An interpretative inquiry into accounting practices in Islamic organisations in Malaysia

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An evaluation of speed management measures in Bangladesh based upon alternative accident recording, speed measurements, and DOCTOR traffic conflict observations

With 21,000 people annually killed in road traffic (estimated figure by World Health Organization), Bangladesh has one of the highest fatality rates in the world. Vulnerable road users (VRUs) account for over 50% of road traffic casualties, and 70% of casualties occur in rural areas. As in many Low and Middle Income Countries (LMICs), the official road accident statistics are incomplete and biased. Safe Crossings (Netherlands) and the Centre for Injury Prevention and Research Bangladesh (CIPRB) (Bangladesh) received permission from the Bangladesh government in 2014 to design and implement an integrated speed management program (consisting of a combination of small-scale infrastructural measures, active community involvement and road user education) at three locations where a national highway intersects small communities. The infrastructural countermeasures to improve road safety consisted of speed humps, rumble strips, signs and road markings and were designed following the Dutch road design guidelines. In a Before–After study design, we used a combination of three research methods to monitor and evaluate the road safety interventions. We created our own traffic accident recording system with trained local record keepers, we conducted laser-gun speed measurements of motorized traffic (both at intervention and control locations), and we applied the Dutch Objective Conflict Technique for Operation and Research (DOCTOR) for observing serious traffic conflicts at the intervention locations. The latter was based upon DOCTOR scores from video recordings of the behaviour at the three experimental locations Before and After the interventions. Prior to installing the intervention program, the three locations combined had, on average, about 100 serious accidents, 10 deaths, and 200 injured people on a yearly basis. In April 2015, all infrastructural measures were completed. In the after period (till the end of January 2016), the alternative accident recording system showed a 66% reduction in the number of serious accidents, a 73% reduction in the number of injured people, and a 67% reduction in the number of people killed. The unobtrusive laser-gun speed measurements resulted in a net reduction of 13.3 km/h (or 20% in relative terms) on average at the intervention locations by taking the general speed development at the control locations into account. According to Nilsson’s power law this would result in a 59% reduction of the number of people killed, well in line with the actual accident figures. The total number of serious conflicts (only DOCTOR scores 3, 4, and 5) was significantly reduced from 64 serious conflicts per location in a 4.5 h period Before to 29 serious conflicts in the After period, on average (Poisson distributed variable, p < 0.01), or a 55% reduction in relative terms. By including the traffic volumes, the reduction in conflict risk overall is 54%. Moreover, the severity of conflicts was reduced in the After period with only one most severe conflict (DOCTOR score 5) left. Buses represent the largest portion of road users involved in serious conflicts at all three locations, followed by cars and CNGs (Compressed Natural Gas vehicle). By far, the most frequently occurring conflict is of the type head-on conflict between an overtaking bus or car that is encountering a road user in opposite direction (for the greater part a CNG). All three evaluation measures point to a similar impact of the intervention program and unveil an improvement in road safety between 54% and 60%. The speed-reducing measures indeed considerably reduce the speed of motorized traffic, both the mean speed and 85th percentile values, both the number and severity of serious conflicts are reduced, and the actual number of accidents has decreased. It appears that Nilsson’s power law for the relation between a difference in mean speed and the change in the number of accidents also applies to LMICs. Speed management measures as common in high-income countries appear to be also effective in LMICs. For evaluation purposes of road safety impacts, a Traffic Conflicts Technique approach (also developed in high-income countries) seems valid and effective as well for application in LMICs. As there are thousands of traffic black spots with similar characteristics as the three intervention locations in Bangladesh, this integrated approach may well offer similar road safety improvements elsewhere

Heterogeneity of the CYP2D6 gene among Malays in Malaysia

Background: Although Malays shared an origin with Chinese, their evolution saw substantial divergences. Phenotyping studies suggested that they differed in CYP2D6 polymorphism, with higher PM prevalence but lesser right-shift for debrisoquine MRs. Objective: To study the genotype distribution of CYP2D6 among the Malays in Malaysia. Method: We obtained DNA from 107 Malays and used PCR to determine common CYP2D6 alleles. Result: CYP2D6*1 occurred at a frequency of 36.0, duplicated gene, 0.93, CYP2D6*4, 2.8, CYP2D6*5, 5.1, CYP2D6*9, 3.3, CYP2D6*10, 49.5 and CYP2D6*17, 0.5. The findings of CYP2D6*17 and CYP2D6*9 were novel for Asia. The frequency for CYP2D6*10 was lower than in other Asian races. The most frequent genotypes were CYP2D6*1/*10 at 39.3. Two subjects had genotypes that predicted PM phenotype, 35 showed genotypes that predicted intermediate metabolizers and one subject had a genotype that predicted ultra-rapid metabolism. Conclusion: The genetic polymorphism of CYP2D6 in Malays is different from Chinese and Far Eastern races. They may be intermediate between East Asians and Caucasians in CYP2D6 activity. Further study in relation to the evolution of races and disease prevalence may help to identify the contributions of the polymorphism in alleged susceptibility to diseases apart from delineating its contributions to ethnic differences in the pharmacology of CYP2D6 drugs

Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors

Estimated central systolic blood pressure (cSBP) and amplification (Brachial SBP-cSBP) are non-invasive measures potentially prognostic of cardiovascular (CV) disease. No worldwide, multiple-device reference values are available. We aimed to establish reference values for a worldwide general population standardizing between the different available methods of measurement. How these values were significantly altered by cardiovascular risk factors (CVRFs) was then investigated.AtCor Medical via an unrestricted gran

Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC)

Background The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. Methods Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. Findings Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3–58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5–56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32–6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20–5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin–kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001). Interpretation Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia. Funding Pfizer, Amgen, Merck Sharp & Dohme, Sanofi–Aventis, Daiichi Sankyo, and Regeneron