text:
#include "dcmtk/config/osconfig.h"     // make sure OS specific configuration is included first

#include "dcmtk/dcmrt/seq/drtcims.h"

// --- item class ---

DRTContentItemModifierSequence::Item::Item(const OFBool emptyDefaultItem)
  : EmptyDefaultItem(emptyDefaultItem),
    ConceptCodeSequence(emptyDefaultItem /*emptyDefaultSequence*/),
    ConceptNameCodeSequence(emptyDefaultItem /*emptyDefaultSequence*/),
    Date(DCM_Date),
    DateTime(DCM_DateTime),
    FloatingPointValue(DCM_FloatingPointValue),
    MeasurementUnitsCodeSequence(emptyDefaultItem /*emptyDefaultSequence*/),
    NumericValue(DCM_NumericValue),
    PersonName(DCM_PersonName),
    RationalDenominatorValue(DCM_RationalDenominatorValue),
    RationalNumeratorValue(DCM_RationalNumeratorValue),
    ReferencedSOPSequence(emptyDefaultItem /*emptyDefaultSequence*/),
    TextValue(DCM_TextValue),
    Time(DCM_Time),
    UID(DCM_UID),
    ValueType(DCM_ValueType)
{
}

DRTContentItemModifierSequence::Item::Item(const Item &copy)
  : EmptyDefaultItem(copy.EmptyDefaultItem),
    ConceptCodeSequence(copy.ConceptCodeSequence),
    ConceptNameCodeSequence(copy.ConceptNameCodeSequence),
    Date(copy.Date),
    DateTime(copy.DateTime),
    FloatingPointValue(copy.FloatingPointValue),
    MeasurementUnitsCodeSequence(copy.MeasurementUnitsCodeSequence),
    NumericValue(copy.NumericValue),
    PersonName(copy.PersonName),
    RationalDenominatorValue(copy.RationalDenominatorValue),
    RationalNumeratorValue(copy.RationalNumeratorValue),
    ReferencedSOPSequence(copy.ReferencedSOPSequence),
    TextValue(copy.TextValue),
    Time(copy.Time),
    UID(copy.UID),
    ValueType(copy.ValueType)
{
}

DRTContentItemModifierSequence::Item::~Item()
{
}

DRTContentItemModifierSequence::Item &DRTContentItemModifierSequence::Item::operator=(const Item &copy)
{
    if (this != &copy)
    {
        EmptyDefaultItem = copy.EmptyDefaultItem;
        ConceptCodeSequence = copy.ConceptCodeSequence;
        ConceptNameCodeSequence = copy.ConceptNameCodeSequence;
        Date = copy.Date;
        DateTime = copy.DateTime;
        FloatingPointValue = copy.FloatingPointValue;
        MeasurementUnitsCodeSequence = copy.MeasurementUnitsCodeSequence;
        NumericValue = copy.NumericValue;
        PersonName = copy.PersonName;
        RationalDenominatorValue = copy.RationalDenominatorValue;
        RationalNumeratorValue = copy.RationalNumeratorValue;
        ReferencedSOPSequence = copy.ReferencedSOPSequence;
        TextValue = copy.TextValue;
        Time = copy.Time;
        UID = copy.UID;
        ValueType = copy.ValueType;
    }
    return *this;
}

void DRTContentItemModifierSequence::Item::clear()
{
    if (!EmptyDefaultItem)
    {
        /* clear all DICOM attributes */
        ValueType.clear();
        ConceptNameCodeSequence.clear();
        DateTime.clear();
        Date.clear();
        Time.clear();
        PersonName.clear();
        UID.clear();
        TextValue.clear();
        ConceptCodeSequence.clear();
        NumericValue.clear();
        FloatingPointValue.clear();
        RationalNumeratorValue.clear();
        RationalDenominatorValue.clear();
        MeasurementUnitsCodeSequence.clear();
        ReferencedSOPSequence.clear();
    }
}

OFBool DRTContentItemModifierSequence::Item::isEmpty()
{
    return ValueType.isEmpty() &&
           ConceptNameCodeSequence.isEmpty() &&
           DateTime.isEmpty() &&
           Date.isEmpty() &&
           Time.isEmpty() &&
           PersonName.isEmpty() &&
           UID.isEmpty() &&
           TextValue.isEmpty() &&
           ConceptCodeSequence.isEmpty() &&
           NumericValue.isEmpty() &&
           FloatingPointValue.isEmpty() &&
           RationalNumeratorValue.isEmpty() &&
           RationalDenominatorValue.isEmpty() &&
           MeasurementUnitsCodeSequence.isEmpty() &&
           ReferencedSOPSequence.isEmpty();
}

OFBool DRTContentItemModifierSequence::Item::isValid() const
{
    return !EmptyDefaultItem;
}

OFCondition DRTContentItemModifierSequence::Item::read(DcmItem &item)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultItem)
    {
        /* re-initialize object */
        clear();
        getAndCheckElementFromDataset(item, ValueType, "1", "1", "ContentItemModifierSequence");
        ConceptNameCodeSequence.read(item, "1-n", "1", "ContentItemModifierSequence");
        getAndCheckElementFromDataset(item, DateTime, "1", "1C", "ContentItemModifierSequence");
        getAndCheckElementFromDataset(item, Date, "1", "1C", "ContentItemModifierSequence");
        getAndCheckElementFromDataset(item, Time, "1", "1C", "ContentItemModifierSequence");
        getAndCheckElementFromDataset(item, PersonName, "1", "1C", "ContentItemModifierSequence");
        getAndCheckElementFromDataset(item, UID, "1", "1C", "ContentItemModifierSequence");
        getAndCheckElementFromDataset(item, TextValue, "1", "1C", "ContentItemModifierSequence");
        ConceptCodeSequence.read(item, "1-n", "1C", "ContentItemModifierSequence");
        getAndCheckElementFromDataset(item, NumericValue, "1-n", "1C", "ContentItemModifierSequence");
        getAndCheckElementFromDataset(item, FloatingPointValue, "1-n", "1C", "ContentItemModifierSequence");
        getAndCheckElementFromDataset(item, RationalNumeratorValue, "1-n", "1C", "ContentItemModifierSequence");
        getAndCheckElementFromDataset(item, RationalDenominatorValue, "1-n", "1C", "ContentItemModifierSequence");
        MeasurementUnitsCodeSequence.read(item, "1-n", "1C", "ContentItemModifierSequence");
        ReferencedSOPSequence.read(item, "1-n", "1C", "ContentItemModifierSequence");
        result = EC_Normal;
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::Item::write(DcmItem &item)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultItem)
    {
        result = EC_Normal;
        addElementToDataset(result, item, new DcmCodeString(ValueType), "1", "1", "ContentItemModifierSequence");
        if (result.good()) result = ConceptNameCodeSequence.write(item, "1-n", "1", "ContentItemModifierSequence");
        addElementToDataset(result, item, new DcmDateTime(DateTime), "1", "1C", "ContentItemModifierSequence");
        addElementToDataset(result, item, new DcmDate(Date), "1", "1C", "ContentItemModifierSequence");
        addElementToDataset(result, item, new DcmTime(Time), "1", "1C", "ContentItemModifierSequence");
        addElementToDataset(result, item, new DcmPersonName(PersonName), "1", "1C", "ContentItemModifierSequence");
        addElementToDataset(result, item, new DcmUniqueIdentifier(UID), "1", "1C", "ContentItemModifierSequence");
        addElementToDataset(result, item, new DcmUnlimitedText(TextValue), "1", "1C", "ContentItemModifierSequence");
        if (result.good()) result = ConceptCodeSequence.write(item, "1-n", "1C", "ContentItemModifierSequence");
        addElementToDataset(result, item, new DcmDecimalString(NumericValue), "1-n", "1C", "ContentItemModifierSequence");
        addElementToDataset(result, item, new DcmFloatingPointDouble(FloatingPointValue), "1-n", "1C", "ContentItemModifierSequence");
        addElementToDataset(result, item, new DcmSignedLong(RationalNumeratorValue), "1-n", "1C", "ContentItemModifierSequence");
        addElementToDataset(result, item, new DcmUnsignedLong(RationalDenominatorValue), "1-n", "1C", "ContentItemModifierSequence");
        if (result.good()) result = MeasurementUnitsCodeSequence.write(item, "1-n", "1C", "ContentItemModifierSequence");
        if (result.good()) result = ReferencedSOPSequence.write(item, "1-n", "1C", "ContentItemModifierSequence");
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::Item::getDate(OFString &value, const signed long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return getStringValueFromElement(Date, value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getDateTime(OFString &value, const signed long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return getStringValueFromElement(DateTime, value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getFloatingPointValue(Float64 &value, const unsigned long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return OFconst_cast(DcmFloatingPointDouble &, FloatingPointValue).getFloat64(value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getNumericValue(OFString &value, const signed long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return getStringValueFromElement(NumericValue, value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getNumericValue(Float64 &value, const unsigned long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return OFconst_cast(DcmDecimalString &, NumericValue).getFloat64(value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getNumericValue(OFVector<Float64> &value) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return OFconst_cast(DcmDecimalString &, NumericValue).getFloat64Vector(value);
}

OFCondition DRTContentItemModifierSequence::Item::getPersonName(OFString &value, const signed long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return getStringValueFromElement(PersonName, value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getRationalDenominatorValue(Uint32 &value, const unsigned long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return OFconst_cast(DcmUnsignedLong &, RationalDenominatorValue).getUint32(value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getRationalNumeratorValue(Sint32 &value, const unsigned long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return OFconst_cast(DcmSignedLong &, RationalNumeratorValue).getSint32(value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getTextValue(OFString &value, const signed long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return getStringValueFromElement(TextValue, value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getTime(OFString &value, const signed long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return getStringValueFromElement(Time, value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getUID(OFString &value, const signed long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return getStringValueFromElement(UID, value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::getValueType(OFString &value, const signed long pos) const
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return getStringValueFromElement(ValueType, value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::setDate(const OFString &value, const OFBool check)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultItem)
    {
        result = (check) ? DcmDate::checkStringValue(value, "1") : EC_Normal;
        if (result.good())
            result = Date.putOFStringArray(value);
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::Item::setDateTime(const OFString &value, const OFBool check)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultItem)
    {
        result = (check) ? DcmDateTime::checkStringValue(value, "1") : EC_Normal;
        if (result.good())
            result = DateTime.putOFStringArray(value);
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::Item::setFloatingPointValue(const Float64 value, const unsigned long pos)
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return FloatingPointValue.putFloat64(value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::setNumericValue(const OFString &value, const OFBool check)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultItem)
    {
        result = (check) ? DcmDecimalString::checkStringValue(value, "1-n") : EC_Normal;
        if (result.good())
            result = NumericValue.putOFStringArray(value);
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::Item::setPersonName(const OFString &value, const OFBool check)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultItem)
    {
        result = (check) ? DcmPersonName::checkStringValue(value, "1") : EC_Normal;
        if (result.good())
            result = PersonName.putOFStringArray(value);
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::Item::setRationalDenominatorValue(const Uint32 value, const unsigned long pos)
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return RationalDenominatorValue.putUint32(value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::setRationalNumeratorValue(const Sint32 value, const unsigned long pos)
{
    if (EmptyDefaultItem)
        return EC_IllegalCall;
    else
        return RationalNumeratorValue.putSint32(value, pos);
}

OFCondition DRTContentItemModifierSequence::Item::setTextValue(const OFString &value, const OFBool check)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultItem)
    {
        result = (check) ? DcmUnlimitedText::checkStringValue(value) : EC_Normal;
        if (result.good())
            result = TextValue.putOFStringArray(value);
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::Item::setTime(const OFString &value, const OFBool check)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultItem)
    {
        result = (check) ? DcmTime::checkStringValue(value, "1") : EC_Normal;
        if (result.good())
            result = Time.putOFStringArray(value);
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::Item::setUID(const OFString &value, const OFBool check)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultItem)
    {
        result = (check) ? DcmUniqueIdentifier::checkStringValue(value, "1") : EC_Normal;
        if (result.good())
            result = UID.putOFStringArray(value);
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::Item::setValueType(const OFString &value, const OFBool check)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultItem)
    {
        result = (check) ? DcmCodeString::checkStringValue(value, "1") : EC_Normal;
        if (result.good())
            result = ValueType.putOFStringArray(value);
    }
    return result;
}

// --- sequence class ---

DRTContentItemModifierSequence::DRTContentItemModifierSequence(const OFBool emptyDefaultSequence)
  : EmptyDefaultSequence(emptyDefaultSequence),
    SequenceOfItems(),
    CurrentItem(),
    EmptyItem(OFTrue /*emptyDefaultItem*/)
{
    CurrentItem = SequenceOfItems.end();
}

DRTContentItemModifierSequence::DRTContentItemModifierSequence(const DRTContentItemModifierSequence &copy)
  : EmptyDefaultSequence(copy.EmptyDefaultSequence),
    SequenceOfItems(),
    CurrentItem(),
    EmptyItem(OFTrue /*emptyDefaultItem*/)
{
    /* create a copy of the internal sequence of items */
    Item *item = NULL;
    OFListConstIterator(Item *) current = copy.SequenceOfItems.begin();
    const OFListConstIterator(Item *) last = copy.SequenceOfItems.end();
    while (current != last)
    {
        item = new Item(**current);
        if (item != NULL)
        {
            SequenceOfItems.push_back(item);
        } else {
            /* memory exhausted, there is nothing we can do about it */
            break;
        }
        ++current;
    }
    CurrentItem = SequenceOfItems.begin();
}

DRTContentItemModifierSequence &DRTContentItemModifierSequence::operator=(const DRTContentItemModifierSequence &copy)
{
    if (this != &copy)
    {
        clear();
        EmptyDefaultSequence = copy.EmptyDefaultSequence;
        /* create a copy of the internal sequence of items */
        Item *item = NULL;
        OFListConstIterator(Item *) current = copy.SequenceOfItems.begin();
        const OFListConstIterator(Item *) last = copy.SequenceOfItems.end();
        while (current != last)
        {
            item = new Item(**current);
            if (item != NULL)
            {
                SequenceOfItems.push_back(item);
            } else {
                /* memory exhausted, there is nothing we can do about it */
                break;
            }
            ++current;
        }
        CurrentItem = SequenceOfItems.begin();
    }
    return *this;
}

DRTContentItemModifierSequence::~DRTContentItemModifierSequence()
{
    clear();
}

void DRTContentItemModifierSequence::clear()
{
    if (!EmptyDefaultSequence)
    {
        CurrentItem = SequenceOfItems.begin();
        const OFListConstIterator(Item *) last = SequenceOfItems.end();
        /* delete all items and free memory */
        while (CurrentItem != last)
        {
            delete (*CurrentItem);
            CurrentItem = SequenceOfItems.erase(CurrentItem);
        }
        /* make sure that the list is empty */
        SequenceOfItems.clear();
        CurrentItem = SequenceOfItems.end();
    }
}

OFBool DRTContentItemModifierSequence::isEmpty()
{
    return SequenceOfItems.empty();
}

OFBool DRTContentItemModifierSequence::isValid() const
{
    return !EmptyDefaultSequence;
}

unsigned long DRTContentItemModifierSequence::getNumberOfItems() const
{
    return SequenceOfItems.size();
}

OFCondition DRTContentItemModifierSequence::gotoFirstItem()
{
    OFCondition result = EC_IllegalCall;
    if (!SequenceOfItems.empty())
    {
        CurrentItem = SequenceOfItems.begin();
        result = EC_Normal;
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::gotoNextItem()
{
    OFCondition result = EC_IllegalCall;
    if (CurrentItem != SequenceOfItems.end())
    {
        ++CurrentItem;
        result = EC_Normal;
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::gotoItem(const unsigned long num, OFListIterator(Item *) &iterator)
{
    OFCondition result = EC_IllegalCall;
    if (!SequenceOfItems.empty())
    {
        unsigned long idx = num + 1;
        iterator = SequenceOfItems.begin();
        const OFListConstIterator(Item *) last = SequenceOfItems.end();
        while ((--idx > 0) && (iterator != last))
            ++iterator;
        /* specified list item found? */
        if ((idx == 0) && (iterator != last))
            result = EC_Normal;
        else
            result = EC_IllegalParameter;
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::gotoItem(const unsigned long num, OFListConstIterator(Item *) &iterator) const
{
    OFCondition result = EC_IllegalCall;
    if (!SequenceOfItems.empty())
    {
        unsigned long idx = num + 1;
        iterator = SequenceOfItems.begin();
        const OFListConstIterator(Item *) last = SequenceOfItems.end();
        while ((--idx > 0) && (iterator != last))
            ++iterator;
        /* specified list item found? */
        if ((idx == 0) && (iterator != last))
            result = EC_Normal;
        else
            result = EC_IllegalParameter;
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::gotoItem(const unsigned long num)
{
    return gotoItem(num, CurrentItem);
}

OFCondition DRTContentItemModifierSequence::getCurrentItem(Item *&item) const
{
    OFCondition result = EC_IllegalCall;
    if (CurrentItem != SequenceOfItems.end())
    {
        item = *CurrentItem;
        result = EC_Normal;
    }
    return result;
}

DRTContentItemModifierSequence::Item &DRTContentItemModifierSequence::getCurrentItem()
{
    if (CurrentItem != SequenceOfItems.end())
        return **CurrentItem;
    else
        return EmptyItem;
}

const DRTContentItemModifierSequence::Item &DRTContentItemModifierSequence::getCurrentItem() const
{
    if (CurrentItem != SequenceOfItems.end())
        return **CurrentItem;
    else
        return EmptyItem;
}

OFCondition DRTContentItemModifierSequence::getItem(const unsigned long num, Item *&item)
{
    OFListIterator(Item *) iterator;
    OFCondition result = gotoItem(num, iterator);
    if (result.good())
        item = *iterator;
    return result;
}

DRTContentItemModifierSequence::Item &DRTContentItemModifierSequence::getItem(const unsigned long num)
{
    OFListIterator(Item *) iterator;
    if (gotoItem(num, iterator).good())
        return **iterator;
    else
        return EmptyItem;
}

const DRTContentItemModifierSequence::Item &DRTContentItemModifierSequence::getItem(const unsigned long num) const
{
    OFListConstIterator(Item *) iterator;
    if (gotoItem(num, iterator).good())
        return **iterator;
    else
        return EmptyItem;
}

DRTContentItemModifierSequence::Item &DRTContentItemModifierSequence::operator[](const unsigned long num)
{
    return getItem(num);
}

const DRTContentItemModifierSequence::Item &DRTContentItemModifierSequence::operator[](const unsigned long num) const
{
    return getItem(num);
}

OFCondition DRTContentItemModifierSequence::addItem(Item *&item)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultSequence)
    {
        item = new Item();
        if (item != NULL)
        {
            SequenceOfItems.push_back(item);
            result = EC_Normal;
        } else
            result = EC_MemoryExhausted;
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::insertItem(const unsigned long pos, Item *&item)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultSequence)
    {
        OFListIterator(Item *) iterator;
        result = gotoItem(pos, iterator);
        if (result.good())
        {
            item = new Item();
            if (item != NULL)
            {
                SequenceOfItems.insert(iterator, 1, item);
                result = EC_Normal;
            } else
                result = EC_MemoryExhausted;
        } else
            result = addItem(item);
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::removeItem(const unsigned long pos)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultSequence)
    {
        OFListIterator(Item *) iterator;
        if (gotoItem(pos, iterator).good())
        {
            delete *iterator;
            iterator = SequenceOfItems.erase(iterator);
            result = EC_Normal;
        } else
            result = EC_IllegalParameter;
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::read(DcmItem &dataset,
                                                 const OFString &card,
                                                 const OFString &type,
                                                 const char *moduleName)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultSequence)
    {
        /* re-initialize object */
        clear();
        /* retrieve sequence element from dataset */
        DcmSequenceOfItems *sequence;
        result = dataset.findAndGetSequence(DCM_ContentItemModifierSequence, sequence);
        if (sequence != NULL)
        {
            if (checkElementValue(*sequence, card, type, result, moduleName))
            {
                DcmStack stack;
                OFBool first = OFTrue;
                /* iterate over all sequence items */
                while (result.good() && sequence->nextObject(stack, first /*intoSub*/).good())
                {
                    DcmItem *ditem = OFstatic_cast(DcmItem *, stack.top());
                    if (ditem != NULL)
                    {
                        Item *item = new Item();
                        if (item != NULL)
                        {
                            result = item->read(*ditem);
                            if (result.good())
                            {
                                /* append new item to the end of the list */
                                SequenceOfItems.push_back(item);
                                first = OFFalse;
                            }
                        } else
                            result = EC_MemoryExhausted;
                    } else
                        result = EC_CorruptedData;
                }
            }
        } else {
            DcmSequenceOfItems element(DCM_ContentItemModifierSequence);
            checkElementValue(element, card, type, result, moduleName);
        }
    }
    return result;
}

OFCondition DRTContentItemModifierSequence::write(DcmItem &dataset,
                                                  const OFString &card,
                                                  const OFString &type,
                                                  const char *moduleName)
{
    OFCondition result = EC_IllegalCall;
    if (!EmptyDefaultSequence)
    {
        result = EC_MemoryExhausted;
        DcmSequenceOfItems *sequence = new DcmSequenceOfItems(DCM_ContentItemModifierSequence);
        if (sequence != NULL)
        {
            result = EC_Normal;
            /* an empty optional sequence is not written */
            if ((type == "2") || !SequenceOfItems.empty())
            {
                OFListIterator(Item *) iterator = SequenceOfItems.begin();
                const OFListConstIterator(Item *) last = SequenceOfItems.end();
                /* iterate over all sequence items */
                while (result.good() && (iterator != last))
                {
                    DcmItem *item = new DcmItem();
                    if (item != NULL)
                    {
                        /* append new item to the end of the sequence */
                        result = sequence->append(item);
                        if (result.good())
                        {
                            result = (*iterator)->write(*item);
                            ++iterator;
                        } else
                            delete item;
                    } else
                        result = EC_MemoryExhausted;
                }
                if (result.good())
                {
                    /* insert sequence element into the dataset */
                    result = dataset.insert(sequence, OFTrue /*replaceOld*/);
                }
                if (DCM_dcmrtLogger.isEnabledFor(OFLogger::WARN_LOG_LEVEL))
                    checkElementValue(*sequence, card, type, result, moduleName);
                if (result.good())
                {
                    /* forget reference to sequence object (avoid deletion below) */
                    sequence = NULL;
                }
            }
            else if (type == "1")
            {
                /* empty type 1 sequence not allowed */
                result = RT_EC_InvalidValue;
                if (DCM_dcmrtLogger.isEnabledFor(OFLogger::WARN_LOG_LEVEL))
                    checkElementValue(*sequence, card, type, result, moduleName);
            }
            /* delete sequence (if not inserted into the dataset) */
            delete sequence;
        }
    }
    return result;
}

// end of source file


Deciding whether your child needs braces or not is easier with the help of your general dentist or a qualified orthodontist. If your child has severely crooked teeth or has other serious problems that could interfere with his or her ability to eat and speak properly, the decision to wear braces can be a life-changing event. If only minor cosmetic flaws are present, you may wish to weigh the pros and cons. To find pediatric orthodontists in Peoria who are highly rated, ask your family dentist, your friends and neighbors, and others about their experiences.


text:
Case-control study of metabolic syndrome and ovarian cancer in Chinese population
Ying Chen1, 2, 3Email author,
Lei Zhang1, 2, 3,
Wenxin Liu1 and
Ke Wang1
Recent studies have proved metabolic syndrome (MetS) was linked to cancer risks. However, few data has examined the relationship between MetS and epithelial ovarian cancer (EOC).
We conducted a population-based case-control study in Tianjin Medical University Cancer Institute and Hospital, China (2010–2015) that enrolled 573 EOC patients and 1146 matched controls. Data were collected through in-person interviews, anthropometric measurement, and 8-h fasting bloods drawn. MetS was estimated by Chinese Diabetes Society (CDS) definition requiring presence of ≥3 of the following risk factors: 1) body mass index (BMI) ≥25.0 kg/m2,2) fasting plasma glucose ≥6.1 mmol/L or 2-h plasma glucose ≥ 7.8 mmol/L, 3) systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, 4) triglyceride (TG) ≥1.70 mmol/L or high-density lipoprotein cholesterol (HDL-C) < 1.0 mmol/L. Statistics were completed using chi-square tests and logistic regression analysis. The survival analysis was conducted by the Kaplan-Meier method and Cox proportional hazard regression models.
MetS was significantly more prevalent among EOC (25.13%) than controls (6.89%). A statistically significant increase risk for EOC was observed for MetS (multivariable-adjusted OR = 3.187; 95% CI: 2.135–4.756). MetS was significantly associated with histological grade (P < 0.001), FIGO stage (P = 0.003), and lymph node (LN) status (P = 0.002) of EOC. In binary logistic regression analysis, the presence of MetS predicts the risk of advanced FIGO stage (OR = 2.155, 95% CI: 1.327–3.498, P = 0.002), lower differentiation (OR = 2.472, 95% CI: 1.164–5.250, P = 0.019), and LN metastasis (OR = 2.590, 95% CI: 1.089–6.160, P = 0.031) of EOC. Moreover, MetS is the independent factor for the evaluation of PFS and OS of EOC patients (both of them P < 0.001) in Cox proportional hazard model.
MetS is obviously related to increased EOC risk. EOC patients with MetS in Chinese population were found to have statistically significant tumor advanced stage, low differentiation, LN metastasis and poor prognosis.
Approximately 95% of ovarian cancers are of epithelial origin. Epithelial ovarian cancer (EOC) was the leading killer among women with gynecologic cancers. In 2015, there were 22,280 estimated new diagnoses of ovarian cancer and 14,240 deaths from the disease [1]. Statistic revealed the morbidity and mortality of ovarian cancer were rising obviously [2]. However, scientists do not reach a consensus about the prevalence of ovarian cancer because of oncologic diseases have multiple causes. Recently, many researchers considered tumorigenesis process in the body as a systemic disease [3]. So, research attentions focused on the etiology and cause of cancer that lead to dysfunction and abnormality of metabolism increasingly [4, 5].
The metabolic syndrome (MetS) is a cluster of risk factors that includes central adiposity, high blood pressure, elevated blood glucose levels, elevated triglycerides (TG), and low high-density lipoprotein cholesterol (HDL-C) [6, 7]. In the last several years, several interesting studies have been published showing an association between cancer risk and the different components of MetS [8]. A noted large population-based enrolled 16,677 participants who were on medications for hyperlipidemia, diabetes and hypertension and were followed them for up to 8 years. A total of 823 incidents of cancer occurred during the study period, including a significantly increased risk of pancreatic cancer in males and colorectal cancer in females. Additionally, risks of women with liver, gallbladder and billiard tract, breast, and endometrial cancers were also increased [9]. MetS has emerged as a possible clinical condition that predisposes women to suffer breast and endometrial cancers, which associated with hormone disorder [10, 11].
However, epidemiologic studies linking MetS to ovarian cancer are scarce in spite that ovarian cancer is hormone related. Therefore, this present study aimed to collect the information on different components of MetS in a population-based control study of ovarian cancer and examined the role of metabolic dysfunction in EOC, in addition to examining risk with individual components of the MetS.
Our population-based case-control study of physical activity and ovarian cancer risk was approved by institutional review board of Tianjin medical university cancer institute and hospital. The clinicopathologic information of ovarian cancer group was collected from consenting patients diagnosed and treated for EOC between January 2010 and December 2015 at Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital. Clinical data from 630 consecutive EOC patients were extracted with routine preoperative serum detection. Twenty-five patients with concomitant endometrial cancer were excluded due to possible confounding neoplastic effect on serum lipid, while 32 patients were excluded with a previous history of cancer (five patients with breast cancer, seven with colon cancer, six with rectum cancer and fourteen with other cancers), leaving 573 patients for further analysis. The population-based controls were collected from Physical Examination Center, Tianjin medical university cancer institute and hospital, with all of the participants agreeing and signing consent forms. The controls had no history of hysterectomy, ovarian diseases, or previous cancer and were frequency matched to cases (2:1 ratio). Remarkably, there were not statistically different significances between the EOC group and the control group on age, pregnant times, menopause age, ever hormone use, and age of first pregnancy when choosing matched control cases.
Data were collected through in-person interviews using a structured questionnaire and cognitive interviewing methods, in which information on demographic variables and ovarian cancer risk factors including medical history and exogenous hormone use. Three measurements of height, weight and waist circumference were taken using standardized methods for anthropometric measurements at the time of interview, with the mean used as the final measurement. Blood was collected after a minimum 8-h fast, either prior to surgical treatment by hysterectomy or post surgery and subsequent to interviews for cases whose blood could not drawn pre-surgery. Blood was drawn post-interview among controls. A 10-mL blood sample was collected according to a standardized protocol, and samples were processed into blood fractions (serum, plasma, red blood cells, and buff coat), frozen at −80 °C within 24 h of collection, and transported for storage to a specimen bio-repository at the Department of Gynecological Oncology, Tianjin medical university cancer institute and hospital, Tianjin, China.
At present, there are two kinds of international definitions to diagnose MetS that are currently available for clinical use: (1) the National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP) III [12]; (2) the International Diabetes Federation (IDF) [13]. Considering Chinese population was enrolled in this study, MetS was defined according to the Chinese Diabetes Society (CDS) definition [14]. Patients were diagnosed with MetS when they had three or more of the following indications: 1) body mass index (BMI) ≥25.0 kg/m2,2) fasting plasma glucose ≥6.1 mmol/L or 2-h plasma glucose ≥ 7.8 mmol/L, 3) systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, 4) triglyceride (TG) ≥1.70 mmol/L or high-density lipoprotein cholesterol (HDL-C) < 1.0 mmol/L. Participants met the criteria for high blood pressure or high fasting glucose concentration if they underwent hypertension or hyperglycemia treatment. BMI was calculated as weight in kilograms divided by the square of height in meters.
Data were collected until death or December 2016. Overall survival (OS) was defined as the time interval from the date of primary surgery to the date of death (failure) or to the end of follow-up for women who were alive (censored). Progression-free survival (PFS) was defined as the time elapsed from the date of primary surgery to the appearance of disease recurrence or progression (failure) or the last follow-up for women who were alive with no evidence of disease recurrence or progression (censored).
Continuous data and frequency data were analyzed by Fisher's exact test and the chi-square test. Results of continuous variables were expressed as mean ± standard deviation (SD). Logistic regression analysis was used to estimated ORs and 95% CIs for developing ovarian cancer in association with presence of MetS and individual biological MetS components. The individual biological MetS components were modeled as meeting the respective cut-point according to CDS definition. Two-sided P-values were considered statistically significant at P ≤ 0.05. The survival was determined by the Kaplan-Meier method, and the log rank test was used to determine significance. MetS and its components were included in the multivariate analysis by using of Cox proportional hazard regression models. Statistical analysis was performed using SPSS software passage for Windows (version 20.0; SPSS Inc., Chicago, IL, USA).
The participant characteristics in this study were presented in the Table 1. Among this population, the average ages in 573 EOC and 1146 control cases were 52.59 ± 9.20 and 52.97 ± 9.73 years, respectively. In Table 1, the proportion of cases with levels of TG, HDL-C, BMI were demonstrated in EOC and control groups according to the cut-offs for MetS criterion in China. The proportion of cases with a history of hypertension or diabetes was also collected in Table 1.
characteristics of epithelial ovarian cancer cases and population-based controls
Epithelia ovarian cancer (n = 573)
Control (n = 1146)
Case (n, %)
Age(mean ± SD), y
Pregnant times
131 (22.86)
> 2
Menopause age(mean ± SD), y
50.9 ± 7.13
Ever hormone use
Estrogen only
14 (2.44)
Estrogen + progestin
Other hormone therapy
Age of first pregnancy
Fasting plasma glucose (mmol/L)
Diabetes history (cases)
Body mass index, kg/m2
BMI ≥25.0 kg/m2
BMI<25.0 kg/m2
Weight(mean ± SD), kg
62.95 ± 9.3
Waist circumference(mean ± SD), cm
Triglyceride (TG, mmol/L)
TG<1.70
TG ≥ 1.70
HDL-C (mmol/L)
HDL-C<1.0
92 (16.06)
HDL-C ≥ 1.0
1092 (95.29)
Hypertension history
As given in Table 2, we compared the proportion of participants having MetS according to three different definitions and the results did not differ significantly. The kappa value of interrater agreement was 92.5% between CDS and ATP III, 93.2% between CDS and IDF, and 90.0% between ATP III and IDF. The prevalence of MetS in our whole population ranged from 12.62% to 13.90% overall, assessing by three MetS criterions respectively. A higher range in proportion of 24.96% to 27.75% among EOC patients was found according to MetS diagnosis compared to control population ranging from 6.46% to 6.98% (Table 2).
proportion of metabolic syndrome by three different criteria in our study
Definition risk factors
Metabolic syndrome definition
NCEP-ATPIII
Waist circumference(WC)
>88 cm
≥25.0 kg/m2
≥1.69 mmol/L
HDL-C
<1.3 mmol/L
Systolic BP ≥ 130 or diastolic BP ≥ 85 mmHg
Systolic BP ≥ 140
or diastolic BP ≥ 90 mmHg
≥6.1 mmol/L
≥6.1 mmol/L or 2-h plasma glucose ≥7.8 mmol/L
3 or more of the above
WC necessary and any 2 or the above
Cases (%)
Kappa value
NECP national cholesterol education program, ATPIII adult treatment panelIII, IDF international diabetes federation, CDS Chinese diabetes society, NA not available
As shown in Table 3, the proportion of patients with MetS as identified by CDS guidelines was significantly greater among 144 cases (25.13%) than 79 control cases (6.89%) and was associated with a 3.187-fold increase in EOC risk (multivariable-adjusted OR = 3.187; 95% CI: 2.135–4.756). Similarly, the magnitude of the risk increase was also observed with the other 2 versions of MetS (ATPIIIand IDF), with statistically significant ORs ranging from 3.277 (95% CI: 2.150–4.993) to 3.376 (95% CI: 2.271–5.018) for the multivariable model (Table 3). EOC risk also was enhanced by most of the individual components of the MetS, including BMI ≥ 25.0 kg/m2 (multivariable-adjusted OR = 1.385; 95% CI: 1.129–1.699), TG ≥1.70 mmol/L (multivariable-adjusted OR = 2.861; 95% CI: 1.040–7.873), HDL-C < 1.0 mmol/L (multivariable-adjusted OR = 2.142; 95% CI: 1.730–2.652), ever being diagnosed and treated for hypertension (multivariable-adjusted OR = 2.423; 95% CI: 1.963–1.2.990), and diabetes (multivariable-adjusted OR = 2.240; 95% CI: 1.749–2.869). All of the above were P < 0.01.
age-adjusted and multivariable ORs and 95% CIs for risk of ovarian cancer
Case (%)
Age-adjusted
OR (95% CI)
Multivariable-adjustedaOR (95% CI)
1.609 (1.298–1.994)
TG ≥ 1.70 mmol/L
HDL-C < 1.0 mmol/L
2.396 (1.86403.081)
ATPIII
aMultivariable-adjusted model: The individual components of the metabolic syndrome have been mutually adjusted, menopause, pregnant times, and ever hormone use
Consequently, we compared the pathological characteristics between EOC patients with or without MetS as defined by definition of CDS in Table 4. One hundred and forty-four cases (25.13%) EOC patients were diagnosed with MetS using by definition of CDS. The mean age with MetS group was 56.02 ± 8.00 years, which was higher than the non-MetS group (51.44 ± 9.29 years). Among 144 patients with MetS, we found 50 cases (34.72%) with lower differentiation, 119 cases (82.64%) with advanced FIGO stage, and 33 cases (22.92%) with lymph nodes (LN) metastasis, respectively, which were obviously higher than non-MetS patients with lower differentiation (18.82%), advanced stage (69.93%), and LN metastasis (12.35%). According to our results, statistically significant differences were observed in tumor differentiation grade, FIGO stage, and LN status between patients with or without MetS (P<0.05). In other words, tumor combining with MetS was more malignant clinical pathological behaviors in EOC patients.
comparison of pathological characteristics between ovarian cancer patients with or without metabolic syndrome using Chinese Diabetes Society definition
MetS (n, %)
Non-MetS (n, %)
429(74.87)
Age(mean ± SD) (years)
serous
mucous and others
44(30.56)
G1-2
FIGO Stage
III-IV
Lymph nodes metastasis
MetS metabolic syndrome, SD standard deviation, FIGO international federation of gynecology and obstetrics
Consequently, in age-adjusted binary logistic regression analysis, the presence of MetS predicts the risk of advanced FIGO stage (OR = 2.155, 95% CI: 1.327–3.498, P = 0.002), lower differentiation (OR = 2.472, 95% CI: 1.164–5.250, P = 0.019), and LN metastasis (OR = 2.590, 95% CI: 1.089–6.160, P = 0.031) of EOC patients (Table 5). Additionally, other parameters relating to MetS were listed in Table 5.
Binary logistic regression analysis examining patients with MetS for characteristics of epithelial ovarian cancer
OR (95% CI)a
LN metastasis
2.155(1.327–3.498)
BMI(kg/m2)
TG (mmol/L)
HDL-C(mmol/L)
MetS metabolic syndrome, OR odds ratio, CI confidence interval, BMI body mass index, DM diabetes mellitus, HBP high blood pressure, TG Triglyceride, HDL-C high-density lipoprotein cholesterol
aAdjusted for age in logistic regression model
The survival analysis was showed in Table 6. By the Kaplan-Meier method of univariate analysis, the shorter median of PFS and OS were related to EOC patients with MetS (39 vs 42 months and 67 vs 71 months, respectively, both of them P < 0.01, Fig. 1) and BMI ≥25 kg/m2 (40 vs 44 months and 67 vs 70 months, respectively, both of them P < 0.01). Furthermore, in Cox proportional hazard model, MetS was the independent factor for the evaluation of PFS and OS of EOC patients (both of them P < 0.001).
Univariate and multivariate survival analysis of MetS for progression-free and overall survival in 573 EOC patients
Cases (N)
Progression-free survival (PFS)
Overall survival (OS)
Univariate analysis
Media of PFS
P a
95% CI For HR
P b
Media of OS
MetS metabolic syndrome, P a P value, log rank test, OR odds ratio, CI confidence interval, P b P value, Cox regression
Kaplan–Meier curves for survival of 573 patients with epithelial ovarian cancer. Cumulative progression-free survival (a) and overall survival (b)
MetS was originally recognized as a cluster of risk factors that better predicted cardiovascular disease and diabetes incidence, than simple BMI or obesity measures [15] since it was firstly proposed by Reavan in 1988 [16] and the accepted criteria for clinical identification of the components of MetS has been promulgated by NCP-ATPIII [17] and WHO as well as IDF [13], and the American Association of Clinical Endocrinologists (AACE) [18]. At present, accumulating epidemiological literature appeared and had manifested that MetS was closely related to the occurrence and development of malignant diseases in different territorial populaiton [8]. Chiu HM et al.[19] and Morita T et al. [20] had reported people with MetS are at increased risk of colon cancer and adenoma in Asian populations. Sha N et al.[21] also observed that MetS was significantly associated with histological grade and stage of bladder cancer in 323 patients of Chinese population. Especially for endometrial cancer, collective data supported MetS could be a means for identifying a risk of endometrial cancer that might otherwise be missed or before any one component of MetS becomes more advanced [7]. Ni et al.[22] also clarified that MetS is associated with FIGO stage, grade, vascular invasion, tumor size, and lymphatic metastasis in endometrial cancer and confirmed MetS lead to a poor outcome in Chinese patients with endometrial cancer. A case–control study from Italian population revealed that MetS definition most strongly associated with endometrial cancer included BMI >30 kg/m2 and at least 2 of hypertension, diabetes, and hyperlipidemia [23]. Furthermore, a study in Norway suggested that inactivity and high energy intake are major risk factors for endometrial cancer [24].
However, limited study was available on the relationship between MetS, as well as the components of MetS, and characteristics of EOC. Thus, we designed this population based case-control study of EOC to explore the association between MetS, as well as components of MetS, and several important clinical characteristics and prognosis of EOC patients.
To begin with, 573 EOC and 1146 control cases were included in this study according to the case-control matching standard. The judgment of MetS and further analysis with EOC were reference to CDS definition. So, we firstly evaluated the consistency incidence of MetS estimation among CDS, ATP III and IDF definitions. Statistics demonstrated the kappa value of interrater agreement was 92.5% between CDS and ATP III, 93.2% between CDS and IDF, and 90.0% between ATP III and IDF, which indicated that CDS definition was available and a little superior to the international admissive criterions in our Chinese population. Additionally, the case proportion of MetS in EOC patients was found to be higher than the control population whichever assessing by three MetS criterions respectively.
Consequently, in logistic regression model, we found 3 different definitions of MetS, as well as the components of MetS, were all associated with an elevated EOC risk. the proportion of patients with MetS as identified by CDS guidelines was significantly greater among 144 cases (25.13%) than 79 control cases (6.89%) and was associated with a 3.187-fold increase in EOC risk.
Previously, epidemic literature about MetS as a cluster of risk assessed with regard to ovarian cancer in large scale project was very scary only in one study. The research conducted by Bjorge and colleagues [25] included 287,320 women from Austria, Norway and Sweden. Relative risks of ovarian cancer were estimated using Cox regression from MetS. Their results suggested 644 EOC and 388 deaths from ovarian cancer were identified during follow-up. In the end, they concluded there was no overall association between MetS and ovarian cancer risk. However, increasing levels of cholesterol and blood pressure increased the risks of mucinous and endometrioid tumors, respectively. Increasing levels of BMI conferred an increased risk of ovarian cancer mortality in women above the age of 50 years. There are a few unconformities between Bjorge's and our conclusions, which may be contributed to the different race population and study design. In order to avoid bias and deviations, more and further studies of multi-centers deserved to perform to explore the relationship between MetS and ovarian cancer.
Furthermore, we compared the pathological characteristics between EOC patients with or without MetS as defined by definition of CDS. Statistics significantly proved the differences were observed in tumor differentiation grade, FIGO stage, and LN status between patients with or without MetS, which implied that tumor combining with MetS was more malignant clinical pathological behaviors in EOC patients. What's more, in binary logistic regression analysis, the presence of MetS predicts the risk of advanced FIGO stage, lower differentiation, and LN metastasis of EOC patients.
As we know, based on symptoms before the development of ovarian cancer, such as irregular menstruation and then amenorrhea, and overweight, there is an assumption that polycystic ovaries syndrome (PCOS) can precede ovarian cancer [26]. Importantly, one of the criteria for PCOS is overweight or obesity. Obesity and MetS are constant companions of PCOS [27].
Obesity is one of the characteristics of MetS, according to the population-based longitudinal study in the People's Republic of China. Standardized prevalence has reached up to 9.1% for obese population [28]. Notably, it has already accounted for a significant proportion. A number of studies verified obesity increased risk of several cancers, including breast, endometrium, kidney, esophageal, bladder, and colon carcinomas [29]. Especially, Calle et al. had already proved that significant trends of increasing risk with higher BMI values were observed for death of many cancers, including ovarian cancer. Importantly, they concluded increased body weight was associated with increased death rates for all cancers combined and for cancers at multiple specific sites [30]. Similarly, studies showed the relationship between the development of neoplastic diseases of female genitals (ovary and uterus) and presence of obesity [31, 32]. Approximately 60% to 90% of patients with ovarian cancer and endometrial cancer have overweight [33, 34]. Some studies have indicated obesity is a negative prognostic indicator for survival [35]. Large cohorts of ovarian cancer patients have demonstrated that the risk of ovarian cancer mortality is increased among those with higher BMI [36, 37]. A BMI ≥ 25 kg/m2 was used as measurement for obesity in our study. Our results showed BMI is associated with FIGO stage of ovarian cancer in binary logistic regression analysis. Some reasons may be used to explain the result. The cancer cells use the glucose, fatty acids, ketones, lactate, cholesterol, and other metabolites of fats and carbohydrates metabolism [38]. Biochemically, excess energy in hosts can contribute to risks of carcinogenesis [39, 40]. Excessive fat is also associated with systemic inflammatory response, which may play an important role in cancer. Interestingly, Oshakbayev et al.[41] ever reported a case that they treated a 41-year-old woman with end-stage ovarian carcinoma by using of weight loss therapy. While the patient was losing the gained body mass, tumors surprisingly shrank or disappeared (ultrasound data) during the observation period after start of the treatment.
Additionally, studies had already illustrated that diabetes was an independent risk factor for mortality in patients with EOC [42]. Ovarian cancer patients with diabetes were found to have a two and a half year lifespan reduction compared to non-diabetes [43]. Possible reason maybe reduced insulin sensitivity and elevated levels of IGF-1 [21]. IGF-1 is a growth factor that is secreted by the liver and is commonly associated with obesity and hyperinsulinism [44]. Hyperinsulinism decreases hepatic secretion of IGF binding protein (IGFBP), further increasing evels of free IGF-1 [42]. Conversely, starvation and calorie restriction are associated with lower levels of IGF-1 and downstream signaling [42]. IGF-1 has been confirmed to enhance growth of ovarian cancer cell [45]. Furthermore, previous research had proved that the high expression of IGF-1 in obesity and DM indicated the increased risk of EOC and poor prognosis [42].
According to our data, the components of MetS (diabetes, hypertension, TG, and HDL-C), when assessed individually, it was no statistically significant associated with advanced stage, low differentiation, and LN metastasis of EOC. However, when they considered with MetS, patients with MetS were found to have statistically significant advanced stage, low grade and LN metastasis of EOC.
Finally, we also proved that MetS was the independent factor for the evaluation of PFS and OS of EOC patients in Cox proportional hazard model, which were consistent with previous results in other cancers. Ni et al. showed that MetS was an independent prognostic factor for endometrial adenocarcinoma [22]. Voutsadakis reviewed published literature and indicated that obesity and diabetes were the prognostic factors in colorectal cancer [46].
Conclusively, MetS criteria of CDS are applicable and appropriate in Chinese population. Our study provides strong evidence for a role of MetS in EOC risk. EOC risk increases with presence of MetS compared to the control Chinese population. EOC patients with MetS were found to have statistically significant advanced FIGO stage, low tumor grade, and LN metastasis. Furthermore, the presence of MetS predicts the risk of advanced FIGO stage, lower differentiation, and lymph node metastasis of EOC patients. Moreover, MetS is the independent indicator for the PFS and OS evaluations of EOC patients. Thus, possible recommendations to reduce ovarian cancer should continue to encourage women to maintain a healthy weight and targeting MetS maybe reduce the EOC risk. Of course, further study certainly should be taken to confirm our results in the future.
BMI:
Chinese Diabetes Society
EOC:
Epithelial ovarian cancer
FIGO:
International federation of gynecology and obstetrics
LN:
MetS:
This work was supported by Tianjin Health Bureau of Science and Technology Funds (2012KZ073) and National Natural Science Foundation (81302250).
The data will not be shared, since part of the data is being reused by another study.
Study was designed by CY; Data was collected by CY and ZL; Statistics was performed by CY and LW; Article was drafted and completed by CY and WK. All authors read and approved the final manuscript.
Ethics and approval and consent to participate
This study was approved by institutional review board of Tianjin medical university cancer institute and hospital and in accordance to the Declaration of Helsinki. All of the participants agreed and signed consent forms.
Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, 300060, China
Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
National Clinical Research Centre of Cancer, Tianjin, 300060, China
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.View ArticlePubMedGoogle Scholar
Chen W, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66(2):115–32.View ArticlePubMedGoogle Scholar
Aituov B, et al. Pathogen-driven gastrointestinal cancers: Time for a change in treatment paradigm? Infect Agent Cancer. 2012;7(1):18.View ArticlePubMedPubMed CentralGoogle Scholar
Balogun N, et al. Noninvasive nutritional management of ovarian cancer patients: beyond intestinal obstruction. Int J Gynecol Cancer. 2012;22(6):1089–95.View ArticlePubMedGoogle Scholar
Extermann M. Metabolic syndrome and cancer: from bedside to bench and back. Interdiscip Top Gerontol. 2013;38:49–60.View ArticlePubMedGoogle Scholar
Micucci C, et al. Current perspectives between metabolic syndrome and cancer. Oncotarget. 2016;7(25):38959–72.PubMedPubMed CentralGoogle Scholar
Friedenreich CM, et al. Case-control study of the metabolic syndrome and metabolic risk factors for endometrial cancer. Cancer Epidemiol Biomarkers Prev. 2011;20(11):2384–95.View ArticlePubMedGoogle Scholar
Uzunlulu M, Telci Caklili O, Oguz A. Association between metabolic syndrome and cancer. Ann Nutr Metab. 2016;68(3):173–9.View ArticlePubMedGoogle Scholar
Russo A, Autelitano M, Bisanti L. Metabolic syndrome and cancer risk. Eur J Cancer. 2008;44(2):293–7.View ArticlePubMedGoogle Scholar
Trabert B, et al. Metabolic syndrome and risk of endometrial cancer in the united states: a study in the SEER-medicare linked database. Cancer Epidemiol Biomarkers Prev. 2015;24(1):261–7.View ArticlePubMedPubMed CentralGoogle Scholar
Bhandari R, et al. Metabolic syndrome is associated with increased breast cancer risk: a systematic review with meta-analysis. Int J Breast Cancer. 2014;2014:189384.View ArticlePubMedPubMed CentralGoogle Scholar
National Cholesterol Education Program Expert Panel on Detection, E. and A. Treatment of High Blood Cholesterol. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421.Google Scholar
Alberti KG, Zimmet P, Shaw J. Metabolic syndrome--a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006;23(5):469–80.View ArticlePubMedGoogle Scholar
Zhou H, et al. Evidence on the applicability of the ATPIII, IDF and CDS metabolic syndrome diagnostic criteria to identify CVD and T2DM in the Chinese population from a 6.3-year cohort study in mid-eastern China. Diabetes Res Clin Pract. 2010;90(3):319–25.View ArticlePubMedGoogle Scholar
Expert Panel on Detection, E. and A. Treatment of High Blood Cholesterol. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486–97.View ArticleGoogle Scholar
Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37(12):1595–607.View ArticlePubMedGoogle Scholar
Lakka HM, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002;288(21):2709–16.View ArticlePubMedGoogle Scholar
Ford ES. Insulin resistance syndrome: the public health challenge. Endocr Pract. 2003;9 Suppl 2:23–5.View ArticlePubMedGoogle Scholar
Chiu HM, et al. Effects of metabolic syndrome and findings from baseline colonoscopies on occurrence of colorectal neoplasms. Clin Gastroenterol Hepatol. 2015;13(6):1134–42. e8.View ArticlePubMedGoogle Scholar
Morita T, et al. The metabolic syndrome is associated with increased risk of colorectal adenoma development: the Self-Defense Forces health study. Asian Pac J Cancer Prev. 2005;6(4):485–9.PubMedGoogle Scholar
Sha N, et al. The evaluation of the association between the metabolic syndrome and tumor grade and stage of bladder cancer in a Chinese population. Onco Targets Ther. 2016;9:1175–9.PubMedPubMed CentralGoogle Scholar
Ni J, et al. Metabolic syndrome is an independent prognostic factor for endometrial adenocarcinoma. Clin Transl Oncol. 2015;17(10):835–9.View ArticlePubMedGoogle Scholar
Rosato V, et al. Metabolic syndrome and endometrial cancer risk. Ann Oncol. 2011;22(4):884–9.View ArticlePubMedGoogle Scholar
Furberg AS, Thune I. Metabolic abnormalities (hypertension, hyperglycemia and overweight), lifestyle (high energy intake and physical inactivity) and endometrial cancer risk in a Norwegian cohort. Int J Cancer. 2003;104(6):669–76.View ArticlePubMedGoogle Scholar
Bjorge T, et al. Metabolic risk factors and ovarian cancer in the metabolic syndrome and cancer project. Int J Epidemiol. 2011;40(6):1667–77.View ArticlePubMedGoogle Scholar
El Hayek S, et al. Poly cystic ovarian syndrome: an updated overview. Front Physiol. 2016;7:124.View ArticlePubMedPubMed CentralGoogle Scholar
Kubota T. Update in polycystic ovary syndrome: new criteria of diagnosis and treatment in Japan. Reprod Med Biol. 2013;12(3):71–7.View ArticlePubMedPubMed CentralGoogle Scholar
Hou X, et al. Risk factors for overweight and obesity, and changes in body mass index of Chinese adults in Shanghai. BMC Public Health. 2008;8:389.View ArticlePubMedPubMed CentralGoogle Scholar
Organization, W.H. Weight Control and Physical Activity. Weight Control & Physical Activity. 2002: p. 1–315.Google Scholar
Calle EE, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348(17):1625–38.View ArticlePubMedGoogle Scholar
Pothiwala P, Jain SK, Yaturu S. Metabolic syndrome and cancer. Metab Syndr Relat Disord. 2009;7(4):279–88.View ArticlePubMedPubMed CentralGoogle Scholar
Reeves GK, et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ. 2007;335(7630):1134.View ArticlePubMedPubMed CentralGoogle Scholar
Barrett SV, et al. Does body mass index affect progression-free or overall survival in patients with ovarian cancer? Results from SCOTROC I trial. Ann Oncol. 2008;19(5):898–902.View ArticlePubMedGoogle Scholar
Fader AN, et al. Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship. Gynecol Oncol. 2009;114(1):121–7.View ArticlePubMedGoogle Scholar
Pavelka JC, et al. Effect of obesity on survival in epithelial ovarian cancer. Cancer. 2006;107(7):1520–4.View ArticlePubMedGoogle Scholar
Modesitt SC, van Nagell Jr JR. The impact of obesity on the incidence and treatment of gynecologic cancers: a review. Obstet Gynecol Surv. 2005;60(10):683–92.View ArticlePubMedGoogle Scholar
Zhang M, et al. Body mass index in relation to ovarian cancer survival. Cancer Epidemiol Biomarkers Prev. 2005;14(5):1307–10.View ArticlePubMedGoogle Scholar
Bonuccelli G, et al. Ketones and lactate "fuel" tumor growth and metastasis: evidence that epithelial cancer cells use oxidative mitochondrial metabolism. Cell Cycle. 2010;9(17):3506–14.View ArticlePubMedPubMed CentralGoogle Scholar
Bianchini F, Kaaks R, Vainio H. Overweight, obesity, and cancer risk. Lancet Oncol. 2002;3(9):565–74.View ArticlePubMedGoogle Scholar
Kluth LA, et al. Obesity is associated with worse outcomes in patients with T1 high grade urothelial carcinoma of the bladder. J Urol. 2013;190(2):480–6.View ArticlePubMedGoogle Scholar
Oshakbayev KP, et al. Weight change therapy as a potential treatment for end-stage ovarian carcinoma. Am J Case Rep. 2014;15:203–11.View ArticlePubMedPubMed CentralGoogle Scholar
Craig ER, et al. Metabolic risk factors and mechanisms of disease in epithelial ovarian cancer: a review. Gynecol Oncol. 2016;143(3):674–83.View ArticlePubMedGoogle Scholar
Bakhru A, Buckanovich RJ, Griggs JJ. The impact of diabetes on survival in women with ovarian cancer. Gynecol Oncol. 2011;121(1):106–11.View ArticlePubMedGoogle Scholar
Park J, et al. Obesity and cancer--mechanisms underlying tumour progression and recurrence. Nat Rev Endocrinol. 2014;10(8):455–65.View ArticlePubMedPubMed CentralGoogle Scholar
Hursting SD, et al. Calorie restriction, aging, and cancer prevention: mechanisms of action and applicability to humans. Annu Rev Med. 2003;54:131–52.View ArticlePubMedGoogle Scholar
Voutsadakis I.A.. Obesity and diabetes as prognostic factors in patients with colorectal cancer. Diabetes Metab Syndr 2016.Google Scholar

redpajama_set_name: RedPajamaCommonCrawl


Several variables can affect the ability to weigh accurately with high-performance balances, such as the location of the balance in the lab and the environment around the balance. Lab balances, must, therefore, provide the most reliable and repeatable weighing results within that lab's unique situation. To help maximise operational efficiency and experimental outcomes, a fully customisable laboratory balance is an ideal solution to align weighing needs with each lab's unique demands and requirements.
The ability to pick and choose the hardware, accessories, software, and applications of a fully customisable lab balance allows researchers to meet their specific needs and situation, thus minimising their research costs and maximising return on investment. The Cubis® II balance, with its practical array of modular components, including hardware, software, applications, and accessories offers labs the potential to fully individualise their balance, thus enabling faster, more efficient workflows and enhanced protocol applications.
Because of its intelligent design with the ability of the optional climate monitor to detect environmental influences and the status of the balance via a dashboard, the Cubis II series of lab balances ensures the highest level of weighing accuracy and precision even when the balance is placed in unideal locations within the lab. Almost all physical variables, such as vibration, drafts and air pressure, temperature, humidity, and static electricity, can affect weighing accuracy with high-resolution balances. Therefore, high-resolution balances must be able to operate accurately in unideal locations, and must be able to report to the user when and how the placement conditions are affecting weighing results. With the Cubis II, customers can choose an interface unit that actively monitors temperature, atmospheric pressure, and humidity with climate sensors and alerts users to the potential for these variables to affect their weighing results.
The customisable modularity of the Cubis II series begins with hardware; customers may choose from among 45 weighing modules, two user interfaces, and seven draft shields. Depending on a lab's specific needs, for instance, weighing modules may be ultra-micro- or micro, semi-micro or analytical, precision, or high-capacity.
Both user interfaces allow touch-control and include essential weighing applications. The advanced user interface has the ability to run tasks with integrated QApps, which are clustered by theme in packages according to topic and are clearly structured and compact, so they are easy for Sartorius to test and validate for the customer. In addition, to help enhance productivity, efficiency, and data integrity in the lab, the advanced user interface allows communication over standard internet protocols, which helps eliminate manual data transcription errors and enhances data quality and integrity because it communicates directly with external software systems. Moreover, if customers have special needs regarding their SOPs or workflows, Sartorius developers are able to modify the software exactly to the customer's needs.
All balance draft shields are designed to protect substances being weighed from the effects of drafts and, with ionisers installed, static electricity. Drafts and moving air will be detected by highly precise balances. The mechanical force exerted by static electricity is also detectable with analytical balances, with an increasing influence on micro- and ultramicro balances, and is the cause of instability in weighing measurements. Static elimination accessories, such as external air ionisers, can be purchased to dissipate static charges in the air around the balance.
The innovative draft shield technology of the Cubis II balance not only protects from drafts, but has an optional accessory to eliminate static effects. This draft shield is an automatic glass draft shield that may be operated by gesture sensors, allowing the user to open the draft shield and print with specific movements of the hand over the infrared sensor. One of the Cubis II balance's draft shield options also includes an integrated ioniser to eliminate static charges on samples and sample containers, and a conductive coating for extra protection against electrostatic build-up, particularly that which derives from users.
One of the other factors affecting accurate results is correct levelling of the balance because even being slightly off-level can introduce systematic error. The Cubis II line of balances has a quick and easy, motorised, auto-levelling function to simplify the process of preparing the balance for use and keeping it level for the most accurate weighing results.
The Cubis® II laboratory balance has a fully customisable hardware, software, and connectivity suite that will align with each lab's unique demands and compliance requirements to help maximise operational efficiency and experimental outcomes.


Drew Angerer/Getty Images(RICHMOND, Va.) — A second woman came forward Friday to accuse Virginia Lt. Gov. Justin Fairfax of sexual assault.
"Lt. Governor Fairfax has also shown exceptionally poor judgment in his handling of these allegations. He repeatedly attacked his accuser, he reportedly used vile and degrading language to describe her, he mischaracterized an investigation into the encounter, and he sought to blame others for events in his own past. These actions do not meet the standard to which we hold Virginia's highest elected officers," the statement read.
The new questions about Fairfax come as the state's other top two elected officials, Gov. Ralph Northam and Attorney General Mark Herring, also Democrats, face controversies of their own.
State Attorney General Mark Herring meanwhile dropped another political bombshell on the state Wednesday, revealing in a statement that in 1980 he dressed up as rapper Kurtis Blow and wore "brown makeup," to a college party.


Being a student can be tough. Long days in the lecture hall, long nights in the library and weekends spent working in part time employment. On top of this, the cost of books, equipment and living expenses will likely leave you in debt. However, you can survive being a student by learning how to manage your finances effectively. Here are some ways to keep your finances in order while you are a student.
It might sound ridiculous, but the best way to manage your money is to find out exactly what you spend and exactly how much you have coming in. This way you can find out if you really need to borrow any money to help with your expenditure. Books, equipment, food, travel and living expenses all cost money so find out how much you need per month to cover these things. You can save money if you bargain shop for food and limit the number of nights out you have a month. Everyone needs a break, but excessive spending will leave you in more debt. Try to look for second hand books instead of the brand new ones. Often people sell them around campus and on book selling websites for students so shop around. Draw up a spreadsheet to manage your monthly outgoings and you can see at a glance if you need to borrow.
If you do need to borrow after you have managed your money as best you can, consider a student credit card. Mastercard and American Express are just two examples of companies which offer reward credit cards. These include lots of benefits including travel insurance and even free movies! Some, like the MBNA rewards card, offer points where, for every $1 you spend, you will receive a point. Ratesupermarket are very good for finding the best credit cards for your situation as they offer a credit card compare service.
You should also check out which credit card offer points and rewards. For example with MBNA rewards card you will also receive 1000 points for every year you own the card. The points can be used for a reward, which can be cashback, travel, gift cards and more. Be sure to pay your balance on time and remember to put your card expenditure down on your budget plan.
If your parents dealt with loan applications and general financial activities before you started school, you might want to get all the details of these so that you are prepared for the bills you will receive when you graduate. A good idea is to put any spare cash into a savings account which you can use to start paying off the loans and the interest when you finish school. You can also work more hours in the summer and vacation periods and put some of this money away for future repayments.
If you manage your money effectively while you are attending college, you will find yourself in a better, more stable financial situation when you graduate. Think of it as another learning curve; you will be able to manage your money and budget more effectively when you finally gain employment and get out into the real world. For now, keep control of your finances well and you will be off to a good start when you do leave college/university.
Oh wow… I can't even imagine how ridiculous that must have been!


Reshape was founded as an independent investment planning firm with the sole purpose of providing our clients personalized wealth management solutions that balance core investment portfolios with the flexibility to access institutional quality investments, income producing real estate, and private companies raising capital, all of which can create tremendous additional wealth, far beyond the capabilities of the standard models used by traditional advisors.
Reshape Wealth provides personalized wealth planning solutions that balance our core investment portfolios with access to public and private investment solutions that have historically been attainable to only the wealthiest investors.
Reshape was created on the principle that people have the right to be wealthy and have access to the best investments, the smartest minds, and the leading technologies.
Comprehensive financial planning is at the core of how Reshape helps clients prepare for sound financial futures. We help answer the question of what do you need to do today to get to where you want to be tomorrow?
Comprehensive financial planning is at the core of how Reshape helps clients prepare for sound financial futures.
Wealth Management at Reshape is a philosophy designed around three key principles of how successful investors create, protect, and manage their wealth.
Reshape's philosophy designed around three key principles of how successful investors create and manage their wealth.
Investment Strategies is the core of what sets Reshape apart, and what delivers the performance to fulfill or exceed the goals set in each client's Financial Plan. These are our tools for wealth creation.
Investment Strategies is what sets Reshape apart, and how we create wealth for our clients.
The rate of advancement makes disruption a constant. Reshape identifies and partners with the most innovative financial technologies and entrepreneurs around the world to provide an ongoing advantage and cutting edge security for clients.
Emerging technologies and disruptive industries have the opportunity to offer significant returns.


Dunkin' Donuts, America's all-day, everyday stop for coffee and baked goods, has put a new twist on the classic bakery favorite, the cinnamon roll. Dunkin' Donuts today introduced the Cinnamon Twist, a delicious treat of four bite-sized cinnamon rolls stacked together. Served warm, the Cinnamon Twist features cinnamon swirled throughout sweet dough, drizzled with icing. The individual rolls within the Twist can be pulled apart, making them easy to enjoy while on the run. Cinnamon Twists are available through June 2 at participating Dunkin' Donuts shops throughout the country, at a suggested retail price of $1.39.
The launch of the Cinnamon Twist continues Dunkin' Donuts' commitment to offer new and innovative breakfast choices served fast, fresh and at an affordable price. Dunkin' Donuts' latest breakfast innovations include the Waffle Breakfast Sandwich and Egg White Flatbread Sandwiches, the industry's first egg white sandwiches.


text:
Home Daily News Beaumont Hospital, Wayne Announces New and Expanded Breast Care Center
Beaumont Hospital, Wayne Announces New and Expanded Breast Care Center
Beaumont Health in Southfield has announced a new, expanded Breast Care Center, set to open June 28 on the campus of Beaumont Hospital, Wayne, and feature the latest in screening and diagnostic technology along with expanded services.
Beaumont Health in Southfield has announced its new and improved Breast Care Center in Wayne. // Courtesy of Beaumont Health
Patient volume for breast care services at Beaumont, Wayne has grown 30 percent in the last five years. The new $5 million facility will feature three tomosynthesis mammography machines, tripling the screening capacity. Available advanced imaging technologies for breast care will also include digital mammography, breast ultrasound, MRI, and image-guided breast procedures.
"Our enhanced breast care center will provide patients with more space, greater access to diagnostic technology, greater access to care, quicker diagnoses and more timely treatments," says Tammy Scarborough, president, Beaumont Hospital, Wayne.
The new center is 6,625 square-feet, more than double the size of the original off-site facility. Along with advanced imaging, the new facility features diagnostic and surgical consultation connected to the hospital and adjacent surgical services. In addition to the three 3D mammography rooms, the center will also have three breast ultrasound rooms, four exam rooms, a dedicated bone density testing suite and a breast surgeon onsite.
"Our new, expanded Beaumont Breast Care Center, Wayne would not have been possible without the generous support of our capital campaign donors," says Scarborough.
"The Beaumont Hospital, Wayne medical staff and employees through the Spirit of Giving Program gave generously. A special thank you to Dr. Donald Conn and the radiologists at Harris, Birkhill, Wang, Songe and Associates for their $1 million gift. I'd also like to acknowledge Dr. Muzammil Ahmed, chief of staff; Dr. Ashok Jain, chief medical officer; and Brian Madison for their gifts."
The hospital states all women over the age of 40 should have an annual mammogram, along with those with a family history of breast cancer. Dr. Jessica Kaniowski, medical director of Beaumont Breast Care Center, Wayne, says breast cancer is most treatable in its earliest stages, and mammograms are the best technology for early detection.
"Our goal is to decrease our patient's anxiety of waiting. The new center's advanced imaging capabilities should improve wait times," Kaniowski says. "As a diagnostic radiologist with specialty training in breast imaging, my advice to women: despite the pandemic, don't delay getting your mammogram. The sooner, the better. A mammogram can be lifesaving. It can detect cancer long before a woman feels a lump."
Previous articleDBusiness Named No. 2 Regional Business Magazine in U.S., Wins Seven AABP Awards for 2020 Coverage
Next articleWoodward Dream Cruise Returns in August, Ford is Main Sponsor


As the CEO of successful management consultancy firm Pragmatium Consulting Inc, Haris Ahmed has assisted the implementation of effective business changes for over two decades. His experiences span across corporations, and firms in different industries globally have benefitted from the insight Ahmed has been able to provide. While every organization certainly has different needs and requires specific advice, every firm's objective drives at continued success. There are similarities in each and every corporation no matter the product, service, or charity that they provide.
Outside of his professional life Haris Ahmed is an active community leader, and has sought to give back to the community by extending his education and expertise outside of the workplace. He currently serves on the board of many non-profit organizations, and is also a charter member of OPEN Chicago. OPEN Chicago is a voluntary organization committed to promoting entrepreneurship throughout diaspora communities in Chicago and the Midwest. As a chartered member along with other entrepreneurs, venture capitalists, social leaders and academics, Haris Ahmed shares the same skills he utilizes in his work to aspiring business owners, to help them become the business leaders of tomorrow. Look up Haris Ahmed on Authorstream for presentations which give insight on his professional expertise and opinions.
Central to his work is the belief that in business and leadership change can be intelligently implemented for the better. Haris Ahmed has coached over 100 leaders on the best ways to implement necessary change, and has also lectured at his alma mater of University of Notre Dame on these specialized areas. The strategic structural changes that can aid business success are also applicable to non-profits all over the world. Having actively fund-raised for hunger relief efforts, and been involved for many years with local not-for-profits, Haris Ahmed recognizes valuable opportunities for businesses also to help bring about community beneficial change.
A differentiated approach in business does not mean that the strategic elements of success cannot be shared across industries. Although intended outcomes may fundamentally differ, organizations stand to learn a lot from each other – from federal organizations to not-for-profits to large scale, global corporations. Haris Ahmed, Naperville, and his team of experienced management consultants in Chicago are adept at applying their broad knowledge base to any challenge that an organization might face.
Every business leader worth his or her salt in the modern age recognizes the importance of operating high-performance teams within a business. However, whilst most recognize this importance, few have the ability or know how on how to implement such changes to oil the cogs of the corporate machinery. Haris Ahmed, CEO and founder of Pragmatium Consulting Group Inc., has built a towering reputation as one of Chicago's finest entrepreneurs, businessmen and most importantly change implement adviser. Integral to Mr. Ahmed's philosophy s the competent structure and productivity of teams, and helping businesses built their company around these dynamics.
You can watch Haris Ahmed- A Versatile Leader and Management Consultant video on YouTube here. In a recent interview with the magazine the Chicago Association of Realtor's, Mr. Ahmed outlined the importance, definition and dynamism of high-performance teams. For Haris Ahmed, it is first important to distinguish between teams and groups. The primary difference between a group and a team is that team members are equally committed to a common purpose and goal, which they cannot reach individually. The purpose and goal can only be met when the individuals come together as a team. A team needs to articulate common purpose, goals and an agreed upon working approach.
Haris Ahmed recognizes then that to bring about these high-performance teams, it is vital the business or organization has a company structure that allows everyone to share the same goal and visions. This is why it is so important to set out company strategies that can be understood and followed by everyone in the teams and their units.
Pragmatium Consulting Group Inc. have excelled in offering strategic company development and allowing businesses to understand and implement change management policies. IN doing so, Haris Ahmed hopes that they can go on to cultivate the high-performance teams that can make a business thrive. Watch Haris Ahmed on YouTube to find out more about him and his consultancy team.
Every Business needs development changes with time for better performance. People need innovation and changes for organizational growth. For this, they need great leader or change agent who can help in management issues. Haris Ahmed is a great leader and changes agent in Naperville, Illinois. He owned a management consultancy firm known as Pragmatium Consulting Group INC. He is goal oriented and expert change agent who helps many companies for solving management issues. Many companies value his advice's and consult him for improvement in their business operations.
Haris Ahmed Chicago has done MBA and worked with many big companies before he founded his own consulting group. He started his career as a group underwriter with Aetna health plans in the year 1990. In 1995 he started working with Price water house coopers as a consultant. Then he worked as a senior consultant with Watson Wyatt worldwide in the year 2000. He left this job in 2005 and joined Hewitt Associates as a senior consultant till 2007. Before opening his own firm, he worked with Oliver Wyman as a principal for almost two years.
He is an active user on social media platforms like LinkedIn, Pinterest, twitter and Facebook etc. You can follow him on these social media sites and learn more about his ideas on change management. Anyone can contact Hairs Ahmed, city of Chicago for management consultation.
Very much a couple individuals lock in yet only few of them lock in for the change of mankind. In this innocuous world there are only couple of people who direct to the others and it is crucial for the world to add to a fitting appreciation of time and tide and lead a prevalent life. The hour's need is that people from around the world get together and enhance a spot however only a humble group of people are readied to make that give up. Advising organizations have been genuinely determined about outfitting people with the best of opportunity to fathom their lives and advantage however much as could reasonably be expected from it. Truly a couple individuals visit these organizations never-endingly for the change of an unrivaled life. People from around the world are happy to have such organizations.
Haris Ahmed-Served His Expert Services To Clients and has guaranteed that every one of their organizations and choices are right. The astonishing pattern of seeing an advisor before doing anything is forming the world for better and individuals have the capacity to take advantage of each open door that comes their direction. Haris Ahmed has been truly resolute and unending with his quality administration; he has assumed an essential part in the advancement of better tomorrow and is truly proceeding with the time and tide for a superior tomorrow. The world is in desperate need of a greater amount of such individuals. Haris Ahmed Naperville – Pragmatium Consulting Group is working for a superior tomorrow and a superior world.
Haris Ahmed has served different clients and relationship with his expert organizations. Some of his clients fuse Booz Allen Hamilton, City of Chicago, Independence Blue Cross, Internal Revenue Service, Highmark Blue Cross Blue Shield, Inland Real Estate Group, Johnson & Johnson, Allstate Corporation, Pillar Global Spirits and Wine, Inc., KeyCorp, MGM International, Motorola, United Airlines, Unilever, Volunteers of America, NewEdge, Northwestern Memorial Hospital.
Change is the law of nature. Additionally, everything and everyone need to change with time, to oblige the essential law of nature. Tolerating thusly, Haris Ahmed is endeavoring to join organization qualities in individuals so that the best decisions in the association's backing can be taken. Haris welcomes a long standing consultative relationship with a number CEOs and business pioneers transversely over unmistakable business ventures.
What a life would have been without entrepreneurs inventing new products and innovating new ideas. Entrepreneurs and business founders from around the world has pushed human race forward. The development in the contemporary world and the presence of products that makes it easier for common people to lead a comfortable life is a gift of these entrepreneurs to the common people. Haris Ahmed on his personal level is a philanthropist, he is in love with the humanity and he works for the welfare of the common people.
Haris Ahmed's professional profile on linkedIn speaks volumes about him and his life changing business idea. At Pragmatium Haris Ahmed is not making money, instead he is inspiring lives and he is leveraging people with the best insight about their brighter future.
Haris Ahmed Chicago – The Founder And CEO Of Pragmatium says that his business aims to leave people in a better condition than the one they found them in. Pragmatium is an enterprise that helps people in identifying their potential and their leadership qualities.
Being the masses entrepreneur Haris Ahmed understands the power of leadership skills hence he is working hard along with his employees to leverage people with the best insight about leadership qualities. Haris takes pride in doing what he does, he is more than happy to see that people from around the world are joining them and identifying their potential. Promoting leadership is the only way towards the development of a better world.


Oklahoma City rallying from a 13-point deficit to win by 11 points was the story of the fourth quarter and Game One of the NBA Finals. Kevin Durant and Russell Westbrook had huge games with 36 and 27 points respectively. OKC did what they do best, they created fast turnarounds for points. Surprisingly the Thunder did not share the scoring amongst the team as they usually do, whereas Miami did, but the Thunder slowed Miami scoring to a near halt late in the fourth quarter. Coming out of the gate fast, the Heat have been criticized for not having enough production outside of their starters to be a threat late in the game.
Game Two will have to bring out something new from within the heart of Miami. The Thunder are again odds favorites at a 5.5 spread. Or maybe what the Heat need is something new, maybe they just need Dwyane Wade to score points again. When asked about his low scoring game Wade defended himself with by suggesting that playing aggressively sometimes means he gets the ball to someone else and at other times it means he pushes for the shot. None of us make millions to play basketball, but most of us can figure out that, in the NBA Finals, the second best player on the team needs to be making lot of shots. If Dwyane Wade is being told to pass the ball off, Erik Spoelstra might want to change that...just saying!
The Oklahoma City Thunder had a slow start but the team cohesion and confidence they exhibited pre-game was the glue that held them together through all four quarters. They also got their match-ups right while guarding LeBron James. Durant did a decent job of watching James but Thabo Sefolosha did even better. In Game Two look to see Miami's stars pull up a little earlier and shoot from further back than they were in Game One to adjust to Oklahoma's great defense. On the topic of slow starts, OKC has been starting slow all post-season; it seems to be their modus operandi. The Thunder's lineup of Westbrook, Fisher, Sefolosha, Durant and Collison were especially productive; starting these guys in Game Two would help fix the slow starter. Then again why fix what's winning games.
Kevin Durant is expecting the Heat to pressure him in Game Two, but at what cost to Miami? Giving Durant more coverage will only open things up for other Thunder players to make some plays. What Miami needs to do is to do a gut check and, to a man, ask themselves who is going to play championship caliber basketball. Again the right match ups and the right substitutions will be critical if the Heat want to keep the pressure on when Durant or Westbrook are off the court.
Game One drew the highest ever ratings for a Finals game one on ABC. With the excitement we got Tuesday night there is sure to be more to follow from Game Two. OKC has the home court edge and the odds behind them, the good bet is OKC.


If you are an adult, 18 years of age or older, who wishes to become a Catholic; or perhaps you are a Catholic who has not yet been confirmed, please contact the Rectory.
Classes will begin soon for the reception of the sacraments at the Easter Vigil.
This entry was posted on January 4, 2015. Bookmark the permalink.


text:
Q: Add/remove class to a button I'm having problem adding new class to a button.
Button arrow should be showing right(fa-angle-right) when sidebar is closed.
And left (fa-angle-left) again when it's open.
https://jsfiddle.net/tjkzmvLg/
HTML

    <button id="sidebarToggle" class="btn btn-primary btn-sm">

     </button>

JS
(function() {

    var $sidebarAndWrapper = $("#sidebar, #wrapper");
    var $icon = $("#sidebarToogle i.fa");

    $("#sidebarToggle").on("click", function () {
        $sidebarAndWrapper.toggleClass("hide-sidebar");
        if ($sidebarAndWrapper.hasClass("hide-sidebar")) {
            $icon.removeClass("fa-angle-left");
            $icon.addClass("fa-angle-right");
        } else {
            $icon.addClass("fa-angle-left");
            $icon.removeClass("fa-angle-right");
        }

    });

})();

A: Couple of things, the you should use toggleClass for switching classes, it's more concise.  Additionally, I'd use the relative selector .find so that you can support multiple buttons.  To only address the question, you did typo sidebarToggle.  After fixing the typo it worked.

(function() {
    var $sidebarAndWrapper = $("#sidebar, #wrapper");

    $("#sidebarToggle").on("click", function () {
        $sidebarAndWrapper.toggleClass("hide-sidebar");
        $(this).find("i.fa").toggleClass("fa-angle-left").toggleClass("fa-angle-right");

    });
})();
/* minified because I only changed JavaScript */

#main{background-color:#aea9a9;padding:4px;margin:0}#footer{background-color:#808080;color:#eee;padding:8px 5px;position:fixed;bottom:0;width:100%}.headshot{max-width:50px;border:1px solid #808080;padding:3px}.menu{font-size:12px;color:aquamarine}.menu li{list-style-type:none}.menu li.active{font-weight:bold}#sidebar{background:#525050;color:aliceblue;position:fixed;height:100%;width:250px;overflow:hidden;left:0;margin:0;transition:left ease .35s}#sidebar.hide-sidebar{left:-250px;transition:left ease .35s}#wrapper{margin:0 0 0 250px;transition:margin-left ease .35s}#wrapper.hide-sidebar{margin-left:0}

Home

About

Contact

 <button id="sidebarToggle" class="btn btn-primary btn-sm">  </button>

The world

This will be a fun website soon!
<form>
 Date <input/>

 Location <input/>

<input type="submit" value="Add"/>
</form>

 © 2017 The World Ltd.

<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/font-awesome/4.4.0/css/font-awesome.min.css">

A: Your spelled sidebarToggle wrong -_-
var $icon = $("#sidebarToggle i.fa");

redpajama_set_name: RedPajamaStackExchange


text:
MainAll NewsInside IsraelIsrael Facing Worst Water Crisis in 80 Years
Israel Facing Worst Water Crisis in 80 Years
The Water Authority Director announced Tuesday morning that Israel's water supply faces "the worst crisis... since they started keeping records."
Nissan Ratzlav-Katz, 08/07/08 16:57
Looking for water? The National Water Carrier
(Photo: Josh Shamsi)
Israel Water Authority Director Uri Shani announced Tuesday morning that Israel's water supply faces "the worst crisis in 80 years, since they started keeping records."
Major sources of drinking water in Israel, including Lake Kinneret (the Sea of Galilee), the mountain aquifer, and the coastal aquifer, are
Lake Kinneret and the mountain aquifer are... below their red lines.
all below their red lines, Shani said at a special press conference in Tel Aviv. The coastal aquifer has fallen below the black line, indicating it could suffer rapid and possibly irreversible damage. Shani predicted that the Kinneret itself could fall below its black line by December 2008.
The Kinneret's red line - below which it is not recommended to draw water from the northern lake - is at 213 meters below sea level. Speaking with Israel National News earlier this month, a water economy official explained: "You must understand that the red line is merely a recommendation. The government definitely tries to make sure not to reach that level, but it really has no choice but to continue drawing water even beyond the 213 mark." However, he added, "in the past few years, the government has designated a black line, at 215 meters below sea level, and that is something that truly cannot be breached."
According to Director Shani, "Israel's water needs have been met by borrowing on the future."
To ameliorate the crisis, the Israel Water Authority has authorized the following emergency measures: water will be pumped from the sources of the Kinneret (water which should have reached the Kinneret in 2010); desalination plants will increase output; and polluted wells will be purified. Water use for gardening will also be limited.
The price of water is expected to nearly double, from 3.90 NIS per cubic meter to 7.40 NIS, for some uses. Home consumption will rise by tens of percent. Income from the price hike, and a government investment of one billion shekels, will be used over the next five years for water infrastructure, desalination and sewage treatment for agriculture, according to the Water Authority.
The Water Authority's announcement Tuesday follows a warning Shani issued in March at a meeting of the Knesset Interior Committee. Shani told the MKs at the time: "I have no doubt that the level of the Kinneret will drop this coming July below the red line," ultimately leading to a situation in which "water will not be able to be drawn."


We are proud to announce that Hunters will participate in the 2018 London Legal Walk on Monday, 21 May.
The 10 kilometre walk is sponsored by The London Legal Trust and is an event that brings London's entire legal community together with thousands of participants, including The Lord Chief Justice, Lord Burnett and the President of the Supreme Court, Lady Hale.
Hunters will be raising funds for our Charity of the Year, The Trussell Trust, an organisation committed to working closely with local communities across the UK to help eradicate hunger through a 400-strong network of emergency foodbanks.
If you would like to make a donation, please kindly do so through the online fundraising portal found here.