Ten-year fracture risk by FRAX and osteoporotic fractures in patients with systemic autoimmune diseases.

The Fracture Risk Assessment Tool (FRAX) has been used universally for the purpose of fracture risk assessment. However, the predictive capacity of FRAX for autoimmune diseases remains inconclusive. This study aimed to compare the applicability of FRAX for autoimmune disease patients. This retrospective study recruited rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and primary Sjögren syndrome (pSS) patients with bone mineral density (BMD) tests. Patients with any osteoporotic fractures were identified. Taiwan-specific FRAX with and without BMD were then calculated. In total, 802 patients (451 RA, 233 SLE and 118 pSS) were enrolled in this study. The cumulative incidences of osteoporotic fractures in the RA, SLE and pSS patients were 43.0%, 29.2% and 33.1%, respectively. For those with a previous osteoporotic fracture, T-scores were classified as low bone mass. Overall, the patients' 10-year probability of major fracture risk by FRAX without BMD was 15.8%, which then increased to 20.3% after incorporation of BMD measurement. When analyzed by disease group, the fracture risk in RA patients was accurately predicted by FRAX. In contrast, current FRAX, either with or without BMD measurement, underestimated the fracture risk both in SLE and pSS patients, even after stratification by age and glucocorticoid treatment. For pSS patients with major osteoporotic fractures, FRAX risks imputed by RA were comparable to major osteoporotic fracture risks of RA patients. Current FRAX accurately predicted fracture probability in RA patients, but not in SLE and pSS patients. RA-imputed FRAX risk scores could be used as a temporary substitute for SLE and pSS patients.

Combination immunosuppressant therapy and lupus nephritis outcome: a hospital-based study.

Lupus nephritis (LN) is the leading cause of mortality in lupus patients. This study aimed to investigate the treatment outcome and renal histological risk factors of LN in a tertiary referral center. Between 2006 and 2017, a retrospective observational study enrolled 148 biopsy-proven LN patients. After propensity score matching, 75 cases were included for further analysis. The classification and scoring of LN were assessed according to the International Society of Nephrology/Renal Pathology Society. Treatment response was evaluated by daily urine protein and urinalysis at two years after commencing induction treatment and the development of end-stage renal disease (ESRD). In total, 50.7% patients achieved complete remission (CR) or partial remission (PR), while 49.3% patients were categorized as nonresponders. Therapeutic responses in terms of CR/PR rates were associated with Systemic Lupus Erythematosus Disease Activity Index scores (odds ratio (OR): 1.34, 95% confidence interval (CI): 1.12-1.60, p = 0.001). Moreover, higher baseline creatinine levels (hazard ratio (HR): 2.10, 95% CI: 1.29-3.40, p = 0.003), higher renal activity index (HR: 1.30, 95% CI: 1.07-1.58, p = 0.008) and chronicity index (HR: 1.40, 95% CI: 1.06-1.85, p = 0.017) predicted ESRD. Among pathological scores, cellular crescents (HR: 4.42, 95% CI: 1.01-19.38, p = 0.049) and fibrous crescents (HR: 5.93, 95% CI: 1.41-24.92, p = 0.015) were independent risk factors for ESRD. In conclusion, higher lupus activity was a good prognostic marker for renal remission. Renal histology was predictive of ESRD. Large-scale prospective studies are required to verify the efficacy of mycophenolate in combination with azathioprine or cyclosporine in LN patients.

Genetic association of complement component 2 polymorphism with systemic lupus erythematosus.

Complement component 2 (C2), an early member of the classical pathway, mainly participates in apoptotic cell clearance. We hypothesize that C2 polymorphism may confer genetic susceptibility to complement dysfunction in systemic lupus erythematosus (SLE). The major aim of our study was to investigate the clinical and serological associations of C2 variants in Chinese patients with SLE. The single-nucleotide polymorphism (rs2844455, G/A SNP) located in the intron region of C2 gene was genotyped by direct sequencing in 95 SLE patients and 95 matched normal control subjects. The gene expression profiles were generated by quantitative real-time polymerase chain reaction (PCR) and reverse transcription PCR. Our results showed that the AA genotype was observed more frequently in SLE patients than in normal control subjects (22.1% vs 9.5%, P < 0.05). The A allele was strongly associated with the occurrence of hair loss, photosensitivity and anti-cardiolipin antibodies; whereas, the G allele was associated with lower frequencies of these clinical presentations. Relative expression levels were significantly lower in patients with the AA genotype [median: 18.86, interquartile range (IQR) 11.36-22.43, P = 0.002] than in those with the GG genotype (35.76, IQR: 19.33-49.71). As expected, we confirmed the A allele as a risk factor for SLE development in a Chinese population, in contrast, the G allele might be a protective factor against the pathogenic autoantibody formation and cutaneous manifestations in SLE patients.

The potential role of Th17 cells and Th17-related cytokines in the pathogenesis of lupus nephritis.

T helper type 17 (Th17) cells, a novel distinct subset of Th cell, can secrete interleukin (IL)-17 in humans. Although recent data suggest that Th17 cells and IL-17 play an important role in the pathogenesis of lupus nephritis (LN), the expression of Th17-related cytokines in the kidneys of SLE patients has not been studied in detail. In the present study, we investigated circulating Th17-cell frequencies using flow cytometry and serum Th17-related cytokine levels by enzyme-linked immunosorbent assay (ELISA) in 24 LN patients (17 patients with class IV and seven patients with class V) and 12 healthy controls. We also investigated glomerular Th17-related cytokine expression in LN patients and minimal change nephropathy (MCN) patients using immunohistochemistry. Our results showed significantly higher median frequencies of circulating Th17 cells in LN patients (0.68%) than in healthy controls (0.12%, p < 0.001). Serum levels of IL-17, IL-6 and IL-23 were significantly higher in LN patients (median 7.26, 232.60 and 37.01 pg/ml, respectively) than in healthy controls (median 0.82, 34.60 and 7.42 pg/ml, respectively; all p < 0.001). Circulating Th17-cell frequencies were positively correlated with SLEDAI, renal SLEDAI and histological activity index, the degree of cellular crescent and endocapillary proliferation. Significantly higher levels of glomerular IL-17 and IL-23 expression were observed in renal biopsies from class IV LN patients as compared to those from MCN patients and normal controls. Glomerular IL-17 and IL-23 expression levels were positively correlated with renal SLEDAI and histological activity index for LN patients. Our results suggest the potential role of the IL-23/Th17 axis in the intra-renal inflammation of SLE.

Observation of increases in emission from modern vehicles over time in Hong Kong using remote sensing.

In this study on-road gaseous emissions of vehicles are investigated using remote sensing measurements collected over three different periods. The results show that a high percentage of gaseous pollutants were emitted from a small percentage of vehicles. Liquified Petroleum Gas (LPG) vehicles generally have higher gaseous emissions compared to other vehicles, particularly among higher-emitting vehicles. Vehicles with high vehicle specific power (VSP) tend to have lower CO and HC emissions while petrol and LPG vehicles tend to have higher NO emissions when engine load is high. It can be observed that gaseous emission factors of petrol and LPG vehicles increase greatly within 2 years of being introduced to the vehicle fleet, suggesting that engine and catalyst performance deteriorate rapidly. It can be observed that LPG vehicles have higher levels of gaseous emissions than petrol vehicles, suggesting that proper maintenance of LPG vehicles is essential in reducing gaseous emissions from vehicles.

On-board gaseous emissions of LPG taxis and estimation of taxi fleet emissions.

Instantaneous CO, NO, and HC emissions and exhaust flow rates from four LPG taxis, which adhered to Euro 2-4 emission standards, were measured using a sophisticated portable emission measurement system (PEMS). Instantaneous air/fuel ratios, emission rates, and emission factors at different operating modes were derived to explore the emission characteristics of these four taxis. Results show that gaseous emissions from these four taxis exceed emission standards, due to extended vehicle use and poor maintenance. NO emissions from newer taxis are lower whilst CO and HC emissions of the Euro 4 taxi are similar to those of Euro 2 taxis during idling and low speed travel. The taxis emit lower amounts of gaseous pollutants whilst idling and emit the highest amounts of CO and NO whilst accelerating. Large fluctuations in air/fuel ratios can be observed from the Euro 4 taxi during idling, indicating a malfunction of fuel supply control to the engine. Such fluctuations are not observed from the other taxis. This shows that a Euro 4 taxi is not necessarily cleaner than a Euro 3 taxi. Emission factors derived from on-board measurements are applied to estimate gaseous emissions from the taxi fleet; these results show that emissions are higher during peak hour traffic conditions. An estimate of the taxi fleet's emissions whilst the older taxis are replaced is also calculated. It can be seen that faster replacement of older taxis can lead to reductions in gaseous emissions from the taxi fleet. This study shows that the PEMS is an adequate tool for measuring emissions from LPG vehicles and that there is an urgent need to enforce emission standards on taxis. This study also shows that on-board measurements should be incorporated in the estimation of emissions from other vehicle types. This would result in better emission estimations under local traffic conditions.

Antinucleosome antibodies as a potential biomarker for the evaluation of renal pathological activity in patients with proliferative lupus nephritis.

The objective of this study is to evaluate the correlation between antinucleosome antibodies and renal pathological activity in patients with proliferative lupus nephritis (LN). We evaluated 36 patients with proliferative LN, 14 non-renal lupus patients and 10 healthy volunteers. Lupus activity was assessed using the British Isles Lupus Assessment Group 2004 (BILAG 2004) index, serum anti-double stranded DNA (anti-dsDNA) levels, serum complement levels and daily urinary protein levels. All 36 lupus nephritis patients received renal biopsy. Antinucleosome antibodies were detected by enzyme-linked immunosorbent assay (ELISA). Our results showed that levels of serum antinucleosome antibodies were significantly higher in LN patients (median 90.35 units/ml, interquartile range [IQR] 37.38-135.23) than in non-renal SLE patients (median 5.45 units/ml, IQR 2.6-28.93, p <0.05) and in healthy volunteers (median 3.35 units/ml, IQR 2.95-5.23, p <0.001). Serum levels of antinucleosome antibodies were positively correlated with BILAG index (Spearman's r = 0.645, p <0.001) and serum anti-dsDNA antibody levels (r(s) = 0.644, p <0.01), while serum levels of antinucleosome antibodies were negatively correlated with serum levels of C3 (r(s) = -0.400, p <0.01) and C4 (r(s) = -0.300, p <0.05). Serum levels of antinucleosome antibodies were positively correlated with the histological activity index of LN (r(s) = 0.368, p <0.05). However, there was no significant correlation between serum levels of antinucleosome antibodies and the histological chronicity index. In conclusion, the serum level of antinucleosome antibodies is a potential biomarker for early recognition of renal involvement and evaluation of disease activity in SLE. Our preliminary results suggested that serum levels of antinucleosome antibodies might be a potential biomarker in evaluating pathological activity of LN.

Development of emission factors and emission inventories for motorcycles and light duty vehicles in the urban region in Vietnam.

This paper reports on a 2-year emissions monitoring program launched by the Centre for Environmental Monitoring of the Vietnam Environment Administration which aimed at determining emission factors and emission inventories for two typical types of vehicle in Hanoi, Vietnam. The program involves four major activities. A database for motorcycles and light duty vehicles (LDV) in Hanoi was first compiled through a questionnaire survey. Then, two typical driving cycles were developed for the first time for motorcycles and LDVs in Hanoi. Based on this database and the developed driving cycles for Hanoi, a sample of 12 representative test vehicles were selected to determine vehicle specific fuel consumption and emission factors (CO, HC, NOx and CO(2)). This set of emission factors were developed for the first time in Hanoi with due considerations of local driving characteristics. In particular, it was found that the emission factors derived from Economic Commission for Europe (ECE) driving cycles and adopted in some previous studies were generally overestimated. Eventually, emission inventories for motorcycles and LDVs were derived by combining the vehicle population data, the developed vehicle specific emission factors and vehicle kilometre travelled (VKT) information from the survey. The inventory suggested that motorcycles contributed most to CO, HC and NOx emissions while LDVs appeared to be more fuel consuming.

Predictors for 5-year survival in a prospective cohort of elderly stroke patients.

OBJECTIVES: To examine predictors for 5-year survival in elderly stroke patients. MATERIALS AND METHODS: Prospective cohort study of 186 consecutive acute stroke patients aged ≥65 years admitted to Bankstown-Lidcombe Hospital, Australia 03/2002 to 03/2003. All subjects were followed up in 2007/8, at 5 years post-stroke, for outcome measures. Logistic regression analysis was performed to predict 5-year survival using covariables, including functional status, age, stroke type and severity and vascular risk factors. Patients lost to follow-up (n = 20) were excluded from the analyses. RESULTS: One hundred patients (60%) were dead at study end. Predictors for survival in final logistic regression model were as follows: Glasgow Coma Scale (GCS) on admission (OR 1.49, 95%CI 1.1-2.0, P = 0.01), preadmission functional independence measure (FIM) score (OR 1.04, 95%CI 1.0-1.1, P = 0.01), age (OR 0.93, 95%CI 0.87-0.98, P = 0.01) and atrial fibrillation (OR 0.43, 95% CI 0.19-0.95, P = 0.04). For 5-year survivors, mean Modified Rankin Scale was 3.1 ± 1.5, total FIM score 85 ± 32, mini-mental state examination (MMSE) 22 ± 8 and Hospital Anxiety and Depression (HAD) scores 5.4 ± 3.4 and 5.2 ± 3.9, respectively. FIM cognition score was significantly lower at 5 years when compared to baseline (24 ± 8 vs 29 ± 8, P < 0.05) (all scores expressed as mean ± SD). In contrast, MMSE, HAD and total FIM scores were not significantly different at 5 years when compared to baseline. CONCLUSIONS: The study identified lower GCS on admission, lower preadmission FIM score, age and atrial fibrillation as negative predictors for 5-year survival following stroke.

Meta-analysis of the cardiovascular benefits of intensive lipid lowering with statins.

OBJECTIVE: To evaluate the efficacy of intensive lipid lowering with higher-dose statins. METHODS: Meta-analysis of seven randomized controlled trials comprising 50,972 participants. RESULTS: Mean follow-up was 3.1 years with mean age 63 years. Final LDL-C levels in intensive lipid-lowering group were 1.42-2.07 mmol/l compared to 2.1-3.5 mmol/l in the less intensive or control group. The intensive arm had significantly lower risks for stroke OR 0.80 (95% CI 0.71-0.89); major coronary events OR 0.74 (95% CI 0.65-0.83); cardiovascular disease (CVD) or coronary heart disease (CHD) deaths OR 0.84 (95% CI 0.74-0.95). Significantly higher liver enzyme abnormalities occurred in intensive group* (OR 3.96; 95% CI 2.08-7.53), but it was not associated with drug discontinuations (OR 1.20; 95% CI 0.88-1.64). CONCLUSION: In those at high risk of cardiovascular events, intensive lipid lowering with statins to LDL-C level <2.1 mmol/l significantly reduces risk of stroke, major coronary events and CVD or CHD deaths compared to LDL-C level ≥ 2.1 mmol/l. [*Correction added on 11 January 2011 after first online publication on 27 October 2010. The phrase, "Significantly higher liver enzyme abnormalities occurred in less intensive group", was amended to "Significantly higher liver enzyme abnormalities occurred in intensive group".].

Improved observer dependent perception of weak edges when scanning an image in real time indicated by introducing 1/f noise into the primary visual cortex V1. Theory and experimental support.

We present results of a new process for generating 1/f type noise sequences and introducing the noise in the primary visual cortex which then enables improved perception of weak edges when an observer is scanning a complex image in real time to detect detail such as in mammogram reading sessions. It can be explained by an adaptation of information theory for functional rather than previous task-based methods for formulating processes for edge formation in early vision. This is enabled from a two "species" classification of the interaction of opposing on-centre and off-centre neuron processes. We show that non-stationary stochastic resonances predicted by theory can occur with 1/f noise in the primary visual cortex V1 and suggest that signalling exchanges between V1 and the lateral geniculate nucleus (LGN) of the thalamus can initiate neural activity for saccadic action (and observer attention) for weak edge perception. Improvements predicted by our theory were shown from 600 observations by two groups of observers of limited experience and an experienced radiologist for reference (but not for diagnosis). They scanned and rated the definition of microcalcification in clusters separately rated by the experienced radiologist. The results and supporting theory showed dependence on the observer's attention and orderly scanning. Using a compact simplified equipment configuration the methodology has important clinical applications for conjunction searches of features and for detection of objects in poor light conditions for vehicles.

Formaldehyde and volatile organic compounds in Hong Kong homes: concentrations and impact factors.

UNLABELLED: This paper presents formaldehyde and volatile organic compounds (VOC) concentrations, potential sources and impact factors in 100 homes. The 24-h average formaldehyde concentration in 37 homes exceeded the good class of the Hong Kong Indoor Air Quality Objectives (HKIAQO), whereas the total VOCs concentration in all homes was lower than the HKIAQO. Compared to other East Asian cities, indoor formaldehyde and styrene in Hong Kong was the highest, reflecting that the homes in Hong Kong were more affected by household products and materials. The formaldehyde concentration in newly built apartments was significantly higher than that in old buildings, whereas no relationship between the concentration and the building age was found for VOCs. There was no difference for formaldehyde and toluene between smoking and non-smoking homes, suggesting that cigarette smoking was not the major source of these two species. Homes of a couple with a child had higher formaldehyde and acetic acid concentrations, while homes with more than three people had higher concentrations of 1-butanol, heptane and d-limonene. When shoes were inside the homes, heptane, acetic acid, nonane and styrene concentrations were statistically higher than that when shoes were out of the homes. Furthermore, higher levels of 1,2,4-trimethylbenzene, styrene, nonane and heptane were found in gas-use families rather than in electricity-use homes. PRACTICAL IMPLICATIONS: Long-term exposure to formaldehyde and volatile organic compounds (VOC) in indoor environments may cause a number of adverse health effects such as asthma, dizziness, respiratory and lung diseases, and even cancers. Therefore, it is critical to minimize indoor air pollution caused by formaldehyde and VOCs. The findings obtained in this study would significantly enhance our understanding on the levels, emission sources and factors which affect indoor concentrations of formaldehyde and VOCs. The results can help housing designers, builders, home residents, and housing department of the government to improve indoor air quality (IAQ) by means of appropriate building materials, clean household products and proper life styles. It can also help policy makers reconcile the IAQ objectives and guidelines.

Association between setting quantified road safety targets and road fatality reduction.

Since the 1980s, many countries have set quantified road safety targets as part of their comprehensive road safety strategies. This paper studies the association between the setting of quantified road safety targets and road fatality reduction over the past two decades. Both aggregate and disaggregate levels of hypothesis tests are performed on data from 14 countries that set road safety targets during the period 1981-1999. A before-and-after analysis of the treatment and comparison groups is conducted, and the results show that the majority of countries with quantified road safety targets experienced a reduction in road fatalities in this period. Overall, the establishment of quantified road safety targets is found to have an appreciable association with an improvement in road safety.

Application of the mixed venous blood concentration equation in desflurane anesthesia.

BACKGROUND: We have previously proposed an equation derived from Fick's law and Lin's concept of effective blood concentration (EBC) to calculate the mixed venous blood concentration (MVBC) of isoflurane. Desflurane has a lower blood/air partition coefficient than isoflurane and, as such, promotes a faster induction and recovery from anesthesia. In this study, we investigated the application of the MVBC equation to predict the MVBC of desflurane. METHODS: We maintained anesthesia with a fixed inspired concentration (CI) of desflurane (10%) during cardiac anesthesia in 11 patients. In order to measure the real concentrations of desflurane in mixed venous blood, pulmonary arterial blood samples were collected at different time points via a Swan-Ganz catheter for gas chromatographic-mass spectrometric determination. The relationship between the calculated concentrations and the actual blood sample concentrations of desflurane in mixed venous blood was investigated. Lin's EBC method was also used and the results were compared with those of MVBC. RESULTS: The calculations from our derived MVBC equation and the actual blood concentrations showed a similar kinetic pattern; the concentration levels were approximately the same and correlated well (r = 0.89) during anesthesia. However, the EBC method failed to accurately estimate the actual blood concentrations. CONCLUSIONS: The results demonstrate that our equation, but not the EBC method, may be useful for estimating pulmonary blood concentrations of desflurane. The clinical significance and the importance of the method merit further investigation.

Identifying the determinants of 1-year post-stroke outcomes in elderly patients.

OBJECTIVES: To examine 12-month outcomes and develop predictive models for outcomes in elderly stroke patients. METHODS: Prospective study of 186 consecutive acute stroke patients aged > or = 65 years admitted to a local hospital between March 2002 and March 2003. Outcome measurements included mortality, functional independence measure (FIM) score and nursing home placement. Two predictive models, using multiple logistic regression analysis, were developed to identify the factors associated with (i) mortality, and (ii) being alive and independent (defined as mean FIM score > or = 90) at 12 months. RESULTS: One hundred and seventy two (92%) patients were followed up at 12 months post-stroke. Mortality rate was 31%, and was significantly higher in nursing home vs non-nursing home origin patients (68% [15/22] vs 25% [38/150]). Nursing home placement for non-nursing home origin survivors was 28% (31/112). Age > or = 85 years was associated with higher mortality (odds ratio = 5.3, 95% confidence interval = 1.8-15, P < 0.01) and lower FIM for patients living at home pre-stroke. Predictive models showed that age, not living at home pre-stroke, pre-stroke FIM < 108, inability to walk on admission, dysphasia, visual field loss and haemorrhagic stroke were associated with worse outcome. CONCLUSIONS: Predictive models--by developing new strategies to improve outcomes through identifying treatable predictive factors--may be clinically useful in elderly stroke patients.

Application of MVBC equation to predict mixed venous blood concentrations of sevoflurane in cardiac anaesthesia.

We have proposed an equation for estimating the real-time mixed venous blood concentration (MVBC) of isoflurane in cardiac anaesthesia. However, information related to the application of our method to sevoflurane is lacking. We studied 12 patients undergoing cardiac surgery and anaesthetised with sevoflurane. At different time points, pulmonary arterial blood samples were collected for gas chromatography-mass spectrometry (GC-MS) to determine the real mixed venous concentrations of sevoflurane. The inspired and expired concentrations of sevoflurane, measured by a gas monitor, were used for the MVBC calculations. Using Bland-Altman analyses, we found that the calculated MVBCs accurately represent the actual concentrations of sevoflurane in pulmonary arterial blood, as shown by a near-zero percentage bias with a 0.14% precision between the two concentrations. The results demonstrated that our equation could be a useful method for estimating the pulmonary blood concentration of sevoflurane.

Would relaxing speed limits aggravate safety? A case study of Hong Kong.

This paper studies the effect of the changed speed limits on accident counts for major roadways in the urban environment of Hong Kong. In 1999-2002, the speed limits of a number of sections of roadway were reviewed and increased. Nineteen of them were major roadways. Their speed limits were raised by 10-20 km/h from 50 to 70 km/h. Before and after studies were carried out to investigate the changes in accident counts with respect to the set of carefully chosen comparison groups. Qualification tests for these comparison groups were conducted to confirm their suitability for the studies. In the majority of the treatment sites, the accident counts were worse after the increase in speed limits, both for the category of fatal, serious and slight (FSS) accidents, and for the category of fatal and serious (FS) accidents. Overall, the relaxation of the speed limit from 50 to 70 km/h increased the FSS accident counts by 15% and the FS accident counts by 1%. The relaxation of the speed limit from 70 to 80 km/h increased the FSS accident counts by 18% and the FS accident counts by 36%.

Prevalence of Parkinson's disease in Sydney.

OBJECTIVE: To examine the prevalence of Parkinson's disease (PD) in Bankstown, Sydney, using the same methodology as a previous study in Randwick, Sydney, Australia (1998-1999). PARTICIPANTS AND METHODS: Twenty census districts (CDs) for the Bankstown local government area were randomly selected. Research personnel door-knocked every household within the CDs to locate people aged > or =55 years. A structured questionnaire (containing four screening questions for PD) was administered to those agreeing to participate. Screened positive participants were invited to come for a clinical examination. This is a continuation of the previous study and data have been combined. RESULTS: Combining data for Bankstown and Randwick gave 1028 participants; crude prevalence, 780 per 100,000 (CI: 546-1077). In Bankstown, there were 501 participants aged > or =55 years (response rate 70%); 135 were screened positive with 101 (74.8%) agreeing to a clinical examination. The prevalence of PD in the Bankstown community was 3.4% (17 of 501) (95% CI: 1.98-5.43) for those aged > or =55 years; crude prevalence 776 per 100,000 (CI: 452-1241). CONCLUSION: The combined results of two Sydney studies appear to indicate that Sydney has one of the highest prevalence estimates of PD in developed countries.

Mammogram object detection using dendronic image analysis.

Breast cancer can be treated with better patient outcomes and significantly lower costs if detected early. Using the spatial dendronic structure, image masks can be obtained, showing regions in the mammogram image corresponding to the breast and lead marker. The technique is robust to noise and placement of the breast within the image. The technique not only reduces the size of the region to be analysed, but also provides the dendronic structure of the breast in which stealth-like masses can be found more easily.

A qualitative assessment methodology for road safety policy strategies.

This paper proposes a qualitative assessment methodology that is comprised of a cluster analysis and an autoregression analysis that assess the effects of various road safety strategies implemented in Hong Kong over the last 10 years. The cluster analysis is first used to group over a hundred road safety projects and programs into a smaller set of meaningful road safety policy strategy clusters. These strategies, together with the trend factor, seasonal pattern, car crashworthiness and meteorological data are then used in the autoregression analysis to relate to the fatality and casualty rates of drivers, passengers, motorcyclists, and pedestrians. This method allows the evaluation of the overall effects of the road safety strategies, and the effects and relative significance of each individual strategy. The evaluation method is described, and the main findings of the study are discussed.