bluuebunny/crossref_metadata_2025 huggingface dataset:
Global Stability and Optimal Control of Dengue with Two Coexisting Virus Serotypes
Authors: Abidemi Afeez , Ahmad Rohanin , Aziz Nur Arina Bazilah
Published: January 2020

This study presents a two-strain deterministic model which incorporates Dengvaxia vaccine and insecticide (adulticide) control strategies to forecast the dynamics of transmission and control of dengue in Madeira Island if there is a new outbreak with a different virus serotypes after the first outbreak in 2012. We construct suitable Lyapunov functions to investigate the global stability of the disease-free and boundary equilibrium points. Qualitative analysis of the model which incorporates time-varying controls with the specific goal of minimizing dengue disease transmission and the costs related to the control implementation by employing the optimal control theory is carried out. Three strategies, namely the use of Dengvaxia vaccine only, application of adulticide only, and the combination of Dengvaxia vaccine and adulticide are considered for the controls implementation. The necessary conditions are derived for the optimal control of dengue. We examine the impacts of the control strategies on the dynamics of infected humans and mosquito population by simulating the optimality system. The disease-freeequilibrium is found to be globally asymptotically stable whenever the basic reproduction numbers associated with virus serotypes 1 and j (j 2 {2, 3, 4}), respectively, satisfy R01,R0j 1, and the boundary equilibrium is globally asymptotically stable when the related R0i (i = 1, j) is above one. It is shown that the strategy based on the combination of Dengvaxia vaccine and adulticide helps in an effective control of dengue spread in the Island.
Mathematics Teachers' Conceptual Knowledge of Algebra: A Literature Review/ Pengetahuan Konseptual Algebra Guru Matematik: Satu Kajian Literatur
Authors: Abdullah Nor Adibah
Published: January 2020

Conceptual knowledge is one of the mathematical knowledge areas which should be mastered by mathematics teachers besides factual, procedural, and metacognitive knowledge. Teachers are prone to cast conceptual knowledge aside and prioritise procedural knowledge without understanding the concepts which influence the options of mathematical strategies and models in the context of problem solving. A literature review was conducted to discuss past research findings in identifying secondary school teachers' conceptual knowledge in the algebra topic. 68 past research articles were referred to and chosen based on the research purpose which was to investigate mathematics teachers' conceptual knowledge level and its implementation in several mathematical topics quantitatively and qualitatively in local and international contexts.  There have been a lot of researches conducted on teachers' conceptual knowledge in several mathematical topics, however there is still a lack of research in investigating teachers' conceptual knowledge on the algebra topic. Most of the past research findings showed that the teachers' conceptual knowledge level was at a low level in several mathematical  topics therefore a similar research is also needed in the algebra topic. This study can be extended to a more improved research in spite of the research sample, design or research methodology, instruments, and other factors.
Ageing Care Centre Women Entrepreneur: A Silver Bullet for Ageing Tsunami in Malaysia
Authors: Noor Shaista , Md. Isa Filzah , Mohd Nor Leilanie
Published: January 2020

An ageing population is a global problem, and it affects all aspects of life. Globally, a drastic increase in the elderly population has been recorded, which is almost three times from the year 1980 (259 million) to 2025 (761 million). Similar trend also takes place in Malaysia, even though Malaysia is categorized as a developing country. Its population census reported an intense increase in ageing population from the year 2005 (7%), which is expected to be double (14%) by the year 2028. In addition, women comprise about half of the population in Malaysia. Thus, the Malaysian Government has acknowledged the importance of women entrepreneurs in the country’s economic growth. The report estimates that 20% of the entire registered business in Malaysia run by women, and about 650,000 women are engaged in various business activities. Currently, there are about 365 ageing care centres in Malaysia, and women entrepreneurs run a few of them, as sole ownership or partnership. The Malaysian Government is gradually facing the worrisome situation of dealing with the ageing population, as until the year 2030, Malaysia will be in the line of ageing group countries. Due to ageing population importance, this study inquires the situation of Malaysian women as ageing care centre entrepreneur, and ageing population issues in Malaysia. To gather the information, the qualitative research strategy, and semi-structured interviews technique was chosen for data collection. The target population of this study are five women entrepreneurs of ageing care centres in Malaysia. The findings highlight the social problems of elderly and difficulties of Malaysian women entrepreneur in care centre business such as funding, licensing issues, less technology, staff retention, and lack of trained staff. The results show that successful entry of womenfolk in ageing care centres business will bring significant social change and will help the government to overcome the challenge of the ageing population. This study will help the policymakers to formulate strategies for women entrepreneurship in Malaysia, especially the care centres entrepreneurs. Hence, the women can act as a silver bullet to subside the ageing tsunami that will crash Malaysians’ social life comfort.
Reduced Na+K+‐ATPase activity may reduce amino acid uptake in intrauterine growth restricted fetal sheep muscle despite unchanged ex vivo amino acid transporter activity
Authors: Stremming Jane , Jansson Thomas , Powell Theresa L , Rozance Paul J , Brown Laura D
Published: January 2020

Key points

Fetuses with intrauterine growth restriction (IUGR) have reduced muscle mass that persists postnatally, which may contribute to their increased risk for adult onset metabolic diseases, such as diabetes and obesity.

Amino acid transporter‐mediated histidine uptake and system L amino acid transporter activity were similar in sarcolemmal membranes isolated from control and IUGR hindlimb skeletal muscle.

Activity of Na+K+‐ATPase, which is responsible for establishing the sodium gradient necessary for system A and N amino acid transporter function, was significantly reduced in IUGR skeletal muscle sarcolemma compared to control.

ATP content was lower in IUGR skeletal muscle.

Expression and phosphorylation of proteins in the mechanistic target of rapamycin pathway were similar in control and IUGR skeletal muscle homogenate.

Our data suggest that lower Na+K+‐ATPase activity, which reduces the driving force for active amino acid transport, and lower ATP availability contribute to reduced amino acid uptake and protein synthesis in IUGR fetal skeletal muscle.

Fetuses with intrauterine growth restriction (IUGR) have lower muscle mass that persists postnatally. Using a sheep model of placental insufficiency and IUGR, we have previously demonstrated lower net total uptake of amino acids by the fetal hindlimb and lower skeletal muscle protein synthesis rates. To investigate the mechanisms underlying these changes, we tested the hypothesis that ex vivo amino acid transporter and Na+K+‐ATPase activity is reduced, and ex vivo ATP levels are lower in hindlimb skeletal muscle of the IUGR fetus. We developed a novel protocol to measure transporter‐mediated histidine uptake, system L amino acid transporter activity and Na+K+‐ATPase activity using sarcolemmal membranes isolated from hindlimb muscle of control (CON, n = 11‐12) and IUGR (n = 12) late gestation fetal sheep. We also determined ATP content and the activity of insulin and mechanistic target of rapamycin (mTOR) signalling, which are involved in regulating cellular amino acid uptake and protein synthesis, by measuring the expression and phosphorylation of AKT, 4E‐BP1, eIF2α, AMPKα, p70 S6 kinase and rpS6 in muscle homogenates. Transporter‐mediated histidine uptake and system L activity were similar in control and IUGR sarcolemma, although ex vivo Na+K+‐ATPase activity was lower by 64% (P = 0.019) in IUGR sarcolemma. ATP content was lower by 25% (P = 0.007) in IUGR muscle. Insulin, AMPK, and mTOR signalling activity was similar in control and IUGR muscle. We speculate that reduced muscle sarcolemmal Na+K+‐ATPase activity and lower ATP content diminishes the sodium gradient in vivo, resulting in a reduced driving force for sodium‐dependent transporters and subsequently lower muscle amino acid uptake.
GIS and land cover-based assessment of ecosystem services in the North Karelia Biosphere Reserve, Finland
Authors: Poikolainen Laura , Pinto Guilherme , Vihervaara Petteri , Burkhard Benjamin , Wolff Franzeska , Hyytiäinen Reima , Kumpula Timo
Published: January 2020

Conservation and sustainable use of biodiversity, ecosystems and their services are key principles behind the establishment of “Biosphere Reserves”. Mapping of ecosystem services is one of the activities that is expected to increase the knowledge of sustainable land use planning. The Biosphere Reserves, established by the UNESCO Man and Biosphere Programme, aims to find the balance between nature conservation, use of natural resources, recreation and other culture-related activities. For this purpose, the ecosystem services approach is a promising tool for examining the relationships between people and nature in practice. This study applies the ecosystem services approach and examines which ecosystem services are perceived to be relevant in the North Karelia Biosphere Reserve in Eastern Finland. The results of a matrix method, with expert-based approach, showed that particularly old-growth forests and undrained open and forested mires have a broader potential to provide different ecosystem services. Water and urban areas are considered important for cultural services. However, these areas cover only a relatively small area altogether. The results of the ecosystem services assessment were compared to areas of high biodiversity, as defined by local biodiversity experts. The areas with high capacity for ecosystem services provision (from now on “high ecosystem services areas”) were found in areas with high biodiversity. In most cases, these areas are already under protection. The results also showed that ambiguity is an issue with the use of the ecosystem services concept in both stakeholder and expert evaluations.
Exercise-Based Rehabilitation and Manual Therapy Compared With Exercise-Based Rehabilitation Alone in the Treatment of Chronic Ankle Instability: A Critically Appraised Topic
Authors: Walsh Bridget M. , Bain Katherine A. , Gribble Phillip A. , Hoch Matthew C.
Published: January 2020

Clinical Scenario: Patients with chronic ankle instability (CAI) commonly display lower levels of self-reported function and health-related quality of life. Several rehabilitation interventions, including manual therapy, have been investigated to help CAI patients overcome these deficits. However, it is unclear if the addition of manual therapy to exercise-based rehabilitation is more effective than exercise-based rehabilitation alone. Clinical Question: Does incorporating manual therapy with exercise-based rehabilitation improve patient-reported outcomes when compared with exercise-based rehabilitation alone? Summary of Key Findings: The literature was searched for articles that examined the difference in outcomes for patients with CAI between manual therapy with exercise-based rehabilitation and exercise-based rehabilitation alone. A total of 3 peer-reviewed randomized controlled trials were identified. Two articles demonstrated improved patient-reported outcome scores following the incorporation of manual therapy with exercise-based rehabilitation, whereas one study found no statistically significant differences between interventions. Clinical Bottom Line: The current evidence suggests that incorporating manual therapy in addition to exercised-based rehabilitation may improve patient-reported outcome scores in patients with CAI. Strength of Recommendation: In accordance with the Strength of Recommendation Taxonomy, the grade of A is recommended due to consistent evidence from high-quality studies.
Dietary Xanthan Gum Alters Antibiotic Efficacy against the Murine Gut Microbiota and Attenuates
Clostridioides difficile
Colonization
Authors: Schnizlein Matthew K. , Vendrov Kimberly C. , Edwards Summer J. , Martens Eric C. , Young Vincent B.
Published: January 2020

A healthy gut bacterial community benefits the host by breaking down dietary nutrients and protecting against pathogens.
Clostridioides difficile
capitalizes on the absence of this community to cause diarrhea and inflammation. Thus, a major clinical goal is to find ways to increase resistance to
C. difficile
colonization by either supplementing with bacteria that promote resistance or a diet to enrich for those already present in the gut. In this study, we describe an interaction between xanthan gum, a human dietary additive, and the microbiota resulting in an altered gut environment that is protective against
C. difficile
colonization.
The Galleria mellonella Infection Model Does Not Accurately Differentiate between Hypervirulent and Classical Klebsiella pneumoniae
Authors: Russo Thomas A. , MacDonald Ulrike
Published: January 2020

Hypervirulent
Klebsiella pneumoniae
(hvKp) is of increasing concern because it can infect individuals in community and health care settings and because such infections are becoming difficult to treat. Identification of hvKp is important for patient care and to track its global spread. The genetic definition of hvKp, which can be used for its identification and the development of diagnostic tests, has not been optimized. Determination of possession of 4 of 5 genes that are present on the hvKp-specific virulence plasmid is highly accurate for identifying hvKp. However, an ongoing issue is whether strains that possess only some of these markers are still hypervirulent. The
Galleria mellonella
model and, less commonly, the murine infection model have been used to assess the virulence of these ambiguously identifiable strains. This report demonstrates that the murine model but not the
G. mellonella
model accurately identifies suspected hvKp strains. This information is critical for the development of diagnostics for patient care and for future research studies.
Candida auris Forms High-Burden Biofilms in Skin Niche Conditions and on Porcine Skin
Authors: Horton Mark V. , Johnson Chad J. , Kernien John F. , Patel Tarika D. , Lam Brandon C. , Cheong J. Z. Alex , Meudt Jennifer J. , Shanmuganayagam Dhanansayan , Kalan Lindsay R. , Nett Jeniel E.
Published: January 2020

The emerging fungal pathogen
Candida auris
causes invasive infections and is spreading in hospitals worldwide. Why this species exhibits the capacity to transfer efficiently among patients is unknown. Our findings reveal that
C. auris
forms high-burden biofilms in conditions mimicking sweat on the skin surface. These adherent biofilm communities persist in environmental conditions expected in the hospital setting. Using a pig skin model, we show that
C. auris
also forms high-burden biofilm structures on the skin surface. Identification of this mode of growth sheds light on how this recently described pathogen persists in hospital settings and spreads among patients.
Neoarchean large igneous provinces on the Kaapvaal Craton in southern Africa re-define the formation of the Ventersdorp Supergroup and its temporal equivalents
Authors: Gumsley Ashley , Stamsnijder Joaen , Larsson Emilie , Söderlund Ulf , Naeraa Tomas , de Kock Michiel , Sałacińska Anna , Gawęda Aleksandra , Humbert Fabien , Ernst Richard
Published: January 2020

U-Pb geochronology on baddeleyite is a powerful technique that can be applied effectively to chronostratigraphy. In southern Africa, the Kaapvaal Craton hosts a well-preserved Mesoarchean to Paleoproterozoic geological record, including the Neoarchean Ventersdorp Supergroup. It overlies the Witwatersrand Supergroup and its world-class gold deposits. The Ventersdorp Supergroup comprises the Klipriviersberg Group, Platberg Group, and Pniel Group. However, the exact timing of formation of the Ventersdorp Supergroup is controversial. Here we present 2789 ± 4 Ma and 2787 ± 2 Ma U-Pb isotope dilution-thermal ionization mass spectrometry (ID-TIMS) baddeleyite ages and geochemistry on mafic sills intruding the Witwatersrand Supergroup, and we interpret these sills as feeders to the overlying Klipriviersberg Group flood basalts. This constrains the age of the Witwatersrand Supergroup and gold mineralization to at least ca. 2.79 Ga. We also report 2729 ± 5 Ma and 2724 ± 7 Ma U-Pb ID-TIMS baddeleyite ages and geochemistry from a mafic sill intruding the Pongola Supergroup and on an east-northeast–trending mafic dike, respectively. These new ages distinguish two of the Ventersdorp Supergroup magmatic events: the Klipriviersberg and Platberg. The Ventersdorp Supergroup can now be shown to initiate and terminate with two large igneous provinces (LIPs), the Klipriviersberg and Allanridge, which are separated by Platberg volcanism and sedimentation. The age of the Klipriviersberg LIP is 2791–2779 Ma, and Platberg volcanism occurred at 2754–2709 Ma. The Allanridge LIP occurred between 2709–2683 Ma. Klipriviersberg, Platberg, and Allanridge magmatism may be genetically related to mantle plume(s). Higher heat flow and crustal melting resulted as a mantle plume impinged below the Kaapvaal Craton lithosphere, and this was associated with rifting and the formation of LIPs.
Dendrochronological dating of landslides in western Oregon: Searching for signals of the Cascadia A.D. 1700 earthquake
Authors: Struble William T. , Roering Joshua J. , Black Bryan A. , Burns William J. , Calhoun Nancy , Wetherell Logan
Published: January 2020

Large-magnitude earthquakes and hydrologic events in mountainous settings commonly trigger thousands of landslides, and slope failures typically constitute a significant proportion of the damage associated with these events. Large, dormant deep-seated landslides are ubiquitous in the Oregon Coast Range, western United States, yet a method for calculating landslide ages with the precision required to diagnose a specific triggering event, including the A.D. 1700 Cascadia earthquake, has remained elusive. Establishing a compelling connection between prehistoric slope instability and specific triggers requires landslide ages with precision greater than that provided by 14C dating of detrital materials. Tree-ring analysis is the only known method capable of determining landslide age with this precision. Dozens of landslide-dammed lakes in western Oregon present an opportunity to use tree rings from drowned snags, or “ghost forests,” to establish the year of death, and thus landsliding. We cross-dated tree-ring indices from drowned Douglas fir trees with live tree-ring records from the Oregon Coast Range that exhibit synchronous, time-specific patterns due to regional climate variations. Our analyses determined that the landslides responsible for creating Wasson and Klickitat Lakes occurred in A.D. 1819 and 1751, respectively. The 14C dates from selected tree rings and landslide deposit detritus are consistent with our tree-ring analysis, although the ages exhibit high variability, revealing the limitations of using 14C dating alone. Because dendrochronology provides annual precision for landsliding, sampling of tree rings at additional landslide-dammed lakes throughout the Oregon Coast Range can be used to constrain the potential effects of ground motion and major storms on Cascadia landscapes.
Two late Carboniferous belts of Nb-enriched mafic magmatism in the Eastern Tianshan: Heterogeneous mantle sources and geodynamic implications
Authors: Zhang Yunying , Yuan Chao , Sun Min , Long Xiaoping , Huang Zongying , Jiang Yingde , Li Pengfei , Du Long
Published: January 2020

Identification of subduction to post-collisional tectonic transitions is critical to the study of orogenic belts. To characterize such a transition in the Tianshan Orogenic Belt, a systematic study was conducted on the late Carboniferous (305–301 Ma) Hongshankou dolerite and Dikan’er basalt of Eastern Tianshan. The Hongshankou dolerites have relatively high Ti and Nb contents, akin to Nb-enriched arc basalts. Based on the Nb/La ratios, these dolerites can be divided into low-Nb/La (0.35–0.40) and high-Nb/La (0.67–1.4) groups, which were likely derived respectively from slab melt-metasomatized mantle wedge and a mixed mantle source involving depleted super-slab and enriched sub-slab asthenospheric components. Like the low-Nb/La dolerites, the Dikan’er basalts possess low Nb/La (0.42–0.46) ratios, suggesting a mantle source previously modified by slab components. In addition, the Dikan’er basalts have variable Nb contents and can be grouped into normal arc basalts and Nb-rich basalts that can be attributed to a common mantle source with different degrees of mantle melting, as demonstrated by the positive correlations of La/Sm with La and Nb. By integrating available data, two late Carboniferous belts of Nb-enriched mafic magmatism are recognized in the Eastern Tianshan, with one in the Yamansu arc (336–301 Ma) and the other in the Bogda Mountains (305–301 Ma). The former is characterized by low Nb/La (<0.6) ratios, reflecting derivation from mantle metasomatized by slab-derived melt during a subduction process; the latter exhibits an abrupt Nb/La increase from 0.6 to 1.4, indicating significant input of sub-slab asthenospheric mantle that was probably induced by slab break off. Accordingly, we propose that the tectonic transition from subduction to post-collision in the Eastern Tianshan occurred in the latest Carboniferous (305–301 Ma) and was marked by the abrupt input of deep and enriched asthenospheric mantle.
Neotectonics of the Bailongjiang and Hanan faults: New insights into late Cenozoic deformation along the eastern margin of the Tibetan Plateau
Authors: Li Hailong , Zhang Yueqiao , Dong Shuwen , Zhang Junlong , Sun Yujun , Wang Qiangmao
Published: January 2020

The way that far-field stresses and deformation propagated eastward in response to the growth and extrusion of the northeastern Tibetan Plateau remains a crucial scientific issue. This paper focuses on the Bailongjiang and Hanan faults, which are the easternmost part of the East Kunlun fault in northeast Tibet. Based on new field geological investigations, structural data, satellite imagery interpretation, and optically stimulated luminescence and 14C dating results, this paper presents the structural geometry and neotectonic activities of the two faults. The ∼200-km-long Bailongjiang fault, bounding the Bayan Har block in northeast Tibet, consists of two segments. Along the western segment, late Pleistocene lacustrine-facies deposits and Holocene activities were discovered in a great fault scarp. The left-slip rate of the fault is estimated to be ∼1.73–2.61 mm/yr, with an elapsed time of ∼2205 yr after a catastrophic paleoseismic event greater than M 7.2 ruptured the fault. The eastern segment splits into two branches and shows a positive flower structure where a pull-apart basin developed, filled with ∼200-m-thick mudstone and argillaceous siltstone, which record the mid-late Miocene deformation of the Bailongjiang fault. The Hanan fault features reverse faulting caused by NNW-SSE compression in the late Cenozoic. The two faults, together with the Maqên-Maqu-Tazang fault, confine the area of a strip block, the eastward extrusion of which was accommodated by thrusting due to the resistance of the stable Bikou massif since the late Cenozoic, which led to decreasing slip rates along the easternmost part of the Kunlun fault.
Ecological disturbance in tropical peatlands prior to marine Permian-Triassic mass extinction
Authors: Chu Daoliang , Grasby Stephen E. , Song Haijun , Corso Jacopo Dal , Wang Yao , Mather Tamsin A. , Wu Yuyang , Song Huyue , Shu Wenchao , Tong Jinnan , Wignall Paul B.
Published: January 2020

The Permian-Triassic mass extinction is widely attributed to the global environmental changes caused by the eruption of the Siberian Traps. However, the precise temporal link between marine and terrestrial crises and volcanism is unclear. Here, we report anomalously high mercury (Hg) concentrations in terrestrial strata from southwestern China, synchronous with Hg anomalies in the marine Permian-Triassic type section. The terrestrial sediments also record increased abundance of fossil charcoal coincident with the onset of a negative carbon isotope excursion and the loss of tropical rainforest vegetation, both of which occurred immediately before the peak of Hg concentrations. The organic carbon isotope data show an ∼5‰–6‰ negative excursion in terrestrial organic matter (bulk organic, cuticles, and charcoal), reflecting change in atmospheric CO2 carbon-isotope composition coincident with enhanced wildfire indicated by increased charcoal. Hg spikes provide a correlative tool between terrestrial and marine records along with carbon isotope trends. These data demonstrate that ecological deterioration occurred in tropical peatlands prior to the main marine mass extinction.
Environmental predictors of deep-sea polymetallic nodule occurrence in the global ocean
Authors: Dutkiewicz Adriana , Judge Alexander , Müller R. Dietmar
Published: January 2020

Polymetallic nodules found on the abyssal plains of the oceans represent one of the slowest known geological processes, and are a source of critical and rare metals for frontier technologies. A quantitative assessment of their occurrence worldwide has been hampered by a research focus on the northeastern Pacific Ocean and the lack of a global open-access data set of nodules. We have compiled a global data set of >10,000 seabed nodule and control samples, and combine it with digital grids of key environmental parameters to generate a predictive machine-learning model of nodule occurrence. In order of decreasing parameter ranking, we find that nodules are associated with very low sedimentation rates (< 0.5 cm/k.y.), moderately high oxygen values (150 and 210 mmol/m3), lithologies of clay followed by calcareous ooze, low summer surface productivity (<300 mgC/m2/day), low benthic biomass concentration (<1 log mgC/m2), water depths >4500 m, and low total organic carbon content (0.3–0.5 wt%). Competing hypotheses for nodule sustention and thus continued growth on the seafloor are the removal of sediment by bottom-water currents and biological activity. Using a high-resolution eddy-resolving ocean circulation model, we find that the bottom-current speeds over nodule fields are too low (<5 cm/s) to remove sediment, implicating the activity of epibenthic megafauna as the most likely mechanism. Our global nodule probability map combined with the assessment of a range of environmental drivers provides an improved basis for decision and policy making in the controversial area of deep-sea exploration.
All-cause mortality following low-dose aspirin treatment for patients with high cardiovascular risk in remote Australian Aboriginal communities: an observational study
Authors: Zhao Yuejen , Jeyaraman Kanakamani , Burgess Paul , Connors Christine , Guthridge Steven , Maple-Brown Louise , Falhammar Henrik
Published: January 2020

Objectives

To evaluate the benefit and risk of low-dose acetylsalicylic acid (aspirin) in patients from remote Aboriginal communities in the Northern Territory, Australia.

Design

Retrospective cohort study using primary care and hospital data routinely used for healthcare. Aspirin users and non-users were compared before and after controlling confounders by matching. Marginal structural models (MSM) were applied to ascertain the benefit and risk.

Setting

The benefit and harm of aspirin were investigated in patients aged ≥18 years from 54 remote Aboriginal communities.

Participants

None had a previous cardiovascular event or major bleeds. Patients on anticoagulants or other antiplatelets were excluded.

Intervention

Aspirin at a dose of 75–162 mg/day.

Outcome measures

Endpoints were all-cause, cardiovascular mortality and incidences of cardiovascular events and major bleeds.

Results

8167 predominantly Aboriginal adults were included and followed between July 2009 and June 2017 (aspirin users n=1865, non-users n=6302, mean follow-up 4 years with hospitalisations 6.4 per person). Univariate analysis found material differences in demographics, prevalence of chronic diseases and outcome measures between aspirin users and non-users before matching. After matching, aspirin was significantly associated with reduced all-cause mortality (HR=0.45: 95% CI 0.34 to 0.60; p<0.001), but not bleeding (HR=1.13: 95% CI 0.39 to 3.26; p=0.820). After using MSMs to eliminate the effects of confounders, loss of follow-up and time dependency of treatment, aspirin was associated with reduced all-cause mortality (HR=0.60: 95% CI 0.47 to 0.76; p<0.001), independent of age (HR=1.06; p<0.001), presence of diabetes (HR=1.42; p<0.001), hypertension (HR=1.61; p<0.001) and alcohol abuse (HR=1.81; p<0.001). No association between aspirin and major bleeding was found (HR=1.14: 95% CI 0.48 to 2.73; p=0.765). Sensitivity analysis suggested these findings were unlikely to have been the result of unmeasured confounding.

Conclusion

Aspirin was associated with reduced all-cause mortality. Bleeding risk was less compared with survival benefits. Aspirin should be considered for primary prevention in Aboriginal people with high cardiovascular risk.
Recent trends in seroprevalence of rubella in Korean women of childbearing age: a cross-sectional study
Authors: Choi Rihwa , Oh Yejin , Oh Youngju , Kim Sung Ho , Lee Sang Gon , Lee Eun Hee
Published: January 2020

Objectives

The aim of this study was to investigate the immunity against rubella using the serological status of rubella-specific IgG antibodies (antirubella IgG) in Korean women of childbearing age (15–49 years).

Design

Retrospective cross-sectional study.

Setting

Population-based cross-sectional study in South Korea.

Participants

Between January 2010 and December 2017, test results from Korean women aged 15–49 years who had visited an obstetric private clinic (nationwide institutions) and had requested rubella-specific IgG antibody tests from Green Cross Laboratories were obtained from the laboratory information system.

Results

Between 2010 and 2017, antirubella IgG test results from 328 426 Korean women aged 15–49 years who had visited private obstetric clinics (1438 institutions nationwide) were retrospectively analysed by tested year, age, cohort and geographic regions. Over the 8-year study period, the rate of unimmunised women ranged from 7.8% to 9.7%. Multivariable-adjusted logistic regression models showed that the odds of being immune to rubella (positive and equivocal results of antirubella IgG test) were lower in 2017 compared with 2010, in women in their 40s, in a pre-catch-up cohort and in women living in Incheon, Busan, South Gyeongsang, North and South Jeolla and Jeju provinces (p<0.0001).

Conclusions

In consideration of the factors associated with prevalence of women unimmunised to rubella, future public health efforts should be focused on catch-up activities. The results of this study could be used to strengthen disease control and prevent rubella, including a nationwide immunisation programme.
Impact of healthcare access and HIV testing on utilisation of cervical cancer screening among US women at high risk of HIV infection: cross-sectional analysis of 2016 BRFSS data
Authors: Zhang Dongyu , Advani Shailesh , Huchko Megan , Braithwaite Dejana
Published: January 2020

Objective

Previous studies identified several factors associated with cervical cancer screening. However, many of them used samples from the general population and limited studies focused on women with high-risk health behaviours. We aimed to disentangle the association of cervical cancer screening with healthcare access and HIV testing among women at a high risk of HIV infection.

Design

Nationwide cross-sectional survey in the USA.

Setting

2016 Behavioral Risk Factor Surveillance System.

Participants

3448 women with a history of high-risk behaviours associated with HIV infection

Exposure and outcome

Clinical check-up, having personal healthcare provider, health coverage and HIV testing history were treated as exposures. Appropriate cervical cancer screening, which was defined according to 2016 US Preventive Services Task Force guideline, was treated as the outcome of interest.

Data analysis

Multivariable logistic regression model was performed to evaluate associations of healthcare access and HIV testing with the uptake of cervical cancer screening; adjusted odds ratio (aOR) and 95% CI were reported. We further investigated if educational attainment modified associations identified in the primary multivariable model.

Results

A total of 2911 (84.4%) high-risk women in our sample underwent cervical cancer screening. In the multivariable model, delayed clinical check-up (≥5 years ago vs within the past year: aOR: 0.19, 95% CI: 0.14 to 0.26), having no health insurance (aOR: 0.60, 95% CI: 0.46 to 0.79) and no history of HIV testing (no testing vs testing within the past year: aOR: 0.46, 95% CI: 0.35 to 0.61) were inversely associated with cervical cancer screening utilisation.

Conclusion

Factors reflecting healthcare access, specifically clinical check-up and health coverage, as well as history of HIV testing were associated with cervical cancer screening in this population-based study of high-risk women. Targeted interventions are warranted to further increase cervical cancer screening among women at high risk of HIV infection.
Association between birth weight and neurodevelopment at age 1–6 months: results from the Wuhan Healthy Baby Cohort
Authors: Zhang Man , Gazimbi Marufu Martin , Chen Zhong , Zhang Bin , Chen Yanru , Yu Yizhen , Tang Jie
Published: January 2020

Objective

The association between birth weight and infants’ neurodevelopment is not well understood. We aimed to examine the impact of birth weight on neurodevelopment of infants at age 1–6 months using data from the Wuhan Healthy Baby Cohort (WHBC) study.

Setting and participants

This is a prospective cohort study of 4026 infants from the WHBC study who were born at the Women and Children’s Hospital of Wuhan, China between October 2012 and September 2013 and who had complete healthcare records within 6 months after birth. Participants were categorised into three groups according to their birth weight: low birth weight (LBW; birth weight <2500 g), normal birth weight (2500 g ≤ birth weight <4000 g) and macrosomia (birth weight ≥4000 g).

Main outcome measures

The main outcomes were development quotient (DQ) and clinical diagnosis of neurodevelopmental delay. Both adjusted regression coefficients and ORs were estimated for LBW and macrosomia.

Results

Of the 4026 infants, 166 (4.12%) were of LBW and 237 (5.89%) were with macrosomia. Adjusted regression coefficients of LBW and macrosomia for gross motor DQ were −11.18 (95% CI −11.36 to 10.99) and 0.49 (95% CI 0.36 to 0.63), fine motor DQ −6.57 (95% CI −6.76 to −6.39) and −2.73 (95% CI −2.87 to −2.59), adaptability DQ −4.87 (95% CI −5.05 to −4.68) and −1.19 (95% CI −1.33 to −1.05), language DQ −6.23 (95% CI −6.42 to −6.05) and 0.43 (95% CI 0.29 to 0.57), and social behaviour DQ −6.82 (95% CI −7.01 to −6.64) and 1.10 (95% CI 0.96 to 1.24). Adjusted OR of LBW for clinical diagnosis of ‘neurodevelopmental delay’ in gross motor was 2.43 (95% CI 1.65 to 3.60), fine motor 1.49 (95% CI 1.01 to 2.19) and adaptability 1.56 (95% CI 1.06 to 2.31). LBW has no significant effects on ‘neurodevelopmental delay’ in language and social behaviour, and macrosomia has no significant effects on clinical diagnosis of ‘neurodevelopmental delay’ in all domains.

Conclusion

Both LBW and macrosomia are associated with infants’ DQ, and LBW increases the risk of being diagnosed with ‘neurodevelopmental delay’ in gross motor, fine motor and adaptability among infants aged 1–6 months.
The North Texas Concussion Registry (ConTex)
Authors: Cullum C. Munro , Bunt Stephen , Hicks Cason , Didehbani Nyaz , Miller Shane , Vargas Bert , Sabo Tonia , Bell Kathleen , Batjer H Hunt
Published: January 2020

Purpose

The North Texas Concussion Registry (ConTex) was established in 2015 as a multi-institutional collaboration intended to study risk factors, recovery patterns and clinical outcomes associated with concussion across the lifespan, with a particular emphasis on sport-related concussion.

Participants

Prospective enrolment of individuals who sustained a concussion within the past 6 months who were seen at one of four North Texas ConTex concussion clinics which employ common diagnostic criteria and assessment metrics to evaluate effects of a concussion as well as longitudinal tracking of recovery.

Findings to date

The ConTex database and multidisciplinary oversight team has been established, and over 1700 participants aged 5–88 years have been enrolled. A majority of concussions were sport-related (60%), with a mean age of 17.5 years and similar numbers of males and females. Three-month follow-up compliance has been excellent (86%), with a majority of subjects reporting good recovery by that time. ConTex has provided a rich data source for multiple research projects focused on concussion characteristics, risk factors and outcomes, and led to the development of a statewide youth concussion registry.

Future plans

ConTex data are being analysed to add to the body of knowledge regarding concussion mechanisms, factors related to recovery and improving outcomes for concussion patients. ConTex will serve as a platform for future treatment studies and may serve as a model for other concussion surveillance programmes.
Influence of combined exposure to perceived risk at work and unstable employment on self-rated health: a comparison of two cross-sectional surveys in Europe and Korea
Authors: Cho Seong-Sik , Paek Domyung , Kang Mo-Yeol
Published: January 2020

Objectives

The purpose of this study was to investigate the combined effect of exposure to perceived risk at work and unstable employment on self-rated health in both Korea and the European Union.

Design

Cross-sectional study.

Setting

We conducted the analyses using employees data from the third Korean Working Conditions Survey (KWCS) conducted in 2011 and the fifth European Working Conditions Survey (EWCS) conducted in 2010.

Participants

Employees of the third KWCS and the fifth EWCS from 35 European countries were the participants of the study.

Primary outcome measures

Employment status was divided into two categories: stable and unstable employment. Perceived risk regarding safety and health at work were assessed. Primary health outcomes were poor or moderate self-rated health. Exposures and health status were assessed via a questionnaire.

Results

Among Korean employees, the OR of poor self-rated health was 2.00 (95% CI: 1.80 to 2.22) for those with perceived risk at work, 1.18 (95% CI: 1.09 to 1.28) for those with unstable employment and 3.22 (95% CI: 2.72 to 3.81) for those with both perceived risk at work and unstable employment. Relative excess risk due to interaction (RERI) was 1.03 (95% CI: 0.48 to 1.58). Among European employees, the OR for poor self-rated health was 3.20 (95% CI: 2.93 to 3.49) for those with perceived risk at work, 1.04 (95% CI: 0.97 to 1.13) for those with unstable employment and 3.41 (95% CI: 2.93 to 3.98) for those with both perceived risk at work and unstable employment. The RERI was 0.18 (95% CI: −0.36 to 0.71).

Conclusions

Among Korean employees, a supra-additive interaction between perceived risk at work and unstable employment on poor self-rated health was observed. Conversely, a supra-additive interaction was not observed among European employees.
The effect of leadership on public service motivation: a multiple embedded case study in Morocco
Authors: Belrhiti Zakaria , Van Damme Wim , Belalia Abdelmounim , Marchal Bruno
Published: January 2020

Objectives

We aimed at exploring the underlying mechanisms and contextual conditions by which leadership may influence ‘public service motivation’ of health providers in Moroccan hospitals.

Design

We used the realist evaluation (RE) approach in the following steps: eliciting the initial programme theory, designing the study, carrying out the data collection, doing the data analysis and synthesis. In practice, we adopted a multiple embedded case study design.

Settings

We used purposive sampling to select hospitals representing extreme cases displaying contrasting leadership practices and organisational performance scores using data from the Ministry of Health quality assurance programmes from 2011 to 2016.

Participants

We carried out, on average, 17 individual in-depth interviews in 4 hospitals as well as 7 focus group discussions and 8 group discussions with different cadres (administrators, nurses and doctors). We collected relevant documents (eg, performance audit, human resource availability) and carried out observations.

Results

Comparing the Intervention-Context-Actor-Mechanism-Outcome configurations across the hospitals allowed us to confirm and refine our following programme theory: “Complex leaders, applying an appropriate mix of transactional, transformational and distributed leadership styles that fit organisational and individuals characteristics [I] can increase public service motivation, organisational commitment and extra role behaviours [O] by increasing perceived supervisor support and perceived organizational support and satisfying staff basic psychological needs [M], if the organisational culture is conducive and in the absence of perceived organisational politics [C]”.

Conclusions

In hospitals, the archetype of complex professional bureaucracies, leaders need to be able to balance between different leadership styles according to the staff’s profile, the nature of tasks and the organisational culture if they want to enhance public service motivation, intrinsic motivation and organisational commitment.
Optimal dose-fractionation schedule of palliative radiotherapy for patients with bone metastases: a protocol for systematic review and network meta-analysis
Authors: Tang Xiaofang , Hu Qiancheng , Chen Ye , Wang Xin , Li Xiaofen , Cheng Ke , Cao Dan
Published: January 2020

Introduction

The optimal dose-fractionation schedule of palliative radiotherapy has been debated in patients with bone metastases. Our objective is to comprehensively compare multiple fraction schedules with single fraction radiotherapy in terms of efficacy and toxicities by performing a systematic review and network meta-analysis.

Methods and analysis

Electronic searches of titles/abstracts of palliative radiotherapy for bone metastases will be performed, using PubMed, Cochrane Library, Embase,clinical trials, American Society for Therapeutic Radiology and Oncology and European Society of Radiotherapy and Oncology. The primary outcome of interest is the incidence of skeletal-related event following palliative radiotherapy for bone metastases in prospective studies. The risk of bias and quality of evidence will be evaluated based on Cochrane Collaboration’s tool and Grades of Recommendation, Assessment, Development and Evaluation in the network meta-analysis. We will conduct subgroup analysis and sensitivity analysis regardless of heterogeneity estimates.

Ethics and dissemination

This study will synthesise the evidence regarding dose-fractionation schedule of palliative radiotherapy in patients with bone metastases. We hope the findings from this study will help clinicians and patients select optimum palliative radiotherapy by identifying the optimal dose-fractionation schedule of palliative radiotherapy with the most value in terms of patient-important outcomes. The evidence obtained from network meta-analysis will help to guide head-to-head research in the future. The results will be disseminated through international conference reports and peer-reviewed manuscripts. Ethics review board is not required for this network meta-analysis.

PROSPERO registration number

CRD42019135195.
Effects of tai chi on postural control during dual-task stair negotiation in knee osteoarthritis: a randomised controlled trial protocol
Authors: Wang Xiangbin , Hou Meijin , Chen Shaoqing , Yu Jiao , Qi Dalu , Zhang Yanxin , Chen Bo , Xiong Feng , Fu Shengxing , Li Zhenhui , Yang Fengjiao , Chang Alison , Liu Anmin , Xie Xuerong
Published: January 2020

Introduction

Stair ascent and descent require complex integration between sensory and motor systems; individuals with knee osteoarthritis (KOA) have an elevated risk for falls and fall injuries, which may be in part due to poor dynamic postural control during locomotion. Tai chi exercise has been shown to reduce fall risks in the ageing population and is recommended as one of the non-pharmocological therapies for people with KOA. However, neuromuscular mechanisms underlying the benefits of tai chi for persons with KOA are not clearly understood. Postural control deficits in performing a primary motor task may be more pronounced when required to simultaneously attend to a cognitive task. This single-blind, parallel design randomised controlled trial (RCT) aims to evaluate the effects of a 12-week tai chi programme versus balance and postural control training on neuromechanical characteristics during dual-task stair negotiation.

Methods and analysis

Sixty-six participants with KOA will be randomised into either tai chi or balance and postural control training, each at 60 min per session, twice weekly for 12 weeks. Assessed at baseline and 12 weeks (ie, postintervention), the primary outcomes are attention cost and dynamic postural stability during dual-task stair negotiation. Secondary outcomes include balance and proprioception, foot clearances, self-reported symptoms and function. A telephone follow-up to assess symptoms and function will be conducted at 20 weeks. The findings will help determine whether tai chi is beneficial on dynamic stability and in reducing fall risks in older adults with KOA patients in community.

Ethics and dissemination

Ethics approval was obtained from the Ethics Committee of the Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine (#2018KY-006–1). Study findings will be disseminated through presentations at scientific conferences or publications in peer-reviewed journals.

Trial registration number

ChiCTR1800018028.
Core competencies in neurocritical care training in China: consensus developed by a national Delphi consensus survey combined with nominal group technique
Authors: Cui Zhen , Gao Liang , Huang Qi Bing , Li Li Hong , Qiu Bing Hui , Shi Guang Zhi , Yu Xiang You , Wang Yan , Zhang Li , Wang Yumei , Zhang Linlin , Zhou Jian-Xin
Published: January 2020

Objectives

To define the core competencies essential for specialist training in neurocritical care in China.

Design

Modified Delphi method and nominal group (NG) technique.

Setting

National.

Participants

A total of 1094 respondents from 33 provinces in China participated in the online survey. A NG of 11 members was organised by the Neuro-Critical Care Committee affiliated with the Chinese Association of Critical Care Physicians and the National Center for Healthcare Quality Management in Neurological Diseases.

Results

1094 respondents from 33 provinces in China participated in the online survey. A formal list containing 329 statements was generated for the rating by a NG. After five rounds of NG meetings and one round of comments and iterative review, 198 core competencies (54 on neurological diseases, 64 on general medical diseases, 42 on monitoring of practical procedures, 20 on professionalism and system management, five on ethical and legal aspects, three on the principles of research and certification and 10 on scoring systems) formed the final list.

Conclusion

By using consensus techniques, we have developed a list of core competencies for neurocritical care training, which may serve as a reference for future specialist training programmes in China.