bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Biochar on Soil Fertility and Crop Yields: Experience from the Southern Highlands of Tanzania
Authors: Rogers Peter M. , Yanda Pius Z. , Pauline Noah M. , Haikola Simon , Hansson Anders , Fridahl Mathias
Published: June 2022

The world’s agricultural production is declining due to severe loss of soil fertility through natural processes or because of human activities. Biochar has been identified as a potential soil amendment to regain its fertility and increase crop productivity. This study aimed to assess the effects of biochar on soil nutrients and crop yields in the southern highlands of Tanzania. Data were collected through key informant and household interviews, and from sampling of soils in coffee farms where biochar of maize cobs origin was incorporated at the rate of 3 t ha-1. Purposive sampling approach was deployed to identify the villages in which farmers have been incorporating biochar in farms. A total of 172 households, 30 key informants, and 12 top and subsoil samples were involved in this study. Quantitative data were analyzed using SPSS version 20, and excel spreadsheet was used for descriptive results and relationships. The findings revealed that biochar significantly increased soil pH, iron (Fe), organic carbon (OC), cation exchange capacity (CEC) and exchangeable bases (potassium-K, magnesium-Mg). T - tests showed significant increase of soil nutrients in biochar treated soils. In addition, biochar increased coffee and maize yields from 1 t ha-1 to 3 t ha-1.

Keywords: Biochar; Soil Nutrients; Food Security; Resilience; Adaptation
Comparison on Vegetation Composition and Structure in Fire Prone Forest of Ilunde and Fire Suppressed Forest of Kitwe in Tanzania
Authors: Mganga Nyatwere D
Published: June 2022

Fire is among the factors influencing survival and development of plants in ecosystems. This study was conducted in frequently burnt and fire suppressed miombo woodlands of Ilunde and Kitwe, respectively. Tree stem density, basal area and composition of plants were determined. The methods used involved recording the numbers of tree stems, diameter at breast height and classifying vegetation to species level. In Kitwe forest, mean stem density of 582.7 ± 52.90 stems ha– was higher than 356.8 ± 38.98 stems ha– which was recorded in Ilunde forest (t = 15.98, df = 29, p < 0.05). Similarly, a higher mean tree basal area of 16.14 ± 1.32 m2 ha– was recorded in Kitwe forest, while 8.54 ± 0.94 m2 ha– being recorded in Ilunde forest (t = 3.34, df = 14, p < 0.05). Czekanowski’s similarity coefficients for trees, shrubs and saplings, and herbs and grasses were 0.46, 0.34 and 0.22, respectively. Fire adapted species were recorded in Ilunde forest. Fire prone miombo woodland had lower tree stem density, basal area and dominated by fire adapted species. Similarity coefficient between the two forests was also low. Prescribed burning is recommended in miombo woodlands for sustainable species composition and tree structure.

Keywords: vegetation; composition, structure, fire prone, miombo.
Czym jest synodalność? Rozwój świadomości synodalności na przestrzeni historii Kościoła
Authors: Proniewski Andrzej
Published: June 2022

Synodalność to pojęcie, które zyskało na popularności w Kościele katolickim w czasach pontyfikatu papieża Franciszka. Już pierwsze wieki chrześcijaństwa miały wpływ na formowanie się synodalnej drogi Kościoła. II Sobór Watykański położył fundament pod odnowienie życia synodalnego za pomocą nauki o kolegialności biskupów. Posoborowe prawo kanoniczne stworzyło możliwość organizowania synodów powszechnych, regionalnych i diecezjalnych. W celu wytłumaczenia procesu rozwoju świadomości synodalności w Kościele na przestrzeni dziejów autor analizuje i wyjaśnia podstawowe pojęcia w punkcie explicatio terminorum (1), następnie opisuje wybrane wydarzenia synodalne i soborowe, które towarzyszyły dziejom Kościoła (2), wskazuje na dziedzictwo, które przetrwało 12 ks. Andrzej Proniewski do dzisiejszych czasów (3), i ukazuje aktualny stan zakresu działań sprzyjających formowaniu wiernych do synodalności w Kościele (4).

What is synodality? The development of synodality awareness throughout the history of the Church

Synodality is a concept that gained popularity in the Catholic Church during the pontificate of Pope Francis. Already the first centuries of Christianity had an impact on the formation of the synodal path of the Church. The Second Vatican Council laid the foundation for the renewal of synodal life through the doctrine of the collegiality of bishops. Post-conciliar canon law created the possibility of organizing universal, regional and diocesan synods. In order to explain the process of development of the awareness of synodality in the Church throughout history, the author analyses and explains the basic concepts in the point explicatio terminorum (1), then describes selected synodal and conciliar events that have accompanied the history of the Church (2), points to a legacy that has survived to the present day (3) and shows the current state of the range of activities conducive to the formation of the faithful for synodality in the Church (4).
Ofiara eucharystyczna w życiu Kościoła
Authors: Ptak Robert
Published: June 2022

Najświętsza Eucharystia, w której sam Chrystus Pan jest obecny, ofiarowuje się i jest spożywany, daje prawdziwe życie i wzrost założonemu przez Niego Kościołowi. Sakrament Eucharystii w jego wymiarze ofiarniczym uobecnia jedyną ofiarę Chrystusa Zbawiciela, która dokonała się w Misterium Paschalnym. Kościół jako Mistyczne Ciało Chrystusa w każdej celebracji eucharystycznej sprawowanej we wspólnocie wiernych buduje duchową więź określaną jako communio. Ofiara eucharystyczna staje się dla wiernych w ich codziennym życiu ofiarą Mszy Świętej.

Eucharistic sacrifice in the life of the Church
The Holy Eucharist, in which Christ the Lord Himself is present, offered and eaten, gives true life and growth to the Church founded by Him. The sacrament of the Eucharist, in its sacrificial dimension, makes present the one sacrifice of Christ the Savior which was accomplished in the Paschal 138 ks. Robert Ptak SCJ Mystery. The Church, as the Mystical Body of Christ, in every Eucharistic celebration celebrated in the community of the faithful, builds a spiritual bond known as communio. The Eucharistic Sacrifice becomes for the faithful in their daily lives a sacrifice of the Holy Mass.
Intelligent Crop Recommendation System using Machine
Learning
Authors: Gangolla Priya  , B Ashwina  , B Akhila  , N Divya Rani  , S Anuhya  , K Prem Kumar
Published: June 2022

Agriculture plays a critical role in the entire life of a given economy. Choosing the wrong crop for the farmer based on the
soil needs results in significant losses. Therefore, the problem with this approach is addressed to agricultural accuracy.
Precision agriculture is the science that helps increase yields and make management decisions using advanced technology and new
tools. It is a new concept adopted globally to increase productivity, reduce labor time, and provide effective fertilizer management and
irrigation systems. This can help the farmer by choosing the right crop according to the needs of the soil.
Comparative Analysis of Coal, Fuel oil and Natural gas
for Cement Production
Authors: Vishal Pancham  , Pranay Mankar  , K.D. Bhuyar
Published: June 2022

This study is a comparative analysis of the use of coal, fuel oil and natural gas cement production that marks their
physical and chemical properties, costs and availability, impact on the environment and human health. In seven cents
manufacturing industries in Nigeria. Based on the research analysis, it appears that between these Three (3) oil, petroleum is
currently expensive even though it is available, while coal once natural gas is cheap, but coal is not available due to the closure
of Nigerian coal mine. In terms of environment and health, coal oil and petrol pose a significant risk gas in the environment also
cause additional health problems to cover the employee however natural gas slowly releases these harmful gases into the
environment and causes little health problems for employees. Research therefore shows that natural gas is at the forefront
gasoline because it is cheaper, more easily available and creates fewer problems nature.
IoT Based Automatic Vehicle Accident Tracking Down
and Alerting System Using GPS and Twilio
Authors: Md Abdul Althaf  , Kondu Sushma  , Pasunuri Shivakumar
Published: June 2022

The Accident detection used to be a complex system design but using the basic Arduino, GPS NEO 6m and ADXL
335/345 accelerometer sensor we can easily detect the accident occurrence and also can grab the coordinates of the location of the
accident. The major reduction of complexity and also the cost is where we totally replaced the high cost GSM module with the
software use of the message services like Twilio Messaging API Services.
Experimental Setup Of Pedal Operated Water Purifier
Authors: Nakul Jakkannavar  , Rakesh Athanimath  , Rohan Khot  , Manish Nesarekar  , Siddesh.G.M  , Rajendra Galagali
Published: June 2022

The analytic design of a pedal operated water purifier for the villagers is discussed in this study. It operates on
the idea of compressing and quickly releasing the tube by creating negative pressure in the tube, which sucks water from
the sump in the pump while the motors push the water through filter, purifying the water. The design includes a pedalpowered centrifugal pump, a filter, and hose. When a person sits down and begins to pedal, the pedal cranks converts
movement to a rotor, which presses the tube against rollers designed to pass the fluid. By delivering and improving
drinkable water for usage, this technology will reduces labour cost and stresses.
Totalitarismo, fascismo y su importancia para América Latina: continuidad de la Guerra Fría en el campo cultural y las ciencias sociales
Authors: Urrego Ardila Miguel Ángel
Published: June 2022

Varios estudiosos de la historia mundial insisten en defender el argumento del fin de la Guerra Fría a raíz de la desintegración de la Unión Soviética. Otros hablan de una “nueva” guerra debido a las recientes diferencias entre Estados Unidos y China. A nuestro juicio, y especialmente en plano cultural y de la producción de saber en las ciencias sociales, la Guerra Fría no ha culminado y, por el contrario, asistimos a un rejuvenecimiento de las tesis expuestas en los años cincuenta y sesenta del siglo pasado y que se caracterizan por un anticomunismo visceral y una legitimación de la política imperial, especialmente de Estados Unidos, hecho evidente, por ejemplo, en las interpretaciones  sobre el reciente ascenso de partidos de extrema derecha y el actual conflicto entre Ucrania y Rusia. Por otra parte, el neoliberalismo ha restablecido el rasgo fascista del capitalismo y asistimos a una guerra contra la sociedad y en particular contra los sectores marginados. Por ello creemos pertinente detenernos en el examen de dos categorías que son urgentes debatir nuevamente: fascismo y totalitarismo, y especialmente sobre las posibilidades su empleo en América Latina y la importancia de rescatar las enseñanzas de la lucha antifascista para entender el momento presente.
On an Extremal Problem in ``Investment-Consumption'' Models
Authors: Николенко П.В. , Новикова Л.В.
Published: June 2022

В модели <<инвестиции-потребления>> темп роста фондовооружености представляет собой разность между собственными инвестициями и темпом амортизации. Если имеется цель достигнуть заданного уровня фондовооружености к фиксированному моменту времени, но собственных инвестиций для этого недостаточно, то необходимо привлекать дополнительные средства, которые поступают в~виде финансового потока. Величина потока ограничена сверху функцией - предельной способностью к поглощению инвестиций. Получен ответ на вопрос о том, какова минимальная величина дополнительных средств и в форме какого финансового потока они должны поступить, чтобы поставленная цель была достигнута. Оказывается, искомый поток устроен следующим образом. Существует пара значений фондовооруженности между начальным и целевым значениями, такая, что пока фондовооруженность меняется от меньшего к большему значению, используются только собственные инвестиции. В остальное время используются дополнительные средства в максимальном возможном темпе. Получены формулы для вычисления указанных значений фондовооруженности, а также формула для вычисления объема дополнительных средств.
Контрпример к гипотезе Андреотти - Грауэрта
Authors: Youssef A.
Published: June 2022

In 1962, Andreotti and Grauert showed that every $q$-completecomplex space $X$ is cohomologically $q$-complete, that is for every coherent analytic sheaf${\mathcal{F}}$ on $X$, the cohomology group $H^{p}(X, {\mathcal{F}})$ vanishes if $p\geq q$.Since then the question whether the reciprocal statements of these theorems are true have been subject to extensive studies, where more specific assumptions have been added. Until now it is not known if these two conditions are equivalent. Using test cohomology classes, it was shown however that if $X$ is a Stein manifold and, if $D\subset X$ is an open subset which has $C^{2}$ boundary such that $H^{p}(D, {\mathcal{O}}_{D})=0$ for all $p\geq q$, then $D$ is $q$-complete.The aim of the present article is to give a counterexample tothe conjecture posed in $1962$ by Andreotti and Grauert [1]to show that a~cohomologically $q$-complete space is not necessarily $q$-complete.More precisely, we show that there exist for each $n\geq 3$ open subsets$\Omega\subset\mathbb{C}^{n}$ such that for every ${\mathcal{F}}\in coh(\Omega)$,the cohomology groups $H^{p}(\Omega, {\mathcal{F}})$ vanish for all $p\geq n-1$but $\Omega$ is not $(n-1)$-complete.
An analysis of convexity and starlikeness attributes for breaz integro-differential operator
Authors: Al-Janaby H. F. , Ghanim F.
Published: June 2022

The Geometric Theory of Analytic Functions (GTAF) is the attractive part ofcomplex analysis, which correlates with the rest of the themes in mathematics. Itsessential purpose is to formulate numerous classes of geometric analytic functions and todiscuss their geometric attributes. In continuation, the association between operatortheory and the GTAF area started to take shape and has remained a topic of wide attentiontoday. In the previous century, operator theory was extended to the complex open unit diskand has been applied to propose diverse sorts of generalizations of normalized analyticfunctions. As a result, the operator theory appears to be a good way to look for thingsin the GTAF area. Since then, the acquisition of geometric attributes by employingoperators has become a significant theme of research studies. The current studycenters on and investigates, in the classes of $\ell$-uniformly convex and starlikefunctions of order $\beta$, the convexity attribute by utilizing a modified Breazintegro-differential operator in the unit disk. Furthermore, in the class of analyticfunctions, some conditions that make the Breaz operator look like a star are looked into.
Ensuring Safety of Russian Population in the Process of Improving Methods to Combat Illegal Removal of Human Organs or Tissues for Their Transplantation
Authors: Бражников Д.А. , Кобец П.Н.
Published: June 2022

В статье рассматриваются основные причины, способствующие незаконной трансплантации донорских органов от человека к человеку, анализируется имеющийся международный опыт борьбы с незаконной трансплантацией, предлагаются меры по профилактике преступлений в данной сфере. Авторы приходят к выводу о необходимости совершенствования отечественного законодательства, достаточного государственного финансирования в анализируемой сфере, а также внедрения зарубежного опыта по борьбе с рассматриваемой преступностью

The article examines key causes of illegal transplantation of donor organs from person to person, analyzes existing international experience in combating illegal transplantation, and suggests measures to prevent crimes in this area. The authors come to the conclusion about the need to improve domestic legislation, provide sufficient state funding, and introduce foreign experience in this sphere.
Problems of Investigation of Crimes that Violate the Electoral Rights of Citizens
Authors: Иващенко М.А.
Published: June 2022

В статье рассматриваются процессуальные проблемы расследования преступлений, нарушающих избирательные права граждан; обращается внимание на вопросы, возникающие на стадии возбуждения уголовного дела; перечисляются важные процессуальные задачи, стоящие перед следователем при составлении постановления о привлечении лица в качестве обвиняемого; приводятся актуальные примеры из следственной практики; даются конкретные рекомендации по расследованию уголовных дел данной категории

The article deals with the procedural problems of crimes’ investigation that violate the electoral rights of citizens; attention is paid to the questions arising at the stage of initiation of a criminal case; there are listed the important procedural tasks facing the investigator when drawing up a decision to bring a person as an accused; provides relevant examples from investigative practice; specific recommendations are given on the investigation of criminal cases in this category
International Legal Aspects of Regulating Insolvency (Bankruptcy) in the Russian Federation and the European Union Member States
Authors: Кириловская Н.Н. , Мишальченко Ю.В. , Львова Е.Л.
Published: June 2022

В статье проведен анализ законодательства о несостоятельности (банкротстве) в России и государствах – членах Европейского союза. Внимание уделено различиям как между странами Евросоюза, так и между ними и Российской Федерацией. Сравнительно-правовой анализ позволил выделить особенности института несостоятельности в странах ЕС и Российской Федерации, в частности наличие самостоятельной правовой основы данного института, определение механизма банкротства. В то же время реализация механизма банкротства породила ряд проблем, к числу которых следует отнести определение приоритетности кредиторов, базовой страны должника, последствий несостоятельности, действие принципа удобного законодательства о несостоятельности и др.

The article analyzes legislation on insolvency (bankruptcy) in Russia and the European Union member states. Attention is paid both to differences among EU countries and among them and the Russian Federation. A comparative legal analysis helps identify features of the institution of insolvency in the EU and the Russian Federation, in particular, existence of an independent legal basis for this institution, definition of the bankruptcy mechanism. At the same time, the bankruptcy mechanism implementation has generated a number of problems, such as determining priority of creditors, a base country of the debtor, consequences of insolvency, operation of the convenient insolvency law principle, etc.
Features of Legal Regulation of the Use of Confidential Assistance of Certain Categories of Persons by Bodies Engaged in Operational Investigative Activities
Authors: Софронов Д.Н.
Published: June 2022

В статье рассматривается проблема определения пределов ограничений, установленных в ч. 3 ст. 17 Федерального закона от 12.08.1995 № 144-ФЗ «Об оперативно-розыскной деятельности». Анализ особенностей юридической конструкции ст. 17 позволяет прийти к выводу, что запрет не является абсолютным и законодатель предоставил соответствующим компетентным органам право на использование конфиденциального содействия отдельных категорий лиц, перечисленных в указанном правовом предписании.

The article deals with the problem of determining limits of restrictions established in Part 3 of Article 17 of the Federal Law No. 144-FZ of August 12, 1995 “On operational investigative activities”. Analysis of features of the legal structure of Article 17 allows us to conclude that prohibition is not absolute and the legislator has granted relevant competent authorities the right to use confidential assistance of certain categories of persons listed in the specified legal regulation
Legal Regulation of the Procedure for Notification of the Facts of Inducing a Federal Civil Servant to Commit Corruption Offenses in the System of Anti-Corruption Measures
Authors: Мельникова Н.А. , Житков А.А.
Published: June 2022

В статье дан анализ действующего законодательства по вопросам реализации обязанности государственного служащего уведомлять о фактах обращения в целях склонения его к совершению коррупционных правонарушений. Рассмотрены виды деяний, относимых к коррупционным правонарушениям в сфере государственной службы. Особое внимание авторы уделяют характеристике процедуры уведомления, выделяя при этом ее недостатки. Также сформулированы предложения по совершенствованию порядка уведомления государственными служащими о фактах обращения в целях склонения к совершению коррупционных правонарушений, которые заключаются в унификации данной процедуры для всех государственных органов

The article analyzes the current legislation on implementing the obligation of a civil servant to notify about the facts of inducing him/her to commit corruption offenses. The types of acts related to corruption offenses in the field of public service are considered. The authors pay special attention to characteristics of the notification procedure, highlighting its shortcomings. The authors propose to improve the procedure for notifying civil servants of the facts of inducing corruption offensesby unifying this procedure for all state bodies.
SCIENTIFIC AND METHODOLOGICAL FOUNDATIONS OF THE LOCATING THEORY ACTUALIZATION BASED ON THE DEGREES OF FREEDOM ANALYSIS OF THE LOCATING OBJECT
Authors:   Mechanical Engineering Research Institute of the Russian Academy of Sciences, BAZROV Boris M. , RODIONOVA Nataliya A. ,   Mechanical Engineering Research Institute of the Russian Academy of Sciences, BUDKIN Yury V. ,   Federal State Budgetary Institution “Russian Standardization Institute”, CHIZHIK Sergey A. ,   A.V. Luikov Heat and Mass Transfer Institute of the NAS of Belarus, KHEIFETZ Mikhail L. ,   Institute of Applied Physics of the NAS of Belarus, GUREVICH Valery L. ,   Belarusian State Institute of Metrology
Published: June 2022

The disadvantages of the traditional description of a mechanical engineering product are considered, which are based on features focused on single, typical and group operations of the technological process. It is proposed to design and manufacture individual elements of parts and the product as a whole from the standpoint of operation and monitoring of its condition using the modular approach in engineering and technology. The representation of parts by sets of modules makes it possible to identify the locating, working and binding modules of the surfaces and on their basis to build a unified classification of parts focused on various stages of the product life cycle. The fundamentals of the locating theory are updated, taking into account the revision of the existing description from theoretical mechanics by means of the position of 3 coordinate points; for the transition to a new description from the theory of machines and mechanisms by depriving of object of locating the degrees of freedom (mobility) in the technical system (design, technological, measuring one). It is shown how the design of the production technology of the product and the measurement of its characteristics is carried out in a system that includes equipment and facilities as mechanisms, the closing link of which are locating items.
African and african diasporic religions: reflections on the relevance and prospects of african indigenous religion
Authors: Kehinde Ojetayo Gabriel
Published: June 2022

The importance of Religion in any human community cannot be over emphasized. Man’s need to reach out to the divine being higher and mightier than himself appears to be both basic and universal. Man felt this need when mystified by forces of nature, threatened by ferocious wild beasts and perplexed by death and hereafter. The affirmation of transcendental being is the core of religion. Hardly did any human civilization row in early times without giving due recognition to religion. This paper posits that before the advent of foreign religions there had been the indigenous religion upheld by African forebears and passed on to succeeding generations. The paper argues that African Traditional Religion is the religion which emerged from the sustaining faith held by the forebears of the present African generation and which is being practiced today in various forms and intensities by a good number of people irrespective of their colour, tribe or race, openly or surreptitiously. The studies reveals that African Traditional Religion is not a fossil religion (a thing of the past) but a religion that Africans today have made theirs by living it and practicing it. Although African Traditional Religion with minority of adherents all over the globe had spread to some areas on the planet earth especially where Africans are found and has influenced the lives of even non-Africans. African Traditional Religion is found in America especially, the Caribbean Islands, Jamaica, Haiti, Trinidad, Cuba and Brazil among others. The researcher employed historical method in carrying out the research.
The Women Empowerment in Agriculture Sector of Pakistan
Authors: Nasir Rakia
Published: June 2022

The study interviewed 100 households in the Sargodha District of Pakistan's Punjab Province, which is the largest and most populated province. The study used a multistage sample process for sampling and interviewed male and female residents of the Sargodha district. The WEAI was calculated using Alkire and Foster's (2011) technique. The women empowerment agricultural index is used to assess women's empowerment. These five factors 5DE identifies the important areas where empowerment must be strengthened, whereas gender parity depicts the relative discrepancy between male and female members of the same family. For the Sargodha district, the Women Empowerment in Agriculture Index value is 0.61. It is calculated by taking 90% of the 5DE sub index value of 0.66 and adding 10% of the GPI value of 0. 68.
Assessment of the American Joint Committee on Cancer 7th Edition Staging for Localised Prostate Cancer in Asia Treated with External Beam Radiotherapy
Authors: Wong Meihua , Yip Connie , Li Huihua , Tan Terence , Kanesvaran Ravindran , Chowbay Balram , Tan Puay Hoon , Tan Min-Han , Wong Fuh Yong
Published: June 2022

Introduction: Most international clinical practice guidelines for prostate cancer (PCa) are driven by data derived in a Western setting. However, tumour biology and clinical disease progression are likely to differ in the Asian population. We compare the performance of the revised American Joint Committee on Cancer (AJCC) prognostic groups with the commonly used D’Amico Risk Classification and conventional predictors for PCa, in a large cohort of Asian patients. Materials and Methods: We retrospectively reviewed data for 404 consecutive Singaporean patients receiving definitive radiotherapy at our centre between December 1996 and October 2006. The primary outcome was biochemical relapse-free survival (BRFS), defined using the Phoenix definition. The secondary outcome was overall survival (OS). Prognostic risk groups were defined using AJCC 7th edition (AJCC7) and 6th edition (AJCC6). Univariate analysis (UVA) and multivariate analysis (MVA) were performed for the following putative risk factors: age, Gleason score, prognostic grouping, tumour classification, radiation delivery technique, radiotherapy dose, hormonal therapy and initial PSA value. Results: For the cohort, median age was 69 years. Median follow-up was 66.3 months. Five-year BRFS rate was 84.3% with 71 biochemical relapses and 5-year OS rate was 89.1% with 54 deaths. The concordance-indices for BRFS prediction were 0.588, 0.550 and 0.567 for AJCC7, AJCC6 and D’Amico respectively. Initial PSA, T-stage and AJCC7 were prognostic for BRFS on UVA. Comparison of AJCC7 vs. D’Amico showed no statistical additional value of either classification system although D’Amico was superior when compared to AJCC6 in predicting BRFS. T-stage ≥3 and D’Amico were significant prognostic factors for BRFS on MVA. Conclusion: In our local, predominantly Chinese population, neither AJCC6 nor AJCC7 demonstrated a high predictive accuracy for BRFS although AJCC7 has a slightly better predictive ability than AJCC6.

Key words: D'amico, Intensity modulated radiotherapy, Prognosis, Risk stratification
Oncologic Outcomes of Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer: A Single-institution Experience
Authors: Leong Yiat Horng , Leong Cheng Nang , Tay Guan Sze , Sim Richard , Lopes Gilberto , Low Wilson , Choo Bok Ai , Tey Jeremy
Published: June 2022

Introduction: This study reports the outcomes of patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation followed by surgery in a local population of Singapore. Materials and Methods: The records of 85 patients who underwent neoadjuvant chemoradiation for locally advanced rectal cancer followed by surgery at the Tan Tock Seng Hospital (TTSH) between November 2002 and January 2012 were reviewed. The treatment protocol comprised radiotherapy to a total dose of 50.4 Gy concurrent with 5-fluorouracil-based chemotherapy. Patients underwent total mesorectal excision surgery following the completion of neoadjuvant chemoradiation. Local control, disease-free survival and overall survival were analysed using Kaplan-Meier methods. Results: Median age of the patients was 61 years. All of them completed radiotherapy. One patient did not complete neoadjuvant chemotherapy. The median time to surgery was 52 days. Fifty-five percent (47 of 85) of patients achieved pathological downstaging and 13% (11 of 85) of patients had a pathologic complete response to preoperative treatment. The neoadjuvant chemoradiation was well tolerated. Four percent of patients had grade 3 diarrhoea and 4% of them had grade 3 dermatitis. There were no grade 4 toxicities. With a median follow-up of 41 months, the 5-year actuarial local recurrence, disease-free survival and overall survival rates were 7%, 71.9%, and 83.2% respectively. Univariate analysis showed that patients with positive surgical margins had significantly worse disease-free survival and overall survival (P = 0.012 and P <0.001 respectively) and a trend towards a higher rate of local recurrence (P = 0.08). Conclusion: Our study provides evidence that neoadjuvant chemoradiation is an effective treatment for locally advanced rectal cancer. Our outcomes are comparable with internationally published data and demonstrate the reproducibility of the neoadjuvant approach in an Asian population.

Key words: Chemoradiotherapy, Preoperative, Rectal carcinoma
Singapore Chapter of Rheumatologists Consensus Statement on the Eligibility for Government Subsidy of Biologic Disease Modifying Antirheumatic Agents for Treatment of Rheumatoid Arthritis (RA)
Authors: Teng Gim Gee , Cheung Peter P , Lahiri Manjari , Clayton Jane A , Chew Li Ching , Koh Ee Tzun , Koh Wei Howe , Lau Tang Ching , Ng Swee Cheng , Thong Bernard Y , Vasudevan Archana R , Yoong Jon KC , Leong Keng Hong
Published: June 2022

Introduction: Up to 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional non-biologic disease modifying antirheumatic drugs (nbDMARDs), and may benefit from therapy with biologic DMARDs (bDMARDs). However, the high cost of bDMARDs limits their widespread use. The Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore aims to define clinical eligibility for government-assisted funding of bDMARDs for local RA patients. Materials and Methods: Evidence synthesis was performed by reviewing 7 published guidelines on use of biologics for RA. Using the modified RAND/UCLA Appropriateness Method (RAM), rheumatologists rated indications for therapies for different clinical scenarios. Points reflecting the output from the formal group consensus were used to formulate the practice recommendations. Results: Ten recommendations including diagnosis of RA, choice of disease activity measure, initiation and continuation of bDMARD and option of first and second-line therapies were formulated. The panellists agreed that a bDMARD is indicated if a patient has (1) active RA with a Disease Activity Score in 28 joints (DAS28) score of ≥3.2, (2) a minimum of 6 swollen and tender joints, and (3) has failed a minimum of 2 nbDMARD combinations of adequate dose regimen for at least 3 months each. To qualify for continued biologic therapy, a patient must have (1) documentation of DAS28 every 3 months and (2) at least a European League Against Rheumatism (EULAR) moderate response by 6 months after commencement of therapy. Conclusion: The recommendations developed by a formal group consensus method may be useful for clinical practice and guiding funding decisions by relevant authorities in making bDMARDs usage accessible and equitable to eligible patients in Singapore.

Key words: Drug therapy, Funding, Management, Practice Guidelines
A New Population-based Reference for Gestational Age-specific Size-at-birth of Singapore Infants
Authors: Aris Izzuddin M , Gandhi Mihir , Cheung Yin Bun , Soh Shu E , Tint Mya Thway , Gluckman Peter D , Lee Yung Seng , Yap Fabian KP , Chong Yap Seng
Published: June 2022

Introduction: There is currently a lack of representative data for local gestational age-specific size-at-birth percentile charts. Existing charts also suffer from limitations relating to the measurement of gestational age (GA) and an outdated population. We aim to construct reference values and charts for size-at-birth from 35 to 41 weeks, based on the healthy local population. Materials and Methods: Prospective observational birth cohort study which recruited pregnant mothers from the 2 major public hospitals with obstetric service in Singapore, at <14 weeks gestation and data was collected for birth weight, length and head circumference of infants born from November 2009 to May 2011. Percentile curves were created separately for male and female infants using the lambda-mu-sigma (LMS) method. The new percentile curves were then compared with other internationally published growth charts. Results: Smoothened curves for birth weight, length and head circumference centiles were created from 863 infants (460 males, 403 females). Male infants consistently exceeded female infants in all 3 variables at each GA. For a male and female Singapore infant at 38 weeks gestation, the 10-50-90th centile values for weight would be 2663-3096-3597 vs. 2571-2966-3417 grams, for length 46.4-48.6-51.1 vs. 45.6-48.0-50.4 cm, and for head circumference 32.0-33.5-35.2 vs. 31.4-32.9-34.6 cm. There was no statistically significant difference between ethnic groups. On comparing our birth weight curves with data from Finland across all gestations, birth weights in our term infants (GA ≥37 weeks) were found to be lower across the 10-50-90th percentiles. Conclusion: The new centile charts in this study may be used as reference charts for size-at-birth for a subgroup of near-term and term infants. The use of foreign charts may lead to misclassification of small for gestational age (SGA) or large for gestational age (LGA) infants.

Key words: Birth head circumference, Birth length, Birth weight
Stroke Literacy in Singapore: Data From a Survey of Public Housing Estate Residents
Authors: Lim Wei-Yen , Chuang Ding Fang , Chue Koy Min , Lee Damian Z , Leong Nicholas J , Peng Kailing , Shen Xiayan , Tham Ye Ni , Wang Kangjie , De Silva Deidre Anne
Published: June 2022

Introduction: Knowledge of stroke symptoms is associated with seeking medical attention early, and knowledge of risk factors is an essential factor in stroke prevention. In this study, we evaluated the level of stroke literacy in Singapore. Materials and Methods: A cross-sectional study of Singapore citizens and permanent residents aged 21 years and above was conducted in a public housing estate. Participants were randomly sampled using multi-stage stratified sampling. Assessment of awareness of stroke symptoms and risk factors was performed using open-ended questions. In total, 687 respondents were recruited, with a response rate of 69.7%. Results: Overall, 52.4% of respondents identified the brain as the source of pathology, and 47.6% could cite at least 1 of the 3 FAST symptoms (facial droop, arm weakness and speech difficulty), while 40% could name 2 or more of 7 established risk factors for stroke (high blood pressure, high cholesterol, cigarette smoking, diabetes mellitus, older age, previous heart attacks and stroke). Respondents at higher risk of stroke (older individuals and those with stroke risk factors) did not have greater awareness of stroke symptoms and risk factors. The majority of respondents reported they would seek immediate medical care if they experienced stroke symptoms. Only 59.4% knew the emergency ambulance service telephone number. Conclusion: In a sample of Singaporean adults residing in a public housing estate, we found evidence of poor stroke literacy, highlighting the need for comprehensive population-based education efforts. There is a role for opportunistic education among those at higher risk of stroke. Key words: Health education, Health promotion
Comparison between Single and Double Cleavage-Stage Embryo Transfers, Single and Double Blastocyst Transfers in a South East Asian In Vitro Fertilisation Centre
Authors: Kwek Lee Koon , Saffari Seyed Ehsan , Tan Heng Hao , Chan Jerry KY , Nadarajah Sadhana
Published: June 2022

Introduction: This study investigated the differences in clinical pregnancy rate (CPR), live birth rate (LBR) and multiple pregnancy rate (MPR) between double cleavage-stage embryo transfers compared to single and double blastocysts stage embryo transfers in a single academic medical centre. Materials and Methods: This was a retrospective cohort study performed at the KK Women’s and Children’s Hospital In Vitro Fertilisation (KKIVF) Centre of all women who underwent fresh-cycle in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) cycles over a 5-year period. The outcome measures were CPR, LBR and MPR. The study included 5294 cycles, of which 539 patients underwent single embryo transfer (SET); 4533 patients underwent double embryo transfer (DET); 84 patients underwent double blastocyst transfer (DBT); and 65 patients underwent single blastocyst transfer (SBT). Results: The mean age of  patients undergoing single blastocysts stage embryo transfer was lower than the other 2 groups. The DET, single and double blastocysts stage embryo transfer groups achieved similar LBR (33.9%, 38.7%, 35.4%, P >0.05) and CPR (42.4%, 46.2%, 46.9%). Conclusion: We found that single blastocysts stage embryo transfer is associated with similar LBR and CPR compared to double blastocysts stage embryo transfer and DET, with lower MPRs, and should be offered as standard practice, where possible.

Key words: Infertility, Pregnancy outcomes
Radiofrequency Microtenotomy with Concurrent Gastrocnemius Recession Improves Postoperative Vitality Scores in the Treatment of Recalcitrant Plantar Fasciitis
Authors: Huang Deborah M , Chou Andrew CC , Yeo Nicholas EM , Singh Inderjeet R
Published: June 2022

Introduction: Gastrocnemius recession and radiofrequency microtenotomy treat plantar fascia via different mechanisms. While studies have shown additive effects in performing plantar fasciotomy in conjunction with gastrocnemius recession, no such study exists examining the effects of performing radiofrequency microtenotomy with gastrocnemius recession. We hypothesised that performing both gastrocnemius recession and radiofrequency microtenotomy concurrently for recalcitrant plantar fasciitis is more effective than performing either procedure individually. Materials and Methods: We analysed all patients who underwent either a radiofrequency microtenotomy, a gastrocnemius recession, or both procedures concurrently between 2007 and 2014. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the SF-36 Health Survey, and 2 questions regarding patient satisfaction and met expectations were assessed preoperatively and postoperatively up to 1-year. Results: Patients who underwent both procedures concurrently had significantly higher vitality scores on the SF-36 Health Survey at 1-year postoperatively compared to patients who underwent either procedure individually. Type of intervention offered and preoperative factors were not predictive for patient outcomes. Conclusion: Combining radiofrequency microtenotomy and gastrocnemius recession in patients with recalcitrant plantar fasciitis and an underlying gastrocnemius contracture shows favourable medium-term outcomes compared to performing either procedure in isolation.

Key words: Patient outcomes, SF-36
Projection of Eye Disease Burden in Singapore
Authors: Ansah John P , Koh Victoria , de Korne Dirk F , Bayer Steffen , Pan Chong , Thiyagarajan Jayabaskar , Matchar David B , Lamoureux Ecosse , Quek Desmond
Published: June 2022

Introduction: Singapore’s ageing population is likely to see an increase in chronic eye conditions in the future. This study aimed to estimate the burden of eye diseases among resident Singaporeans stratified for age and ethnicity by 2040. Materials and Methods: Prevalence data on myopia, epiretinal membrane (ERM), retinal vein occlusion (RVO), age macular degeneration (AMD), diabetic retinopathy (DR), cataract, glaucoma and refractive error (RE) by age cohorts and educational attainment from the Singapore Epidemiology of Eye Diseases (SEED) study were applied to population estimates from the Singapore population model. Results: All eye conditions are projected to increase by 2040. Myopia and RE will remain the most prevalent condition, at 2.393 million (2.32 to 2.41 million) cases, representing a 58% increase from 2015. It is followed by cataract and ERM, with 1.33 million (1.31 to 1.35 million), representing an 81% increase, and 0.54 million (0.53 to 0.549 million) cases representing a 97% increase, respectively. Eye conditions that will see the greatest increase from 2015 to 2040 in the Chinese are: DR (112%), glaucoma (100%) and ERM (91.4%). For Malays, DR (154%), ERM (136%), and cataract (122%) cases are expected to increase the most while for Indians, ERM (112%), AMD (101%), and cataract (87%) are estimated to increase the most in the same period. Conclusion: Results indicate that the burden for all eye diseases is expected to increase significantly into the future, but at different rates. These projections can facilitate the planning efforts of both policymakers and healthcare providers in the development and provision of infrastructure and resources to adequately meet the eye care needs of the population. By stratifying for age and ethnicity, high risk groups may be identified and targeted interventions may be implemented.

Key words: Ophthalmology, System dynamics
General Practitioner’s Attitudes and Confidence in Managing Patients with Dementia in Singapore
Authors: Subramaniam Mythily , Ong Hui Lin , Abdin Edimansyah , Chua Boon Yiang , Shafie Saleha , Siva Kumar Fiona Devi , Foo Sophia , Ng Li Ling , Lum Alvin , Vaingankar Janhavi A , Chong Siow Ann
Published: June 2022

The number of people living with dementia is increasing globally as a result of an ageing population. General practitioners (GPs), as the front-line care providers in communities, are important stakeholders in the system of care for people with dementia. This commentary describes a study conducted to understand GPs’ attitudes and self-perceived competencies when dealing with patients with dementia and their caregivers in Singapore. A set of study information sheet and survey questionnaires were mailed to selected GP clinics in Singapore. The survey, comprising the “GP Attitudes and Competencies Towards Dementia” questionnaire, was administered. A total of 400 GPs returned the survey, giving the study a response rate of 52.3%. About 74% of the GPs (n = 296) were seeing dementia patients in their clinics. Almost all the GPs strongly agreed or agreed that early recognition of dementia served the welfare of the patients (n = 385; 96%) and their relatives (n = 387; 97%). About half (51.5%) of the respondents strongly agreed or agreed that they felt confident carrying out an early diagnosis of dementia. Factor analysis of the questionnaire revealed 4 factors representing “benefits of early diagnosis and treatment of patients with dementia”, “confidence in dealing with patients and caregiver of dementia", “negative perceptions towards dementia care” and “training needs”. GPs in Singapore held a generally positive attitude towards the need for early dementia diagnosis but were not equally confident or comfortable about making the diagnosis themselves and communicating with and managing patients with dementia in the primary care setting. Dementia education and training should therefore be a critical first step in equipping GPs for dementia care in Singapore. Shared care teams could further help build up GPs’ knowledge, confidence and comfort in managing patients with dementia.

Key words: Communication, Diagnosis, Management
Sarcopenia in Elderly Surgery
Authors: Woo Emile CH , Rodis Belinda
Published: June 2022

Sarcopenia is a condition in which patients have an abnormally low muscle mass with poor muscle function. It is prevalent in older patients and is often associated with frailty. It has gained increasing recognition as a significant indicator of poor surgical outcomes. In this review, we examine the concept of sarcopenia and its impact on surgical outcomes and current research on its management. We also discuss the diagnosis of sarcopenia in terms of muscle mass and muscle function and common definitions of both terms. An overview of the impact of sarcopenia on different surgical specialties is reviewed. Lastly, a survey of current treatments available for sarcopenia and their limited impact are discussed with a view to encouraging possible future studies.

Key words: Exercise, Frailty, Nutrition, Perioperative medicine, Prehabilitation
Impact of Knowledge and Attitudes on Lifestyle Practices in Preventing Type 2 Diabetes Mellitus
Authors: Ang Benson WG , Tan Mui Yee , Goh Cheryl MY , Rahardja Sylwan , Lim Beatrice Y , Chiew Wenqi , Heng Thurston YJ , Tan Kuang Ian , Foo Jenies HX , Tham Sarah ZL , Chng Jason KS , Seow Wei Jie , Luo Nan
Published: June 2022

Introduction: Diabetes mellitus is a major public health issue in Singapore. To shape healthcare policies for the primary prevention of diabetes, it is crucial to understand Singaporeans’ knowledge, attitudes and practices related to diabetes and its prevention. This study aimed to assess the knowledge, attitudes and lifestyles of individuals without diabetes. Materials and Methods: A cross-sectional household survey was performed between 31 January to 3 February 2019 to examine knowledge, attitudes and practices related to diabetes. Inclusion criteria of the participants included: 1) Singaporeans/permanent residents, 2) between 30 to 64 years old, and 3) who did not have a diagnosis of diabetes. Logistic and linear regression models were used to analyse the association of knowledge and attitudes with physical activity and diet habits, respectively. Results: Among 806 participants, 72.2% did not meet the Health Promotion Board’s physical activity recommendation. Physical activity was associated with better diabetes knowledge (odds ratio [OR] 5.38, 95% confidence interval [CI] = 1.65-17.53, P = 0.049), stronger beliefs in diabetes prevention (OR 3.36, 95% CI = 1.02-11.12, P = 0.047) and lower levels of worry about diabetes (OR 0.41, 95% CI 0.17-1.00, P = 0.049). Neither knowledge nor beliefs or worries about diabetes was associated with diet. Conclusion: There is a need to reinforce the importance of physical activity and healthy diet in preventing diabetes. Although improving the knowledge level of diabetes may increase physical activity of the population, it is unlikely to improve dietary choices without effective behaviour change interventions. Key words: Healthy diet, Physical activity, Singapore, “War on Diabetes”