bluuebunny/crossref_metadata_2025 huggingface dataset:
The Value of Monomer Hydrogen Proton Magnetic Resonance Spectra in the Diagnosis of Liver Benign and Malignant Lesions
Authors: Li Yongsheng , Zhang Yuguang , Zhang Xia
Published: September 2020

The early diagnosis and treatment of liver disease are very important in clinics. Magnetic resonance spectroscopy (MRS) provides a non-invasive 'window' on the biochemical processes in the body. This study deployed research based on application of monomer element 1HMRS in
the diagnosis of benign or malignant liver lesions. Patients with different liver diseases were recruited along with healthy controls. GE Signa Twinspeed 1.5T MRI was performed on livers along with monomeric hydrogen MRS, followed by SAGE software analysis. In healthy patient's livers, both
choline and lipid peaks were observed under MRS, with occasionally glutamine and glutamic acid complex (Glx) peak and glucogen and glucose complex (Glu) peak. Malignant liver lesions had significantly elevated choline peak and choline/lipid ratio compared to control or benign lesions (P
< 0.05). The accuracy, sensitivity and specificity of MRI against malignant tumors were 89.4%, 86.2% and 91.1%, respectively. These figures for choline/lipid and MRI plus choline/lipid were 87.2%, 92.3% and 90.1%, and 94.1%, 89.1% and 90.4%, respectively. Our study shows that monomeric
hydrogen proton MRS might be used as the diagnostic evidences for malignant liver diseases, especially for choline peak level and choline/lipid ratio. However, large cohort multi-center study is required to confirm the findings in the future.
Trends in Gender Disparities Among High-Achieving Students in Mathematics: An Analysis of the American Mathematics Competition (AMC)
Authors: Bahar A. Kadir
Published: September 2020

Using the test scores of more than 2,250,000 students who participated in the American Mathematics Competitions (AMC) from 2009 to 2019, this study examined the direction and magnitude of the trends in gender disparity in participation and high achievement in self-select mathematics exams. The results of this study indicated that the male to female ratio among the AMC participants increased significantly from 2009 to 2019. The findings also showed an established disparity that favored males for each year and for all competitions in both the top 1% and 5% levels, while the trend in the male to female ratios over a decade was stable, except for the top 1% of the population in the AMC 8, in which there was a significant increasing trend that favored males. The possible impacts of these findings within the context of the underrepresentation of women in STEM (science, technology, engineering, and mathematics) fields are discussed.
Dreaming with drones: Palestine under the shadow of unseen war
Authors: Kanwal Aroosa
Published: September 2020

This article discusses how the first-person genre, especially a Gazan wartime diary, allows both writer and reader to imagine new possibilities for understanding contemporary colonial drone warfare, which is instrumental in the strategic silencing and invisibilization of war victims. By creating this zone of invisibilization (one that I will name the “dronesphere”) through obfuscating loss of life, war perpetrators aim to drown out the voices of opposition and resistance in Gaza. This is precisely why an increasing autonomy of military technologies that I call the “anthropomorphizing of drones” has triggered fierce debates over the unaccountability for war crimes committed against those on the receiving end of such autonomous weaponry. One specific case that deserves serious attention in this regard is the deafening silence surrounding Israel’s use of lethal drones to assassinate people in Palestine, which has led to the strategic silencing and invisibility of Palestinian deaths and a struggle for survival through the use of top-down control via drones in the region. However, Atef Abu Saif’s use of “strategic anthropomorphism” in his wartime diary The Drone Eats with Me: A Gaza Diary does not grant the drone absolute autonomy in death-dealing but imagines Drone as a fictional character. Instead, the execution of Gazans is presented as a prolonged reconnaissance performance, which not only allows Gazans to see drones as an extension of (absent) drone operators’ bodies, but also to register their protest against the Israeli authorities by imagining Drone as a living entity. Therefore, using the authority of direct experience that Youval Noah Harari calls “flesh witnessing” (2008), Abu Saif’s wartime diary enables the formation of Palestinian subjectivities held under the sign of erasure, thereby claiming their rights as social and political human bodies.
Animals, others, and postcolonial ecomasculinities: Nadeem Aslam’s The Blind Man’s Garden
Authors: Rahman Shazia
Published: September 2020

Nadeem Aslam’s novel The Blind Man’s Garden (2013) describes the post-9/11 international conflict in Afghanistan and its effect on a Pakistani character named Mikal, who ends up imprisoned and tortured by both Afghan warlords and American soldiers and remains especially cognizant of the multispecies nature of our world. In this article, I argue that even though the novel presents the toxic effects of hegemonic masculinity by depicting war, it also provides an alternative. In particular, Mikal, with his non-hierarchical response to the War on Terror, gender equity, and nonhuman animals, models much-needed helpful rather than harmful behaviours. I call this stance postcolonial ecomasculinity and link it to the way in which a snow leopard cub influences Mikal’s decision to rescue a US soldier by risking his own life and wellbeing. Even though the US soldier also befriends the same snow leopard cub, his hegemonic masculine desire for dominance makes it difficult for him to overcome his ethnocentrism. Similarly, Aslam’s novel depicts Rohan, who identifies with and appreciates nonhuman birds and trees, but because of his patriarchal privilege cannot see the ways in which women are also oppressed. As the novel ends, its women characters provide hope for Rohan, the blind man, to navigate through the garden, which is Pakistan, using a rope walk to connect Rohan to the plants and trees in the garden. These connections are symbolic of lessons in egalitarian masculinity, teaching not only Rohan but also two young boys how to live without domination and violence. As a result, we are left with images of pathways which broaden our vision of masculinity beyond the stereotypical.
“Holding the Line”: Investigating How Urban School Leaders’ Respond to Gentrification in New York City Schools
Authors: Roda Allison
Published: September 2020

This case study investigated how three New York City schools responded to gentrification’s effects as student demographics shifted. I used the conceptual framework of urban school leaders as cultural workers to examine the tensions, successes, and challenges inherent in the school gentrification and integration process. I found that each school leader defied the school gentrification narrative by “holding the line” in terms of preserving diversity, cultivating integration, and counterbalancing the opportunity hoarding behaviors of White, advantaged parents. The results have implications for urban school leaders who want to be agents of change by leveraging gentrification’s effects into positive results.
Human capital divergence and the size distribution of cities: Is Gibrat’s law obsolete?
Authors: Broxterman Daniel , Yezer Anthony
Published: September 2020

This article studies how the changing geographic distribution of skilled workers in the US affects theoretical models that use Gibrat’s law to explain the size distribution of cities. In the empirical literature, a divergence hypothesis holds that college share increases faster in cities where college share is larger, and a growth hypothesis maintains that the rate of city population growth is also directly related to initial college share. Examining the divergence hypothesis, the classic test for Gibrat’s law is shown to be a test for [Formula: see text]-convergence. Testing shows that there has been absolute, not relative, divergence in human capital since the 1970s. However, the combination of even absolute divergence and the growth hypothesis is shown to violate the condition that a city’s population growth is independent of its size. Additional testing finds that the relation between college share and city growth is concave rather than monotonic. These results imply that stochastic growth models can survive the challenge posed by divergence in the distribution of human capital.
The (de)territorialised appeal of international schools in China: Forging brands, boundaries and inter-belonging in segregated urban space
Authors: Kong Lily , Woods Orlando , Zhu Hong
Published: September 2020

This paper considers how the (de)territorialised appeal of international schools in China can reflect, enforce and expand pre-existing patterns of urban segregation. Whilst exploration of the effects of educational marketplaces on urban environments has become a focus of scholarly research, the recent expansion in the supply of, and demand for, international education has caused these effects to become more nuanced. As (de)territorialised entities, international schools can cause multiple forms of spatial and psycho-social distinction and (dis)association to become intertwined, the effects of which start from the school and radiate out from there. International schools can therefore cause segregation to become a structurally entrenched phenomenon. These ideas are illustrated through an empirical examination of three international schools located in the eastern Chinese city of Suzhou. We explore the ways in which these schools are branded spaces that reproduce socio-spatial boundaries and thus foster a (de)territorialised sense of inter-belonging amongst their students.
How Adolescents Think When Responding to Alcohol-Related Questionnaires: A Think-Aloud Study
Authors: Nehlin Christina , Carlsson Kristina , Öster Caisa
Published: September 2020

Self-report questionnaires on alcohol use are commonly used in both research and in clinical work with adolescents, but little is known about how adolescent responders perceive and interpret them. This study explores how adolescents think while responding to two alcohol-related questionnaires. It also investigates whether the instruments can initiate self-reflective processes on alcohol use. Data were collected among adolescents visiting a center for young people with substance use problems in Sweden. The participants found the questionnaires easy to complete and widely relevant, and the questionnaires commonly initiated a process of self-reflection. Results support the use in clinical settings.
A Relational Turbulence Model of Sexual Communication in Couples With Depression
Authors: Delaney Amy L.
Published: September 2020

Couples coping with depression are prone to unique and pervasive sexual intimacy challenges and experience troubles communicating effectively. Successful sexual communication improves sexual and relationship satisfaction, making communication particularly important for couples facing sexual difficulties. In this study, the relational turbulence model serves as a framework to examine associations between sexual communication and both sexual and relationship satisfaction in couples ( N = 106) in which one or both partners live with depression. Results of a cross-sectional survey suggest sexual communication mediates relationships between both relational uncertainty and interference from a partner with sexual/relationship satisfaction. Results illuminate functions of communication about sex as couples navigate sexual and relational effects of depression.
Age-Related Differences in Mood, Diabetes-Related Distress, and Functional Outcomes in Adults With Type 2 Diabetes Mellitus and Comorbid Obstructive Sleep Apnea and Insomnia
Authors: Jeon Bomin , Sereika Susan M. , Callan Judith A. , Luyster Faith S. , DiNardo Monica M. , Chasens Eileen R.
Published: September 2020

Purpose

The purpose of this study was to examine age-related differences in mood, diabetes-related distress, and functional outcomes in activities sensitive to impaired sleep in adults with type 2 diabetes mellitus (T2DM) and comorbid obstructive sleep apnea (OSA) and insomnia. This study also evaluated the associations of age, insomnia severity, and OSA severity on outcome variables.

Methods

This study was a secondary analysis of pooled baseline data from 2 randomized controlled trials among adults with T2DM with symptoms of sleep disorders (N = 145,109 younger adults, 36 older adults; 46.2% male; 67.6% white). Comorbid OSA and insomnia was defined as Apnea-Hypopnea Index ≥5 events per hour and Insomnia Severity Index ≥10. Outcome variables included mood, diabetes-related distress, and functional outcomes.

Results

Older adults reported better mood, lower diabetes-related distress, and higher functional outcomes relative to younger adults (all Ps < .05). Insomnia severity was associated with worse mood ( b = 2.59, P < .001) and diabetes-related distress ( b = 1.40, P < .001) and lower functional outcome ( b = −0.22, P < .001). Older age was associated with lower diabetes-related distress ( b = −0.44, P = .040).

Conclusion

Older age was a protective factor of mood disturbance, diabetes-related distress, and functional impairment in adults with T2DM and comorbid OSA and insomnia. Insomnia severity was associated with greater mood disturbance, diabetes-related distress, and functional impairment when OSA and insomnia coexist. The results suggest that diabetes care and education specialists should assess patients for impaired sleep.
Fully Automatic Measurement of Intima-Media Thickness in Ultrasound Images of the Common Carotid Artery Based on Improved Otsu’s Method and Adaptive Wind Driven Optimization
Authors: Wang Kun , Pu Yuanyuan , Zhang Yufeng , Wang Pei
Published: September 2020

The intima media thickness (IMT) of the common carotid artery (CCA) can be used to predict the risk of atherosclerosis. Many image segmentation techniques have been used for IMT measurement. However, severe noise in the ultrasound image can lead to erroneous segmentation results. To improve the robustness to noise, a fully automatic method, based on an improved Otsu’s method and an adaptive wind-driven optimization technique, is proposed for estimating the IMT (denoted as “improved Otsu-AWDO”). First, an advanced despeckling filter, i.e., “ Nagare’s filter” is used to address the speckle noise in the carotid ultrasound images. Next, an improved fuzzy contrast method (IFC) is used to enhance the region of the intima media complex (IMC) in the blurred filtered images. Then, a new method is used for automatic extraction of the region of interest (ROI). Finally, the lumen intima interface and media adventitia interface are segmented from the IMC using improved Otsu-AWDO. Then, 156 B-mode longitudinal carotid ultrasound images of six different datasets are used to evaluate the performance of the automatic measurements. The results indicate that the absolute error of proposed method is only 10.1 ± 9.6 (mean ± std in μm). Moreover, the proposed method has a correlation coefficient as high as 0.9922, and a bias as low as 0.0007. From comparison with previous methods, we can conclude that the proposed method has strong robustness and can provide accurate IMT estimations.
Caregivers’ Information Overload and Their Personal Health Literacy
Authors: Kim Sujin
Published: September 2020

Caregivers may receive information at a rate far higher than their individual abilities to process. Hence, caregivers can cause less desirable health outcomes for their care recipients. This study sought to identify caregiver information overload in comparison to noncaregivers. Relating factors such as caregiving contexts, health status, and personal health literacy were also compared between caregivers and noncaregivers. Using a nationally representative survey, the Health Information National Trends Survey, the differences between caregivers and noncaregivers regarding information overload were compared. A total of 2,918 noncaregivers and 484 caregivers were identified. More than two-thirds of the study sample demonstrated information overload regardless of caregiving status. Male, less educated, lower income, married, and employed caregivers are likely overloaded with information. Caregivers with information overload show less healthy conditions and expressed more information seeking burden. Effective countermeasures of heavy information overload should be devised based on specific causes and their accompanying consequences.
The Impact of Including Costs and Outcomes of Dementia in a Health Economic Model to Evaluate Lifestyle Interventions to Prevent Diabetes and Cardiovascular Disease
Authors: Breeze Penny , Thomas Chloe , Thokala Praveen , Lafortune Louise , Brayne Carol , Brennan Alan
Published: September 2020

Objectives

Economic evaluations of lifestyle interventions, which aim to prevent diabetes/cardiovascular disease (CVD), have not included dementia. Lifestyle interventions decrease dementia risk and extend life expectancy, leading to competing effects on health care costs. We aim to demonstrate the feasibility of including dementia in a public health cost-effectiveness analysis and quantify the overall impacts accounting for these competing effects.

Methods

The School for Public Health Research (SPHR) diabetes prevention model describes individuals’ risk of type 2 diabetes, microvascular outcomes, CVD, congestive heart failure, cancer, osteoarthritis, depression, and mortality in England. In version 3.1, we adapted the model to include dementia using published data from primary care databases, health surveys, and trials of dementia to describe dementia incidence, diagnosis, and disease progression. We estimate the impact of dementia on lifetime costs and quality-adjusted life years (QALYs) gained of the National Health Service diabetes prevention program (NHS DPP) from an NHS/personal social services perspective with 3 scenarios: 1) no dementia, 2) dementia only, and 3) reduced dementia risk. Subgroup, parameter, and probabilistic sensitivity analyses were conducted.

Results

The lifetime cost savings of the NHS DPP per patient were £145 in the no-dementia scenario, £121 in the dementia-only scenario, and £167 in the reduced dementia risk scenario. The QALY gains increased by 0.0006 in dementia only and 0.0134 in reduced dementia risk. Dementia did not alter the recommendation that the NHS/DPP is cost-effective.

Conclusions

Including dementia into a model of lifestyle interventions was feasible but did not change policy recommendations or modify health economic outcomes. The impact on health economic outcomes was largest where a direct impact on dementia incidence was assumed, particularly in elderly populations.
Estimating Downstream Budget Impacts in Implementation Research
Authors: Wagner Todd H. , Dopp Alex R. , Gold Heather T.
Published: September 2020

Health care decision makers often request information showing how a new treatment or intervention will affect their budget (i.e., a budget impact analysis; BIA). In this article, we present key topics for considering how to measure downstream health care costs, a key component of the BIA, when implementing an evidence-based program designed to reduce a quality gap. Tracking health care utilization can be done with administrative or self-reported data, but estimating costs for these utilization data raises 2 issues that are often overlooked in implementation science. The first issue has to do with applicability: are the cost estimates applicable to the health care system that is implementing the quality improvement program? We often use national cost estimates or average payments, without considering whether these cost estimates are appropriate. Second, we need to determine the decision maker’s time horizon to identify the costs that vary in that time horizon. If the BIA takes a short-term time horizon, then we should focus on costs that vary in the short run and exclude costs that are fixed over this time. BIA is an increasingly popular tool for health care decision makers interested in understanding the financial effect of implementing an evidence-based program. Without careful consideration of some key conceptual issues, we run the risk of misleading decision makers when presenting results from implementation studies.
Chinese Middle-Aged and Older Adults’ Internet Use and Happiness: The Mediating Roles of Loneliness and Social Engagement
Authors: Xu Yi , Huang Yijie
Published: September 2020

Little research has examined the effects of internet use in promoting well-being among middle-aged and older people using large-scale samples in developing countries. Using a subsample of a national survey with 4,083 adults aged 50 years and above, we explored this topic in China. Internet users were found to be significantly younger, more educated, with a higher SES, and more likely to live in urban areas. Structural equation modeling showed that internet use was indirectly associated with higher levels of happiness, and this association was mediated by less loneliness and more volunteering. In the multi-group analysis, age, gender, and household registration (urban vs. rural) moderated path coefficients but did not impact the general pattern. This study suggests promising benefits of internet use for Chinese middle-aged and older adults. In addition, the digital divide between our urban and rural subsamples calls for interventions to promote internet use in rural areas.
Cities and extreme weather events: impacts of flooding and extreme heat on water and electricity services in Ghana
Authors: Kayaga Sam M , Amankwaa Ebenezer F , Gough Katherine V , Wilby Rob L , Abarike Mercy A , Codjoe Samuel N A , Kasei Raymond , Nabilse Cuthbert K , Yankson Paul W K , Mensah Peter , Abdullah Karim , Griffiths Paula
Published: September 2020

Extreme weather events disproportionately affect residents of low-income urban settlements in the global South. This paper explores the impacts of extreme heat and flooding on water and electricity services in Accra and Tamale, Ghana. Interviews with water/electricity providers and water quality analysis are combined with household interviews, focus group discussions and observations conducted in eight low-income urban settlements. The findings highlight the interconnected nature of service provision during extreme weather events, with challenges in one sector reinforcing problems in another, exacerbating difficulties with access. Although households can utilize rainwater during flooding, it is highly susceptible to faecal contamination, and electricity supplies are often disconnected. During extreme heat, demand for water and electricity outstrips supply, leading to severe shortages, especially in Tamale. Water and electricity service providers should consider their interconnected nature and adopt a joined-up approach to cope with extreme weather events, which are predicted to increase with climate change.
Disseminated Neospora caninum infection in a dog with severe colitis
Authors: Curtis Benjamin , Harris Adam , Ullal Tarini , Schaffer Paula A. , Muñoz Gutiérrez Juan
Published: September 2020

A 12-y-old spayed female Schipperke dog with a previous diagnosis of inflammatory bowel disease was presented with a 2-mo history of severe colitis. The patient’s condition progressed to hepatopathy, pneumonia, and dermatitis following management with prednisolone and dexamethasone sodium phosphate. Colonic biopsies identified severe necrosuppurative colitis with free and intracellular parasitic zoites. Postmortem examination confirmed extensive chronic-active ulcerative colitis, severe acute necrotizing hepatitis and splenitis, interstitial pneumonia, ulcerative dermatitis, myelitis (bone marrow), and mild meningoencephalitis with variable numbers of intracellular and extracellular protozoal zoites. PCR on samples of fresh colon was positive for Neospora caninum. Immunohistochemistry identified N. caninum tachyzoites in sections of colon, and a single tissue cyst in sections of brain. Administration of immunosuppressive drugs may have allowed systemic dissemination of Neospora from the intestinal tract.
The Line Snuggler: A Central Line Bundling Innovation Evaluated in a High-Risk Pediatric Population
Authors: Tetlow Marybeth , Allen Deborah , Barnes Angel , Shaw Ryan J.
Published: September 2020

Central line associated blood stream infections and complications in children require prevention strategies related to both traditional childhood activities as well as adverse events in the intensive care unit or bone marrow transplant unit. This study evaluated a nurse-invented product, the Line Snuggler, designed to protect intravenous tubing and central lines from contamination or entanglement. Patients ( n = 30) were enrolled following the chemotherapy phase of transplant. Using a pre–post intervention design, each subject served as their own control for the control phase of the study (Days 1-3 without a Line Snuggler) and the intervention phase (Days 4-6 with a Line Snuggler), with bacterial levels of product and sheets tested on Days 1, 3, 4, and 6. At study conclusion, staff ( n = 44) and parents/guardians ( n = 25) completed an online survey assessing satisfaction with the product, and perceived utilization and safety. Using t tests, the Line Snuggler bacterial levels showed no difference in growth in adenosine triphosphate levels compared with the same patient’s sheets, thereby supporting no increased risk of bacterial growth. Both staff and parents/guardians reported high satisfaction with their use of the Line Snuggler and noted the benefit of its protecting and bundling intravenous lines into a single organizer. This innovative product designed by nurses was evaluated as a means to provide exceptional, high-quality care to achieve the best outcomes while eliminating hospital-acquired complications ( https://www.linesnugglers.com/ ).
Cultural Competency Among Pediatric Registered Nurses in Saudi Arabia: A Cross-Sectional Design
Authors: Alharbi Manal F. , Alhamlan Manal H. , Aboshaiqah Ahmad E.
Published: September 2020

Introduction

Saudi Arabia’s culturally diverse population is growing rapidly. The need for cultural competence is greatest in pediatric units where nurses provide care to children in collaboration with their parents.

Method

Nonprobability sampling of 394 nurses and cross-sectional descriptive design was used to investigate nurses’ cultural competence, and to examine the relationships between the variables and participants’ demographic data in pediatric units across five hospitals in Riyadh, Saudi Arabia, by asking nurses to complete a self-report questionnaire.

Results

The results suggest a high degree of cultural competency. Participants’ scores indicated high levels of perceived cultural awareness, sensitivity, and cultural competence behavior for performance.

Discussion

This study supports the 3-D Puzzle Model of culturally congruent care for cultural competence, which assumes that cultural competence is deeply influenced by one’s experiences. The findings revealed a high level of cultural competence despite a lack of information with respect to patient views.
The Relationship Among Vocabulary Size, Grammar Proficiency, and Critical Thinking Skills of Adult Language Learners
Authors: Ünaldı İhsan , Yüce Erkan
Published: September 2020

This study aims to determine the possible relationships among foreign language vocabulary size, foreign language grammar proficiency, and critical thinking skills. To this end, 126 adult language learners were examined in terms of vocabulary size, grammar proficiency, and critical thinking skills. The results revealed that participants’ grammar proficiency levels and their vocabulary size scores correlated significantly with certain aspects of critical thinking skills. However, unlike their vocabulary size scores, grammar proficiency level scores of the participants correlated significantly with their overall critical thinking skills scores. These results will be discussed in relation to adult language learners.
A Case Study of the Use of Newsela PRO Among Adult, Emergent Bi/Multilingual Learners in a Precollege Program
Authors: Housel David A. , Oranjian Nevair
Published: September 2020

Adult literacy and English as an Additional Language (EAL) programs are often challenged to find suitable and authentic reading texts and instructional materials for their students. Newsela PRO, an entirely online resource, provides high-interest fiction, timely news articles, and other nonfiction texts in both English and Spanish that focus on developing reading and critical thinking skills by providing students with five levels of reading difficulty. Although originally designed for younger learners, the use of Newsela PRO has recently expanded into adult literacy programs. This convergent mixed-methods study investigated the usability and instructional use of this educational technology in an intensive, precollege EAL program in a community college in the northeastern United States. This case study found that instructors felt the detailed reports provided by Newsela PRO enhanced their instruction and feedback and enabled them to differentiate instruction more effectively. Regardless of language-proficiency level, students found Newsela “easy to very-easy-to-use.” They were motivated to read more extensively and developed more confidence in their academic skills and English-language proficiency. These preliminary findings justify the additional cost of Newsela PRO as well as exploring its expanded use in other adult education, EAL, and literacy programs, especially Spanish-language literacy programs, both in the United States and internationally. As many adult and higher education programs were mandated to transition to distance learning exclusively during the recent COVID-19 pandemic, the effective instructional use of educational technology has become critical.
A miniature piezomembrane hydraulic pump with decreasing chambers in succession
Authors: Yu Mai , Chen Song , Kan Jun Wu , Zhang Zhong Hua , Qian Chao Ping , Wang Jian Tao
Published: September 2020

A miniature piezomembrane hydraulic pump with decreasing chambers in succession (PHPDCS) is presented. The number of chambers in PHPDCS decreases successively in two serial stages. The first stage consists of two chambers in parallel while the second stage consists of only one chamber. The proposed PHPDCS has the comprehensive advantages of serial and parallel connection of multi-chamber and has a high energy conversion efficiency. The prototype of PHPDCS is designed and manufactured. The output performance of PHPDCS under different external loads is investigated by experiments. Experimental results indicate that the optimum flow rate of the proposed PHPDCS is obtained when phase difference between two serial stages is 180°. The output performance of PHPDCS is superior to that of traditional piezoelectric pumps with two chambers in serial (PPCS). At 50 Hz, the maximum flow rate of PHPDCS under external load of 5 kPa is more than twice as high as that of PPCS. Under the external load of 10 kPa, the maximum flow rate of PHPDCS reaches 6.87 mL/min, whereas PPCS has no flow rate output.
Development of Pictograms to Communicate Technological Solution Instructions (Labeling) Among Low-Literacy Users
Authors: Kisaalita William S. , Sempiira Edison J.
Published: September 2020

Conveying information for appropriate use of devices is uniquely challenging in low-resource settings. Drug makers have previously developed culturally meaningful informational pictograms to, for example, convey timing of doses, among low-literacy patients. We tested a similarly structured process among Ugandan smallholder farmers. Over 67% of the pictograms scored a passing grade after the second round of testing, meeting our overall success criterion. The process is efficacious in developing instructional/teaching (labeling) pictograms. These findings can help solution/device developers for low-resource settings to provide correctly interpretable pictograms and thus eliminate misuse-driven low uptake.
Comparison of Outcome of Deltoid Ligament Repair According to Location of Suture Anchors in Rotational Ankle Fracture
Authors: Park Young Hwan , Jang Kyu Sun , Yeo Eui Dong , Choi Gi Won , Kim Hak Jun
Published: September 2020

Background:

The suture anchors for the repair of deltoid ligament in rotational ankle fracture are inserted mostly into the medial malleolus, but sometimes are placed into the talus depending on the rupture site. This study sought to compare the radiological and clinical outcomes of deltoid ligament repair according to using these 2 locations for suture anchor placement.

Methods:

The cases of 131 patients (114 patients with suture anchors on the medial malleolus and 17 patients with suture anchors on the talus) who underwent deltoid ligament repair along with ankle fracture fixation were retrospectively reviewed. Medial clear space oblique (MCSo), medial clear space perpendicular (MCSp), tibiofibular clear space (TFCS), and tibiofibular overlap (TFO) were measured as radiological outcomes, while the Olerud-Molander Ankle Score (OMAS) and visual analog scale (VAS) score for pain were calculated as clinical outcomes. The follow-up period did not differ between the 2 groups (16.8 ± 10.9 months in the medial malleolus group vs 17.9 ± 14.3 months in the talus group; P = .670).

Results:

There were no differences in MCSo, MCSp, TFCS, and TFO at 3 months after surgery and final follow-up. The OMAS and VAS for pain did not show intergroup differences at final follow-up.

Conclusion:

The surgical outcome of deltoid ligament repair in rotational ankle fracture did not differ whether the suture anchors were inserted into the medial malleolus or into the talus.

Level of Evidence:

Level III, retrospective comparative study.
Clarifying Conceptions Underlying Adult Psychopathy Measures: A Construct Validity Metric Approach
Authors: Kennealy Patrick J. , Skeem Jennifer L. , Lilienfeld Scott O.
Published: September 2020

Although the Psychopathy Checklist–Revised (PCL-R) and Psychopathic Personality Inventory (PPI) ostensibly measure the same construct, they seem to emphasize different conceptions of psychopathy. This study was designed to clarify these differences by testing how well the PCL-R and PPI map alternative conceptions of psychopathy. Construct validity metrics were used to compare patterns of associations between psychopathy measures and 14 theory-relevant criterion variables that were observed in a sample of 1,281 offenders—with patterns of associations that were predicted based on alternative psychopathy conceptions. PCL-R total scores were most consistent with Karpman’s affective dysfunction-centered secondary conception, and PPI total scores were most consistent with the McCords’ lovelessness-based conception. Although similarities emerged at the factor level, the PPI demonstrated higher levels of consistency between theory-based predictions and observed relations than did the PCL-R. These results provide direction for refining measures in future research and interpreting PCL-R and PPI scores in current practice.
The Council of State Governments Justice Center Approach to Increasing Risk-Level Consistency in the Application of Risk Assessment Instruments
Authors: Kroner Daryl G. , Derrick Bree
Published: September 2020

Correctional and forensic mental health settings potentially have multiple risk assessment instruments administered on a single client. Because of the various methods of determining risk categories, risk-level consistency can become an issue. The Council of State Governments Justice Center developed a Five-Level System that can be applied to most risk assessment instruments. Using the Level of Service Inventory–Revised and two created risk assessment instruments, the present study assessed if the Five-Level System (vs. normative percentile categories) demonstrated greater agreement between the two instruments, and, if so, the percentage of greater agreement. The Five-Level System demonstrated 4% to 5% greater agreement for both risk-level placement and recidivism rates. The implications of this greater consistency among risk assessment instruments is an increased fairness in making risk-level assignments.
The Development of the Informant Five-Factor Borderline Inventory
Authors: Min Jiwon , Mullins-Sweatt Stephanie N. , Widiger Thomas A.
Published: September 2020

Borderline personality disorder (BPD) is one of the most studied personality disorders and is associated with significant outcomes such as suicide. Although BPD is represented in DSM-5 as a categorical diagnosis, it may be better characterized dimensionally, such as from the perspective of the five-factor model of general personality (FFM). The Five-Factor Borderline Inventory (FFBI) assesses BPD from the perspective of maladaptive variants of FFM traits. Previous research suggests that informant-reports may increase the validity of personality disorder assessment, providing additional information that may supplement self-report. Therefore, the current study developed an informant measure of the FFBI, Informant Five-Factor Borderline Inventory (IFFBI) and examined its convergent and discriminant validity compared with the self-report FFBI, FFM, and traditional measure of BPD. Overall, the IFFBI demonstrated good convergent validity and moderate discriminant validity with the FFBI, FFM, and other traditional measures of BPD.
Lost in Translation: The Jimmo Case as Policy Implementation Failure
Authors: Cabin William
Published: September 2020

The Jimmo case involved a 2011 lawsuit against the Centers for Medicare and Medicaid Services (CMS) alleging they illegally used an improvement standard instead of a need standard to make coverage decisions for Medicare home health and other Medicare beneficiaries. In 2013 CMS and the plaintiffs reached a settlement with CMS agreeing to replace the improvement standard with a need standard and conduct an education campaign to ensure its proper implementation. A literature review indicates no studies on the nature, significance, or impacts of the Jimmo case in Medicare home health. The current study is an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 28 home care nurses between January 2019 and May 2019 in the New York City metropolitan area. Results indicate nurses believe they had little to no knowledge of the Jimmo case; there was limited communication about the case from their agencies; they lacked guidance on the implications of the case on intake and eligibility decisions; they received no guidance on the impact of the case on documentation; and that their lack of knowledge and guidance had adverse impacts on patients.
Multimodal imaging of chorioretinal folds induced by orbital vascular malformation in two cases
Authors: Gündüz Ahmet Kaan , Shields Carol L , Bekdemir Şükran , Shields Jerry A
Published: September 2020

Purpose:

To investigate the alterations in the retinal pigment epithelium (RPE) in the crest and trough portions of chorioretinal folds (CRFs) induced by an orbital vascular tumor.

Methods:

Review of multimodal imaging in two eyes of two patients with globe compression and CRFs from an orbital vascular tumor.

Results:

Fundus photography demonstrated obliquely extending CRFs with alternating hyperpigmented and hypopigmented linear alterations in both eyes. Fundus autofluorescence (AF) imaging showed obliquely oriented hypoAF lines, incompletely alternating with hyperAF lines. In Case 1, the hyperAF lines had interspersed hypoAF segments and Case 2 had peripapillary mottling of AF. Fluorescein angiography (FA) showed alternating hyper and hypofluorescent lines in the late phase in Case 1. Optical coherence tomography (OCT) documented relative thinning of RPE at the folded crests in Case 1 and preservation of RPE in Case 2. Swept-source OCT angiography (SS-OCTA) demonstrated oblique hyporeflective lines in the outer retina and choriocapillaris layers in Case 2. These findings suggest that the crest of a CRF represents thinned or rarified RPE with hypoAF, transmission hyperfluorescence (FA), partially attenuated RPE layer (OCT), and isoreflectivity (SS-OCTA) while the trough represents compressed RPE with irregular hyperAF, transmission hypofluorescence (FA), thickened RPE layer (OCT), and hyporeflectivity (SS-OCTA).

Conclusion:

The anatomic and functional status of the RPE in CRFs based on multimodal imaging reveals normal to attenuated RPE with hypofunctionality at the fold crest and compacted, thickened RPE at the trough with segmental functional impairment on AF imaging. Anatomic information regarding CRFs is evident on OCT, FA, and SS-OCTA while the functional status is depicted on AF.
Tympano-Mastoid Cholesterol Granuloma: Case Report and Review of the Literature
Authors: Pace Annalisa , Iannella Giannicola , Riminucci Mara , Corsi Alessandro , Magliulo Giuseppe
Published: September 2020

Cholesterol granuloma (CG) is a rare condition histological consisting of a foreign body, giant cell reaction to cholesterol crystals and haemosiderin derived from the ruptured of the erythrocytes. A 25-year-old man came to our Department presenting signs and symptoms of tympano-mastoid cholesterol granuloma. He showed all the specific sign and symptoms of the disease. However, considering the lack of literature regarding TMCG, this study was performed with the aim of presenting the main characteristics of tympano-mastoid CG, describing the case report and reviewing the literature.
Re-embodying Syrinx in the ancient Peloponnese and French colonial Belle Époque: Investigating bodily change associated with sexual assault
Authors: Chilianis Melanie
Published: September 2020

This article investigates related contexts and connections that both hide and display the coercion and sexual violence manifest in Western cultural and aesthetic artefacts during ancient Greek and Roman eras and the French imperialist epoch. Exploring ‘Pan and Syrinx’ from Ovid’s ‘Book I’ of the Metamorphoses (8 ce) and Claude Debussy’s Syrinx (1913) for solo flute, I historicise the meanings of rape and sexual assault that informed Ovid’s epic and then revisit the genesis of Debussy’s Syrinx because of the uneasy elements surrounding its creation. I show how its cultural production is complicit with the imperial in several ways. I consider how sexual violence impacts voice, subjectivity and the body, and finally, I draw on Luce Irigaray’s work to sketch an embodied Syrinx in relation with others and her environment. I suggest the desiring potential of sexual difference, with limitations, as a generative conception of figuring the feminine-maternal body beyond masculine appropriation. In this way I open the myth up to watery material-social relations.
Mass media and communication interventions to increase HIV testing among gay and other men who have sex with men: Social marketing and visual design component analysis
Authors: Riddell Julie , Teal Gemma , Flowers Paul , Boydell Nicola , Coia Nicky , McDaid Lisa
Published: September 2020

Mass media and communication interventions can play a role in increasing HIV testing among gay, bisexual and other men who have sex with men (GBMSM). Despite the key role of social marketing principles and visual design within intervention development of this type, evidence is limited regarding interventions’ social marketing mix or visual design. As part of a systematic review, intervention content was assessed using social marketing theory and social semiotics. Data were extracted on the nature of the intervention, mode of delivery, use of imagery, content and tone and the eight key characteristics of social marketing. Data were synthesised narratively. Across the 19 included studies, reference to social marketing principles was often superficial. Common design features were identified across the interventions, regardless of effectiveness, including: the use of actors inferred to be GBMSM; use of ‘naked’ and sexually explicit imagery; and the use of text framed as statements or instructions. Our results suggest that effective interventions tended to use multiple modes of delivery, indicating high social marketing complexity. However, this is only part of intervention development, and social marketing principles are key to driving the development process. We identified consistent aspects of intervention design, but were unable to determine whether this is based on evidence of effectiveness or a lack of originality in intervention design. An openness to novel ideas in design and delivery is key to ensuring that evidence-informed interventions are effective for target populations.
In defence of reading (and watching) trash: Feminists reading the romance
Authors: Philips Deborah
Published: September 2020

In Cultural Populism, Jim McGuigan argues that in British cultural studies ‘there is populist sentiment, but hardly any “sentimentality” is discernible’. There is, however, an arena of British cultural studies that has always been concerned with ‘sentiment’ and that is the romance narrative. This article argues that the study of popular fictions has always been integral to the history of cultural studies, and that it established a site in which feminist voices would make gender politics intrinsic to the field. At a time when gender was not a central issue for either Literature or Cultural Studies, generic fictions written by and for women provided a site for research that was undeniably about female experience, and the analysis of those texts offered a strategy for asserting a feminist focus.
Designing virtual communities of practice for informal caregivers of Alzheimer’s patients: An integrative review
Authors: Romero-Mas Montse , Gómez-Zúñiga Beni , Cox Andrew M , Ramon-Aribau Anna
Published: September 2020

The main aim of this study is to review the literature to show how ideas around virtual communities of practice (VCoP) offer a model for supporting informal caregivers of Alzheimer’s patients (caregivers) to learn how to deal with caregiving demands. Caregivers are individuals who have a significant personal relationship with and provide a broad range of unpaid assistance to an older person or an adult with a chronic or disabling condition outside of a professional or formal framework. This review will examine the current evidence on the needs of caregivers, identify dimensions to be considered in VCoP design and suggest further directions of research. The investigation is an integrative review that builds a bridge between different areas of work. The outcome is eleven dimensions for the design of successful VCoPs for caregivers: Network Structure, Technology, Moderator, Scale, Alignment, Community Design, Sense of Trust, Knowledge Sharing, Sustainability, Ethics and Evaluation. In addition, we propose a Tree Metaphor to present our research results. Well-designed interventions based on VCoP principles have the potential of addressing caregivers’ needs.
Usability inquiry of a gamified behavior change app for increasing physical activity and reducing sedentary behavior in adults with and without autism spectrum disorder
Authors: Lee Daehyoung , Frey Georgia C , Min Aehong , Kim Bogoan , Cothran Donetta J , Bellini Scott , Han Kyungsik , Shih Patrick C
Published: September 2020

The purpose of this study was to conduct the first usability inquiry of a gamified, behavior change theory-guided mobile app PuzzleWalk for increasing physical activity and reducing sedentary behavior in adults with and without autism spectrum disorder (ASD). Eighteen adults with and without ASD participated in a mixed-methods study that consisted of cognitive walkthrough, system usability assessment, and qualitative interviews. The results of the system usability testing indicated satisfactory quality of the PuzzleWalk system that can be readily applicable to both adults with and without ASD. Several notable issues were identified from the qualitative interviews that address critical insights into unique health and social needs in adults with ASD. Future work is warranted to examine the long-term effects of the PuzzleWalk system on increasing physical activity and reducing sedentary behavior in adults with and without ASD in real-world settings.