bluuebunny/crossref_metadata_2025 huggingface dataset:
El Liderazgo Orientado por Resultados y la Optimización de la Calidad de los Servicios al usuario en la oficina general de Gestión de Recursos Humanos del Ministerio de Agricultura y Riego
Authors: Quiñones Li Aura Elisa , Sifuentes Pinto Nilsa , Quiñones Vernazza Augusto
Published: February 2024

El objetivo general de nuestra investigación fue demostrar que el liderazgo orientado por resultados optimizaría la calidad de los servicios al usuario en la Oficina General de Gestión de Recursos Humanos del Ministerio de Agricultura Y Riego Sede-Lima-2015. Nuestra investigación corresponde al diseño de investigación cualitativa. El tipo de investigación fue descriptiva de corte transversal. Se utilizó el método deductivo-explicativo. Entre los resultados más importantes resaltan que la comunicación de estrategias claras que implantará el liderazgo orientado por resultados que beneficiarían a los usuarios, el liderar y empoderar al equipo para resolver las quejas y reclamos que presentan los usuarios, la ejecución de estrategias para el cumplimiento del cronograma de pago a proveedores sin retrasos, la toma de decisiones acertadas por la disponibilidad de indicadores existentes desarrollados por personal capacitado en competencias técnicas claves en la Oficina General de Gestión de Recursos Humanos del Ministerio de Agricultura Y Riego Sede-Lima-2015, beneficiarán a sus usuarios que dispondrán de procesos administrativos eficaces, resolución de quejas en el más corto plazo, cumplimiento irrestricto de pago a proveedores por servicios prestados, personal capacitado en áreas técnicas para desarrollar indicadores adecuados, aplicación de la gestión de calidad en la Oficina General de Gestión de Recursos Humanos del Ministerio de Agricultura Y Riego Sede-Lima-2015. Como conclusión, el liderazgo orientado por resultados influye significativamente en optimizar la calidad de los servicios al usuario en la Oficina General de Recursos Humanos del Ministerio de Agricultura y Riego Sede-Lima-2015.
Penyuluhan Pembuatan Sarana Septic Tank Sesuai SNI Sebagai Langkah ODF di Desa Karangreja
Authors: Latifatul Uumdati  , Rika Sylviana  , Nurlaila Maysaroh Chairunnisa  , Novita Dian Iva Prestiana
Published: February 2024

Desa Karangreja merupakan sebuah desa di Kecamatan Pebayuran. Desa Karangreja memiliki Dusun3 wilayah, 14 RT wilayah dan 7 RW wilayah. Setelah dilakukan observasi ke lingkungan Desa Karangreja,terdapat 2 wilayah RT yang tingkat ODF (Open Defecation Free) nya masih tergolong rendah, yaitu RT 13dan RT 14. Dilakukan penyuluhan pembangunan septic tank pribadi di Desa Karangreja khususnya pada RT13 dan RT 14 yang bertujuan untuk perencanaan sistem septic tank pribadi yang mampu melayani pengguna,mempunyai kapasitas yang cukup, mudah dioperasikan serta dirawat, memenuhi standar dan peraturan yangberlaku. Perencanaan mengacu pada SNI 03-2398-2017 tentang Tata Cara Perencanaan Tangki Septikdengan Sistem Resapan.
Phragmatobia amurensis edita, a new subspecies from Shaanxi Province, China (Lepidoptera: Erebidae: Arctiinae: Arctiini)
Authors: Müller Günter C. , Saldaitis Aidas , Volynkin Anton V.
Published: February 2024

A new subspecies of Phragmatobia amurensis Seitz, 1910, Phragmatobia amurensis edita ssp. n. is described from the Shaanxi Province of China. Adults and genitalia of both sexes of all subspecies of P. amurensis as well as the similar P. fuliginosa (Linnaeus, 1758) and P. placida (Frivaldszky, 1835) are illustrated.
Cloud Security System for ECG Transmission and Monitoring Based on Chaotic Logistic Maps
Authors: Rajasree Gopalakrishnan  , Retnaswami Mathusoothana Satheesh Kumar
Published: February 2024

Biomedical data or information must be transmitted securely via the internet for smart healthcare. The Electrocardiogram (ECG) signal is amongst the most essential clinical signals which must be delivered to hospital facilities. Prime focus of this research is on the encryption of ECG for secure transmission. Chaos theory is used for the development of deterministic nonlinear systems, that can be used to create random numbers for the Chaotic Logistic Map (CLM) based encryption. This study describes a cryptographic algorithm for encrypting ECG signals that uses a mix of the CLM and fingerprint data. The common factor between the patient section and monitoring section is the operation on sample data points of ECG. The choice of proper encryption and decryption theme can save more amount of time and is invulnerable both to noise-based attacks and hacking instances. The proposed framework is implemented on Dropbox based cloud storage and access is possible from any given locations. Simulation tests are used to assess the system performance in terms of Structural Similarity Index Matrix (SSIM), Histogram, Spectral Distortion (SD), Correlation and Log-Likelihood Ratio (LLR). The incorporation of complex layers of CLM encryption increases security.
Investigation of the Influence of Non-Routine and Derived Features in the Development of Early Detection Model for Transformer Health Index Classification
Authors: Azlan Mohmad  , Mohd Hatta Mohammed Ariff  , Mohd Ibrahim Shapiai  , Mohd Solehin Shamsudin  , Norulhakima Zakaria  , Mohammad Adnan Sujan  , Rasli Ghani  , Ifran Bahiuddin
Published: February 2024

Establishing an effective HI model is challenging because it involves balancing cost, risk, and performance. The currently developed Reduced Features Model (RFM) for the transformer Health Index (HI) prediction may lead to late prediction. The RFM utilised non-routine input features to achieve a high-accuracy model where data availability is the primary concern. Hence, the common goal of Transformer Asset Management (TAM) in achieving acceptable availability and reliability of the transformer may not be achieved. In this paper, the primary objective is to investigate the performance of the HI model by considering routine test features as a baseline for developing the Early Detection Model (EDM). The development of EDM is significant, as the model shall provide a sustainable solution to the utility and plant owners in establishing their TAM strategies. Hence, this paper's case studies include performance investigation using routine, non-routine, and derived features from the routine test. Support Vector Machine (SVM) was used for the prediction modelling, and the model's performance was validated based on a 5-fold cross-validation technique to avoid biases. As a result, it was found that the average accuracy performance of 88.4% was obtained by considering only routine test features during the model validation process. However, complementing the routine test with other features, which were non-routine and derived features, increased the average performance accuracy model to 95.3%. Hence, further development of EDM is feasible and crucial for sustainable TAM solutions.
Design of Buck Converter Based on Maximum Power Point Tracking for Photovoltaic Applications
Authors: Nornaim Kamarudin  , Ahmad Asri Abd Samat  , Mohammad Faridun Naim Tajudin  , Muhammad Khusairi Osman  , Saodah Omar  , Irni Hamiza Hamzah
Published: February 2024

e MPPT converter ensures that the PV system operates at the maximum power point, which is the point where the solar panels can generate the most power. This is done by adjusting the voltage of the output. The converter uses a DC-DC conversion process and can be implemented using a buck converter circuit. This project uses a buck converter to adapt the voltage to its appropriate value to reach a maximal power extraction. This power converter can be designed in several ways. This involves employing a typical power converter design to create the power converter in the MPPT converter. Furthermore, the inductance and capacitance derivation for the MPPT converter is insufficient, making determining the inductance and capacitance unfeasible. Hence, this study focuses on designing the buck converter for MPPT application and tracking the maximum power using the Perturb and Observe (P&O) method. This system will be implemented by using MATLAB/Simulink. To design the MPPT buck converter, several parameters need to be considered and derived. This project finds that the MPPT buck converter that has been designed can track the maximum power from 900 W/m2 to 1100 W/m2 of irradiance. The design of the MPPT buck converter using the P&O method is fairly accurate, and the accuracy of tracking the maximum power is around 98%.
Logistic Regression Model for Evaluating Performance of Construction, Technology and Property-Based Companies in Malaysia
Authors: Mohd Rijal Ilias  , Asmahani Nayan
Published: February 2024

Financial distress refers to a situation where a company is facing significant financial difficulties or is at risk of insolvency. Being able to anticipate financial distress can help companies take proactive measures to address underlying problems, improve their financial health, and avoid bankruptcy. Likewise, investors can use such predictions to make informed decisions about their investments. The aim is to examine the significant factors of financial distress and accuracy model that can be effectively used in practice to analyse the financial distress of a construction, technology, and property-based companies. In this study, the Altman, Springate, Grover and Zmijerski model is used to classify the financial distress among construction, technology, and property-based companies in Bursa Malaysia Market Exchange during the 2017 to 2021. The models employ the logistic regression method to predict multiple financial ratios simultaneously to assess a company’s financial distress. The result shows that the most significant financial ratio for Altman Z-Score model is X1, and X4 followed by Springate model are X1, X5 and X6 and lastly, Zmijewski are ROA and DR. It also found that 100% accuracy of the Grover model suggested method has an acceptable efficiency to predict financial distress followed by Altman, Springate and Zmijewski model.
Novel and Advanced Ultrasound Techniques for Thyroid Thermal Ablation
Authors: Chan Wai-Kin , Sun Jui-Hung , Liou Miaw-Jene , Hsu Chia-Jung , Lu Yu-Ling , Chou Wei-Yu , Li Yan-Rong , Liu Feng-Hsuan
Published: February 2024

Thyroid radiofrequency ablation and microwave ablation are widely adopted minimally invasive treatments for diverse thyroid conditions worldwide. Fundamental skills such as the trans-isthmic approach and the moving shot technique are crucial for performing thyroid ablation, and advanced techniques, including hydrodissection and vascular ablation, improve safety and efficacy and reduce complications. Given the learning curve associated with ultrasound-guided therapeutic procedures, operators need training and experience. While training models exist, limited attention has been given to ultrasound maneuvers in ablation needle manipulation. This article introduces two essential maneuvers, the zigzag moving technique and the alienate maneuver, while also reviewing the latest ultrasound techniques in thyroid ablation, contributing valuable insights into this evolving field.
Orbit of the Patroclus–Menoetius Binary System and Predictions for the 2024/2025 Mutual Events Season
Authors: Brozović Marina , Jacobson Robert A. , Park Ryan S. , Descamps Pascal , Berthier Jérôme , Pinilla-Alonso Noemí , Popescu Marcel , Licandro Javier
Published: February 2024

We report on the ephemeris development for Menoetius, the satellite of Patroclus. Our data set consisted of ground–based and Hubble Space Telescope relative astrometry, as well as 42 lightcurves from the mutual events seasons in 2007, 2012, and 2017/2018. Our dynamical model included the effects of oblate, nonspherical shapes of the components, and we assumed that Menoetius contained ∼22% of the system’s mass. We numerically integrated the equations of motion and obtained a set of dynamical parameters that fit the data. We report the fit results in terms of residuals, state vectors, orbital elements and their 1σ uncertainties. The mean osculating semimajor axis is a = 692.5 ± 4.0 km, the mean eccentricity is e = 0.004 ± 0.004, and the International Celestial Reference Frame pole direction in R.A. and decl. is R. A. = 178.0 ± 0.5 deg, δ = −74.1 ± 0.2 deg. We determined the siderial orbital period of P = 4.282753 ± 0.000023 days. The fit yielded the system GM = 0.0950 ± 0.0012 km3 s−2, which, in combination with the system volume determined from the stellar occultation and the assumed volume uncertainty of 20%, suggests a system bulk density of 1.05 ± 0.21 g cm−3(1σ). The next season of mutual events starts in February of 2024 and lasts until January of 2025. The Patroclus system is in opposition for the observers on Earth in late September and is suitable for observations of the mutual events with an edge-on geometry in October.
Artificial Intelligence Assisted Inversion (AIAI): Quantifying the Spectral Features of 56Ni of Type Ia Supernovae
Authors: Chen Xingzhuo , Wang Lifan , Hu Lei , Brown Peter J.
Published: February 2024

Following our previous study of Artificial Intelligence Assisted Inversion (AIAI) of supernova analyses, we train a set of deep neural networks based on the 1D radiative transfer code TARDIS to simulate the optical spectra of Type Ia supernovae (SNe Ia) between 10 and 40 days after the explosion. The neural networks are applied to derive the mass of 56Ni in velocity ranges above the photosphere for a sample of 124 well-observed SNe Ia in the TARDIS model context. A subset of the SNe have multi-epoch observations for which the decay of the radioactive 56Ni can be used to test the AIAI quantitatively. The 56Ni mass derived from AIAI using the observed spectra as inputs for this subset agrees with the radioactive decay rate of 56Ni. AIAI reveals that a spectral signature near 3890 Å is related to the Ni ii 4067Å line, and the 56Ni mass deduced from AIAI is found to be correlated with the light-curve shapes of SNe Ia, with SNe Ia with broader light curves showing larger 56Ni mass in the envelope above the photosphere. AIAI enables spectral data of SNe to be quantitatively analyzed under theoretical frameworks based on well-defined physical assumptions.
Constraining the Existence of Axion Clouds in M87* with Closure Trace Analyses
Authors: Wang Zhiren , Broderick Avery E.
Published: February 2024

Black holes can amplify incoming bosonic waves via rotational superradiance, inducing bound states of ultralight bosons around them. This phenomenon has the potential to confine the parameter spaces of new bosons. Axions and axion-like particles (ALPs) are candidate beyond-standard-model particles that can form such clouds around supermassive black holes (SMBHs) and impact the polarization signal in a similar fashion to Faraday rotation via axion–photon coupling. Prior efforts have used polarized images from the Event Horizon Telescope (EHT) M87 2017 observations to limit the dimensionless axion–photon coupling to previously unexplored regions. However, with the novel calibration-insensitive quantities, closure traces, and conjugate closure trace products, it is possible to constrain the existence of axion clouds while avoiding the dominant sources of systematic uncertainties, e.g., station gains and polarization leakages. We utilize a simple geometric model for the polarization map of M87* to fit the model parameters with both simulated and real data sets and reach a comparable level of constraint in the accuracy with which an axion cloud may be excluded in M87. Future applications of our approach include subsequent M87* and Sgr A* observations by EHT and the next-generation EHT that are expected to produce stronger constraints across a wider range of axion and ALP masses. Because it does not require imaging, closure trace analyses may be applied to target active galactic nuclei for which imaging is marginal, extending the number of SMBHs from which axion limits may be obtained significantly.
The ants of the Galápagos Islands (Hymenoptera, Formicidae): a historical overview, checklist, and identification key
Authors: Herrera Henri W. , Tocora María C. , Fiorentino Gianpiero , Causton Charlotte E. , Dekoninck Wouter , Hendrickx Frederik
Published: February 2024

The Galápagos ant fauna has long been understudied, with the last taxonomic summary being published almost a century ago. Here, a comprehensive and updated overview of the known ant species of the Galápagos Islands is provided with updated species distributions. The list is based on an extensive review of literature, the identification of more than 382,000 specimens deposited in different entomological collections, and recent expeditions to the islands. The ant fauna is composed of five subfamilies (Dolichoderinae, Dorylinae, Formicinae, Myrmicinae, and Ponerinae), 22 genera, 50 species, and 25 subspecies, although three species (Crematogaster crinosa Mayr, 1862, Camponotus senex (Smith, 1858), and Solenopsis saevissima (Smith, 1855)) are considered dubious records. Finally, an illustrated identification key of the species found in the archipelago is presented.
Diagnosis and Treatment of Premature Atrial or Ventricular Complexes
Authors: Ahn Jinhee
Published: February 2024

Premature atrial complex (PAC) and premature ventricular complex (PVC) are the most common arrhythmias. Most of them are benign, whereas some could be an initial sign of any underlying significant heart disease. Evaluation of daily burden and the presence of any association with underlying medical conditions are essential for proper assessment. Recently, newly developed electrocardiogram smart devices are widely available to document arrhythmias and identify correlations with symptoms. Management is required if the daily burden is high, patients are highly symptomatic, or significant structural heart disease is present. Antiarrhythmic drugs (AADs) are the first-line treatment, but if arrhythmias are drug-refractory or the patients are intolerable to AADs, catheter ablation is considered a good alternative in selected cases. In this paper, the proper diagnosis and management for PAC and PVC will be comprehensively reviewed.
A 32-Year-Old Female with Incidentally Detected Multifocal Cystic Pulmonary Lesions on Chest Computed Tomography
Authors: Yoon Hee-Young
Published: February 2024

Lymphangioleiomyomatosis (LAM) is a rare condition that exclusively affects women and is characterized by lung parenchymal destruction and the formation of cysts due to infiltration by LAM cells. It can also impact the lymphatic system, leading to the development of fluid-filled cystic structures and abdominal involvement, including renal angiomyolipomas (AML) or lymphangioleiomyoma. LAM can occur sporadically or be associated with tuberous sclerosis complex. Common symptoms include respiratory issues such as dyspnea, pneumothorax, chylothorax, along with other manifestations like renal AML and lymphatic involvement. The diagnosis of LAM relies on a combination of clinical, radiological, and laboratory findings, and treatment options vary depending on symptoms and patient status, with mTOR inhibitors being considered as a treatment option. This case outlines the diagnostic journey and clinical course of a 32-year-old female patient with LAM.
Viajes de ilusión visual y literaria. El cosmorama de Nicolino Calyó
Authors: Cantos Casenave Marieta
Published: February 2024

Desde 1808, cuando el refugiado piamontés Gazzera abrió el primer cosmorama en París, se anunciaron por toda Europa numerosos espectáculos ópticos con este nombre, cosmorama, sobre todo desde el cierre de su local en 1832. Sin embargo, las informaciones periodísticas demuestran que los cosmoramas llegaron antes a España, cuando Robertson la visitó en 1820. Es cierto que no todas las exposiciones tenían la calidad y novedad requeridas, así que, a menudo, para garantizar el éxito, era más importante la habilidad del exhibidor, el cartel o folleto de la exposición o la reseña periodística. Este artículo analizará tanto las experiencias físicas llevadas a cabo como la literaturización periodística de estos viajes de ilusión, y prestará especial atención al artista Nicolino Calyó, pintor que haría del cosmorama, y de otros espectáculos visuales, su modo de vida tanto en Europa como en América. Además, en su visita a Cuba, el cosmorama mereció una reseña que adoptó la forma de un viaje literario, un artículo que al mismo tiempo que demuestra el vínculo entre el viaje visual y el literario, pone de manifiesto cómo el texto puede convertirse en una experiencia vicaria del espectáculo mismo y este en un simulacro de la vivencia real.
Revising Australian Academic Integrity Policy for the Age of Artificial Intelligence
Authors: Morgan David
Published: February 2024

Academic integrity is considered under threat in the age of artificial intelligence owing to new technologies. The sector has questioned exemplary responses in institutional academic integrity policy and proposed changes to what is exemplary. This chapter examines three issues seen in proposed academic integrity policy changes. The first issue is whether to ban or accept the use of generative artificial intelligence (GenAI) tools. The second issue is whether the proposed changes are sufficient to cover what is needed in academic integrity policy. The third issue is what other changes are needed to support academic integrity throughout a student's interactions with an institution. The chapter concludes with a proposal of how the work of the exemplary academic integrity project should not be added to but modernized to address questions raised in the age of artificial intelligence.
Embracing Generative AI in the Classroom Whilst Being Mindful of Academic Integrity
Authors: Meakin Lynsey A.
Published: February 2024

There are many generative AI (GenAI) tools available, and their rapid advancement has caused concerns relating to academic integrity. This chapter will consider concerns relating to academic integrity in the age of AI, including plagiarism and cheating. Awareness and education will be discussed as strategies for upholding academic integrity, as will proactive measures such as assessment design, and the need for institutional policies concerning the use of AI in education. The chapter concludes by stating that students should be taught to use generative AI ethically, responsibly and transparently and highlights how the integration of AI can foster creativity and enhance students' learning experiences.
A case report on successfully treated invasive pulmonary mucormycosis in a patient with poorly controlled diabetes mellitus
Authors: Dikshaladevi P. , Selvaratnam N. , Nalayini J. , Peranantharajah T.
Published: February 2024

Although fungal infections are common in clinical practice, usually they are superficial and invasive infections are very rare among immunocompetent people. Invasive fungal infections in immunocompromised people are life threatening if left untreated. Among invasive fungal infections, mucormycosis is uncommon. Pulmonary mucormycosis is rarely seen in clinical practice and is often life-threatening. This case report describes a patient with poorly controlled diabetes who presented with pulmonary mucormycosis and responded well to systemic antifungals.
Takayasu arteritis masquerading as recurrent abdominal pain
Authors: Fasrina M. Z. F. , Kularatne W. K. S. , Bowattage S. , Nasim F. N. , Jazeema Z. K. M.
Published: February 2024

Takayasu arteritis (TA) is a rare granulomatous inflammation of large arteries, specifically the aorta and its branches. It is more prevalent in young Asian women with the highest incidence in Japan. There is a delay in diagnosis due to nonspecific early symptoms and unfamiliarity with this disease. We present a case of a young female who presented with recurrent abdominal pain suggestive of mesenteric angina and constitutional symptoms over one-year. Her radial pulses were absent, and she had multiple bruits on examination over the right subclavian and carotid arteries and the epigastrium, along with high inflammatory markers. Her CT angiography of large vessels confirmed the diagnosis of TA and she was treated with high-dose steroids with good clinical remission confirmed by a reduction in inflammatory markers and improvement in symptoms.
Picture quiz - key
Authors: Dalugama Chamara , Hettiarachchi N. Madhuwanthi , Pathirage Manoji
Published: February 2024

No abstract available
Patients with high haemoglobin and negative for JAK2 mutation
Authors: Fernandopulle KHBP
Published: February 2024

No abstract available.
An elderly lady with “racoon eyes” and macroglossia
Authors: Neththikumara U , Ranasinghe DGNN , Samaraweera YR
Published: February 2024

No abstract available.
Bioequivalence study of ticagrelor in normal, healthy Indian subjects under fasting conditions: A randomized, blinded, crossover study
Authors: Pradeep T. Pavan , Gattu Ranjith Kumar , Naralasetty Anil Kumar , Nadig Sreevathsa , Kumar K. Vinodh , Kumar N. Ravi , Birla Ashish , Revankar Santosh Y
Published: February 2024

Objectives:

The objectives of this study were to evaluate the bioequivalence and safety profiles of the test drug and reference drug of 90 mg ticagrelor tablets under fasting conditions.

Methods:

This was a randomized, blinded, balanced, two-treatment, two-period, two-sequence, single-dose, crossover bioequivalence study in normal, healthy adults. Subjects were randomized to receive a single dose of test or reference drug (ticagrelor 90 mg oral) under fasting conditions with a 16-day washout period. The primary pharmacokinetic variables were peak plasma concentration (Cmax), area under the plasma concentration (AUC) time curve measured to the last quantifiable concentration (AUCT), and time to maximum drug concentration (Tmax). Bioequivalence was concluded if 90% confidence intervals (CIs) of the geometric mean ratio of the test/reference drugs AUCT and Cmax are within the predefined range of 80%–125%. Adverse events (AEs) were also assessed.

Results:

Forty-two healthy adult males were enrolled, but 4 withdrew and 38 subjects successfully completed the study. There was no difference between the test and reference drugs regarding pharmacokinetic parameters. The median (range) Tmax was 1.67 h (1–4 h) and 2 h (1–4.5 h) for the test and reference products, respectively. The estimated 90% CIs of the geometric mean ratio for AUCT and Cmax satisfied the predefined bioequivalence criteria of 80%–125%. On analysis of variance, no significant “sequence” and “period” effects were observed for the pharmacokinetic parameters. No AEs were reported in the study.

Conclusion:

Our findings indicate that the test product is bioequivalent to the reference product and safe and well-tolerated in healthy Indian adults.
Eisenmenger syndrome arising from aortopulmonary window diagnosed in adulthood: An unusual presentation as ischemic stroke
Authors: Chigullapalli Sridevi , Jadhav Ajitkumar Krishna , Nalawade Digvijay D. , Wadhokar Pratik Satyajit
Published: February 2024

Aortopulmonary window (AP window) is an uncommon congenital heart condition marked by a connection between the ascending aorta and the pulmonary trunk. Numerous individuals diagnosed with AP window typically manifest symptoms in their early childhood, which may include recurring respiratory tract infections due to a left-to-right shunt, signs of congestive heart failure, and, if not treated in early childhood, the condition can progress to severe pulmonary vascular disease and Eisenmenger syndrome. Without treatment, very few patients survive beyond their second decade of life. In this case, we present a patient who exhibited symptoms of an ischemic stroke while having an undiagnosed large AP window and Eisenmenger syndrome.
Eliminating Viral Hepatitis from India and Southeast Asia by 2030: Challenges and Ways Forward
Authors: Ramasamy Senthilkumar , Raghavan Bitty , Pavithran Sreeshma , Misra Swati , Susindran Balaji , Lahariya Chandrakant
Published: February 2024

This review was conducted to understand the epidemiology of hepatitis in Southeast Asia, examine the current scenario, and suggest a way forward for elimination. A comprehensive desk review was followed by analysis and interpretation. Viral hepatitis fits the criteria for elimination. The availability of safe and effective vaccines against the hepatitis B virus and the effective treatments for the hepatitis C virus makes it possible to eliminate hepatitis. Stepping up interventions such as universal screening, identifying the hotspots, investing in the interventions for elimination, increasing hepatitis testing and linkage to care, attention on adult vaccination, increasing coverage with hepatitis B vaccination for kids, and making hepatitis C treatment available, accessible and affordable are the strategies which need to be expanded. Telemedicine, education and training and hybrid surveillance will help increase access to services for viral hepatitis prevention and treatment. Accelerated efforts to eliminate hepatitis from South East Asia are needed. Key stakeholders need to work together for this agreed goal. The countries need to learn from each other. The primary healthcare approach should be used to achieve the elimination goal.
Developing and Establishing Attribute-based Surveillance System: A Review
Authors: Adnyana I Made Dwi Mertha , Utomo Budi , Eljatin Dwinka S , Setyawan Muhamad F
Published: February 2024

This review was conducted by analysing the nine attributes of the surveillance system according to Updated Guidelines for Evaluating Public Health Surveillance Systems. Information was collected using various databases by setting keywords and the inclusion and exclusion criteria. The results showed that 67% of surveillance system implementations used sentinel surveillance and 33% used epidemiological studies. Surveillance system activities: 83% used active and passive surveillance, whereas 17% used only passive surveillance. The adequacy assessment found that 50% met the attributes of surveillance systems in Nigeria, Indonesia and Pakistan, whereas 50% did not meet the attributes of surveillance systems in Ghana, Australia and Ethiopia. This variability was due to geographical differences, the number of informants and experts, the level of collaboration and the health policies of each country. It is recommended that surveillance systems should aim to meet these nine attributes from the design to implementation stage.
Surge in Caesarean Section Rates across the Indian Subcontinent: A Systematic Review
Authors: Niazi Farah , Choedon Kalsang , Iqbal Mehwish , Kaur Karuna Nidhi , Saeed Shazina , Shannawaz Mohd
Published: February 2024

The increase in caesarean sections (CS) globally and specifically in the Indian subcontinent is a subject of interest in maternal healthcare, considering both the benefits and risks associated with the procedure. This study aims to assess the rate of CS in the Indian subcontinent, analysing data from 10 articles encompassing 702,930 pregnant women aged 15–49 years. The findings show varying CS rates, with Bangladesh at 13.80%, India at 13.74% and Nepal at 4.60%. Factors, such as maternal age, education, place of birth and wealth quintile, were linked to these rates. The study also notes post-partum infection as a common complication associated with CS. The research focuses on three aspects: The prevalence and determinants of CS, the outcomes for mothers and neonates and the impact of CS on healthcare resources. It underscores the need for balanced antenatal counselling and informed decision-making to optimise the use of CS, considering both its necessity in certain cases and the associated healthcare implications.
An internet of things based smart agriculture monitoring system using convolution neural network algorithm
Authors: K S Balamurugan , Pradhan Chinmaya Kumar , A N Venkateswarlu , G Harini , P Geetha
Published: February 2024

Farming is a crucial vocation for survival on this planet because it meets the majority of people's necessities to live. However, as technology developed and the Internet of Things was created, automation (smarter technologies) began to replace old approaches, leading to a broad improvement in all fields. Currently in an automated condition where newer, smarter technologies are being upgraded daily throughout a wide range of industries, including smart homes, waste management, automobiles, industries, farming, health, grids, and more. Farmers go through significant losses as a result of the regular crop destruction caused by local animals like buffaloes, cows, goats, elephants, and others. To protect their fields, farmers have been using animal traps or electric fences. Both animals and humans perish as a result of these countless deaths. Many individuals are giving up farming because of the serious harm that animals inflict on crops. The systems now in use make it challenging to identify the animal species. Consequently, animal detection is made simple and effective by employing the Artificial Intelligence based Convolution Neural Network method. The concept of playing animal-specific sounds is by far the most accurate execution. Rotating cameras are put to good use. The percentage of animals detected by this technique has grown from 55% to 79%.
Comparison of Clinicopathogenomic Features and Treatment Outcomes of EGFR and HER2 Exon 20 Insertion Mutations in Non–Small Cell Lung Cancer: Single-Institution Experience
Authors: Lee So Heun , Jeong Hyehyun , Kim Deok Hoon , Jang Se Jin , Kim Sang-We , Yoon Shinkyo , Lee Dae Ho
Published: February 2024

Purpose Exon 20 insertion mutations (E20ins) in epidermal growth factor receptor (EGFR) or human epidermal growth factor receptor 2 (HER2) in non–small cell lung cancer (NSCLC) patients has become more important with emergence of novel agents targeting E20ins.Materials and Methods Advanced/Metastatic NSCLC patients with E20ins were included. EGFR E20ins was identified by two methods, next-generation sequencing (NGS) or real-time polymerase chain reaction (PCR), while HER2 E20ins was done by NGS only.Results Between December 2013 and July 2021, E20ins were identified in 107 patients at Asan Medical Center; 67 EGFR E20ins and 40 HER2 E20ins. Out of 32 patients with EGFR E20ins who had tested both PCR and NGS, 17 were identified only through NGS and the other 15 through both tests, giving a discordance rate of 53.1%. There was no clinically significant difference in clinicopathologic features between EGFR and HER2 E20ins; both were observed more frequently in adenocarcinoma, female and never-smokers. Brain metastases were evident at diagnosis in 31.8% of EGFR E20ins and 27.5% of HER2 E20ins, respectively. Platinum-based doublets demonstrated objective response rates (ORR) of 13.3% with a median progression-free survival (PFS) of 4.2 months for EGFR E20ins and 35.3% with 4.7 months for HER2 E20ins, respectively. In contrast, novel EGFR E20ins-targeted agents exhibited an ORR of 46.2% with a median PFS of 5.4 months, while HER2-targeted agents showed an ORR of 50% with that of 7.0 months.Conclusion Identification of EGFR and HER2 E20ins is more important as their targeted therapies improved outcomes. Upfront NGS test as a comprehensive molecular approach is strongly warranted.
Case Report: Allergic Bronchopulmonary Aspergillosis and Tropical Pulmonary Eosinophilia Co-Occurrence Masquerading as Refractory Allergic Bronchopulmonary Aspergillosis
Authors: Singh Manish , Peter Deepu K. , Gupta Simple , Rani V Vandana , Singh Shalendra
Published: February 2024

Pulmonary infiltrates with eosinophilia are a heterogeneous group of disorders that are characterized by pulmonary infiltrates on chest radiograph and elevated levels of eosinophils in the peripheral blood. Among patients with these disorders, reports of either allergic bronchopulmonary aspergillosis (ABPA) or tropical pulmonary eosinophilia (TPE) are common. However, the simultaneous occurrence of ABPA and TPE is not often reported. We present the case of a young man with a history of asthma who was diagnosed with ABPA and TPE. Initially, the patient exhibited a partial response to treatment of ABPA, but persistent symptoms and eosinophilia led to suspicion and subsequent diagnosis of TPE. With implementation of antifilarials and steroids, the patient experienced satisfactory clinical and serological improvements. This case underscores the importance of considering multiple diagnoses in patients with overlapping symptoms and highlights the need for comprehensive management strategies in complex lung diseases.
Quality Assessment of Selected Essential Antimicrobial Drugs from Drug Retail Outlets of Selected Cities in Eastern Ethiopia
Authors: Anjulo Hailu , Birhane Worku , Hymete Ariaya , Ashenef Ayenew
Published: February 2024

The prevalence of substandard and falsified (SF) antimicrobial drugs is increasing around the globe. This poses a great concern for the healthcare system. The consumption of SF antimicrobial drugs has the potential to result in treatment failure, emergence and development of antimicrobial resistance, and ultimately a rise in mortality rate. The objective of this study was to assess the quality of four commonly used antimicrobials marketed in the cities of Dire Dawa and Jijiga and the town of Togo-Wuchale, which have high potential for illegal drug trade activities in Ethiopia because they are located near the border with Somalia. A total of 54 brands/samples of amoxicillin, amoxicillin/clavulanic acid, ciprofloxacin, and norfloxacin formulations were collected covertly from 43 facilities using a convenience sampling strategy from March 16 to March 29, 2022. The samples were first screened using Global Pharma Health Fund (GPHF)-Minilab protocols and then analyzed using U.S. Pharmacopoeial and British Pharmacopoeia official methods. The quality evaluation detected no falsified product; however, it showed that 14.3% of the samples failed the GPHF-Minilab screening test semiquantitatively. Overall, 22.2% of the products analyzed did not meet any of pharmacopoeial specifications assessed: 13%, 12.2%, and 11.1% of the products failed in assay, dissolution, and weight variation, respectively. Additionally, 56.3% of amoxicillin samples, 60% of amoxicillin/clavulanate, 20% of ciprofloxacin, and 54.5% of norfloxacin samples were found to be pharmaceutically nonequivalent with their respective comparator products regarding dissolution profiles. The study showed the presence of substandard antimicrobial medicines in the eastern Ethiopian market.
Environmental Detection of Parasites in the Marginalized Paiute Reservations Compared to a Nearby Area
Authors: McKim Shannon , Kopystynsky Kristen , Wolf Nathaniel , Akbar Fahim A. , Bottazzi Maria Elena , Hotez Peter J. , Mejia Rojelio
Published: February 2024

The amounts of parasite DNA in soil samples from different playgrounds and other public areas can help identify areas of possible microbe transmission and give indications of the possible occurrence of parasite infection in nearby communities. We collected 207 soil samples from parks in Paiute indigenous tribal areas in southwestern Utah and from the higher income city of St. George, Utah, and tested them for 11 parasites that can cause human disease. Molecular tests revealed an elevated odds ratio (OR) of 3.072 (range, 1.114–8.065) for detecting the helminth Trichuris trichiura and an elevated OR of 3.036 (range, 1.101–7.966) for any protozoa (not including Acanthamoeba) in the tribal land playgrounds compared with St. George parks. These findings support previous studies showing that areas in lower socioeconomic communities, especially marginalized communities, tend to have more parasites in the soil, which may lead to higher disease prevalence rates.
Five Key Articles on Curriculum Development for Graduate Medical Educators
Authors: Lai Steven , Buchheit Bradley M. , Kitamura Kellie , Cook Mackenzie R. , Yarris Lalena M. , Chen Grace , Kwon Amy , Jordan Jaime
Published: February 2024

Background Curriculum development is an essential domain for medical educators, yet specific training in this area is inconsistent. With competing demands for educators’ time, a succinct resource for best practice is needed.

Objective To create a curated list of the most essential articles on curriculum development to guide education scholars in graduate medical education.

Methods We used a modified Delphi method, a systematic consensus strategy to increase content validity, to achieve consensus on the most essential curriculum development articles. We convened a panel of 8 experts from the United States in curricular development, with diverse career stages, institutions, gender, and specialty. We conducted a literature search across PubMed and Google Scholar with keywords, such as “curriculum development” and “curricular design,” to identify relevant articles focusing on a general overview or approach to curriculum development. Articles were reviewed across 3 iterative Delphi rounds to narrow down those that should be included in a list of the most essential articles on curriculum development.

Results Our literature search yielded 1708 articles, 90 of which were selected for full-text review, and 26 of which were identified as appropriate for the modified Delphi process. We had a 100% response rate for each Delphi round. The panelists narrowed the articles to a final list of 5 articles, with 4 focusing on the development of new curriculum and 1 on curriculum renewal.

Conclusions We developed a curated list of 5 essential articles on curriculum development that is broadly applicable to graduate medical educators.
An Embedded Curriculum to Teach Critical Incident Debriefing to Internal Medicine Residents
Authors: Wykowski James H. , Merel Susan , Starks Helene , Berger Gabrielle , Shepherd Amanda , Gibbon Lindsay , Kritek Patricia A. , Hicks Katherine G.
Published: February 2024

Background Internal medicine residents frequently experience distressing clinical events; critical event debriefing is one tool to help mitigate their effects.

Objective To evaluate the effectiveness of a 1-hour workshop teaching residents a novel, efficient approach to leading a team debrief after emotionally charged clinical events.

Methods An internal needs assessment identified time and confidence as debriefing barriers. In response, we created the STREAM (Structured, Timely, Reflection, tEAM-based) framework, a 15-minute structured approach to leading a debrief. Senior residents participated in a 1-hour workshop on the first day of an inpatient medicine rotation to learn the STREAM framework. To evaluate learning outcomes, participants completed the same survey immediately before and after the session, and at the end of their 4-week rotation. Senior residents at another site who did not complete the workshop also evaluated their comfort leading debriefs.

Results Fifty out of 65 senior residents (77%) participated in the workshop. After the workshop, participants felt more prepared to lead debriefs, learned a structured format for debriefing, and felt they had enough time to lead debriefs. Thirty-four of 50 (68%) workshop participants and 20 of 41 (49%) comparison residents completed the end-of-rotation survey. Senior residents who participated in the workshop were more likely than nonparticipants to report feeling prepared to lead debriefs.

Conclusions A brief workshop is an effective method for teaching a framework for leading a team debrief.
Improving Pediatric Fellows’ Feedback Skills and Confidence Through Objective Structured Examinations
Authors: Yu Jennifer C. , Rhee Kyung E. , Dworsky Zephyr D. , Larrow Annie , Passarelli Patrick , Patel Aarti
Published: February 2024

Background Medical trainees must learn how to provide effective feedback as an essential communication skill, yet few models exist for training and assessing these skills.

Objective To develop an observed structured feedback examination (OSFE) to provide feedback training to pediatric fellows and assess changes in skills and self-reported confidence.

Methods This educational study was conducted from 2019 to 2020 at an academic children’s hospital. Our team developed the OSFE and trained standardized feedback recipients and faculty. Fellows completed baseline self-assessments (31 items) on prior exposure to feedback training, application of skills, and confidence. They then participated in the OSFE, giving feedback to a standardized recipient using a standardized scenario, and were scored by faculty and recipients using a 15-item checklist for performance. Next, fellows participated in feedback training and received individualized feedback, after which they repeated the OSFE and confidence self-assessment. Three months later, fellows completed self-assessments on confidence and application of skills and another OSFE to assess retention. Descriptive statistics and signed rank sum test were used for analysis.

Results Of 60 eligible fellows, 19 participated (32%), with 100% follow-up. After training and individualized feedback, all fellows improved feedback skills as measured by OSFE performance (mean change +0.89). All items, measured on a 5-point Likert scale, were sustained 3 months later (mean change +0.92). All fellows reported improved confidence in feedback knowledge (mean change +2.07 post, +1.67 3 months post).

Conclusions Feedback training using simulation and individualized feedback moderately improved fellows’ performance, confidence, and 3-month retention of feedback skills.
Fellowship Accreditation: Experiences From Health Care Simulation Experts
Authors: Musits Andrew N. , Khan Humera , Cassara Michael , McKenna Ryan T. , Penttila Atte , Ahmed Rami A. , Wong Ambrose H.
Published: February 2024

Background The field of health care simulation continues to grow, accompanied by a proliferation of fellowship programs, leading to fellowship accreditation efforts. There is controversy around the best approach to accreditation.

Objective The authors sought to understand perspectives of simulation leaders on fellowship accreditation to best inform the growth and maturation of fellowship accreditation.

Methods In 2020, simulation leaders identified through snowball sampling were invited to participate in a qualitative study. During one-on-one semistructured interviews, participants were asked about experiences as simulation leaders and their perspective on the purpose and impact of accreditation. The interviews were audio recorded and transcribed. Thematic analysis informed by a phenomenology framework was performed using a masked open coding technique with iterative refinement. The resulting codes were organized into themes and subthemes.

Results A total of 45 simulation experts participated in interviews ranging from 25 to 67 minutes. Participants described discord and lack of consensus regarding simulation fellowship accreditation, which included a spectrum of opinions ranging from readiness for accreditation pathways to concern and avoidance. Participants also highlighted how context drove the perception of accreditation value for programs and individuals, including access to resources and capital. Finally, potential impacts from accreditation included standardization of training programs, workforce concerns, and implications for professional societies.

Conclusions Simulation leaders underscored how the value of accreditation is dependent on context. Additional subthemes included reputation and resource variability, balancing standardization with flexibility and innovation, and implications for professional societies.