bluuebunny/crossref_metadata_2025 huggingface dataset:
INTERPERSONAL CLIMATE AND STUDENTS’ ENGAGEMENT IN NIGERIA UNIVERSITY: A CONFIRMATORY FACTOR ANALYSIS APPROACH
Authors: Abubakar Yusuf Habibat
Published: January 2023

The significant relationships that lecturers develop and maintain with their students in institutions cannot be overlooked as studies recognize it to have a positive impact on their academic outcomes. This study assessed lecturers interpersonal climate and students’ academic engagement in Nigeria university.  The study adopted the correlational design of the survey type.  The population for the study comprised all 49,153 undergraduate students of university of Ilorin, Nigeria. The required number of respondents for the study was ascertained using the Krejcie and Morgan table and 381 participants were chosen using a convenient sampling procedure. A self developed  survey instrument titled “Interpersonal Climate  and Students’ Engagement Survey” (ICSES) was constructed based on the focus of the study to gather primary data by means of empirical survey-based research methods which allows for the test of research hypotheses formulated for the study. ICSES scale was subjected to face and content validity and reliability coefficient of .89 obtained adjudged the instrument reliable.  The factors necessitating these interpersonal climate in school were explored and results show that except for the interrelation of the construct of shared vision on academic engagement with a low factor loading of .30, all other factors explored (Empathy, Leadership Pattern and compassion) were through measures of the constructs with high factor loading >.50 and have significant interactions with student engagement. The formulated hypothesis reveals that a significant relationship exist between the constructs understudied with p-value <.05. The implication of this findings as well as recommendations were highlighted in this study.
The Singapore National Healthcare Group Diabetes Registry – Descriptive Epidemiology of Type 2 Diabetes Mellitus
Authors: Heng Bee Hoon , Sun Yan , Cheah Jason TS , Jong Michelle
Published: January 2023

Introduction: The National Healthcare Group (NHG) launched an enterprise-wide diabetes registry in 2007. We describe the epidemiology of type 2 diabetes mellitus from 2005 to 2008. Materials and Methods: Patients with encounters in NHG from 2005 were identified for inclusion into the Diabetes Registry from existing stand-alone diabetes registries, ICD9CM diagnosis codes, anti-hyperglycaemic medication and laboratory confirmation. Variables extracted for analysis were demographics (age, gender, ethnicity), diabetes-related comorbidities and com plications, most recent anti-hyperglycaemic agents dispensed, and the most recent glycated haemoglobin (HbA1C) measurement. Results: The diabetes registry grew 32% from 129,183 patients in 2005 to 170,513 patients in 2008, making up 12% to 15% of all patients in NHG. About half of the type 2 diabetes patients were aged 45 to 64 years. Females were generally older with a median age of 63 to 64 years vs 59 to 61 years in males. The Indian ethnic group accounted a disproportionately higher 13% of patients. Over 95% of type 2 patients had at least one diabetes-related comorbid condition, and diabetes-related complications were principally renal and cardiovascular complications. The majority (86.2% to 89.2%) of primary care patients were on oral anti-hyperglycaemic agents; however, the rate of insulin treatment increased from 10.8% to 13.8%. HbA1C levels in 2008 improved over that in 2005, with the percentage of patients with good glycaemic control improving with age. Conclusion: The registry has enabled a baseline assessment of the burden and the care of type 2 diabetes patients in NHG, which will provide critical “evidence” for planning future programmes.

Key words: Comorbidities, Complications, Planning
An Audit Study of the Sensitivity and Specificity of Ultrasound, Fine Needle Aspiration Cytology and Frozen Section in the Evaluation of Thyroid Malignancies in a Tertiary Institution
Authors: Tan Winson JH , Sanghvi Kaushal , Liau Kui Hin , Low Cheng Hock
Published: January 2023

Introduction: The aim of this study was to conduct an audit of the sensitivity and specificity of ultrasound, fine needle aspiration cytology (FNAC) and frozen section in the evaluation of thyroid malignancies in our practice. Materials and Methods: The medical records of all the patients who underwent thyroid surgery in a tertiary institution’s General Surgery Department between January 2005 and December 2007 were retrospectively reviewed using a standardised data collection template. Results of the ultrasounds, FNACs and frozen sections were compared with the final histological diagnosis. Results: A total of 112 patients underwent thyroid surgery in the 3-year study period. Thyroid malignancy constituted 34 (30%) of all patients who underwent thyroid surgery. The most popular diagnostic tools used were ultrasound (81%), FNAC (69%) and frozen section (59%). The sensitivity of ultrasound, FNAC and frozen section were 41.4%, 86.4% and 68.8%, respectively. FNAC was shown to be a superior diagnostic test in detecting malignancy compared to ultrasound. FNAC was able to pick up 53% of thyroid cancers missed by ultrasound. Frozen section was able to pick up 33% of thyroid cancers that were missed by both ultrasound and FNAC. Conclusion: FNAC is the most reliable tool in detecting malignancies and ought to form the mainstay for investigation of thyroid nodules. The utilisation of ultrasonographic features in the evaluation of thyroid nodules might not necessary improve the detection rate of thyroid malignancy. Frozen section helps to improve the detection ate of thyroid malignancy but further studies into its cost-effectiveness ought to be performed.

Key words: Investigations, Thyroid lesions
A 5-year Profile of Trauma Admissions to the Surgical Intensive Care Unit of a Tertiary Hospital in Singapore
Authors: Tan Wah Tze , Choy Joyce ML , Foo Joanna M
Published: January 2023

Introduction: This retrospective pilot study provides information on trauma admissions to the Surgical Intensive Care Unit (SICU) of a tertiary hospital in Singapore. The aim was to use the data collected to generate awareness and interest in this area. The authors also wish to use the information to advocate subsequent in-depth collection and analysis of data and the development of a Trauma Registry. As this was a pilot study, the data collected were by no means exhaustive and only descriptive analysis was applied. Materials and Methods: Trauma admissions to the SICU for the period between January 2001 and December 2005 were identified from the admissions logbook maintained in the unit. The physical case-notes or electronic-records for the identified cases were retrieved and the relevant data and parameters were entered into the data collection sheet. Descriptive analysis was applied to the data collected. Results: A total of 503 cases over the 5-year period fulfilled our criteria. Motor vehicle accidents were the greatest contributor of trauma admissions to the SICU (53%). The length of stay (LOS) in the unit ranged from 1 to 59 days. The anatomical area most frequently injured was the head (68%). Out of the 132 mortalities, male patients accounted for 84%. Two-thirds (67%) of injury-related mortality occurred in young patients aged less than 45 years. Motor vehicle accidents accounted for nearly half (47%) of injury-related mortality. Motorcyclists accounted for almost half (46%) of motor vehicle accident deaths. Conclusion: The preponderance of young people involved in motor vehicle accidents with head injuries has a large impact on society and on the hospital workload. The authors hope that this pilot study will generate awareness and interest in the area of trauma injuries. They recommend that a nationwide trauma registry be established to look closer into this “disease”, as other developed countries have done.

Key words: Critical care, Data, Registry
Risk Factors and Clinical Outcomes for Contrast-induced Nephropathy After Percutaneous Coronary Intervention in Patients with Normal Serum Creatinine
Authors: Chong Eric , Poh Kian Keong , Liang Shen , Tan Huay Cheem
Published: January 2023

Introduction: We aim to examine the risk predictors of contrast-induced nephropathy (CIN) in patients with normal baseline serum creatinine (Cr). CIN is an important complication post percutaneous coronary intervention (PCI). Previous studies examined CIN predictors in patients with chronic renal impairment. No large studies investigated patients with normal renal function which constitute the majority undergoing PCI. We aim to identify risk predictors in this cohort and examine the clinical outcomes. Materials and Methods: A total of 3036 patients with normal baseline Cr (<1.5 mg/dL) who did not receive prophylaxis while undergoing PCI were enrolled. We examined the occurrence of CIN and the mortality outcome at 1 and 6 months. Results: CIN occurred in 7.3% of patients. The median age was 59.5 years (range, 26 to 86), 78.7% men, 34.6% diabetics. Risk predictors for CIN include age [odds ratio (OR), 6.4; 95% CI, 1.01-13.3; P = 0.042], female gender (OR, 2.0; 95% CI, 1.5-2.7; P = 0.001), abnormal left ventricular ejection fraction (LVEF) <50%(OR,1.02; 95% CI, 1.01-1.04; P = 0.01), anaemia with haemoglobin <11 mg/dL (OR, 1.5; 95% CI, 1.01-2.4; P = 0.044) and systolic hypotension with blood pressure <100 mmHg (OR, 1.5; 95% CI, 1.01-2.2; P = 0.004). Diabetics on insulin therapy were at the highest risk compared with diabetics on oral hypoglycaemics and diet control (18.9% vs 6.8% vs 3.6%; P = 0.001). Patients who developed CIN had higher mortality at 1 month (14.5% vs 1.1%; P <0.001) and 6 months (17.8% vs 2.2%; P <0.001). Conclusions: Subgroups of patients with normal baseline Cr undergoing PCI are at risk of developing CIN with resultant higher mortality. Age, female gender, insulin dependent diabetes mellitus, presence of hypotension, anaemia and low LVEF are predictors of CIN. Prophylaxis may be considered in these patients.

Key words: Anaemia, Female gender, Haemoglobin, Left ventricular ejection fraction
Factors Affecting the B-Type Natriuretic Peptide Levels in Stroke Patients
Authors: Saritas Ayhan , Cakir Zeynep , Emet Mucahit , Uzkeser Mustafa , Akoz Ayhan , Acemoglu Hamit
Published: January 2023

Introduction: This study aims to evaluate the relationship between increased B-type natriuretic peptide (BNP) levels in stroke patients and clinical parameters such as age, sex, medical history, blood pressure, Glasgow Coma Score (GCS) and National Institutes of Health Stroke Scale (NIHSS). Materials and Methods: This is a prospective study of 123 stroke patients at the Emergency Department. The patients were divided into 3 groups according to the NIHSS scores. The analysis of the mean difference between continuous variables and plasma BNP levels was assessed using the Mann-Whitney and Kruskal-Wallis. Spearman correlation analysis was performed for BNP and other clinical parameters. Results: The BNP levels of patients who had a medical history of hyperlipidaemia, chronic obstructive pulmonary disease, diabetes mellitus and coronary artery disease were significantly higher than in patients without these diseases. Patients who had atrial fibrillation (AF) in their electrocardiography had significantly higher BNP levels than patients with sinus rhythm. A positive correlation was found between plasma BNP levels with age, blood urea nitrogen (BUN) and NIHSS and a negative correlation was found between plasma BNP levels and GCS. There was a significant difference between the BNP levels of NIHSS groups. Conclusion: We consider that plasma BNP levels could help us in interpreting the general clinical severity, functional capacity and clinical progress of stroke patients at the time of admission in the Emergency Department. In evaluating the high BNP levels in stroke patients, we must keep in mind that age, AF, BUN and medical history can affect the BNP levels.

Key words: Emergency Department, Progress, Relationship
Inflammatory Tinea Capitis: Non-healing Plaque on the Occiput of a 4-year-old Child
Authors: Ang Chia Chun , Tay Yong Kwang
Published: January 2023

Introduction: Inflammatory tinea capitis is an uncommon condition in Singapore. In this case report we present a patient whom we managed for this condition. Clinical Picture: A 4-year-old girl presented to us with multiple pustules over the occipital scalp for 6 weeks, associated with painful cervical lymphadenopathy. Her condition did not respond to topical and oral antibiotics. Treatment: The patient was diagnosed with kerion (inflammatory tinea capitis) and fungal culture of plucked hairs from the kerion grew Microsporum species of dermatophyte. She was treated with a course of oral griseofulvin and topical selenium sulfide shampoo. She was advised to bring her pet cats to the veterinarian for screening, as well as not to share combs with her other siblings. Outcome: Her condition improved with the antifungal therapy, and there was no residual alopecia. Conclusion: Physicians should consider tinea capitis when they encounter a patient with scalp folliculitis or scarring alopecia in the appropriate clinical context.

Key words: Kerion, Microsporum species, Scalp folliculitis
Knowledge, Attitudes and Practices of the Advance Medical Directive in a Residential Estate in Singapore
Authors: Tay Matthew , Chia Sin Eng , Sng Judy
Published: January 2023

Introduction: This study investigates the knowledge, attitudes and practices of residents in a residential estate in Singapore on the Advance Medical Directive (AMD). Materials and Methods: A community-based cross-sectional study was conducted with residents in the residential estate of Toa Payoh Lorong 6, Singapore. A stratified random sampling was conducted to obtain a representative sample of the estate. Only residents aged 21 years and older were included. An interviewer-administered questionnaire was conducted, and only those who understood the AMD sufficiently were further evaluated on their knowledge, attitudes and practices. Results: A total of 414 residents were enrolled (50.1% response rate). Only 37.9% of the participants knew about the AMD prior to this study. Participants who had a higher knowledge level of AMD, did not wish “for an artificially prolonged life”, “to be kept alive indefinitely on a life-support machine”, wished to “lessen the financial burden of loved ones”, “avoid prolonged suffering” and accepted the “imminence of death” were more willing to sign an AMD. However, “religious beliefs”, “personal ethical views”, “dissuasion by family members” and “unclear terminology in the AMD” discouraged the participants from signing an AMD. After adjusting for significant factors, participants who did not wish “to be kept alive indefinitely on a life-support machine” and accepted the “imminence of death” were found to correlate significantly with the willingness to sign an AMD [Prevalence Rate Ratio (PRR) = 2.050 [1.140-3.685], P = 0.016; PRR = 2.669 [1.449-4.917], P = 0.02, respectively]. Conclusions: There is a need to increase awareness on the AMD. Public education methods can be improved to inform residents on the implications of the AMD.

Key words: Decision making, Predictors
Monthly Take-Home Methadone Maintenance Regime for Elderly Opium-Dependent Users in Singapore
Authors: Guo Song , Winslow Munidasa , Manning Victoria , Thane Kyaw KW
Published: January 2023

Introduction: Research suggests that methadone maintenance treatment (MMT) effectively reduces opiate dependence and related health and social problems. However, few studies have examined its effectiveness among the elderly. This study examined a monthly MMT regime for elderly opium addicts attending the National Addictions Management Service, Singapore. Materials and Methods: This study used a cross-sectional design and comprised 40 patients attending the addiction service and 40 caregivers who monitored methadone consumption (mostly patients’ sons and daughters). Participants completed a semi-structured interview comprising measures of opiate craving and withdrawal, physical and psychological health. Objective measures were urine drug screens and blood tests. Results: Participants who averaged 74.8 years old had been using opium for around 44 years and had been in MMT for an average of 35 months. The maintenance dose of methadone was 9.2 mg/day. At interview, no opiate usage (other than methadone) was detected in urine screens; however, clinical records indicated that 6 had tested positive during the previous 6 months of MMT. No major withdrawal symptoms, side effects, or incidents of diversion were reported. Quality-of-life scores were in the normal range and satisfaction with the treatment regime was expressed by caregivers. Conclusion: Whilst MMT is the predominant pharmacotherapy for opiate dependence for users of all ages elsewhere, our study group constitutes a unique population that differs markedly from younger opiate users who will eventually grow old. In Singapore, MMT appears to be an effective treatment for stable, elderly opium-dependent patients where families are fully engaged in the treatment regime.

Key words: Caregivers, Craving, Effectiveness, Withdrawal
Foot Screening for Diabetics
Authors: Nather Aziz , Chionh Siok Bee , Tay Patricia LM , Aziz Zameer , Teng Janelle WH , Rajeswari K , Erasmus Adriaan , Nambiar Ajay
Published: January 2023

Introduction: This study aims to evaluate the results of foot screening performed in a study population of 2137 diabetics (3926 feet) screened from 2006 to 2008 by the National University Hospital (NUH) multi-disciplinary team for diabetic foot problems. Materials and Methods: A standardised protocol was designed. Foot screening consisted of detailed history taking and clinical examination including assessment for sensory neuropathy by Semmes Weinstein monofilament (SWMF) and neurothesiometer and assessment of vasculopathy by ankle-brachial index (ABI) and total body irradiation (TBI). The foot screening was performed by a trained staff nurse. All patients were classified according to King’s College Classification. Results: Majority of the patients were in the fifth (27.9%) and sixth (30.0%) decades of life. Two thousand sixty-four had type II diabetes, and only 73 had type I diabetes. Neuropathy was found in 1307 (33.3%) feet based on 5.07 SWMF. Vasculopathy was recorded in 510 (13.0%) and 546 (13.9%) feet based on ABI <0.8 and TBI <0.7. According to King’s Classification, 1069 (50.0%) were Stage 1: Normal and 615 (28.8%) were Stage 2: At-Risk. Conclusion: Foot screening should be performed as early as possible to detect “At-Risk” feet and prevent the development of diabetic foot complications, thereby further reducing the risk of major amputations.

Key words: “At-Risk” feet, Diabetic foot screening, King’s Classification
Novel Trends in Haemodialysis: Where Are We Heading?
Authors: Ng Tsun Gun , Tan Seng Hoe
Published: January 2023

The mortality and morbidity of end-stage renal failure patients undergoing conventional thrice weekly in-centre haemodialysis remain alarmingly high despite continuing advances in haemodialysis technologies and improvements in clinical care. Home haemodialysis continues to be under-utilised in many parts of the world despite the reported benefits. Alternative haemodialysis regimens including longer and/or more frequent dialysis (e.g. nocturnal haemodialysis and short daily haemodialysis), haemodiafiltration and the use of high flux dialysers have become more widespread in recent years as nephrologists struggle to improve the dismal survival figures. Whilst most of the encouraging data have come from observational studies, many randomised controlled trials which will provide more robust data are already underway. This review aims to provide a concise update of the recent and novel trends in haemodialysis.

Key words: Haemodiafiltration, High flux dialysis, Home haemodialysis, Nocturnal haemodialysis, Short daily haemodialysis
Epidemiological Characteristics of Cholera in Singapore, 1992-2007
Authors: Wong Chia Siong , Ang Li Wei , James Lyn , Goh Kee Tai
Published: January 2023

Introduction: We carried out an epidemiological review of cholera in Singapore to determine its trends and the factors contributing to its occurrence. Materials and Methods: Epidemiological data of all notified cases of cholera maintained by the Communicable Diseases Division, Ministry of Health, for the period 1992 to 2007 were collated and analysed. Case-control studies were carried out in outbreaks to determine the source of infection and mode of transmission. Linear patterns in age and ethnic distribution of cholera cases were assessed using χ2 test for trend. Results: There were a total of 210 cholera cases reported between 1992 and 2007. The incidence of cholera declined from 17 cases in 1992 to 7 cases in 2007. About a quarter of the cases were imported from endemic countries in the region. Between 76% and 95% of the reported cases were local residents. Four elderly patients with comorbidities and who sought medical treatment late died, giving a case-fatality rate of 1.9%. Vibrio cholerae 01, biotype El Tor, serotype Ogawa, accounted for 83.8% of the cases. The vehicles of transmission identified in outbreaks included raw fish, undercooked seafood and iced drinks cross-contaminated with raw seafood. Conclusion: With the high standard of environmental hygiene and sanitation, a comprehensive epidemiological surveillance system and licensing and control of food establishments, cholera could not gain a foothold in Singapore despite it being situated in an endemic region. However, health education of the public on the importance of personal and food hygiene is of paramount importance in preventing foodborne outbreaks. Physicians should also maintain a high level of suspicion of cholera in patients presenting with severe gastroenteritis, especially those with a recent travel history to endemic countries.

Key words: Outbreaks, Seafood, O139, Vibrio cholerae O1
Timing of Arrival to a Tertiary Hospital after Acute Ischaemic Stroke – A Follow-up Survey 5 Years Later
Authors: De Silva Deidre Anne , Yassin Norazieda , Toh April JP , Lim Dao Juan , Wong Wan Xin , Woon Fung Peng , Chang Hui Meng
Published: January 2023

Introduction: Intravenous tissue plasminogen activator (tPA) within 3 hours of stroke onset is a licensed proven therapy for ischaemic stroke, with recent trial data showing benefit up to 4.5 hours. We previously published in this journal data of a survey conducted in 2004 showing only 9% of ischaemic stroke patients presenting to the Singapore General Hospital (SGH) arrived within 2 hours of onset. We aimed to determine whether the problem of delayed hospital arrival persists in 2009 and to establish the impact of widening the time window for intravenous tPA to 4.5 hours. Materials and Methods: We prospectively surveyed consecutive ischaemic stroke patients admitted to the SGH from 9th March to 30th April 2009. Patients and/or relatives were interviewed with a standardised form similar to the 2004 survey. Results: Among the 146 ischaemic stroke patients surveyed (median age 67 years, 59% male, median NIHSS score 2), 6% presented to SGH within 2 hours and 15% within 3.5 hours of onset. Median time from stroke onset to hospital arrival was 1245 minutes (20.75 hours). Pre-hospital consultation was significantly associated with hospital arrival after 2 hours from onset. Main reasons cited for delay were not realising the gravity of symptoms (31%) and not recognising them as stroke (27%). Conclusion: Delayed arrival to SGH following acute ischaemic stroke remains a problem in 2009. This confirms the lack of stroke awareness in Singapore and highlights the need for public stroke education. Furthermore, these data confirm that widening the time window for intravenous tPA treatment to 4.5 hours at SGH will increase its utilisation. Key words: Hospital presentation, Singapore, Stroke, Timing
Peripheral Arterial Disease in Community-based Patients with Diabetes in Singapore: Results from a Primary Healthcare Study
Authors: Narayanan Raj Mohan Lekshmi , Koh Woon-Puay , Phang Jonathan , Subramaniam Tavintharan
Published: January 2023

Introduction: Peripheral arterial disease (PAD) is an important complication of diabetes mellitus (DM), significantly associated with increased morbidity and mortality secondary to amputations, strokes and coronary artery disease. Information on DM patients with PAD is limited in our ethnically diverse population in Singapore. We aimed to determine the prevalence, risk factors and co-morbidities of PAD in patients managed for DM in the primary care setting. Materials and Methods: A cross-sectional study was conducted among 521 diabetics in 9 of the 18 government-aided clinics in the community. Data including demographics, presence of co-morbidities and vascular risk factors were collected using an interviewer-administered questionnaire, and Ankle-Brachial Index (ABI) was calculated from systolic ankle and brachial pressure measurements. Results: The prevalence of PAD, defined as resting ABI of <0.9 on either leg and/or a history of gangrene or non-traumatic amputation was 15.2% [95% confidence interval (CI), 12.3-18.5]. This prevalence of PAD was higher in patients with pre-existing microvascular and other macrovascular complications. In multivariate analysis, prevalence of PAD was positively associated with increasing age (OR, 1.08; 95% CI, 1.05-1.12), Malay versus Chinese ethnicity (OR, 2.27; 95% CI, 1.09-4.70), low HDL-cholesterol (OR, 1.87; 95% CI, 1.04-3.37), and insulin treatment (OR, 2.98; 95%CI, 1.39-6.36). Conclusion: PAD is an important cause of concern among patients with diabetes, with a high prevalence which further increases with increasing age and duration of DM, and exhibits ethnic variation. Risk factors identified in this study may improve early identification of PAD, allowing for prompt interventions, with a potential to reduce long-term morbidity and mortality.

Key words: Ethnic variation, Macrovascular complications, Risk factors
Evaluation on the Effectiveness of the National Childhood Immunisation Programme in Singapore, 1982-2007
Authors: Liew Fereen , Ang Li Wei , Cutter Jeffery , James Lyn , Goh Kee Tai
Published: January 2023

Introduction: We undertook a study to evaluate the effectiveness of the National Childhood Immunisation Programme (NCIP) over the past 26 years by reviewing the epidemiological trends of the diseases protected, the immunisation coverage and the changing herd immunity of the population during the period of 1982 to 2007. Materials and Methods: The epidemiological data of all cases of diphtheria, pertussis, poliomyelitis, measles, mumps, rubella and acute hepatitis B notified to the Communicable Diseases Division, Ministry of Health (MOH) from 1982 to 2007 were collated and analysed. Data on tuberculosis (TB) cases were obtained from the TB Control Unit, Tan Tock Seng Hospital. Cases of neonatal tetanus and congenital rubella syndrome (CRS) among infants born in Singapore were identified from the Central Claims Processing System. The number of therapeutic abortions performed for rubella infections was retrieved from the national abortion registry. Coverage of the childhood immunisation programme was based on the immunisation data maintained by the National Immunisation Registry, Health Promotion Board. To assess the herd immunity of the population against the various vaccine-preventable diseases protected, the findings of several serological surveys conducted from 1982 to 2005 were reviewed. Results: The incidence of vaccine-preventable diseases covered under the NCIP had declined over the last 26 years with diphtheria, neonatal tetanus, poliomyelitis and congenital rubella virtually eliminated. The last case of childhood TB meningitis and the last case of acute hepatitis B in children below 15 years were reported in 2002 and 1996, respectively. Conclusion: The NCIP has been successfully implemented as evidenced by the disappearance of most childhood diseases, excellent immunisation coverage rate in infants, preschool and school children, and high level of herd immunity of the childhood population protected. Key words: Epidemiology, Herd immunity, Vaccine-preventable diseases
Phosph-Akt1 Expression is Associated with a Favourable Prognosis in Pancreatic Cancer
Authors: Liu Jun , Sun Sun Hong Cheng , Sun Sun Jing , Huang Chen , Hu Hong Hui , Jin Yu Biao , Qiu Zheng Jun
Published: January 2023

Introduction: Akt, a serine/threonine protein kinase, mediates growth factor-associated cell survival. In several human cancers, including pancreatic cancer, constitutive activation of Akt (phosphorylated Akt, p-Akt) has been observed and may be associated with chemotherapy and radiotherapy resistance. However, there are contradictory viewpoints in p-Akt in pancreatic cancer on prognosis, and the clinical relevance of p-Akt in pancreatic cancer is not well under stood. This study aims to investigate the expressions and relevance of Akt and p-Akt1 in pancreatic cancer tissues and their clinical significance. Materials and Methods: The expressions of Akt and p-Akt in 74 surgically resected paraffin-embedded pancreatic ductal adenocarcinoma samples and 10 normal pancreatic tissue samples were examined by immunohistochemistry. The associations of their expression with clinicopathological and survival data were analysed. Results: The positive expression rate of Akt and p-Akt1 were 87.8% and 83.8%, respectively, which were remarkably higher then those in normal pancreatic tissue (P <0.05). There was a positive correlation between the expression of Akt and p-Akt1. High p-Akt1 expression correlated with lower T stage (P = 0.004), while Akt was not associated with any clinicopathologic variables. Kaplan-Meier survival analysis revealed that higher expression of Akt, p-Akt1 were respectively correlated with favourable prognosis (16.0[4.7-27.3] vs 9.3[9.0-9.6] months, P = 0.007, and 23.0[12.2-33.8] vs 11.1[7.5-14.7] months, P = 0.004, respectively). Multivariate analysis identified p-Akt1 as a significant independent favourable prognostic factor (HR=0.421, P = 0.010). Conclusions: These results suggest that high p-Akt1 expression may be a favourable prognostic factor in pancreatic cancer.

Key words: Clinicopathological variable, Immunohistochemistry, Survival time
Complications Following Tracheoesophageal Puncture: A Tertiary Hospital Experience
Authors: Dayangku Norsuhazenah Pengiran Suhaili , Mat Baki Marina , Mohamad Yunus Mohd Razif , Sabir Husin Athar Primuharsa Putra , Abdullah Sani
Published: January 2023

Introduction: In laryngectomised patients, tracheoesophageal speech is the gold standard for voice rehabilitation. This study evaluated complications related to the tracheoesophageal puncture (TEP) and the success rate in voice prosthesis after total laryngectomy at our institution over a 10-year period. Materials and Methods: A retrospective review of 22 TEPs was performed between January 1998 and December 2008. The timing of TEP, type of voice prosthesis, surgical and prosthesis-related complications, and TEP closure were noted. Results: Eighteen percent of the patients underwent primary and 82% secondary TEP. Our patients were predominantly males (95.4%) of Chinese descent with a mean age of 62.1 years. The types of voice prostheses used were ProvoxTM (n = 15), Voicemasters (n = 6), and Blom-Singer (n = 1). Prosthesis- related complications occurred in 77.3%. Notable complications were leakage (82.5%), prosthesis displacement (41.2%), intractable aspiration (29.4%), and aspiration of prosthesis (23.5%). The most common surgical-related complication was tracheostomal stenosis. An array of interventions comprising resizing or changing prosthesis type, nasogastric catheter insertion, stomaplasty, purse string suturing, and bronchoscopic removal of bronchial aspirated prosthesis were implemented to address encountered complications. In a mean follow-up of 34.8 months, 68.2% of patients achieved functional tracheoesophageal speech (75% of primary TEP and 67% of secondary TEP). There were 7 TEP closures indicated by persistent leakage, recurrent dislodgement, phonatory failure and, in 1 patient, persistent pain. Conclusions: TEP has become an integral part in the rehabilitation of a laryngectomee. However, management of the frequent complications related to TEP requires specific efforts and specialistic commitments in order to treat them.

Key words: Total laryngectomy, Voice prosthesis rehabilitation, Voice rehabilitation
Clean energy transition in Peru: A green hydrogen perspective
Authors: Celis Cesar , Mas Ronald , Marcelo Daniel , Bellido Marlon Max H.
Published: January 2023

For anyone concerned about climate change, fostering the energy transition from fossil-based to low- or zero-carbon energy sources is a must. In this context, this work provides a brief overview of the clean energy transition in Peru, accounting for a green hydrogen perspective. Accordingly, after the corresponding introduction to the subject, the current situation of renewable energies in Peru is highlighted, along with their historical evolution during the last two decades or so, and the prospects for these more environmentally friendly energy sources in the following years. Next, the potential for renewable energy production in Peru is discussed, with especial emphasis on hydropower, wind, solar, and biomass. Finally, green hydrogen and its potential to contribute to the energy transition in Peru is addressed. A particular emphasis is put in this case on the production of green hydrogen and its applications in Peru and worldwide. From the discussions carried out in this work, it is concluded that, although Peru has a large potential to become a green hydrogen producing and exporting country, there is still a long way to go before Peru can achieve the desired carbon neutrality in the coming decades.
Proposed Marketing Strategies for CV. Ganesha Sora to Increase Brand Awareness and Sales
Authors:   School of Business Management, Institut Teknologi Bandung, Rinaldi Stefanus Christian , Belgiawan Prawira Fajarindra ,   School of Business Management, Institut Teknologi Bandung
Published: January 2023

MSMEs are the most important pillars of the Indonesian economy, contributing for 61.07% of GDP or $8,573.89 trillion rupiah. The MSME in the food processing industry is one of the most developed MSMEs. The presence of dairy products produced by these MSMEs benefits the food processing industry. The demand for dairy products in Indonesia has surged by more than 10% each year over the last ten years. Ganesha Sora is one of the MSMEs engaged in the production of dairy products that according to the company’s data is now facing a decrease in sales. Meanwhile, based on preliminary research and problem exploration undertaken by the author reveal that Ganesha Sora continues to have low brand awareness. The purpose of this research is to increase Ganesha Sora brand awareness, identify major product attributes that influence customer purchase intentions, and to design suitable marketing strategies to increase the chances of sales. This study will include both quantitative and qualitative methods. For consumer analysis and hypothesis testing, the quantitative method is used. Data is gathered by distributing questionnaires to respondents who buy mozzarella cheese products in stores and online marketplaces. The output is then processed by SMART PLS. The qualitative method is utilized in preliminary research by interviewing 10 respondents and the business owner. According to the findings of this research, businesses can boost brand awareness by engaging in marketing activities such as sales promotion and advertising, which also have a beneficial impact on purchase intention. The following finding is about important product attributes that influence customer purchase intention, which include convenience, taste, and availability. From those findings, the author makes several recommendations based on internal and external analysis, along with a SWOT and TOWS analysis for Ganesha Sora to increase sales by entering and selling products to tourist attractions, offering testers or price discounts, and providing buy one get one e-vouchers on monthly occasions such as 11.11, 12.12, and so on. Ganesha Sora can conduct advertising activities such as creating an advertising video that highlights the product qualities and campaigns #BanggaDairyBuatanIndonesia to raise awareness. Ganesha Sora can launch a new product in a lighter weight variation and rent cold storage space in numerous potential places to deliver the attributes that consumers value.
Impact Of R&D Investment On Business Performance Of Food Processing Enterprises Listed On Vietnam Stock Exchange
Authors:   University of Labour and Social Affairs, Vietnam, Phuong Tran Thi Minh , Trang Vu Thi Thu ,   ThuongMai University, Vietnam
Published: January 2023

Sharma (2012) shows the positive and direct impact of research and development on business results of enterprises. Research and Development (R&D) investment is known as a key direction in creating competitive advantage of enterprises in the globalization context. This study aims to determine the impact of R&D investment on the business performance of food processing industry listed on the Vietnam stock exchange. The results show that R&D investment has a positive effect on business performance. In which, the factors of R&D fund and firm size have a positive impact on business performance. From this result, food processing industry listed on the Vietnam stock exchange need to determine the right position and importance of R&D investment, should allocate more budget for research and development to improve business efficiency.
PROSES PENGELOLAAN LIMBAH MARMER MENJADI PRODUK PAVING BLOCK
Authors: Haslindah Andi , Idrus Ilham , Basuki Try Agung , Saiful Sultan
Published: January 2023

Kabupaten Pangkep merupakan salah satu daerah penghasil marmer di Indonesia, pada proses penambangannya marmer digunakan untuk kebutuhan furniture  dan lain sebagainya sehingga pada prosesnya menghasilkan limbah. Pemanfaatan limbah potongan marmer dapat meminimalisir jumlah tumpukan limbah yang dapat mencemari kesuburan tanah dan lingkungan. Tujuan penelitian ini Untuk mengetahui pembuatan produk paving block dan hasil uji kuat tekan dengan memanfaatkan limbah marmer. Dengan menggunakan rumus uji kuat tekan untuk mengetahui nilai MPanya apakah produk memenuhi standar SNI 03-0691-1996 pada uji kuat tekannya. Hasil dari penelitian ini Paving block yang memanfaatkan limbah marmer dari bentuk fisiknya mempunyai tampilan yang lebih menarik dengan adanya tambahan aksen marmer pada permukaannya dan juga sebagai tulangan, dalam proses pengujian ini paving yang memanfaatkan limbah memiliki nilai tertingginya 30,36 MPa masuk dalam standar SNI 03-0691-1996 mutu B. Kesimpulannya pemanfaatan limbah marmer menjadi produk paving block memiliki pengaruh besar terhadap hasil penguji kuat tekannya dikarenakan limbah marmer yang diletakan pada paving menjadi tulangan, sehingga produk paving block memiliki nilai uji kuat tekan yang tinggi yang dapat digunakan baik, ditaman, trotoar, maupun digarasi kendaraan pribadi.

 

Pangkep district is one of the marble-producing areas in Indonesia, in the mining process, marble is used for furniture and so on so in the process it produces waste. utilization of marble slices waste can minimize the number of piles of waste that can pollute soil fertility and the environment. This study aimed to determine the manufacture of paving block products and the results of the compressive strength test using marble waste. by using the compressive strength test formula to determine the MPanya value and whether the product meets the SNI 03-0691-1996 standard on the compressive strength test. The results of this study showed that paving blocks that utilize marble waste from their physical form has a more attractive appearance with the addition of marble accents on their surface and also as reinforcement, in this testing process paving that utilizes waste has the highest value of 30.36 MPa which is included in the standard. SNI 03-0691-1996 quality B. In conclusion, the use of marble waste to become a paving block product has a big influence on the results of the pressure test because marble waste is placed on the paving as reinforcement, so the paving block product has a high compressive strength test value and can be used well, in the garden, sidewalks, or in the garage of private vehicles.
PENGARUH KEPUASAAN DAN MOTIVASI KERJA TERHADAP PRODUKTIVITAS KERJA KARYAWAN PADA PT. TIRTA SUKSES PERKASA DENGAN METODE STRUCTURAL EDUCATION MODELING (SEM)
Authors: Haslindah Andi , Syarifuddin Rizal , Iswandi M , Pratiwi Kartika Amika
Published: January 2023

Kepuasan dan motivasi karyawan sangat penting bagi perusahaan karena dapat meningkatkan kinerja karyawan yang dapat berimbas pada peningkatan produktivitas perusahaan. Penelitian ini bertujuan untuk mengetahui apakah kepuasan karyawan dan motivasi kerja dapat mempengaruhi produktivitas kerja karyawan. Sampel dalam penelitian ini berjumlah 200 responden yang ditujukan kepada karyawan PT Tirta Sukses Perkasa.Variabel yang diukur dalam penelitian ini adalah variabel eksogen (motivasi dan kepuasan) dan variabel endogen (produktivitas). Untuk mengukur variabel- variabel tersebut menggunakan skala likert dimana peneliti memberikan lima alternatif jawaban untuk dijawab responden. Metode penelitian ini menggunakan Structural Equation Modelling (SEM) dengan program AMOS 24.  Hasil analisis motivasi kerja terhadap produktivitas kerja karyawan menunjukkan nilai probabilitas 0,962 (p < 0,05) dan nilai C.R -0,048 tidak memenuhi syarat C.R > 1,96. Beda halnya dengan kepuasan kerja terhadap produktivitas kerja menunjukkan nilai probabilitas 0,001 (p < 0,05) dan nilai C.R 3,393 (C.R > 1,96). Kesimpulan dari penelitian ini dimana motivasi kerja tidak berpengaruh positif terhadap produktivitas sedangkan kepuasan berpengaruh positif terhadap produktivitas kerja karyawan.

 

Employee satisfaction and motivation is very important for the company because it can improve employee performance which can have an impact on increasing company productivity. This study aims to determine whether employee satisfaction and work motivation can affect employee work productivity. The sample in this study amounted to 200 respondents addressed to employees of PT Tirta Sukses Perkasa. The variables measured in this study were exogenous variables (motivation and satisfaction) and endogenous variables (productivity). To measure these variables using a Likert scale where the researcher provides five alternative answers for respondents to answer. This research method uses Structural Equation Modeling (SEM) with AMOS 24 program. The results of the analysis of work motivation on employee work productivity show a probability value of 0.962 (p <0.05) and a value of C.R -0.048 that does not meet the requirements of C.R> 1.96. The case with job satisfaction on work productivity shows a probability value of 0.001 (p <0.05) and a C.R value of 3.393 (C.R> 1.96). The conclusion of this study is that work motivation has no positive effect on productivity while satisfaction has a positive effect on employee work productivity.
Penerapan Metode HAZOP Untuk Keselamatan Dan Kesehatan Kerja Pada Bagian Produksi Air Minum Dalam Kemasan Cup Pada PT. Tirta Sukses Perkasa (CLUB)
Authors: Haslindah Andi , Andrie Andrie , Nur Hidayat Feisar , Aryani Sri
Published: January 2023

Keselamatan dan Kesehatan Kerja (K3) merupakan upaya untuk menciptakan suasana bekerja yang aman dan nyaman. Tujuan penelitian mengetahui potensi bahaya.  risiko bahaya, dan tingkat risiko di lingkungan kerja bagian produksi. Jenis penelitian ini merupakan penelitian deskriptif, menggunakan metode Hazop (Hazard and Operability). Identifikasi bahaya dengan metode Hazop dilakukan berdasarkan alur proses produksi. Langkah selanjutnya setelah proses identifikasi adalah penilaian risiko pada masing-masing titik kajian. Berdasarkan hasil penelitian, diketahui terdapat risiko rendah, sedang, tinggi dan ekstrim. Pengumpulan data melalui observasi, wawancara, dan pembagian kuesioner kepada karyawan. Hasil dari penelitian ini menemukan beberapa risiko dengan tingkat risiko seperti, terpleset (pada saat membersihkan di ruang filling) dengan risiko sedang, terjepit forklift dengan risiko sedang, kesetrum (pada saat pengecekan mesin) dengan risiko tinggi. Kesimpulan yang dihasilkan dalam penelitian ini yaitu: terdapat, 4 sumber bahaya yang tergolong risiko tinggi, 16 sumber bahaya yang tergolong risiko sedang, dan 2 sumber bahaya yang tergolong rendah.

 

Occupational Health and Safety (K3) is an effort to create a safe, comfortable working atmosphere and The research objective is to determine the potential hazards. the risk of hazards, and the level of risk in the production work environment. This research was conducted in Makassar. This type of research is a descriptive study, using the Hazop method (Hazard and Operability). Hazop identification using the Hazop method is carried out based on the flow of the production process. The next step after the identification process is a risk assessment at each study point. Based on the research results, it is known that there are low, medium, high, and extreme risks. Collecting data through observation, interviews, and distributing questionnaires to employees. The results of this study found several risks with a level of risk, such as being slipped (when cleaning in the filling room) with moderate risk, being caught by a forklift with moderate risk, and being electrocuted (when checking the machine) with a high risk. The conclusions produced in this study are: there are 4 sources of danger that are classified as high risk, 16 sources of hazards that are classified as moderate risk, and 2 sources of danger that are classified as low.