bluuebunny/crossref_metadata_2025 huggingface dataset:
Synergetic effect of crystal nucleating agent and melt self-enhancement of isotactic polypropylene on its rheological and microcellular foaming properties
Authors: Zhang Xiaoli , Wang Xihuan , Dong Binbin , Zheng Guoqiang , Chen Jingbo , Shen Changyu , Park Chul B
Published: November 2020

Crystal nucleating agent Bis (3, 4- dimethylbenzylidene) sorbitol (DMDBS) was used to tune the melt strength and microcellular foaming properties of isotactic polypropylene (iPP) in this study. Rheological testing results reveal that the introduction of DMDBS could enhance the storage modulus and complex viscosity of iPP, obviously increase its crystallization onset temperature, compared to its counterparts without DMDBS. The addition of DMDBS could also significantly increase the cell nucleating ability of iPP, due to its large surface, cooperating with a thermal history control treatment. Quite fine microcellular iPP/DMDBS foams were fabricated with relatively small average cell sizes of nano to several micrometers, and cell densities up to 1011∼1012 cells/cm3, using the synergy effect of DMDBS and iPP’s melt self-enhancement. Under a comparatively low re-saturation pressure of 8 to 12 MPa, ideal microcellular foams could be generated, at a temperature zone of 158 to 162°C, which is slightly below to iPP’s original pellets nominal melting point.
Congenital right coronary artery-to-right ventricular outflow tract fistula device closure with migration: retrieval of device after eight years
Authors: Singh Jagjit , Singh Harkant
Published: November 2020

Coronary artery congenital fistulas are rare disorders. Transcatheter closure is the primary method of closure. Device migration is a known complication, for which surgical retrieval is required.
A Step to VAR: The Vision Science of Offside Calls by Video Assistant Referees
Authors: Mather George
Published: November 2020

The Video Assistant Referee (VAR) system has had a major impact on decision-making in professional association football. However, offside decisions remain a major area of dispute and debate, with over 34 goals ruled out in the first season of VAR in the Premier League. Evidence in vision science points toward two problems with the application of the offside law in VAR, due to their use of a live TV video feed in reviews. First, due to physical and perceptual limits on spatial resolution, there is a significant probability that the spatial positions of the ball and players as judged by VAR will be several centimetres to one side of their true positions. Second, the 50 Hz TV update rate means that judgements of the time-of-contact between player and ball will on average be 10 ms too late, which translates into an increased likelihood of offside calls in fast-moving play. Suggestions are made for how to compensate for these problems during decision-making.
Implementation of a highway wind power generation using vertical axis wind turbine to automatically power a street lamp
Authors: Sundaram Arunachalam , Almobasher Loiy , Al-Eid Mustafa , Bazroon Mustafa , Abohasson Ali
Published: November 2020

Vision 2030 of the Kingdom of Saudi Arabia envisions a shift towards renewable sources of energy. In accordance with this vision, we have developed an off-grid application using a vertical axis wind turbine (VAWT) to power a street lamp in a highway. VAWT are more suited for this application as they are easy to install than the horizontal axis wind turbine, can function with low-speed blades under varying wind speeds, and can prevail in the harsh weather condition prevailing in the Kingdom. MATLAB is utilized to design the circuit and to analyze the state of charge (SOC) of the battery under no load, varying load, and full load. Arduino based weather station and automatic control of street lamp are implemented to conserve energy. The model was tested in the highway and the test indicates the proposed model is able to harness power from wind to power the street lamp.
On the Impact of Income, Age, and Travel Distance on the Value of Time
Authors: Fournier Nicholas , Christofa Eleni
Published: November 2020

The value of time (VOT) is a fundamental component used in transportation modeling, policy analysis, and economic appraisal. Decades of research and practice have empirically estimated the VOT across many factors (e.g., mode, purpose, time, comfort, etc.), yet little is known about its underlying form. Although it is well established that VOT can vary, it is still unclear whether patterns exist in this variation. The objective of this paper is not to merely estimate the VOT, but to model the VOT across multiple continuous and interacting variables. The purpose is to reveal its functional form with respect to mode, age, gender, purpose, income, and time of day to provide a generalizable understanding for future research and practice. Such an understanding can help develop simpler models and reduce the need for bespoke estimations for every conceivable variable perturbation. This research utilized a household travel survey containing 14,159 reported trips with imputed travel time and costs for the alternative mode choices. The average overall estimated VOT is 40.32 $/h, with results showing VOT varying log-linearly with income and trip distance, but following a Gaussian function (normal curve) with age. Overall, the results show that travel distance dominates VOT variation, which increases exponentially at a rate that is 3.61 times higher per mile of distance than per $10,000 of income, and that VOT by age peaks at age 54. This basic understanding of how the VOT varies sets the foundation for answering the subsequent question for why it might vary.
Test Format and Calculator Use in the Testing of Basic Math Skills for Principles of Economics: Experimental Evidence
Authors: Fennell Melanie A. , Foster Irene R.
Published: November 2020

Results from an experiment in Fall 2013 of 902 incoming students at this university are reported. In this experiment, after students were given a basic math assessment to ensure they had the necessary math skills to take a principles of economics course, they were randomly allocated to a treatment or control group to test whether there was a significant impact of test format, calculator use, and calculator type on students’ scores. The interaction of calculator use/type and test format was also tested. The results from this experiment suggest that each treatment had a significant positive impact on students’ assessment scores, with much variation depending on the type of question asked and the level of performance.

JEL Classifications: A22, C23
“At Least I Didn’t Get Raped”: A Qualitative Exploration of IPV and Reproductive Coercion among Adolescent Girls Seeking Family Planning in Mexico
Authors: Uysal Jasmine , Stockman Jamila K. , Miller Elizabeth , Rocha-Jimenez Teresita , Rangel Gudelia M. , Mercado Alejandra Padilla , Servin Argentina E.
Published: November 2020

Adolescent girls who report intimate partner violence (IPV) are at an increased risk of experiencing reproductive coercion (RC); both these forms of gender-based violence (GBV) are associated with unintended pregnancy. Yet little is known about these experiences among adolescent girls in Mexico. Qualitative data were collected as part of formative research for the adaptation of an evidence-based intervention to address RC and IPV in community health centers in Tijuana, Mexico. From September, 2017 to January, 2018, adolescent girls aged 16 to 20 years old ( n = 20) seeking voluntary family planning (FP) services were identified and recruited from two publicly funded community health centers. We conducted semi-structured, in-depth interviews and analyzed the transcripts using inductive and deductive techniques. Participants in this sample commonly described experiencing IPV and RC (including pregnancy coercion and contraceptive sabotage), which many girls reported resulted in unintended pregnancy. Further, participants’ narratives and general lack of knowledge on how to cope with IPV or RC illuminated the acceptability of offering GBV prevention intervention within FP clinics serving this population. Findings highlight an urgent need to prevent IPV and RC, and reduce risk for unintended pregnancy among adolescent girls in this region and the potential of FP clinics to serve as a safe space for intervention delivery. Findings contribute to the limited qualitative evidence from Mexico, describing adolescent girl’s experiences of IPV and RC, strategies for preventing pregnancy in the context of RC, and opportunities for support from FP providers.
Properties of PMMA end cap holders affect FE stiffness predictions of vertebral specimens
Authors: Agostinho Hernandez Bruno , Gill Harinderjit S , Gheduzzi Sabina
Published: November 2020

Bone cement is often used, in experimental biomechanics, as a potting agent for vertebral bodies (VB). As a consequence, it is usually included in finite element (FE) models to improve accuracy in boundary condition settings. However, bone cement material properties are typically assigned to these models based on literature data obtained from specimens created under conditions which often differ from those employed for cement end caps. These discrepancies can result in solids with different material properties from those reported. Therefore, this study aimed to analyse the effect of assigning different mechanical properties to bone cement in FE vertebral models. A porcine C2 vertebral body was potted in bone cement end caps, [Formula: see text]CT scanned, and tested in compression. DIC was performed on the anterior surface of the specimen to monitor the displacement. Specimen stiffness was calculated from the load-displacement output of the materials testing machine and from the machine load output and average displacement measured by DIC. Fifteen bone cement cylinders with dimensions similar to the cement end caps were produced and subjected to the same compression protocol as the vertebral specimen and average stiffness and Young moduli were estimated. Two geometrically identical vertebral body FE models were created from the [Formula: see text]CT images, the only difference residing in the values assigned to bone cement material properties: in one model these were obtained from the literature and in the other from the cylindrical cement samples previously tested. The average Youngs modulus of the bone cement cylindrical specimens was 1177 ± 3 MPa, considerably lower than the values reported in the literature. With this value, the FE model predicted a vertebral specimen stiffness 3% lower than that measured experimentally, while when using the value most commonly reported in similar studies, specimen stiffness was overestimated by 150%.
Monetary Sanctions in Community Corrections: Law, Policy, and Their Alignment With Correctional Goals
Authors: Ruhland Ebony L. , Petkus Amber A. , Link Nathan W. , Hyatt Jordan M. , Holmes Bryan , Pate Symone
Published: November 2020

The assessment and collection of monetary sanctions (fines, fees, and restitution) have become a common element of the U.S. criminal justice system, especially in community corrections. Although the application of monetary sanctions is often dictated by state-level legislation, court rules, and agency policy, little research has sought to organize and systematically examine a set of these policies to compare them across several community corrections contexts more broadly. As such, this study fills a gap in the literature by using thematic content analysis to examine legislative policies governing the use of monetary sanctions in six states from across the United States. Laws and policies regarding the assessment, waiver, and collection of monetary sanctions utilized by agencies of varying size and jurisdictional scope were considered to identify common themes. We conclude with a discussion of whether the policies and laws examined align with rehabilitative and punitive goals of community supervision and highlight emerging opportunities for research and policy reform.
Speaking Truth to Power: Core Principles for Advancing International Journalism Education
Authors: Pavlik John V. , Alsaad Adnan Abu , Laufer Peter
Published: November 2020

A confluence of forces has brought journalism and journalism education to a precipice. The rise of fascism, the advance of digital technology, and the erosion of the economic foundation of news media are disrupting journalism and mass communication (JMC) around the world. Combined with the increasingly globalized nature of journalism and media, these forces are posing extraordinary challenges to and opportunities for journalism and media education. This essay outlines 10 core principles to guide and reinvigorate international JMC education. We offer a concluding principle for JMC education as a foundation for the general education of college students.
Life Planning and Habitus: Opportunities and Constraints Among Unaccompanied Young Refugees in Sweden
Authors: Lalander Philip , Herz Marcus
Published: November 2020

The article examines how unaccompanied young refugees in Sweden relate to and talk about their everyday lives and life plans during a time of transition from childhood to adulthood. We regard them as navigators and emotional beings embodying social situations, relationships and sentiments in their habitus throughout their lives affecting their life plans and acting to build capital in social fields. Their narratives show that they all have a life plan. However, disruptions and adjustments of life plans occur, often related to their birth families, deeply embodied in their habitus, to their everyday life, but also to socio-economic and political contexts both globally and locally. Their position as young ‘unaccompanied minors’ is fragile when it comes to realizing future goals. A stable social and economic structure, stability capital, appears to contribute to possibilities of adapting to or maintaining sustainable life plans.
Comparison between three protocols of corneal collagen crosslinking in adults with progressive keratoconus: Standard versus accelerated CXL for keratoconus
Authors: Beloshevski Boris , Shashar Sagi , Mimouni Michael , Novack Victor , Malyugin Boris E , Boiko Matthew , Knyazer Boris
Published: November 2020

Objective:

The study aimed to compare eye outcomes between the standard and accelerated corneal cross-linking (CXL) protocols over a 1-year follow-up, and assess whether the accelerated protocols are non-inferior to the standard.

Methods:

A retrospective cohort study including patients older than 18 years diagnosed with progressive keratoconus who underwent a CXL procedure. The primary outcome was defined as an increase of more than 1.5 diopter (D) in Kmax. The analysis included intra- and inter-group comparisons assessing differences in eye characteristics before and 12 months after the procedure. Furthermore, we assessed whether the accelerated procedures were non-inferior to the standard regarding Kmax change after 12 months.

Results:

Eighty-four patients included in the study of which 23, 37 and 23 underwent the standard CXL (group I), 10-min. (group II) and the 3-min. (group III) accelerated procedures, respectively. Intra-group comparison before and after 12 months of mean Ksteep and anterior corneal astigmatism showed significant improvement only for group I (–0.3D decrease for both). Inter-group comparison showed better results after 12 months for group I (–0.9 ± 1.2) compared to group III (0.1 ± 0.8) in Ksteep, Kmean (–0.5+1. vs 0.1+0.7, respectively) and anterior astigmatism (–0.5 + 0.9 vs 0.3+1.1, respectively). We could not declare that the accelerated CXLs are non-inferior to the standard ( p-value = 0.11 and 0.15).

Conclusion:

The standard CXL showed better results for keratometry and astigmatism in comparison with the accelerated. Therefore, the wide use of the accelerated CXL should be considered and reviewed for longer follow-up time and larger sample size in focus on the visual acuity parameters.
Towards a social work of home?
Authors: Buckland Rosie
Published: November 2020

This paper seeks to begin a consideration of the relationship between social work and home in the time of the Covid-19 global pandemic, where staying at home has become a matter of public health. It draws on my own experiences as a practising social worker as well as more personal reflections on the meaning of home, to suggest that social workers are uniquely placed to understand home. It suggests that despite this, we have perhaps lost sight of the emotional and spiritual necessity of home and that there are significant costs to doing so. As such, it calls for a re-centring of home within social work practice.
Amplified injustices and mutual aid in the COVID-19 pandemic
Authors: Bell Finn McLafferty
Published: November 2020

The COVID-19 pandemic has amplified existing injustices in the United States, which is exemplified in Ypsilanti, Michigan. However, the pandemic also provides an opportunity to re-imagine existing ways of being in the world, and mutual aid networks that have provided for people's basic needs during multiple crises while also working towards more radical change provide an opportunity for social workers to examine their relationship to “helping.” The author uses their personal experience with a local mutual aid network to examine the power and possibility of mutual aid, particularly in times of crisis, as well as sources of social work resistance to decentralized and non-professional forms of helping and caring. These lessons are carried beyond the COVID-19 pandemic to their consequences for the looming climate crisis.
Treatment of osteoporosis with a modified zeolite shows beneficial effects in an osteoporotic rat model and a human clinical trial
Authors: Kraljević Pavelić Sandra , Micek Vedran , Bobinac Dragica , Bazdulj Edo , Gianoncelli Alessandra , Krpan Dalibor , Žuvić Marta , Eisenwagen Sandra , Stambrook Peter J , Pavelić Krešimir
Published: November 2020

The severity of osteoporosis in humans manifests in its high incidence and by its complications that diminish quality of life. A societal consequence of osteoporosis is the substantial burden that it inflicts upon patients and their families. Several bone-modifying drugs have been prescribed to patients with osteoporosis. However, evidence for their anti-fracture efficacy remains inconclusive. To the contrary, long-term use of anti-osteoporotic drugs such as bisphosphonates and Denosumab, an RANKL inhibitor, have resulted in adverse events. We now present an alternative and adjuvant approach for treatment of osteoporosis. The data derive from in vivo studies in an ovariectomized rat model and from a randomized double blind, placebo-controlled human clinical study. Both studies involved treatment with Panaceo Micro Activation (PMA)-zeolite-clinoptilolite, a defined cation exchange clinoptilolite, which clearly improved all bone histomorphometric parameters examined from ovariectomized animals, indicative for increased bone formation. Moreover, intervention with PMA-zeolite-clinoptilolite for one year proved safe in humans. Furthermore, patients treated with PMA-zeolite-clinoptilolite showed an increase in bone mineral density, an elevated level of markers indicative of bone formation, a significant reduction in pain, and significantly improved quality of life compared with patients in the control (placebo) group. These encouraging positive effects of PMA-zeolite-clinoptilolite on bone integrity and on osteoporosis warrant further evaluation of treatment with PMA-zeolite-clinoptilolite as a new alternative adjuvant therapy for osteoporosis.
Depressive symptoms and suicidal ideation among Vietnamese students aged 13–17: Results from a cross-sectional study throughout four geographical regions of Vietnam
Authors: Tran Quynh Anh , Le Vu Thuy Huong , Nguyen Thi Hong Diem
Published: November 2020

We conducted a cross-sectional study in four provinces located in four different geographical areas in Vietnam to examine the prevalence and associated factors of depression and suicide ideation among school students aged 13–17. A sample of 6407 students from secondary school and high school participated in our survey to complete self-reported questionnaires. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression scale (CES-D). Suicidal ideation and associated factors were measured by the Global School Student Health Survey (GSHS) questionnaire. We found that 31.7% of students had depressive symptoms, and 11% reported suicidal ideation during the last year. Female students and older students were more at risk of experiencing depressive symptoms and suicidal ideation than male students and younger students. Bullying, violence, smoking, and alcohol consumption appear as risk factors, while a good relationship with parents/guardians may protect school students from having depressive symptoms and suicidal ideation.
Exploring narrative pedagogy: Story, teaching, and the development of virtue
Authors: Youngs Samuel
Published: November 2020

In our ever more connected and open-access world, the vocation of teaching continually strives to rearticulate its significance. This study contributes to such ventures by drawing upon recent theology, psychology, philosophy, and literary theory to envision instruction as a uniquely narratival and virtue-formative practice, especially in Christian educational contexts. Four distinctly narratival-pedagogical approaches are illustrated, followed by a discussion of their capability for instilling and cultivating diverse intellectual virtues.
Latent class distributional regression for the estimation of non-linear reference limits from contaminated data sources
Authors: Hepp Tobias , Zierk Jakob , Rauh Manfred , Metzler Markus , Mayr Andreas
Published: November 2020

Background

Medical decision making based on quantitative test results depends on reliable reference intervals, which represent the range of physiological test results in a healthy population. Current methods for the estimation of reference limits focus either on modelling the age-dependent dynamics of different analytes directly in a prospective setting or the extraction of independent distributions from contaminated data sources, e.g. data with latent heterogeneity due to unlabeled pathologic cases. In this article, we propose a new method to estimate indirect reference limits with non-linear dependencies on covariates from contaminated datasets by combining the framework of mixture models and distributional regression.

Results

Simulation results based on mixtures of Gaussian and gamma distributions suggest accurate approximation of the true quantiles that improves with increasing sample size and decreasing overlap between the mixture components. Due to the high flexibility of the framework, initialization of the algorithm requires careful considerations regarding appropriate starting weights. Estimated quantiles from the extracted distribution of healthy hemoglobin concentration in boys and girls provide clinically useful pediatric reference limits similar to solutions obtained using different approaches which require more samples and are computationally more expensive.

Conclusions

Latent class distributional regression models represent the first method to estimate indirect non-linear reference limits from a single model fit, but the general scope of applications can be extended to other scenarios with latent heterogeneity.
Positive selection alone is sufficient for whole genome differentiation at the early stage of speciation process in the fall armyworm
Authors: Nam Kiwoong , Nhim Sandra , Robin Stéphanie , Bretaudeau Anthony , Nègre Nicolas , d’Alençon Emmanuelle
Published: November 2020

Background

The process of speciation involves differentiation of whole genome sequences between a pair of diverging taxa. In the absence of a geographic barrier and in the presence of gene flow, genomic differentiation may occur when the homogenizing effect of recombination is overcome across the whole genome. The fall armyworm is observed as two sympatric strains with different host–plant preferences across the entire habitat. These two strains exhibit a very low level of genetic differentiation across the whole genome, suggesting that genomic differentiation occurred at an early stage of speciation. In this study, we aim at identifying critical evolutionary forces responsible for genomic differentiation in the fall armyworm.

Results

These two strains exhibit a low level of genomic differentiation (FST = 0.0174), while 99.2% of 200 kb windows have genetically differentiated sequences (FST > 0). We found that the combined effect of mild positive selection and genetic linkage to selectively targeted loci are responsible for the genomic differentiation. However, a single event of very strong positive selection appears not to be responsible for genomic differentiation. The contribution of chromosomal inversions or tight genetic linkage among positively selected loci causing reproductive barriers is not supported by our data. Phylogenetic analysis shows that the genomic differentiation occurred by sub-setting of genetic variants in one strain from the other.

Conclusions

From these results, we concluded that genomic differentiation may occur at the early stage of a speciation process in the fall armyworm and that mild positive selection targeting many loci alone is sufficient evolutionary force for generating the pattern of genomic differentiation. This genomic differentiation may provide a condition for accelerated genomic differentiation by synergistic effects among linkage disequilibrium generated by following events of positive selection. Our study highlights genomic differentiation as a key evolutionary factor connecting positive selection to divergent selection.
Treating HIV-associated cytomegalovirus retinitis with oral valganciclovir and intra-ocular ganciclovir by primary HIV clinicians in southern Myanmar: a retrospective analysis of routinely collected data
Authors: Murray Jillian , Hilbig Adelene , Soe Theint Thida , Ei Win Le Shwe Sin , Soe Kyi Pyar , Ciglenecki Iza
Published: November 2020

Background

Cytomegalovirus retinitis (CMVR) is an opportunistic infection in HIV-infected people. Intraocular or intravenous ganciclovir was gold standard for treatment; however, oral valganciclovir replaced this in high-income countries. Low- and middle-income countries (LMIC) frequently use intraocular injection of ganciclovir (IOG) alone because of cost.

Methods

Retrospective review of all HIV-positive patients with CMVR from February 2013 to April 2017 at a Médecins Sans Frontièrs HIV clinic in Myanmar. Treatment was classified as local (IOG) or systemic (valganciclovir, or valganciclovir and IOG). The primary outcome was change in visual acuity (VA) post-treatment. Mortality was a secondary outcome.

Results

Fifty-three patients were included. Baseline VA was available for 103 (97%) patient eyes. Active CMVR was present in 72 (68%) eyes. Post-treatment, seven (13%) patients had improvement in VA, 30 (57%) had no change, and three (6%) deteriorated. Among patients receiving systemic therapy, four (12.5%) died, compared with five (24%) receiving local therapy (p = 0.19).

Conclusions

Our results from the first introduction of valganciclovir for CMVR in LMIC show encouraging effectiveness and safety in patients with advanced HIV. We urge HIV programmes to include valganciclovir as an essential medicine, and to include CMVR screening and treatment in the package of advanced HIV care.
Nurse-led advance care planning with older people who have end-stage kidney disease: feasibility of a deferred entry randomised controlled trial incorporating an economic evaluation and mixed methods process evaluation (ACReDiT)
Authors: O’Halloran Peter , Noble Helen , Norwood Kelly , Maxwell Peter , Murtagh Fliss , Shields Joanne , Mullan Robert , Matthews Michael , Cardwell Christopher , Clarke Mike , Morton Rachael , Shah Karan , Forbes Trisha , Brazil Kevin
Published: November 2020

Background

Advance Care Planning is recommended for people with end-stage kidney disease but evidence is limited. Robust clinical trials are needed to investigate the impact of advance care planning in this population. There is little available data on cost-effectiveness to guide decision makers in allocating resources for advance care planning. Therefore we sought to determine the feasibility of a randomised controlled trial and to test methods for assessing cost-effectiveness.

Methods

A deferred entry, randomised controlled feasibility trial, incorporating economic and process evaluations, with people with end-stage kidney disease, aged 65 years or older, receiving haemodialysis, in two renal haemodialysis units in Northern Ireland, UK. A nurse facilitator helped the patient make an advance care plan identifying: a surrogate decision-maker; what the participant would like to happen in the future; any advance decision to refuse treatment; preferred place of care at end-of-life.

Results

Recruitment lasted 189 days; intervention and data collection 443 days. Of the 67 patients invited to participate 30 (45%) declined and 36 were randomised to immediate or deferred advance care plan groups. Twenty-two (61%) made an advance care plan and completed data collection at 12 weeks; 17 (47.2%) were able to identify a surrogate willing to be named in the advance care plan document. The intervention was well-received and encouraged end-of-life conversations, but did not succeed in helping patients to fully clarify their values or consider specific treatment choices. There was no significant difference in health system costs between the immediate and deferred groups.

Conclusions

A trial of advance care planning with participants receiving haemodialysis is feasible and acceptable to patients, but challenging. A full trial would require a pool of potential participants five times larger than the number required to complete data collection at 3 months. Widening eligibility criteria to include younger (under 65 years of age) and less frail patients, together with special efforts to engage and retain surrogates may improve recruitment and retention. Traditional advance care planning outcomes may need to be supplemented with those that are defined by patients, helping them to participate with clinicians in making medical decisions.

Trial registration

Registered December 16, 2015. ClinicalTrials.gov Identifier:NCT02631200.
Feature-driven classification reveals potential comorbid subtypes within childhood apraxia of speech
Authors: Stein Catherine M. , Benchek Penelope , Miller Gabrielle , Hall Noémi B. , Menon Dhanya , Freebairn Lisa , Tag Jessica , Vick Jennell , Taylor H. Gerry , Lewis Barbara A. , Iyengar Sudha K.
Published: November 2020

Background

Childhood apraxia of speech (CAS) is a neurodevelopmental disorder with heterogeneous communication and other comorbid manifestations. While previous studies have characterized speech deficits associated with CAS, few studies have examined variability in reading and language and/or other developmental comorbidities. We sought to identify comorbid subgroups within CAS that could be clinically relevant as well as genetically distinctive.

Methods

In a group of 31 children with CAS and 8 controls, we performed hierarchical cluster analysis utilizing measures of articulation, vocabulary, and reading. We also conducted a chart review of the children with CAS to examine other clinical characteristics in these children and their association with subgroup membership.

Results

We identified 3 comorbid subgroups within CAS of varying severity. The high severity subgroup was characterized by poor reading and vocabulary, and the moderate severity subgroup by poor reading and non-word repetition but average vocabulary, compared to the mild severity subgroup. Subgroups were indistinguishable with respect to speech sound production, the hallmark of CAS, all demonstrating poor articulation. Children in the most severe subgroup were more likely to have early problems feeding (p = 0.036).

Conclusions

Children with CAS may potentially be classified into comorbidity groups based on performance on vocabulary and reading measures, providing additional insight into the heterogeneity within CAS with implications for educational interventions.
Readability of online COVID-19 health information: a comparison between four English speaking countries
Authors: Worrall Amy P. , Connolly Mary J. , O’Neill Aine , O’Doherty Murray , Thornton Kenneth P. , McNally Cora , McConkey Samuel J. , de Barra Eoghan
Published: November 2020

Background

The internet is now the first line source of health information for many people worldwide. In the current Coronavirus Disease 2019 (COVID-19) global pandemic, health information is being produced, revised, updated and disseminated at an increasingly rapid rate. The general public are faced with a plethora of misinformation regarding COVID-19 and the readability of online information has an impact on their understanding of the disease. The accessibility of online healthcare information relating to COVID-19 is unknown. We sought to evaluate the readability of online information relating to COVID-19 in four English speaking regions: Ireland, the United Kingdom, Canada and the United States, and compare readability of website source provenance and regional origin.

Methods

The Google® search engine was used to collate the first 20 webpage URLs for three individual searches for ‘COVID’, ‘COVID-19’, and ‘coronavirus’ from Ireland, the United Kingdom, Canada and the United States. The Gunning Fog Index (GFI), Flesch-Kincaid Grade (FKG) Score, Flesch Reading Ease Score (FRES), Simple Measure of Gobbledygook (SMOG) score were calculated to assess the readability.

Results

There were poor levels of readability webpages reviewed, with only 17.2% of webpages at a universally readable level. There was a significant difference in readability between the different webpages based on their information source (p < 0.01). Public Health organisations and Government organisations provided the most readable COVID-19 material, while digital media sources were significantly less readable. There were no significant differences in readability between regions.

Conclusion

Much of the general public have relied on online information during the pandemic. Information on COVID-19 should be made more readable, and those writing webpages and information tools should ensure universal accessibility is considered in their production. Governments and healthcare practitioners should have an awareness of the online sources of information available, and ensure that readability of our own productions is at a universally readable level which will increase understanding and adherence to health guidelines.
Design and impact evaluation of a digital reproductive health program in Rwanda using a cluster randomized design: study protocol
Authors: Nolan Cara , Packel Laura , Hope Rebecca , Levine Jordan , Baringer Laura , Gatare Emmyson , Umubyeyi Aline , Sayinzoga Felix , Mugisha Michael , Turatsinze Janepher , Naganza Aimee , Idelson Laiah , Bertozzi Stefano , McCoy Sandra
Published: November 2020

Background

Rwandan adolescents have limited access to high-quality family planning and reproductive health (FP/RH) information and care to prevent unplanned pregnancy and HIV/STIs. In addition to the immediate implications for health and well-being, teenage pregnancy is a significant cause of school drop-out, limiting girls’ future potential and employment opportunities. This study introduces a direct-to-consumer digital education program that uses storytelling to deliver age-appropriate FP/RH information and economic empowerment training to adolescents. It also facilitates access to high-quality, youth-friendly FP/RH care and products. We evaluate two different school-based models of its implementation to understand how to optimize the uptake of contraception and HIV testing among adolescents.

Methods

The study consists of two distinct phases. The first formative intervention design phase, conducted from 2016 to 2019, used a human-centered design methodology to develop the intervention alongside over 600 Rwandan adolescents, their parents, teachers, and healthcare providers. Through this methodology, we sought to maximize the fit between evidence-based practices (uptake of modern contraception and HIV testing) and the implementation context of adolescents in Rwanda. The second phase is an impact evaluation, in which we will use a Hybrid Trial Type 2 Effectiveness-Implementation study design to determine the overall effectiveness of this digital intervention as well as the relative effectiveness of the two different school-based implementation models. This takes the form of a 3-arm cluster-randomized non-inferiority trial, with a sample of 6000 youth aged 12–19 in 60 schools across 8 districts in Rwanda. Primary outcome measures include use of modern contraception, delayed initiation of childbearing, and uptake of HIV testing.

Discussion

This study will yield insights into not only whether this digital intervention is successful in achieving the intended sexual and reproductive health outcomes, but also which mechanisms are likely to drive this effectiveness. The methodologies used are broadly applicable to the design, implementation, and evaluation of other behavior-based health programs in low and middle-income countries.

Trial registration

ClinicalTrials.gov Identifier: NCT04198272. Prospectively registered 13 December 2019.
Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of seven communities in East and West Africa (SevenCEWA)
Authors: Okello Samson , Muhihi Alfa , Mohamed Shukri F. , Ameh Soter , Ochimana Caleb , Oluwasanu Abayomi Olabayo , Bolarinwa Oladimeji Akeem , Sewankambo Nelson , Danaei Goodarz
Published: November 2020

Background

Few studies have characterized the epidemiology and management of hypertension across several communities with comparable methodologies in sub-Saharan Africa. We assessed prevalence, awareness, treatment, and control of hypertension and predicted 10-year cardiovascular disease risk across seven sites in East and West Africa.

Methods

Between June and August 2018, we conducted household surveys among adults aged 18 years and above in 7 communities in Kenya, Nigeria, Tanzania, and Uganda. Following a standardized protocol, we collected data on socio-demographics, health insurance, and healthcare utilization; and measured blood pressure using digital blood pressure monitors. We estimated the 10-year cardiovascular disease (CVD) risk using a country-specific risk score and fitted hierarchical models to identify determinants of hypertension prevalence, awareness, and treatment.

Results

We analyzed data of 3549 participants. The mean age was 39·7 years (SD 15·4), 60·5% of whom were women, 9·6% had ever smoked cigarettes, and 32·7% were overweight/obese. A quarter of the participants (25·4%) had hypertension, more than a half of whom (57·2%) were aware that they had diagnosed hypertension. Among those diagnosed, 50·5% were taking medication, and among those taking medication 47·3% had controlled blood pressure. After adjusting for other determinants, older age was associated with increased hypertension prevalence, awareness, and treatment whereas primary education was associated with lower hypertension prevalence. Health insurance was associated with lower hypertension prevalence and higher chances of treatment. Median predicted 10-yr CVD risk across sites was 4·9% (Interquartile range (IQR), 2·4%, 10·3%) and 13·2% had predicted 10-year CVD risk of 20% or greater while 7·1% had predicted 10-year CVD risk of > 30%.

Conclusion

In seven communities in east and west Africa, a quarter of participants had hypertension, about 40% were unaware, half of those aware were treated, and half of those treated had controlled blood pressure. The 10-year predicted CVD risk was low across sites. Access to health insurance is needed to improve awareness, treatment, and control of hypertension in sub-Saharan Africa.
Effects of a spatially heterogeneous nutrient distribution on the growth of clonal wetland plants
Authors: Yu Hongwei , Wang Ligong , Liu Chunhua , Yu Dan , Qu Jiuhui
Published: November 2020

Background

Clonal plants are important in maintaining wetland ecosystems. The main growth types of clonal plants are the guerrilla and phalanx types. However, little is known about the effects of these different clonal growth types on plant plasticity in response to heterogeneous resource distribution. We compared the growth performance of clonal wetland plants exhibiting the two growth forms (guerrilla growth form:Scirpus yagara,Typha orientalis,Phragmites australisandSparganium stoloniferum; phalanx growth form:Acorus calamus,Schoenoplectus tabernaemontaniandButomus umbellatus) grown in soil substrates that were either homogeneous or heterogeneous but had the same total amount of nutrients.

Results

We found that the morphological traits (plant height, ramet number, spacer diameter and length) and biomass accumulation of the guerrilla clonal plants (T. orientalis) were significantly enhanced by heterogeneity, but those of the phalanx clonal plants (A. calamus,S. tabernaemontaniandB. umbellatus) were not. The results showed that the benefits of environmental heterogeneity to clonal plants may be correlated with the type of clonal structure.

Conclusions

Guerrilla clonal plants, which have a dispersed, flexible linear structure, are better suited to habitats with heterogeneous resources. Phalanx clonal plants, which form compact structures, are better suited to habitats with homogeneous resources. Thus, wetland clonal species with the guerrilla clonal structure benefit more from soil nutrient heterogeneity.
Peer-led pediatric resuscitation training: effects on self-efficacy and skill performance
Authors: Binkhorst M. , Draaisma J M Th , Benthem Y. , van de Pol E. M. R. , Hogeveen M. , Tan E. C. T. H.
Published: November 2020

Background

Peer-led basic life support training in medical school may be an effective and valued way of teaching medical students, yet no research has been conducted to evaluate the effect on the self-efficacy of medical students. High self-efficacy stimulates healthcare professionals to initiate and continue basic life support despite challenges.

Methods

A randomized controlled trial, in which medical students received pediatric basic life support (PBLS) training, provided by either near-peer instructors or expert instructors. The students were randomly assigned to the near-peer instructor group (n = 105) or expert instructor group (n = 108). All students received two hours of PBLS training in groups of approximately 15 students. Directly after this training, self-efficacy was assessed with a newly developed questionnaire, based on a validated scoring tool. A week after each training session, students performed a practical PBLS exam and completed another questionnaire to evaluate skill performance and self-efficacy, respectively.

Results

Students trained by near-peers scored significantly higher on self-efficacy regarding all aspects of PBLS. Theoretical education and instructor feedback were equally valued in both groups. The scores for the practical PBLS exam and the percentage of students passing the exam were similar in both groups.

Conclusions

Our findings point towards the fact that near-peer-trained medical students can develop a higher level of PBLS-related self-efficacy than expert-trained students, with comparable PBLS skills in both training groups. The exact relationship between peer teaching and self-efficacy and between self-efficacy and the quality of real-life pediatric resuscitation should be further explored.

Trial registration

ISRCTN,ISRCTN69038759. Registered December 12th, 2019 – Retrospectively registered.
Correction to: “It is this very knowledge that makes us doctors”: an applied thematic analysis of how medical students perceive the relevance of biomedical science knowledge to clinical medicine
Authors: Dickinson Bonny L. , Gibson Kristine , VanDerKolk Kristi , Greene Jeffrey , Rosu Claudia A. , Navedo Deborah D. , Porter-Stransky Kirsten A. , Graves Lisa E.
Published: November 2020

An amendment to this paper has been published and can be accessed via the original article.
Data cleaning process for HIV-indicator data extracted from DHIS2 national reporting system: a case study of Kenya
Authors: Gesicho Milka Bochere , Were Martin Chieng , Babic Ankica
Published: November 2020

Background

The District Health Information Software-2 (DHIS2) is widely used by countries for national-level aggregate reporting of health-data. To best leverage DHIS2 data for decision-making, countries need to ensure that data within their systems are of the highest quality. Comprehensive, systematic, and transparent data cleaning approaches form a core component of preparing DHIS2 data for analyses. Unfortunately, there is paucity of exhaustive and systematic descriptions of data cleaning processes employed on DHIS2-based data. The aim of this study was to report on methods and results of a systematic and replicable data cleaning approach applied on HIV-data gathered within DHIS2 from 2011 to 2018 in Kenya, for secondary analyses.

Methods

Six programmatic area reports containing HIV-indicators were extracted from DHIS2 for all care facilities in all counties in Kenya from 2011 to 2018. Data variables extracted included reporting rate, reporting timeliness, and HIV-indicator data elements per facility per year. 93,179 facility-records from 11,446 health facilities were extracted from year 2011 to 2018. Van den Broeck et al.’s framework, involving repeated cycles of a three-phase process (data screening, data diagnosis and data treatment), was employed semi-automatically within a generic five-step data-cleaning sequence, which was developed and applied in cleaning the extracted data. Various quality issues were identified, and Friedman analysis of variance conducted to examine differences in distribution of records with selected issues across eight years.

Results

Facility-records with no data accounted for 50.23% and were removed. Of the remaining, 0.03% had over 100% in reporting rates. Of facility-records with reporting data, 0.66% and 0.46% were retained for voluntary medical male circumcision and blood safety programmatic area reports respectively, given that few facilities submitted data or offered these services. Distribution of facility-records with selected quality issues varied significantly by programmatic area (p < 0.001). The final clean dataset obtained was suitable to be used for subsequent secondary analyses.

Conclusions

Comprehensive, systematic, and transparent reporting of cleaning-process is important for validity of the research studies as well as data utilization. The semi-automatic procedures used resulted in improved data quality for use in secondary analyses, which could not be secured by automated procedures solemnly.