Clinical judgement of General Practitioners for the diagnosis of dementia

Background: The accuracy of General Practitioners' (GPs') clinical judgement for diagnosing dementia is uncertain. Aim: Investigate the accuracy of GPs' clinical judgement for the diagnosis of dementia. Design and Setting: Diagnostic test accuracy study, recruiting from 21 practices around Bristol. Method: The clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had symptoms of possible dementia. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia. Results: 240 people were recruited, with a median age of 80 years (IQR 75 to 84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12 to 36 months) and the median ACE-III score was 75 (IQR 65 to 87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI 2.9 to 15) compared to people aged ≥ 80 years (3.6, 95% CI 1.7 to 7.6), and in women (10.4, 95% CI 3.4 to 31.7) compared to men (3.2, 95% CI 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups. Conclusion: GP judgement is more likely to under identify rather than over identify dementia.

Green Productivity in the Indonesian Leather-tanning Industry

Green productivity (GP) is a strategy by which production processes are improved by efficiently using resources and materials and adverse impacts on the environment are reduced. This study aims to measure GP of an Indonesian leather-tanning industry and develop alternatives to current processes that would improve its environmental and economic impacts. Two small to medium tanneries (Tanneries A and B) in two provinces were used as a case study. Data were collected through direct observation, measurements, in-depth interviews, and activity documentation. Material flow was analyzed using a green material flow map to determine the six sources of green wastes and the environmental indicators. The GP Index (GPI) was used to measure GP. The best method by which to improve GP was determined using GPI to a ratio of GP along with expert analysis using an analytical hierarchy process. GPI at Tannery A, located in West Java, was 0.14 with economic and environmental indicators of 1.44 and 10.41, respectively. GPI at Tannery B, located in Central Java, was 0.16 with economic and environmental indicators of 1.60 and 9.99, respectively. GP in both tanneries was low because of their suboptimal use of water. High water consumption can lead to a high discharge of liquid waste. Six alternatives for Tannery A and four for Tannery B were created. According to GPI, GP ratio, and expert opinion, the best strategy by which to improve GP was water recycling in the soaking and liming processes. This strategy increased GPI at Tannery A to 0.18 and at Tannery B to 0.20.

Analysis of the Graovac–Pisanski Index of Some Polyhedral Graphs Based on Their Symmetry Group

The Graovac–Pisanski (GP) index of a graph is a modified version of the Wiener index based on the distance between each vertex x and its image α(x), where α is an automorphism of graph. The aim of this paper is to compute the automorphism group of some classes of cubic polyhedral graphs and then we determine their Wiener index. In addition, we investigate the GP-index of these classes of graphs.

Diagnosis of the MJO Modulation of Tropical Cyclogenesis Using an Empirical Index

The modulation of tropical cyclone activity by the Madden–Julian oscillation (MJO) is explored using an empirical genesis potential (GP) index. Composite anomalies of the genesis index associated with the different MJO phases are consistent with the composite anomalies in TC genesis frequency that occur in the same phases, indicating that the index captures the changes in the environment that are at least in part responsible for the genesis frequency changes. Of the four environmental variables that enter the genesis potential index, the midlevel relative humidity makes the largest contribution to the MJO composite GP anomalies. The second largest contribution comes from the low-level absolute vorticity, and only very minor contributions come from the vertical wind shear and potential intensity. When basin-integrated MJO composite anomalies of the GP index are regressed against basin-integrated composite anomalies of TC genesis frequency, the results differ quantitatively from those obtained from the analogous calculation performed on the annual climatologies in the two quantities. The GP index captures the MJO modulation of TC genesis to a lesser degree than the climatological annual cycle of genesis (to which it was originally tuned). This may be due to weaknesses of the reanalysis or indicative of the importance of precursor disturbances, not well captured in the GP index computed from weekly data, to the intraseasonal TC genesis frequency fluctuations.