bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical differentiation of keratitis due to fungus and Pythium: A photographic survey
Authors: D’cruz Rakhi P , Mohamed Ashik , Das Sujata
Published: February 2023

Purpose:

To evaluate the knowledge and skills of clinicians in differentiating cases of Pythium from fungal keratitis based on their clinical appearance.

Methods:

Thirty slit-lamp photographs from culture-proven cases of Pythium and fungal keratitis were selected for conducting a prospective online-based photographic survey. The participants were asked to identify the causative organism and enlist the specific clinical features which helped in reaching the diagnosis. Both cornea specialists and clinical fellows/trainees participated in the survey. Sensitivity, specificity, and predictive values were estimated, and the factors associated with these, including the identification rates of clinical signs, were evaluated using bivariate and multivariate linear regression analyses. The identification rates between the consultants and fellows were compared.

Results:

A total of 42 cornea specialists (28 consultants and 14 clinical fellows) participated in the survey. Clinicians were able to differentiate Pythium from fungal etiology in only 56% of cases. The differentiating ability between the consultants and fellows was statistically insignificant. Average sensitivity, specificity, and positive and negative predictive values for differentiating Pythium from fungus were 56%, 65%, 56%, and 66%, respectively. The specific clinical features enlisted by the participants to differentiate Pythium from fungus were the presence of tentacles, peripheral guttering, dot-like infiltrates, and elevated plaques.

Conclusion:

Clinical knowledge regarding the signs and symptoms and the microbiological identification of features for Pythium are still lacking among clinicians. As the treatment protocols are distinctly different for both, it is imperative to enhance the knowledge and diagnosing ability to tackle this emerging microorganism which causes high morbidity.
Efficacy of a biosimilar ranibizumab monotherapy for the treatment of retinopathy of prematurity
Authors: Prajapati Vipul , Choudhary Tanvi , Chauhan Wilhemina , Shah Sonali , Handa Ramya , Jahan Bushra , Malviya Sheetal , Sengupta Sabyasachi
Published: February 2023

Purpose:

To evaluate the efficacy of a biosimilar ranibizumab (Razumab) on outcomes of retinopathy of prematurity (ROP) for the first time.

Methods:

This retrospective study included infants presenting with stage 3+ ROP either in zone 1 or zone 2 posterior or aggressive posterior ROP (APROP). All eligible infants received intravitreal razumab (0.25 mg/0.025 ml) monotherapy. Follow-up was continued monthly till complete retinal vascularization was achieved while retreatment with razumab was given when recurrent neovascularization was noted. In case of no recurrence but incomplete vascularization, laser photocoagulation was done to the residual avascular retina.

Results:

We included 118 eyes of 59 infants with a median gestational age of 30 weeks and median birth weight of 1250 grams. At presentation, APROP was found in 28 eyes (24%) of 14 babies while stage 3 disease was seen in zone 1 in another 28 eyes (24%) and the remaining 62 eyes (52%) had stage 3 ROP in zone 2 posterior region. Complete resolution of ROP along with complete vascularization was seen in 22 eyes (19%) at a median of 55 days (IQR = 31–56 days) and 42 eyes (35%) showed a recurrent neovascularization at a median of 51 days post razumab (IQR = 42–55 days). The cumulative incidence of recurrence of neovascularization (21%, 95% CI = 14%–29%) peaked at seven weeks and was significantly higher in eyes with APROP (43%, 95% CI = 27%–63%) compared to eyes without APROP (13.4%, 95%CI, 8%-22%) (P < 0.001).

Conclusion:

Razumab appears to be safe and effective in treating ROP, with about a third requiring reinjection at seven weeks after the first dose.
Functional Neurological Symptom Disorder in an Adopted Child with Tourette Syndrome: A Case Report
Authors: Veeraraghavan Vishnupriya
Published: February 2023

Abstract

Tourette syndrome or tourette disorder is named after French neurologist Georges Gilles de la Tourette is defined by the presence of both multiple motor and vocal tics for more than one year. It begins by 3-8 years of age and manifest before the age of 11 years. Prevalence ranges from 0.6% to 1%. Clinical problems commonly associated with this syndrome are attention deficit hyperactive disorder, obsessive compulsive disorder, specific learning disability, anxiety disorders, and mood disorders. Functional neurological symptom disorder in a child with Tourette syndrome is a rare and unique phenomenon.
Estimated Number of Cataract Surgeries Performed in Government Hospitals in Nigeria and Factors Affecting Cataract Surgical Activity
Authors: Aniemeka Dilichukwu Isioma , Buchan John , Adeke Azuka Stephen , Dange Abubakar , Momoh Nanaishat
Published: February 2023

Aim:

To estimate the number of cataract surgeries performed from 1 January 2017 to 31 December 2019 in government hospitals in Nigeria and explore factors affecting their cataract surgical activity.

Methods:

This was a retrospective study conducted between 1 August 2020 and 4 October 2020 through online survey emailed to respondents working in 55 government-owned hospitals in the 36 Nigerian states and federal capital territory. Information obtained included a number of cataract surgeries performed yearly and correlation analysed between variables obtained using IBM Statistical Package for Social Sciences software for Windows version 22 (SPSS Inc., Chicago, Illinois, USA).

Results:

A total of 40 institutions were included in the study, 26 (65%) federal government and 16 (35%) state government institutions. About 70,792 cataract surgeries were performed during the study period with the North-West geopolitical zone performing 47.7% of the surgeries. The average price for cataract surgical service in government hospital was USD($)77.45(±7.08) (surgical fee) and USD ($) 128.23(±11.96) (total treatment cost) with a wide variation from zone-to-zone. Lower fees were associated with increased surgical volumes, and GNI per capita of each state did not influence the price set for surgery or the number of surgeries performed. Provision of outreach services, free surgeries, and having an eye manager correlated to increased cataract surgical numbers (P < 0.05).

Conclusion:

There is need to improve existing strategies to increase cataract surgical numbers in government institutions such as increased advocacy for funding for eye care services, conducting frequent outreaches, establishing and redistribution of satellite centres to underserved communities and fostering surgical relationships between institutions to improve surgeon’s competency and cataract surgical outcome.
A Report of Three Cases of Ocular Surface Squamous Neoplasia Treated with 5-Fluorouracil Drops
Authors: Ubah Josephine Nonye , Otuka Olufunmi Adebimpe Ijeoma
Published: February 2023

Objective

To raise the awareness of the use of topical 5-fluorouracil in management of recurrent ocular surface squamous neoplasia.

Methods

A case series study carried out at an Ophthalmic clinic, in Western Nigeria. The subjects were managed for ocular surface squamous neoplasm.

Results

Three patients aged 31–52 years were seen in the period of study. They were operated upon and early recurrence was noted in them. 5-Flourouracil eye drop was used in the management of recurrent tumor with good results.

Conclusion

There was good response with the use of topical 5-fluorouracil for the management of recurrent ocular surface squamous neoplasia.
Genomic and Transcriptomic Characterization Revealed the High Sensitivity of Targeted Therapy and Immunotherapy in a Subset of Endometrial Stromal Sarcoma
Authors: Kang Nan , Zhang Yinli , Guo Shichao , Chen Ran , Kong Fangzhou , Wang Shuchun , Yuan Mingming , Chen Rongrong , Shen Danhua , Wang Jianliu
Published: February 2023

Purpose The unique chromosomal rearrangements of endometrial stromal sarcoma (ESS) make it possible to distinguish high-grade ESS (HGESS) and low-grade ESS (LGESS) from the molecular perspective. Analysis of ESS at the genomic and transcriptomic levels can help us achieve accurate diagnosis of ESS and provide potential therapy options for ESS patients.Materials and Methods A total of 36 ESS patients who conducted DNA- and/or RNA-based next-generation sequencing were retrospectively enrolled in this study. The molecular characteristics of ESS at genomic and transcriptomic levels, including mutational spectrum, fusion profiles, gene expression and pathway enrichment analysis and features about immune microenvironment were comprehensively explored.Results TP53 and DNMT3A mutations were the most frequent mutations. The classical fusions frequently found in HGESS (ZC3H7B-BCOR and NUTM2B-YWHAE) and LGESS (JAZF1-SUZ12) were detected in our cohort. CCND1 was significantly up-regulated in HGESS, while the expression of GPER1 and PGR encoding estrogen receptor (ER) and progesterone receptor (PR) did not differ significantly between HGESS and LGESS. Actionable mutations enriched in homologous recombination repair, cell cycle, and phosphoinositide 3-kinase/AKT/mammalian target of rapamycin pathways were detected in 60% of HGESS patients. Genes with up-regulated expression in HGESS were significantly enriched in five immune-related pathways. Most HGESS patients (85.7%) had positive predictors of immunotherapy efficacy. Moreover, immune microenvironment analysis showed that HGESS had relatively high immune infiltration. The degree of immune infiltration in HGESS patients with ZC3H7B-BCOR fusion was relatively higher than that of those with NUTM2B-YWHAE fusion.Conclusion This study investigated the molecular characteristics of ESS patients at the genomic and transcriptomic levels and revealed the potentially high sensitivity of targeted therapy and immunotherapy in a subset of HGESS with specific molecular features, providing a basis for guiding decision-making of treatment and the design of future clinical trials on precision therapy.
La moral mediática en Venezuela (O de cómo perder lo que no se tiene)
Authors: González Leal Nelson
Published: February 2023

Hace algunos meses atrás (creo que algo así como 9 o 10), el semanario de análisis y opinión política venezolano ‘Temas’ (http://www.temasvenezuela.com) convocó a varios periodistas, historiadores e intelectuales nativos para reflexionar por escrito sobre “el quiebre (moral) de los medios de comunicación en Venezuela”. En la convocatoria enviada vía correo electrónico tuvieron cuidado de colocar la palabra moral exactamente de esa manera, entre paréntesis, como para advertir, en una clara toma de posición, que la única quiebra visible de estas empresas del espectáculo mediático es la que concierne al carácter de honestidad que se vincula a su deber de ser portavoces de la realidad social. Sobre ese aspecto no estuve -ni estoy- de acuerdo y ahora explicaré por qué.
Periodismo en El Salvador. El “refrito” o plagio en las salas de redacción de los medios informativos
Authors: Cantarero Mario Alfredo
Published: February 2023

Los medios de comunicación en El Salvador, cuando producen la noticia y la distribuyen, utilizan información de fuentes documentales -escritas, audiovisuales o de internet-, suelen no citar las fuentes que han utilizado Sin duda, este mal no es exclusivo de los medios locales, se expresa internacionalmente.
El problema, en el marco del desarrollo de las nuevas tecnologías y los enormes volúmenes de información a los que se tiene acceso, se ha extendido y complicado todavía más. Por esto, en el ámbito internacional editores, asociaciones de periodistas y medios de comunicación, están preocupados por atenuar el problema a través de una serie de disposiciones legales y éticas.En nuestro país este problema parece tan natural en el campo profesional de las comunicaciones, se constituye en una de las defraudaciones más comunes, que son reconocidas deontológicamente. A pesar de este reconocimiento por los periodistas, cotidianamente es un problema que no se discute seriamente y se gestiona política, cultural y jurídicamente un proceso de abordaje y solución.
En una democracia incipiente y frágil como la nuestra todavía no se han instaurado los mecanismos jurídicos efectivos que garanticen un régimen responsable de los derechos de autor, especialmente los derechos de los periodistas. Las leyes existentes que fomentan y protegen los derechos de autor sólo se refieren a otras áreas profesionales como la arquitectura, la plástica, la literatura y los productos industriales y comerciales. No aplican en el campo del periodismo.Los derechos de autor reconocidos se caracterizan por su generalidad. No abarca específicamente la actividad periodística, es decir, no abarca los derechos y los deberes jurídicos en el uso de informaciones o datos y compensaciones económicos por los derechos de publicación de informaciones por otros medios nacionales o extranjeros.
Con la finalidad de aportar a la construcción de una práctica profesional más sólida, se proponen en este ensayo una serie de recomendaciones en el orden de la política informativa del medio, en el orden jurídico nacional y en el orden técnico en la rutina de producción de la noticia, encaminadas a la búsqueda de soluciones consensuadas.
Factors Associated with Dropout Among Community Health Workers in Musanze District, Rwanda: A Cross Sectional Study
Authors: Muremba M. F.
Published: February 2023

INTRODUCTION: Dropout has been renowned as one of the main challenges of Community Health Workers (CHWs) programs in addition to the health facilities. This has got a serious public health implication as it can hinder the increase of health service delivery in rural and urban areas. This study aimed to determine the factors associated with dropout among CHWs in Musanze District, Rwanda.METHODS: A descriptive cross-sectional study was conducted. Three sectors from the district were selected purposively with a total sample size of 252 CHWs who were elected and recruited in 2013. Data was collected using semi-structured questionnaire and was analysed using SPSS version 25. Multiple logistic regression analysis was performed to determine the independent factors associated with dropout of CHWs.RESULTS: Out of the total (252 CHWs) enrolled since 2013, about 10% had left the health system in a period of 4 years. Following the multiple logistic regression analysis; being single [AOR=2.58, 95%CI=1.09-6.93], engaged in business [AOR=3.22, 95%CI=1.25-8.27] and relationship with supervisors [AOR=0.25, 95%CI=0.09-0.67] were independently associated with dropout of CHWs.CONCLUSION: Dropout rate during the period of four years was 9.9%. Marital status and occupation are main factors affecting dropout of CHWs in Musanze district.
Immunization coverage in a rural area of Bareilly district: a cross-sectional community-based study
Authors: Khan A. A. , Imtiaz D. , Munif M. A. , Mahmood S. E. , Khan M. S. , Nasar A.
Published: February 2023

INTRODUCTION: Infectious diseases are a major cause of morbidity and mortality in children. Immunization remains a cost-effective method for child survival against vaccine-preventable diseases. Despite all the interventions put in by the government for 100% immunization coverage, there remain pockets of low coverage, especially in rural areas.Our aim was to estimate the immunization coverage and assess sociodemographic factors associated with immunization among children aged 12-23 months in a rural area of Bareilly. METHODS: The present cross-sectional study was carried out in the field practice area under RHTC from January 2016 to June 2016 using a 30 by 7 cluster sampling technique. A total of seven children aged 12-23 months were interviewed from each cluster on a preformed, pretested, and semi-structured questionnaire, thus giving a sample size of 210. Statistical analysis was done using the Chi-square test. RESULTS: More than two-thirds (69%) of study participants were completely vaccinated, whereas about 31% were partially or not vaccinated. Immunization coverage was found to be highest for BCG (80.4%) and lowest for the third dose of DPT (69.0%). The most common reason for partial or non-immunization was found to be unawareness (45.5%) and fear of side effects (43.9%). CONCLUSION: There is a need to create awareness and increase knowledge among caretakers of children about the importance and benefits of getting immunization for their children as a major step toward achieving Sustainable Development Goals (SDGs) goals.
A Theological Appraisal of the Notion of Divine Aseity
Authors: Olabamiji Elisha Oyedele
Published: February 2023

There are times when a shadow could be a reflection of reality. The existence of man denotes that the Supreme Being creates humankind and from the writer's perspective, over the years, the logical questions centre on the existence of God. Verifiably, man's existence is traceable to the biological evidence at birth, and the question is who is God and how does He come into being? The thrust of the paper is to discuss the rationale behind a Christian's faith in God, attempting to answer the question of the self-existence of God from philosophical and theological perspectives as a means of authenticating the doctrine of God concerning biblical justifications on the self-existence of God. The sovereignty of God is understood to mean that He is independent. The paper argues and alludes that the Word aseity comes from the Latin
phrase a se, meaning ‘from’ or ‘by himself’. Aseity is arguably the most fundamental divine characteristic of God; the Church fathers acknowledged the role of philosophy in the doing of theology; this is established by discussing the interplay of philosophy and theology, with many considering that philosophy is significant to the theological appraisal of aseity. Philosophical arguments on the existence of God revolve around four major arguments, including the ontological arguments, cosmological arguments, teleological arguments and moral arguments. Theological assessment of the notion of divine aseity from a Christian perspective in the African context is traceable to the Africans' knowledge of God and the existence of God. This paper concludes that God is the most powerful being; it is only in God's existence that all things are meaningful and explainable; the paper also admits that God is self-sufficient and self-existent because He exists from nothing but His power and wisdom are eternal. Admittedly there are notable arguments for God's existence, including cosmological and ontological
arguments. The sovereignty of God is understood to mean that He is independent, meaning that He depends on no one to survive. The fact that man can conceive the idea of God is in itself a unique proof that substantiates man's conviction about the divine aseity of God, and objectively, the concept of the doctrine God depicts that God's attribute has been defined as the core of a theological system of God.
Increasing Financial Literacy in RT RW net Indonesia Cooperatives and Msmes Through Simple Bookkeeping
Authors: Rahmi Amelia , Andria Fredi , Salmah Salmah
Published: February 2023

This Community Service activity aims to increase financial literacy in RT RW Net Indonesia Cooperatives and MSMEs in Tugubandung Village through simple bookkeeping training. The background of this activity is the phenomenon of cooperatives and MSMEs who have yet to realize the importance of simple bookkeeping and have yet to prepare financial reports. The method for implementing this community service activity is to provide training in preparing simple financial statements. The implication of this community service activity is to increase the knowledge and ability of Cooperative managers and MSMEs owners to present financial reports through simple bookkeeping. By keeping simple bookkeeping, Cooperatives and MSMEs can have competitiveness and strengthen the economic pillars in achieving sustainable economic development goals.
Strategy to Improve the Performance of Regional Government-owned BPR and BPRS through Optimal Funding Contributions from Shareholders
Authors: Purnawan Bangbang , Zulganef Zulganef
Published: February 2023

The regional government established rural banks as financial organizations in an effort to offer services in the financial industry. BPR are a way effort for local governments to bring in local revenues. BPR currently only have a limited amount of capital because it comes only from the APBD. on the other hand, BPR are obligated to constantly offer service enhancements in terms of both service quantity and service quality. So that, to enhance the performance of BPR and BPRS, BPR who are unable to achieve the minimum core capital rules should immediately merge with another BPR that can or be bought by a bank with larger resources or shareholders who are contributing at their maximum potential. Based on the aforementioned issues, the purpose of this study is to present an overview of the approach to enhance BPR or BPRS performance and how shareholder ownership impacts BPR/financial BPRS performance.
Characteristic Factors of Health Micro Insurance Against Considerations in Selection of Health Service Facilities
Authors: Serila Radya Pratiwi , Susanti Dwi , Riaman Riaman
Published: February 2023

Indonesia is still faced with a series of health problems. One of the causes of health problems is the expensive cost of treatment.  An alternative that people can choose for health financing is to have health micro-insurance aimed at lower-middle-class households. The purpose of this study was to identify factors characteristic of micro-insurance, against the consideration of choosing health service facilities. The data used were primary data obtained through a questionnaire of 220 health micro-insurance participants. This research was analyzed with a quantitative descriptive approach. The results of the analysis show that the characteristics of hospitals that are registered as good quality micro-insurance services and responsive to providing referrals to hospitals, when there are patient complaints are the main factors in considering the choice of health service facilities.
Violencia en pareja y diversidad sexo-genérica: Una revisión sistemática sobre las fuentes de apoyo para víctimas
Authors: Laliga Mollá Mónica
Published: February 2023

En la violencia en parejas de minorías sexuales existen determinados factores de riesgo que dificultan a las víctimas solicitar ayuda o acceder a los servicios de apoyo. Este trabajo presenta una revisión sistemática sobre las diferentes fuentes de apoyo para las víctimas, en concreto sobre las barreras en el proceso de búsqueda de ayuda. De 198 estudios revisados, 41 fueron preseleccionados y de estos se seleccionaron 12 estudios que cumplían los criterios de inclusión metodológicos. Los resultados de esta investigación muestran que no todas las víctimas solicitan ayuda en atención a diferentes razones personales, sociales e institucionales. Entre las diferentes fuentes de apoyo a las que recurren las víctimas que sí inician en el proceso de búsqueda de ayuda, el más prevalente es el apoyo formal del asesoramiento psicológico combinándose en muchos casos con el apoyo informal de las amistades. Esta revisión encuentra limitaciones en la literatura analizada y señala recomendaciones para futuras investigaciones.
Likya Napları Bölgesinde Epijenik Buruk Düdeni ve Gümüşdere Obruğunun (Tavas, Denizli) Jeomorfolojik Özellikleri ve Gelişimi
Authors: TUNCER Kadir
Published: February 2023

Yüzey ve yeraltı karstının büyük derinliklere ulaştığı Toros Dağları karst kuşağının batısında gelişmiş olan Buruk Düdeni ile aslında bir çökme dolini olan Gümüşdere Obruğu, Denizli ilinin Tavas ilçesi sınırları içerisinde yer almaktadır. Tektonik olarak aktif bir bölgede yer alan bu karstik şekiller, bindirme, faylanma, grebenleşme, yeraltı su zonlarının daha derinlere göçü, karst ve morfolojik taban düzeylerinin derinleşmesine bağlı olarak çok kökenli-çok dönemli jeomorfik gelişimi karakterize ederler. Her iki karstik şekil de bu çok dönemliliği karakterize eden morfolojik şekil ve yapıları barındırmaktadır. Bu özelliklerin ortaya çıkartılması ve kullanım imkanlarının değerlendirilmesi adına düden ve obruk ayrıntılı bir şekilde etüd edildi. Bunun için düden ve obrukta, doğrultu ve eğim değerleri ölçüldü; taban uzunlukları, sağ-sol genişlikleri ve tavan mesafeleri lazer metreyle ölçüldü. Tüm bu ölçüm değerlerine göre düden mağara ve obruğun planları çıkartıldı, enine ve boyuna kesitleri çizildi. Ayrıca düden mağaranın iklim özelliklerini tespit edebilmek için sıcaklık ve bağıl nem değerleri ile değişik gazların (O2, CO, H2S, CH4) değerleri ölçüldü. Yapılan bu ölçümler sonucunda Buruk Düdeni, ılıman ve nemli bir havaya sahiptir; boğucu ve zehirleyici herhangi bir gaz fazlalığına veya azlığına sahip değildir. Mağara içerisinde yapılan metrik ölçümlere göre düden mağara, 281 m toplam uzunluğa ve girişe göre -71,5 m son nokta derinliğe sahiptir. Ayrıca mağara yarı aktif ve fosil olmak üzere iki kattan oluşmaktadır. Mağaranın 99 metresi fosil kattan oluşmakta olup, bu kat girişe göre -58 metrede son bulmaktadır. Vadoz zonda gelişen mağara, gelişimin henüz başlarında gençleşmeye maruz kalmış ve içerisinden akan yeraltı deresi yatağına menderesler çizerek gömülmüştür. Bunu anahtar deliği morfolojisine sahip olmasıyla karakterize eder. Gümüşdere Obruğu ise Barz Polyesi’ne kuzeyden bağlanan flüvyo-karstik bir depresyonunun batı yamacında gelişmiştir. Obruk, oldukça karstik özellikte olan kireçtaşı içerisinde polyenin oluşum döneminin başlarında gelişmeye başlayan bir mağaranın tavanının göçmesiyle oluşmuştur. Yöre halkı tarafından obruk diye isimlendirilen bu karstik çöküntü, bu oluşum şekliyle aslında anakaya çökme dolinidir. Sahip oldukları morfolojik özellikler, riskler ve doğal çevre özellikleri bakımından değerlendirildiğinde düden mağara turizm ve ya başka amaçlarla kullanıma uygun olmasa da obruk turizm açısından değerlendirilebilir.
The Idea of Ayatollah Khomeini's Renewal
Authors: Sabar
Published: February 2023

Ayatollah Khomeini with his expertise in various fields of science, invited and taught the young men of the time, both the fields of philosophical, political and other theologians, so that little by little they were able to renew the understandings that existed in Iran. Ayatollah Khomeini is a cleric who never gives up hope in achieving his goal of revolution, whichever obstacles he faces, does not at all affect his goal. So that in the 70s Shah's leadership fell.
Implementasi Program Sekolah Penggerak Pada Mata Pelajaran Pendidikan Agama Islam Kelas X SMA Negeri 1 Pamboang
Authors: Harbianto  , Idris hasanuddin  , Muhammad Saddang
Published: February 2023

The problems studied in this study were: (1) The implementation of the Program Sekolah Penggerak on the subject of Islamic Religious Education class X SMA Negeri 1 Pamboang, (2) The Supporting and inhibiting factors experienced in the implementing the Program Sekolah Penggerak on the subject of Islamic Religious Education class X SMA Negeri 1 Pamboang. This type of research was qualitative research that built meaning based on field data. This qualitative research procedure produced descriptive data in the form of written or spoken words of people and observable behaviors. Data collections were carried out by conducting observations, in-depth interviews and documentation. Data analysis was carried out by giving meaning to the datacollected, and the conclusion were drawn from the data. The implementation the concept of the Program Sekolah Penggerak at SMA Negeri 1 Pamboang since 2021, one year ago, had a significant impact on the elements in the school. The concept was good and positive because it could explore the potential, talents and creativity of students. It also encouraged the teachers as a driving force in learning to create learning that can make students comfortable when the learning process took place both in the classroom and outside the classroom. Supporting and inhibiting factors in the implementation of the Program Sekolah Penggerak on the subject of Islamic Religious Education class X SMA Negeri 1 Pamboang: a. Supporting factors include: Teaching tools, School policy makers, Parent/Guardian cooperation; b. Inhibiting factors include: Schools, Teachers, and Students.
Estimation of treatment efficiency of head-and-neck cancer based on tumour control probability model
Authors: Sergeevna Sukhikh Evgeniya , Grigorievich Sukhikh Leonid , Nikolaevna Sutygina Yana , Viktorovna Verkhoturova Vera , Ruslanovich Sagov Islam , Viktorovich Rozanov Vladimir
Published: February 2023

External beam radiotherapy is widely used for the treatment of the locally advanced head-and-neck cancer (LAHNC). Analysis of the developed treatment plans based on tumour control probability (TCP) models could help to estimate expected treatment results of the developed plans and to find optimal treatment schemes with respect to total dose, fractional dose and overall treatment time (OTT). In this study, the simultaneous integrated boost VMAT (SIB-VMAT) plans and sequential boost VMAT (SEQ-VMAT) plans were developed based on the anatomical data of 11 patients. Methods and Material: The data of 11 patients with LAHNC (larynx, oropharynx and oral cavity) were used. For each patient two treatment plans were developed, SIB-VMAT (70 Gy to tumour, 50 Gy to lymph nodes, 25 fractions) and SEQ-VMAT (70 Gy to tumour, 50 Gy to lymph nodes, 35 fractions). The developed plans were analysed using the Niemierko’s TCP model with Maciejewski’s parameters (TCD50 = 70.26 Gy at 49-days OTT) taking into account dose-volume histograms and OTT. Results: The developed plans resulted in high clinical treatment volume (CTV) conformity (98%-98%) for all patients, except one. The average TCP value of SIB-VMAT was equal to 99.9% due to very short OTT. The average value of TCP for SEQ-VMAT was equal to 61.0%. For one patient, the both SIB-VMAT and SEQ-VMAT plans showed zero expected efficiency due to CTV coverage 95%-95%. Conclusions: Use of TCP models allows analysis of treatment plans for each particular patient and development of different treatment schemes with increase of the total dose value, fractional dose and shortening of OTT.
Characteristics of Medical School Graduates who Underwent Problem-Based Learning
Authors: Matsui Keiko , Ishihara Sonoko , Suganuma Taiyo , Sato Yasuto , Tang Ann C , Fukui Yuriko , Yamaguchi Naohito , Kawakami Yoriko , Yoshioka Toshimasa
Published: February 2023

Introduction: In this study, we compared the choice of medical specialty and subspecialty interest among problem-based-learning (PBL) graduates and non-PBL graduates.

Materials and Methods: Questionnaires were mailed to a total of 1398 female doctors who graduated from Tokyo Women’s Medical University (TWMU) between 1989 and 2003. The response rate was over 30%, giving 248 respondents who had undergone a PBL curriculum (PBL+) and 220 subjects who had not (PBL-). Current specialty of the graduates were compared between the PBL+ and PBL-, and also compared with the general Japanese female doctors (Control 1 and 2) of similar age groups. Respondents were analysed in terms of their interests in subspecialty medical care or general medical practise, which includes comprehensive medical care, primary care and basic medicine. Internal medicine doctors working in the university hospitals were compared with those working outside the university hospitals. Internal medicine doctors were also compared with specialists in ophthalmology, otolaryngology, dermatology and psychiatry. Subjects were compared by odds ratio (OR) to examine group difference in the field of interest. OR >2.0 was considered statistically significant.

Results: Most doctors in all groups chose internal medicine. More PBL+ internal medicine doctors showed interests in comprehensive medical care and primary care; more PBL+ internal medicine doctors working outside university hospitals showed interest in comprehensive medical care and primary care when compared with those who were working in the university hospitals. The PBL- graduates did not show such a characteristic.

Conclusions: More PBL+ graduates who chose internal medicine showed interest in holistic medical practices such as primary care and community medicine and more PBL+ specialists showed sustained interest in their respective fields.

Key words: Educational outcome, Medical education, Professional carrier, Specialty interest
Disability and Leprosy: The Way Forward
Authors: Brakel Wim H. van
Published: February 2023

Leprosy is one of the major causes of preventable disability, including impairments, problems in activities of daily life and social exclusion resulting from stigma.1-3 Progress in dealing with these consequences of leprosy has not nearly been as successful as the progress in the anti-bacterial treatment of the disease. There continues to be a large backlog of people with leprosy-related disability who are in need of disability prevention services and/or rehabilitation. Therefore, programmes and services dealing with leprosy will continue to need input from research to inform policy and management, and to improve coverage of services and the quality and quantity of the tools and procedures available for prevention and rehabilitation.
Consequences of Right Siting of Endocrinology Patients – A Financial and Caseload Simulation
Authors: Lim Jeremy FY , Tan Darren MH , Lee Andrew L
Published: February 2023

Introduction: Right siting has been actively advocated to mitigate rising healthcare costs as well as to free up tertiary resources for the provision of care to more complex patients, research and education. There are, however, concerns that in a block budget setting right siting will reduce patient volumes, thus impacting on subsequent funding allocations and also patient revenues. We sought to determine through modelling and simulation the financial and volume impacts of right siting of endocrinology outpatients in a large tertiary hospital in Singapore. Materials and Methods: Data were collected prospectively on patient casemix including complexity (complex defined as requiring specialist care), time required for consultations and revenues garnered. The data were used to simulate 2 scenarios: right siting of all simple cases with freed up resources directed to research and teaching (research scenario) and right siting of all simple cases with replacement by complex cases (service scenario). Results: The department sees an estimated 33,000 outpatients per year with a total annual outpatient revenue of $8.6 million. The research scenario would see a decline in patient volume to 11,880 cases per year which would result in a corresponding decrease in revenue of $5 million and freeing up of 2.8 hours/ week for each staff. The service scenario yields a drop in patient volume of 9500 per annum and a drop in revenue of $1.9 million. Conclusion: Right siting reduces tertiary care patient volumes and revenues and may discourage right siting efforts. A viable business model for the tertiary institutions is needed to facilitate support for right siting. Key words: Healthcare costs, Programme evaluation, Public policy
Bridging the Gap Between Primary and Specialist Care – An Integrative Model for Stroke
Authors: Venketasubramanian Narayanaswamy , Ang Yan Hoon , Chan Bernard PL , Chan Parvathi , Heng Bee Hoon , Kong Keng He , Kumari Nanda , Lim Linda LH , Phang Jonathan SK , Toh Matthias PHS , Widjaja Sutrisno , Wong Loong Mun , Yin Ann , Cheah Jason
Published: February 2023

Stroke is a major cause of death and disability in Singapore and many parts of the world. Chronic disease management programmes allow seamless care provision across a spectrum of healthcare facilities and allow appropriate services to be brought to the stroke patient and the family. Randomised controlled trials have provided evidence for efficacious interventions. After the management of acute stroke in a stroke unit, most stable stroke patients can be sent to their family physician for continued treatment and rehabilitation supervision. Disabled stroke survivors may need added home-based services. Suitable community resources will need to be harnessed. Clinic-based stroke nurses may enhance service provision and coordination. Close collaboration between the specialist and family physician would be needed to right-site patients and also allow referrals in either direction where necessary. Barriers to integration can be surmounted by trust and improved communication. Audits would allow monitoring of care provision and quality care enhancement. The Wagner model of chronic care delivery involves self-management support, shared clinical information systems, delivery system redesign, decision support, healthcare organisation and community resources. The key and critical feature is the need for an informed, activated (or motivated) patient, working in collaboration with the specialist and family physician, and a team of nursing and allied healthcare professionals across the continuum of care. The 3-year Integrating Services and Interventions for Stroke (ISIS) project funded by the Ministry of Health will test such an integrative system.

Key words: Cerebrovascular disease, Chronic disease management, Family physician, Neurologist, Stroke nurse
Providing Integrated Mental Health Services in the Singapore Primary Care Setting – the General Practitioner Psychiatric Programme Experience
Authors: Lum Alvin WM , Kwok Kian Woon , Chong Siow Ann
Published: February 2023

Introduction: The aim of our programme was to right site a selected group of patients to the care of the primary sector for follow-up management. Mental disorders are recognised as a major public health problem worldwide which places an enormous burden on health services. Patients on treatment in the hospitals are largely managed by specialists either in the restructured hospitals or in private practice with minimal involvement of general practitioners (GPs). Yet, there are many patients with chronic mental illnesses who are stable, require maintenance medications and are best managed in the community. Strategies: GPs were given appropriate training and support to help them manage patients with mental illnesses in their clinics. The training involved in-depth, comprehensive training on mental illness, providing the GPs with the skills necessary to manage the stable patients within the community. It also facilitated Early Detection Intervention by enhancing the GPs capabilities to detect and manage the mentally ill. Patients screened by psychiatrists who fulfill the referral criteria agreed upon by both the specialist team and the GP partners were referred to the GPs with initial support from case managers when required. The benefits to patients include: increased convenience, savings in terms of transport costs and travel time, the flexibility of being seen during after office hours, less stigma and the option of managing their other medical conditions, if any, by the same doctor. Results: To date, a total of 200 patients have been successfully referred to the 30 GPs in the programme. This represents an average savings of more than 1000 consultation visits to the hospital per year. Conclusion: The programme allows for the right siting of care for patients and allows the hospital to channel precious resources to more appropriate uses. Key words: Case management, GP partnership, Right siting
Family Medicine Education in Singapore: A Long-standing Collaboration between Specialists and Family Physicians
Authors: Wong Teck Yee , Koh Gerald CH , Lee Eng Hin , Cheong Seng Kwing , Goh Lee Gan
Published: February 2023

In many countries, family medicine (FM) training has been conducted mainly by senior family physicians alone. However, FM training in Singapore in the last 30 years has involved specialists working in close collaboration with family physicians. The areas in which specialists are currently involved include the training of FM trainees in tertiary hospitals, the Master of Medicine in Family Medicine [MMed (FM)] and Graduate Diploma in Family Medicine (GDFM) programmes. This close relationship has been crucial in the continuing vocational and professional development of family physicians and in fostering closer collaboration between family physicians and specialists, thus ultimately benefiting patient care.

Key words: Postgraduate, Training programmes, Vocational and professional development
Improving Access to Outpatient Cardiac Care at the National Heart Centre – A Partnership Between Specialists and Primary Care
Authors: Wee Shiou Liang , Kwok Bernard WK , Tan Chee Beng , Chua Terrance SJ
Published: February 2023

Ensuring timely access to specialist care is an important indicator of the quality of a health service. Demand for cardiology outpatient appointments has grown considerably in the last decade, leading to increased waiting time for cardiology appointments at public hospitals. This paper examines the effectiveness of past and ongoing strategies initiated by the National Heart Centre, many of which were in collaboration with SingHealth Polyclinics, documents the lessons learnt, and provides a framework for approaching this problem. Instead of a simplistic approach where institutions react to long waiting times by growing capacity to meet demand, this paper emphasises the need to focus on the final intended outcome (timely diagnosis and treatment) rather than on a single performance indicator, such as waiting time. A broad systems approach at the national level is advocated, rather than piecemeal, uncoordinated actions by individual hospitals. Key words: Access to specialist care, Cardiology outpatient services, Waiting time
The Relation Between Insulin Resistance Determined by Haemostatic Modelling and Slow Coronary Flow
Authors: Nurkalem Zekeriya , Orhan Ahmet L , Alper Ahmet T , Aksu Huseyin , Ozdamar Murat , Uslu Nevzat , Gorgulu Sevket , Hasdemir Hakan , Sargin Mehmet , Eren Mehmet
Published: February 2023

Introduction: In this study, we sought to determine whether insulin resistance, which is investigated by homeostatic modelling, is related to slow coronary flow (SCF).

Materials and Methods: A total of 24 patients with SCF (4 females/20 males, mean age 47 ± 12 years) and 32 patients with normal coronary artery (10 females/22 males, mean age 52 ± 12 years) were included in the study. Baseline glucose, insulin and plasma lipid levels were measured. A standard oral glucose tolerance test (OGTT) was performed and post-challenge insulin levels were also measured. The index of insulin resistance was calculated with the homeostatic modelling [homeostatic model assessment for insulin resistance index (HOMA-IR)].

Results: There were no differences between the 2 groups with regard to age, lipid levels, blood pressure levels, history of smoking, fasting and post-challenge plasma glucose. Baseline insulin levels were augmented in the SCF group (9.64 ± 5.93 vs 7.04 ± 3.26, P = 0.041). HOMA-IR levels were not different between the study groups (2.20 ± 1.44 vs 1.69 ± 0.86, P = 0.129). Manifest insulin resistance was significantly higher in the CSF group as compared with the control group (25% vs 3%, P = 0.01).

Conclusion: Manifest insulin resistance is seen more frequently in patients with SCF.

Key words: Coronary artery disease, Glucose metabolism, Oral glucose tolerance test
The Toxicity and Outcomes of Continuous 5-fluorouracil/Cisplatin-based Chemotherapy Followed by Chemoradiation in Patients with Resected High-risk Gastric Cancer: Results of a Single Institute
Authors: Yakir Rottenberg , Luna Kadouri , Marc Wygoda , Tamar Sella , Avraham Rivkind , Ayala Hubert
Published: February 2023

Introduction: The majority of patients with gastric cancer relapse after definitive surgery and 5-year survival after surgery is very poor. The Intergroup 0116 study showed a modest survival benefit for postoperative bolus 5-fluorouracil-based chemoradiation with a high rate of toxicity. We hypothesised that treatment outcome could be further improved with feasible toxicity using a combination of bolus 5-fluorouracil, continuous 5-fluorouracil, and cisplatin followed by chemoradiation after 3 months of chemotherapy.

Materials and Methods: Thirty-six patients with stages Ib through IV adenocarcinoma of the stomach or gastrooesophageal junction who had undergone gastric resection and negative margins were assigned to postoperative chemoradiation. The treatment consisted of 6 cycles of continuous 5-fluorouracil (600 mg/m2) for 24 hours, push 5-fluorouracil (400 mg/m2) and leucoverin (LCV) (200 mg/m2) on day 1 to 2 every 2 weeks, cisplatin (60 mg/m2) every 4 weeks followed by combined modality therapy using 45 Gy at 1.8 Gy per day concomitant with weekly bolus 5-fluorouracil (600 mg/m2) and LCV (50 mg).
Results: The median age was 59 years (range, 29 to 75) and 25 patients were male. Thirty-five per cent had proximal tumour, T3 or T4 were diagnosed in 92% of the patients and lymph nodes metastases were confirmed in 83%. Grade 3 or 4 neutropaenia was documented in 25%, and gastrointestinal toxicity in 16%. There was no toxic death, but 1 patient had long-term complications. The median disease-free survival was 37.4 months and the overall survival was 40.3 months.
Conclusions: Postoperative chemoradiation with combination of bolus 5-fluorouracil, continuous 5-fluorouracil and cisplatin is a feasible and well-tolerated approach. Larger clinical trials should be conducted to further evaluate the toxicity and the efficacy of this regimen.

Key words: Adjuvant, Combined modality therapy, Gastric neoplasms
SMART WATERING SYSTEM BASED ON INTERNET OF THINGS FOR URBAN PLANTING
Authors:   Department of Informatics, Universitas Trilogi, Jakarta, Indonesia, Handy Permana Silvester Dian ,   Department of Informatics, Universitas Trilogi, Jakarta, Indonesia, Yogha Bintoro Ketut Bayu ,   Department of Informatics, Universitas Trilogi, Jakarta, Indonesia, Rifqi Fauzi Ahmad ,   Department of Agroecotechnology, Universitas Trilogi, Jakarta, Indonesia, Dewi Krishnasari Erneza ,   Department of Visual Communication Design, Universitas Trilogi, Jakarta, Indonesia
Published: February 2023

People in the city of Jakarta are busy people. Many Jakarta residents do not have time to look after plants. In fact, as a resident of the city of Jakarta, plant maintenance is very good for exchanging contaminated air into clean air. Plants must be watered every day to be able to photosynthesize. However, the busyness of the citizens of the city of Jakarta makes the residents do not have time to water their plants. Therefore, in this proposed study, a system that can water plants will be created automatically. The system consists of microcontroller as a control device, mobile-web app as the application which used by user and RabbitMQ as a server that control request from user. Microcontroller connected to internet use Wifi network and connected to RabbitMQ through MQTT protocol. Microcontroller as a control device connected with water pump through relay. When the given time has arrived, the water will automatically flow a few mili litters according to the needs of the tree from a bucket filled with water. The results of this research are expected to help urban communities in Jakarta to care for and maintain plants in the midst of their busy life