bluuebunny/crossref_metadata_2025 huggingface dataset:
A methodology for a pricing regime for three-wheeler taxi services
Authors: Bandara Y. M. , Kevitiyagala P. M. , De Alwis N.
Published: June 2022

The alarming growth of the informal transport sector in Sri Lanka during the past decade has given rise to the need to develop a regulatory framework to ensure the protection of both consumers’ and service providers’ rights, alongside those of the society at large. This study focuses on existing socio-economic features and the operational characteristics of three-wheeler taxi services, takes note of regulatory requirements, and devises a methodology for developing a fare index for three-wheeler transport services with the objective of developing a regulatory framework. At present, there are over one million three-wheelers in operation; a number which increases daily due to the attractiveness of income generated and the minimum prevalence of barriers to enter the industry. These findings are based on a survey conducted with the participation of 342 three-wheeler drivers from Colombo District. The analysis results show that fare setting, fare meters, regulation, standardization, and inspections, service time and operating hours, registration, identification, certification from relevant authorities (Provincial/Municipal council, any governing bodies), age and minimum level of experience, police recommendation, regulations for allocation vehicles to parks and related barriers are the factors relevant to the development of a regulatory framework for informal transport operations. Further, the paper also presents a price index based on cost-plus pricing method that may be used in a future regulatory mechanism.
Decorative consumption and socio-demographic antecedents: revelations from a study on wristwatches and houses among Colombo office workers
Authors: Karunanayake Chathurga , Gunaruwan T. Lalithasiri
Published: June 2022

Modern day man engages in vicarious consumption patterns in order to showcase wealth, enhance prestige and embrace others’ attention through Conspicuousness, Exclusiveness and Emulation. Yet, too little attention has been devoted to this obtrusive consumer desire in Sri Lanka and elsewhere in the world. In light of this, the purpose of this study was to provide a basis to what the authors denote as ‘Decorative Consumption’ and to examine the impact of socio-demographic determinants in terms of Conspicuousness, Snobbism and Conformism. This paper reports the outcomes of an exploratory survey conducted on 250 employees working within Colombo city limits, under different socio-demographic segments: age, gender, sector, religion and monthly income, employing the cases of wristwatches and houses. Results highlighted that ‘sector’ has a strong impact on the decorative consumption of wristwatches, as it is prone towards decorativeness in all three dimensions; conspicuousness, snobbism and conformism. ‘Age’ and ‘religion’ could influence through conspicuousness and snobbism whereas ‘monthly income’ could influence through conspicuousness and conformism. In the case of houses, ‘religion’ appeared prone towards decorativeness in all three dimensions, while ‘age’ and ‘monthly income’ are prone to decorative consumption through conspicuousness and snobbism, and ‘sector’ is prone only through snobbism.
Rethinking the development of post-conflict Sri Lanka based on the Singapore model
Authors: Ramanayake Sanika Sulochani , Wijetunga Chandana Shrinath
Published: June 2022

This study explores three major points: namely, Singapore’s development process, Singapore’s model of economic development, and the economic challenges of post-conflict Sri Lanka. This study explores pages of Singapore’s past and elaborates the focal points that resulted in its current development status. Sri Lanka’s development is discussed and compared with that of Singapore. Insights into Sri Lanka and other developing countries are also provided. This study reveals clear influences of Singapore’s nation-building process on its economic development. In contrast, Sri Lanka’s civil conflict spanning three decades and its politically unstable post-colonial history are seen to have adversely affected the country’s development. The industrial sectors of Sri Lanka are concentrated on low-skilled labour and manufacturing, mainly textile and clothing. The civil conflict in Sri Lanka ended in 2009, but many challenges remain. Therefore, this study examines the lessons that can be learnt in developing policies for rebuilding the nation and re-setting economic goals for post-conflict Sri Lanka.
Insurance contract for epidemiological diseases spread
Authors: Samaranayake D. I. J. , Samaranayake D. L. M.
Published: June 2022

This paper presents the use of actuarial modeling for the spread of epidemiological diseases. Study is done based on a developed actuarial model of SIR infection which describes the transfer dynamics in an insurance contract in a given population. At the initial stage, we satisfied key assumptions and observed that the rate of infection is positively related and the rate of recovery is negatively related to the level premium payment. Hence, we developed a MATLAB program to calculate the minimum adjusted level premium for a hospitalization plan. Furthermore, this study expanded the basic model to eliminate some problems such as the Vector-Host relationship due to unsatisfied assumptions for the real data. It is reasonable to expand the SIR model by including Vector-Host transfer dynamics to find out an actuarial model for Dengue fever. Accordingly the length of an epidemic season for Dengue over the sample period can be estimated. Results demonstrate no impact from Vector-Host in determining the level premium payment and reveal the possibility of introducing an insurance policy for the spread of Dengue fever in Sri Lanka. Further, as a result, difficulties to clearly identify seasonal patterns of other diseases may also be overcome. We suggest the SIRS infection model with delayed differential equations as an appropriate solution to define an actuarial model for a wide range of diseases.
Issues in food security and domestic food production in Sri Lanka
Authors: Henegedara G. M.
Published: June 2022

No abstract available
Design Optimization of a Hybrid Spur Gear Including Tooth Bending Effects
Authors: Gauntt Sean , McIntyre Sean , Campbell Robert
Published: June 2022

A multiobjective design optimization technique for hybrid gears with sinusoidally shaped interlocks has been developed and applied to a hybrid spur gear. The hybrid gear concept consists of a metallic outer ring to support high tooth contact stress bonded to a composite inner web for
weight reduction. Three design objectives were minimized for various geometric parameters controlling the composite–steel interface. Borg MOEA, a multiobjective evolutionary algorithm, was used to generate Pareto-optimal solutions for this design problem. Candidate designs were chosen
from the Pareto-optimal set for more detailed analysis. From the results, we infer that the spur hybrid gear studied herein has the potential to decrease gear weight by approximately 27–45%, at the expense of a 22–34% increase in tooth pitch-point deflection, and that the optimal
interface has between 15–20 cycles of the sinusoid with an amplitude of 0.25–0.35 mm.
Acupuncture in the treatment of Dry Eye Syndrome with anxiety symptoms. A case report
Authors: Pesavento Francesco , Lovato Antonello , Cappello Stefano , Postiglione Marco
Published: June 2022

Dry Eye Syndrome (DES) is an eye disorder caused by alteration of production or composition of tear film. Symptoms include dry eye dryness, burning, itching and pain, and often is associated with emotional stress, anxiety and depression. Evidence of the effectiveness of acupuncture to treat DES has recently appeared in literature but not on acupuncture treatment of DES related anxiety or depression symptoms.A 53-year-old male, good health, no serious medical conditions, with history of contact lenses wearing, anxious personality traits and anxiety symptoms, suffering from DES, was treated with acupuncture, twice a week for three weeks with somatic and ear acupoints selected from literature.Inferior marginal lacrimal meniscus, lipid layer interferometry, tear ferning test, psychiatric examination, State-Trait Inventory -Y (STAI-Y) questionnaire and Hamilton-Anxiety Rating Scale (HAM-A) scale was evaluated before and after treatment and at 15 , 30 , 60, and 90 days follow-up.Results show clear and lasting improvements with remission of eye symptoms, together with clear and stable improvements of anxiety symptoms.Acupuncture is an effective treatment also for DES related anxiety symptoms.
Comparative Evaluation of the Sealing Ability of an Alkasite Restorative Material and Resin-Modified Glass Ionomer Cement in Primary Molars
Authors: Pooja M. P. , Karuna Y. M. , Rao Arathi , Suman Ethel , Natarajan Srikant , Suprabha B. S.
Published: June 2022

Background:

Cention N is relatively new and an “alkasite” restorative material, indicated for direct restorations.

Aim:

The aim of this study was to comparatively evaluate the sealing ability of Cention N and resin-modified glass ionomer cement (GIC) when used to restore primary molars.

Methods and Materials:

It is a split-mouth study. Twenty children having bilateral deep dentinal caries involving primary molars requiring restoration were selected. After caries excavation under the rubber dam, samples were collected from the cavity. Restorations of the teeth were done using either resin-modified GIC (RMGIC) or Cention N. Patients were recalled after 6 weeks and the restorations done previously were removed using contra angled micromotor handpiece under rubber dam isolation. The samples were collected again. The collected samples were used to estimate the total viable count.

Statistical Analysis:

The pretreatment, posttreatment colony counts, and the differences between the groups were analyzed using paired t-test.

Results:

No statistically significant difference was observed in the mean differences of the pre- and posttreatment colony count between alkasite restorative material and RMGIC (P = 0.056).

Conclusion:

Restorations done using alkasite restorative material and RMGIC performed equally in terms of sealing ability.
Free Gingival Grafting of Single Tooth Recession with Advanced-Platelet-Rich Fibrin as a Palatal Bandage
Authors: Rath Avita , Zheng Melissa Wong Li , Fernandes Bennete , Priyadarshini H. R.
Published: June 2022

Although techniques such as subepithelial connective tissue graft are now widely used for root coverage procedures, free gingival graft (FGG) continues to be a common mucogingival procedure used to increase keratinized tissue dimensions. However, the palatal donor site heals with secondary intention and requires a longer healing time causing more discomfort and pain to the patient. A healthy 22-year-old female patient presented with Miller's class II recession in relation to the tooth 31 with high frenal attachment and a shallow vestibule, which was treated using FGG, and the donor site was bandaged with advanced-platelet-rich fibrin (A-PRF). This report evaluates the healing of the donor site over a 12-month period and assesses the root coverage as well as the postoperative discomfort after the harvesting of graft. In terms of healing, the use of A-PRF membrane as a palatal bandage appears to accelerate healing at the donor site, thereby reducing postoperative complications.
Linking Sustainable Mobility Criteria to Policymaking: Results of Multi-Criteria Analysis
Authors: Safronova Alina , Barisa Aiga , Kirsanovs Vladimirs
Published: June 2022

With increasing emissions from the transport sector, the need to reduce emissions is becoming increasingly acute. The EC's Climate Law aims to re-duce emissions by 55% by 2030, while the growing transport sector is the slowest to meet these targets. Only a few European Union (EU) countries met the 2020 renewable energy source target in the transport sector, which indicates that major changes are needed to meet the new EU requirements. As each country has limited financial resources, it is necessary to assess the impact of the policy before its implementation. In this study, a survey of 19 industry experts was conducted to identify the most promising policy in-struments for reducing emissions in the road transport sector, as well as to identify the most promising fuels for which more resources should be devoted. In this publication, data analysis was performed by the combined Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methodology. The obtained data can be further used for in-depth analysis such as cost-benefit analysis or complex system dynamics analysis for later use in sustainable policy formulation.
Regularity results for a noncoercive nonlinear Dirichlet problem
Authors: Alfano Emilia Anna , Di Gironimo Patrizia , Monsurrò Sara
Published: June 2022

In this paper, we prove some regularity results for a noncoercive nonlinear Dirichlet problem in an unbounded domain. The main result is obtained in the hypothesis that suitable coefficients of the operator associated to the problem belong to a class of functional spaces strictly containing Lebesgue ones. This can be done by approximation via coercive nonlinear Dirichlet problems. Under additional assumptions, we also get the boundedness of a solution.
Possible Sarcopenia and Its Association with Nutritional Status, Dietary Intakes, Physical Activity and Health-Related Quality of Life among Older Stroke Survivors
Authors: Wong Hui Jie , Harith Sakinah , Lua Pei Lin , Ibrahim Khairul Azmi
Published: June 2022

Background: Screening for sarcopenia in the stroke population is an emerging concept in research and clinical practice. Therefore, this cross-sectional study aimed to assess the prevalence of possible sarcopenia and its associated factors among older stroke survivors who visited the neurology and rehabilitation departments of three public hospitals in Malaysia. Methods: We acquired data on sociodemographic characteristics, clinical profiles, malnutrition risk, dietary intake, physical activity level, and health-related quality of life. Possible sarcopenia was diagnosed in individuals with decreased calf circumference and low handgrip strength, as proposed by the Asia Working Group for Sarcopenia (2019). Finally, we performed descriptive analysis and binary logistic regression. Results: Among 196 older adults with stroke (mean± standard deviation of age: 67.60 ± 5.70 years), 42.3% had possible sarcopenia, with a higher prevalence in the more advanced age group (≥70 years). In univariable analysis, possible sarcopenia was significantly associated with anthropometric indices, malnutrition risk, nutrient intake, physical activity level, and health-related quality of life. In multivariable analysis, body mass index (adjusted odds ratio [AOR]=0.57; 95% confidence interval [CI], 0.43–0.75) was the only factor associated with possible sarcopenia among individuals aged ≥70 years. Recurrent stroke (AOR=3.48; 95% CI, 1.02–11.92), body mass index (AOR=0.64; 95% CI, 0.54–0.76), and EQ-5D index (AOR=0.15; 95% CI, 0.03–0.78) were significantly associated with possible sarcopenia in the 60–69-year age group.Conclusion: The prevalence of possible sarcopenia among community-dwelling older stroke survivors was high. Therefore, we recommend routine screening for possible sarcopenia to ensure early nutritional and exercise intervention.
Food Insecurity during COVID-19 in Yemen
Authors: Rahmat Zainab Syyeda , Islam Zarmina , Mohanan Parvathy , Kokash Diana Mutasem , Essar Mohammad Yasir , Hasan Mohammad Mehedi , Hashim Hashim Talib , Basalilah Ashraf Fhed Mohammed
Published: June 2022

The United Nations has declared Yemen as the world’s worst humanitarian crisis with 21 million people in need of humanitarian assistance. Due to the convergence of severe economic instability exacerbated by the COVID-19 pandemic, stifling war, and spiking food prices, the Yemeni people are at the brink of famine with women and children especially malnourished. Desperate to feed their families, civilians are forced to resort to begging, participate in child marriages, or plunge into debt. An inflated currency has significantly diminished the purchasing power of the Yemeni population, and COVID-19 restrictions have made acquisition of food and essential commodity imports arduous. Immediate action by global and local governments is essential to prevent the deaths of thousands of people in the wake of severe food scarcity.
Fantasizing a Free Black History: Post-Black Arts Movement Novels and Plays Re-Imagining Jim Crow
Authors: Lastarria Wynter
Published: June 2022

“Fantasizing a Free Black History: Post-Black Arts Movement Novels and Plays Re-Imagining Jim Crow” closely reads one novel and one play written in the early twenty-first century and set in the Jim Crow period. Analyzing how Toni Morrison’s novel Love (2005) and Lynn Nottage’s drama By the Way, Meet Vera Stark (2011) take up Jim Crow era Black history together, I find that both works intentionally offer incomplete, subjective and fictive narrations of black life during Jim Crow to deny readers a sense of realism. In doing so, these authors represent a group of African American novelists and playwrights that contend with the decades following Black Arts Movement being so temporally removed from Jim Crow in two steps. Firstly, they acknowledge in their partial and obscure narratives that this historical Black experience cannot be fully recovered by treating Jim Crow Black history like a historical site to be discovered with a literary return. Secondly, they demonstrate in their direct appeal to their audiences to co-create the fictions’ narratives with the characters that black history can instead be a praxis of inter-generational, collaborative fiction writing that imagines past Black individuals, making them more transparent in the contemporary moment. These features of narrative and structural address signify that this group of post-Black Arts Movement authors consider Black individuals’ freedom during Jim Crow more accessible by conjecturing how it manifested with their audiences.
EĞİTİM BAĞLAMINDA METAVERSE
Authors: GÖÇEN Ahmet
Published: June 2022

Bu çalışmanın amacı Metaverse olgusunu eğitim bilimleri alanyazını ışığında incelemek ve Türkiye’de eğitim bağlamındaki Metaverse konulu çalışmalarda vurgulanan noktaları açıklamaktır. Çalışmada derleme yöntemi kullanılmış olup alanyazın incelemesinde 2010-2022 yılları arasındaki yayınlara yer verilmiştir. Çalışmada Metaverse yol haritası ve boyutları, Metaversal eğitim, güncel girişimler, eğitimde artırılmış ve sanal gerçeklik gibi konulara odaklanılmıştır. Türkiye bağlamında politika yapıcıların Metaverse konusunda önemle takip etmesi gereken noktalar irdelenmiştir. İncelenen çalışmalara dayalı olarak şunlar ifade edilebilir: Madde üzerine inşa edilen sanayi devrimlerine geç kalınmasıyla oluşan ülkeler arası fark, Toplum 5.0 ve Metaverse yolunda bilgi ve yaratıcılık üzerine kurgulanan eğitsel teknoloji devrimleri ile kapatılabilir. Yeni süreçte eğitim örgütlerinde en önemli görev öğretimsel-teknoloji liderlerine düşmektedir. Bununla birlikte eğitim kurumları tüm paydaşları ile değişime proaktif şekilde hazır olmalıdır.
Maintenance Initiation Prediction Incorporating Vibrations and System Availability
Authors: Gopikuttan Lasithan Lasyam , Veettil Shouri Puthan , Govindan Rajesh Vazhayil
Published: June 2022

As per ISO-10816, electric motors up to 15 kW are classified as Class I machines, and the major reason for their failure is that the vibrations in them are above the alert limit. This study presents a new model for predicting the condition-based maintenance (CBM) initiation points through vibration measurement in a system of Class I machines. The proposed model follows the accelerated life testing (ALT) procedure. ALT includes the formation of an artificial wear environment in bearings to analyze the resultant system vibrations on system availability. The artificial wear environment created is close to the real industrial situation. The results show that the prediction of the CBM initiation points is based on the established relation between the system availability and vibrations. Furthermore, a relation between the available time for maintenance initiation and different vibration velocities is demonstrated.
Observer-Based Quadratic Guaranteed Cost Control for Linear Uncertain Systems with Control Gain Variation
Authors: Hayakawa Satoshi , Hoshi Yoshikatsu , Oya Hidetoshi
Published: June 2022

This study proposes a method for designing observer-based quadratic guaranteed cost controllers for linear uncertain systems with control gain variations. In the proposed approach, an observer is designed, and then a feedback controller that ensures the upper bound on the given quadratic cost function is derived. This study shows that sufficient conditions for the existence of the observer-based quadratic guaranteed cost controller are given in terms of linear matrix inequalities. A sub-optimal quadratic guaranteed cost control strategy is also discussed. Finally, the effectiveness of the proposed controller is illustrated by a numerical example. The result shows that the proposed controller is more effective than conventional methods even if system uncertainties and control gain variations exist.
Voter Identification Intelligence System (VIIS)
Authors: Prakash Raut Aniket , Marry S Sarala
Published: June 2022

These days decision within the world's voting system is based mostly on physical attractiveness. Electronic Voting Machines (EVMs) are becoming increasingly popular in India. are utilized, but there are so numerous discussions being seen as of now in India. So, having just voted in these judgments, we offer new framework called the Framework for VIIS. We provide the finest option for people to modify in order to vote anonymously within the system. booth by addressing all worries about differentiating evidence of citizenship. The proposed work might be a mash-up of retina distinguishing evidence, the skull, and everything else conceivable biometrics parameters to form the signature code that supplies subordinate distinguishing evidence of Aadhar ID number or other distinguishing proof records The Voter Recognizable Proof Insights Framework (VIIS) employing (AI and Blockchain Innovation) will ensure that the present voting process is carried out in a proper, exact, and extremely safe manner.
PROBLEMATIC ASPECTS OF THE KHANTY-MANSI AUTONOMOUS OKRUG JUDICIARY In the 1930s AND 1950s ON SELECTED EXAMPLES OF THE PEOPLE ‘S COURT OF THE SAMARA DISTRICT
Authors: Kaburkin Aleksandr A. , Sokolova Valentina I.
Published: June 2022

The article provides brief information on the formation of the judiciary in the Ostyako-Vogul National, later Khanty-Mansi Autonomous Okrug, including the district court and people’s courts, reflects the problems and shortcomings of the judicial system of the district using concrete examples of the first and second sections of the People’s court of the Samarovsky district, identifies the causes of problematic issues, and provides information on audits and inspections of this court. The stages of formation of administrative-territorial structure in the region are touched upon. The establishment of the district and the formation from that moment on its territory of its own structure of Soviet and party organs, including judicial ones, are noted. Historical and geographical factors affected the fact that the district had not practically been developed by the time of its formation; there were no permanent and reliable transport links in the region. These reasons influenced the slow development of the territory, as well as the difficulties in the work of the district courts. The judiciary was important for the enforcement of the Soviet law in the district and the establishment of the Soviet authority. The relevance of the stated topic is noted. It is concluded that the courts, even when there were problems, coped with the tasks entrusted to them and contributed to the formation of the state structure of the district, ensuring its socio-economic development.
Wake-up Stroke and Onset-to-door Duration Delays: Potential Future Indications for Reperfusion Therapy
Authors: Tan Melissa SH , Ang Elaine SL , Ho Shu Swen , Ng Szu Chyi , Talabucon Loreto , Woon Fung Peng , De Silva Deidre A
Published: June 2022

Introduction: There is limited utilisation of acute stroke reperfusion treatments which have narrow therapeutic windows, with delayed hospital presentation being a major limiting factor in Singapore. Most patients who wake up with symptoms are ineligible for reperfusion treatments as duration from onset time is not known. We studied the profile of wake-up strokes, onset-to-door duration and their associated factors among ischaemic stroke patients in the context of potential new treatments. Materials and Methods: This is an observational study of consecutive ischaemic stroke patients presenting within 2 weeks of symptom onset to the Singapore General Hospital in 2012. Results: Of the 642 ischaemic stroke patients studied, 33% of the cases were wake-up strokes [median age 64 years, 88% <80 years; median NIHSS score 4, 98% <20]. The median onset-to-door duration was 14.3 hours (Interquartile range, 4.8 to 38.2 hours), 20% of them arrived <3.5 hours (considering eligibility for intravenous alteplase in the proven 4.5 hours window accounting for a one hour door-to-needle duration), 14%: ≥3.5 to <8 hours, 11%: ≥8 to <12 hours, and 56%: ≥12 hours. Most patients with known stroke risk factors including atrial fibrillation (66%), hypertension (78%) and prior stroke (81%) presented beyond 3.5 hours. Conclusion: The one- third proportion of wake-up stroke in this cohort and low prevalence of relative contraindications suggest this is a promising group for emerging thrombolysis indications. With the majority of patients presenting after 8 hours, widening of the therapeutic window with new potential reperfusion treatments would not appreciably increase treatment utilisation. This study reaffirms the urgent need for public education to improve stroke awareness in Singapore. Key words: Hospital presentation, Ischaemic stroke, Stroke awareness
Surgical Outcome in Thoracolumbar Fractures Managed by Short-segment Pedicle Instrumentation
Authors: Yang Min , Ding Guo Zheng , Xu Zhu Jun
Published: June 2022

Introduction: This study aims to evaluate the efficiency of short-segment instrumentation in treating thoracolumbar fractures in our institute. Materials and Methods: Twenty-two patients underwent posterior short-segment instrumentation for thoracolumbar fractures in our institute from 2007 to 2010 were included in this retrospective study. Radiological evaluations were carried out by measuring regional kyphosis angle (RA), anterior vertebral body compression percentage (AVC), and sagittal index (SI) during preoperative, postoperative and final follow-up, with the aim to investigate the rate of correction loss and implantation failure in relation to the Arbeitsgemeinschaft für Osteosythese (AO) classification of fracture system and the Load Sharing score system. CT scans were also used to determine the preoperative to postoperative canal compromise ratio. During the final follow-up, clinical outcomes were analysed based on scores from the Denis’ Pain’s and Work scales and neurological function was scored according to the Frankel classification. Results: At the final follow-up (average duration of 15 months), 21 patients (95%) who partially or fully recovered from thoracolumbar fractures were able to resume daily activities with no complaints of pain, or only slight pain. No deterioration in neurological function were recorded. Upon evaluation at each point of time, (preoperative, postoperative and final follow-up), the average RA improved from 21° to 3.5° to 5.6°, average AVC improved from 40.8% to 90.2% to 88.2%, and average SI changed from 19.1° to 3.1° to 4.1°, respectively. Average canal compromise ratio decreased from 45% to 6.7% after surgery. No correlation was found between loss of correction and AO classification of fracture system, and loss of correction and Load Sharing system scores. Also, no correlation was found between clinical outcomes and the correction loss limited to 10°. Conclusion: Posterior short-segment fixation in thoracolumbar fractures showed a satisfactory outcome in 95% of the patients based on a 15-month follow-up in our institute, even among patients with comminuted fractures injuries. Key words: Short-segment fixation, Spine, Kyphosis angle
Projecting the Number of Older Singaporeans with Activity of Daily Living Limitations Requiring Human Assistance Through 2030
Authors: Thompson James , Malhotra Rahul , Love Sean , Ostbye Truls , Chan Angelique , Matchar David
Published: June 2022

Introduction: In the context of rapid population ageing and the increase in number of activity of daily living (ADL) limitations with age, the number of older persons requiring human assistance in Singapore is likely to grow. To promote informed planning for the needs of these elderly, we project the number of resident Singaporeans 60 years of age and older with 1 or more ADL limitations requiring human assistance through 2030. Materials and Methods: The proportion of community-dwelling older adults with ADL limitations requiring human assistance, stratified by gender and age group, was calculated utilising a recent nationally-representative survey of older Singaporeans. The proportion of older adults in nursing homes with ADL limitations was estimated based on available literature. Together, these prevalence estimates were applied to a simulation of the future population of older adults in Singapore to derive an estimate of the number of individuals with ADL limitations requiring human assistance through 2030. Results: By 2030, the number of resident Singaporeans aged 60 years or older with 1 or more ADL limitations requiring human assistance is projected to be 82,968 persons (7% of the total population aged 60 years or older). Of this number, 38,809 (47%) are estimated to have 1 or 2 ADL limitations, and 44,159 (53%) are estimated to have 3 or more. Conclusion: The number of elderly Singaporeans with activity limitations is expected grow rapidly from 31,738 in 2010 to 82,968 in 2030. Estimates of the number of older individuals with ADL limitations requiring human assistance are of value for policymakers as well as acute and long-term care capacity planners as they seek to meet demand for health and social services in Singapore.

Key words: Ageing, Activities of daily living, Forecasting, Long-term care, Singapore
Comparison of Adults with Insulin Resistance (IR) in Latent Autoimmune Diabetes Versus IR in Glutamic Acid Decarboxylase Antibody-negative Diabetes
Authors: Salem Sameer D , Saif-Ali Riyadh , Muniandy Sekaran , Al-Hamodi Zaid , Ismail Ikram S
Published: June 2022

Introduction: Insulin resistance in latent autoimmune diabetes in adults (LADA) patients is controversial. The aim of this study was to evaluate insulin resistance and its related factors (metabolic syndrome parameters) among subjects with LADA and glutamic acid decarboxylase antibodies (GADA) negative diabetes, as well as the impact of these factors on insulin resistance. Materials and Methods: GADA levels were investigated in 1140 diabetic patients aged between 30 and 70 years. Insulin resistance and metabolic syndrome parameters were assessed in LADA and GAD-negative diabetic patients by general linear model. In addition, the impact of metabolic syndrome factors on insulin resistance was assessed in LADA and glutamic acid decarboxylase (GAD)-negative diabetic patients. Results: LADA was diagnosed in 33 subjects from 1140 Malaysian diabetic patients (prevalence = 2.9%). The results showed that LADA patients had higher insulin resistance and high density lipoprotein cholesterol (HDLc) (P = 0.003 and 0.00017 respectively) and lower body mass index (BMI) (P = 0.007) compared to GAD-negative diabetic patients. The HDLc was associated with decreased insulin resistance in LADA patients (P = 0.041), whereas HbA1c, triacylglycerides (TG) and waist were associated with increased insulin resistance in GAD-negative diabetic patients (P = 3.6×10-12, 1.01×10-5 and 0.004 respectively). HbA1c was highly associated with decreasing β-cell function in both LADA (P = 0.009) and GAD-negative diabetic subjects (P = 2.2×10-28). Conclusion: Insulin resistance is significantly higher in LADA than GAD-negative diabetic Malaysian subjects.

Key words: GAD-negative diabetes, Insulin resistance, LADA
Identification of Insulin Resistance in Subjects with Normal Glucose Tolerance
Authors: Lin Jiunn Diann , Chang Jin Biou , Wu Chung Ze , Pei Dee , Hsieh Chang Hsun , Hsieh An Tsz , Chen Yen Lin , Hsu Chun Hsien , Liu Chuan Chieh
Published: June 2022

Introduction: Decreased insulin action (insulin resistance) is crucial in the pathogenesis of type 2 diabetes. Decreased insulin action can even be found in normoglycaemic patients, and they still bear increased risks for cardiovascular disease. In this study, we built models using data from metabolic syndrome (Mets) components and the oral glucose tolerance test (OGTT) to detect insulin resistance in subjects with normal glucose tolerance (NGT). Materials and Methods: In total, 292 participants with NGT were enrolled. Both an insulin suppression test (IST) and a 75-g OGTT were administered. The steady-state plasma glucose (SSPG) level derived from the IST was the measurement of insulin action. Participants in the highest tertile were defined as insulin-resistant. Five models were built: (i) Model 0: body mass index (BMI); (ii) Model 1: BMI, systolic and diastolic blood pressure, triglyceride; (iii) Model 2: Model 1 + fasting plasma insulin (FPI); (iv) Model 3: Model 2 + plasma glucose level at 120 minutes of the OGTT; and (v) Model 4: Model 3 + plasma insulin level at 120 min of the OGTT. Results: The area under the receiver operating characteristic curve (aROC curve) was observed to determine the predictive power of these models. BMI demonstrated the greatest aROC curve (71.6%) of Mets components. The aROC curves of Models 2, 3, and 4 were all substantially greater than that of BMI (77.1%, 80.1%, and 85.1%, respectively). Conclusion: A prediction equation using Mets components and FPI can be used to predict insulin resistance in a Chinese population with NGT. Further research is required to test the utility of the equation in other populations and its prediction of cardiovascular disease or diabetes mellitus.

Key words: Area under the receiver operating characteristic curve, Body mass index, Insulin resistance, Metabolic syndrome, Oral glucose tolerance test
The Use of Traditional Chinese Medicine Among Breast Cancer Patients: Implications for The Clinician
Authors: Wong Kar Yong , Tan Ern Yu , Chen Juliana JC , Teo Christine
Published: June 2022

Introduction: Traditional Chinese Medicine or Traditional Complementary Medicine (TCM) is commonly used in our culture. There are several concerns regarding its use in patients undergoing conventional treatments for breast cancer. In this study, we aimed to evaluate the prevalence and pattern of TCM use among our breast cancer patients, and to identify patients who were most likely to choose TCM. Materials and Methods: A total of 300 patients on active follow-up with Breast Service at Tan Tock Seng Hospital were interviewed using a structured questionnaire. Results: A total of 35% (104 of 296) of patients reported using TCM. The majority of the patients were introduced to TCM by family and friends following the diagnosis of breast cancer. All except 3 patients continued with recommended conventional therapy although most did not inform their clinicians of TCM use. None of the patients reported any serious adverse events and 75% of them perceived a benefit from TCM use. Younger patients and those of Chinese ethnicity were more likely to use TCM (P <0.01 and P = 0.03 respectively). There was no significant difference in the dialect group, religious beliefs and educational level between the 2 groups (P >0.05). Conclusion: TCM use is common among our breast cancer patients, particularly the younger women. However, most patients do not inform their clinicians of TCM use while on recommended conventional therapies. It is therefore important for clinicians to initiate discussions regarding TCM use in order to be aware of potential unwanted drug interactions. Key words: Adjuvant therapy, Complementary medicine, Young breast cancer patients
Epidemiology of Oral Cancer Diagnosed at a Singapore Tertiary Healthcare Institution
Authors: Lim Asher AT , Wee Tze Haur , Wong Raymond CW
Published: June 2022

Introduction: Oral and pharyngeal cancers grouped together are the sixth most common cancer seen worldwide. Oral cancers are, however, relatively not common in Singapore. There are few published epidemiological studies of oral cancers seen in Singapore. This article is a retrospective study of oral cancer incidence in a major tertiary institution in Singapore from 1991 to 2001. Materials and Methods: All oral cancers diagnosed from 1991 to 2001 were extracted from the register of histopathology results and case notes were reviewed. Results: In our study, it was found that oral malignancies preferentially affect older males. Chinese, being the predominant ethnicity, reports the highest incidence of oral malignancy. Squamous cell carcinoma was the most common oral malignancy with the tongue being the most commonly affected site. The majority of patients who sought treatment had complaints of swelling and were referred from restructured government hospitals and clinics. Conclusion: Dental professional should be aware of the common clinical presentation of oral cancers. As oral cancer is a disease of high morbidity and mortality, a concerted effort from the government and healthcare profession will be required to improve the outcome of the disease.

Key words: Oral malignancies, Oral squamous cell carcinoma
Single Centre Experience of Transjugular Liver Biopsy in 152 Patients
Authors: Patel Ankur , Gogna Apoorva , Irani Farah Gillan , Teo Terence KB , Yeow Tow Non , Jain Deepak , Lo Richard HG , Tay Kiang Hiong , Tan Bien Soo , Azhar Rafay , Chang Jason PE , Taneja Manish
Published: June 2022

Introduction: Liver biopsy is considered the definitive investigation in the diagnosis and management of liver disease. This study describes the experience of performing transjugular liver biopsy (TJLB) over the last 9 years in a local single centre. Materials and Methods: A retrospective review of consecutive TJLB procedures performed at our institution was conducted. A total of 152 patients (74 males and 78 females), with a mean age of 47.4 years (range, 13 to 83 years) underwent a total of 154 TJLB procedures at our institution between March 2003 and November 2011. The principal indication for TJLB was severe coagulopathy in over 80% of patients. The technical success, number of passes, histological adequacy and complication rates were analysed. Results: The procedural success rate was 98.7% (152 out of 154 procedures). Adequate material for diagnosis was obtained in 149 out of 152 (98.0%) technically successful procedures. There was procedure related morbidity in 8 patients (5.2%) of which all but one were self-limiting requiring no further intervention. We also performed hepatic venous pressure gradient (HVPG) measurements in 19% of patients at the time of TJLB. Conclusion: TJLB performed at our institution is a safe and reliable technique in patients in whom traditional percutaneous liver biopsy may be hazardous. TJLB has a high technical success rate as well as a high diagnostic yield with a low complication rate. TJLB also has the added benefit of performing HVPG, which is of increasing importance in management and prognostication of chronic liver disease.

Key words: Indications, Safety, Singapore, Transjugular Liver Biopsy
Ceftaroline—An Anti-MRSA Cephalosporin and Its Implications for Singapore
Authors: Chen Hui Hiong , Hon Pei Yun , Hsu Li Yang
Published: June 2022

Introduction: Ceftaroline is a fifth-generation cephalosporin with activity against methicillin-resistant Staphylococcus aureus (MRSA) that was recently launched in Singapore. It received approval from the United States (US) Food Drug Administration (FDA) and European Commission for the treatment of adult patients with community acquired pneumonia (CAP) and complicated skin and soft tissue infections (cSSTI). This study aimed to review current published data and determine its clinical role, particularly in the local setting. Materials and Methods: A literature review on published articles in English on ceftaroline, focusing in particular on clinical trials and other clinical reports. Susceptibility testing was also performed on a limited sample of local MRSA and Streptococcus pneumoniae isolates. Results: Ceftaroline has an extensive spectrum of activity, including coverage of MRSA and multidrug-resistant S. pneumoniae. However, it has limited activity against non-fermenting Gram-negative bacteria and is susceptible to hydrolysis by extended spectrum beta-lactamases. It is only available for intravenous delivery, with a reconstituted stability of just 6 hours, rendering it unavailable for use for outpatient antibiotic therapy. Clinical trials demonstrate non-inferiority compared to first-line comparators in the treatment of CAP and cSSTI. Published case reports/series suggest a potential greater role in the treatment of MRSA bacteremia and endocarditis. No resistance was found among local archived MRSA and S. pneumoniae isolates. Conclusion: We believe ceftaroline will occupy primarily niche roles for culture-directed treatment of various infections—in particular those caused by MRSA—until further clinical trial data become available. A variety of factors render it less useful or appealing for empirical treatment of CAP or healthcare-associated infections. Key words: Antimicrobial agent, Bacteremia, Pharmacodynamics, Pharmacokinetics, Vancomycin hetero-resistant Staphylococcus aureus
Use of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) in the Diagnosis of Granulomatous Mediastinal Lymphadenopathy
Authors: Low Su Ying , Koh Mariko S , Ong Thun How , Phua Ghee Chee , Anantham Devanand
Published: June 2022

Introduction: This study assessed the clinical utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of suspected granulomatous mediastinal lymphadenopathy. Materials and Methods: Retrospective chart review of all patients who underwent EBUS-TBNA for suspected granulomatous mediastinal lymphadenopathy at Singapore General Hospital between December 2008 and December 2011 inclusive. Results: Over a period of 3 years, a total of 371 patients underwent EBUS-TBNA of whom 33 (9%) had the procedure performed for evaluation of suspected granulomatous mediastinal lymphadenopathy — 18 for suspected tuberculosis (TB) and non-tuberculous mycobacterial (NTM) lymphadenitis, and 15 for suspected sarcoidosis. EBUS-TBNA was diagnostic in 9 of the 13 patients with a final diagnosis of TB/NTM. EBUS-TBNA cultures were positive in 6 of them (46%), 1 showed acid-fast bacilli (AFB) although cultures were negative, and 2 had necrotising granulomatous inflammation from EBUS-TBNA biopsies and sputum cultures grew TB. EBUS-TBNA was diagnostic in 9 of the 14 patients with a final diagnosis of sarcoidosis through histology showing non-caseating granulomatous inflammation. The sensitivities of EBUS-TBNA for diagnosis of TB/NTM, sarcoidosis and overall granulomatous mediastinal lymphadenopathy were 69%, 64%, 64%; the negative predictive values were 56%, 17%, 33%; and accuracies were 78%, 67%, 70%, respectively. Conclusion: EBUS-TBNA can be useful in the diagnosis of suspected granulomatous mediastinal lymphadenopathy with sensitivities and accuracies of >60%.

Key words: Lymphadenitis, Non-tuberculous mycobacterial, Sarcoidosis, Tuberculosis
The Looi Suture Technique for Anchoring the Lateral Tarsal Strip to the Lateral Orbital Wall
Authors: Chan Joy BM , Looi Audrey LG
Published: June 2022

Introduction: The lateral tarsal strip procedure (LTS) was first reported by Anderson and Gordy in 1979 for the management of paralytic or senile eyelid laxity. Since its description, the LTS procedure has been subject to several modifications by various authors. In this study, we described the Looi suture technique, a small modification in the technique of suturing the LTS to the lateral orbital wall periosteum. Using this technique, the surgeon achieves a larger area of contact between the anterior surface of the tarsal strip and the lateral orbital wall periosteum, promoting a stronger adhesion. With a double-armed suture, the technique also allows for adjustment of the lower lid tension to avoid over- or under-correction of horizontal lid laxity. This study aimed to evaluate the technique. Materials and Methods: This was a retrospective non-comparative case series of 39 eyelids of 31 patients who underwent LTS with Looi suturing technique for the correction of involutional lower lid laxity which had resulted in either entropion or ectropion. In this procedure, a novel technique utilising a double armed 5/0 Ethibond suture is used to secure the LTS to the lateral orbital rim, with the aim of increasing appositional contact between the LTS and periosteum. Results: In 36 eyelids with entropion, the procedure was combined with lower lid retractor repair, and in 3 eyelids with ectropion, with medial tarsoconjunctivoplasty. Surgery was successful in 37 of 39 eyelids (94.87%) after one procedure. The remaining 2 eyelids required repeat procedures to achieve anatomical success. Both cases had been performed by trainee surgeons under supervision. Postoperative follow-up period ranged from 1 day (in a visiting overseas patient) to 2 years. Conclusion: This study described the Looi suturing technique in performing the LTS procedure and we found it a simple and effective modification when dealing with lower lid laxity.

Key words: Entropion, Lower lid laxity
Anticoagulation Needs in Asians with Atrial Fibrillation: A Mythbuster
Authors: Aribou Zeenathnisa M , Mondry Adrian
Published: June 2022

Atrial fibrillation (AF) has long been known to increase the risk of stroke. As a result, relevant international guidelines recommend that measures to reduce the risk of thrombus formation should be considered in all patients presenting with AF. Based on risk assessment scores, patients would then receive either thrombocyte aggregation inhibitors or oral anticoagulants. Despite this advice, compliance rates with the recommendations are poor across all countries surveyed. Evidence from the Global Anticoagulant Registry in the Field (GARFIELD) registry shows that major deviation from guidelines is due in large part to physicians’ decision-making. In this brief narrative review, we address some of the frequent reasons cited by physicians why the guidelines are disregarded for Asian patients.

Key words: Bleed, Elderly, Falls, Patient preference, Stroke prevention