bluuebunny/crossref_metadata_2025 huggingface dataset:
Inibidores de checkpoints imunológicos no tratamento de câncer de pulmão de células não pequenas (NSCLC)
Authors: Vieira Lins Mariana , Maria Nering Carlos Bianca , Souza Esperidião de Oliveira Eloisa , Matos Lima Larissa , Felipe Gomes Michelin Luis , Alexandrino Antunes Aline
Published: June 2022

Câncer é uma definição abrangente para se falar sobre mais de 100 tipos de doenças; o câncer de pulmão de células não pequenas (NSCLC) é um dos tipos de câncer mais comuns na sociedade, sendo o que provoca maior mortalidade entre homens e mulheres ao redor do mundo. Em seus estágios mais avançados, o paciente diagnosticado com NSCLC possui uma perspectiva de vida de 1 a 2 anos, sendo necessários tratamentos mais assertivos e que não comprometam a saúde já debilitada desses pacientes. Os quimioterápicos ainda são o tratamento principal de escolha para o tratamento desses pacientes, entretanto o número e gravidade dos eventos adversos oriundos deste tratamento e uma resposta não tão favorável, no que se refere ao aumento da sobrevida desses pacientes impulsiona estudos e pesquisas de novas terapias, a fim de garantir uma resposta cada vez mais eficiente e segura no combate ao NSCLC. Combinações de diferentes terapias, como cirurgia, radioterapia e administração de quimioterápicos seguem sendo analisadas, mas nos últimos anos uma nova classe se juntou à luta: os Imunoterápicos são medicamentos que atuam na ativação ou inibição de algumas respostas do sistema imunológico, promovendo um ataque alvo às células tumorais, preservando as células sadias do organismo.
Periodic and Bounded Solutions of Second-Order Nonlinear Differential Equations
Authors: Ахмедов Д.Т. , Мухамадиев Э.М. , Нуров И.Д.
Published: June 2022

В работе исследуются вопросы о существовании периодических или ограниченныхрешений нелинейных дифференциальных уравнений второго порядка вида$y''+g(y,y')=f(t,y,y').$ Здесь функция $g (y,z)$ - непрерывная и положительно однородная первого порядка,а $f(t,y,z)$ - непрерывная функция, определенная при всех значениях $t$, $y$, $z$ и удовлетворяющая условию малости по отношению $|y|+|z|$ на бесконечности. Для данного уравнения вопросы существования априорной оценки, периодических решений в~случае периодической по $t$ функции $f(t,y,z)$, и ограниченных решений в случае лишь ограниченности по~$t$ функции $f(t,y,z)$, тесно связаны с качественным поведением решения однородного уравнения $y''+g(y,y')=0.$ Поэтому, на первом этапе представляется важным исследование характера поведения траектории эквивалентной однородному уравнению системы. Перейдя к полярным координатам, получим формулы представления решения системы, которые позволяют описать полную классификацию всевозможных фазовых портретов решения системы в терминах свойства функции $g(y,y')$. В частности, получены условия отсутствия ненулевых периодических или ограниченных на всей оси решений. Задача существования периодических решений исходного уравнения эквивалентна существованию решений интегрального уравнения в пространстве $C[0,T]$-непрерывных на отрезке $[0,T]$ функций. В свою очередь, интегральное уравнение порождает вполне непрерывное векторное поле в пространстве $C[0,T]$, нули которого определяют решение интегрального уравнения. Получены формулы для вычисления вращения векторного поля на сферах достаточно большого радиуса пространства $C[0,T]$. На основе полученных результатов найдены условия существования периодических и ограниченных решений неоднородного уравнения. Отметим, что полученные результаты доведены до расчетных формул.
Approximation Properties of Polynomials $\hat{l}_{n,N}^\alpha(x),$ Orthogonal on Any Sets
Authors: Магомедова З.М. , Нурмагомедов А.А.
Published: June 2022

Пусть $\Omega=\{x_0, x_1, x_2, \dots, x_j, \dots\}$~--- дискретная система точек, таких что $0=x_0<x_1< x_2<\dots<x_j< \dots$, $\lim_{j\rightarrow\infty}x_j=+\infty$ и $\Delta{x_j}=x_{j+1}-x_j$, $\delta=\sup_{0\leq j<+\infty}\Delta x_j<\infty, N=1/\delta$. В данной работе исследуются асимптотические свойства многочленов $\hat{l}_{n,N}^\alpha(x)$, образующих ортонормированную систему с весом $\rho_1^\alpha(x_j)=e^{-x_j}(x_{j+1}^{\alpha+1}-x_j^{\alpha+1})/(\alpha+1)$ при $-1<\alpha\leq 0$ и с весом $\rho_2^\alpha(x_j)=e^{-x_{j+1}}(x_{j+1}^{\alpha+1}-x_j^{\alpha+1})/(\alpha+1)$ при $\alpha>0$ на произвольных сетках, состоящих из бесконечного числа точек полуоси $[0, +\infty)$. А~именно, установлена асимптотическая формула, в которой при возрастании $n$ вместе с $N,$ асимптотическое поведение этих многочленов близко к асимптотическому поведению ортонормированных многочленов Лагерра $\hat{L}_n^\alpha(x)$.\par}\vspace*{-12pt}{\hangindent17pt\hangafter=0\noindent\footnotesize{\bf Ключевые слова:} многочлен, ортогональная система, сетка, вес, асимптотическая формула.
Legal Issues of the Russian Penal Legislation
Authors: Антипов А.Н. , Строгович Ю.Н.
Published: June 2022

Эффективность функционирования уголовно-исполнительной системы Российской Федерации в большой степени зависит от качества нормативного правового регулирования в данной сфере. Нередко имеющие место недостатки обусловлены такими правовыми дефектами, как терминологическая нечеткость, что формирует риски неопределенности и (или) неоднозначности в правоприменительной практике, пробельность при конструировании правовых норм. Авторы на примере анализа ч. 3 ст. 80 Уголовно-исполнительного кодекса Российской Федерации рассматривают имеющиеся проблемы и обозначают перспективные направления их возможного устранения

Effective functioning of the Russian penal enforcement system largely depends on the quality of regulatory legal regulation in this area. Inherent shortcomings often are associated with legal defects, such as terminological vagueness, which creates risks of uncertainty and (or) ambiguity in law enforcement practice, gaps in the construction of legal norms. Having analyzed Part 3 of Article 80 of the Penal Enforcement Code of the Russian Federation, the authors determine existing problems and promising directions for their possible solution.
Topical Issues of Expanding the List of Other Participants in Criminal Proceedings in the Criminal Procedural Code of the Russian Federation
Authors: Морозов Р.М. , Воробьева А.А.
Published: June 2022

В статье на основе действующего российского законодательства, судебной практики рассматриваются статусы секретаря судебного заседания, судебного пристава по организации обеспечения установленного порядка деятельности судов и представителя учреждений, органов, исполняющих уголовное наказание, как иных участников уголовного процесса. Проведен сравнительный уголовно-процессуальный анализ зарубежного законодательства, регламентирующего вопросы участия отдельных участников уголовного процесса. Авторами указывается на правовой пробел, связанный с отсутствием правового статуса вышеуказанных участников уголовного процесса в уголовно-процессуальном законодательстве. Сформулированы изменения, предусматривающие создание новой главы УПК РФ, где должны быть отражены понятия отдельных должностных лиц, выступающих в качестве иных участников уголовного процесса, а также их отдельные права и обязанности.

On the basis of current Russian legislation and judicial practice, the article examines statuses of the court session secretary, bailiff for organization of ensuring the established procedure for court activities and representative of institutions and bodies executing criminal punishment as other participants in the criminal process. A comparative criminal procedural analysis of foreign legislation regulating individual’s participation in the criminal process is conducted. The authors point out the legal gap associated with absence of the legal status of the abovementioned participants in the criminal process in the criminal procedure legislation. The work presents amendments envisaging creation of a new chapter of the Criminal Procedural Code of the Russian Federation, which should reflect concepts of individual officials acting as other participants in the criminal process, as well as their individual rights and obligations
On Improving Legal Regulation of the Criminal Case Initiation Stage
Authors: Цветков Ю.А.
Published: June 2022

В статье анализируются основные аргументы сторонников и противников сохранения стадии возбуждения уголовного дела, в частности указываются истинные причины проблем, возникающих в практике применения норм, регламентирующих данную стадию. Автором формулируются первоочередные задачи и предложения, направленные на совершенствование уголовно-процессуального законодательства и позволяющие приспособить данный институт к требованиям времени вместо ликвидации либо деконструкции.

The article analyzes key arguments of supporters and opponents of preserving the stage of initiation of criminal proceedings, indicates true roots of the problems arising in the practice of applying norms regulating this stage, formulates priority tasks and proposals aimed at improving the criminal procedural legislation and adapting this institution to requirements of the time, instead of its liquidation or deconstruction
On the Issue of Typical Problems in the Activities of Penal Inspectorates in Small Settlements
Authors: Кириловский О.В. , Рыбакова А.А.
Published: June 2022

В статье рассмотрены актуальные проблемы в деятельности уголовно-исполнительных инспекций и их филиалов, расположенных в населенных пунктах с небольшой численностью жителей. Выявленные сложности имеют различные основания возникновения, условно их можно разделить на две группы: вопросы организационно-правового характера, связанные с исполнением наказаний в виде обязательных и исправительных работ, и проблемы повышения эффективности выполнения служебных обязанностей молодыми сотрудниками инспекций. Авторами предлагаются меры правового и организационного характера, устраняющие данные казусы, направленные на повышение эффективности деятельности уголовно-исполнительных инспекций в целом

The article deals with current problems in the activities of penal inspectorates and their branches located in settlements with a small population. The identified difficulties have various reasons for their occurrence; conditionally they can be divided into two groups: organizational and legal issues related to execution of punishments in the form of mandatory and correctional labor, and problems of improving performance of official duties by young employees of inspectorates. The authors propose measures of a legal and organizational nature that eliminate these incidents and are aimed at improving efficiency of penal inspectorates in general.
Detective Work in Russia at the Beginning of the 19th Century
Authors: Кучин О.С. , Бондаренко П.К.
Published: June 2022

В статье на основе изучения официальных документов Российской империи проанализирована деятельность полиции в начале XIX в. В частности рассматриваются создание Министерства внутренних дел и попытки образовать особый полицейский орган для розыскных дел. На протяжении исследуемого периода функции и задачи МВД, его подразделений на местах уточнялись и совершенствовались

Based on the study of official documents of the Russian Empire, the article analyzes activities of the police at the beginning of the 19th century; in particular, creation of the Ministry of the Interior and attempts to form a special police body for investigative cases are being considered. During the study period, functions and tasks of the Ministry of the Interior and its local units are clarified and improved.
FORMATION OF TRIBOTECHNICAL Al-Cu COATINGS WITH FUNCTIONAL ADDITIVES BY CENTRIFUGAL INDUCTION SURFACING
Authors:   Joint Institute of Mechanical Engineering of the NAS of Belarus, KOMAROV Aleksandr I. , ORDA Dmitriy V. ,   Joint Institute of Mechanical Engineering of the NAS of Belarus, SOSNOVSKY Igor A. ,   Joint Institute of Mechanical Engineering of the NAS of Belarus, KURILYONOK Artem A. ,   Joint Institute of Mechanical Engineering of the NAS of Belarus
Published: June 2022

The article presents the results of metallographic and tribotechnical studies of composite coatings based on aluminum with a high copper content formed on the inner surface of the workpiece by centrifugal induction surfacing. According to the results of the study, with a copper content of more than 40 wt.% a composite structure is formed based on the θ-phase (Al2Cu) with inclusions of т-phase grains (Cu3NiAl6 ), particles of silicon, tin and iron-containing phases. This structure has a high hardness and a parameter of the coefficient of thermal linear expansion close to steel, so that the coating does not peel off from the steel base. It is also shown that tin introduced into the melt does not form intermetallide compounds and is released in its pure form, acting as a solid lubricant and reducing the coefficient of friction to 0.03 at loads up to 20 MPa.
Impacto y Desafíos en la pandemia 2020
Authors: Alcocer Betty Sarabia , Sarabia Betty Mónica Velázquez , Gutiérrez Tomás Joel López , Rodriguez Pedro Gerbacio Canul , Canché Baldemar Aké , Diego Alicia Mariela Morales , Gamboa Carmen Cecilia Lara , Canché Gonzalo Abdiel Canul
Published: June 2022

El primer caso o caso índice de COVID-19 en México se detectó el 27 de febrero de 2020 en la Ciudad de México. Se trató de un mexicano que había viajado a Italia y tenía síntomas leves. Objetivo: Identificar el tratamiento establecido, la evolución, desenlace del cuadro clínico y la relación de las comorbilidades de los pacientes ingresados con diagnostico confirmado, durante la pandemia de COVID 19. Material y métodos: Estudio observacional, descriptivo, transversal y retrospectivo. Resultado: Con base a los métodos y pruebas de diagnóstico realizados previos al ingreso en el área COVID, el 61% de los pacientes contaban con PCR, el 37% ingreso al área con método de tomografía computarizada compatible a COVID previo a algún laboratorio que lo corroborase. Conclusión: Se hospitalizaron un total de 41 pacientes con diagnósticos confirmados de SARS COV2 61%.
Analysis of Chinese tilapia supply and demand without and with the COVID-19 epidemic impact
Authors: Dai Yunyun , Zhou Zhen , Zhao Huanhuan , Yu Yunbo , Xu Xudan
Published: June 2022

We analyzed the supply and demand for tilapia in China while assessing the future developmental trends. China has become the world’s largest producer, exporter, and consumer of tilapia. China entered a period of rapid aquaculture development in the 1990s, and the tilapia supply has increased yearly. Tilapia products are mainly supplied to the international market, especially the US. The global market for the Chinese tilapia has grown dramatically, but a downward trend occurred in 2019–2020. The Chinese domestic market demand is relatively stable, and even the COVID-19 epidemic did not significantly impact the supply and demand of tilapia. Internationally, it is expected that the demand for tilapia will decline considerably in the near future. However, this decline could be alleviated after the impact of the COVID-19 epidemic passes and increasing demand will resume. The increased supply of Chinese tilapia might slow down or even decrease due to market uncertainty, the increasing constraints on natural resources, and the Chinese government’s requirements for high-quality aquaculture environments.
On the Nonlinear Impact of Tourism on Environment Quality in South Asia: Evidence from the NARDL Approach
Authors: Ahmad Waheed , Tanveer Zubair , Majeed Muhammad Tariq
Published: June 2022

The current study inspects the nonlinear effects of tourism (TOR), energy use, and output growth on carbon emissions in the selected South Asian (SA) countries, namely Pakistan, Nepal, Sri Lanka, and India. The empirical results are obtained by implementing the recently developed nonlinear autoregressive distributive lag (NARDL) technique covering the data spanning from 1990 to 2019. The empirical findings suggest the nonlinear effect of TOR on carbon emissions in the long run. Further, the results revealed that positive shocks in TOR have a positive and significant effect on carbon emissions in the SA region. In contrast, negative shocks in TOR mitigate carbon emissions in all SA economies except Nepal. Moreover, the results demonstrate that energy use and output growth also have a meaningful impact on carbon emissions. Based on the findings, the directions for future research and policy implications are proposed.
Overcoming Barriers to Mammography Screening: A Quasi-randomised Pragmatic Trial in a Community-based Primary Care Setting
Authors: Seetoh Theresa , Siew Wei Fong , Koh Alvin , Liau Wei Fong , Koh Gerald CH , Lee Jeannette JM , Wong Mee Lian , Seow Adeline
Published: June 2022

Introduction: Breast cancer is the leading cancer among women in Singapore. Five years after a population-wide breast cancer screening programme was introduced, screening rates remained relatively low at 41%. Studies have shown decreased screening propensity among medically underserved women typically of minority or socioeconomically disadvantaged status. We conducted a quasi-randomised pragmatic trial aimed at encouraging mammography screening among underscreened or unscreened women in a publicly funded primary care facility in Singapore. Materials and Methods: The study was conducted from May to August 2010. Components of intervention included (1) tailored education, (2) doctor’s reminder, and (3) cost reduction. Researchers administered a structured questionnaire to eligible female polyclinic attendees and patient companions aged 40 to 69 years. Individual knowledge, attitudes, beliefs, and barriers towards mammography screening were identified and educational messages tailored. Doctor’s reminder and cost reduction were implemented additively. Results: Overall, out of 448 participants, 87 (19.4%, 95% confidence interval (CI), 15.8% to 23.1%) completed mammography screening across 3 arms of study. Participants who received a cost reduction were more likely to attend screening compared to participants in other intervention arms (adjusted odds ratio (OR) 2.4, 95% CI, 1.2 to 4.5, P = 0.009). Cost of screening, ethnicity, prior screening history, and attitudes towards mammography screening were identified as significant factors predicting mammogram attendance. Conclusion: Including a cost reduction component was the most effective intervention that increased mammography screening rates. Women's underlying beliefs, attitudes, and other predisposing factors should also be considered for integration into existing breast cancer screening programmes.

Key words: Asia, Breast cancer, Community health services, Patient navigation, Singapore
The Relationship Between Gamma-Glutamyltransferase (GGT), Bilirubin (Bil) and Small Dense Low-Density Lipoprotein (sdLDL) in Asymptomatic Subjects Attending a Clinic for Screening Dyslipidaemias
Authors: Kotani Kazuhiko , Tsuzaki Kokoro , Sakane Naoki
Published: June 2022

Introduction: Gamma-glutamyltransferase (GGT), bilirubin (Bil) and small dense low-density lipoprotein (sdLDL) particles are each known to be risk markers for cardiometabolic diseases which are characterised by oxidative stress conditions. These markers are connected with the oxidative milieu; however, the association between GGT, Bil, and sdLDL has been hardly examined. This hospital-based study investigated the association between GGT and sdLDL, as well as the association between Bil and sdLDL, in asymptomatic subjects. Materials and Methods: Cardiometabolic variables, GGT, Bil and the mean LDL particle size were measured in 100 asymptomatic subjects attending a clinic for screening dyslipidaemias (36 men and 64 women, mean age 64 years). Correlation analyses of the association between the mean LDL particle size and other variables, such as GGT and Bil, were performed. Results: The mean (standard deviation) levels of GGT, Bil, and the mean LDL particle size were found to be 21.7 (8.3) IU/L, 14.0 (4.3) μmol/L, and 26.7 (0.6) nm, respectively. An univariate correlation test showed both a significant inverse correlation between the mean LDL particle size and GGT (r = – 0.33, P <0.01) and a significant positive correlation between the mean LDL particle size and Bil (r = 0.32, P <0.01). A multiple regression analysis revealed similarly significant results of their correlations, independent of the other cardiometabolic variables. Conclusion: These results suggest that the correlation of GGT and sdLDL, as well as that of Bil and sdLDL, may be cooperatively associated with cardiometabolic processes. Further research is warranted in order to confirm the observed association.

Key words: Atherosclerosis, LDL particle size, Oxidative stress, γGT, Total bilirubin
Can Preoperative Scoring Systems be Applied to Asian Hip Fracture Populations? Validation of the Nottingham Hip Fracture Score (NHFS) and Identification of Preoperative Risk Factors in Hip Fractures
Authors: Kau Chung Yuan , Kwek Ernest BK
Published: June 2022

Introduction: Hip fractures in the elderly are a major cause of morbidity and mortality. Determining which patients will benefit from hip fracture surgery is crucial to reducing mortality and morbidity. Our objectives are: 1) to define the rate of index admission, 1-month and 1-year mortality in all hip fracture patients, and 2) to apply the Nottingham Hip Fracture Score (NHFS) to determine validity in an Asian population. Materials and Methods: This is a prospective cohort study of 212 patients with hip fractures above 60 years from September 2009 to April 2010 for 1-year. Sociodemographic, prefracture comorbidity and data on functional status was collected on admission, and at intervals after discharge. The main outcome measures were mortality on index admission, 1 month and 12 months after treatment. Results: In our study, the overall mortality at 1-month and 1-year after surgery was 7.3% and 14.6% respectively. Surgically treated hip fracture patients had lower odds ratio (OR) for mortality as compared to conservatively treated ones. The OR was 0.17 during index admission, 0.17 at 1-month, and 0.18 at 12-months after discharge. These were statistically significant. Adjustments for age, gender, and duration to surgery were taken into account. The NHFS was found to be a good predictor of 1-month mortality after surgery. Conclusion: Surgically treated hip fracture patients have a lower OR for mortality than conservatively managed ones even up to 1-year. The NHFS has shown to predict 1-month mortality accurately for surgically treated hip fracture patients, even for our Asian population. It can be used as a tool for clinicians at the individual patient level to communicate risk with patients and help plan care for fracture patients.

Key words: Elderly, Femur neck, Geriatric, Intertrochanteric
Clinical Outcome and Cost Comparison Between Laparoscopic and Open Appendicectomy
Authors: Tan Winson JH , Pek Wansze , Kabir Tousif , Chan Weng Hoong , Wong Wai Keong , Ong Hock Soo
Published: June 2022

Introduction: Local data comparing laparoscopic appendicectomy (LA) and open appendicectomy (OA) is lacking. We perform a cost and outcome comparison between LA and OA. Materials and Methods: A retrospective review of all appendicectomies performed for suspected appendicitis from July 2010 to December 2010 was conducted. Patient demographics, duration of surgery, complication rates, total cost of stay (COS) and length of stay (LOS) were compared between LA and OA. Results: A total of 198 patients underwent appendicectomy during the duration of study; 82 LA and 116 OA. There were 115 males (58.1%) and 83 females (41.9%). Median age was 33 years. Patients who underwent LA were significantly younger (P <0.001) with a greater proportion of females (P <0.0001) and were more likely to be negative appendicectomies (18.3% vs. 6.9%, P = 0.023). Duration of surgery was significantly longer in LA patients (86 min vs. 74 min, P = 0.003). LOS in the LA group was shorter by 1.3 days compared to OA (2.0 days vs. 3.3 days, P <0.0001). The differences in operative duration and LOS between LA and OA remained significant on multivariate analysis (P = 0.001 and P = 0.008, respectively). The COS (P = 0.359), wound infection rates (P = 0.528) and complication rates (P = 0.131) were not significantly different between the 2 groups. Conclusion: LA is associated with a shorter LOS while its cost is equivalent to OA. From the perspective of utilisation of healthcare resources, LA appears to be superior.

Key words: Complications, Cost utility, Singapore
Five-Year Review of Patients Presenting with Non-Accidental Injury to a Children’s Emergency Unit in Singapore
Authors: Chew Yi Rong , Cheng Michaela HL , Goh Mei Ching , Shen Liang , Wong Peter CY , Ganapathy Sashikumar
Published: June 2022

Introduction: There is an increasing trend of physical child abuse cases reported in Singapore. Children presenting to the Emergency Department with injuries require a high index of suspicion for clinicians to distinguish those that are abusive in nature. Materials and Methods: A retrospective study of children with diagnosis of NAI presenting to KK Women’s and Children’s Hospital (KKH) from June 2011 to May 2016 was conducted. Results: There were 1917 cases reported from 1730 subjects, of  which: 8.8% of subjects had repeat visits; 55.2% of cases were male; and mean age was 7.69 years. Racial demographics were: Chinese 45.5%, Malay 33.4%, Indian 15.4% and Others 5.9%. The most frequent injuries sustained were head and neck (50.8%), limbs (32.2%), and chest (5.7%). Of the type of injuries, 55% had contusions, 21% had cane marks, 16% had lacerations, 4.4% had burn marks and 1% sustained fractures. Males were more likely to be caned (P <0.001); 54.9% of cases were admitted and 38.9% were discharged. Cases that presented without a parent (P <0.001), were known to Child Protective Service (P <0.001), or had a history of  parental substance abuse (P = 0.038), mental illness in caregiver (P = 0.021), or domestic violence (P <0.001) were more likely to require admission. Conclusion: Analysing these factors provide a better understanding of  the presentation of  NAI cases, including 'red flags' and vulnerable groups who should have better protection.

Key words: Physical abuse, Presentation of child abuse, Risk factors of child abuse
Incipient Albuminuria in Persons with Newly Diagnosed Type 2 Diabetes Mellitus: A 5-Year Retrospective Cohort Study
Authors: Tan Shermin , Wong Lai Yin , Toh Matthias Paul HS
Published: June 2022

Introduction: This study aimed to determine the 5-year incidence of  albuminuria among Asian persons with newly diagnosed type 2 diabetes mellitus (DM), and to identify the risk factors at diagnosis for progression to albuminuria. Materials and Methods: A retrospective 5-year closed cohort study was conducted among 1016 persons aged ≥18 years old who were diagnosed with type 2 DM between 1 January 2007 and 31 December 2009 at primary care facilities in Singapore. The cumulative incidence of  progression from normoalbuminuria to albuminuria—termed “progression”—was determined. The risk factors associated with progression were evaluated using multiple logistic regression analysis. Results: A total of 541 (53.2%) participants were men. The mean (SD) onset age of type 2 DM was 54 (11) years. From diagnosis of type 2 DM, the 5-year cumulative incidence of  progression was 17.3% and mean (SD) duration to progression was 2.88 (1.23) years. Higher onset age (OR 1.02; 95% CI, 1.00-1.04), history of  hypertension (OR, 1.88; 95% CI, 1.32-2.70) and higher glycated haemoglobin (HbA1c) (OR, 1.17; 95% CI, 1.09-1.26) at diagnosis were associated with progression. In addition, being on angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) treatment at baseline modified the effect of hypertension on progression. Conclusion: This study highlighted the importance of early screening and treatment of diabetes as well as prevention of hypertension, which could potentially delay the onset of  microalbuminuria in persons with type 2 DM. Persons on ACEI or ARB treatment should continue to be monitored regularly for progression to albuminuria. Key words: Incidence, New onset, Proteinuria, Risk factors
Psychological Profile of Patients with Psoriasis
Authors: Lim Derek SY , Bewley Anthony , Oon Hazel H
Published: June 2022

Introduction: Psoriasis is a chronic inflammatory disease with a global prevalence of approximately 2% and significant psychiatric comorbidity. There is a great deal of existing literature assessing different aspects of psychology in psoriasis. We aimed to conduct an in-depth review of current evidence linking psoriasis to personality traits and psychiatric comorbidities, as well as factors that put these patients at risk of psychopathology. Materials and Methods: A search of the PubMed database identified 1632 articles. We included articles studying psychological comorbidity in patients with psoriasis, looking especially at personality characteristics, and data linking psoriasis with increased risks of psychological distress, depression, anxiety and suicidality. In particular, we also evaluated subgroups in psoriasis found to be at risk. Results: Patients with psoriasis are more likely to be alexithymic, lack body awareness and possess a Type D personality. Alcohol, but not illicit drug use, disorders are also more common in patients with psoriasis. Patient groups who are especially at risk of psychological distress include women, younger patients, patients with a younger age of disease onset, those who self-assess their psoriasis to be severe, and those with lesions on visible or sensitive areas. Adopting motivational interviewing skills and incorporating the use of learning materials during consultations have been found to be useful. Conclusion: The knowledge of personality characteristics, “at-risk” groups, and early recognition of psychological distress among patients with psoriasis can help clinicians provide better holistic care and encourage a change in patients’ behaviour. Key words: Alexithymia, Personality, Psychopathology, Suicidality
Making Clinical Practice Guidelines Pragmatic: How Big Data and Real World Evidence Can Close the Gap
Authors: Chew Si Yuan , Koh Mariko S , Loo Chian Min , Thumboo Julian , Shantakumar Sumitra , Matchar David B
Published: June 2022

Clinical practice guidelines (CPGs) have become ubiquitous in every field of medicine today but there has been limited success in implementation and improvement in health outcomes. Guidelines are largely based on the results of traditional randomised controlled trials (RCTs) which adopt a highly selective process to maximise the intervention’s chance of demonstrating efficacy thus having high internal validity but lacking external validity. Therefore, guidelines based on these RCTs often suffer from a gap between trial efficacy and real world effectiveness and is one of the common reasons contributing to poor guideline adherence by physicians. “Real World Evidence” (RWE) can complement RCTs in CPG development. RWE—in the form of data from integrated electronic health records—represents the vast and varied collective experience of frontline doctors and patients. RWE has the potential to fill the gap in current guidelines by balancing information about whether a test or treatment works (efficacy) with data on how it works in real world practice (effectiveness). RWE can also advance the agenda of precision medicine in everyday practice by engaging frontline stakeholders in pragmatic biomarker studies. This will enable guideline developers to more precisely determine not only whether a clinical test or treatment is recommended, but for whom and when. Singapore is well positioned to ride the big data and RWE wave as we have the advantages of high digital interconnectivity, an integrated National Electronic Health Record (NEHR), and governmental support in the form of the Smart Nation initiative. Key words: Guideline adherence, Real world data, Physicians' practice patterns
Can Robots Accelerate the Learning Curve for Surgical Training? An Analysis of Residents and Medical Students
Authors: Lau Joel WL , Yang Tao , Toe Kyaw Kyar , Huang Weimin , Chang Stephen KY
Published: June 2022

Surgical traineeship has traditionally been based on a master apprentice model where learning takes place in the operating theatre. This approach has changed over the past few years with greater emphasis on surgical training taking place within the surgical skills laboratory. We developed a high fidelity simulator, the Image-guided Robotic Assisted Surgical simulator (IRAS) with an incorporated robotic guidance feature. The robot system is developed to mimic the process of an experienced surgeon physically holding a trainee's hands to demonstrate manoeuvring of the laparoscopic instruments. We aimed to assess the efficacy of incorporating robotic guidance into this high fidelity surgical simulator. Forty-two participants (13 surgical residents and 29 medical students) were recruited. Participants had one practice run for familiarisation and subsequently performed the virtual laparoscopic cholecystectomy (LC) once. Among the medical students, they were randomised to either a control or intervention group. They were tasked to perform a second- and third-timed LC assessment. Participants were asked to rate the simulator using a 5-point Likert scale questionnaire. IRAS rated favourably in hand-eye coordination and training bimanual dexterity (mean score: 4.1 and 4.0 among students, 3.4 and 3.4 among residents) though it faired suboptimally in realism. At baseline, residents were statistically faster compared to students (overall time: 418.9 vs 586.8 seconds, P = 0.001). Participants randomised to the intervention group consistently scored better. However, their overall time were not statistically significant from the control group. The robotic guidance capability of the IRAS is a key advantage of this simulator platform over the conventional platform.

Key words: Cholecystectomy, Laparoscopy, Simulation training, Virtual reality
Health Technology Disinvestment in Singapore
Authors: Lim Boon Peng , Heng Bee Hoon , Tai Hwei Yee , Tham Linus , Chua Hong Choon
Published: June 2022

Healthcare decision-makers are constantly challenged by growing healthcare needs in tandem with rising healthcare costs. Disinvesting in technologies and practices that are “low in value” is one strategy to re-allocate limited resources to the most effective, safe and cost effective technologies. We put forward a health technology reassessment framework and examined the opportunities and challenges on technology disinvestment in Singapore and deliberated on possible solutions. We coordinated and supported a disinvestment programme in 2 hospitals, 1 specialist centre and 9 primary care institutions in the public healthcare sector. The key processes were identifying, prioritising and assessing low-value health technologies and practices, disseminating and implementing disinvestment recommendations, and post-implementation evaluation. Through case studies, we explored the barriers and enablers to the success of the programme. One of the barriers to disinvestment included difficulty in demonstrating a lack of benefit of in-use technologies from published studies. Differing viewpoint and priority might preclude a healthcare leader’s support in such initiatives and that posed an unsurmountable hurdle. On the other hand, engaging the stakeholder throughout the evidence review process and striking a balance between rigour and timeliness of review were likely to assure success. Lastly, monitoring the impact on resources and patient outcomes can be diverse and methods need to be developed. Understanding barriers and enablers in health technology disinvestment can translate into improved opportunities for eliminating and minimising resource wastage. Key words: Cost containment, Healthcare budget, Low-value, Value-based care
Confirmatory Factor Analysis and Measurement Invariance of the Multidimensional Scale of Perceived Social Support in Young Psychiatric and Non-Psychiatric Asians
Authors: Teh Wen Lin , Shahwan Shazana , Abdin Edimansyah , Zhang Yunjue , Sambasivam Rajeswari , Devi Fiona , Verma Swapna , Chong Siow Ann , Subramaniam Mythily
Published: June 2022

Introduction: Studies of the 3-factor (family, friends and significant others) Multidimensional Scale of Perceived Social Support (MSPSS) have shown mixed results in non-Western and/or psychiatric populations due to factorial inconsistencies in its structure. Our study aimed to replicate and expand previous findings of MSPSS through confirmatory factor analysis (CFA) and measurement invariance analysis in a young Asian population of psychiatric and non-psychiatric subjects. Materials and Methods: Data on 209 subjects were examined. The majority were Chinese (66.5%) followed by Malays (17.2%), Indians (14.4%) and other ethnicities (1.9%). Subjects in the non-psychiatric group (n = 100) did not report any psychiatric illnesses. Subjects in the psychiatric group (n = 109) were outpatients of a tertiary hospital in Singapore who had been diagnosed with depressive disorders. Results: The 3-factor models of MSPSS showed better fit indices than the 2-factor models (friends/significant others and family, or family/significant others and friends) which indicated that the 3-factor structure of MSPSS was valid. Multigroup CFA demonstrated metric invariance, indicating MSPSS scores can be compared across groups. In the psychiatric group, descriptive and weighted univariate analyses revealed significantly lower levels of perceived social support in every domain of MSPSS. Conclusion: The 3-factor model of MSPSS can be used to compare psychiatric and non-psychiatric subjects locally. Since psychiatric patients reported lower MSPSS scores, future research could examine the causative factors that contribute to lower perceived social support in young adults seeking psychiatric intervention. Key words: Factorial validity, Multiethnic, Southeast Asia
Outcome of Enhanced Recovery After Surgery (ERAS) for Colorectal Surgery in Early Elderly and Late Elderly Patients
Authors: Lohsiriwat Varut
Published: June 2022

Introduction: This study aimed to determine the outcome of enhanced recovery after surgery (ERAS) programme in elderly colorectal surgery patients. Materials and Methods: Details and surgical outcomes of elderly patients undergoing elective colectomy and/or proctectomy according to ERAS protocol from 2011 to 2017 were retrospectively reviewed. Patients were divided into 2 groups: early elderly (EE, n = 107) aged 65–74 years old and late elderly (LE, n = 74) aged ≥75 years old. Results: This study included 181 patients. The LE group had poorer baseline characteristics, but the operative details in both groups were comparable. Overall complication and severe complication rates were 28% and 3.3%, respectively. The LE group had a higher overall complication rate (38% vs 22%; P = 0.016) but comparable rate of severe complications (2.7% vs 3.7%; P = 1.00). Median postoperative stay was 4 days (interquartile range [IQR], 4–6 days) and it was not significantly different between both groups (5 days for LE vs 4 days for EE; P = 0.176). No difference was seen in time to gastrointestinal recovery and 30-day mortality or readmission between both groups. Overall compliance with ERAS protocol was 76% (IQR, 65–82%) and it did not vary significantly between the LE (71%) and EE (76%) groups (P = 0.301). However, the LE group had lower compliance with fluid management, nutrition therapy and use of multimodal analgesia. Conclusion: ERAS is a safe and effective protocol that can be used in EE and LE colorectal surgery patients. Key words: Aged, Colon, Compliance, Complication, Rectum
The Changing Epidemiology of Serious Trauma in the Elderly Population: An Increasing Concern of a Tertiary Hospital in Singapore
Authors: Go Karen TS , Cheng Jolene YX , Seah Xinlu , Goh Mui Heng , Teo Li Tserng , Cole Elaine
Published: June 2022

Introduction: Although trauma is often seen in the young, there is a recent shift in this trend as more elderly patients are hospitalised for traumatic injuries. This study examined serious trauma in young and elderly patients and hypothesised that the increase in incidence of elderly serious trauma has led to greater burden of care in hospitals and health services. Materials and Methods: Details of trauma patients admitted with an Injury Severity Score ≥9 or to the intensive care unit or high dependency unit of a tertiary acute hospital between 2004 and 2015 were retrospectively reviewed. Patients ≥65 years old who sustained low-impact trauma that resulted from same-level falls with isolated hip fractures or compression fractures of the vertebral column were excluded. Patients were classified as either elderly (≥65 years old, n = 5074) or young (<65 years old, n = 9088) and their baseline characteristics, complications rate and length of hospital stay were evaluated. Results: Elderly patients ≥65 years old accounted for 51.2% of seriously injured patients after 2014 and their numbers are increasing at an annual rate of 16.5%. They also experienced longer hospital stay in the general ward than younger patients. Conclusion: The number of elderly trauma patients were thrice that of all trauma patients seen and they also required longer hospitalisation. This trend has led to greater burden of care in hospitals and health services in Singapore. Key words: Burden of care, Length of stay, Resource utilisation, Trend
Palliative Care Awareness Among Advanced Cancer Patients and Their Family Caregivers in Singapore
Authors: Ozdemir Semra , Malhotra Chetna , Teo Irene , Yang Grace MJ , Kanesvaran Ravindran , Yee Alethea CP , Finkelstein Eric Andrew ,   Cost of Medical Care of Patients with Advanced Serious Illness in Singapore (COMPASS) Study Group
Published: June 2022

Introduction: We investigated the awareness of palliative care (PC) services in advanced cancer patients and their family caregivers and whether negative perceptions was a possible barrier to PC utilisation in Singapore. Materials and Methods: Patients with stage 4 solid cancer and their caregivers were interviewed between July 2016 and March 2018 at outpatient clinics located in the medical oncology departments of 2 major public hospitals in Singapore. Patients and caregivers were asked whether they were aware of PC services, how they first learned about them, who first recommended PC to the patient, whether the patient had received PC, and reasons for not receiving PC. Results: Awareness of PC was lower in patients compared to caregivers (43% vs 53%; P <0.01). The odds of being aware in patients was higher if they had higher education (odds ratio [OR] = 2.927; P <0.001) and higher income (OR = 1.798; P = 0.005). Compared to patients, more caregivers reported that a healthcare provider recommended PC to the patient (10% vs 20%; P <0.012). Furthermore, 7% of patients and 15% of caregivers reported that the patient received PC (P = 0.031). The most common reasons for not receiving PC reported by patients and caregivers (respectively) were that the patient was still receiving treatment (68% and 78%), it is not time for PC (76% and 59%) and PC would not be of help (18% and 19%). Conclusion: Less than half of patients indicated an awareness of PC. Our findings suggest that efforts should be made to increase awareness of PC and promote its acceptance in cancer patients and their family caregivers in Singapore. Key words: Decision-makers, End-of-life, Perceptions
الزيف البصري في المشهد المصري
Authors: مرزوق سارة
Published: June 2022

تواجه السينما المصرية أزمة محورية كبرى في أعمالها التاريخية والمستلهمة من التراث بشكل عام، وهي أزمة رداءة التمثيل الفيلمي لمفردات الحضارة المصرية من كافة حقبها؛ وزيف أحسن ما في هذا التمثيل، واستساغة القبح حتى صار له من يدافع عنه ممن يُظَن بهم أنهم هم أول منتقدوه، وذلك لغياب ثقافة الوعي بجوهر المناظر المصرية. وعلى الجانب الآخر، فحتى الأصوات المنددة بالزيف البصري، لم تجتمع تحت مظلة تدوين علمي منتظم تبين مواطنه وكيفية تجاوزه، ووضع تصورات التأهيل العلمي والعملي للأجيال الجديدة من السينمائيين. وتعد حالة ومشروع شادي عبد السلام منطلقا للتأصيل العلمي لتمثيل الفيلمي لمفردات الحضارة المصرية، ونموذجا ملهما يحتذى في هذا الشأن؛ إذ أن تكوينه العفوي في تل العمارنة وانطلاقته التشكيلية وعمله كمهندس مناظر، أسسته كي يكون علما مصريا شهيرا بين أبناء الوطن وعالميا، على عمق الفهم والحذق والمهارة في أفلمة مفردات التراث المصري، بصريا وقصصيا وسمعيا في عمل واحد. ورغم أن أعماله معدودة، إلا أنه كان بمثابة – بل وهو كذلك - مشروع عملي علمي منيرا الدرب لجيلنا والأجيال القادمة في شأن التمثيل البصري للتراث المصري حتى في الجوانب التي لم يتطرق إليها، كحامل شعلة نار لا يتحرك من مكانه، لكنه كسر الظلمة لمئات حوله ..
إعادة الإحياء المتكامل للمناطق التراثية وإعادة توظيف واستخدام المباني التراثية والاثرية الواقعة بمحيطها
Authors: السقا السيد
Published: June 2022

لا شك ان تفاعل البشر مع بعضهم على مر السنين يترك اثرا على الارض باقيا حتى بعد مماتهم او احراق كتبهم او فناء ثقافتهم بتغير اللغة يبقى الاثر شاهدا يجذب نظرك للتساؤل عن حكايته طالما مررت بجانبه. يتناول المشروع قضية المحافظة على التراث ليس كمبنى فقط بل بمكانه المحيط به... ككتله واحدة متماسكة تحكي في تناغم تنقلك كأنك سافرت بالزمن. من هنا ينبثق المشروع في محاولة جدية لإعادة احياء المنطقة ككل ليس فقط كمنظر جمالي بل بشكل متغلغل في النسيج المجتمعي. يتم تنفيذ المشروع على ثلاث مراحل: 1- من حصر وتوثيق لكل المباني التي تحمل طرازا معماريا وتسجيلها علميا 2- ثم ازالة وهدم كل التعدي الجارح واعادة انشاءه الحتمي لكن بنفس التفاصيل المعمارية المجاورة له في تجانس تام يحترم ما مضى ويظهره. 3- ثم تأتي المرحلة الاخيرة وهي مرحلة حتمية ستكتمل تلقائيا اعادة تسكين من تم اخراجهم في المباني الجديدة واعادة التوظيف واعادة الاستخدام الحتمي للمباني التراثية والاثرية الواقعة في المحيط بعد ان تم ابرازهم وجعلهم محورا هاما وسيحققون مفهوم الاستدامة وهذا ايضا ضمن اهداف المشروع.
حوكمة التراث الثقافي المصري
Authors: موسى منى
Published: June 2022

يناقش هذا المقال نظرية وممارسة الحوكمة كحل لمشاكل التراث الثقافي المصري، والتي تظهر هذه المشاكل انها متجذرة في الإطار القانوني والمؤسسي وحتى الاجتماعي للتعامل مع التراث. ويطرح المقال الحوكمة كحل يضمن المشاركة المجتمعية وتعزيز صنع القرار على مستوى المجتمعات. والذي يمكن أن يساهم في تحسين تخصيص الموارد، وزيادة التزام ووعي المجتمع، وإعادة تأكيد هويات المجتمع عبر الاتفاق على صيغ وتعريفات للثقافة والتراث، وتقوية مجموعات المجتمع المدني وأصواتهم ودورهم في مراحل التخطيط والتنفيذ والمراقبة لنظم الادارة المطورة بناء على مبادئ الحوكمة، ويساهم كل ما سبق في تطوير إجراءات تعاونية جديدة، ووضع قوانين وتشريعات جديدة والتي بدورها يمكن أن تزيد من معدل نجاح الحوكمة وتطويرها كمبدأ للتعامل مع التراث الثقافي بما يناسب السياق المصري.
العقلانية والموضوعية منهجاً لدراسة التراث العربي
Authors: شاهين شيماء
Published: June 2022

المفكر المغربي محمد عابد الجابري هو احد أبرز المفكرين العرب الذين ساهموا في دراسة مسألة التراث العربي ودوره في تشكيل الواقع المعاصر، وتعرض خلال مسيرته لدراسة الموضوع من جوانب عدة ، كان مركزها محاولة تخطي الإشكاليات الفكرية المرتبطة بالتراث إرساء منهج فكري يستند على التراث ولكن لا يتجمد عنده ويعيد تشكيل علاقتنا به لتصبح طبقا لكلماته الى تراث نحتويه لا يحتوينا . وهذا المقال يلقي الضوء على ملامح فكر الدكتور محمد عابد الجابري المرتبطة بالتراث ويعرض بشيء من التفصيل لكتابه "التراث والحداثة، دراسات ومناقشات" أحد الأعمال التي تناولت بالتفصيل منهج الجابري في إعادة تشكيل وعينا بالتراث، ودراسته بعقلانية، وموضوعية.