core Data Set Measures, but Not by the Absence of Rheumatoid Factor, Anticitrullinated Protein Antibodies, or Radiographic Erosions.

To identify baseline variables that predict remission according to different criteria in rheumatoid arthritis (RA) in a comprehensive French ESPOIR early arthritis database. Individual variables and indices at baseline were analyzed in 664 patients for capacity to predict remission either 6 or 12 months later according to 4 criteria that require a formal joint count: the American College of Rheumatology/European League Against Rheumatism Boolean criteria, the Simplified Disease Activity Index, the Clinical Disease Activity Index, and the 28-joint Disease Activity Score; and 2 remission criteria that do not require a formal joint count: the Routine Assessment of Patient Index Data 3 (RAPID3) and the RAPID3 ≤ 3 + swollen joint, using univariate and multivariate logistic regressions. Remission was predicted significantly 6 and/or 12 months later in 26.8%-51.4% of patients, according to all 6 criteria by younger age, low index scores, and better status for the 6/7 clinical RA core dataset measures: tender joint count, swollen joint count (SJC), physician's global estimate, patient self-report Health Assessment Questionnaire (HAQ) physical function, pain, and patient's global estimate. Remission was not predicted by the absence of "poor prognosis RA" indicators, rheumatoid factor (RF), anticitrullinated protein antibodies (ACPA), or radiographic erosions. In multivariate regressions that included only 3 variables, low HAQ function predicted remission by all criteria as effectively as SJC, erythrocyte sedimentation rate, or C-reactive protein. Younger age and 6 core dataset clinical measures, but not the absence of traditional "poor prognosis RA" indicators, RF, ACPA, or radiographic erosions, predicted remission according to 6 criteria, including 2 without a formal joint count.

Liver fibrosis indices for identifying patients at low risk of developing hepatocellular carcinoma after eradication of HCV.

Hepatocellular carcinoma (HCC) in patients with chronic hepatitis C can develop after sustained virological response (SVR) to antiviral therapy for HCV, that is, the eradication of HCV, and effective surveillance systems for HCC should be established for this population. We retrospectively evaluated the utility of three laboratory liver fibrosis indices (aspartate aminotransferase-platelet ratio index [APRI], FIB-4 index and Forns index) for identifying patients at low risk of HCC development after SVR, for whom the termination of surveillance for HCC can be considered. APRI, FIB-4 index and Forns index scores were calculated based on laboratory data prior to anti-HCV therapy and at 24 weeks after the end of anti-HCV therapy (SVR24) in 522 patients with SVR who continued surveillance for HCC after SVR. The associations between HCC development and laboratory indices at both points were analysed. Twenty-one patients developed HCC after SVR during 2.3-24.4 years follow-up. Whereas HCC developed even in patients with low APRI or FIB-4 index scores, no patients with low Forns index scores developed HCC after SVR. These results were confirmed in a separate cohort of 309 patients who achieved SVR (HCC developed in 17 patients during 1.7-21.6 years follow-up). Forns index, especially assessed prior to anti-HCV therapy, was a useful laboratory liver fibrosis index for identifying patients at low likelihood of HCC after SVR. This index may be used as one of indicators to consider the termination of surveillance for HCC after the eradication of HCV.

A Global Index for Mapping the Exposure of Water Resources to Wildfire

Wildfires are keystone components of natural disturbance regimes that maintain ecosystem structure and functions, such as the hydrological cycle, in many parts of the world. Consequently, critical surface freshwater resources can be exposed to post-fire effects disrupting their quantity, quality and regularity. Although well studied at the local scale, the potential extent of these effects has not been examined at the global scale. We take the first step toward a global assessment of the wildfire water risk (WWR) by presenting a spatially explicit index of exposure. Several variables related to fire activity and water availability were identified and normalized for use as exposure indicators. Additive aggregation of those indicators was then carried out according to their individual weight. The resulting index shows the greatest exposure risk in the tropical wet and dry forests. Intermediate exposure is indicated in mountain ranges and dry shrublands, whereas the lowest index scores are mostly associated with high latitudes. We believe that such an approach can provide important insights for water security by guiding global freshwater resource preservation.

Disutility in Patients with Hidradenitis Suppurativa: A Cross-sectional Study Using EuroQoL-5D.

Disutility reflects the disability caused by a disease. The EuroQoL-5D (EQ-5D) questionnaire is a measure of health-related overall utility. The questionnaire has only been applied previously to a small number of patients with hidradenitis. In this study a survey of 421 patients with hidradenitis suppurativa was conducted using the EQ-5D questionnaire. Questions regarding pain, malodour and pruritus were included to determine quantitatively whether these factors are associated with low EQ-5D index and visual analogue scale (VAS) scores. The index and VAS scores obtained were compared with reference values for the general population in Denmark. A significantly decreased utility in patients with hidradenitis suppurativa was found for all age group levels, except for 65-74-year-olds. The total index score in the cohort was 0.705 (population mean 0.887) and the VAS was 62.25 (population mean 82.6). Multivariate analysis found significant associations between loss of utility and pain, malodour and pruritus (p < 0.0001). Patients with hidradenitis suppurativa had a significantly decreased EQ-5D compared with the background population. Malodour and pruritus were found to be associated with low index values, and pain and malodour with low VAS. Patient-reported pain and discomfort had the most negative overall effect on mean index scores.

Marmosets treated with oxytocin are more socially attractive to their long-term mate.

Adult male-female bonds are partly characterized by initiating and maintaining close proximity with a social partner, as well as engaging in high levels of affiliative and sociosexual behavior. Oxytocin (OXT), a neuromodulatory nonapeptide, plays a critical role in the facilitation of social bonding and prosocial behavior toward a social partner (Feldman, 2012). However, less attention has been given to whether augmentation of OXT levels in an individual alters others’ perceptions and behavior toward an OXT-treated social partner. We examined social dynamics in well-established male-female pairs of marmoset monkeys (Callithrix jacchus) in which one member of the pair was administered an intranasal OXT agonist, an OXT antagonist (OXTA), or saline. OXT treatment did not alter the expression of affiliative toward an untreated partner. However, OXT did significantly influence the expression of proximity and grooming behavior with a treated partner, as a function of OXT treatment and sex. Female interest in initiating and maintaining proximity with a pair-mate was altered by OXT treatment. Untreated female marmosets departed from their saline-treated partner more frequently than they approached them, as indicated by a low proximity index score. However, when males received an intranasal OXT agonist they had a significantly increased proximity index score relative to saline, indicating that their untreated partner approached them more often than they departed from them). Saline-treated females initiated and received equivalent levels of grooming behavior. However, when female marmosets were treated with an OXT agonist their untreated partner groomed them proportionately more often, for a greater total duration, and for more time per bout, than they initiated grooming behavior. These results suggest that intranasal OXT altered male and female marmosets’ stimulus properties in such a way as to increase the amount of grooming behavior that females received from their long-term mate, as well as increase female interest in initiating and maintaining proximity with their long-term mate. Furthermore, these results support the notion that central OXT activity plays an important neuromodulatory role in the maintenance of long-lasting male-female relationships.

Social Support Reciprocity in Terms of Psychosocial Variables in Care Taking and Care Giving Processes of Spinal Cord Injury Patients and their Care Givers

The purpose of this study was to investigate the role of social support reciprocity's and different kinds of social support's on the relationship between psychopathology symptoms and illness psychosocial adjustment of spinal cord injury patients. Within the scope of this study Psychosocial Adjustment to Illness Scale Self-Report, The Brief Symptom Inventory, The Inventory of Socially Supportive Behaviors, The Provided Social Support Scale, The Multidimensional Scale of Perceived Social Support were used. The participants were 31 patients who were diagnosed with tetraplegia and paraplegia and received treatment in Physical Medicine and Rehabilitation Units in hospitals in İstanbul and their caregivers. The results showed a negative relationship between psychopathology symptoms and illness psychosocial adjustment. Among the scores of perceived social support, received social support, given social support and the index score of social support reciprocity's common effects on the relationship between level of psychopathology symptoms and illness psychosocial adjustment, only social support reciprocity showed sign moderator effect on the relationship between psychopathology symptoms and illness psychosocial adjustment. According to these results, in patients with low index score of social support reciprocity, a strong relationship was found between psychopathology symptoms and illness psychosocial adjustment.

Clinicopathologic and Immunophenotypic Features of Primary Intestinal Extranodal NK/T-Cell Lymphoma, Nasal Type.

Primary intestinal extranodal NK/T-cell lymphoma, nasal type, is an extremely rare type of lymphoma with poor prognosis, and early diagnosis is challenging. Here we have investigated the clinicopathologic features and immunophenotypes of primary intestinal extranodal NK/T cell lymphomas, nasal type, in 10 Chinese patients. Complete staging data showed that 1 patient had stage I disease, 7 had stage II disease, and 2 had stage III disease. Eight of 10 (80%) patients had lymphadenopathy and none had bone marrow involvement. All the patients had a low International Prognostic Index (IPI) score (<3) at presentation. The median age at the time of diagnosis was 37.5 years (range = 24-68 years). All the patients died within 21 months, and the median survival time was 9.5 months (range = 2-21 months). So the conventional IPI and staging system failed to predict the outcome of the patients with the lymphoma. Except for the size of tumor cells, most of the morphologic features of the cases we studied were similar to those involving the midline facial tissue. Immunohistochemical studies showed the expression of cytotoxic markers (100%), CD2 (100%), CD3ε (90%), CD56 (80%), P53 (60%), CD30 (30%), LMP1 (30%), EBNA3A (0%). Nine cases (90%) highly expressed Ki-67. In situ hybridization for Epstein-Barr virus-encoded small RNA was positive in all cases.

Seasonal change in tropical habitat quality and body condition for a declining migratory songbird.

Many migratory songbirds spend their non-breeding season in tropical humid forests, where climate change is predicted to increase the severity and frequency of droughts and decrease rainfall. For conservation of these songbirds, it is critical to understand how resources during the non-breeding season are affected by seasonal patterns of drying, and thereby predict potential long-term effects of climate change. We studied habitat quality for a declining tropical forest-dwelling songbird, the wood thrush (Hylocichla mustelina), and tested the hypothesis that habitat moisture and arthropod abundance are drivers of body condition during the overwintering period. We examined habitat moisture, abundance of arthropods and fruit, and condition of individual birds (n = 418) in three habitat types--mature forest, mature forest with increased presence of human activity, and riparian scrub--from October to April. We found a strong pattern of habitat drying from October (wet season) to March (prior to spring migration) in all habitats, with concurrent declines in arthropod and fruit abundance. Body condition of birds also declined (estimated ~5 % decline over the wintering period), with no significant difference by habitat. Relatively poor condition (low body condition index, low fat and pectoral muscles scores) was equally apparent in all habitat types in March. Climate change is predicted to increase the severity of dry seasons in Central America, and our results suggest that this could negatively affect the condition of individual wood thrushes.

Adherence to the healthy Nordic food index and total and cause-specific mortality among Swedish women.

Several healthy dietary patterns have been linked to longevity. Recently, a Nordic dietary pattern was associated with a lower overall mortality. No study has, however, investigated this dietary pattern in relation to cause-specific mortality. The aim of the present study was to examine the association between adherence to a healthy Nordic food index (consisting of wholegrain bread, oatmeal, apples/pears, root vegetables, cabbages and fish/shellfish) and overall mortality, and death by cardiovascular disease, cancer, injuries/suicide and other causes. We conducted a prospective analysis in the Swedish Women's Lifestyle and Health cohort, including 44,961 women, aged 29-49 years, who completed a food frequency questionnaire between 1991-1992, and have been followed up for mortality ever since, through Swedish registries. The median follow-up time is 21.3 years, and mortality rate ratios (MRR) were calculated using Cox Proportional Hazards Models. Compared to women with the lowest index score (0-1 points), those with the highest score (4-6 points) had an 18% lower overall mortality (MRR 0.82; 0.71-0.93, p < 0.0004). A 1-point increment in the healthy Nordic food index was associated with a significantly lower risk of all-cause mortality: 6% (3-9%), cancer mortality: 5% (1-9%) and mortality from other causes: 16% (8-22%). When examining the diet components individually, only wholegrain bread and apples/pears were significantly inversely associated with all-cause mortality. We observed no effect-modification by smoking status, BMI or age at baseline. The present study encourages adherence to a healthy Nordic food index, and warrants further investigation of the strong association with non-cancer, non-cardiovascular and non-injury/suicide deaths.

Study of a comprehensive assessment method of the environmental quality of soil in industrial and mining gathering areas

Industrial and mining activities have been recognized as major sources of heavy metal contamination in soil. Here, we developed a comprehensive assessment method for the soil environment in industrial and mining gathering areas based on the pressure–state–response model. Using this method, we assessed the environmental quality of soil in a typical industrial and mining gathering area in Tianjin City, China. The results are as follows: (1) The comprehensive environmental quality index of the soil in the study area was 0.532, which corresponds to an alert state and shows that the soil environment is generally poor. (2) The pressure, state, and response indexes were 0.609, 0.634, and 0.163, respectively, which suggests that the pressure in the soil environment of the study area is barely acceptable, and the state is merely passable. Furthermore, the response measures are not ideal. (3) The low response index scores indicate poor production processes, low pollutant treatment level, and unsatisfactory level of management by the enterprises in the study area. (4) The distribution of soil risks was found to be inseparably related to that of contamination sources and land use types. Furthermore, the distribution was uneven to a certain degree. Finally, we propose recommendations for the optimization, adjustment, and management of typical industrial and mining gathering areas with petrochemical, metallurgy, and other heavily polluting enterprises.

Periostin: a novel tissue biomarker correlates with chronicity index and renal function in lupus nephritis patients.

Lupus nephritis (LN) is one of the most serious complications in patients with systemic lupus erythematosus (SLE). At present, there is no specific biomarker with high sensitivity and renal pathology involvement in use in clinical practice. Periostin is an extracellular matrix protein involved in kidney development and kidney injury. We performed immunohistochemical analysis for periostin and routine staining of 42 kidney tissues from LN patients compared with controlled kidney tissues. Activity index, chronicity index and periostin staining were evaluated and scored by a renal pathologist. Periglomerular staining of periostin was the most predominant finding. Positive periostin staining was also observed in areas with fibrosis such as sclerosed glomeruli, interstitial fibrosis and fibrous vessels. Moreover, the tubules seemed to be the main location for periostin staining. There was a statistically different level of periostin staining score between patient and control tissues. Periostin staining score also correlated with the chronicity index score of renal pathology (r = 0.594, p < 0.001). Periostin was also correlated with worsening renal outcomes including serum creatinine, blood urea nitrogen and estimated glomerular filtration rate (eGFR). Subgroup analysis within patients with low activity index score or low chronicity index score found that there was a statistical difference in serum creatinine and eGFR between groups with low and high periostin staining scores. We concluded that periostin staining score correlated with chronicity index score and renal function in patients with lupus nephritis.

Effect of ankle proprioceptive training on static body balance.

[Purpose] This study aimed to investigate the effect of ankle proprioceptive training on static body balance. [Subjects and Methods] In this randomized-controlled, single-blind study, 59 university students (35 females, 24 males) were randomized into study (n=29) and control (n=30) groups. The study group received a foot and ankle proprioceptive exercise program including stretching, strengthening (plantar and dorsi-flexors, invertor and evertor muscles), and balance board exercises, each with 10 repetitions per session, 5 days a week, for a total of 10 sessions. The control group did not receive any intervention. Static body balance was evaluated by a kinesthetic ability trainer, which showed the balance index scores under both single foot and both feet conditions. This evaluation was repeated at the end of two weeks for both groups. [Results] Outcome measures of the groups were similar at the baseline. Balance index scores of both groups improved at the end of two weeks, and the study group had significantly lower index scores than those of the control group, indicating better balance. [Conclusion] Ankle proprioceptive training had positive effects on static body balance parameters in healthy individuals, and it is worth investigating the effects of this type of training in patients with balance disorders.

Addressing Corner Solution Effect for Child Mortality Status Measure: An Application of Tobit Model

Although various models regarding corner solution data have been suggested, it is known that corner solution data is too complicated to predict the model. A corner solution is a unique solution in the sense that it is characterized by a mass-point at zero and a long right tail. For the present study, the data was taken from MICS collected by Punjab Bureau of Statistics (BOS) during 2011-2012. However, this study is based on the particular data. The child mortality within five-year interval was taken as a response variable. In the data obtained, 65% of the response variable observed to be zero. Tobit model reveals that it is the most accurate and widely used technique in this regard. The implementation of Tobit model shows that the significant predictor of child mortality in a family within five year are women age, postnatal checkups, antenatal care, total children ever born, and wealth index score. Since the majority (i.e. 74.4%) of mother age in the data is between 20 to 35 years. The results indicate that the chances of child survival are relatively higher for the mothers of age group of 20-35 years. Furthermore, Child mortality is highest for the families with low wealth index score. In addition, child mortality percentage tends to decrease with the improvement in postnatal and antenatal care facilities. The specification of Tobit model also used to verify the result of the Tobit model.

Conservation Agriculture and Household Wellbeing: A Non-Causal Comparison among Smallholder Farmers in Mozambique

This research examines the relationship between household wellbeing and the use of conservation agriculture (CA) by smallholder farmers in Mozambique. Wellbeing indicators are regressed on household demographic attributes, farm management practices, and a variable indicating farmer adoption of CA. Findings suggest that households using CA have higher wellbeing index scores related to farm tool and implement ownership and housing material quality, but lower index scores related to livestock ownership. The findings present an encouraging, baseline picture of the association between the use of CA technologies by farmers in Mozambique and household wellbeing.

Modern pollen rain in Canary Island ecosystems and its implications for the interpretation of fossil records

Vegetation history in the Canary Islands, one of the most biodiverse regions within Europe, has recently and for the first time, been the subject of palaeoecological studies. The interpretation of fossil records may be limited by several uncertainties regarding how well the different vegetation types are represented in the pollen rain. In this study we address this key knowledge gap within Canarian vegetation science, taking the island of Tenerife as a model. Based on quantitative and qualitative data we analysed pollen–vegetation relationships to test whether different vegetation types can be discriminated by means of their pollen rain composition, to identify under- and over-represented taxa, and to test the match between modern pollen rain and fossil pollen assemblages. We found clear differences in pollen composition and abundance among major Canarian vegetation types. We also identified good indicator taxa of the local occurrence of their source plants by their high fidelity and low dispersibility index scores. Extra-regional types (taxa without potential source plants in the Canary Islands) were not detected in our traps. However, several important floristic elements are either over-represented (Pinus, Morella and Ericaceae trees, Chenopodiaceae, Poaceae, Rumex and Urticaceae herbs and shrubs) or under-represented (Lauraceae trees, Fabaceae and Euphorbia shrubs). Results indicate that pollen composition is a good reflection of vegetation in Canarian ecosystems and can be used effectively to reconstruct past environments.

A NEW PASSENGER ORIENTED PERFORMANCE MEASUREMENT FRAMEWORK FOR PUBLIC RAIL TRANSPORTATION SYSTEMS

This paper presents a practical approach for monitoring public transportation systems' performance by focusing on customer evaluations. Within the framework of the developed method, 22 indicators are aggregated for 6 different measures, which are time, cost, accessibility and transfer, comfort, safety – security and quality of service respectively. Passenger Oriented Performance IndeX (POPIX) has been developed and applied to the Istanbul Metro, Light Rail and Tram systems. The goal of this research is to propose a new customer oriented performance index for transportation systems, enabling a reliable and objective base for monitoring system performance by setting performance goals and identifying priorities. Meanwhile, the proposed methodology also allows for the investigation of the performance changes of a particular transportation system and for performance comparison of different systems directly from the customer point of view. The data of the index is attained by the Customer Satisfaction Survey of Istanbul Public Railways' 2005, 2006 and 2007. The POPIX methodology has been defined and the corresponding POPIX scores are calculated for the systems investigated. Furthermore, the % POPIX concept has been developed for the comparison of different systems. Lastly, the shifted POPIX concept has been proposed for more reliable comparison between different years. The framework has been implemented to the public railway systems and individual index scores are calculated for each indicator, measure and overall system. The measures of cost, accessibility and transfer and comfort have lower index scores. Metro index scores are superior in comparison to the Tram and Light Rail for all the years analyzed.

Adipokines, insulin resistance, hepatic steatosis, and necroinflammation in patients with chronic viral hepatitis

Abstract Background: Hypoadiponectinemia and hyperleptinemia, and reductions in the ratio of adiponectin to leptin (A/L ratio) are associated with the development of hepatic necroinflammation in nonalcoholic fatty liver, but the association of the adipokines with hepatic steatosis in chronic viral hepatitis is unclear. Objective: To investigate the relationship between serum A/L ratio, insulin resistance, degree of hepatic steatosis, and necroinflammation in patients with chronic viral hepatitis. Methods: We measured serum adiponectin, leptin, and resistin levels, insulin resistance, and analyzed the association between liver histopathology and the level of the adipokines in 44 patients with chronic viral hepatitis before they started treatment. Results: We found that insulin resistance, leptin, and resistin levels tended to increase in the group with a greater degree of hepatic steatosis and necroinflammation, but that the increase was not significant. The adiponectin/leptin ratio (A/L ratio) in a group with a low degree of hepatic steatosis was significantly higher than it was in the group with a high degree of hepatic steatosis (3.1 ± 3.1 vs 1.2 ± 0.8; P = 0.008). The A/L ratio in a group with low histological activity index (HAI) scores was significantly higher than in the group with high HAI scores (3.7 ± 3.4 vs 1.1 ± 1.1; P = 0.006). Abdominal obesity was the only variable that showed a significant association with the HAI score (P = 0.03). Conclusion: The serum A/L ratio in patients with chronic viral hepatitis showed a significant inverse association with their degree of hepatic steatosis and necroinflammation.