Search

We use agent-based computer simulation to test the effect of environmental conditions (available biomass/carrying capacity and environmental risk) on the development of wealth inequality and patron-client herding networks in nomadic pastoral economies. Our results show that 1) wealth inequality reaches very high levels when carrying capacity is high and risk is low, and 2) patron-client contract herding networks increase in size and duration when carrying capacity is high and risk is low. We compare empirical data from the Mongol (1206–1368 CE) and Xiongnu (209 BCE– 48 CE) empires with simulation results to develop an explanatory mechanism for the apparent correlation between nomadic empire creation and positive environmental conditions. We argue that the internal dynamics of nomadic pastoral societies are sufficient to produce high degrees of inequality and hierarchical herding networks. Nomadic empires are more likely to form during key periods of increased biomass and decreased environmental risk. [ABSTRACT FROM AUTHOR]

Evaluation of soil redistribution rates and influence on crop yield in agricultural catchments is very important information, which can provide a scientific basis for arrangement of soil and water conservation measures and sustainable crop production. In recent decades, the soil erosion has greatly aggravated in the Mollisol region of Northeast China due to unreasonable land management, which in turn has reduced crop yield. The objectives of this study were to investigate the spatial distribution of soil redistribution and the relationship between crop yield and soil redistribute at a catchment of the Chinese Mollisol region. A total of 176 soil samples were collected based on a 200 m by 200 m grid and 4 yr of corn (Zea mays L.) yields were measured. The 137Cs trace technique and Zhang Xinbao’s mass balance model indicated that the soil redistribution rates ranged from −7122.25 to 5471.70 t km−2 yr−1 and averaged −830.10 t km−2 yr−1. Soil erosion dominated in the research area. The corn yields for four years ranged from 43.24 to 136.19 kg km−2 and averaged 90.42 kg km−2. The spatial distribution of soil redistribution rates and corn yield showed a similar ribbon and plaque characteristics at the catchment. An equation between corn yield and soil redistribution rates was fitted and showed that there was a significant negative correlation between corn yield and soil erosion rates, while there was no relationship between the corn yield and soil deposition rates. Therefore, effective soil and water conservation measures are urgently needed to increase crop yield and realize sustainable land-use management. [ABSTRACT FROM AUTHOR]

Background: In this research, an meta-analysis was performed for assessment of the associations between O6-methyguanine-DNA methyltransferase (MGMT) promoter hypermethylation possessing low-grade intraepithelial lesion (LSIL), high-grade intraepithelial lesion (HSIL), cervical cancer (CC), and clinicopathological characters of CC. Methods: Literature selection were conducted through searching PubMed, Web of science, EMBASE, China National Knowledge Infrastructure and Wanfang databases (up to November 2018). An assessment of associations between MGMT methylation and LSIL, HSIL, CC risk and clinicopathological characteristics was performed through pooled odds ratios (ORs) with relevant 95% confidence intervals (CIs). Subgroup analyses, meta-regressions and Galbraith plots were conducted to conduct an exploration on the possible sources of heterogeneity. The genome-wide DNA methylation array studies were extracted from Gene Expression Omnibus (GEO) databases for validation of these outcomes. Results: In this meta-analysis of 25 published articles, MGMT hypermethylation gradually elevated the rates among control group (12.16%), LSIL (20.92%), HSIL (36.33%) and CC (41.50%) specimens. MGMT promoter methylation was significant associated with the increased risk of LSIL by 1.74-fold (P<0.001), HSIL by 3.71-fold (P<0.001) and CC by 7.08-fold (P<0.001) compared with control. A significant association between MGMT promoter methylation with FIGO stage was also found (OR = 2.81, 95% CI: 1.79–4.41, p<0.001). The results of GEO datasets showed that 5 CpG sites in MGMT with a great diagnostic value for the screening of cervical cancer. Conclusion: The meta-analysis indicated the association between MGMT promoter hypermethylation and squamous intraepithelial lesion and cervical cancer. MGMT methylation detection might have a potential value to be an epigenetic marker for the clinical diagnosis of cervical cancer. [ABSTRACT FROM AUTHOR]

Aim: To assess the effect of Lactobacillus supplementation on Helicobacter pylori eradication rates and side effects of the triple therapy. Methods: PubMed, Embase, Web of Science and Cochrane Library were searched for articles published up to July, 2019. Review Manager 5.3 and Stata 12.0 were used for statistical analyses. Results: The initial database search resulted in 852 articles. Through exclusion and screening, 11 randomized controlled trials involving a total of 724 patients were finally included in this meta-analysis. The H. pylori elimination rate in the Lactobacillus supplement group was significantly higher than that in the control group (RR 1.16, 95% CI 1.08–1.25, P<0.0001). Subgroup analysis showed that the eradication rates were significantly enhanced in both adults and children group, and no significant difference was detected between Asia and Europe group. In addition, sub-analysis based on duration of Lactobacillus supplementation showed the pooled RRs in the long-term and short-term groups were 1.17 (95%CI 1.06–1.30) and 1.16 (95% CI 1.04–1.30), respectively. Regarding the Lactobacillus strains, the pooled RR was 1.33 (95% CI 1.10–1.62) in the L. casei group, 1.18 (95% CI 1.03–1.34) in the L. reuteri group while 1.02 (95% CI 0.87–1.21) in the Lactobacillus GG group. As for the total side effects, Lactobacillus supplementation significantly reduced the incidence of taste disturbance (RR = 0.36, 95% CI 0.17–0.74, P = 0.005). Conclusions: Lactobacillus supplementation during the treatment of Helicobacter pylori infection can effectively improve the eradication rates, and reduce the incidence of therapy-related taste disturbance. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that D-dimer levels are significantly correlated with the differential diagnosis and clinicopathological features of breast cancer. However, the results are currently limited and controversial. Therefore, we performed this meta-analysis to evaluate the relationship between D-dimer levels and breast cancer. Materials and methods: The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang databases were searched to find studies that assessed the association of D-dimer with clinicopathological features of breast cancer and its usefulness in aiding with differential diagnosis. The standardized mean difference (SMD) was applied as the correlation measure. Results: A total of 1244 patients with breast cancer from 15 eligible studies were included in the meta-analysis. D-dimer levels were higher in the breast cancer group than in the benign (SMD = 1.02; 95% confidence interval [CI] = 0.53–1.52) and healthy (SMD = 1.27; 95% CI = 0.85–1.68) control groups. In addition, elevated D-dimer levels were associated with progesterone receptor-negative tumors (SMD = -0.25; 95% CI = -0.44–-0.05). Similarly, there was a significant correlation between D-dimer levels and tumor node metastasis staging (n = 11, SMD = 0.82; 95% CI = 0.57–1.06) and lymph node involvement (n = 8, SMD = 0.79; 95% CI = 0.50–1.09). In contrast, other clinicopathological factors, including estrogen receptor expression and human epidermal growth factor receptor 2 expression, were not associated with D-dimer levels. Conclusion: The results of this meta-analysis indicate that plasma D-dimer levels can be used as an important reference for the early identification and staging of breast cancer. [ABSTRACT FROM AUTHOR]

We undertook a systematic review of the diagnostic accuracy of artificial intelligence-based software for identification of radiologic abnormalities (computer-aided detection, or CAD) compatible with pulmonary tuberculosis on chest x-rays (CXRs). We searched four databases for articles published between January 2005-February 2019. We summarized data on CAD type, study design, and diagnostic accuracy. We assessed risk of bias with QUADAS-2. We included 53 of the 4712 articles reviewed: 40 focused on CAD design methods (“Development” studies) and 13 focused on evaluation of CAD (“Clinical” studies). Meta-analyses were not performed due to methodological differences. Development studies were more likely to use CXR databases with greater potential for bias as compared to Clinical studies. Areas under the receiver operating characteristic curve (median AUC [IQR]) were significantly higher: in Development studies AUC: 0.88 [0.82–0.90]) versus Clinical studies (0.75 [0.66–0.87]; p-value 0.004); and with deep-learning (0.91 [0.88–0.99]) versus machine-learning (0.82 [0.75–0.89]; p = 0.001). We conclude that CAD programs are promising, but the majority of work thus far has been on development rather than clinical evaluation. We provide concrete suggestions on what study design elements should be improved. [ABSTRACT FROM AUTHOR]

Chikungunya virus (CHIKV) is a re-emerging arbovirus known to cause chronic myalgia and arthralgia with high morbidity. CHIKV is now considered endemic in many countries across Asia and Africa. In this study, the susceptibility of various human, mammalian and mosquito cell lines to CHIKV infection was evaluated. CHIKV infection was found to be cell-type dependent and virus strain-specific. Furthermore, SJCRH30 (human rhabdomyosarcoma cell line) was showed to be highly permissive to CHIKV infection, with maximum production of infectious virions observed at 12 h.p.i. Pre-infection treatment of SJCRH30 with various inhibitors of endocytosis, including monodansylcadaverine (receptor-mediated endocytic inhibitor), dynasore (clathrin-mediated endocytic inhibitor), as well as filipin (caveolin-mediated endocytosis inhibitor), resulted in minimal inhibition of CHIKV infection. In contrast, dose-dependent inhibition of CHIKV infection was observed with the treatment of macropinocytosis inhibitor, 5-(N-ethyl-N-isopropyl)amiloride (EIPA). Furthermore, siRNA-mediated knockdown of sortin nexin 9 (SNX9) a protein involved in macropinosome formation, also resulted in a significant dose-dependent reduction in viral titre. By performing a virus entry assay, CHIKV particles were also observed to colocalize with FITC-dextran, a macropinosome marker. This study shows for the first time, that the infectious entry of CHIKV into human muscle cells is mediated by macropinocytosis. Together, the data from this study may pave the way for the development of specific inhibitors that target the entry process of CHIKV into cells. [ABSTRACT FROM AUTHOR]

Background: Severe falciparum malaria is a medical emergency characterised by potentially lethal vital organ dysfunction. Patient fatality rates even with parenteral artesunate treatment remain high. Despite considerable research into adjuvant therapies targeting organ and tissue dysfunction, none have shown efficacy apart from renal replacement therapy. Understanding the causal contributions of clinical and laboratory abnormalities to mortality is essential for the design and evaluation of novel therapeutic interventions.Methods and Findings: We used a structural model causal inference approach to investigate causal relationships between epidemiological, laboratory, and clinical variables in patients with severe falciparum malaria enrolled in clinical trials and their in-hospital mortality. Under this causal model, we analysed records from 9,040 hospitalised children (0-12 years, n = 5,635) and adults (n = 3,405, 12-87 years) with severe falciparum malaria from 15 countries in Africa and Asia who were studied prospectively over the past 35 years. On admission, patient covariates associated with increased in-hospital mortality were severity of acidosis (odds ratio [OR] 2.10 for a 7-mEq/L increase in base deficit [95% CI 1.93-2.28]), renal impairment (OR 1.71 for a 2-fold increase in blood urea nitrogen [95% CI 1.58, 1.86]), coma (OR 3.59 [95% CI 3.07-4.21]), seizures (OR 1.40 [95% CI 1.16-1.68]), shock (OR 1.51 [95% CI 1.14-1.99]), and presumed pulmonary oedema (OR 1.58 [95% CI 1.04-2.39]). Lower in-hospital mortality was associated with moderate anaemia (OR 0.87 for a decrease of 10 percentage points in haematocrit [95% CI 0.80-0.95]). Circulating parasite density was not associated with mortality (OR 1.02 for a 6-fold increase [95% CI 0.94-1.11]), so the pathological effects of parasitaemia appear to be mediated entirely by the downstream effects of sequestration. Treatment with an artemisinin derivative decreased mortality compared with quinine (OR 0.64 [95% CI 0.56-0.74]). These estimates were consistent across children and adults (mainly representing African and Asian patients, respectively). Using inverse probability weighting, transfusion was not estimated to be beneficial in children with admission haematocrit values between 15% and 25% (OR 0.99 [95% CI 0.97-1.02]). Except for the effects of artemisinin treatment and transfusion, causal interpretations of these estimates could be biased by unmeasured confounding from severe bacterial sepsis, immunity, and duration of illness.Conclusion: These data suggest that moderate anaemia is associated with a reduced risk of death in severe falciparum malaria. This is possibly a direct causal association. The severe anaemia threshold criteria for a definition of severe falciparum malaria should be reconsidered. [ABSTRACT FROM AUTHOR]

Using abandoned gas wells as geothermal resources for energy production is an effective way to extract geothermal energy from geological formations. These abandoned wells have the potential to significantly contribute in the rising global demand for energy without requiring the land disruption resulting from deep drilling or digging, processes necessary for energy extraction from geological formations via more traditional methods. In this paper, a method to extract geothermal energy from abandoned gas wells is proposed. The method offers an efficient, economical, and environmentally-conscious way to generate electricity. A mathematical model of a thermal and hydraulic coupling process is constructed, and a 3D numerical model is generated to study the process of geothermal energy extraction by retrofitting an abandoned gas reservoir into a geothermal reservoir. Using the model, heat extraction and fluid flow are analyzed over a period of 50 years. The heat production, electricity generation, and thermal recovery over the lifetime of the reservoir indicate that a commercially viable geothermal dual well system can produce geothermal energy effectively. Dual-well systems contain at least one injection well and one production well. They are composed of a two-way flow system in which the fluid flows into the reservoir via an injection well and returns from the production well having absorbed thermal energy from the surrounding rocks. Sensitivity analysis of the main parameters controlling the average outlet temperature of the fluid from the sedimentary geothermal system reveals that abandoned gas wells are a suitable source of geothermal energy. This energy can be harvested via a method whose use of reservoir fluids differs from that of the traditional method of closed-loop circulation via a borehole heat exchanger. Here, it is demonstrated that abandoned oil and gas fields can be repurposed to be geothermal energy sources that provide low-cost electricity and are economically sustainable. [ABSTRACT FROM AUTHOR]

Previous research has suggested an association between antidepressants use and clinical restless legs syndrome (RLS) in patients, but there has never been a single study investigating the risk of RLS in irritable bowel syndrome (IBS) patients treated with antidepressants. Hence, we aimed to explore the association between IBS and RLS and to examine the risk of RLS in IBS patients treated with antidepressants. With the use of the National Health Insurance Research Database of Taiwan, 27,437 adults aged ≥ 20 years with newly diagnosed IBS (ICD-9-CM Code 564.1) and gender- and age-matched 54,874 controls without IBS were enrolled between 2000 and 2012. All patients were followed-up until RLS diagnosis, withdrawal from the National Health Insurance program, or end of 2013. We used the Cox proportional hazards model to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of RLS. RLS was more prevalent in IBS patients than in the non-IBS group (7.57 versus 3.36 per 10,000 person-years), with an increased risk of RLS (adjusted HR [aHR], 1.91; 95% CI, 1.52–2.40). Multivariate Cox proportional hazards analysis identified older age (age, 51–65 years; aHR, 1.67; 95% CI, 1.09–2.56; and age > 65; aHR, 1.59; 95% CI, 1.02–2.48), hypothyroidism (aHR, 4.24; 95% CI, 1.92–9.37), CAD (aHR, 1.70; 95% CI, 1.17–2.48), and depression (aHR, 3.15; 95% CI, 2.14–4.64) as independent RLS risk factors in IBS patients. In addition, the male SSRIs users were associated with significantly higher risk of RLS (aHR, 3.05 95% CI, 1.34–6.92). Our study showed that the IBS group has higher risk of RLS. Moreover, SSRIs use may increase the risk of RLS in male IBS patients. [ABSTRACT FROM AUTHOR]

Physical education professionals aim to develop quality programmes for physical education. This study aimed to develop and validate a scale using professionals’ perceptions of Quality Physical Education QPE in Asia using twenty-four items regarding QPE quality issues. The items covered status and roles, development of educational elements and supportive features in physical education. A sample of N = 799 sport and physical education professionals from eleven Asian cities participated in this questionnaire survey. Twenty-four items relating to QPE were examined via exploratory factor analysis (EFA) using maximum likelihood extraction and direct oblimin rotation methods. Nevertheless, only 20 items were extracted following the EFA examination. Items 1, 9, 14 and 18 were excluded because of low factor loadings. The remaining items were clustered into four subscales: Development and Supportive Elements for Quality Physical Education in Schools (DSFQPE; α = .918), Core Values of Quality Physical Education (CVPE; α = .908), Curriculum Arrangement of Physical Activities (CAPA; α = .884) and Provision and Norms in Physical Education (PNPE; α = .865). The Cronbach’s alpha coefficient (α = .875) indicated excellent internal consistency for the overall measure. Furthermore, the 4 retained factors from the EFA were assessed via robust confirmatory factor analysis (CFA). The 4-factor model demonstrated a good fit with the data (CMIN/DF = 3.450, CFI = .928, TLI = .916, PCFI = .801, RMSEA = .078). The study identified a 4-factor structure with internal consistency and acceptable interfactor correlations. The structure seemed to be applicable, including the twenty items identified as useful and necessary tools for the framework of analysis in the investigation of diverse settings for the study of quality physical education. [ABSTRACT FROM AUTHOR]

Targeted environmental and ecosystem management remain crucial in control of dengue. However, providing detailed environmental information on a large scale to effectively target dengue control efforts remains a challenge. An important piece of such information is the extent of the presence of potential dengue vector breeding sites, which consist primarily of open containers such as ceramic jars, buckets, old tires, and flowerpots. In this paper we present the design and implementation of a pipeline to detect outdoor open containers which constitute potential dengue vector breeding sites from geotagged images and to create highly detailed container density maps at unprecedented scale. We implement the approach using Google Street View images which have the advantage of broad coverage and of often being two to three years old which allows correlation analyses of container counts against historical data from manual surveys. Containers comprising eight of the most common breeding sites are detected in the images using convolutional neural network transfer learning. Over a test set of images the object recognition algorithm has an accuracy of 0.91 in terms of F-score. Container density counts are generated and displayed on a decision support dashboard. Analyses of the approach are carried out over three provinces in Thailand. The container counts obtained agree well with container counts from available manual surveys. Multi-variate linear regression relating densities of the eight container types to larval survey data shows good prediction of larval index values with an R-squared of 0.674. To delineate conditions under which the container density counts are indicative of larval counts, a number of factors affecting correlation with larval survey data are analyzed. We conclude that creation of container density maps from geotagged images is a promising approach to providing detailed risk maps at large scale. [ABSTRACT FROM AUTHOR]

Aim: Intestinal metaplasia (IM) and gastric atrophy (GA) are precancerous lesions in the stomach. There is a large debate on natural course of these lesions and surveillance strategy in these patients. This meta-analysis was aimed to find the most appropriate follow up and the rate of progression from IM and GA to GC. Methods: This meta-analysis is followed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including EMBASE, PubMed, Web of Science databases, Scopus, and the Cochrane Library were searched until July 2018. Cochran’s Q test and I-square (I2) test were used to examine heterogeneity across included studies. We pooled data using random-effect or fixed effect models indicated as incidence rate or proportion with 95% confidence intervals (CI). The variables of study included demographic data, endoscopy interval, follow up interval and time, GA and IM type and GC stage. Moreover, incidence rate of GC and progress rate, regress and persistence proportion in both GA and IM patients were assessed. Results: Overall, 68 original articles out of 32981 citations were included in our meta-analysis. The pooled GC incidence rate in patients with GA was 1.24 (95% CI, 0.80, 1.76; I2: 83.6%) cases per 1,000 person-years. The rates of later diagnosis of IM and gastric dysplasia in patients with GA were estimated as 41.42 (95% CI, 3.11, 64.45; I2: 95.6%) and 6.23 (95% CI, 2.34, 11.46; I2: 83.0%) cases per 1,000 person-years, respectively. The pooled regressed proportion was 32.23 (95% CI, 18.07–48.02; I2: 94.0%) and the persistence proportion was 38.83 (95% CI, 20.20–59.13; I2: 97.0%) per 100 observations in GA patients. In IM studies, the pooled incidence rate of GC was 3.38 (95% CI, 2.13, 4.85; I2: 93.4%) cases per 1,000 person-years. The progressed rate to dysplasia in IM patient was estimated to be 12.51 (95% CI, 5.45, 22.03; I2: 95.1%) cases per 1,000 person-years. The pooled regressed proportion was 31.83 (95% CI, 25.48–38.51; I2: 91.0%) and the persistence proportion was 43.46 (95% CI, 32.52–54.71; I2: 96.0%) per 100 observations in IM patients. Conclusion: Overall, the incidence of GC in patients with IM and GA are low but there is heterogeneity in data with the highest rate in Asian, males with those with incomplete IM. There is probability of regression or persistence without progression in patients with IM and GA who receive appropriate management. [ABSTRACT FROM AUTHOR]

Cesarean section (CS) is associated with maternal morbidity and mortality in developing countries. This study is conducted to assess factors associated with CS in Pakistan using partial least squares (PLS) algorithm, where categorical factors are modeled. Nationally representative maternal data from Pakistan Demographic and Health Surveys (PDHS) conducted during 2012-2013 is used in this study. Among correlation coefficient based PLS regression proposed algorithms for categorical factors, Pearson’s Contingency Coefficient (CC) PLS coupled with loading weight (LW) appeared to be the most efficient method in terms of model performance and influential factor selection. Region of residence, type of place of residence, mother’s and her partner’s level of education, wealth index, year of birth, previous terminated pregnancy, use of contraception, prenatal care provided by a doctor and nurse/midwife/LHV (lady health visitor), assistance provided by a nurse/midwife/LHV,number of antenatal visits, size of child, antenatal care provided by government hospital, transport facility for medical care, baby birth status, mother’s age at first birth, preceding birth interval and vaccination of hepatitis B-1 and B2 are found to be significantly affecting the CS delivery method. Correlation coefficient based PLS regression algorithms may serve more efficiently as a multivariate technique to treat high-dimensional categorical data. [ABSTRACT FROM AUTHOR]

Bosten Lake is an important region of Northwest China that has transformed from a freshwater lake to a saltwater lake since the 1970s. The water quality in the Bosten Lake basin is important for social and economic development, and nitrogen (N) and phosphorus (P) are the key indicators of water quality. The land use data, precipitation data and Digital Elevation Model (DEM) data with the Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) model were used to simulate the N and P exports of the Bosten Lake basin. The spatial and temporal dynamics of nitrogen and phosphorus exports, and the response of nitrogen and phosphorus exports to land use change and precipitation change were analyzed between 2000 and 2015. The results show that the amount of N and P exports increased during 2000–2015, and the N and P exports are mainly distributed around Bosten Lake. The N and P exports are greatly affected by cultivated land, built-up areas and grassland, while they are less affected by other land use types. The high precipitation areas with small exports of N and P are mainly distributed in mountain areas, while small precipitation areas with large exports of N and P are distributed in plains where the cultivated land and built-up areas are concentrated. The InVEST model can be used in Northwest China, and the statistical downscaling of reanalysis precipitation data can be used in the InVEST model to improve the simulation accuracy in the data scarce regions of Northwest China. [ABSTRACT FROM AUTHOR]

Recent years have seen tremendous advances in the scientific study of networks, as more and larger data sets of relationships among nodes have become available in many different fields. This has led to pathbreaking discoveries of near-universal network behavior over time, including the principle of preferential attachment and the emergence of scaling in complex networks. Missing from the set of network analysis methods to date is a measure that describes for each node how its relationship (or links) with other nodes changes from one period to the next. Conventional measures of network change for the most part show how the degrees of a node change; these are scalar comparisons. Our contribution is to use, for the first time, the cosine similarity to capture not just the change in degrees of a node but its relationship to other nodes. These are vector (or matrix)-based comparisons, rather than scalar, and we refer to them as “rewiring” coefficients. We apply this measure to three different networks over time to show the differences in the two types of measures. In general, bigger increases in our rewiring measure are associated with larger increases in network density, but this is not always the case. [ABSTRACT FROM AUTHOR]

Objective: To investigate the cost differences between magnetic resonance-guided focussed ultrasound (MRgFUS) and unilateral deep brain stimulation (DBS) for the treatment of medication-refractory essential tremor (ET) in Japan using a cost-minimisation model. Methods: A cost-minimisation model estimated total costs for MRgFUS and unilateral DBS by summing the pre-procedure, procedure, and post-procedure costs over a 12-month time horizon, using data from published sources and expert clinical opinion. The model base case considered medical costs from fee-for-service tariffs. Scenario analyses investigated the use of Diagnosis Procedure Combination tariffs, a diagnosis-related group-based fixed-payment system, and the addition of healthcare professional labour costs healthcare professionals using tariffs from the Japanese Health Insurance Federation for Surgery. One-way sensitivity analyses altered costs associated with tremor recurrence after MRgFUS, the extraction rate following unilateral DBS, the length of hospitalisation for unilateral DBS and the procedure duration for MRgFUS. The impact of uncertainty in model parameters on the model results was further explored using probabilistic sensitivity analysis. Results: Compared to unilateral DBS, MRgFUS was cost saving in the base case and Diagnosis Procedure Combination cost scenario, with total savings of JPY400,380 and JPY414,691, respectively. The majority of savings were accrued at the procedural stage. Including labour costs further increased the cost differences between MRgFUS and unilateral DBS. Cost savings were maintained in each sensitivity analysis and the probabilistic sensitivity analysis, demonstrating that the model results are highly robust. Conclusions: In the Japanese healthcare setting, MRgFUS could be a cost saving option versus unilateral DBS for treating medication-refractory ET. The model results may even be conservative, as the cost of multiple follow-ups for unilateral DBS and treatment costs for adverse events associated with each procedure were not included. This model is also consistent with the results of other economic analyses of MRgFUS versus DBS in various settings worldwide. [ABSTRACT FROM AUTHOR]

Noise is considered as one of the challenging problems in big cities. However, this noise could be utilized in producing energy especially in dense urban areas. Sound as a form of mechanical energy, it can be converted to electric energy through many approaches including heating, by using the diaphragm and through using piezoelectric materials. This research aims at utilizing noise through using piezoelectric materials as an approach of conversion to produce green sustainable electric energy that can be used to decrease the energy consumption from non-renewable sources and utilizing this energy in street lighting. The study was carried in three bus stations in Alexandria by having measurements during weekdays and weekends in order to study the noise produced in the selected stations and the amount of electric energy that could be produced and utilized in street lighting. The noise level index LDEN was calculated for each of the three selected locations. The equivalent noise level values were always exceeding the limits through the day, evening and night. At daytime they ranged between 75–85 dB which is higher that the permissible limit by 10–20 dB, at evening they ranged from 80–85 dB which is also higher than the permissible limit with 20–25 dB and at the night they ranged from 75–80 dB which is higher by 20–25 dB than the permissible limit. The research concluded that utilizing noise using the piezoelectric material is successful. The electric energy produced from an area of 1.45 m2 containing 690 piezoelectric QB220-503YB transducers at each of the selected stations was about 0.024 watt hr. This amount of electric energy is too small to be used in an application. So the application area should be maximized to hundreds of square meters to produce beneficial electric energy that can be used in lighting 1 LED street lamp or it can be stored and used when needed in applications that use greater amount of electric energy and this would help in reducing the energy consumed. [ABSTRACT FROM AUTHOR]

The Sustainable Energy Development Authority of Malaysia (SEDA) regularly receives complaints about damaged components and distribution boards of PV systems due to lightning strikes. Permanent and momentary interruptions of distribution circuits may also occur from the disturbance. In this paper, a solar PV Rooftop system (3.91 kWp) provided by SEDA was modelled in the PSCAD/EMTDC. The Heidler function was used as a lightning current waveform model to analyse the transient current and voltage at two different points susceptible to the influence of lightning events such as different lightning current wave shape, standard lightning current and non-standard lightning current. This study examines the effect on the system components when lightning directly strikes at two different points of the installation. The two points lie between the inverter and the solar PV array and between inverter and grid. Exceptionally high current and voltage due to the direct lightning strike on a certain point of a PV Rooftop system was also studied. The result of this case study is observed with and without the inclusion of surge protective devices (SPDs). The parameters used were 31 kA of peak current, 10 metres cable length and lightning impulse current wave shape of 8/20μs. The high current and voltage at P1 striking point were 31 kA and 2397 kV, respectively. As for the AC part, the current and voltage values were found to be 5.97 kA and 5392 kV, respectively.Therefore, SPDs with suitable rating provided by SEDA were deployed. Results showed that high transient current voltage is expected to clamp sharply at the values of 1.915 kV and 0 A at the P1 striking point. As for the AC part, the current and voltage values were found to be 0 kA and 0.751 V, respectively. Varying lightning impulse current wave shapes at striking point P2 showed that the highest voltage was obtained at waveshape 10/350 μs at 11277 kV followed by wave shapes of 2/70 μs, 8/20 μs and 0.7/6 μs. The high value of transient voltage was clamped at a lower level of 2.029 kV. Different lightning amplitudes were also applied, ranging from 2–200 kA selected based on the CIGRE distribution. It showed that the current and voltage at P1 and P2 were directly proportional. Therefore, the SPD will be designed at an acceptable rating and proper position of SPD installation at solar PV Rooftop will be proposed. The results obtained in this study can then be utilised to appropriately assign a SPD to protect the PV systems that are connected to the grid. Installing SPDs without considering the needs of lightning protection zones would expose the expensive equipment to potential damage even though the proper energy coordination of SPDs is in place. As such, the simulation results provide a basis for controlling the impacts of direct lightning strikes on electrical equipment and power grids and thus justify SPD coordination to ensure the reliability of the system. [ABSTRACT FROM AUTHOR]

Background: Residential density was found to be associated with excess body weight among adults in Western societies but it remains unclear in China. We aimed to explore the relationship between residential density and excess body weight among adults in China. Methods: This cross-sectional study was conducted in 2017 in urban areas of Nanjing, China. A multi-stage sampling method was used to randomly select participants aged 35–74 years from 8 urban neighborhoods in Nanjing. Status of excess body weight was the outcome variable which was categorized as "yes (BMI≥24)" or "no (BMI<24)" according to specific recommendations for Chinese adults. Residential density was the main explanatory variable which was grouped into tertiles. Odds ratios (OR) and 95% confidence interval (CIs) were calculated to assess the relationship between residential density and excess body weight using mixed-effects regression models after adjusting for age, sex, education, occupation, marital status, redmeat, smoking, physical activity, diabetic status and potential neighborhood-level clustering effect. Results: A total of 1551 participants were recruited with a response rate of 98.9% (1551/1568). The mean age (standard deviation) of participants was 54.7 (11.1) years, and 46% of them were men. With adjustment for potential influential factors, participants in neighborhoods with lower (OR = 1.38, 95% CI = 1.06–1.81) and middle (OR = 1. 29, 95% CI = 1. 01, 1. 64) tertile of residential density were at significantly higher risk of gaining excess body weight relative to their counterparts in communities with upper tertile of residential density. Such a negative association between residential density and excess body weight was observed for men only after stratified analysis by gender. Conclusions: A negative association between residential density and excess body weight was identified in overall and male urban Chinese adults, and the association was independent of physical activity. Results of our study have important implications in guiding public health policy making regarding prevention of excess body weight at community level via establishment of health-friendly neighborhood environment in China. [ABSTRACT FROM AUTHOR]

In fish, the circadian clock represents a key regulator of many aspects of biology and is controlled by combinations of abiotic and biotic factors. These environmental factors are frequently manipulated in fish farms as part of strategies designed to maximize productivity. The flatfish turbot, Scophthalmus maximus, represents one of the most important species within the aquaculture sector in Asia and Europe. Despite the strategic importance of this species, the function and regulation of the turbot circadian system remains poorly understood. Here, we have characterized the core circadian clock genes, clock1, per1, per2 and cry1 in turbot and have studied their daily expression in various tissues under a range of lighting conditions and feeding regimes. We have also explored the influence of light and feeding time on locomotor activity. Rhythmic expression of the four core clock genes was observed in all tissues studied under light dark (LD) cycle conditions. Rhythmicity of clock gene expression persisted upon transfer to artificial free running, constant conditions confirming their endogenous circadian clock control. Furthermore, turbot showed daily cycles of locomotor activity and food anticipatory activity (FAA) under LD and scheduled-feeding, with the activity phase as well as FAA coinciding with and being dependent upon exposure to light. Thus, while FAA was absent under constant dark (DD) conditions, it was still detected in constant light (LL). In contrast, general locomotor activity was arrhythmic in both constant darkness and constant light, pointing to a major contribution of light, in concert with the circadian clock, in timing locomotor activity in this species. Our data represents an important contribution to our understanding of the circadian timing system in the turbot and thereby the optimization of rearing protocols and the improvement of the well-being of turbot within fish farming environments. [ABSTRACT FROM AUTHOR]

Objective: To investigate morbidity for patients after the primary surgical management of cervical cancer in low and middle-income countries (LMIC). Methods: The Pubmed, Cochrane, the Cochrane Central Register of Controlled Trials, Embase, LILACS and CINAHL were searched for published studies from 1st Jan 2000 to 30th June 2017 reporting outcomes of surgical management of cervical cancer in LMIC. Random-effects meta-analytical models were used to calculate pooled estimates of surgical complications including blood transfusions, ureteric, bladder, bowel, vascular and nerve injury, fistulae and thromboembolic events. Secondary outcomes included five-year progression free (PFS) and overall survival (OS). Findings: Data were available for 46 studies, including 10,847 patients from 11 middle income countries. Pooled estimates were: blood transfusion 29% (95%CI 0.19–0.41, P = 0.00, I2 = 97.81), nerve injury 1% (95%CI 0.00–0.03, I2 77.80, P = 0.00), bowel injury, 0.5% (95%CI 0.01–0.01, I2 = 0.00, P = 0.77), bladder injury 1% (95%CI 0.01–0.02, P = 0.10, I2 = 32.2), ureteric injury 1% (95%CI 0.01–0.01, I2 0.00, P = 0.64), vascular injury 2% (95% CI 0.01–0.03, I2 60.22, P = 0.00), fistula 2% (95%CI 0.01–0.03, I2 = 77.32, P = 0.00,), pulmonary embolism 0.4% (95%CI 0.00–0.01, I2 26.69, P = 0.25), and infection 8% (95%CI 0.04–0.12, I2 95.72, P = 0.00). 5-year PFS was 83% for laparotomy, 84% for laparoscopy and OS was 85% for laparotomy cases and 80% for laparoscopy. Conclusion: This is the first systematic review and meta-analysis of surgical morbidity in cervical cancer in LMIC, which highlights the limitations of the current data and provides a benchmark for future health services research and policy implementation. [ABSTRACT FROM AUTHOR]

Objective: In Taiwan, light motorcycles (LMCs) with cylinder capacities between 50 and 250 cc are widely used for daily commute. These vehicles are operated in a mixed traffic environment and prohibited on highways. In light of increasing motorcycle casualties, we conducted a multicentre study to analyse rider factors affecting injury severity. Methods: Riders hospitalised upon LMC crashes were contacted. Information on demographics, comorbidities, and riding behaviours was collected through questionnaires and linked to hospital data. The injury severity score (ISS) and length of hospitalisation (LOH) were used as injury severity measures. Results: In total, 725 patients (mean age: 37.7 years; 64% men) completed their questionnaires. Multivariate analysis results showed that age ≥ 65 years, half-face helmets, protective clothing, collisions with a bus/truck or car, and fatigue riding were risk factors for having an ISS of ≥9. Age ≥ 65 years; motorcycle crashes ≥2 times in the previous year; anaemia; rural crashes; half-face helmets; protective boots; collisions with a bus/truck, car, or a stationary object; alcohol/stimulating refreshment consumption; and fatigue riding were risk factors for increased LOH. A protective factor was individuals working in commerce. Collisions with opening car doors caused low risks of having an ISS of ≥9 and a short LOH. Conclusion: Certain factors were significantly associated with riders’ injury severity and related medical resource consumption. Because of differences in the power output, use, and riding environment, risk factors for severe injuries in LMC crashes are dissimilar from those for heavy motorcycles (cylinder capacities > 250 cc) in developed countries and deserve more attention for injury prevention. Further in-depth evaluation of significant factors based on this study’s results can yield valuable information to reduce severe injuries after LMC crashes in countries and areas with a high dependency on motorcycles, even considering the popularity of electric motorcycles. [ABSTRACT FROM AUTHOR]

Background: Thorough understanding of developmental changes of human facial shape is lacking. The present study aimed to evaluate developmental shape changes of facial morphology based on a prospective, population-representative, Chinese cohort in Hong Kong. Methods: A population-representative sample of Chinese in Hong Kong was followed. Serial facial images of over 260 participants were obtained at age 12, 15, and 18 years. Facial landmarks were digitized and the corresponding coordinates were submitted for Generalized Procrustes Analysis. The resultant Procrustes shape coordinates, which captured shape information encoded by the facial landmarks, were then used for statistical shape analyses. Results: Small but significant developmental changes in mean facial shape were observed (p < 0.0001 for all pairwise comparisons). Significant age-related changes in the magnitude of variance of facial shape were also observed (p < 0.05). Phenotypic growth trajectories representing developmental shape changes were similar in size (p > 0.05) between sexes but differed in direction (p < 0.05) in shape space and trajectory shape (p < 0.05). The magnitude of shape differences between sexes remained constant from 12 to 18 years. Results of frontal facial shape analyses after removing the effect of allometry were similar to results obtained before removal of allometry. For lateral facial configurations, allometric trajectories among the age-by-sex groups were similar in slope (p > 0.05) but varied in directions in the multidimensional shape space. Conclusions: Our findings suggested significant age-related changes in facial shape and provided a dynamic view of developmental changes in sexual dimorphism of facial shape. Allometry contributed minimally to developmental changes in frontal facial shape. In addition, the allometric trajectories for lateral facial configurations were similar in rate of shape change but differed in their directions in shape space. [ABSTRACT FROM AUTHOR]

Background: Despite allergic rhinitis (AR) being a highly prevalent disease, according to literature, it is often underdiagnosed or undertreated. Aim: This study explored the disease characteristics of AR in the Saudi community and the non-conventional coping measures used to alleviate symptoms. Methods: The study was a nationwide cross-sectional study, using a self-report electronic survey distributed via social media networks in 2018. The survey included an explanatory letter and consent. The sample size comprised 3,458 participants and 2,849 adults had at least one of the four signs of AR, i.e. watery-nose, sneezing, nasal obstruction, itchy nose, watery eyes, in the past year, not related to cold/flu. The outcomes of the study were the triggers, pattern, severity and the classification of AR (2016 ARIA guidelines) and coping measures. Descriptive statistics, univariate analytic statistics and binary logistic regression analyses were conducted. The P-value was considered statistically significant at <0.05. Results: The leading reported trigger of AR was dust (74%, n = 2118), followed by pollen (17%, n = 477), mold (5%, n = 140) and fur (4%, n = 114). The prevalence of intermittent AR was (54%, n = 1,635), while that of persistent AR was (46%, n = 1,314). Almost one-third (34%, n = 959) complained of mild forms of AR, while others complained of moderate to severe forms (66%, n = 1890). The coping measures were mainly shower/humidification 368(12.9%) and herbal hot drinks 266(9.3%). Older participants (adj.OR = 1.3[1.1–1.5]) and overweight participants, (adj.OR = 1.2[1.1–1.4]) reported more persistent forms of rhinitis compared to their counter groups, (adj.P<0.001 and adj.P = 0.032) respectively. Female participants (adj.OR = 0.8[0.7–0.9]) had significantly milder forms of AR, in comparison to males, adj.P = 0.006. Conclusion: This study presented the disease characteristics of self-reported AR and its associated factors in Saudi Arabia. Special attention should be paid to older age groups and overweight patients who reported persistent forms of AR. Males reported more severe and persistent forms of AR. [ABSTRACT FROM AUTHOR]

Temperature can be a major factor for the distribution of insects, especially among invasive insects. Sirex noctilio (Hymenoptera: Siricidae) has invaded many regions in China, causing enormous ecological and economic losses. We aimed to explore the trend and potential of diffusion by researching the thermal survival limits of S. noctilio. We measured the supercooling point (SCP), critical thermal temperature (CTmax), high lethal temperature (HLT) and low lethal temperature (LLT) for S. noctilio population in China and assessed life stage-related variation in thermal tolerance. Moreover, we determined the temperature tolerance range of S. noctilio and identified the temperature parameters for its potential invasive distribution risk analysis. The SCP of adults was -11.78 ± 0.67 (mean ± SEM), the CTmax was 37.67 ± 0.54, and those of larvae were -20.77 ± 0.44 and 40.53 ± 0.27, respectively. The LLT increased with exposure time, and the HLT was generally near 43°C. S. noctilio adults can tolerate higher temperatures than larvae, and the larvae showed high resistance to cold temperature. We calculated several temperature indexes based on our results, such as the lower temperature threshold (DV0) at -2.7°C, the upper temperature threshold (DV3) at 31°C, the temperature threshold for both heat stress (TTHS) at 35°C and cold stress (TTCS) at -32.5°C. We observed that, S. noctilio was not resistant to high temperatures, its CTmax is slightly lower than the lethal temperature, and the adults were more tolerant than larvae. Our next goal was to combine the temperature tolerance of symbiotic fungi, information on climate change and the current distribution of this species to predict its potential global distribution. [ABSTRACT FROM AUTHOR]

Background: Despite perennial sunshine, vitamin D deficiency is prevalent among Malaysians especially pregnant women. This study determines the vitamin D status and its associated factors among third trimester pregnant women attending government health clinics in Selangor and Kuala Lumpur, Malaysia. Methods: Information on socio-demographic characteristics, obstetrical history, and sun exposure were obtained through face-to-face interviews. Vitamin D intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Serum 25-hydroxyvitamin D concentration was measured and classified as deficient (< 30 nmol/L), insufficient (30–50 nmol/L), and sufficient (≥ 50 nmol/L). Results: Of the 535 pregnant women recruited, 42.6% were vitamin D deficient. They consumed an average of 8.7 ± 6.7 μg of vitamin D daily. A total of 80.4% of the vitamin D were obtained from the food sources, while 19.6% were from dietary supplements. Fish and fish products showed the highest contribution to vitamin D intake (35.8%). The multivariable generalized linear mixed models, with clinic as a random effect, indicates that higher intake of vitamin D is associated with lower odds of vitamin D deficiency among pregnant women (OR = 0.96; 95% CI = 0.93–0.99). The odds of having vitamin D deficiency was reduced by 87% in non-Malays (OR = 0.14; 95% CI = 0.05–0.41) compared to Malays. No associations were found between age, educational level, monthly household income, work status, gravidity, parity, pre-pregnancy body mass index, total hours of sun exposure, total percentage of body surface area, and sun exposure index per day with vitamin D deficiency. Conclusion: Vitamin D deficiency is prevalent among Malaysian pregnant women. Considering the possible adverse obstetric and fetal outcomes of vitamin D deficiency during pregnancy, future nutrition education should emphasise on vitamin D-fortified foods consumption among pregnant women by taking into consideration ethnic differences. [ABSTRACT FROM AUTHOR]

The adoption of the shared prosperity goal by the World Bank in 2013 and Sustainable Development Goal 10, on inequality, by the United Nations in 2015 should strengthen the focus of development interventions and cooperation on the income growth of the bottom 40 percent of the income distribution. This paper contributes to the incipient literature on within-country allocations of development institutions and assesses the geographic targeting of World Bank projects to the bottom 40 percent. Bivariate correlations between the allocation of project funding approved over 2005–14 and the geographical distribution of the bottom 40 as measured by survey income or consumption data are complemented by regressions with population and other potential factors affecting the within-country allocations as controls. The correlation analysis shows that, of the 58 countries in the sample, 41 exhibit a positive correlation between the shares of the bottom 40 and World Bank funding, and, in almost half of these, the correlation is above 0.5. Slightly more than a quarter of the countries, mostly in Sub-Saharan Africa, exhibit a negative correlation. The regression analysis shows that, once one controls for population, the correlation between the bottom 40 and World Bank funding switches sign and becomes significant and negative on average. This is entirely driven by Sub-Saharan Africa and not observed in the other regions. Hence, the significant and positive correlation in the estimations without controlling for population suggests that World Bank project funding is concentrated in administrative areas in which more people live (including the bottom 40) rather than in poorer administrative areas. Furthermore, capital cities receive disproportionally high shares of World Bank funding on average. [ABSTRACT FROM AUTHOR]

Background: Strongyloides stercoralis is a neglected soil-transmitted helminth that occurs worldwide, though it is particularly endemic in tropical and subtropical areas. It can cause long-lasting and potentially fatal infections due to its ability to replicate within its host. S. stercoralis causes gastrointestinal and dermatological morbidity. The objective of this study was to assess the S. stercoralis infection risk and, using geostatistical models, to predict its geographical distribution in Cambodia. Methodology / Principal findings: A nation-wide, community-based parasitological survey was conducted among the Cambodian population, aged 6 years and older. S. stercoralis was diagnosed using a serological diagnostic test that detects IgG antibodies in urine. Data on demography, hygiene and knowledge about helminth infection were collected. S. stercoralis prevalence among 7,246 participants with a complete data record was 30.5%, ranging from 10.9% to 48.2% across provinces. The parasite was ubiquitous in Cambodia; only five south-eastern provinces had prevalence rates below 20%. Infection risk increased with age for both men and women, although girls under the age of 13 and women aged 50 years and over had lower odds of infection than their male counterparts. Open defecation was associated with higher odds of infection, while having some knowledge of the health problems caused by worms was a protective factor. Infection risk was positively associated with nighttime maximum temperature, minimum rainfall, and distance to water; it was negatively associated with land occupied by rice fields. Conclusions / Significance: S. stercoralis infection is rampant in Cambodia. Control programs delivering ivermectin are needed to manage the parasite. However, the high cost of this drug in Cambodia currently precludes the implementation of control initiatives. Donations, subsidies or affordable generics are needed so that S. stercoralis, which infects almost a third of the Cambodian population, can be addressed through an adequate control program. [ABSTRACT FROM AUTHOR]

The Bitcoin market becomes the focus of the economic market since its birth, and it has attracted wide attention from both academia and industry. Due to the absence of regulations in the Bitcoin market, it may be easier to bring some kinds of illegal behaviors. Thus, it raises an interesting question: Is there abnormity or illegal behavior in Bitcoin platforms? To answer this question, we investigate the abnormity in five leading Bitcoin platforms. By analyzing the financial index, i.e. the normalized logarithmic price return, we find that the properties of price return in bitFlyer are completely different from others. To find the possible reasons, we find that the abnormal ask price and bid price appear simultaneously in bitFlyer, which may be potentially linked to either price manipulation or money laundering. It verifies our conjecture that there may be abnormity or price manipulation in Bitcoin platforms. Furthermore, our findings in price return could also provide an innovative and effective method to detect the abnormity in Bitcoin platforms. [ABSTRACT FROM AUTHOR]

In recent years, with the rapid development of China's air transport industry and the change in market consumption structure, service quality has become one of the important factors affecting airline revenue. How to formulate a reasonable pricing strategy and maintain competitiveness in the fierce market competition has become an urgent problem for airlines. First, the impact factor of service quality level in the traditional pricing model is introduced and a static price competition model for multi-oligopoly airlines based on service quality is established in this paper. And then, a dynamic pricing model based on service quality of the multi-oligopoly airlines is established. The model incorporates the weight factor of service quality impact, which is used to indicate the weight of the service quality level in the process of airline dynamic pricing. The research results show that the service quality level of airlines has an indispensable influence on its development. Airlines should improve service quality as soon as possible to enhance market competitiveness and achieve sustainable development. [ABSTRACT FROM AUTHOR]

Objective: Many studies focused on reasons behind the increasing incidence and the spread of human brucellosis in mainland China, yet most of them lacked comprehensive consideration with quantitative evidence. Hence, this study aimed to further investigate the epidemic mechanism and associated factors of human brucellosis so as to provide thoughts for future countermeasures in China and the rest of the world. Methods: Data of human brucellosis incidence and some associated factors in economy, animal husbandry, transportation as well as health and hygiene were collected at provincial level from 2005–2016. Time series plots were first used to visualize the annual incidence and annual rate of change of human brucellosis for each province, then cluster analysis categorized all the 31 provinces of mainland China based on their incidence time series during the study period. In addition, according to the characteristics of data, the dynamic panel data model in combination with supervised principal component analysis was proposed to explore effects of associated factors on human brucellosis. Results: 1. The incidence rate of human brucellosis in mainland China increased three-fold from 1.41 per 100,000 people in 2005 to 4.22 per 100,000 people in 2014, though it went down a little in 2015 and 2016. Incidence rates in the north have always been higher than those in the south, but the latter also experienced an upward trend especially between 2012 and 2016. 2. The 31 provinces of mainland China were categorized into three clusters, and each cluster had its own characteristics of incidence time series. 3. The impact of health and hygiene situations on the prevention and control work of human brucellosis was still very limited and trivial (regression coefficient = -0.02). Therefore, it was plausible to presume that improving the personal average number of medical institutes and the proportion of rural medical expenditure might be helpful in preventing and controlling human brucellosis. Conclusions: The epidemic status of human brucellosis has changed in both spatial and temporal dimensions in recent years in mainland China. Apart from traditional control measures, more attention should be paid to the improvement of medical healthcare especially in rural areas in the hope of enhancing the control effect. [ABSTRACT FROM AUTHOR]

Background: Lead, mercury, cadmium and arsenic are the priority heavy metals of major public health concern in industrialized countries. Exposure to them can cause cognitive impairment and depressive disorders through an effect on Brain-derived neurotrophic factor (BDNF) which is an important biomarker of pregnancy. Despite a number of prior studies on heavy metals pollution, there is few of studies on the effect of heavy metals on BDNF during early pregnancy. This study aims to examine the association between maternal blood heavy metals concentrations and BDNF during the first trimester pregnancy among Myanmar migrants in Thailand. Methodology: This cross sectional study, a part of ongoing birth cohort was conducted at the antenatal care clinic from June to October 2018. A total of 108 with Myanmar migrant pregnancy with a single viable fetus of 0 to 14 gestation weeks who stayed within the industrial plant at least 3 months before were recruited. Socio-demographic characteristics and health behaviors were accessed using a self-report questionnaire. Maternal blood heavy metals (lead (Pb), mercury (Hg), cadmium (Cd) and arsenic (As)) were measured using an inductively coupled plasma mass spectrometer and plasma BDNF was measured using an enzyme-linked immunosorbent assay. Multivariate binary logistic regression were modeled to access the association. Results: Median (interquartile rank: IQR) concentrations were: BDNF (6.49 (1.79) μg/ml), Pb (2.77 (1.46) μg/dL), Hg (0.62 (0.54) μg/dL), Cd (0.93(0.86) μg/L) and As (0.40 (0.11) μg/dL) respectively. We categorized BDNF concentrations into high (> median) (n = 54) and low (≤ median) (n = 54) groups. After adjusting for potential confounders, high blood total arsenic concentration had 2.6-fold increased odds (aOR = 2.603, 95% CI: 1.178, 5.751) of low plasma BDNF level as compared with low blood total arsenic group. However, there was no significant association between BDNF and Pb, Hg and Cd. Conclusions: The present findings demonstrate higher blood total arsenic level were more likely to have lower BDNF in early pregnancy. Our study suggested that heavy metal could be worsen BDNF level which plays its important role on biological effect of maternal depressive disorder and newborn neurodevelopment. [ABSTRACT FROM AUTHOR]

This paper develops two-stage inverse data envelopment analysis models with undesirable outputs to formulate resource plans for 16 Chinese listed commercial banks whose outputs are increased and overall efficiency is kept unchanged in the short term. We use these models to meet three different output targets, namely, increasing both the desirable and undesirable outputs by the same percentage, increasing these outputs by different percentages, and increasing only the desirable outputs while keeping the undesirable outputs unchanged. We find that operation cost and interest expense are more flexible than labor in the adjustment process and that deposits have no obvious law of change. The findings of this work provide some suggestions for bank managers. [ABSTRACT FROM AUTHOR]

This paper aims to demonstrate the impact of coal enterprises’ vertical integration on the performance of innovation corporate social responsibility (ICSR) and to elaborate its specific transmission path through financing structure and market power. This paper takes the data of A-share listed coal company from 2008 to 2017 as samples, uses input-output table method to measure the degree of vertical integration, and explores the relationship between the four factors through multiple linear regression and Bootstrap method. We found that: (1) the vertical integration of coal enterprises has positive incentives for the promotion of ICSR. (2) Financing structure and market power play a chain intermediary role in this process of incentive. (3) In areas with high marketization process, vertical integration has more significant incentive effect on ICSR. The paper extends the research on the relationship between vertical integration and innovation, which provides a reference for the improvement of China’s supply-side reform and corporate social responsibility (CSR) fulfillment policy. It is helpful to promote the sustainable development of the coal industry, stimulate the innovation vitality of enterprises, and improve the fulfillment of CSR. [ABSTRACT FROM AUTHOR]

There is growing interest to restore oyster populations and develop oyster reefs for their role in ecosystem health and delivery of ecosystem services. Successful and sustainable oyster restoration efforts largely depend on the availability and selection of suitable sites that can support long-term growth and survival of oysters. Hence, in the present study a habitat suitability index (HSI) model was developed for the intertidal rock oyster (Saccostrea cucullata), with special attention: (1) to the role of the monsoon in the suitability of oyster habitats, and (2) to identify potential suitable sites along the south-eastern Bangladesh coast. Seven habitat factors were used as input variables for the HSI model: (1) water temperature; (2) salinity; (3) dissolved oxygen; (4) particulate inorganic matter (PIM); (5) pH; (6) Chlorophyll-a; and (7) water flow velocity. Seven field surveys were conducted at 80 locations to collect geo-spatial environmental data, which were then used to determine HSI scores using habitat suitability functions. The model results showed that the areas suitable (HSI >0.50) for oyster settlement and growth were characterized by relatively high salinities, Chlorophyll-a, dissolved oxygen and pH values. In contrast, freshwater dominated estuaries and nearby coastal areas with high suspended sediment were found less suitable (HSI <0.50) for oysters. HSI model results were validated with observed oyster distribution data. There was strong correlation between the HSI calculated by the model and observed oyster densities (r = 0.87; n = 53), shell height (r = 0.95; n = 53) and their condition index (r = 0.98; n = 53). The good correspondence with field data enhances the applicability of the HSI model as a quantitative tool for evaluating the quality of a site for oyster restoration and culture. [ABSTRACT FROM AUTHOR]

Background: Grasping the human cost of war requires comprehensive evaluation of multiple dimensions of conflict. While the number of civilian casualties is a frequently used indicator to evaluate intensity of violence in conflict, the inclusion of other indicators may provide a more complete understanding of how war impacts people and their communities. The Syrian conflict has been specifically marked by attacks against healthcare facilities, and the advancement of technology has provided an avenue for remote data analysis of conflict trends. This study aims to determine the feasibility of using publicly available, online data of attacks on healthcare facilities to better describe population-level violence in the Syrian Civil War. Methods: This study utilized publicly available datasets from the Violations Documentation Center (VDC) and Physicians for Human Rights (PHR) to compare trends in attacks on healthcare facilities and civilian casualties from March 2011 to November 2017 in the Syrian Civil War. We used descriptive statistics, bivariate tests and a multivariable hypothesis testing model to measure the association between the two indicators while adjusting for confounding variables. Results: We examined for associations between attacks on healthcare facilities and overall civilian casualties. In the adjusted regression model, each attack on a healthcare facility in the Syrian conflict corresponded to an estimated 260 reported civilian casualties in the same month (95% CI: 227 to 294). This model adjusted for population displacement (using number of registered refugees as a proxy). The May 2014 interaction term, used a transition point of early/late war based on political events during that time, illustrated that each healthcare facility attack after May 2014 corresponded to a statistically significant decrease of 228 civilian deaths. This suggests that although attacks on healthcare facilities continued to contribute to overall civilian deaths, the scale that this was happening was lower after May 2014. Conclusion: In the Syrian Civil War, our findings suggest that the inclusion of other humanitarian indicators, such as attacks on hospitals, may add granularity to traditional indicators of violence (e.g. such as civilian casualties) to develop a more nuanced understanding of the warring tactics used and violence against civilians in the Syrian conflict. This exploratory case study represents a novel approach to utilizing open-source data along with statistical analysis to interpret violence against civilians. Future research could benefit from analyzing attacks on healthcare facilities and other civilian infrastructure concurrently with civilian casualty data for further data-driven utilization of open-source data. [ABSTRACT FROM AUTHOR]

The Nankai Trough in Japan has been identified as a geological feature that could cause extensive damage in the event of a major earthquake. In this study, we investigated the impact of effective guidance signs for hearing-impaired individuals requiring special care when escaping to a tsunami evacuation building (emergency evacuation location) using geographical information system (GIS) and viewshed analysis. We selected an area we considered would suffer severe damage following a major earthquake and tsunami; we identified difficulties in the provision of escape routes. Using GIS, we determined the time required for escape and tsunami arrival time if effective signs were installed; we undertook such analysis using the height data of buildings in the target area. With effectively installed guidance signs, the average required evacuation time was 36.88 minutes; without such signs (which is currently the case in the target area), the average time was 47.10 minutes: that would result in citizens getting caught by the tsunami. Installing effective guidance signs would allow hearing-impaired individuals to escape to an evacuation building before being hit by the tsunami. [ABSTRACT FROM AUTHOR]

The deterioration of water quality has become a primary environmental concern worldwide. Understanding the status of water quality and identifying the influencing factors are important for water resources management. However, reported analyses have mostly been conducted in small and focused areas. It is still unclear if factors driving spatial variation in water quality would be different in extended spatial scales. In this paper, we analyzed spatial pattern of inland surface water quality in China using a dataset with four water quality parameters (i.e., pH, DO, NH4+-N and CODMn) and the water quality level. We tested the effects of anthropogenic (i.e., land use and socio-economic) and natural (i.e., climatic and topographic) factors on spatial variation in water quality. The study concluded that the overall inland surface water quality in China was at level III (fair). Water quality level was strongly correlated with CODMn and NH4+-N concentration. In contrast to reported studies that suggested land use patterns were the determinants of inland surface water quality, this study revealed that both anthropogenic and natural factors played important roles in explaining spatial variation of inland surface water quality in China. Among the tested explanatory variables, mean elevation within watershed appeared as the best predictor for pH, while annual precipitation and mean air temperature were the most important explanatory variables for CODMn and DO, respectively. NH4+-N concentration and water quality level were most strongly correlated with the percent of forest cover in watershed. Compared to studies at smaller spatial scales, this study found different influencing factors of surface water quality, suggesting that factors may play different roles at different spatial scales of consideration. Therefore management policies and measures in water quality control must be established and implemented accordingly. Since currently adopted parameters for monitoring of inland surface water quality in China are largely influenced by natural variables, additional physicochemical and biological indicators are needed for a robust assessment of human impacts on water quality. [ABSTRACT FROM AUTHOR]

Accurately predicting reference evapotranspiration (ET0) with limited climatic data is crucial for irrigation scheduling design and agricultural water management. This study evaluated eight machine learning models in four categories, i.e. neuron-based (MLP, GRNN and ANFIS), kernel-based (SVM, KNEA), tree-based (M5Tree, XGBoost) and curve-based (MARS) models, for predicting daily ET0 with maximum/maximum temperature and precipitation data during 2001–2015 from 14 stations in various climatic regions of China, i.e., arid desert of northwest China (NWC), semi-arid steppe of Inner Mongolia (IM), Qinghai-Tibetan Plateau (QTP), (semi-)humid cold-temperate northeast China (NEC), semi-humid warm-temperate north China (NC), humid subtropical central China (CC) and humid tropical south China (SC). The results showed machine learning models using only temperature data obtained satisfactory daily ET0 estimates (on average R2 = 0.829, RMSE = 0.718 mm day−1, NRMSE = 0.250 and MAE = 0.508 mm day−1). The prediction accuracy was improved by 7.6% across China when information of precipitation was further considered, particularly in (sub)tropical humid regions (by 9.7% in CC and 12.4% in SC). The kernel-based SVM, KNEA and curve-based MARS models generally outperformed the others in terms of prediction accuracy, with the best performance by KNEA in NWC and IM, by SVM in QTP, CC and SC, and very similar performance by them in NEC and NC. SVM (1.9%), MLP (2.0%), MARS (2.6%) and KNEA (6.4%) showed relatively small average increases in RMSE during testing compared with training RMSE. SVM is highly recommended for predicting daily ET0 across China in light of best accuracy and stability, while KNEA and MARS are also promising powerful models. [ABSTRACT FROM AUTHOR]

Background: Extensive studies have been carried out over the years to determine the maximum acceptable weight that a worker is capable of lifting in a given situation among Occidental populations across Europe and US. Nonetheless, studies that place emphasis on using lifting frequency as the quantifying task parameter, especially in developing countries such as Malaysia, appear to be in scarcity. Hence, this study determined the maximum acceptable frequency of lift (MAFL) for combined manual material handling (MMH) tasks amongst Malaysian males. Method: Two lifting loads were considered in this study: 1 kg and 5 kg. Each subject adjusted his frequency of lifting using a psychophysical approach. The subjects were instructed to perform combined MMH task as fast as they could over a period of 45 minutes without exhausting themselves or becoming overheated. The physiological response energy expenditure was recorded during the experimental sessions. The ratings of perceived exertion (RPE) for four body parts (forearms, upper arm, lower back and entire body) were recorded after the subjects had completed the instructed task. Results: The mean frequencies of the MMH task had been 6.8 and 5.5 cycles/minute for lifting load of 1 and 5 kg, respectively, while the mean energy expenditure values were 4.16 and 5.62 kcal/min for 1 and 5 kg load, respectively. These displayed a significant difference in the Maximum Acceptable Frequency of Lift (MAFL) between the two loads, energy expenditure and RPE (p < 0.05) whereby the subjects appeared to work harder physiologically for heavier load. Conclusion: It can be concluded that it is significant to assess physiological response and RPE in determining the maximum acceptable lifting frequency at varied levels of load weight. The findings retrieved in this study can aid in designing tasks that do not exceed the capacity of workers in order to minimise the risk of WRMSDs. [ABSTRACT FROM AUTHOR]

In this study, we designed a delayed payment mechanism in laboratory second price auctions (SPAs), under which subjects received a cash endowment two weeks after the experiment day and had to use their own money to pay the experimental losses (if any) on the experiment day. We compared the effect of delayed payment on overbidding in the induced value SPAs with the conventional “on-the-spot” payment mechanism where the subjects received an endowment on the experiment day, and the prepaid mechanism where the subjects received the endowment two weeks before the experiment day. Each auction was repeated for 20 rounds to provide sufficient learning opportunities to the bidders. Our results showed that bids converged to the corresponding values over auction rounds and overbidding was reduced by previous losses, consistently with the adaptive learning theory. Moreover, overbidding seems to depend significantly on bidders’ cash holding, and the magnitude of the payment treatment effects depends crucially on liquidity constraints. In the presence of liquidity constraints, both delayed and prepaid payment mechanisms reduced overbidding, while in the absence of liquidity constraints, only the delayed endowment mechanism reduced overbidding. Furthermore, when controlling the degree of liquidity constraints, subjects with higher GPAs were less likely to overbid and the delayed endowment mechanism significantly reduced overbidding compared to other payment mechanisms. These results suggest that overbidding in SPAs might be caused by bounded rationality and could be reduced by adaptive learning especially when overbidding becomes “truly” costly to subjects. [ABSTRACT FROM AUTHOR]

Despite considerable air pollution prevention and control measures that have been put into practice in recent years, outdoor air pollution remains one of the most important risk factors for health outcomes. To identify the potential research gaps, we conducted a scoping review focused on health outcomes affected by outdoor air pollution across the broad research area. Of the 5759 potentially relevant studies, 799 were included in the final analysis. The included studies showed an increasing publication trend from 1992 to 2008, and most of the studies were conducted in Asia, Europe, and North America. Among the eight categorized health outcomes, asthma (category: respiratory diseases) and mortality (category: health records) were the most common ones. Adverse health outcomes involving respiratory diseases among children accounted for the largest group. Out of the total included studies, 95.2% reported at least one statistically positive result, and only 0.4% showed ambiguous results. Based on our study, we suggest that the time frame of the included studies, their disease definitions, and the measurement of personal exposure to outdoor air pollution should be taken into consideration in any future research. The main limitation of this study is its potential language bias, since only English publications were included. In conclusion, this scoping review provides researchers and policy decision makers with evidence taken from multiple disciplines to show the increasing prevalence of outdoor air pollution and its adverse effects on health outcomes. [ABSTRACT FROM AUTHOR]

Arsenic (As) is a carcinogenic and hazardous substance that poses a serious risk to human health due to its transport into the food chain. The present research is focused on the As transport in different lentil genotypes and the role of Arbuscular Mycorrhizal Fungi (AMF) in mitigation of As phyto-toxicity. Arsenic transport from soil to root, shoot and grains in different lentil genotypes was analyzed by flow injection hydride generation atomic absorption spectrophotometry. AMF were applied for the reduction of As uptake as well as the improvement of plant growth in lentil genotypes. Arsenic phyto-toxicity was dose-dependent as evidenced by relatively higher shoot length, fresh and dry weight of root and shoot in 5 and 15 mgkg-1 As-treated lentil plants than that in 100 mgkg-1 As-treated lentil. Arsenic accumulation occurred in roots and shoots of all BARI-released lentil genotypes. Arsenic accumulation in grains was found higher in BARI Mashur 1 than other lentil genotypes. AMF treatment significantly increased growth and biomass accumulation in lentil compared to that in non-AMF plants. Furthermore, AMF effectively reduced the As concentrations in roots and shoots of lentil plants grown at 8 and 45 mgkg-1 As-contaminated soils. This study revealed remarkable divergence in As accumulation among different BARI-released lentil genotypes; however, AMF could reduce As uptake and mitigate As-induced phyto-toxicity in lentil. Taken together, our results suggest a great potential of AMF in mitigating As transfer in root and shoot mass and reallocation to grains, which would expand lentil cultivation in As-affected areas throughout the world. [ABSTRACT FROM AUTHOR]

Introduction: Only a few, large population-based studies, have reported on whiplash-associated disorder (WAD). However, none of them have investigated the influence of crash severity on WAD outcome. In the present study, we aimed to determine whether crash severity predicts outcomes among patients with no-fault government insurance for acute WAD. Methods: We utilized data from a compulsory, no-fault government automobile liability insurance agency in Japan. Individuals involved in a car accident between April 2001 and June 2015 with residual disabilities reported at the end of the treatment between October 2014 and September 2015 were included. Crash severity was assessed based on property damage costs, size of the other vehicle (large car, medium car, small car, or two-wheeled vehicles), and collision types (rear-end collision, contact with vehicle moving in the same direction, or in the opposite direction). Outcomes included the time to claim closure and the number of treatment visits. Results: We analyzed data for a total of 52,251 individuals (28,571 male and 23,680 female) with a median age of 44 years (range: 2–95 years). The median time to claim closure was 220 days (range: 1–4,938 days), and the median number of treatment visits was 102 (range: 1–2,492). There was no significant association between outcomes and property damage costs or size of the other vehicle. Collision types exhibited no consistent association with outcomes. However, older age and affected body parts, in addition to the neck, were independent risk factors for delayed claim closure and a large number of visits, although, all odds ratios were low (often less than 2.0). Conclusions: There was no obvious association of outcomes with property damage costs, size of the other vehicle, or collision types in acute WAD patients. Further studies should investigate the influence of psychological factors, compensation systems, and cultural conditions. [ABSTRACT FROM AUTHOR]

This paper combines a Granger causality test and a VAR model to investigate the relationships among oil price shocks, global economic policy uncertainty (GEPU), and China’s industrial economic growth. Based on monthly data from 2000 to 2017, we reveal that GEPU and world oil prices jointly Granger cause China's industrial economic growth; world oil prices have a positive effect on China's industrial economic growth, while GEPU has a negative effect. Further analyses investigate the asymmetry effect of oil prices and find that the negative component shows a more significant impact on China's industrial economic growth. The results are robust to different oil price and EPU proxies. [ABSTRACT FROM AUTHOR]

Objectives: Every day, an average of 3,400 deaths and tens of millions of injuries occur as a result of traffic accidents. This study aims to model and validate road traffic injury (RTI) times series, specifically considering gender. Study design: Time trend studies of monthly road traffic injuries (RTI) in Iran from March 2005 to February 2016, as well as those of males and females from March 2009 to February 2016 were performed. Methods: The seasonal auto-regressive integrated moving average method (SARIMA) was employed to predict RTI time series. The final model was selected from various SARIMA models based on the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). To examine whether the residuals were white noise, the Ljung-Box (LB) test and residuals plots were used for un-correlation, and the zero mean and stationarity, respectively. Additionally, smoothing methods were utilized to validate the SARIMA models for fitting and out-of-range prediction of the time series models under study. The sample auto-correlation function (ACF) and the partial autocorrelation function (PACF) with 20 lags were employed to determine the order of models and to ascertain if the residuals of the model were uncorrelated. Results: Based on the obtained results, SARIMA (2,1,0)(0,1,1)12, SARIMA (0,1,1)(0,1,1)12, SARIMA (1,1,1)(0,0,1)12, and SARIMA (2,0,0)(1,0,0)12 were chosen for the time series including incidence rates of total road traffic injuries (IRTI), IRTI of males, females, and males-to-females, respectively. The AIC values were -87.57, 413.38, -732.91, and -85.32, respectively. The LB test for the residuals of the time series models of (0.539) IRTI, (0.3) IRTI of males, (0.23) females, and (0.237) males-to-females indicated that residuals were uncorrelated. Furthermore, prediction values for the next 24 months (2016 to 2018) showed no decline in the incidence rate of male and female traffic injuries. Results of the predictions using exponential smoothing methods indicated out-of-range prediction validity of the SARIMA models. Conclusion: This study exemplified the high efficiency of SARIMA models in predicting road traffic injuries (RTIs). Based on observations, the IRTI mean in Iran was 35.57 in 2016. The predicted values of the IRTI for 2016–2018 by the SARIMA model showed no decreasing trend. During the studied period, the observed values of IRTI for males were two to three times the female values. Thus, prediction of RTI can provide a useful tool for traffic safety policymaking by simulating interrupted time series when applying new traffic enforcement interventions and regulations in the future. Additionally, IRTI analysis of males and females showed that men had a non-increasing trend but higher incidence of traffic injuries, whereas the IRTI for women revealed an increasing trend from 2009 to 2012 with a lower incidence of injuries. This growth could be attributed to the impact of increased outdoor activities of women and the increased number of issued driving licenses in the period of 2009–2012. [ABSTRACT FROM AUTHOR]

Background: HIV spread in injecting drug users (IDU) occurs efficiently between individuals within their social networks. While methadone maintenance treatment has long known to be effective in combating HIV transmission in IDU, the impacts of one’s social connections and HIV status have not been well characterised. A study was conducted with the objective of differentiating the pattern of treatment participation between HIV-positive and negative methadone users and to understand its association with social connections with peers. Methods: Attendance data in one calendar year were extracted from a territory-wide electronic clinical record database of over 8000 methadone users attending 19 clinics in Hong Kong, a city with a relatively low HIV prevalence in injecting drug users. A case-control design was used by matching HIV positive methadone users with HIV negative controls. A temporal-social co-occurrence approach was adopted to construct a social network. Multiple logistic regression and network-based analyses were conducted. Results: In 2016, a total of 8332 methadone users had attended a clinic at least once, giving 1694016 attendance records that were included in the study. Some 432 methadone, 54 of whom HIV positive, were included in the case-control analyses. Multivariable logistic regression model showed that HIV-positive status was associated with drug injection history (adjusted odds ratio [aOR] 2.28, 95% confidence interval [95% CI] 1.19–4.38), not working fulltime (aOR 3.34, 95% CI 1.15–9.72), ethnic minority (aOR 2.59, 95% CI 1.33–5.02) and minimum daily dose of at least 20mg (aOR 3.64, 95% CI 1.08–12.26). Those having connections with other peers were older (aOR 1.02, 95% CI 1.00–1.04), had a higher mode dose (aOR 1.03, 95% CI 1.02–1.04) and had been admitted to methadone programme for longer time (aOR 1.07, 95% CI 1.02–1.13). Among those with connections, HIV-negative users did not have more connections (median degree centrality 21.00 vs 34.50, p = 0.26) but the network structure was stronger (clustering coefficient 0.65 vs 0.53, p = 0.03). Conclusion: The weak and sparse linkages may explain the generally low HIV prevalence and incidence in opioid-dependent persons in Hong Kong. Social support could play a constructive role in harm reduction and ethnic minority community-based organisations could help and reinforce treatment adherence. [ABSTRACT FROM AUTHOR]

Background: In the current meta-analysis, we aimed to systematically review and summarize the eligible studies evaluating the association between dietary acid load in terms of potential renal acid load (PRAL) and net-endogenous acid production (NEAP) with anthropometric parameters and serum lipids in adult population. Methods: In a systematic search from PubMed, Scopus, Web of Sciences and Cochrane electronic databases up to December 2018, relevant studies were included. Cross-sectional, case control or cohort studies evaluating the association between PRAL and NEAP with the mean values of body mass index (BMI), waist circumference (WC), low and high density lipoprotein cholesterol (LDL, HDL), triglyceride (TG), total cholesterol (TC) and the prevalence of obesity were included. Results: According to our results, having higher dietary acid load content in terms of high PRAL scores was associated with higher triglyceride concentrations (weighted mean difference (WMD): 3.468; confidence interval (CI): -0.231, 7.166, P = 0.04) and higher obesity prevalence (30% and 27% in highest versus lowest categories). Accordingly, being in the highest category of NEAP was associated with higher prevalence of obesity (25% and 22% in highest versus lowest category). In subgroup analysis, higher PRAL scores was associated with higher BMI in women (WMD: 0.122; CI: -0.001, 0.245; P = 0.049) and higher NEAP in men (WMD: 0.890; CI: 0.430, 1.350; P < 0.001). There was no association between dietary acid load and other studied parameters. Conclusions: In the current meta-analysis, high dietary acid load content was associated with higher serum triglyceride concentrations and higher obesity prevalence. Reducing dietary acid load content might be a useful preventive strategy against obesity and metabolic disorders. [ABSTRACT FROM AUTHOR]

Introduction: Factors associated with persistently high Human Immunodeficiency Virus (HIV) prevalence levels in several districts of India are not well understood. This study was undertaken to determine the association of socio-demographic characteristics, economic factors, awareness about HIV and Sexually Transmitted Infections (STIs), and condom use with consistently high HIV prevalence in the Indian districts and to ascertain whether these associations differed across various regions of India. Methods: This study was carried out including all 640 districts of India. Secondary analysis of data obtained from the Census of India-2011, HIV Sentinel Surveillance in India and District Level Household Survey-III was done. Population profile, socio-economic characteristics, levels of HIV/STI/condom awareness and condom use, were compared between the districts with and without consistently high HIV prevalence. Due to the presence of collinearity among predictor variables, we used principal component analysis and the principal component scores were included as covariates for further analysis. Considering the districts at level 1 and the regions at level 2, multi-level analysis was done by generalised linear mixed models. Variance partition coefficient and median odds ratio were also calculated. Results: Sixty-three districts with consistently high HIV prevalence were found clustered in the South and the North-east regions of India. Population size, density and urbanisation were found to be positively associated with consistently high HIV prevalence in these districts. Higher levels of literacy, better socio-economic status, higher proportion of population in reproductive age group and late marriages were positively associated with consistently high HIV prevalence in all regions of India except in the Southern region. Higher levels of knowledge about the role of condoms in HIV prevention and condom use were associated with low HIV prevalence at the district level. Conclusions: Considerable heterogeneity among factors associated with consistently high HIV prevalence at the district level in different regions of India necessitates special region-specific strategies for HIV control. Increasing awareness about HIV alone is not sufficient for controlling the HIV epidemic and there is a need to raise knowledge levels about preventive measures against HIV and promote the use of condoms amongst population. [ABSTRACT FROM AUTHOR]