bluuebunny/crossref_metadata_2025 huggingface dataset:
A masculinidade de Otaviano sob ataque: relações de poder e potencialidade para liderança de Roma, no século I AEC
Authors: Campos Carlos Eduardo Da Costa
Published: January 2021

No que tange à Antiguidade, verificamos que os discursos dos escritores latinos e gregos, geralmente, representavam os feitos do princeps Augusto, em Roma, como um exemplum de “uir bonus” (bom cidadão). Entretanto, devido à diversidade textual sobre Otávio Augusto, tivemos de estabelecer uma seleção documental. Sendo assim, elencamos Marco Túlio Cícero e Veleio Patérculo para problematizar as evidências que expressam os ataques, as tensões e as defesas na cultura literária sobre a masculinidade do jovem Augusto, complementando-as com os escritos posteriores de Suetônio. Desse modo, analisaremos a ênfase discursiva sobre a sexualidade e a moralidade como elementos intrínsecos às relações de poder e a potencialidade para o governo de Roma, no século I AEC.
Agile Workforce a Post Pandemic Revival Plan for SMEs
Authors: Elanthi Mohamed Basheer , Dhanabhakyam M.
Published: January 2021

The global spread of the coronavirus (COVID-19) has left a clueless situation to all economies globally. Entrepreneurs of SME, during the contagion, have to build and rebuild many survival strategies for the upcoming times. Agility in the workforce will be one of the principal revivals plans to bring back the business on rails. This chapter mainly aims to enhance the understanding of the importance of SME know-how of how SME leads to creating jobs, grasping the present situation of SME employees, understanding different post-pandemic SMEs revival plans, and finding how workforce agility can be used as a revival plan. The study confirms that workforce agility can play a vital role in the SME sector in India to survive this pandemic and to bring back the growth rate. Apart from all the other strategies, agility tops with high priority among growing SMEs. To enable workforce agility in the practice, organizations can use techniques like cross-training, employee empowerment, employee compensation, information-sharing, and work design.
Ambidextrous Leadership for SMEs in the COVID-19 Era
Authors: Atiku Sulaiman Olusegun , Randa Isaac Okoth
Published: January 2021

The coronavirus pandemic has compounded the challenges of small and medium enterprises (SMEs). Apart from the operational challenges that business owners need to sort out for their SMEs, regulatory disruption is a factor in the business environment influencing business operations and sustainability. This chapter examines the place of ambidextrous leadership in sustaining SMEs in the post-pandemic era. A desktop research approach was adopted to analyze the impact of ambidextrous leadership on the innovative performance of SMEs through empirical studies conducted in big conglomerates, as well as SMEs. This chapter found that ambidextrous leadership is positively associated with the innovation of SMEs in the high-tech sector in developed and developing countries. Entrepreneurs may adopt an ambidextrous leadership style to drive the innovative performance of their businesses in the pandemic period. Ambidextrous leadership is fundamental in promoting workforce creativity, continuous business process improvement, and resource-efficiency.
Government Strategies to Minimize the COVID-19 Fallout on MSMEs in India
Authors: Bansal Palvi
Published: January 2021

Currently, the whole country is going across a stressful era. Pandemic has swept the whole planet into its grasp and has smudged the lives of citizens as well as the global economies as a result. COVID-19 has been one of the 2020 mega tragedies. The correlation is clear since the primary issue does seem to be unemployment and financial losses, which causes a huge decrease in consumer spending for all industrialized nations. Consequently, workers have been eliminated, and consumers have a drastic lack of their wages, creating a large fall in prices. Findings reflect that economies all around the world are suffering from COVID-19, which has made the entire world panic and the pandemic virus has taken over almost 195 countries in its grip. It is quite evident that the enterprises in the MSME sector are the most vulnerable ones in the era of the COVID-19 pandemic because of their size, the scale of operation, limited financial managerial resources, and more importantly, they do not have the capacity to deal with something so unexpected.
Innovation of SMEs and Effect on Productivity in Jalisco
Authors: Vargas-Hernández José G. , Vargas-González Omar C.
Published: January 2021

Small and medium enterprises (SMEs) in Jalisco represent one of the main entities of economic activity that supports the bulk of the population living in the state; using statistics as a fundamental tool for conducting studies in the economic, natural, health sciences, among others, allows proactive foundations for decision making within companies by senior executives and in the field public by officials responsible for promoting the growth of the industry in the State of Jalisco. This research tries to represent, under a statistical scheme, the use and disposition of information and communication technologies (ICTs) as a tool to increase average productivity levels within companies and under the Cobb production function. Douglas determines the ICT impact.
SME Sustainability in South Africa Post-COVID-19
Authors: Naidoo Vannie
Published: January 2021

COVID-19 has spread across countries throughout the world. This deadly virus has had devastating effects on government, society, healthcare, education, business, and the economy. As researchers and scientists throughout the world are searching for a cure, the virus remains deadly, and the infection rate is on the rise. SMEs throughout the world have been affected by this global pandemic. Since many countries imposed lockdown, SMEs were one of the most vulnerable in the business sector and suffered some devastating financial losses. During COVID-19, lockdown Stage 5 in South Africa occurred, where many SMEs that were non-essential were asked to shut down during this period.
Strategies for Entrepreneurial Innovation and Sustainability
Authors: Deshpande Mukund
Published: January 2021

SMEs contribute up to 60% of total employment and up to 40% of GDP in emerging economies. These SMEs recently faced, due to COVID-19 pandemic, chaotic circumstances resulting in business shut down, loss of man-hours, halt of machinery and material movement by which they lost their economy. Quick solutions to address the challenges were out of view. Moreover, making major changes swiftly in the set business system was impractical and probably impossible. Getting normalcy back on track delayed extensively owing to the unavailability of vaccines. Ignorance in terms of the remedy made the businesspersons helpless to bear with the situation. Literature exposed that the pandemic situation paralyzed the business functions entirely. Obviously, to safeguard the SMEs from such incidences in the future, this study became essential in understanding remedial, innovative, and sustainable strategies.
Youth Entrepreneurship and SME Challenges
Authors: April Wilfred Isak Aibs
Published: January 2021

COVID-19 (coronavirus) has significantly affected small-medium enterprises (SMEs) and entrepreneurs in the Republic of Namibia in terms of the massive shift in which all businesses were required to go online or find alternative means to operate or function. Despite the theatrical change, there is a lack of understanding amongst SME owners and entrepreneurs as to what it means to conduct business in the new normal, and thus proper communication channels, with bold leadership need to be followed especially in developing nations such as Namibia, where language barrier and the diversity of people can create challenges. This chapter first reviewed literature that discusses how SME owners/entrepreneurs are dealing with the challenges, followed by an entrepreneurial response Namibians has to implement, brought about by the COVID-19 pandemic. Twenty Namibian SME owners were interviewed to understanding how they deal with the COVID-19 pandemic.
Students Perceptions, System Characteristics and Online Learning During the COVID-19 Epidemic School Disruption
Authors: Quadir Benazir , Zhou Menghui
Published: January 2021

Due to the emergency educational consequences of the COVID-19 epidemic, it is necessary to find an effective and alternative way of learning. Moreover, during this epidemic, the Chinese Ministry of Education announced the “Disrupted Classes, Undisrupted Learning” initiative, offering flexible online learning. With the aim of facilitating a sound learning environment when using online learning systems, various kinds of tools can be applied. Tencent Meeting is one tool that offers various learning features. This study aimed to investigate how students perceived the effect of the Tencent Meeting system features on the two main determinants of the TAM model, namely perceived ease of use (PEOU) and perceived usefulness (PU). The study further analyzed the effects of these two determinants on learning performance. Data were analyzed using regression analysis. The study found the Tencent Meeting system features could account for 55.1% of PEOU and 40% of PU. Another finding shows that PEOU and PU had a significant effect on the students' learning performance. Finally, a discussions and implications are presented.
A New Learning Path Model for E-Learning Systems
Authors: Ramos David Brito , Ramos Ilmara Monteverde Martins , Gasparini Isabela , Teixeira de Oliveira Elaine Harada
Published: January 2021

This work presents a new approach to the learning path model in e-learning systems. The model uses data from the database records from an e-learning system and uses graphs as representation. In this work, the authors show how the model can be used to represent visually the learning paths, behavior analysis, help to suggest group formation for collaborative activities, and thus assist the teacher in making decisions. To validate the practical utility of the model, the authors created two tools, one to visualize the learning paths and another to suggest groups of students for collaborative activities. Both tools were tested in a real environment, presenting useful results. The authors carried experiments with students from three programs: physics, electrical engineering, and computer science. Experiments show that it is possible to use the proposed learning path to analyze student behavior patterns and recommend group formation with positive results.
State-of-the-Art of Commercial Proctoring Systems and Their Use in Academic Online Exams
Authors: Arnò Simone , Galassi Alessandra , Tommasi Marco , Saggino Aristide , Vittorini Pierpaolo
Published: January 2021

Online proctoring generally refers to the practice of proctors monitoring an exam over the internet, usually through a webcam. This technology has gained relevance during the current COVID-19 pandemic, given that the social distance owing to health reasons has consequently led to the switching of all learning and assessment activities to online platforms. This paper summarises the available state-of-the-art of commercial proctoring systems by identifying the main features, describing them, and analysing the way in which different proctoring programs are grouped on the basis of the services they offer. Furthermore, the paper reports on two case studies concerning online exams taken with both automated and human proctoring approaches. The outcomes from state-of-the-art approaches and the experience gained by the two case studies are then summarised in the conclusion, where the need for an organisational effort in loading photographs that can be used to easily recognise student faces, and using an automated online proctoring program to support manual proctoring have been suggested.
“IL POLITICO” E LE RELAZIONI INTERNAZIONALI
Authors: Clementi Marco
Published: January 2021

nel primo numero de “Il Politico”, con cui la Facoltà di ScienzePolitiche dell’Università di Pavia dà seguito nel 1950 agli “Annali”che aveva preso a pubblicare dal 1928, bruno leoni inaugura il suomandato di direttore specificando gli obbiettivi che la rivista si poneva.In poche pagine dal taglio più consono a un breve saggio scientificoche a un pezzo editoriale, leoni chiama la rivista all’analisi scientificadei fenomeni politici e al confronto con il mondo non scientifico. Così,mentre auspica che la rivista sappia porsi come punto di riferimentoanche all’esterno dell’accademia e sappia contribuire a risolvere i problemipiù urgenti del paese, rimanendo però “al di fuori e al di sopradegli interessi” delle fazioni politiche1, leoni analizza i rapporti fra alcunedelle discipline che concorrono alla conoscenza scientifica di ciòche è politico. In tal modo, egli teorizza ancora prima che annunciarequelli che saranno i tratti imprescindibili de “Il Politico” degli anni avenire: l’impegno a promuovere e valorizzare il confronto e l’interazionefra discipline e metodi differenti e la tensione a includere temi ecompetenze di confine, o trasversali.
LEOPARDI POLITICO TRA AMOR PATRIO E FRATELLANZA UNIVERSALE
Authors: Di Donato Giulio
Published: January 2021

Mai come durante le settimane di dolore e preoccupazione legateall’emergenza Coronavirus si sono manifestati così tanti atteggiamentidi fierezza nazionale: un sussulto di orgoglio generato da un concorsodrammatico di circostanze che è diventato quasi un moto spontaneo eliberatorio utile ad esorcizzare le paure e le tensioni accumulate.Il senso di comunità inevitabilmente si rafforza soprattutto neimomenti di smarrimento collettivo, quando si cerca un ‘noi’ che ciprotegga e rassicuri. Va compresa dunque questa forma di patriottismoche nasce dall’angoscia e dal desiderio di non sentirsi soli in frangentitanto difficili.Certo, tutto
Subtypes of PSP and Prognosis
Authors: Mahale Rohan R. , Krishnan Syam , Divya K. P , Jisha V. T , Kishore Asha
Published: January 2021

Background:

Progressive supranuclear palsy (PSP) is a clinically heterogeneous disease characterized by supranuclear gaze palsy and varying combinations of Parkinsonism, gait disturbances, postural instability, and fronto-limbic cognitive dysfunction. A major challenge in clinical diagnosis is the existence of subtypes whose clinical features overlap with those of other Parkinsonian disorders.

Objectives:

To categorize patients of PSP into its using the recently proposed movement disorder society criteria (2017) and to determine the prognosis of the PSP subtypes.

Methods:

Demographic and clinical data of patients diagnosed with PSP over a 21 year period were collected by review of medical records and categorized into its subtypes. Subtype prognosis was assessed from the interval between disease onset and attainment of the first of 5 clinical disability milestones namely wheelchair dependency, unintelligible speech, severe dysphagia, severe cognitive impairment, and urinary catheterization.

Results:

When categorized into subtypes, out of the 334 patients with PSP, PSP-RS predominated (72%), followed by PSP-parkinsonism (PSP-P) (13.5%), PSP-corticobasal syndrome (PSP-CBS) (5.1%), PSP-frontal (PSP-F) (4.2%), PSP-progressive gait freezing (PSP-PGF) (4.2%), PSP-postural instability (PSP-PI) (0.6%), and PSP-speech/language (PSP-SL) (0.3%). PSP-P reaches the milestones of wheelchair dependency, unintelligible speech, and dysphagia later than other subtypes.

Conclusion:

PSP-RS was the commonest and PSP-OM the rarest PSP subtype in our retrospective PSP cohort analysis. PSP-P had a better prognosis than all other subtypes of PSP. A large proportion of these cases would remain unclassified using NINDS-SPSP (1996) criteria.
Viral infections and implications for male reproductive health
Authors: Teixeira Thiago A , Oliveira Yasmin C , Bernardes Felipe S , Kallas Esper G , Duarte-Neto Amaro N , Esteves Sandro C , Drevet Joël R , Hallak Jorge
Published: January 2021

Viral infections have haunted humankind since times immemorial. Overpopulation, globalization, and extensive deforestation have created an ideal environment for a viral spread with unknown and multiple shedding routes. Many viruses can infect the male reproductive tract, with potential adverse consequences to male reproductive health, including infertility and cancer. Moreover, some genital tract viral infections can be sexually transmitted, potentially impacting the resulting offspring's health. We have summarized the evidence concerning the presence and adverse effects of the relevant viruses on the reproductive tract (mumps virus, human immunodeficiency virus, herpes virus, human papillomavirus, hepatitis B and C viruses, Ebola virus, Zika virus, influenza virus, and coronaviruses), their routes of infection, target organs and cells, prevalence and pattern of virus shedding in semen, as well as diagnosis/testing and treatment strategies. The pathophysiological understanding in the male genital tract is essential to assess its clinical impact on male reproductive health and guide future research.
Quantitative corneal neural imaging using in vivo confocal microscopy in cases of congenital corneal anesthesia
Authors: Gopal Madhumita , Ramappa Muralidhar , Mohamed Ashik , Dhakal Rohit , Chaurasia Sunita
Published: January 2021

Purpose:

Congenital corneal anesthesia (CCA) is a rare clinical entity that poses a diagnostic dilemma, particularly in the pediatric age group with very little literature on this. Accurate initial diagnosis, evaluation, early identification of risk factors, aggressive systemic workup, and appropriate therapy are paramount to prevent visual loss due to long-term complications of corneal anesthesia. The purpose of the study was to estimate and compare the corneal neural architecture using real time, in vivo confocal microscopy (IVCM) in patients with CCA as against a control population.

Methods:

This was a retrospective nonconsecutive, comparative clinical case series in a tertiary hospital in South India from June 2015 to December 2018.

Methods:

IVCM was accomplished in cooperative children in whom central cornea was relatively clear. The clearest three to five images from each eye were selected, and the nerves were analyzed for length, thickness, density, dichotomous pattern, and beading. Statistical analysis was done using Origin v7.0 (Origin Lab Corporation, Northampton, MA, USA).

Results:

In total, 15 eyes of 11 cases and 20 eyes of 10 controls were imaged. Measurements on corneal nerve density showed a significant difference (P = 0.0005), cases having a lower mean (3.85 ± 1.38 mm per mm2) compared to the controls (6.74 ± 1.75 mm per mm2). Measurements on corneal nerve length (P = 0.28), thickness (P = 0.45), and presence of beading (P = 0.97) and dichotomous pattern (P = 0.07) did not reveal a significant difference between cases and controls.

Conclusion:

There is a strong relationship between the functional loss (absent corneal sensation) and anatomical decrease (reduced subbasal nerve density) of corneal nerves in congenital corneal anaesthesia.
Pneumoretinopexy versus scleral buckling in retinal detachments with superior breaks
Authors: Singh Arshi , Behera Umesh Chandra
Published: January 2021

Purpose:

The purpose of this study is to study single surgery reattachment rate, refractive shift, surgical time, cost, and complications of pneumoretinopexy (PR) compared to scleral buckling (SB) in rhegmatogenous retinal detachments (RRDs) with superior breaks.

Methods:

Data of RRD with superior breaks, from 2013 through 2016, treated either with PR or SB surgery at a tertiary eye-care center were retrospectively reviewed. Treatment outcomes, procedural costs, refractive shift, surgical time, and complications, namely, cataract and glaucoma, were analyzed.

Results:

Thirty-two cases treated by PR (n = 15) and SB surgery (n = 17) fulfilled the selection criteria. Macula off RRD (91%) was the commonest presentation. Baseline parameters like duration of vision loss, presenting vision, and ocular characteristics were comparable. Single surgery retinal reattachment (66.7% PR vs. 76.5% SB) was analogous (P = 0.698). Retinal reattachment with secondary intervention was achieved in all cases at the last follow-up. Average vision gain in logMAR of 0.8 in PR and 0.6 in SB was not significantly different (P = 0.645) between the two groups, with SB group having a 1.9 Dioptre myopic shift and PR group none. Surgical time was shorter in PR versus SB at 15 versus 85 min and surgical cost (including additional surgery) was 50% less in PR. Complications like cataract progression (P > 0.99) and glaucoma (P = 0.71) were analogous among the groups. Horse-shoe tears were associated with failed primary surgery in 60% of PR and 75% of SB procedures.

Conclusion:

In RRDs secondary to superior breaks, PR proved to be faster, more economical, and less tissue manipulative than scleral buckle surgery, with equivalent efficacy and safety profile.
The effects of active warming on perioperative inadvertent hypothermia in patients undergoing vitreoretinal surgery under local anesthesia
Authors: Urfalioglu Aykut , Urfalioglu Selma , Oksuz Gozen , Doganer Adem , Teksen Seyma , Guler Ozlem , Calisir Feyza
Published: January 2021

Purpose:

Perioperative inadvertent hypothermia (PIH) is the decrease in core temperature below 36°C. We aimed to assess whether PIH develops in patients operated under local anesthesia (ULA) for vitreoretinal surgery in the operating room and investigate active warming efficacy.

Methods:

Seventy-two patients were divided into two groups: Group 1 contained unwarmed patients (n = 36), and Group 2, warmed patients (n = 36). The core temperatures, heart rate (HR), and mean arterial pressure (MAP) of the patients were measured at the beginning of surgery, after 20 min, 40 min, 1 h, at the end of the operation, and during the postoperative period.

Results:

PIH incidence was 44.6% in Group 1, whereas no hypothermia was observed in Group 2. Patient temperatures at 20 min (P = 0.001), 40 min (P < 0.001), 1 h (P < 0.001), the end of the operation (P < 0.001), and the postoperative period (P < 0.001) were significantly higher in Group 2 than in Group 1. Patient HRs at the end of the operation and during the postoperative period were significantly lower in Group 2 (P = 0.005) than in Group 1 (P < 0.001). The intraoperative 40th (P = 0.044) and 60th (P < 0.001) minutes, end of operation (P < 0.001), and postoperative MAP (P < 0.001) values of Group 1 were significantly higher than those of Group 2.

Conclusion:

PIH may develop in patients operated ULA, especially with a low ambient temperature. Actively warming may help prevent the harmful effects of PIH.
Clinical efficacy and safety of Razumab® (CESAR) study
Authors: Verma Lalit , Thulasidas Mithun , Purohit Ajay , Gupta Avnindra , Narula Ritesh , Talwar Dinesh
Published: January 2021

Purpose:

The aim of this study was to evaluate the efficacy and safety of Razumab (the biosimilar Ranibizumab by Intas Pharmaceuticals Ltd.) for the treatment of chorioretinal vascular diseases such as diabetic macular edema (DME), choroidal neovascular membrane (CNVM), and macular edema secondary to retinal vein occlusion (RVO).

Methods:

We conducted a single-center, retrospective study, including patients with DME, CNVM, and RVO, who had received treatment with Razumab® between October 2018 and September 2019. Primary outcome measures were the changes in corrected distance visual acuity (CDVA) and central foveal thickness (CFT) from baseline to 1 month and 3 months. Secondary outcome measures included intraocular pressure (IOP) at day 1, any signs of ocular inflammation or systemic adverse events during the follow-up.

Results:

One hundred and fifty-three eyes of 141 patients were analyzed. The indications included DME in 70 (45.8%) eyes, CNVM in 70 (45.8%) eyes, and RVO in 13 (8.4%) eyes. Mean CDVA improved from baseline (0.62 ± 0.44) to month 1 (0.45 ± 0.42) and maintained till 3 months (0.42 ± 0.44; P < 0.001). Mean CFT showed significant reduction from baseline (405.68 ± 192.422 μm) to month 1 (286.08 ± 118.36 μm) and month 3 (271 ± 104.24 μm; P < 0.001). None of the eyes recorded IOP >20 mmHg on day 1. No evidence of ocular toxicity or systemic adverse event was noted.

Conclusion:

Razumab® showed a rapid improvement in CDVA and CFT in most of the eyes with efficacy observed as early as 1 month and maintained till 3 months. The biosimilar Ranibizumab can be a safe and effective low-cost drug for treating macular diseases.
MYX technique
Authors: Bhatia Karan , Manaktala Ruchita , Sachdev Mahipal , Tank Nikunj , Saha Indranil , Mishra Deepak
Published: January 2021

Scleral-fixated intraocular lens implantation in an important tool in the armamentarium of an ophthalmologist for managing aphakia. Various techniques have been described in the literature with variable learning curves. Herein, we describe an easy, fast, reproducible technique; the “MYX” technique, which utilizes the advantages of both the Yamane and the X-NIT technique, where the handshaking of the prolene haptic of a 3-piece PMMA IOL into the lumen of a 26-gauge needle is done externally (like in X-NIT technique), and the exteriorized haptic is cauterized to form a flange transconjunctivally, thereby avoiding the scleral pocket tucking (like Yamane technique), to achieve excellent surgical outcomes.
A comparative study on endothelial cell loss in nanophthalmic eyes undergoing cataract surgery by phacoemulsification
Authors: Rajendrababu Sharmila , Wijesinghe Hiruni Kaushalya , Uduman Mohammed Sithiq , Kannan Naresh Babu , Mishra Chitaranjan , Prajna Lalitha
Published: January 2021

Purpose:

The purpose of this study is to compare the endothelial cell loss (ECL) in nanophthalmic eyes and age-matched controls undergoing cataract surgery by phacoemulsification and also to identify the risk factors influencing the endothelial cell density (ECD). This was a prospective comparative interventional case series.

Methods:

We enrolled 19 nanophthalmic eyes (study group) and 42 age-matched cataract controls (control group) undergoing phacoemulsification after meeting the inclusion criteria. Ocular parameters like best-corrected visual acuity, intraocular pressure, pachymetry, specular microscopy, and slit lamp findings were noted preoperatively and at month 1 and 3 postsurgery. All nanophthalmic eyes underwent cataract surgery with concomitant prophylactic posterior sclerostomy.

Results:

The median percentage endothelial loss in nanophthalmic eyes was 4.0 (IQR 0–23.5), 7.4 (IQR 1.0–-22.4) at 1 and 3 months postoperatively compared to 6.3 (IQR 1.7–14.1) and 6.4 (IQR 2.6–-12.1) in age controlled normal eyes (P = 0.94, P = 0.46, respectively). Linear regression analysis showed increasing age as the only variable influencing the percentage decrease in corneal ECD in the study group (P = 0.001). Nanophthalmic eyes with ACD <2.5 mm had a significantly greater reduction in ECD at 3 months postcataract surgery compared to baseline (P = 0.039). Visual outcomes and IOP reduction in the study group with ACD >2.5 mm were significantly better postcataract surgery (P = 0.02 and P = 0.002, respectively).

Conclusion:

The percentage of ECL in nanophthalmic eyes undergoing phacoemulsification is equivalent to normal eyes. However, in the nanophthamic eyes with AC depth <2.5 mm, the percentage cell loss was significantly higher warranting the need for extensive intraoperative care. Increasing age was found to be the only significant risk factor influencing the ECD in short eyes.
The importance of physical examination in primary health care provided by NPHW is being threatened in COVID19 times
Authors: Jain Rachna , Jain Yogesh
Published: January 2021

Physical examination has been one of the three pillars of diagnostic evaluation of illnesses. It has a larger role in the armamentarium of non-physician health workers. Due to prescriptions for social distancing in preventing COVID19, physical examination is being performed lesser than before. This poses a serious threat to the abilities of NPHW as well as to their relationship with the community.
Test-retest reliability of subjective visual vertical measurements with lateral head tilt in virtual reality goggles
Authors: Wang Chia-Han , Winnick Ariel A. , Ko Yu-Hung , Wang Zheyu , Chang Tzu-Pu
Published: January 2021

Objective:

The objective is to investigate the test-retest reliability of subjective visual vertical (SVV) in the upright position and with lateral head tilts through a computerized SVV measuring system using virtual reality (VR) goggles.

Materials and Methods:

Thirty healthy controls underwent SVV test in upright position, with the head tilted to the right 30°, and with the head tilted to the left 30°. Subjects wore SVV VR goggles, which contained a gyroscope for monitoring the angle of head tilt. Each subject completed 10 adjustments in each head position. The mean value of SVV deviations and SVV imprecision (the intra-individual variability of SVV deviations from the 10 adjustments) were recorded and compared across different head positions. The participants then repeated the same SVV protocol at least 1 week later. The test-retest reliability of SVV deviation and SVV imprecision were analyzed.

Results:

The SVV deviation (mean ± standard deviation) was 0.22° ± 1.56° in upright position, −9.64° ± 5.91° in right head tilt, and 7.20° ± 6.36° in left head tilt. The test-retest reliability of SVV deviation was excellent in upright position (intra-class correlation coefficient [ICC] = 0.77, P < 0.001), right head tilt (ICC = 0.83, P < 0.001) and left head tilt (ICC = 0.84, P < 0.001). The SVV values from the 10 adjustments made during right and left head tilts were less precise than when measured at upright (P < 0.001). The test-retest reliability of SVV imprecision was poor at upright (ICC = 0.21, P = 0.26) but fair-to-good in right head tilt (ICC = 0.72, P < 0.001) and left head tilt (ICC = 0.44, P = 0.04).

Conclusion:

The test-retest reliability of SVV deviation during lateral head tilts via VR goggles is excellent, which supports further research into the diagnostic value of head-tilt SVV in various vestibular disorders. In addition, the degree of SVV imprecision during head tilt has fair-to-good test-retest reliability, which suggests SVV imprecision may have clinical applicability.
Epidemiology of atypical parkinsonian syndromes
Authors: Lo Raymond Y.
Published: January 2021

Atypical parkinsonism or atypical parkinsonian syndromes (APS) refer to a group of neurodegenerative disorders which mimic typical Parkinson's disease but poorly respond to levodopa treatment and deteriorate faster. APS are very rare and among them, progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD) are the three relatively better characterized entities. The prevalence estimates of PSP, MSA, or CBD are mostly <10/105, and the incidence estimates are around 1/105 person-year; both estimates remain stable over the past few decades. The age at onset is relatively young for MSA at late 50s, followed by CBD at early 60s, and then PSP at late 60s. The gender difference is not significant in APS, although slight female predominance in CBD has been reported in literature. Little is known about genetic and environmental risk factors for PSP, MSA, and CBD; although the COQ2 mutation has been identified as a genetic risk for MSA, familial cases are extremely rare. Survival after symptom onset is generally within 10 years, but cases with longer disease duration do exist. Respiratory infection remains the major cause of death for APS, but cardiac arrest should be particularly considered in MSA. In addition to disease rarity, the phenotype–pathology discrepancy in APS makes the epidemiological studies even more challenging. Including biomarkers in future diagnostic criteria and establishing disease registry for collecting sufficient number of APS cases may increase the likelihood of finding modifiable risk factors for prevention and intervention.
Could Alcohol-Based Hand Sanitizer Be an Option for Hand Hygiene for Households in Rural Bangladesh?
Authors: Yeasmin Dalia , Dutta Notan C. , Nizame Fosiul A. , Rahman Musarrat J. , Ashraf Sania , Ram Pavani K. , Leontsini Elli , Rahman Mahbubur , Winch Peter J. , Luby Stephen P. , Unicomb Leanne
Published: January 2021

In low- and middle-income countries (LMICs), hand sanitizer may be a convenient alternative to soap and water to increase hand hygiene practices. We explored perceptions, acceptability, and use of hand sanitizer in rural Bangladesh. We enrolled 120 households from three rural villages. Promoters distributed free alcohol-based hand sanitizer, installed handwashing stations (bucket with tap, stand, basin, and bottle for soapy water), and conducted household visits and community meetings. During Phase 1, promoters recommended handwashing with soap or soapy water, or hand sanitizer after defecation, after cleaning a child’s anus/feces, and before food preparation. In Phase 2, they recommended separate key times for hand sanitizer: before touching a child ≤ 6 months and after returning home. Three to 4 months after each intervention phase, we conducted a survey, in-depth interviews, and group discussions with child caregivers and male household members. After Phase 1, 82/89 (92%) households reported handwashing with soap after defecation versus 38 (43%) reported hand sanitizer use. Participants thought soap and water removed dirt from their hands, whereas hand sanitizer killed germs. In Phase 2, 76/87 (87%) reported using hand sanitizer after returning home and 71/87 (82%) before touching a child ≤ 6 months. Qualitative study participants reported that Phase 2–recommended times for hand sanitizer use were acceptable, but handwashing with soap was preferred over hand sanitizer when there was uncertainty over choosing between the two. Hand sanitizer use was liked by household members and has potential for use in LMICs, including during the coronavirus pandemic.
COVID-19 Infection in the Human Reproductive Tract of Men and Nonpregnant Women
Authors: Morelli Fabrício , Meirelles Lyvia E. de F. , de Souza Maria V. F. , Mari Natália L. , Mesquita Cristiane S. S. , Dartibale Camila B. , Damke Gabrielle M. Z. F. , Damke Edilson , da Silva Vânia R. S. , Souza Raquel P. , Consolaro Marcia E. L.
Published: January 2021

SARS-CoV-2 is an enveloped non-segmented positive-sense RNA virus, classified as a beta coronavirus, responsible for the COVID-19 pandemic. Angiotensin-converting enzyme 2 (ACE2), reported as a SARS-CoV-2 receptor, is expressed in different human tissues (lung, intestine, and kidney) and in the testis, ovaries, uterus, and vagina. This suggests a potential risk to the human reproductive tract in COVID-19 patients. In addition, SARS-CoV-2 RNA has been detected in the blood, urine, facial/anal swabs, semen, and vaginal secretion, suggesting other potential means of transmission. However, little has been reported about SARS-CoV-2 infection in the male and nonpregnant female reproductive tracts, which may provide direct evidence on sexual transmission and fertility problems. Therefore, we focused this narrative review mainly on the distribution of ACE2 and SARS-CoV-2 positivity in the male and nonpregnant female reproductive tracts, providing an overview of the potential threat of COVID-19 to reproductive health and sexual transmission.
Twelve-Year Longitudinal Trends in Trachoma Prevalence among Children Aged 1–9 Years in Amhara, Ethiopia, 2007–2019
Authors: Sata Eshetu , Nute Andrew W. , Astale Tigist , Gessese Demelash , Ayele Zebene , Zerihun Mulat , Chernet Ambahun , Melak Berhanu , Jensen Kimberly A. , Haile Mahteme , Zeru Taye , Beyen Melkamu , Dawed Adisu Abebe , Seife Fikre , Tadesse Zerihun , Callahan Elizabeth Kelly , Ngondi Jeremiah , Nash Scott D
Published: January 2021

Trachoma control in the Amhara region of Ethiopia, where all districts were once endemic, began in 2001 and attained full scale-up of the Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE) strategy by 2010. Since scaling up, the program has distributed approximately 14 million doses of antibiotic per year, implemented village- and school-based health education, and promoted latrine construction. This report aims to provide an update on the prevalence of trachoma among children aged 1–9 years as of the most recent impact or surveillance survey in all 160 districts of Amhara. As of 2019, 45 (28%) districts had a trachomatous inflammation-follicular (TF) prevalence below the 5% elimination threshold. There was a statistically significant relationship between TF prevalence observed at the first impact survey (2010–2015) and eventual achievement of TF < 5% (2015–2019). Of the 26 districts with a first impact survey < 10% TF, 20 (76.9%) had < 5% TF at the most recent survey. Of the 75 districts with a first survey between 10% and 29.9% TF, 21 (28.0%) had < 5% TF at the most recent survey. Finally, among 59 districts ≥ 30% TF at the first survey, four (6.8%) had < 5% TF by 2019. As of 2019, 30 (18.8%) districts remained with TF ≥ 30%. Amhara has seen considerable reductions of trachoma since the start of the program. A strong commitment to the SAFE strategy coupled with data-driven enhancements to that strategy is necessary to facilitate timely elimination of trachoma as a public health problem regionally in Amhara and nationwide in Ethiopia.
Illuminating Shakespeare’s Terra Anglia
Authors: Voss Tony
Published: January 2021

Review:– Stuart Elden, Shakespearean Territories (Chicago and London: University of Chicago Press, 2018)– Margaret Tudeau-Clayton, Shakespeare’s Englishes: Against Englishness (Cambridge: Cambridge UniversityPress, 2020)
In Memoriam: André Neethling Lemmer (1944–2020)
Authors: Walters Paul , Van Renen Charles
Published: January 2021

No Abstract
Characterization, purity assessment, and preparation of liposomal formulation of 2,4,6-trihydroxygeranylacetophenone
Authors: Alkhateeb Yamen , Jarrar Qais B. , Abas Faridah , Rukayadi Yaya , Shaari Khozirah
Published: January 2021

Purpose: To prepare, characterize, and determine the purity of 2,4,6-trihydroxygeranylacetophenone (tHGA), and also to develop and characterize a liposomal formulation of tHGA to overcome its poor water solubility.

Methods: The tHGA was synthesized and then purified in two steps using two types of column chromatography separation techniques. The compound was characterized using different analytical techniques, while the purity of tHGA was determined by quantitative-nuclear magnetic resonance (qNMR). Proliposomes method was developed to produce liposome-encapsulated tHGA which was characterized based on particle size, polydispersity, stability, and encapsulation efficiency. A selective and rapid high-performance liquid chromatography (HPLC) method was developed and validated to quantify tHGA in a liposomal formulation in order to evaluate the encapsulation efficiency.

Results: The tHGA was successfully prepared and characterized with 98.4 % purity. A simple and reproducible proliposomes method was successfully developed to produce liposome-encapsulated tHGA. The liposomal formulation exhibited excellent encapsulation efficiency (90.4 %). This formulation also yielded a homogenous liposome population (polydispersity index = 0.39) with a small particle size (250.8 nm). The prepared liposome-encapsulated tHGA was stable at refrigerated temperature (4 ºC) for at least four weeks. The developed HPLC method showed good linearity over the range of 10 to 500 μg/mL with high precision and accuracy.

Conclusion: The compound produced has a high purity which can be used as an analytical reference standard. The developed formulation is  effective for dissolving and entrapping a high amount of tHGA which helps to overcome its poor solubility.

Keywords: Liposomes, Proliposomes, Trihydroxygeranylacetophenone, tHGA, Spectroscopic characterization, Poor solubility
Antimicrobial properties of bioactive compounds isolated from epidermal mucus in two Ray species (Dasyatis marmorata and Gymnura altavela)
Authors: Uyan Ali , Turan Cemal , Erdogan-Eliuz Elif Ayse , Sangun Mustafa Kemal
Published: January 2021

Purpose: To investigate the occurrence and antimicrobial effects of certain biochemical compounds in the epidermal mucus secretions of fish and to demonstrate their potential for biomedical applications.Methods: Crude, aqueous, and acidic epidermal mucus samples were collected from live ray specimens. Gas chromatography and gas chromatography-mass spectrometry (GC/MS) analyses were performed to identify the biochemical compounds present in the mucus. The spectrophotometric broth microdilution method was used to determine the antibacterial and antifungal properties of the mucus extracts. The bacterial strains, Bacillus subtilis, Escherichia coli, Enterococcus faecalis, and Klebsiella pneumonia, were used for the tests, as well as the fungal strains, Candida parapsilosis and Candida albicans.Results: GC/MS analysis revealed the presence of several hydrocarbon-derived compounds in the epidermal mucus of the two ray species. The acidic extract of G. altavela epidermal mucus produced a high MIC value, indicating the highest inhibitory effect of 8.64 μL against E. coli, while the crude extract of G. altavela epidermal mucus (41.13 μL against B. subtilis) was the least effective.

Conclusion: Epidermal mucus extracts, especially when acid-based, displays strong antimicrobial properties against all the tested pathogens. These findings suggest the plants possess some potential for the development of novel antimicrobial components for applications in medicine.

Keywords: Fish, Ray species, Epidermal mucus, Antimicrobial properties, Bioactive compounds
The mushroom, Cordyceps cicadae, ameliorates renal interstitial fibrosis via TLR2-mediated pathways
Authors: Zheng Rong , Wang Yuhuang , Zhong Yifei , Zhu Rong
Published: January 2021

Purpose: To evaluate the mushroom, Cordyceps cicadae, for its ability to suppress tissue fibrosis and Toll-like receptors 2 (TLR 2) pathway activation in a mouse model of renal interstitial fibrosis (RIF).Methods: Cordyceps cicadae powder was obtained from BioAsia Group (Shanghai, China). RIF was induced via unilateral ureteral obstruction (UUO) in male C57Bl/6 mice. Animals were treated via the intragastric administration of Cordyceps cicadae powder (0.1g, 0.3 g/ml/100 g/day), beginning 24 h prior to UUO, and the treatment was continued for the following 14 days. Changes in tissue histology were then assessed via hematoxylin and eosin, and Sirius red stainings. Tissue macrophages were characterized based upon their expression of inducible nitric oxide synthase (iNOS) and interleukin-10 (IL-10), while Western blotting technique was used to measure the levels of TLR2, Myeloid differentiation factor 88 (MyD88), and nuclear factor-κB (NF-κB)/p-NF-κB in samples from these animals.Results: Treatment with Cordyceps cicadae powder is associated with a shift in macrophage phenotype that in turn decreased the production of extracellular matrix and alleviated RIF occurrence in mice model.Conclusion: This mechanistic study highlights the novel potential approach for treating and preventing RIF using Cordyceps cicadae powder.

Keywords: Renal interstitial fibrosis, TLR2-mediated pathway, Cordyceps cicadae
A cross-sectional assessment of health-related quality of life among healthcare providers in Alkharj, Saudi Arabia
Authors: Albassam Ahmed A. , Iqbal Muhammad Shahid , Ain Mohammad Ruhal , Alotaibi Anwar , Althemery Abdullah , Alfaifi Abdullah
Published: January 2021

Purpose: To determine the current level of health-related quality of life (HRQoL), and evaluate factors influencing it among health-care providers (HCPs) in Alkharj, Saudi Arabia.Methods: A prospective cross-sectional study was conducted among HCPs in Alkharj, Saudi Arabia, using the standardized research tool, BREF-WHOQOL. A self-administered questionnaire was distributed in hospitals, in the medical colleges of Prince Sattam Bin Abdulaziz University, andcommunity pharmacies in Alkharj, Saudi Arabia. Descriptive, comparative, and inferential statistics were performed using SPSS.Results: A total of 289 HCPs agreed to participate in the study, 52 % of whom were female. Most participants were married (69 %), and most had fewer than 10 years of experience (58 %). Statistically significant differences in marital status, education level, income, and year of practice were found that correlated with HCPs’ HRQoL (p ≤ 0.05). Overall, respondents reported an above-average score for all survey items.Conclusion: The results indicate that HCPs see their general quality of life as good - a particularly important consideration in view of the demanding nature of their job. This study will help the concerned authorities to exactly know the current level of HRQoL among HCPs in Alkharj, Saudi Arabia, as well as help in designing better healthcare policies in Saudi Arabia.

Keywords: Healthcare providers (HCP), Health-related quality of life (HRQoL), Healthcare policies, Occupational stress
Pharmacoepidemiological assessment of off-label drug use in pediatric ambulatory departments at four tertiary care hospital in Pakistan
Authors: Sharif Rabeea , Aamir Muhammad , Shakeel Faisal , Faisal Shah , Khan Jamshaid Ali
Published: January 2021

Purpose: To assess the frequency and possible predictors of off-label drug use in ambulatory pediatric units of four tertiary healthcare institutions in a Pakistani city.Methods: A prospective study was conducted at the pediatric ambulatory department of four tertiary care hospitals of Peshawar, Pakistan. A total 1589 patients were included in the study which to evaluate their prescriptions for off-label drug use with the aid of Thomson Healthcare Micromedex DRUGDEX database.Results: A total of 79 different drugs were prescribed 5668 times to pediatric patients. A high rate of offlabel drug use (71.8 %) was observed in this study. Compared to corresponding reference categories, infants (OR 4.134, 95 % CI 2.076-8.235) and children (OR 1.857, 95 % CI 0.967-3.568) were more likely to receive off-label prescriptions. However, pediatric patients receiving less than four drugs (OR 0.414, 95 % CI 0.312-0.548) were less likely to receive off-label prescriptions.Conclusion: A high incidence of off-label drug use has been observed in the ambulatory pediatric population studied, especially in infants. More research is needed to identify and evaluate the contributory factors to off-label use of drugs in ambulatory pediatric population in developing countries to achieve optimal drug therapy for pediatrics.

Keywords: Pediatric population, Ambulatory, Off-label drug use