Background The CRUSADE, ACTION and ACUITY-HORIZONS scores are commonly used for predicting in-hospital major bleeding events in patients with acute coronary syndrome (ACS), but the homogeneous nature of these models...Background The CRUSADE, ACTION and ACUITY-HORIZONS scores are commonly used for predicting in-hospital major bleeding events in patients with acute coronary syndrome (ACS), but the homogeneous nature of these models' population limits simple ex- trapolation to other local population. We aimed to compare the performance of the three risk models in Chinese patients. Methods We evaluated the performance of the three predicting scores for predicting in-hospital major bleeding events defined by thrombolysis in myocar- dial infarction (TIMI) serious (major and minor) episodes, in a cohort of Chinese ACS patients with either non-ST-elevation ACS (NSTE-ACS) or ST-elevation myocardial infarction (STEMI). Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow test and C-statistic, respectively. We compared the predictive accuracy of the risk scores by the Delong non-parametric test. Results TIMI serious bleeding rate was 1.1% overall (1.9% and 0.86% for STEMI and NSTE-ACS, respectively). The CRUSADE, ACTION and ACUTIY-HOR/ZONS scores showed an adequate discriminatory capacity for major bleeding: in overall patients, the C-statistic was 0.80, 0.77, and 0.70, respectively; in NSTE-ACS patients, the C-statistic was 0.73, 0.72, and 0.64, respectively; in STEMI patients, the C-statistic was 0.91, 0.92, and 0.75, respectively. The C-statistic for the ACUITY-HORIZONS model was significantly lower than those of the CRUSADE and ACTION scores for the prediction of TIM/serious bleeding in overall patients (compared with CRUSADE, z = 3.83, P = 0.02; compared with ACTION, z = 3.51, P = 0.03); in NSTE-ACS patients (compared with CRUSADE, z = 2.37, P = 0.01; compared with ACTION, z = 2.11, P = 0.04), and in STEMI patients (compared with CRUSADE, z = 2.6.77, P = 0.02; compared with AC- TION, z = 7.91, P = 0.002). No differences were observed when the CRUSADE and ACTION models were compared to each other, regard- less of overall patients (z = 0.68, P = 0.31) and both of ACS types (NSTE-ACS, z = 0.52, P = 0.60), and STEMI patients (z = 0.36, P = 0.74). However, the three risk scores all overestimated the absolute major bleeding risk in each risk stratification in our study. For example, the predicted rate of CRUSADE score at high risk stratification was 11.9% vs. an actual rate of 5.3%. Conclusions The CRUSADE and AC- TION scores had a greater calibration and discrimination for in-hospital major bleeding compared with the ACUITY-HORIZONS score in Chinese patients with ACS undergoing PCI. However, they all overestimated the bleeding risk rate for Chinese populations. Calibration of these risk scores would be useful for the generalization in Chinese populations.展开更多
Sustainable construction in the future will be influenced significantly by the beliefs and actions of civil engineering students studying at university today. A comparative investigation of the appreciation and attitu...Sustainable construction in the future will be influenced significantly by the beliefs and actions of civil engineering students studying at university today. A comparative investigation of the appreciation and attitudes regarding sustainable construction of civil engineering students at The NUCE (National University of Civil Engineering) in Vietnam, and the Universities of Loughborough and Liverpool in the UK were therefore conducted. Results indicate that students at all three universities appreciate the importance of the development of sustainable construction and have positive attitudes with regards to sustainability. Construction design and appropriate use of materials were two issues generally considered the most important with regards to sustainability, but were also thought to be adequately covered on the courses in all three institutions.展开更多
The aim of this paper is to analyse the legal status of irregular migrants, both in Brazil and in Italy, from a comparative law perspective. Irregular migration has always been a sensitive issue in Italian politics an...The aim of this paper is to analyse the legal status of irregular migrants, both in Brazil and in Italy, from a comparative law perspective. Irregular migration has always been a sensitive issue in Italian politics and is going to be a core-issue in a time of economic crisis, while in Brazil the current wave of international migration is regarded as a new phenomenon, resulting from the recent economic growth. From a legal standpoint, this study provides an analysis of both national legal order and the jurisprudential trends issued by the Inter-American Court of Human Rights (IACtHR) and the European Court of Human Rights (ECtHR), specifically underlining the judicial borrowing and interaction between the two courts.展开更多
This analysis of the multi-model aerosol optical depth (AOD) in eastern China using the Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP) datasets shows that the global models underestimate the ...This analysis of the multi-model aerosol optical depth (AOD) in eastern China using the Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP) datasets shows that the global models underestimate the AOD by 33% and 44% in southern and northern China, respectively, and decrease the relative humidity (RH) of the air in the surface layer to 71%–80%, which is less than the RH of 77%–92% in reanalysis meteorological datasets. This indicates that the low biases in the RH partially account for the errors in the AOD. The AOD is recalculated based on the model aerosol concentrations and the reanalysis humidity data. Improving the mean value of the RH increases the multi-model annual mean AOD by 45% in southern China and by 33% in June–August in northern China. This method of improving the AOD is successful in most of the ACCMIP models, but it is unlikely to be successful in GISS-E2-R, in which the plot of its AOD efficiency against RH strongly deviates from the rest of the models. The effect of the improvement in the modeled RH on the AOD depends on the concentration of aerosols. The shape error in the frequency distribution of the RH is likely to be more important than the error in the mean value of the RH, but this requires further research.展开更多
文摘Background The CRUSADE, ACTION and ACUITY-HORIZONS scores are commonly used for predicting in-hospital major bleeding events in patients with acute coronary syndrome (ACS), but the homogeneous nature of these models' population limits simple ex- trapolation to other local population. We aimed to compare the performance of the three risk models in Chinese patients. Methods We evaluated the performance of the three predicting scores for predicting in-hospital major bleeding events defined by thrombolysis in myocar- dial infarction (TIMI) serious (major and minor) episodes, in a cohort of Chinese ACS patients with either non-ST-elevation ACS (NSTE-ACS) or ST-elevation myocardial infarction (STEMI). Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow test and C-statistic, respectively. We compared the predictive accuracy of the risk scores by the Delong non-parametric test. Results TIMI serious bleeding rate was 1.1% overall (1.9% and 0.86% for STEMI and NSTE-ACS, respectively). The CRUSADE, ACTION and ACUTIY-HOR/ZONS scores showed an adequate discriminatory capacity for major bleeding: in overall patients, the C-statistic was 0.80, 0.77, and 0.70, respectively; in NSTE-ACS patients, the C-statistic was 0.73, 0.72, and 0.64, respectively; in STEMI patients, the C-statistic was 0.91, 0.92, and 0.75, respectively. The C-statistic for the ACUITY-HORIZONS model was significantly lower than those of the CRUSADE and ACTION scores for the prediction of TIM/serious bleeding in overall patients (compared with CRUSADE, z = 3.83, P = 0.02; compared with ACTION, z = 3.51, P = 0.03); in NSTE-ACS patients (compared with CRUSADE, z = 2.37, P = 0.01; compared with ACTION, z = 2.11, P = 0.04), and in STEMI patients (compared with CRUSADE, z = 2.6.77, P = 0.02; compared with AC- TION, z = 7.91, P = 0.002). No differences were observed when the CRUSADE and ACTION models were compared to each other, regard- less of overall patients (z = 0.68, P = 0.31) and both of ACS types (NSTE-ACS, z = 0.52, P = 0.60), and STEMI patients (z = 0.36, P = 0.74). However, the three risk scores all overestimated the absolute major bleeding risk in each risk stratification in our study. For example, the predicted rate of CRUSADE score at high risk stratification was 11.9% vs. an actual rate of 5.3%. Conclusions The CRUSADE and AC- TION scores had a greater calibration and discrimination for in-hospital major bleeding compared with the ACUITY-HORIZONS score in Chinese patients with ACS undergoing PCI. However, they all overestimated the bleeding risk rate for Chinese populations. Calibration of these risk scores would be useful for the generalization in Chinese populations.
文摘Sustainable construction in the future will be influenced significantly by the beliefs and actions of civil engineering students studying at university today. A comparative investigation of the appreciation and attitudes regarding sustainable construction of civil engineering students at The NUCE (National University of Civil Engineering) in Vietnam, and the Universities of Loughborough and Liverpool in the UK were therefore conducted. Results indicate that students at all three universities appreciate the importance of the development of sustainable construction and have positive attitudes with regards to sustainability. Construction design and appropriate use of materials were two issues generally considered the most important with regards to sustainability, but were also thought to be adequately covered on the courses in all three institutions.
文摘The aim of this paper is to analyse the legal status of irregular migrants, both in Brazil and in Italy, from a comparative law perspective. Irregular migration has always been a sensitive issue in Italian politics and is going to be a core-issue in a time of economic crisis, while in Brazil the current wave of international migration is regarded as a new phenomenon, resulting from the recent economic growth. From a legal standpoint, this study provides an analysis of both national legal order and the jurisprudential trends issued by the Inter-American Court of Human Rights (IACtHR) and the European Court of Human Rights (ECtHR), specifically underlining the judicial borrowing and interaction between the two courts.
基金jointly supported by the National Key Research and Development Program of China [grant number2016YFE0201400]the Basic Research Program of the State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry,Institute of Atmospheric Physics,Chinese Academy of Sciences [grant number 7-082999]
文摘This analysis of the multi-model aerosol optical depth (AOD) in eastern China using the Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP) datasets shows that the global models underestimate the AOD by 33% and 44% in southern and northern China, respectively, and decrease the relative humidity (RH) of the air in the surface layer to 71%–80%, which is less than the RH of 77%–92% in reanalysis meteorological datasets. This indicates that the low biases in the RH partially account for the errors in the AOD. The AOD is recalculated based on the model aerosol concentrations and the reanalysis humidity data. Improving the mean value of the RH increases the multi-model annual mean AOD by 45% in southern China and by 33% in June–August in northern China. This method of improving the AOD is successful in most of the ACCMIP models, but it is unlikely to be successful in GISS-E2-R, in which the plot of its AOD efficiency against RH strongly deviates from the rest of the models. The effect of the improvement in the modeled RH on the AOD depends on the concentration of aerosols. The shape error in the frequency distribution of the RH is likely to be more important than the error in the mean value of the RH, but this requires further research.