bluuebunny/crossref_metadata_2025 huggingface dataset:
cIAP1/2 Antagonism Induces Antigen-Specific T Cell–Dependent Immunity
Authors: Ventre Katherine S , Roehle Kevin , Bello Elisa , Bhuiyan Aladdin M , Biary Tamara , Crowley Stephanie J , Bruck Patrick T , Heckler Max , Lenehan Patrick J , Ali Lestat R , Stump Courtney T , Lippert Victoria , Clancy-Thompson Eleanor , Conce Alberto Winiffer D , Hoffman Megan T , Qiang Li , Pelletier Marc , Akin James J , Dougan Michael , Dougan Stephanie K
Published: March 2023

Checkpoint blockade immunotherapy has failed in pancreatic cancer and other poorly responsive tumor types in part due to inadequate T cell priming. Naive T cells can receive costimulation not only via CD28 but also through TNF superfamily receptors that signal via NF-κB. Antagonists of the ubiquitin ligases cellular inhibitor of apoptosis protein (cIAP)1/2, also called second mitochondria-derived activator of caspases (SMAC) mimetics, induce degradation of cIAP1/2 proteins, allowing for the accumulation of NIK and constitutive, ligand-independent activation of alternate NF-κB signaling that mimics costimulation in T cells. In tumor cells, cIAP1/2 antagonists can increase TNF production and TNF-mediated apoptosis; however, pancreatic cancer cells are resistant to cytokine-mediated apoptosis, even in the presence of cIAP1/2 antagonism. Dendritic cell activation is enhanced by cIAP1/2 antagonism in vitro, and intratumoral dendritic cells show higher expression of MHC class II in tumors from cIAP1/2 antagonism-treated mice. In this study, we use in vivo mouse models of syngeneic pancreatic cancer that generate endogenous T cell responses ranging from moderate to poor. Across multiple models, cIAP1/2 antagonism has pleiotropic beneficial effects on antitumor immunity, including direct effects on tumor-specific T cells leading to overall increased activation, increased control of tumor growth in vivo, synergy with multiple immunotherapy modalities, and immunologic memory. In contrast to checkpoint blockade, cIAP1/2 antagonism does not increase intratumoral T cell frequencies. Furthermore, we confirm our previous findings that even poorly immunogenic tumors with a paucity of T cells can experience T cell–dependent antitumor immunity, and we provide transcriptional clues into how these rare T cells coordinate downstream immune responses.
Type 2 Dendritic Cells Orchestrate a Local Immune Circuit to Confer Antimetastatic Immunity
Authors: Weizman Orr-El , Luyten Sophia , Krykbaeva Irina , Song Eric , Mao Tianyang , Bosenberg Marcus , Iwasaki Akiko
Published: March 2023

The progression of transformed primary tumors to metastatic colonization is a lethal determinant of disease outcome. Although circulating adaptive and innate lymphocyte effector responses are required for effective antimetastatic immunity, whether tissue-resident immune circuits confer initial immunity at sites of metastatic dissemination remains ill defined. Here we examine the nature of local immune cell responses during early metastatic seeding in the lung using intracardiac injection to mimic monodispersed metastatic spread. Using syngeneic murine melanoma and colon cancer models, we demonstrate that lung-resident conventional type 2 dendritic cells (DC2) orchestrate a local immune circuit to confer host antimetastatic immunity. Tissue-specific ablation of lung DC2, and not peripheral DC populations, led to increased metastatic burden in the presence of an intact T cell and NK cell compartment. We demonstrate that DC nucleic acid sensing and transcription factors IRF3 and IRF7 signaling are required for early metastatic control and that DC2 serve as a robust source of proinflammatory cytokines in the lung. Critically, DC2 direct the local production of IFN-γ by lung-resident NK cells, which limits the initial metastatic burden. Collectively, our results highlight, to our knowledge, a novel DC2–NK cell axis that colocalizes around pioneering metastatic cells to orchestrate an early innate immune response program to limit initial metastatic burden in the lung.
Murine Cytomegalovirus Encodes a Specific Cell Surface Marker That Can Trigger Attack by NK Cells
Authors: Campbell Kerry S
Published: March 2023

This Pillars of Immunology article is a commentary on “Direct Recognition of Cytomegalovirus by Activating and Inhibitory NK Cell Receptors,” a pivotal article written by H. Arase, E. S. Mocarski, A. E. Campbell, A. B. Hill, and L. L. Lanier, and published in Science, in 2002. https://www.science.org/doi/10.1126/science.1070884.
Impact of first-trimester body mass index on pregnancy outcomes: observational study
Authors: Oluwole Ayodeji A. , Ugwu Aloy Okechukwu
Published: March 2023

The epidemic of obesity is gradually becoming a global health concern across all age groups. In pregnant mothers, overweight or obesity have been known to be associated with significant antenatal, intrapartum, postpartum, and neonatal complications. Therefore, this study aimed to investigate the association between high maternal Body Mass Index (BMI) and adverse pregnancy outcomes. This was a longitudinal observational study done at the Lagos University Teaching Hospital between May 2019 and February 2020. Antenatal women with gestational age <12 weeks with singleton pregnancies were recruited for the study. They were followed up throughout pregnancy and postpartum to assess for complication during pregnancy, labour, and puerperium. A total of 568 pregnant women were involved in the study. Five hundred and fifty six (556) had complete data and were included in the data analysis. Of these, 169 (30.4%) had BMI of 30 and above while 387 (69.6%) had BMI<30. Women with BMI of 30 and above had significant (p<0.05) risk for development of complications in pregnancy. There is an obvious association between increased maternal BMI and adverse pregnancy outcomes. Public health implications of obesity are enormous for both the mother and baby during pregnancy and delivery. Preconception counselling and health education programs may be beneficial in order to maintain normal BMI in women of reproductive age.
Capabilities, limitations and the use of the GEOROC computer package
Authors: Yu Y S
Published: March 2023

Computer codes have been used by various researchers in modelling viscoelastic formations, with a good degree of success. Serata used a complex rheological model, REM (Rheological Element Model) code, to simulate mine openings [2]. Others, in the U.S. Nuclear
Waste Isolation Programme, have evaluated the capability of various codes for the design of nuclear waste repository [3]. Because of the proprietary nature of the above codes, they are not available to mine operators in Canada. Consequently, in 1984, CANMET initiated a research project to develop a
numerical modelling package for use in the design of underground potash mine openings. GEOROC is the resultant computer program; it was developed by RE/SPEC Ltd., of Calgary under contract to CANMET. In recent years, computer simulation is playing an increasingly important role in evaluating the
short and long term structural stability of underground mine openings, and in ground control studies related to mine design and layout. Such simulations are increasingly being used in the design of underground salt and potash mines. Because of the viscoelastic nature of salt rock formations,
simulation models must take into consideration their time dependent properties if they are to correctly predict opening closures, ground stresses, and ground stability based on prescribed failure criteria. This presentation describes the capabilities, limitations and the use of computer code -
GEOROC. A case history in which GEOROC is used to simulate a typical room and pillar mining section of a Western Canadian potash mine is provided. Predicted ground behaviour using the code is compared with actual behaviour as determined through field measurements. Results indicate that good
correlation exits between predicted and measured ground behaviour, and is an encouragement to greater use of modelling in mine stability studies related to mine design.
REMOTELY PILOTED AIRCRAFT SYSTEMS WITH RGB CAMERA TO MAP COMMERCIAL TABLE TOMATO NURSERIES
Authors: Furquim Maria Gláucia Dourado , Nascimento Abadia dos Reis , Costa João Vitor Silva , Ferreira Manuel Eduardo , Corcioli Graciella , Borges Lino Carlos
Published: March 2023

Remotely Piloted Aircraft Systems (RPAS) are already a reality in Brazil. They are used in different fields of knowledge to obtain digital products that contribute to the identification, monitoring, control, and precision of the agricultural decision process. However, the cost-benefit of applying this technology to produce seedlings in commercial tomato nurseries needs better evaluation. This research analyzes the use of an RPAS with RGB camera over areas of table tomato seedlings and compares the cartographic products with the information obtained through semi-structured interviews with rural property owners in the States of Goiás, Minas Gerais, and the Federal District (Brasília). The results were not divided into external area applications and internal (greenhouse) mapping, as adopting technology for monitoring the seedling production process inside greenhouses is still economically unfeasible compared to human identification, thus not justifying the investment. Nonetheless, images of the external area provide crucial information for planning a nursery, considering its structural aspects and adequate disposal. Keywords: Seedling production; Digital Image Processing; UAV; Drones.
SPATIAL CIRCUIT OF THE PRODUCTION OF FOOTWEAR AND TERRITORIAL INTERACTIONS OF THE COMPANY GRENDENE, SOBRAL, CE
Authors: Teles Glauciana Alves , Costa Maria da Penha dos Santos
Published: March 2023

For the footwear industry, Sobral, in Ceará, stands out as the most expressive productive territory, a fact that is justified by the location of Grendene's production units. This article sought to analyze the general aspects of territorial interactions in the production of footwear by Grendene-Sobral based on the spatial circuits of production. In order to carry out this demand, the methodological procedures consisted of: a) literature review based on authors specialized in the subject; b) documentary and statistical survey and c) field research. Through the research, it was found, among other results, that Sobral receives all orders and determinations of production, characterizing itself as a territory used for production itself. Therefore, the product is designed in the South, produced in Sobral and distributed to the national and global consumer market, which explains the multi-scalarity of inputs, the organization of the production process and the multi-scalarity of distribution and consumption of the company's footwear production. Keywords: Footwear industry. Spatial circuit of production. Sobral. Grendene.
The Study of Modelling and Development Environment for Virtual Manufacturing Systems
Authors: Yuan Qing-Ke , Xin Chen , Yao David Y. , Wang Wen G.
Published: March 2023

For adapting the demands of the rapid changing and enhancing the competing capability of enterprise in the international market, various modern manufacturing systems have been put forward, which are aimed at various specifications, perfect performance and high quality, low production cost and short manufacturing cycle of products, virtual manufacturing system (VMS) has been emerged as the times require, which is effective technology to meet the challenge of 21 century's manufacturing industries. Based on analyzing modern manufacturing systems, according to the characteristics and requirement of VMS, in this paper, the architecture, the key technologies and the implement way of VMS were explored, and development environment for VMS was put forward, which is a powerful tool for building VMS.
The Advanced Daimler-Benz Driving Simulator
Authors: Käding Wilfried , Hoffmeyer Friedrich
Published: March 2023

The Daimler-Benz Driving Simulator is a tool for research and development. It was put into operation in 1984/85 and has been enhanced since that time in many details, having gained a lot of experience in many different applications.

During a major modernization phase from autumn ‘93 until summer ‘94, the driving dynamics computer system as well as the visual system have been exchanged, and the hydraulic motion system has been extended in lateral direction to improve motion simulation quality.
Gdańsk as a Hanseatic City in the Late Middle Ages. Selected Aspects: Symbolism, Ruling Elites, Maritime Contacts
Authors: Możejko Beata
Published: March 2023

For 13th‑century Gdańsk, as for other cities of medieval Europe, it was important to create a community identity, which was expressed in the symbolism of seals and later also heraldic colours and coats of arms. In Gdańsk a seal of 78 mm in diameter, which survives on a document dating from 1299 (hence from pre‑Teutonic times), depicts an unmanned cog borne along by the waves. In late medieval Gdańsk, as in other Hanseatic towns, power belonged to elite families, who formed a ruling group. During 1454–1525 families such as the Falckes, Bischofs, Bocks, Ferbers, Scheweckes, Suchtens, and Zimmermanns each had two members who served as mayors. Maritime contacts played one of the most vital roles in the social and economic life of late medieval Gdańsk, and these included trade links with the English –competitors of the Hanse who could not be taken lightly.
Catherine the Great’s Danish Portraitist: Projecting Majesty across the Baltic Sea
Authors: Blakesley Rosalind P.
Published: March 2023

This chapter considers the Baltic Sea as a unique conduit for Russia’s transcultural exchange, with all the imperialist rivalry that this entailed. It takes as its case study a handful of portraits that the Danish artist Vigilius Eriksen painted for Catherine the Great in the 1760s and ‘70s, and the way in which their circulation and display enabled the empress to become arguably the most efficient ruler of her generation to foster a personal iconography that announced and then cemented her eminence on the European stage. Tracing the trajectories of Eriksen’s portraits reveals a commanding nexus between political ascendency, international relations, and visual imagery, and the function of paintings as highly charged conductors of regal clout around the Baltic Sea. Collectively, they engaged with power differentials in highly suggestive ways, confirming the vitality with which portraiture constructed and signalled status and authority between some of the Baltic’s most competitive courts.
Gdynia 1920–1939: Poland’s Gateway to the World
Authors: Grzechnik Marta
Published: March 2023

In 1923, construction of a new Polish seaport began in the small fishermen’s village of Gdynia. By 1926, the village transformed into a port town, and by 1939 it was the biggest and one of the most modern ports on the Baltic Sea, responsible for half of Poland’s foreign exchange. The construction, which was a great investment and considerable strain on the country’s modest resources, was accompanied by intensive enthusiastic propaganda. It was carried out by research institutions (e.g. Baltic Institute) organisations such as Maritime and Colonial League, journalists, writers etc., and it was expressed in exhibitions, public events such as “Holidays of the Sea,”literature, poetry, film and other media. Gdynia became a symbol of Poland’s transformation from nation of farmers to one of seafarers; of modernisation, civilizational development, and even overseas expansion and acquiring colonies. This was summarised with a metaphor of the port being Poland’s “window”or “gateway to the world,”thanks to which it could escape its historically problematic position between Germany and Russia/USSR, and –through a network of trade connections, seafaring, and colonies in Africa and South America –acquire a global presence. This article discusses the rhetoric and realities of Gdynia as the symbol of this ambition in interwar Poland, the contrast and similarities between the image of Gdynia created in contemporary propaganda and publications, and the reality of the actual city.
The The Effectiveness of Student's Worksheet Based On 21st Century Learning Skills to Improve Critical Thinking Skills
Authors: Renny Dwijayanti  , Soesilowati Etty , Handayati Puji
Published: March 2023

This study aims to determine the effectiveness of Student Worksheets (LKM) based on 21st-century learning skills in entrepreneurship courses. The research methodology employed a set pre-test and post-test design with limited studies of students in business education programs selected based on the abilities of up to 15 low-, intermediate, and high-ability students. Pre-test and post-test are used to determine students' critical thinking skills. Data were analyzed descriptively and quantitatively. The results showed that student worksheets based on 21st-century learning skills in entrepreneurship courses were effective as teaching materials since the pre-test and post-test data were normally distributed and the average N-Gain results were in the high category.
Perspectiva dinámica de los derechos sociales y retos para una buena administración
Authors: Rey Varela José Manuel
Published: March 2023

Igual que el Derecho presenta una visión dinámica para responder al contrato social entre el Estado y los ciudadanos y a los cambios sociales, económicos y culturales donde identificamos tres generaciones de derechos; proponemos para el Derecho Constitucional y el Administrativo, especialmente en el ámbito de los derechos sociales, por cuanto precisan una acción positiva del Estado para su realización, un cambio de paradigma a través de tres perspectivas superadoras de su perspectiva tradicional legal y normativa, que sin renunciar a ella, incorpore la perspectiva de las políticas públicas y la buena administración así como la perspectiva económica, para que bajo esta visión tridimensional siga sirviendo con objetividad los intereses generales en una realidad cada vez más cambiante, compleja, globalizada y exigente con la persona y su dignidad como centro de su actuación.
LA MEDIACIÓN INTERCULTURAL: PROFUNDIZANDO EN EL CONCEPTO DE CULTURA
Authors: Tomé da Mata Edileny
Published: March 2023

En las labores de mediación intercultural, se dan por hecho algunos conceptos y, por ende, se dan por zanjada sus fundamentaciones, cuando sus significados son de importancia inestimable y, éste es el caso del concepto de cultura. Por ello, procurando aclarar algunas claves pertinentes de la mediación intercultural, en este artículo intentaré resaltar cuestiones como la noción de cultura, la condición postcolonial, multiculturalidad vs. interculturalidad, así como los debates y discusiones surgidos en torno a ellas.
Utilization of Virtual Learning Environment in Malaysian Non-Arabic Speaking Learners’ Classroom
Authors: Kassim Noorafini
Published: March 2023

This study aimed to understand the utilization of VLE in Non-Arabic Speaking Learners’ classrooms from the perspective of Arabic teachers in higher education institutions. Purposive sampling was utilized to pick the research sample for this study. Then, the sample used for this study consisted of 3 Arabic language teachers. One-to-one in-depth interviews were conducted with the three informants. Semi-structured interviews were used to gather the data to allow the informants to express their experiences in an accessible manner. A case study was used in this study to create a qualitative design. The researcher used a method called thematic analysis (TA) and followed a few steps, including (i) word-by-word transcription, (ii) interview transcription, (iii) coding, and (iv) labeling. The findings illustrated the Arabic teachers’ perspectives on using VLE, the approaches when implementing VLE, and how VLE can effectively teach the Arabic language. The responses of the three informants would illustrate the main themes found using the thematic analysis (TA) method. The analysis of this study helps provide such information to universities on the perspectives of Arabic teachers on the use of VLE, their approaches when implementing VLE, and how VLE can be effective in their language teaching in a virtual learning context. This study allows us to understand better how Malaysian Arabic teachers adapt to virtual language learning environments by utilizing VLE at the university level.
Travel Characteristics and Health Practices Among Travellers at the Travellers’ Health and Vaccination Clinic in Singapore
Authors: Lee Vernon J , Wilder-Smith Annelies
Published: March 2023

Introduction: Singapore has a fast-growing travel industry, but few studies have been done on travel characteristics and travel health practices. This study describes the profile and health-seeking behaviour of travellers attending a travel health clinic in Singapore.

Materials and Methods: A cross-sectional survey was conducted on travellers attending the Traveller’s Health and Vaccination Centre (THVC) between September and November 2002 using a standardised questionnaire. Information obtained included individual demographic and medical information, travel patterns, vaccination status and travel health practices.
Results: Four hundred and ninety-five (74%) eligible travellers seen at THVC responded to the questionnaire. Their mean age was 36 years; 77% were professionals, managers, executives, and businessmen, students, and white collar workers. Asia was the main travel destination, and most travelled for leisure and resided in hotels or hostels. The median duration of travel was 16 days. Although >90% had previously travelled overseas, only 20% had previously sought pre-travel advice. Malays were significantly underrepresented (P <0.01); and Caucasians and Eurasians were significantly more likely (P <0.01) to have previously sought pre-travel advice compared with Chinese, Indians and Malays. Factors associated with seeking pre-travel advice included travel outside of Asia, especially Africa and South America.
Conclusion: Singaporean travellers travel more often to cities rather than rural areas, compared with non-Asian travellers. Asia is the preferred destination, and travel outside of Asia is perceived as more risky and is associated with seeking pre-travel advice and vaccinations. Travel patterns and behaviours need to be taken into account when developing evidence-based travel medicine in Asia.

Key words: Cross-sectional survey, Health behaviour, Travel, Vaccination
Laparoscopic Appendicectomy in Children: A Trainee’s Perspective
Authors: Prasad TR Sai , Chui Chan Hon , Jacobsen Anette Sundfor
Published: March 2023

Introduction: The emergence of operative laparoscopy has brought a great demand for training surgical residents, but there are no clear guidelines regarding choice of procedure for training, proficiency assessment and accreditation. We aim to examine from a trainee’s point of view, the safety and efficacy of laparoscopic appendicectomy (LA) as a laparoscopic training procedure.

Materials and Methods: A retrospective analysis of all the consecutive cases of LA done by a trainee in paediatric laparoscopic surgery from September 2003 to February 2005 was done.
Results: A total of 70 consecutive patients (37 males and 33 females) aged 3 to 15 years (mean, 10.5 ± 2.5) with suspected appendicitis underwent LA. Twelve (17.1%) patients had acute appendicitis, 25 (35.7%) had acute suppurative appendicitis adherent to the caecum with localised and/or pelvic pus pocketing, 29 (41.4%) had perforated appendicitis with generalised peritonitis and 4 (5.7%) had normal appendix [mesenteric adenitis (1), omental infarct (1), torted Meckel’s diverticulum (1) and primary peritonitis (1)]. There were no operative complications and none required conversion to open surgery. The operative duration ranged from 25 to 110 minutes (mean, 55.6 ± 23.4). There were two complications; one had adhesive intestinal obstruction and underwent successful laparoscopic adhesiolysis and one had umbilical wound infection.
Conclusions: LA is a safe and effective laparoscopic training procedure, in addition to being effective for all stages of appendicitis, as well as concurrent lesions encountered in children with suspected appendicitis.

Key words: Appendicitis, Laparoscopy, Training
Recurrent Non-immune Fetal Hydrops: A Case Report
Authors: Goh Shen L , Tan June VK , Kwek Kenneth YC , Yeo George SH
Published: March 2023

Introduction: Recurrent non-immune fetal hydrops (NIH) has been reported in the literature but is a rare entity, with fewer than 6 reported cases so far. It has been postulated to be related to a recessive gene.

Clinical Picture: We report a case of recurrent fetal hydrops in a multigravida with no medical history of note. She presented in her current pregnancy with a significant history of having 4 (out of 7) previous pregnancies affected by hydrops.
Treatment: All the affected pregnancies resulted in mid-trimester pregnancy termination (MTPT) following diagnosis in the second trimester. Previous investigations for hydrops did not yield any obvious cause.
Outcome: Her most recent pregnancy was unaffected. We discuss the possible differential diagnoses and the likelihood of autosomal recessive metabolic diseases being the aetiological factor.
Conclusion: Rare causes of fetal hydrops need to be excluded in cases of recurrent non-immune hydrops with no obvious aetiology following routine investigations.

Key words: Hydrops fetalis, Lysosomal storage disorders, Non-immune, Thalassaemia, Ultrasonography
Socio-demographic Profile and Help-seeking Behaviour of Buprenorphine Abusers in Singapore
Authors: Winslow Munidasa , Ng Wei-Ling , Mythily Subramaniam , Song Guo , Yiong Huak-Chan
Published: March 2023

Introduction: The US Food and Drug Administration (FDA) approved buprenorphine or Subutex for the treatment of opiate dependence in October 2002. Buprenorphine is a partial agonist of the mu-opioid receptor; although initial animal research suggested a low abuse potential for buprenorphine, it was subsequently shown to have an abuse potential similar to that of morphine or hydromorphone. The objectives of this study were to establish the sociodemographic profile and help-seeking behaviour of buprenorphine abusers attending the de-addiction treatment clinics of the Community Addictions Management Programme. Materials and Methods: One hundred and twenty subjects, all buprenorphine abusers fulfilling the diagnostic criteria for opiate dependence, who consented to the study, completed an interviewer-administered questionnaire. Results: The mean age of those participating in the study was 39.2 [standard deviation (SD) 8.0] years. The majority of the participants were male (90%), 52.5% were currently employed and 98% had at least primary education. A family history of drug abuse was reported by 27% of the subjects. Illicit drug abuse occurred at an early age with mean age of onset of illicit drug abuse being 16.9 (SD 4.8) years with gateway drugs like marijuana and glue. Conclusions: It is vital for our medical profession to be aware of the trend in the local population to move from the abuse of illicit substances, to the abuse of prescriptive medications. It makes it necessary to increase the understanding of addictions both amongst our practising medical fraternity, and amongst those training to enter the profession. At the hospital level, it necessitates a higher level of vigilance among our emergency room physicians and those treating infectious diseases.
Can Long-term Corticosteroids Lead to Blindness? A Case Series of Central Serous Chorioretinopathy Induced by Corticosteroids
Authors: Loo Jing-Liang , Lee Shu-Yen , Ang Chong-Lye
Published: March 2023

Introduction: Long-term, high-dose corticosteroid therapy is well-known to cause systemic and ocular complications. A lesser known complication is chronic central serous chorioretinopathy (CSCR). Although idiopathic central serous chorioretinopathy (CSCR) is known to be mild with spontaneous recovery and minimal effects on the final visual acuity, chronic CSCR as a complication of long- term steroid therapy behaves differently, and may cause irreversible visual impairment.

Clinical Picture: Three cases of chronic, recurrent CSCR were precipitated by long-term corticosteroids prescribed for post-renal transplant immunosuppressive therapy, post-pituitary surgery and pemphigus vulgaris.
Treatment and Outcome: Two cases resolved with tapering of corticosteroids while one case was treated by focal laser photocoagulation. Two eyes had severe impairment of vision as a result of subretinal scar formation while the other 4 eyes had mild reduction of visual acuity from retinal epithelium pigment atrophy.
Conclusion: Long-term corticosteroid therapy can be complicated by severe, chronic and recurrent CSCR and occasionally peripheral exudative retinal detachment. This may result in subretinal fibrosis and permanent loss of vision.

Key words: Opioid dependence, Partial agonist, Primary care setting
Leadership and Professionalism Curriculum in the Gross Anatomy Course
Authors: Pawlina Wojciech , Hromanik Michael J , Milanese Tia R , Dierkhising Ross , Viggiano Thomas R , Carmichael Stephen W
Published: March 2023

Introduction: Today’s physicians must demonstrate both professionalism and leadership skills in order to succeed in largely team-based healthcare environments. The purpose of this study was to determine if professionalism attributes, leadership style, and leadership style adaptability are associated with academic performance among first-year students early in their medical curriculum. Materials and Methods: Students were divided into 4-member dissection groups for the duration of the Gross and Developmental Anatomy course. Leadership responsibility was randomly assigned to a team member on a rotating basis every 5 weeks. After each 5-week block, student performance was measured by written and practical examinations, and each student assessed their leader’s or their own professionalism attributes and leadership style using validated survey instruments. Results: Most students demonstrated either a “selling” only (57%) or “participating” only (30%) leadership style with low to moderate leadership adaptability. “Participating” and “delegating” leadership styles have the highest average group written exam scores (89.4%, P <0.008). “Telling” only or “selling” only leaders have the lowest average group exam scores (83.5%, P <0.001). “Selling” and “participating” leaders have significantly lower average group practical exam scores than other styles (81.5%, P <0.007). Positive associations were observed between the written and practical examination scores and the leader’s integrity (P = 0.003, P = 0.002) and responsibility (P <0.001 , P = 0.037). Conclusions: This study demonstrates that various situational leadership styles and aspects of professionalism are associated with written and practical examination scores in the Gross and Developmental Anatomy course. Furthermore, it demonstrates that first-year medical students are in need of leadership skill development. Key words: Basic science, Gross anatomy, Leadership style, Medical curriculum, Teamwork, Team-based learning
Evidence-based Medicine in Clinical Curriculum
Authors: Wanvarie Samkaew , Sathapatayavongs Boonmee , Sirinavin Sayomporn , Ingsathit Atiporn , Ungkanont Artit , Sirinan Chomchaba
Published: March 2023

Introduction: The teaching of evidence-based medicine (EBM) has now been incorporated as an integral part of medical curriculum at the Faculty of Medicine, Ramathibodi Hospital but there is little research into the effectiveness of the course. The purpose of this report is to evaluate the EBM skills of medical students and competency of the faculty member.

Materials and Methods: The EBM course was created by the EBM Working Group at the Faculty of Medicine, Ramathibodi Hospital for 3rd- to 6th-year medical students. The principles of EBM, clinical epidemiology and biostatistics were gradually instilled during the 4 years of medical school. Information technology infrastructure was also provided to facilitate critical appraisal skills. At the end of the Community Medicine clerkship, students anonymously evaluated aspects of the course regarding their EBM skills and faculty member competency with Likert scale questions.
Results: Medical students generally gave high evaluations to all aspects of the EBM course taught in the Community Medicine Department. For each of the evaluation questions, the means were higher for faculty member competency.
Conclusions: The teaching of EBM course at the Faculty of Medicine, Ramathibodi Hospital is useful for medical students to enhance their critical thinking skills, and they seem to value the sessions positively.

Key words: Community Medicine, Critical thinking skill, Evaluation, Medical curriculum
An Online Evaluation of Problem-based Learning (PBL) in Chung Shan Medical University, Taiwan – A Pilot Study
Authors: Chen Jia-Yuh , Lee Meng-Chih , Lee Hong-Shan , Wang Yeou-Chih , Lin Long-Yau , Yang Jen-Hung
Published: March 2023

Introduction: Problem-based learning (PBL) embraces principles of good learning and teaching. It is student-directed, fosters intrinsic motivation, promotes active learning, encourages peer teaching, involves timely feedback, and can support student self and peer assessment. The most important function of the assessment process is to enhance student learning, to improve the curriculum and to improve teaching.

Materials and Methods: To improve the PBL tutorial in Chung Shan Medical University, we developed an online evaluation system containing the evaluation forms for students, tutor, self and peer. The Cronbach α reliability coefficients were 0.9480, 0.9103, and 0.9198 for the Student, Tutor and Self and Peer Evaluation Form, respectively. The online evaluations were mandatory to both students and tutors, and the information was completely anonymous.
Results and Conclusions: The survey response rates of the online evaluations ranged from 95.6% to 100%. The online evaluations provided a documented feedback to the students on their knowledge, skills and attitudes. Correspondingly, tutors too received feedback from students in evaluating their performance on the appropriateness and effectiveness of tutoring the group. Although there was an initial lack of coordination regarding responsibilities and how to use the online system for both students and the Faculty, the system enabled us to look into how effective our PBL course had been, and it provided both process and outcome evaluations. Our strategy for evaluating the success of PBL is only at its initial stage; we are in an ongoing process of collecting outcome data for further analysis which will hopefully provide more constructive information to the PBL curricula.

Key words: Facilitator, Formative evaluation, PBL tutors, Small group
The Influence of Capital and Transportation in the Implementation of the Public Private Partnership Scheme
Authors:   Master of Sharia Economics, Islamic University of Maulana Malik Ibrahim Malang, Indonesia, Badzlina Ghassani
Published: March 2023

Indonesia as a country that is currently carrying out developments requires a lot of funds to carry out infrastructure development. The methods used carrying out infrastructure development is by implementing a Public Private Partnership or PPP scheme. Several experts have put forward the definition of PPP, which is contained in No. 38 of 2015 Presidential Regulation concerning Government Cooperation with Business Entities in the Provision of Infrastructure. In reality the implementation of the PPP scheme is said to be able to influence several things including the use of capital and transportation.
The influence of the age of granite paving blocks in outdoor public spaces on the ambient temperature during the warm months affecting their users
Authors: Stefanopoulos Kyriakos , Lianos Nikolaos , Polychronopoulos Dimitris , Zoras Stamatis
Published: March 2023

In this research, we present the results from the comparison of temperature measurements that were made over different external points of public spaces in the old town of Xanthi. The area is located in northern Greece and is a protected settlement. All the points where the measurements were made are paved with dark gray granite blocks. This material has always been used to pave the open public spaces of the old town. Through the comparison of temperature measurements, it was found that the older paving materials develop higher temperatures compared to similar, but newer materials. Thus, it was concluded that the age of the paving materials affects the comfort of the users of the open public spaces. To test this, measurements were made during two months in spring and summer. During this period, the temperatures are higher and thus affect the users of the outdoor areas more; this results in a more useful comparison of the coating materials.
MATERNIDADE E EDUCAÇÃO: REFLETINDO SOBRE O APOIO NA INSTITUIÇÃO DE ENSINO
Authors: Langa da Silva Edilâine Almeida , Novais Lucimar
Published: March 2023

Resumo A educação formal tem sido um fator importante que auxilia diversas mulheres a superarem problemas sociais. Se a mulher for mãe durante os períodos de estudos, a conciliação com a maternidade pode ser um desafio ou representar barreiras que a impedem de continuar. Desta forma, vale evidenciar a importância da rede social de apoio à mulher para auxiliá-la no cuidado e educação do bebê. Este trabalho objetivou refletir sobre o apoio dado às mães, oferecido principalmente pela instituição educativa, após o período de atendimento domiciliar. Para isto, aplicou-se um questionário a 22 mulheres que tiveram bebês e retomaram seus estudos após o atendimento domiciliar no ano de 2019. Os resultados apontaram que estas mulheres, em geral, receberam incentivos para continuarem estudando, mas 68% tiveram dificuldades com a organização dos estudos em casa e 40% apresentaram dificuldades na reintegração aos estudos presenciais. Além disto, questões emocionais de sofrimento, relacionadas à separação, foram vivenciadas por grande parte das mulheres. Também se refletiu sobre a necessidade de a escola fazer parte da rede de apoio que deve ser dado às mães e bebês, de forma que viabilize maior contato entre eles e reforce laços, colaborando para uma sociedade mais humanizada. O presente estudo visa defender, portanto, que espaços educativos acolham todos, inclusive mães com seus bebês.
Perceived social support and psychological well-being among patients with epilepsy
Authors: Nazia Nazir  , Muhammad Salman Zafar  , Muhmmad Numan Akram  , Maryam Khokhar  , Iqra Yousaf
Published: March 2023

This cross-sectional study aimed to explore the relationship between perceived social support and psychological well-being in patients with epilepsy. The study was conducted, from January to December 2019, after ethical approval from the research ethical committee of FMU (Faisalabad Medical University, Faisalabad). A sample of 90 patients, attending free epilepsy camp in Mujahid Hospital Madina Town Faisalabad and psychiatry OPD of government General hospital G.M. Abad Faisalabad, was collected by using the Multidimensional Scale of Perceived Social Support (Urdu version). Moreover, Psychological well-being was assessed by Ryff Scale. Statistical analysis was done through data Correlation and T-test SPSS version 21. A positive correlation between psychological well-being and perceived social support in epileptic patients was established (p<0.001).
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Binocular treatment for amblyopic children: a review
Authors: Bokhary Kholoud Ahmad , Alsabih Razan Ibrahim , Gamal Abdelrahman El-Hiti
Published: March 2023

The narrative review was planned to investigate the efficiency of binocular treatment for amblyopic children, and to compare it with the standard methods. Literature search was conducted for articles in English language available on PubMed, Cochrane Library, Embase, Medline and PsycInfo databases as well as through bibliographies of peer-reviewed studies. Studies in the field of binocular treatment for amblyopia were included. Visual outcomes considered were visual acuity, types of amblyopia and stereoacuity. Studies on deprivation amblyopia, animal studies, literature review of amblyopia treatment, case reports, and trials targeting participants in whom previous amblyopia treatment had failed were excluded. Of the 40 studies found, 21(52.5%) met the inclusion criteria. Visual acuity and binocular function improved with binocular treatment for treating amblyopia in children by decreasing suppression depth extent and increasing stereopsis.
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Treatment of periodontal disease in pregnancy for the prevention of adverse pregnancy outcomes: a systematic review of systematic reviews
Authors: Sajjad Khan Najia , Craven Rebecca , Rafiq Ayesha , Rafiq Anam
Published: March 2023

Objective: To assess the systematic reviews and meta-analyses investigating whether or not periodontal treatment in pregnancy was effective in reducing the adverse pregnancy outcomes of preterm birth, low birth weight, preterm low birth weight, stillbirth, foetal growth restriction, and pre-eclampsia.
Method: The umbrella review was conducted on May 30, 2021, and comprised search of electronic databases MEDLINE, EMBASE, Cochrane Database of Systematic Reviews via Ovid and CINAHL via EBSCO for all systematic reviews and meta-analyses, regardless of the publication date, of randomised controlled trials which investigated the effects of periodontal treatment during pregnancy in preventing or reducing the frequency of at least one adverse pregnancy outcome. The selected studies were subjected to quality assessment and narrative synthesis.
Results: Of the 110 studies found, 17(15.5%) met the inclusion criteria. Of them, quality assessment was high for 1(5.9%), moderate 14(82.3%), and low 2(11.8%). A total of 8(47%) studies demonstrated an association with low birth weight, 7(41.2%) with preterm birth, 3(17.6%) with preterm low birth weight, 1(5.9%) with small for gestational age, and 1(5.9%) with stillbirth, while no study demonstrated any association with pre-eclampsia.
Conclusion: Differential findings provided unclear evidence, but periodontal therapy in pregnancy is still recommended as it causes no harm and reduces the bacterial burden in periodontal disease.
Key Words: Periodontal diseases, Infant, Low birth weight, Premature birth, Foetal growth retardation, Stillbirth, Pre-eclampsia.
Tumour lysis syndrome as a rare complication of chemotherapy in paediatric Wilms’ Tumour: a case report
Authors: Qamar Sobia , Irfana Ishaq Sindhu  , Shaheen Najma
Published: March 2023

Wilms tumour is the most common renal malignancy in children, with two-thirds of cases diagnosed before five years and 95 percent before 10 years of age. Over the last decade, the five-year survival rate has improved dramatically and now approaches 90 %. Tumour lysis syndrome, commonly seen in association with haematological malignancies, is rarely seen in Wilms tumour. We present two cases of Wilms tumour developing tumour lysis syndrome in the first week of initiation of chemotherapy. Both patients presented with huge abdominal masses causing mass effect on surrounding structures. Chemotherapy was administered as per International Society of Pediatric Oncology guidelines (SIOP). Both patients developed laboratory and clinical tumour lysis syndrome (TLS) after the first cycle of chemotherapy requiring continuous renal replacement therapy (CRRT). However, both died because of multiorgan failure.
Key Words: tumour lysis syndrome, Wilms tumour, chemotherapy, continuous renal replacement therapy, case report.
Bone marrow infiltration by Non-Hodgkin lymphoma: An experience in a tertiary care centre
Authors: Suhail Maymoona , Asad Mahmood  , Rafia Mahmood  , Saima Zahir  , Syeda Samia Shafaat  , Sumaira Illyas
Published: March 2023

Objective: To determine the frequency and patterns of bone marrow infiltration in non-Hodgkin lymphoma patients.
Method: The cross-sectional study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from April to October 2021, and comprised patients of either gender aged 20-80 years who had been diagnosed with non-Hodgkin lymphoma. Following assessment and as per standard protocol, bone marrow aspirate and trephine biopsy were done on all patients from the posterior superior iliac spine, and slides were prepared and assessed. Data was analysed using SPSS 25.
Results: Of the 100 patients, 67(67%) were males and 33(33%) were females. The overall mean age was 54.99+12 years, and mean duration of symptoms was 11.7±1.5 months. Diffuse large B-cell lymphoma was the commonest type 43(43%). Infiltration of marrow occurred in 38(38%) patients, with 12(12%) of them being cases of mantle cell lymphoma. The commonest infiltration pattern was diffuse in 17(17%) cases, followed by focal/nodular in 10(10%).
Conclusion: Diffuse large B-cell lymphoma was found to be the commonest type of non-Hodgkin lymphoma, and marrow infiltration occurred most frequently in cases of mantle cell lymphoma.
Key Words: Bone marrow, Infiltration, Non-Hodgkin lymphoma.
Alice in Wonderland Syndrome (AIWS) as a potential side-effect in Attention Deficit Hyperactivity Disorder (ADHD) patients undergoing Methylphenidate treatment
Authors: Akhlaque Eesha
Published: March 2023

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Air pollution and increasing asthma hospitalizations: a looming healthcare crisis?
Authors: Shaikh Hamid Saeed , Arslan Irfan Pir Muhammad  , Arslan Ali
Published: March 2023

Asthma is a major non-communicable disease (NCD) affecting adults and children, among whom it is the most common chronic disease reported all around the globe1
Asthma has been a significant cause of hospitalizations and financial burdens for low and lower- middle -income countries like Pakistan. According to the latest WHO data published in 2020, asthma deaths in Pakistan reached a staggering 20,750 or 1.42% of total deaths.2
Many etiologies including social and environmental factors, genetic predispositions, and ambient air pollution, influence asthma morbidity and mortality. In particular, the worsening air quality index in the country needs to be a point of focus as a significant cause of asthma related morbidity.
The rapid decline in air quality levels in Pakistan, particularly in major industrial cities such as Lahore and Karachi, is a cause of grave concern. For example, air quality in Lahore has declined over the last two decades: in 1998, its pollution concentration was 33 µg/m³. By 2016, it had doubled to 64 µg/m³—more than six times the WHO guideline.3
Similarly, Karachi, the largest city in Pakistan, has a PM2.5 concentrations, which is 3.4 times the WHO annual air quality guideline value, an alarming scenario for a city where environmental policies and infrastructure is not in place.4
A study in Lahore noted the role of ambient air pollution among various population groups of the city. The research showed a positive Pearson correlation between environmental air pollutants and the number of asthma patients visiting the OPD.5 However, a similar, comprehensive study has not been conducted in Karachi on the same level.
As in most cases, the first step toward solving a problem is to recognize it. Hence there’s a need for more research to be conducted to determine the number of hospitalizations of asthmatic patients caused by low air quality as it will give us a better understanding of the true extent of the issue at hand and allow more appropriate prioritization, in the context of public health by the government.
Once this is done, resources can be allocated more efficiently towards areas and populations suffering more acutely to relieve the suffering of the majority. In addition, educational campaigns can be designed considering the population’s educational demographics and general knowledge regarding the exact reasons for the worsening air quality in those areas.
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