bluuebunny/crossref_metadata_2025 huggingface dataset:
The experience of sleep for women with borderline personality disorder: An occupational perspective
Authors: Wood Anna , Brooks Rob , Beynon-Pindar Catherine
Published: July 2015

Introduction

Sleep difficulties are prevalent in borderline personality disorder; however, the experience of sleep for individuals with a diagnosis of borderline personality disorder has not been considered from an occupational therapy perspective.

Method

This study adopted a qualitative methodology. Semi-structured interviews were utilised to explore how sleep is experienced by four women with a diagnosis of borderline personality disorder, in an inpatient setting. Interviews were recorded and transcribed verbatim.

Findings

Through thematic analysis four themes were identified: ‘there isn’t a proper pattern or structure to my sleeps’, ‘sleep is getting away for me’, ‘before I came in [to the unit] my life–work balance was all chaotic’ and ‘I know the routine, but it doesn’t really seem to affect me’. These findings described the variety of problems experienced by participants with regard to sleep and the implications of sleep difficulties on occupational performance and participation.

Conclusion

Women with borderline personality disorder on an inpatient unit experienced a variety of sleep difficulties that impact on their ability to engage in occupations. Sleep and sleep difficulties should be explicitly addressed by occupational therapists and sleep interventions should be individually tailored; further research is required to examine occupational therapy interventions for sleep.
Beyond the Frame of Practical Reason: The Indian Evidence Act and Its Performative Life
Authors: Samaddar Ranabir
Published: July 2015

This article is about the Indian Evidence Act. It explains how evidence is the script that carries law's unconscious. One one hand, evidence is the site of reason, and on the other hand it is the performative site of the unconscious. The operation of the Evidence Act requires a court, arguments, ways of producing evidence, counter-arguments, scrutiny of the nature of the evidence submitted, and finally the disputation around what constitutes an evidence – and then the judgement. This article argues, through a brief presentation of the history of the Act, how law in this way combines the normative and the performative – science of inquiry and the unpredictable script of the outcome, procedure and the spectacle built around elements such as live deposition and the hermeneutic power of the image, rational considerations and emotion, virtuality and the event, serious business in the court and the element of drama. The article suggests (with a bit of irony) the injunction that to see what law is and how it functions we can go to the cinema, and to see what cinema is we can go to the court.
Forgetting Hiroshima, remembering Auschwitz
Authors: Neiman Susan
Published: July 2015

This paper uses two museum exhibitions to raise questions about how Hiroshima and Auschwitz are coped with in the present. The stake of the paper is to examine how it has been possible for different polities to come to terms with criminal pasts that should cause shame and guilt. The criminality of Auschwitz is established, but not that of Hiroshima. In the first instance, then, the paper establishes the extent to which the justifications for the bombing of Hiroshima were and remain controversial. The second part of the paper compares debates around two exhibitions: the Hiroshima exhibition at the Smithsonian in Washington, DC and the exhibition ‘Extermination War: Crimes of the Wehrmacht 1941–44’ which travelled through Germany and Austria in the late 1990s.
Effect of basic design parameters on IC debonding of CFRP-strengthened shallow RC beams
Authors: Al-Saawani Mohammed A , El-Sayed Ahmed K , Al-Negheimish Abdulaziz I
Published: July 2015

Bonding of fiber-reinforced polymer (FRP) plates to the tension face is an effective technique for strengthening reinforced concrete (RC) beams. However, an important design issue is the sudden and premature failure by intermediate crack (IC) debonding of the externally bonded FRP plates from the concrete surface of the strengthened beams. The objective of this paper is to examine the effect of basic design parameters on the IC debonding of the FRP-strengthened RC beams and to assess the accuracy of prediction models of IC debonding in international codes and guidelines. A total of 13 RC beams were constructed and tested for this purpose. The test variables include steel reinforcement ratio, compressive strength of concrete, depth of the beam, and the width of the FRP reinforcement. None of the test variables caused a change in the IC debonding failure mode, except for the strengthened beam with FRP area covering its full width. Among studied variables, only the compressive strength of concrete had a significant effect on the debonding strain of the FRP plates. The results of this experimental work were compared with IC debonding prediction models—currently in effect—of international codes and guidelines. Among these codes, ACI 440.2R-08 and the Italian guide CNR DT200 showed the most accurate and consistent prediction of the IC debonding strain.
Reducing alternate level of care days at Winchester District Memorial Hospital
Authors: Ricottone Madeline
Published: July 2015

Winchester District Memorial Hospital has maintained near-zero alternative level of care census days for three consecutive years by focusing on partnerships, staff/physician engagement, and maintaining a circle of care with patients and families. The strategies and challenges faced revisiting internal discharge processes and linking directly to their local community through change management techniques are discussed.
Lessons from Mount Lu: China and cross-cultural understanding
Authors: Longxi Zhang
Published: July 2015

Su Shi, one of China’s greatest poets, has a simple but famous poem on viewing Mount Lu, presenting different images viewed from different perspectives. Reading this as an allegory of understanding China, this article examines the paradigmatic change of Sinology or China studies in the United States with regard to Paul Cohen’s “China-centered” approach, presents a critique of the dichotomous view of China as the reverse image of the West, and argues for the synthesis of different perspectives without privileging either the insider’s or the outsider’s view, hence the necessity to integrate Sinology with Chinese native scholarship, the desirability of a pluralistic view in cross-cultural hermeneutics.
Decolonizing what? Categories, concepts and the enduring ‘not yet’
Authors: Ashar Meera
Published: July 2015

What does it mean to decolonize? At one level, decolonization refers to the attainment of political sovereignty. The transfer of power from colonial to regional and indigenous authorities, however, also involves a handover of political forms and institutions. This process leaves behind some of the narratives that accompany coloniality, even if refashioned versions of these. This enduring coloniality resides within and proliferates through the categories of political discourse. In India, we may find its continual hum in tirades against ‘corruption’ or in laments that Indians lack a ‘civic sense’. The decolonial project, having found expression in nationalist movements, in political and epistemic resistance, and in reform and revival, therefore continues to be undertaken in the language of coloniality, which obscures all that resides outside the colonial worldview.
Challenges facing China and harmony as a state strategy
Authors: He Weihua
Published: July 2015

After its defeat in the Opium Wars, China was drawn into the orbit of Western influence. Since then, dewesternization has always been one of the hotly debated topics among Chinese intellectuals and politicians. With the implementation of the reform and opening-up policy in 1978, China’s economic take-off was almost instant due to its low-cost labor, rich resources, and the government’s firm resolution to modernize. The booming of a market economy with Chinese characteristics can be quoted as a success story of China’s dewesternization project. However, while enjoying the benefits of its attempts to modernize itself, China also begins to encounter the dark side of modernity. Problems like environmental deterioration, the widening gap between the rich and the poor, and food safety are causing anxieties among Chinese people. In order to cope with the detrimental effects of the neo-liberal doctrines, harmony was put forward as a state strategy. Ostensibly disinterested, harmony aims at the well-being, happiness, and welfare of all. However, while harmony can serve as a national strategy to ameliorate the fermenting social discontent in China, it may also be a lofty ideal to attract, unite, and inspire people in other parts of the world. According to the spirit of harmony, different nations can pursue the well-being of their own people in their own ways which is in accordance with the notion of pluriversality as proposed by decolonial thinkers. Besides analyzing the social, economic, and political significance of harmony both within China and abroad, this essay also attempts to address the theoretical problems posed by harmony, if it is to be considered a productive ideal in this globalized world.
Ex nihilo: The Christian creation story and the founding of modern Singapore
Authors: Fong Samantha
Published: July 2015

Singapore is often lauded as a triumph of modernity—a prosperous city created from nothing—based on a logic perversely parallel to that of the Christian doctrine of creatio ex nihilo. However, this brief essay argues that the nationalistic narrative of Singapore as pure, Man-made creation participates in a colonial historiography that not only hides but continues to enact forms of erasure and destruction.
Configuration synthesis of series–parallel hybrid transmissions
Authors: Ngo Huutich , Yan Hongsen
Published: July 2015

The purpose of this paper is to synthesize systematically the feasible configurations of series–parallel hybrid transmissions for automotive systems utilized in passenger vehicles subject to the deduced design constraints. The design process includes the following steps: first, search for all feasible mechanisms that can be used for synthesizing hybrid transmissions; second, identify all potential locations for the inputs and the output to the mechanisms; third, identify all potential locations for clutches and the brakes of the systems subject to the required operation modes. Through the proposed design process, 30 planetary gear trains for hybrid electric vehicle transmissions with seven members and 10 joints are generated. The power arrangement process generates 42 clutchless hybrid systems. Then, the clutch arrangement process generates 48 corresponding series–parallel transmissions. To demonstrate the feasibility of the synthesized configurations, a novel configuration system is taken as a numerical example to illustrate the principles of operation and performance.
Optimization of the component sizing for a plug-in hybrid electric vehicle using a genetic algorithm
Authors: Madanipour Vahid , Montazeri-Gh Morteza , Mahmoodi-k Mehdi
Published: July 2015

This paper describes a methodology to optimize the component sizes of a plug-in hybrid electric vehicle in a blended control strategy using a genetic algorithm. For this purpose, first, a fuzzy logic controller with two operating modes is developed for the energy management system of a parallel plug-in hybrid electric vehicle. Then, the battery requirements to drive the vehicle during the all-electric range are determined. In order to optimize the transmission components, multi-objective constrained optimization based on a genetic algorithm is developed, where the objective function consists of the weighted fuel consumption and the weighted exhaust emissions. Also, the driving performance requirements of the vehicle are considered as the constraint functions from which, when they exceed their allowable bounds, the penalty functions are evaluated and added to the objective function. Finally, the results of optimization of the component sizing in a blended control strategy are compared for the optimized data and their default component sizes. The simulation results demonstrate the effectiveness of the approach and noticeable reductions in the equivalent fuel consumption and in the exhaust emissions while ensuring a good longitudinal vehicle performance in various driving cycles.
Estimating negative likelihood ratio confidence when test sensitivity is 100%: A bootstrapping approach
Authors: Marill Keith A , Chang Yuchiao , Wong Kim F , Friedman Ari B
Published: July 2015

Objectives

Assessing high-sensitivity tests for mortal illness is crucial in emergency and critical care medicine. Estimating the 95% confidence interval (CI) of the likelihood ratio (LR) can be challenging when sample sensitivity is 100%. We aimed to develop, compare, and automate a bootstrapping method to estimate the negative LR CI when sample sensitivity is 100%.

Methods

The lowest population sensitivity that is most likely to yield sample sensitivity 100% is located using the binomial distribution. Random binomial samples generated using this population sensitivity are then used in the LR bootstrap. A free R program, “bootLR,” automates the process. Extensive simulations were performed to determine how often the LR bootstrap and comparator method 95% CIs cover the true population negative LR value. Finally, the 95% CI was compared for theoretical sample sizes and sensitivities approaching and including 100% using: (1) a technique of individual extremes, (2) SAS software based on the technique of Gart and Nam, (3) the Score CI (as implemented in the StatXact, SAS, and R PropCI package), and (4) the bootstrapping technique.

Results

The bootstrapping approach demonstrates appropriate coverage of the nominal 95% CI over a spectrum of populations and sample sizes. Considering a study of sample size 200 with 100 patients with disease, and specificity 60%, the lowest population sensitivity with median sample sensitivity 100% is 99.31%. When all 100 patients with disease test positive, the negative LR 95% CIs are: individual extremes technique (0,0.073), StatXact (0,0.064), SAS Score method (0,0.057), R PropCI (0,0.062), and bootstrap (0,0.048). Similar trends were observed for other sample sizes.

Conclusions

When study samples demonstrate 100% sensitivity, available methods may yield inappropriately wide negative LR CIs. An alternative bootstrapping approach and accompanying free open-source R package were developed to yield realistic estimates easily. This methodology and implementation are applicable to other binomial proportions with homogeneous responses.
The (Il)legal Indian
Authors: Zoettl Peter Anton
Published: July 2015

This article traces different aspects of the present-day juridification and judicialization of indigenous lives using the example of the Tupinambá Indians of north-eastern Brazil. The Tupinambá’s identity is being increasingly bureaucratized by public administration and is constantly being questioned by public and private agents to deny the Tupinambá’s constitutional land rights. In the course of the still ongoing process of the demarcation of the Indigenous Territory Tupinambá de Olivença, indigenous inhabitants are facing a plethora of civil actions, and Tupinambá leaders are being persecuted and criminalized by the police and the judiciary. This article exposes the legal intricacies of possessory actions against indigenous people in Brazil and discusses the different acts and attitudes of the actors of the Brazilian ‘juridical field’ as regards the indigenous rights. It suggests a view of law, law enforcement and law suits as means of social sense making, that is, a public staging, interpretation, imagining and ‘mapping’ of Brazil’s ‘indigenous question’, which has, ultimately, to be legitimized by society at large.
A smart composite-piezoelectric one-dimensional finite element model for vibration damping analysis
Authors: Alaimo Andrea , Milazzo Alberto , Orlando Calogero
Published: July 2015

A one-dimensional finite element method for generally layered smart beams is presented in this paper. The model implements the first-order shear deformation beam theory and is based on the preliminary analytical condensation of the electric state to the mechanical state. This allows us to establish an effective mechanical beam kinematically equivalent to the original smart beam including the effects of electro-elastic couplings. The contributions of the external electric loads are included in both the equivalent stiffness properties and the equivalent mechanical boundary conditions. Hermite shape functions, which depend on parameters representative of the staking sequence through the equivalent electro-elastic stiffness coefficients, are used to formulate the finite element method. The state space representation is then invoked for the assembled smart beam finite element model to favor its implementation in a block diagram environment for multi-domain simulation. Validation results and solutions for passive and active vibrations damping system are presented last.
Collective Actors, Common Desires
Authors: Frank Jason
Published: July 2015

Honig’s essay emphasizes neoliberalism’s destruction of a world of public things and addresses how we might respond to the catastrophe of their loss. However, to adequately confront the political dilemmas posed by neoliberalism, we must attend to the simultaneous disappearance of both common desires and collective actors. Honig’s examples risk obscuring the political importance of this question.
Role of a Limited Transarticular Release in Severe Hallux Valgus Correction
Authors: Wagner Emilio , Ortiz Cristian , Figueroa Francisco , Vela Omar , Wagner Pablo , Gould John S.
Published: July 2015

Background:

Hallux valgus (HV) treatment is continuously evolving, and no definitive treatment can be recommended. Osteotomies are the main surgical choice for these deformities, but no clear role for soft tissue procedures is available.

Objective:

To perform a retrospective comparison of the radiographic and clinical outcomes of 2 groups of patients with severe HV operated with the same osteotomy technique but differing on the type of lateral release.

Methods:

Two groups of patients with symptomatic moderate to severe HV deformities were operated with the same proximal metatarsal osteotomy, which differed on the type of lateral release: group 1 had limited transarticular lateral capsule release (n = 62), and group 2 complete lateral release, including capsule, adductor tendon, and intermetatarsal (IM) ligament (n = 57). We recorded the American Orthopaedic Foot & Ankle Society (AOFAS) score, HV and IM angles, first metatarsal shortening, concomitant metatarsal shortening osteotomies (Weil), Akin osteotomies, and complications.

Results:

The postoperative AOFAS score in group 1 was similar to that of group 2. The HV and IM angles improved in both groups with no significant difference. The multivariate analysis showed no influence of any variable analyzed on HV or IM angle improvement. Regarding AOFAS score improvement, a limited lateral release was associated with a higher increase in AOFAS score ( P = .019).

Conclusion:

No studies are available to identify which soft tissue structures are involved in HV deformities nor which have to be released, if any. A limited transarticular release can provide similar clinical and radiologic outcomes when compared with a classic open lateral release.

Level of Evidence:

Level IV, case series.
Analysis of a sliding frictional contact problem with unilateral constraint
Authors: Sofonea Mircea , Souleiman Yahyeh
Published: July 2015

We consider a mathematical model that describes the equilibrium of an elastic body in frictional contact with a moving foundation. The contact is modeled with a multivalued normal compliance condition with unilateral constraint, associated with a sliding version of Coulomb’s law of dry friction. We present a description of the model, list the assumptions on the data and derive its primal variational formulation, in terms of displacement. Then we prove an existence and uniqueness result, Theorem 3.1. We proceed with a penalization method in the study of the contact problem for which we present a convergence result, Theorem 4.1. Finally, under additional hypotheses, we consider a variational formulation of the problem in terms of the stress, the so-called dual variational formulation, and prove an equivalence result, Theorem 5.3. The proofs of the theorems are based on arguments of monotonicity, compactness, convexity and lower semicontinuity.
Influences of shear stresses and rotary inertia on the vibration of functionally graded coated sandwich cylindrical shells resting on the Pasternak elastic foundation
Authors: Sofiyev AH , Hui D , Najafov AM , Turkaslan S , Dorofeyskaya N , Yuan GQ
Published: July 2015

In this study, the behavior of vibration of sandwich cylindrical shells covered by functionally graded coatings and resting on the Pasternak elastic foundation considering combined influences of shear stresses and rotary inertia are examined. It is assumed that the effective material properties of functionally graded coatings changes exponentially in thickness direction. The modified Donnell type equations of motion of functionally graded and homogeneous sandwich cylindrical shells on the Pasternak elastic foundation are deduced using the first-order shear deformation theory. Basic equations are reduced to an algebraic equation of the sixth order and numerically solving this algebraic equation gives the dimensionless fundamental frequency. The expressions for the dimensionless fundamental frequencies of functionally graded and ceramic coated sandwich cylindrical shells with and without taking into account the effects of Pasternak elastic foundation and shear stresses obtained in a special case. Calculations, the influences of an elastic foundation, compositional profiles of coatings, shear stresses, rotary inertia, and sandwich shell geometry parameters on the nondimensional fundamental frequency are described. The results are verified by comparing the obtained values with those in the existing literature.
Institutional reforms and their effect on legislators’ behavior
Authors: Shomer Yael
Published: July 2015

Do electoral systems and intra-party candidate selection procedures influence the degree to which parties act in unison? Whereas the theoretical literature is quite clear about the hypothetical effect of these institutions, empirical evidence is mixed. In this article, I solve the puzzle and theorize about the interactive effects of elections and selections on parties’ behavior. I argue that the effect of candidate selections depends on the electoral environment within which they operate. Specifically, in an electoral environment that creates incentives for candidate-centeredness, the less restrictive the selection method a party uses, the less unified its record; whereas in an electoral environment that emphasizes party-centeredness, the effect of selections on unity is more muted. Using the electoral reform and divergent selection mechanisms characterizing Israel during the last three decades and utilizing Rice Scores, I provide support for the conditional effect of electoral systems and selection procedures on party behavior.
Why does increasing public access to medicines differ between countries? Qualitative comparison of nine countries
Authors: Gauld Natalie , Bryant Linda , Emmerton Lynne , Kelly Fiona , Kurosawa Nahoko , Buetow Stephen
Published: July 2015

Objective

To identify factors associated with differences between developed countries in reclassifying (switching) medicines from prescription to non-prescription availability.

Methods

Cross-national qualitative research using a heuristic approach in the US, UK, Japan, Australia and New Zealand, supplemented by data from Canada, Denmark, the Netherlands and Singapore. In-depth interviews with 80 key informants (65 interviews) explored and compared factors in terms of barriers and enablers to reclassification of medicines in each country. Document analysis supplemented interview data.

Results

Each country had a unique mix of enablers and barriers to reclassification. Enablers included government policy (particularly in UK), pharmacist-only scheduling (particularly in Australia and New Zealand) and large market size (particularly in the US and Europe). Local barriers included limited market potential in small countries, the cost of a reclassification (particularly in the US), competition from distributors of generic medicines, committee inconsistency and consumer behavior. UK had more enablers than barriers, whereas in Australia the opposite was true.

Conclusions

Different factors limit or enable reclassification, affecting consumer access to medicines in different countries. For countries attempting to reduce barriers to reclassification, solutions may include garnering government support for reclassification, support and flexibility from the medicines regulator, having a pharmacy-only and/or pharmacist-only category, providing market exclusivity, ensuring best practice in pharmacy, and minimizing the cost and delays of reclassification.
Towards a comprehensive framework for the evaluation of small and medium enterprise policy
Authors: Vega Arturo , Chiasson Mike
Published: July 2015

This research demonstrates the relevance of the evaluative cycle and its diverse methodological designs in small and medium enterprise (SME) policy. We structure our arguments based on the most common phases of the cycle, namely policy justification, needs, policy theory, implementation, impact and efficiency assessments. We use an in-depth case study of public assistance to an SME to illustrate how findings from these phases go beyond the results of the additionality practice in SME policy. We employ the findings as starting points to discuss several methodological designs for the evaluation of entire programmes, policies and systems.
Thermoplastic polyurethanes/polyester/polypropylene composites: Effect of thermoplastic polyurethanes honeycomb structure on acoustic-absorbing and cushioning property
Authors: Li Ting-Ting , Lou Ching-Wen , Huang Chen-Hung , Huang Chien-Lin , Lin Jia-Horng
Published: July 2015

A new acoustic absorbing/cushioning composite is fabricated by thermoplastic polyurethanes honeycomb structure – thermoplastic polyurethane honeycomb cushion and grid, and composite nonwoven in this study. Composite nonwoven is composed of different layers of polyester/polypropylene nonwoven and polyester nonwoven. Research result shows that layer combination of polyester/polypropylene nonwoven and polypropylene nonwoven affects acoustic absorption and thermal conductivity of resulting composite nonwovens. The thermal conductivity of composite nonwovens decreases to 0.02213 W/(m K), showing excellent thermal-insulating property. Honeycomb structure–thermoplastic polyurethane honeycomb cushion and grid broadens the acoustic absorbed frequency and improves the mid- and high-frequency absorption coefficient and cushioning property of thermoplastic polyurethane/polyester/polypropylene composites. Incorporation of different honeycomb structure into composite nonwovens presents diversified acoustic-absorbing characteristic profiles. The resulting 35-mm-thick thermoplastic polyurethane/polyester/polypropylene composites absorb 85% acoustic waves at 1250 Hz and 94.2% at above 2000 Hz as well as 92.88–96.59% impact energy. Therefore, it becomes an excellent alternative for protective wall in kindergarten and gerocomium and compartment wall in the building.
Evaluation of Photoneutron Dose Measured by Bubble Detectors in Conventional Linacs and Cyberknife Unit
Authors: Biltekin Fatih , Yeginer Mete , Ozyigit Gokhan
Published: July 2015

This study aims to reduce the uncertainty about the photoneutron dose produced over a course of radiotherapy with high-energy photon beams and evaluate photoneutron contamination-based secondary malignancy risk for different treatment modalities. Dosimetric measurements were taken in Philips SL25/75, Elekta Synergy Platform (Elekta AB, Stockholm, Sweden), Varian Clinac DHX High Performance systems (Varian Medical Systems, Palo Alto, CA), and Cyberknife Robotic Radiosurgery Unit (Accuray Inc., Sunnyvale, CA) using bubble detector for neutron dosimetry. The measurement data were used to determine in-field and out-of-field neutron equivalent dose in 6-MV 3D conformal radiotherapy, sliding window–intensity-modulated radiotherapy, and stereotactic body radiotherapy and to calculate the effective dose in 18-MV 3D conformal radiotherapy and sliding window–intensity-modulated radiotherapy techniques for patients with prostate cancer undergoing a standard treatment. For the 18-MV treatment techniques, the secondary malignancy risk due to the neutron contamination was estimated using the risk factors published by The International Commission on Radiological Protection. The neutron contamination-based secondary malignancy risk for the 18-MV 3D conformal radiotherapy and sliding window–intensity-modulated radiotherapy modalities was found to be 0.44% and 1.45% for Elekta Synergy Platform and 0.92% and 3.0% for the Varian Clinac DHX High Performance, respectively. For 6-MV 3D conformal radiotherapy, sliding window–intensity-modulated radiotherapy, and stereotactic body radiotherapy treatment techniques, neutron equivalent doses inside the treatment field were found to be lower than 40 mSv. Our measurements reveal that equivalent dose and effective dose due to the neutron contamination are at a considerable level for 18-MV sliding window–intensity-modulated radiotherapy treatments, while 6-MV photon beams used in different modalities still induce only negligible photoneutrons. The secondary malignancy risk based on photoneutron should be therefore taken into consideration in case of selecting 18-MV photons in a sliding window–intensity-modulated radiotherapy treatment instead of 6 MV.
Optimization of reliability for a hierarchical facility location problem under disaster relief situations by a chance-constrained programming and robust optimization
Authors: Ghezavati Vahidreza , Soltanzadeh Faezeh , Hafezalkotob Ashkan
Published: July 2015

Despite the frequent use of hierarchical facility location decisions for public facilities such as hospitals and schools and their important role in positioning relief facilities effectively, few studies have examined the optimized positioning of such facilities under uncertainty, which is imposed by the nature of a disaster. In this article, we present a hierarchical facility location model in a supply chain of disaster relief under uncertainty in order to schedule the customers’ services. In this model, we consider a positive probability for roadways to become closed for relief operations when a disaster occurs. In this network, a higher level relief facility offers all services provided by a minimum relief facility. Since the aim of this model is to rapidly provide the appropriate emergency supplies to the affected villages, we optimize the reliability of the network by constructing more roads and infrastructure between all villages and relief centers. For this purpose, a robust optimization and chance-constrained programming method was applied. Finally, the hybridization of the genetic algorithm, simulated annealing and an optimization technique will be introduced to solve the model efficiently.
Preliminary Results of Mismatch Repair Deficiency Screening via Immunohistochemical Staining in Young Asian Colorectal Cancers
Authors: Koh Poh-Koon , Chew Min-Hoe , Tan Yan-Sheng , Lim Kiat-Hon , Loi Carol , Tang Choong-Leong , Eu Kong-Weng
Published: July 2015

Background:

The incidence of mismatch repair (MMR) deficiency in young colorectal cancers (CRC) remains unknown in Asians. This preliminary study assessed the clinicopathological features and efficacy of screening for MMR protein deficiency in young Asian CRC patients.

Methods:

From January 2006 to October 2009, patients under the age of 50 with immunohistochemical (IHC) staining for MMR proteins in resected CRC specimens were retrieved from a prospective computerised database.

Results:

Eighty unrelated patients comprising predominantly 80% Chinese (n = 64), with median age of diagnosis at 41 years (range 22–50 years) had IHC performed. Twenty-three per cent (n=18) of the patients had abnormal IHC staining. Loss of staining for MLH1, MSH2 and MSH6 proteins were observed in 18%, 2% and 6% of tumours respectively. Of the 15 patients who had abnormal staining of MLH1, three had concomitant equivocal staining for MSH6. One tumour specimen had abnormal staining in all 3 proteins. Multivariate analysis revealed that family history was the only significant predictive factor for defective MMR detection (OR 8.06, 95% CI 1.69–38.35, p=0.002). However if Amsterdam criteria alone were to be used, 72% (n=12) of the cohort would have not been detected for MMR gene defects.

Conclusion:

The overall burden of germline MMR deficiency in the Singapore population may be as high as 23%. Amsterdam criteria alone are insufficient to detect hereditary non-polyposis colorectal cancer (HNPCC) related patients. The use of IHC staining of at least 3 MMR proteins is a useful screening strategy for HNPCC diagnosis and routine screening of mismatch repair deficiency may be recommended for all young Asian CRC patients.
The Role of Endoscopy in the Management of Cystic Pancreatic Lesions
Authors: Ang Tiing Leong
Published: July 2015

Pancreatic cystic lesions may be due to pseudocysts and related inflammatory fluid collections, simple cysts, cystic tumours such as serous cystadenoma, mucinous cystic neoplasm and intraductal papillary mucinous neoplasm, as well as solid tumours with areas of cystic degeneration. The main diagnostic challenge is to distinguish premalignant and malignant cystic lesions from benign cystic lesions. Cross-sectional imaging using computer tomography and magnetic resonance imaging/ magnetic resonance cholangiopancreatography provides the initial morphological characterization. Endoscopic ultrasound (EUS) is an important tool when diagnostic doubts persist and is crucial in the assessment of invasive malignancy. EUS-guided fine needle aspiration and cyst fluid analysis has been shown to be cost-effective for risk stratifying the malignant potential of cystic tumours and the need for surgical resection. In the management of symptomatic pseudocysts and related fluid collections, endoscopic drainage has been established as the preferred technique, with efficacy similar to surgery but lower costs and morbidity.
Molecular Genetics of Gastric Adenocarcinoma
Authors: Eng Alvin Kim Hock , Kon Oi Lian
Published: July 2015

Gastric carcinoma is the second leading cause of cancer deaths in the world. Its aetiology is closely linked to the bacterial pathogen Helicobacter pylori which is believed to induce a state of chronic inflammation that predisposes to a cascade of molecular and cellular alterations leading to carcinogenesis. Although the exact process of gastric carcinogenesis has yet to be elucidated fully, the interaction of the genetic factors with environmental factors is likely to be a significant consideration. Numerous genes and molecular pathways have been discovered to be associated with gastric adenocarcinoma and more importantly, it is now becoming possible to use some of these as means of prognostication and targeted therapy. This review will outline our current understanding of the aetiology and molecular genetics of gastric adenocarcinoma and its current clinical applications.
Allergic Eosinophilic Gastroenterocolitis: Review of the Nutritional Management
Authors: Han Wee Meng , Tan Nancy , Chiang Wen Ching , Chu Hui Ping
Published: July 2015

The immunopathologies of food allergies can involve Immunoglobulin E (IgE), or non-IgE, or have a mixed IgE and non-IgE response. In the past decade, food allergy manifestations have evolved and there have been increased reports of the latter two presentations. A case report of a young child with allergic eosinophilic gastroenterocolitis, with a mixed immune reaction is described. The nutritional management of the condition is reviewed.
Cross-Sectional and Longitudinal Validity of the Hughston Clinic Knee Questionnaire in Arthroscopic Meniscal Repair
Authors: Pua Yong Hao , Lim Cheng Kuan
Published: July 2015

Aim:

To examine the cross-sectional and longitudinal convergent and discriminant validity and the sensitivity to change of the Hughston Clinic Knee Questionnaire (HCQ) in young adults with meniscal repair.

Method:

Seventeen young adults completed the HCQ and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at 1 week and at 6 weeks after an arthroscopic meniscal repair. Convergent validity was assessed by evaluating the correlation between the HCQ and the SF-36 physical function subscale. Discriminant validity from pain measure was assessed by examining the HCQ with the physical function and bodily pain subscales of the SF-36. Sensitivity to change was assessed using standardised response means. Spearman correlation coefficients were also calculated.

Results:

The HCQ showed moderate to strong cross-sectional and longitudinal convergent validity with the SF-36 physical function subscale; however, discriminant validity was not evident for the HCQ. The HCQ showed a larger standardised response mean than did the SF-36 physical function subscale.

Conclusion:

Cross-sectional and longitudinal convergent — but not discriminant — validity was established for the HCQ. Although the HCQ was more adept in detecting change scores than did the SF-36 physical function subscale, the reason for this finding was unclear.
Community-Associated Methicillin-Resistant Staphylococcus Aureus Skin and Soft Tissue Infections
Authors: Wijaya Limin , Hsu Li Yang
Published: July 2015

The prevalence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections is increasing globally and in Singapore. Skin and soft tissue infections (SSTIs) are the most common manifestations, ranging from common furuncles to the rare but life-threatening necrotizing fasciitis. Surgical drainage and debridement where feasible are the mainstay of therapy, whereas MRSA-active antibiotics are essential when surgery is not possible or as adjunctive therapy for severe and/or complicated SSTIs. In itself, the continued inexorable rise in CA-MRSA rates poses difficult challenges for primary healthcare and hospital infection control. Innovative approaches are required to mitigate its impact in both the community and hospital settings.
Pseudosarcomatous Soft Tissue Lesions: A Review
Authors: Ng Victor Weng Leong
Published: July 2015

Pseudosarcomatous soft tissue lesions are potential pitfalls to both clinicians and pathologists due to their clinical presentation, resemblances to malignant lesions and their rarity. They also have a wide range of differential diagnosis histologically due to their relatively non-specific morphology and natural history of evolving features. The difficulty can be exacerbated by samples obtained from curettings or small biopsies as the architecture of the lesion is very helpful in pointing to the correct diagnosis. Familiarity with these entities is needed to avoid misdiagnosis and unnecessarily radical surgery. Despite recent advances in immunohistochemistry and genetic studies, their diagnosis still rest primarily on a combination of clinical history, radiological findings and histologic morphology.
Autologous Growth Factors: A Biological Treatment in Sports Medicine
Authors: Leong Darren Kok Cheong , Benedict Benedict Chi'Loong Tan , Chew Kelvin Tai Loon
Published: July 2015

Autologous growth factors have been used in maxillofacial and plastic surgery since the 1990s. The use of preparations rich in growth factors has seen an increase in sports medicine is due to its potential to enhance muscle, tendon, ligament and cartilage healing, and thereby accelerating an athlete's functional return to play. The efficacy of these autologous preparations rich in growth factors has seen varying healing effects for ligament, tendon, muscle, and cartilage injuries. Current clinical evidence is in its infancy with mainly animal and retrospective human studies, but the use of preparations rich in growth factors has increased, given its favourable safety profile and efficient preparation and delivery systems. It is important for physicians to keep abreast with the latest available preparation devices and current clinical evidence looking into the effects of autologous growth factors on tendon, ligament, muscle and cartilage healing.
Foreign Material in Histological Specimens from Living Intravenous Drug Abusers (IVDA) — Illustration of 3 Cases
Authors: Poh Wee Teng
Published: July 2015

Drug addicts using the injection mode for drug delivery often suffer from complications relating to non-sterile needle pricks besides unintentional effects of the drugs such as anaphylaxis and other organ damage. Non-sterile injections lead to infections of all kinds, most common being viral such as Hepatitis B & C and HIV infections; besides the usual bacterial and fungal infections. The evidence for this habit however, resides in the inert fillers they inject into their bodies together with the drug. Particles phagocytosed by macrophages in the body constitute permanent evidence of their past demeanor. The present write-up serves to illustrate the presence of injected crystalline material in various organs/tissues of 3 living subjects as seen at routine diagnostic histology in a regional acute hospital. The findings at autopsies of those who die from illicit drug abuse are well documented in the forensic literature1.
Association of Patent Ductus Arteriosus with Tetralogy of Fallot
Authors: Koh Angela S , Le Tan Ju
Published: July 2015

In adults, patent ductus arteriosus (PDA) is usually an isolated lesion. We describe a case of an adult male patient with a residual PDA after repair of Tetralogy of Fallot (TOF) in childhood.
Glue Sniffing: A Review
Authors: Tulsidas Haresh
Published: July 2015

Inhalant abuse is a prevalent and often overlooked form of substance abuse in adolescents and young adults. It causes a euphoric feeling, may become addictive and can be a serious health concern associated with significant morbidity and mortality. Acute effects of inhalants include sudden sniffing death syndrome, asphyxia, and traumatic injuries. Chronic inhalant abuse can damage the brain, heart, lung, kidney, liver, and bone marrow in addition to being an important cause of psychosocial and economic problems. This article is proposed to emphasize on the harmful effects of glue-sniffing, its prevention and management.
Neuromonitoring for Traumatic Brain Injury in Neurosurgical Intensive Care
Authors: Lee Say Kiat , Goh June Pheck Suan
Published: July 2015

The primary aim of neuromonitoring in patients with traumatic brain injury is early detection of secondary brain insults so that timely interventions can be instituted to prevent or treat secondary brain injury. Intracranial pressure monitoring has been a stalwart in neuromonitoring and is still very much the main parameter to guide therapy in brain injured patients in many centres. Cerebral oxygenation is also established as an important parameter for monitoring: global cerebral oxygenation is reliably measured using jugular venous oxygen saturation while brain tissue oxygen tension measurement allows focal brain oxygenation to be monitored. Near-infrared spectroscopy allows a non-invasive option for monitoring of regional cerebral oxygenation. Cerebral microdialysis makes focal measurements of markers of cellular metabolism and cellular injury and death possible, and it is in transition from being a research tool to being an important clinical tool in neuromonitoring. Multimodal monitoring allows different parameters of brain physiology and function to be monitored and can improve identification and prediction of secondary cerebral insults. Multimodal monitoring can potentially improve outcomes in patients with traumatic brain injury by promoting customised treatment strategies for individual patients in place of the commonplace practice of strict adherence to achieving the same standard physiological targets for every patient.
Falls in a Psychiatric Unit
Authors: Meng ZJA , Sim PA , Pee Jon Binte , Kwok Victor , Ng Beng Yeong
Published: July 2015

Our study in a psychiatric ward of a general hospital aims to identify acutely ill psychiatric patients who are at high risk of falls. Patient falls were identified by data collectors after they were reported by hospital staff into the Fall Reporting Risk Management System (RMS). From 2007 to 2009, there were a total of 26 patients who fell in the psychiatric ward. Falls are likely to occur while the patient is ambulating beside the bed and is unlikely to be elimination-related. Slipping or tripping was the most common fall mechanism. There were no life-threatening injuries sustained and the most common type of injury was pain, swelling, contusions and abrasions. Two main patient profiles were identified to be at risk of falls, the first being elderly patients with mood disorders and co-morbid medical conditions such as diabetes. These patients are usually deemed high risk in the fall assessment. The second group of patients is young females with eating disorders and who are not on psychotropic medications. Both groups are likely to be alert and oriented, with no muscle weakness or a history of previous falls.
Reversible Hyperkinetic Movement Disorder Related to Quetiapine Withdrawal: A Case Report
Authors: Ahmad Mohammed Tauqeer , Yip Chun Wai , Prakash Kumar M
Published: July 2015

Quetiapine is used in treatment of schizophrenia, schizoaffective and bipolar disorders as well as psychosis in Parkinson's disease (PD) patients. Neurological side effects are not uncommon with this drug. However, there is limited knowledge about quetiapine withdrawal extra-pyramidal side effects. More recently quetiapine is used for sleep disorders and behaviour abnormalities in PD and its related syndrome. Therefore withdrawal dyskinesias may become more widely observed in the future, and patients need to be warned against sudden discontinuation of the drug. We present a rare case of Quetiapine withdrawal and discussing his bizarre abnormal movement.
Anaesthesia for the First Neurosurgery under Intraoperative High Field Magnetic Imaging Guidance in Singapore
Authors: Abdullah Hairil Rizal , Wong Theodore Gar-Ling , Goh June Pheck Suan
Published: July 2015

In 2008, Singapore General Hospital installed an Intraoperative Magnetic Resonance Imaging system (IMRI) in its Major Operating Theatre. This article discusses the first ever case done in the IMRI suite, the challenges faced and identified, as well as their learning points and potential solutions.
Rapidly Progressive Dementia in a 65-Year-Old Man
Authors: Ting Simon Kang Seng , Lim Teh Aun , Lo Yew Long
Published: July 2015

Cognitive impairment is a common complaint in an aging society, should be differentiated clinically into chronic and rapidly progressive categories. This case of Creutzfeldt-Jakob disease (CJD) illustrates the typical clinical features, imaging and EEG changes of an important cause of rapidly progressive dementia.
Biomarkers in Colorectal Cancer
Authors: Lim Hwee Yong , Toh Han Chong
Published: July 2015

Colorectal cancer remains one of the most frequently diagnosed cancers in the developed world. The advent of new therapeutic agents has further expanded our treatment options. Epidermal growth factor receptor (EGFR) inhibitors have been shown to improve survival in metastatic cancer. However, there remain a substantial proportion of patients who do not benefit from this treatment. KRAS mutation status has been validated to predict the response to EGFR inhibitors with mutant status predicting non-responders. The validation of other predictive and prognostic markers will result in further optimization of the care plan for patient with colorectal cancer; maximising benefits while minimising toxicities. This article aims to provide an update of the various molecular markers for use in detection, prognostication and predicting responses in colon cancer.