bluuebunny/crossref_metadata_2025 huggingface dataset:
S’adapter au changement climatique sur le littoral : retours empiriques sur une démarche participative chercheurs-habitants (Côte d’Opale, France)
Authors: Hellequin Anne-Peggy , Rufin-Soler Caroline , Deboudt Philippe , Ruz Marie-Hélène , Lebreton Florian , Héquette Arnaud , Herbert Vincent
Published: November 2024

Cet article propose une présentation et un retour d’expérience empirique à propos d’une démarche d’action participative de co-construction, entre chercheurs et résidents de deux communes côtières de la région Hauts-de-France (Oye-Plage et Wissant), de stratégies d’adaptation au changement climatique. L’article est structuré en deux parties. La première partie présente les protocoles méthodologiques utilisés avec la description des dispositifs participatifs (réunions publiques, ateliers participatifs, suivis collaboratifs), les outils mobilisés par les chercheurs. La seconde partie propose un retour d’expérience sur ces dispositifs en mettant en avant trois principaux résultats suite à l’analyse de cette démarche participative et en soulignant les avancées et les limites de celle-ci.
Social Learning Theory
Authors: Saka Nurhan Tütüncü
Published: November 2024

Albert Bandura's Social Learning Theory (SLT) focuses on how learners can acquire knowledge and change their behaviors and attitudes by observing people around them and through their social interactions. People's behaviors, social media tools, and verbal instructions can be called as models, and the actions desired to be taught are regarded as modeled behaviors. Both the modeled actions and reactions to those actions in learning environment can lead to behavior or attitude changes in learners. In order to increase the likelihood of the desired outcome, four steps are suggested: attention, retention, reproduction, and motivation. All these steps are intertwined, and affect learning. Therefore, teachers embracing SLT should plan their teaching considering these four steps; be aware of their roles as models; and enrich learning environments by adapting diverse strategies to increase learners' attention, to ease the retention process, to encourage the reproduction of the behavior and lastly to motivate learners.
Exploring the Influence of Humanistic Psychology on Adult Education Practices
Authors: Farah Adnan Mohammad
Published: November 2024

This chapter explores the premise that humanistic psychology has demonstrably influenced adult education practices, including the background of humanistic psychology, key figures, theoretical frameworks, core principles, humanistic psychology and adult learning theory, the impact of humanistic psychology on adult teaching and learning, impact on pedagogical practices, promoting self-directed learning, adult learning autonomy, enhancing learning motivation and engagement, and challenges and future directions for applying humanistic psychology to adult education.
The Dynamics of Adult Learning
Authors: Rodríguez-Padín Rocío
Published: November 2024

This chapter explores the intersection of adult learning theories and their practical applications, with a focus on numeracy and mathematics education. It begins by defining adult learning and discussing its relevance to various contexts, including personal and professional environments. The chapter critically examines how different adult learning theories—such as transformative learning and experiential learning—inform instructional strategies and address diverse learner needs. It integrates recent research findings on numeracy practices and highlights their implications for both theoretical development and practical implementation. The chapter concludes by suggesting areas for future research and offering recommendations for educators to enhance adult learning experiences through targeted pedagogical approaches. Overall, it aims to bridge the gap between theory and practice, providing a comprehensive overview for scholars and practitioners in the field of adult education.
An update on the identity of Longitarsus (Coleoptera: Chrysomelidae) species introduced or relocated in Canada for the biological control of tansy ragwort (Asteraceae)
Authors: De Clerck-Floate Rosemarie A. , Toševski Ivo , Floate Kevin D.
Published: November 2024

Starting in the 1960s, the flea beetle Longitarsus jacobaeae (Waterhouse) (Coleoptera: Chrysomelidae) has been imported and relocated to North America for the control of the weed tansy ragwort, Jacobaea vulgaris (Asteraceae). Some Longitarsus species are morphologically almost indistinguishable, leading to questions regarding the taxonomic identity of the beetles released. Here, we present the results of a molecular study that addresses these questions and updates a list of the releases of Longitarsus within Canada. Our findings confirm the suspected release of the cryptic species L. flavicornis concurrent with releases of L. jacobaeae at sites in British Columbia, Canada, in the 1970s. However, we find no evidence for the continued presence of L. flavicornis at historical release sites in British Columbia nor in Nova Scotia, Canada, where it might potentially have been redistributed. We confirm the presence of L. gracilis Kutschera in Nova Scotia and British Columbia, the latter population likely established from a 2005 release of Longitarsus from Nova Scotia. To our knowledge, this study provides the first published confirmation of L. gracilis in Canada. Finally, we provide evidence that what were recognised in earlier work as three separate taxa (L. succineus (Foudras), L. near noricus, and Longitarsus sp.) are likely all L. succineus.
Workplace spirituality and its relevance to workplace flourishing
Authors: Tigedi Rethabile N. , Van der Walt Freda , Nyetanyane Mpho P.
Published: November 2024

Orientation: Workplace spirituality may previously have been just a new buzzword in the corporate world, but it has now become a topic of serious scientific inquiry, which cannot be ignored or disregarded. The reason for the increased attention given to workplace spirituality in recent years is the positive psychological working environment that it creates for employees.Research purpose: The research established whether workplace spirituality at the individual, work unit and organisational levels influence each other and whether individual spirituality influences workplace flourishing.Motivation for the study: The work and life domains in which employees need to function are not always conducive to their well-being. Therefore, it is necessary to consider to what degree work-related factors such as workplace spirituality influence employees’ flourishing, that is, holistic well-being, in the work context.Research approach/design and method: The study used a deductive approach, employing a correlational cross-sectional research design. Data collection involved a structured questionnaire, resulting in a final sample of 394 respondents.Main findings: The study’s main findings were that individual spirituality impacted emotional well-being. Also, organisational and work unit spirituality influences individual spirituality, and organisational spirituality influences work unit spirituality.Practical/managerial implications: Workplace spirituality should be considered to increase employees’ experience of work-related well-being, expressed as a sense of happiness and contentment and feeling satisfied at work. Furthermore, the spiritual development and growth of spiritual employees should be emphasised.Contribution/value-add: The study contributes to theory development and knowledge creation of the constructs of workplace spirituality and workplace flourishing.
Worker well-being in the digital economy: Lens through bibliometrics analysis
Authors: Chigori Darlington T.
Published: November 2024

Orientation: The study employed bibliometrics analysis to investigate key research themes and trends on digital economy and worker well-being.Research purpose: The study aims to provide a comprehensive understanding of worker well-being and digital economy to identify prominent and emerging research themes in this domain.Motivation for the study: Given the rapid digital transformation of workplaces, there is a need to assess literature trends on workers’ well-being and the digital economy.Research approach/design and method: The study employed a quantitative bibliometrics analysis to map literature on worker well-being and the digital economy. Data from Scopus were collected and screened through Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). A total of 1473 documents were considered meeting the study’s criteria. The scientific literature production, country scientific production, conceptual structure (co-occurrence network, thematic map and thematic evolution) and keyword analysis were used to analyse the data.Main findings: The analysis revealed the following key themes, including task performance, emotional labour, employee voice, career adaptability, job satisfaction, employee well-being, work engagement, proactive personality and psychology of work.Practical/managerial implications: The findings underscore the need for organisations to implement employee well-being initiatives and support mechanisms to address the challenges posed by digital work environments.Contribution/value-add: This study contributes to the existing literature by providing a detailed map of the research landscape. The study shows the need to address well-being challenges because of poverty, vulnerability and changing psychology of work. The study also shows importance of adaptability, work engagement and support systems for employees.
Re-reading Genesis 24:55b–60 in the context of marriage by proxy in Awkunanaw, Enugu State
Authors: Ugwuewo Chisom S. , Obiorah Mary J. , Odo Damian O.
Published: November 2024

Genesis 24:55–60 takes cognisance of the right of a damsel in marriage arrangement. The study aims to examine Genesis 24:55–60 in the context of marriage by proxy in Awkunanaw, Enugu State, Nigeria. The methodology employed in this study is narrative analysis. The findings of the research indicate that marriage by proxy has been a longstanding practice in ancient Awkunanaw. The approach to this practice has evolved between ancient Awkunanaw and contemporary Awkunanaw. The study also reveals that damsels were granted the right to choose their life partners within the socio-cultural context of Genesis 24:55–60. The Hebrew phrase supporting this claim is niqrä’ lanna‘árä, meaning ‘we will call to the girl’. This suggests that Rebekah, the damsel in the text, consented to the marriage made on her behalf. Therefore, the study recommends that parents and guardians in contemporary Awkunanaw should adopt the socio-cultural practices of Laban’s society, as indicated in the study, to help curb the state of chaos within families in Awkunanaw.Intradisciplinary and/or interdisciplinary implications: This study emphasises the need to advocate for the rights of young women in Awkunanaw concerning marriage by proxy. It indicates that allowing a woman to choose her marriage partner would help reduce domestic violence and other marital crises in Nigeria, particularly in Awkunanaw.
Ascension of Jesus: Drawing from the thoughts of Andries van Aarde
Authors: Jones Chris
Published: November 2024

This article stems from the author’s dialogue with New Testament scholar Andries van Aarde about the divinity of Jesus, during which the topic of Jesus’ ascension also arose. The author aims to focus on Van Aarde’s thinking about the ascension of Jesus. The article does not intend to provide a reflection on the exegetical and hermeneutical analysis of the biblical texts alluding to the ascension of Jesus Christ. Instead, it argues that these texts existentially emphasise a believer’s new life, theologically expressed as ‘personal ascension’, implying participation with God. In the New Testament, language expressing Jesus’ ascension was borrowed particularly from royal psalms in the Old Testament. The concept of ‘ascent to heaven’ to access the divine presence is central not only to Jewish Christian apocalyptic symbolism but it also became part of the church’s liturgy. Van Aarde contends that the modern church should preserve the reference to Jesus’ ascension in ecclesial confessional language, despite no longer affirming a three-tiered universe or adhering to the mythical language of ‘descended into hell’ and ‘ascended to heaven’.Intradisciplinary and/or interdisciplinary implications: This article makes the case that Jesus Christ’s ascension serves as a liturgical celebration of victory over trauma. It demonstrates the need for a metaphorical interpretation of the ancient references to ascension. These mythological descriptions become anachronistic in our time if they are interpreted in a realistic, historical and literal sense. However, rich and meaningful victory poetry can still be communicated if the ‘ascension’ is interpreted metaphorically.
New Fueter-Type Variables Associated to the Global Operator in the Quaternionic Case
Authors: Alpay Daniel , Diki Kamal , Vajiac Mihaela
Published: November 2024

The purpose of this paper is to develop a new theory of three non-commuting quaternionic variables and its related Schur analysis theory for a modified version of the quaternionic global operator.
Hazard Reduction for Horizontal Earthboring Machines
Authors:   MTC9, Trenching and Horizontal Earthboring Machines
Published: November 2024

This SAE Standard applies to horizontal earthboring machines found in SAE J2022 of the following types:

a

Auger boring machines

b

Rod pushers

c

Rotary rod machines

d

Impact machines

This document does not apply to horizontal directional drilling (HDD) machines as defined in ISO 21467, mining machinery covered in SAE J1116, Table 1, nor does it apply to conveyors, tunnel boring machines, pipe jacking systems, micro tunnelers, or well drilling machines.
Building an Understanding of Mathematics through Ethnic Mathematics: A Case study of Learning in Bintuni Bay Regency
Authors: Ibrahim Riza Adrian , Wahid Alim Jaizul
Published: November 2024

This study explores the application of ethnomathematics in mathematics education within the context of Teluk Bintuni Regency. Ethnomathematics is the approach of linking mathematical concepts with local cultural practices, aiming to make learning more relevant and engaging for students. The research focuses on how this approach enhances students' understanding and motivation by integrating elements of local culture, such as traditional textile patterns, food-sharing customs, and handicrafts, into the mathematics curriculum. A qualitative case study method was used, involving classroom observations, interviews with teachers and students, and document analysis across three primary schools in Teluk Bintuni. The findings indicate that students responded positively to the ethnomathematical approach, showing increased engagement and improved comprehension of mathematical concepts when taught in a culturally relevant context. Teachers also observed higher levels of participation, although they faced challenges related to limited resources and inadequate training. Despite these obstacles, ethnomathematics proved to be a valuable tool for deepening students' critical thinking and creativity, as well as fostering a connection between academic learning and their cultural heritage. The study concludes that ethnomathematics has significant potential to improve the quality of mathematics education, especially in culturally diverse regions like Indonesia. However, to optimize its implementation, further support is needed, including teacher training and the development of culturally appropriate teaching materials. This research contributes to a growing body of literature advocating for the integration of local culture into the educational process, offering recommendations for policymakers and educators to develop more responsive and inclusive curricula.
Coastal Ethnomathematics in Geometry Learning: A Study at Senior High Schools in Panimbang Regency
Authors: Okta Y Setyo Luthfi
Published: November 2024

This study examines the integration of coastal ethnomathematics into geometry learning in senior high schools in Panimbang Regency, Indonesia. Ethnomathematics merges local cultural elements with mathematical concepts, providing a contextualized approach to teaching. The research focuses on how coastal culture, such as fishing boat designs and net patterns, can be used to teach geometric concepts like symmetry, angles, and shapes. A pretest-posttest experimental design was conducted with 30 Grade X students. Initially, students were taught using a traditional method, followed by a pre-test to assess their understanding. They then learned geometry through coastal cultural examples, with a post-test measuring their progress. The average test score improved from 61.4 to 77.2, indicating a significant enhancement in learning outcomes. A questionnaire revealed that students found the ethnomathematics approach made geometry more relatable, easier to grasp, and increased their motivation. The study concludes that integrating ethnomathematics into geometry lessons not only improves students' understanding and engagement but also fosters a greater appreciation for their local culture.
Strategic Transformation at PT Bank Central Asia Tbk: Lessons in Market Adaptation and Leadership
Authors: Kalfin Kalfin , Yuningsih Siti Hadiaty , Halim Nurfadhlina Abdul
Published: November 2024

This paper provides an in-depth analysis of strategic management practices employed by PT Bank Central Asia Tbk (BCA), one of Indonesia's leading banks. The study investigates BCA's strategic initiatives across multiple dimensions including organizational strategy, competitive positioning, customer service enhancement, digital transformation, and sustainability efforts. Through a strategic management lens, the analysis examines how BCA has navigated challenges and capitalized on opportunities in the dynamic banking landscape of Indonesia. Key strategic decisions, such as market segmentation, product innovation, and technology adoption, are explored to understand their impact on BCA's market leadership and financial performance. Additionally, the paper discusses the role of corporate governance and leadership in driving BCA's strategic objectives forward.
Cocoa Cultivation Technology and Cocoa Post-harvest Technology in The Kusuma Sari Women Farmers Group
Authors: Singapurwa Ni Made Ayu Suardani
Published: November 2024

The primary product made in Candikusuma Village, Melaya District, Jembrana Regency, Bali, is cocoa. In order to boost community empowerment based on cocoa plantations, including cocoa cultivation and cocoa post-harvest technology, the PM-UPUD initiative seeks to support the growth of farmer groups and micro, small, and medium-sized enterprises. The operational techniques that are employed include direct practice, monitoring, assessment, surveys, and consultations. The Kusuma Sari Women's Farming Group, a farmer group affiliated with PM-UPUD (Community Service for Regional Superior Product Businesses), is situated in Candikusuma Village, Melaya District, Jembrana Regency, Bali. Partners encounter issues with the caliber of the cocoa beans they produce as well as insufficient knowledge about planting and caring for cocoa trees following harvest. The Kusuma Sari Women's Farmers Group now has the ability to grow cocoa and manage it post-harvest in an integrated and thorough way thanks to PM-UPUD initiatives. The application of cocoa bean fermentation technology and cocoa planting technology are among the talents that the PM-UPUD program partner group will use in 2024. Farming communities now have the ability to create fermented cocoa beans, which are more valuable to consumers. PM-UPUD initiatives have the potential to boost community welfare and revenue, particularly for those in the cocoa producer group.
Platform Regulation and the Protection of Fundamental Rights
Authors:   Budapest Metropolitan University; contract researcher, Institute of the Information Society of the Ludovika University of Public Service, Klein Tamás
Published: November 2024

The emergence and spread of online platforms have had a disruptive effect on society, bringing about significant changes in many social subsystems. Although the social impact of online platforms can be examined from a wide variety of perspectives and disciplinary viewpoints, the focal point of this paper is their impact on democracy and fundamental rights from a constitutional law perspective. Due to the specificity of operating models, online platforms have a disruptive effect on the exercise of fundamental rights and on democratic publicity and procedures. Hence, for years, the academic discourse has been advocating the imposition of public interest obligations on service providers, in order to protect the fundamental rights of users and preserve the integrity of democratic processes. The protection of fundamental rights is traditionally conceived as a constitutional safeguard against state repression (infringement): it compels the state to respect rights (in some cases, to ensure the enforcement of rights) and/or provides people the individual right to enforce their fundamental rights if need be. However, there are increasingly strong and convincing arguments suggesting that fundamental rights require protection not only against the state but also in private relations (horizontal effect). Such voices are only reinforced by the restrictive power of online platforms.
A FUNÇÃO DA AUDITORIA INTERNA NA TRANSPARÊNCIA DAS ORGANIZAÇÕES
Authors: Machado Renato Vieira
Published: November 2024

Este artigo explora como a auditoria interna contribui para a promoção da transparência e da confiança nas organizações, tanto no setor privado quanto no público. O estudo adota uma abordagem bibliográfica, analisando livros, artigos, dissertações e teses para fundamentar a discussão. A auditoria interna é apresentada como uma ferramenta essencial para assegurar a precisão das informações financeiras e operacionais, fortalecendo a governança organizacional e a confiança dos stakeholders. Além disso, o artigo aborda os desafios enfrentados pela auditoria interna, como a falta de pessoal capacitado e a resistência cultural, especialmente em Micro e Pequenas Empresas (MPEs). Estratégias para superar esses obstáculos incluem a capacitação contínua e o uso de tecnologias da informação e comunicação (TIC) para melhorar a eficiência dos processos de fiscalização. Conclui-se que a auditoria interna é vital para promover um ambiente de crescimento sustentável e competitivo, adaptando-se às tendências emergentes e às mudanças tecnológicas.
PERSONALISMO ÉTICO: FUNDAMENTOS FILOSÓFICOS E DESAFIOS CONTEMPORÂNEOS
Authors: Naves Laura Helena , Lourenço Maria Heloisa de Jesus Paraiba , Nogueira Silas Santana
Published: November 2024

Este trabalho de conclusão de curso aborda o tema "Ética e Dignidade Humana: Reflexões sobre o Respeito à Vida e aos Direitos Fundamentais" sob a perspectiva personalista. Nosso estudo faz uma revisão integrativa dos princípios da ética personalista que podem ser aplicados para promover e proteger a dignidade humana, especialmente no contexto da bioética. A pesquisa analisa conceitos fundamentais como o respeito à vida, os direitos fundamentais e a unicidade da pessoa humana, propondo uma reflexão crítica sobre os desafios e as práticas atuais. A metodologia inclui revisão bibliográfica de fontes acadêmicas relevantes e análise de casos práticos, buscando oferecer contribuições teóricas e práticas para o campo da bioética.
Multifeatured Electronic Helmet to Enhance Road Safety and Rider’s Comfort
Authors: Vijay Mahadev Mane  , Harshal Ambadas Durge
Published: November 2024

This paper presents a multi-featured electronic helmet designed to tackle critical road safety issues, including accidents, drunk driving, and over-speeding. The design incorporates a global system for mobile communications (GSM) and global positioning system (GPS) modules to accurately capture driver’s current location and send messages to predefined contacts. When encountering an accident, the helmet promptly notifies designated contacts and authorities, ensuring swift assistance. By integrating features for detecting over-speeding, accidents, and drunk driving, the helmet renders real-time alerts to both the driver’s family and traffic police, enhancing accountability and safety measures. Additionally, the helmet includes solar charging functionality for mobile devices receive 100% charged in 3.37 hours, thereby optimizing usability and emergency communication. A rain detection system protects mobile devices, while an internal warming mechanism caters to adverse weather conditions, and proffers enhanced comfort by maintaining internal form temperature between 26-27 ℃ and safety, especially in cold regions or for military personnel.
Critical Assessment on the Stability and Convergence of the Conventional Gear Tooth Contact Analysis
Authors: Maksat Temirkhan  , Andas Amrin  , Christos Spitas  , Bakytzhan Sariyev  , Chingis Kharmyssov
Published: November 2024

Mathematical modeling of gear engagement is crucial during design to ensure optimal performance in manufacturing. This study reproduces the conventional tooth contact analysis (TCA) model, highlighting convergence issues in parallel-axis gears and limitations in local synthesis methods. The research critically analyzes the TCA method, which solves five nonlinear equations to assess performance and accuracy. Simulations replicate the conditions of previous studies to ensure valid comparisons. Initial guess values are randomly generated within a specific range to guide the iterative process toward convergence, with this range progressively narrowed to improve computational efficiency and accuracy. Results indicate that the TCA approach is highly sensitive to initial guess values, particularly the starting angular position. Convergence issues arise from the complexity of nonlinear equations and multiple roots. This can lead to divergence or reverting to the initial guess when values deviate significantly from the true solution.
AI-Enhanced Qualitative Research: Insights from Adele Clarke’s Situational Analysis of TED Talks
Authors: Kasperiuniene Judita , Mazeikiene Natalija
Published: November 2024

This study explores the integration of ChatGPT-4 into the qualitative research process, focusing on the methodology of Situational Analysis by Adele Clarke and analysing TED Talks transcripts. Findings show ChatGPT's ability to process data quickly in initial coding, formulating broader categories reflecting Clarke's complexity of “situation,” recognising human and non-human elements, discourses, debates, and issues, temporal and spatial. In analysing data for different map types (situational, social worlds and arenas, positional), ChatGPT-4 “understands” their different analytical purposes, recognising different levels of abstraction and theoretical structuring. The research highlighted the challenges for generative AI in translating complex theoretical frameworks into situational maps and visual representations and underlined the importance of effective prompting strategies. Also, the study identified several roles for generative AI in qualitative research, including co-analyst, consultant and trainer, highlighting the central role of human researchers in decision making and interpretation.
VOLTAGE AND INSULATION COORDINATION OF 35 KV NOMINAL VOLTAGE OVERHEAD DISTRIBUTION NETWORK
Authors:   GPS Insulators doo, Republika Srbija, Gudžević Alen , Maleš Darko ,   Elektrodistribucija Srbije, Republika Srbija, Stojanović Biljana ,   Elektrodistribucija Srbije, Republika Srbija
Published: November 2024

The aim of this paper is to point out the problems of coordination of the highest voltage of the equipment and the corresponding coordination of the voltage for the equipment in overhead network of nominal voltage 35 kV. In the paper a difference between voltage coordination and insulation coordination is defined. Furthermore, an overview of the current practice of these coordinations is given based on the following standards and regulations: Regulations on technical norms for the construction of overhead power lines with a nominal voltage of 1 kV to 400 kV, SRPS N.A2.001:1989 and SRPS N.B0.030:1978, as well as the requirements of new coordinations according to the latest editions of standards: SRPS EN 60038:2013 and SRPS EN IEC 60071-1:2020. In the conclusion, it is proposed to comply the coordination for overhead lines in the network of nominal voltage 35 kV with the highest equipment voltage of 38 kV, as it was defined before in the old standards and regulations, instead of the highest voltage of the equipment of 40.5 kV recommended by the standard.
OPPORTUNITY FOR IMPROVING THE MAINTENANCE OF 35/x kV TRANSFORMERS
Authors:   The Nikola Tesla Institute of Electrical Engineering: Belgrade, RS, Radin Vesna , Đurić Branka ,   The Nikola Tesla Institute of Electrical Engineering: Belgrade, RS, Jovanović Đorđe ,   The Nikola Tesla Institute of Electrical Engineering: Belgrade, RS, Ostraćanin Vladimir ,   Elektrodistribucija Srbije d.o.o., Todorović Radomir ,   Elektrodistribucija Srbije d.o.o.
Published: November 2024

The largest part of the Serbian distributive network is occupied by medium voltage level transformers equipped with de-energized tap changers. The statistical analysis of measurement results of dissolved gas analysis (DGA) results allowed an insight into the frequency of different fault types, where the most common is a thermal fault of temperatures above 700ºC (T3). According to experiences from practice, it has been observed that local overheating most often occurs on the de-energized tap changers, which was also confirmed by electrical measurements and/or during factory repair. This study explores the importance of regular DGA as a tool for rapid fault detection. Presented cases showed a decrease in the gasses development rate which occurred as a consequence of several switching operations during resistance measurement. This very phenomenon was considered as an opportunity for improvement of the transformer maintenance protocol, in order to reduce the occurrence of such faults.
Infectious Disease Eradication: Poliomyelitis as a Lesson in Why “Close” is Not Good Enough
Authors: Ong BKC , Fisher DA
Published: November 2024

The current polio epidemic in Indonesia is a reminder that infectious agents know no political or race boundaries. Like most of the world, this country was polio-free and prior to this outbreak, there were only 6 countries with endemic polio: Nigeria, India, Pakistan, Afghanistan, Niger and Egypt.1 The outbreak in Indonesia began in March 2005 and to date, in excess of 225 children have been paralysed due to imported poliovirus. 2 The infections were initially in 2 provinces on Java but have spread to involve Jakarta, as well as Sumatra and Central Java.
Locally Advanced and Metastatic Breast Cancer in a Tertiary Hospital
Authors: Tan EY , Wong HB , Ang BK , Chan MYP
Published: November 2024

Introduction: The breast cancer incidence among Singapore women has risen through the years and is now the highest in Asia. Despite efforts to promote a greater awareness of breast cancer among the public, a significant number of patients still present with locally advanced or metastatic breast cancer. Our study aims to evaluate the clinical and pathological characteristics between patients presenting with locally advanced (LABC) and metastatic breast cancer (MBC) and those presenting with early breast cancer (EBC), to identify factors that predict for advanced disease.

Materials and Methods: We reviewed 622 patients who were newly diagnosed with invasive breast cancer in our department over a 4-year period from January 2000 to December 2003. Patient and tumour characteristics including age, parity, family history, tumour size and histology, grade and hormonal receptor status were analysed. Comparisons were made between those with EBC and those with LABC and MBC, as well as between Malay women and women of other ethnic groups.

Results: One hundred and thirty-four patients (21.5%) presented with either LABC or MBC. Adjusted analysis found that these patients were older and more likely to be nulliparous than those with EBC. Older patients tend to have larger tumours, but otherwise, age and parity did not correlate with tumour histology, grade or hormonal status. It was noted that Malay women, who were more likely to present with LABC or MBC, were more likely to have oestrogen receptor- and progesterone receptor-negative tumours.

Conclusions: Older women and those who were nulliparous were found more likely to present with LABC and MBC. However, age and parity did not appear to be related to tumour histology, grade and hormonal status. Given that tumour size and stage have the greatest impact on overall survival, efforts to raise public awareness of the benefits of early detection and treatment should be continued, and possibly directed towards these groups of women who appear to be at an increased risk of presenting late.
Carbon Monoxide Poisoning: A Five-year Review at Tan Tock Seng Hospital, Singapore
Authors: Handa PK , Tai DYH
Published: November 2024

Introduction: Carbon monoxide poisoning (COP) is one of the leading causes of death from poisoning worldwide. There is no published study of COP in Singapore so far.

Materials and Methods: All patients admitted with the diagnosis of COP to Tan Tock Seng Hospital (TTSH) over 5 years from 1999 to 2003 were retrospectively reviewed. The diagnosis was based on a history of potential exposure to carbon monoxide (CO) and elevated levels of carboxyhaemoglobin (COHb). The causes, demographic data, clinical presentations, management and complications were analysed.

Results: There were 12 patients with COP. Their average age was 38.9 (± 11.8) years, with a male-to-female ratio of 3:1. Accidental COP (58.3%) was more common than intentional COP (41.7%). The most common cause of accidental COP was smoke inhalation from a faulty vehicle. Gas stove was the most preferred source for intentional poisoning. Presenting features were headache (83.3%), confusion (83.3%), coma (12.7%) and agitation (8.3%). The mean COHb level on admission was 35.9% (± 13.6). All were treated with 100% oxygen. All the patients achieved normal levels of COHb within 24 hours of admission. Two (16.7%) required intubation for airway protection as they were comatose on arrival, of which 1 presented with very high level of COHb (48.1%) and was the only patient to be treated with hyperbaric oxygen. Acute complications were globus pallidus infarction (16.6%), acute respiratory distress syndrome (8.3%) and myocardial ischaemia (8.3%). Most of the patients (91.7%) were discharged well from the hospital. One patient developed parkinsonism after a follow-up of 2 years. There were no deaths.

Conclusion: COP is relatively uncommon in Singapore. It has a low rate of short- and long-term complications.
Tsunami in South Asia: What is the Risk of Post-disaster Infectious Disease Outbreaks?
Authors: Wilder-Smith A
Published: November 2024

The World Health Organization has warned that in the aftermath of the recent tsunami, infectious disease outbreaks will add to the heavy toll of the disaster itself, possibly even doubling the number of casualties. However, many experts believe the risks of infectious disease outbreaks following natural disasters have been overemphasised and have led to unnecessary and potentially harmful public health activities. This paper discusses the risk and prevention strategies of potential infectious diseases in the aftermath of the tsunami based on a literature review of previous similar disasters and current evidence. Infectious disease outbreaks, if any, will most likely be the consequence of post-tsunami camp situations involving large displaced populations rather than the tidal wave itself. Lessons have been learned from previous large-scale humanitarian crises about the provision of aid and the mitigation of epidemics. This paper examines the risk and preventive strategies of vector- and food/water-borne diseases, measles, acute respiratory infections and meningitis. Alert thresholds at which to trigger outbreak investigations, and standardised guidelines with regard to their control are outlined, based on the Sphere Project.
Periampullary Diverticulum: A Case of Bleeding from a Periampullary Diverticula
Authors: Kua JEH , Seah A , So JBY
Published: November 2024

Introduction: Duodenal diverticula are uncommon and usually asymptomatic. Complications like bleeding, perforation and biliary fistulae are rare. The management of a bleeding duodenal diverticulum can be challenging. With the improvement of endoscopic techniques, many of the cases reported in the literature were managed with endoscopic methods. We present a case report of bleeding duodenal diverticulum.

Clinical Features: The patient was treated successfully with endoscopic haemostasis during her first episode when she initially presented with bleeding duodenal diverticulum, but recurred after 2 months.

Treatment: Despite initial endoscopic haemostasis during her second episode, she rebled after 2 days, necessitating surgical management. Outcome: After suture ligation of the ulcer, the patient recovered and there was no more recurrence.

Conclusion: Periampullary diverticulum is a rare source of gastrointestinal bleeding, which can be challenging to diagnose and treat. A multidisciplinary approach encompassing radiology, endoscopy and surgery is most effective.
Dural Sinus Thrombosis after Minor Head Injury in a Child
Authors: Yuen HW , Gan BK , Seow WT , Tan HKK
Published: November 2024

Introduction: Dural sinus thrombosis following minor head injury is rare. We report such a case in a child after mild head injury.

Clinical Picture: A 4-year-old child presented with giddiness and vomiting after a fall. Clinical examination was unremarkable. Magnetic resonance venogram revealed thrombosis of the right sigmoid and transverse sinuses.

Treatment: The patient was managed conservatively. Outcome: Repeat scans 10 weeks after injury showed recanalisation of the thrombosis.

Conclusion: Dural sinus thrombosis should be excluded in children presenting with persistent giddiness and vomiting after minor head injury.
Beyond Ortner’s Syndrome – Unusual Pulmonary Complications of the Giant Left Atrium
Authors: Phua GC , Eng PCT , Lim SL , Chua YL
Published: November 2024

Introduction: The giant left atrium (GLA) is a complication of severe mitral valve disease and causes morbidity by compressing adjacent intra-thoracic structures.

Clinical Picture: We report 2 cases of unusual pulmonary complications of the GLA. Case 1 developed recurrent collapse of the left lung due to left main bronchus compression. Case 2 was diagnosed with right middle lobe compression and collapse.

Treatment and Outcome: Case 1 was successfully treated by mitral valve replacement and left atrial reduction surgery. Case 2 was treated conservatively.

Conclusion: Pulmonary atelectasis may occur in patients with GLA due to bronchopulmonary compression. Surgical management with valve replacement and atrial reduction may be necessary to relieve airway compression.
New Treatments for Atopic Dermatitis – Facts, Comparisons and Uncertainties
Authors: Bigby M
Published: November 2024

Atopic dermatitis is associated with asthma and allergic rhinitis, and presents with a typical morphology and distribution. Eighty-four per cent of cases of atopic dermatitis are mild, 14% moderate, and 2% severe.1 There are 10 randomised controlled trials, and 1 systematic review addressing the appropriate frequency of application of topical corticosteroids for atopic eczema.2 In none of the studies was more frequent application superior to oncedaily application. However, the point estimates suggest that a small difference in favour of more frequent application cannot be excluded. As there is insufficient evidence for twice daily versus daily application, topical corticosteroids should be prescribed once or twice daily, using the lowest appropriate potency and acquisition cost.
2005 Distinguished Academician Lecture: Evolution of Postgraduate Medical Education in Singapore – Role of Professional Associations
Authors: Shanmugaratnam K
Published: November 2024

From 1910 to 1945, doctors in Singapore received postgraduate training through apprenticeship. During the early post-war period, some doctors in the public service were given scholarships to study in Britain and to obtain higher professional qualifications from the British Royal Colleges. The events that most influenced subsequent development of postgraduate education in Singapore occurred between 1956 and 1969: the formation of the Academy of Medicine and the Singapore Medical Association (SMA); organisation of courses for candidates preparing for examinations of the Royal Australasian and British Colleges; competition between the Academy and the University over responsibility for postgraduate medical education; the inauguration of the School of Postgraduate Medical Studies (SPMS); and the introduction of Master of Medicine (M Med) degrees in various medical specialties. From 1970 to 1999, there was expansion in several aspects of postgraduate medical education: SPMS awarded more than 2000 M Med degrees; the Singapore Medical Council (SMC) established a Register of Specialists and formed a Specialist Accreditation Board; the Academy formed Chapters in 10 specialties and developed Advanced Specialty Training programmes leading to Fellowship of the Academy of Medicine Singapore (FAMS); the SMA formed Societies in some 20 specialties; and a College of Family Physicians was inaugurated. There have been more developments from 2000 to 2005: the University restructured SPMS as a Division of Graduate Medical Studies within the Faculty of Medicine; the SMC implemented compulsory Continuing Medical Education; and the Academy converted 6 of its 10 Chapters into Colleges.
Inaugural Lecture of the College of Surgeons, Singapore: Of Role and Role Model (A College Takes its First Steps Towards Collective and Individual Excellence in the 21st Century)
Authors: Satku K
Published: November 2024

Dr Colin Song, President of the College of Surgeons; Colleagues; Ladies and gentlemen: It is indeed a great honour to be invited to deliver the Inaugural Lecture of the College of Surgeons. I am glad to see eminent members as well as younger members of our various surgical disciplines gathered here today. This is a testimony to the continuing involvement and vibrancy of our surgical Fellowship.
10th Yahya Cohen Memorial Lecture: Clinical Predictors in Obstructive Sleep Apnoea Patients with Computer-assisted Quantitative Videoendoscopic Upper Airway Analysis
Authors: Hsu PP , Tan BYB , Chan YH , Tay HN , Lu PKS , Tan AKL , Blair RL
Published: November 2024

Aim: To identify the clinical predictors and assist surgeons in their clinical management of obstructive sleep apnoea (OSA) – a prospective study with a new approach to analyse the static and dynamic upper airway morphology between patients with OSA and normal subjects. To introduce a new method of assessment for surgical outcome.

Materials and Methods: Quantitative computer-assisted videoendoscopy (validated with upper airway magnetic resonance imaging) was performed in 49 (43 males, 6 females) patients with OSA and compared with 39 (22 males, 17 females) controls (apnoea-hypopnoea index <5). Absolute cross-sectional areas, transverse and longitudinal diameters at the retro-palatal and retro-lingual levels were measured during end of quiet respiration and during Mueller’s manoeuvre in the erect and supine positions, allowing us to study static and dynamic morphology (collapsibility) of the upper airway. We analysed 3744 parameters.

Results: In males, retro-palatal and retro-lingual areas during Mueller’s manoeuvre in the supine position of 0.7981 cm2 [receiver operating characteristics (ROC) = 0.9284, positive predictive value (PPV) = 86.05%, negative predictive value (NPV) = 84.62%] and 2.0648 cm2 (ROC = 0.8183, PPV = 76%, NPV = 83.33%), respectively, were found to be good predictors/ cut-off values for OSA. Retro-palatal area measured in the supine position during Mueller’s manoeuvre (AS1M) and collapsibility of retro-palatal area in the supine position calculated (CAS1) were found to have significant correlations with severity of OSA. In females, areas measured during Mueller’s manoeuvre in the supine position of 0.522 cm2 at retro-palatal level (ROC = 1, 100% PPV and NPV) and transverse diameter at retro-lingual level during erect Mueller’s manoeuvre of 1.1843 cm (ROC = 0.9056, PPV = 100%, NPV = 83.33%) were found to be predictive. All measurements at the retro-palatal level and in the supine position had higher predictability. Area measurements obtained during Muller’s manoeuvre were more predictive (ROC >0.9910) than resting measurements (ROC >0.8371). Several gender and anatomical-site specific formulas with excellent predictability (ROC close or equal to 1) were also devised. Examples of surgical outcome assessment were introduced.

Conclusion: Upper airway Mueller’s studies are predictive and useful (independent samples t-test/Mann Whitney U test, ROC) in identifying patients with OSA. With these gender and anatomical-site specific OSA predictors/formulas and this innovative clinical method, we hope to assist other surgeons with quantitative clinical diagnosis, assessment, surgical planning and outcome assessment tools for OSA patients.
Address by Master, Academy of Medicine, Singapore at the Opening Ceremony of the 39th Singapore-Malaysia Congress of Medicine and Induction Ceremony (Celebrating 100 Years of Medical Education)
Authors: Low CH
Published: November 2024

Our Guest of Honour, the Honourable Minister for Health, Mr Khaw Boon Wan and Mrs Khaw; Professor Dato’ Mrs Kew, President of the 39th Singapore-Malaysia Congress of Medicine and Master, Academy of Medicine, Malaysia; Distinguished guests, ladies and gentlemen.
Address by Dean, Faculty of Medicine, National University of Singapore at the Opening Ceremony of the 39th Singapore-Malaysia Congress of Medicine
Authors: Wong JEL
Published: November 2024

We are gathered here today for a historic meeting of the Singapore and Malaysian medical communities. Today, we commemorate 100 years of medical education in our 2 countries. This is something magnificent and worthy of us to pause and take stock: of our history, where are we are now, and what the future portends for us.
Address by the President of the Congress and Master, Academy of Medicine of Malaysia at the Opening Ceremony of the 39th Singapore-Malaysia Congress of Medicine
Authors: Kew ST
Published: November 2024

As the President of the Congress, it is my honour and pleasant duty, on behalf of the Council of the Academy of Medicine of Singapore and the Council of the Academy of Medicine of Malaysia, to warmly welcome you to this 39th Singapore-Malaysia Congress of Medicine.