bluuebunny/crossref_metadata_2025 huggingface dataset:
Conditions for the sustainable development of electromobility in the European Union road transport from the perspective of the European Green Deal
Authors: Motowidlak Urszula
Published: February 2023

The article concerns the analysis of trends and policies supporting the development of zero-emission mobility, in accordance with the assumptions of the European Green Deal. The aim of the study is to identify and assess the essential factors determining the level of sustainability of the electromobility system in relation to individual car transport in the European Union. he article reviews strategies for the development of climate-neutral mobility as outlined in strategic documents, the European Green Deal and the “Fit for 55” package. The current state of development of the electric vehicle market and charging infrastructure is shown, which implies a number of challenges in the pursuit of emission-free mobility. A review of the literature on the subject and the results of the expert analysis confirmed the importance of national and regional policies in the uptake of electric vehicles. Taking active measures to increase the level of sustainability of the electromobility system should first focus on the further development of charging infrastructure, the creation of an EV battery value chain and the uptake of cars. The main expectations for the development of electromobility are to reduce CO2 emissions, reduce dependence on the supply of fossil fuels, increase the competitiveness and innovation of the economy, and reduce the social costs generated by transportation.
Public transport stops and crime within the city space. The case of Stare Bałuty in Łódź
Authors: Mordwa Stanisław
Published: February 2023

The goals of the study presented in the article draw attention to the role of public transport stops in the spatial distribution of crime in the Stare Bałuty estate in Łódź, Poland. Answers are provided to the questions of spatio-temporal structure of criminal acts committed within the estate, the influence zone of transport stops as well as the assessment and effects of environmental crime predictors in their vicinity. Crime location quotient (LQC) was used to assess the intensity of crime and identify the influence zone that attracts certain categories of crimes to the vicinity of stops. The influence of environmental predictors on the level of threat was identified and assessed on the basis of B. Czarnecki’s method. The variables used in the analysis initially spanned 739 crimes and 53 public transport stops evaluated with regard to 20 safety aspects and their impact on the pro-crime effects on the scale of location as well as various forms and functions of urban development. A strong negative influence of public transport stops ‒ attracting various categories of crime, mostly property theft ‒ was discovered. The negative influence of stops on the concentration of crime within 200 metres is reinforced by the existence of environmental crime predictors. The recommendations and discussions resulting from the findings should influence the policy of crime prevention on the level of object location, management and the maintenance of socio-spatial order in the vicinity.
Diversification of policies for the development of electric public transport in the Czech Republic, Poland and Slovakia
Authors: Połom Marcin
Published: February 2023

Urban transport in countries of East-Central Europe, including the Czech Republic, Poland and Slovakia, played an important role in the residents’ daily mobility. The underdevelopment of individual motorisation contributed to the lasting significant role of public transport. Due to the operating characteristics of electric vehicles, as well as emerging fuel crises, electric public transport played a key role, especially in large cities. Differences in the development of economies in the electrotechnical segment influenced the structure of public transport in the analysed countries. The higher level of development of the Czechoslovak transport sector contributed to a greater share of trams and trolleybuses in total transport. Despite many development plans in Poland, the process of developing traditional means of electric transport slowed down with the political change in 1989. The situation was slightly different in the Czech Republic and Slovakia, where, despite financial difficulties, the development of tramway and trolleybus networks continued. Modernisation of public transport began after joining the European Union. Technological development has led to the emergence of a new means of transport –electric buses. The apparent ease of putting them into service revolutionised the situation in Poland, thus popularising electric transport. The situation was different in the Czech Republic and Slovakia, where the main focus was on the development of tramway and trolleybus transport. The article reconstructs the development of urban electric transport after 1989 in the analysed countries and identifies factors that differentiate contemporary transport development policies in the Czech Republic, Poland and Slovakia.
Effects of choice of data aggregation method to a point on walking accessibility results using the G2SFCA method
Authors: Lechowski Łukasz
Published: February 2023

In spatial accessibility studies based on market areas, such as floating catchment area (FCA) family methods, it is crucial to identify the point to which weights are assigned, both on the demand and supply side. Bearing in mind that it is not always possible to work on disaggregated data, the aim of this paper was to investigate which method of determining a point, minimises bias in the estimation of walking accessibility. The research used the G2SFCA method, introduced by Dai, which has been employed several times to model walking accessibility. Results clearly show that point location methods for area units, based on disaggregating data to buildings, perform better at the scale of statistical districts or cadastral precincts, compared to those based on the centrally weighted mean. They also show that positional measures such as the Euclidean centrally weighted median can improve the results of analyses in units that are heterogeneous in terms of settlement network pattern.
Structure of finite groups with restrictions on the set of conjugacy classes sizes
Authors: Gorshkov Ilya
Published: February 2023

Let $N(G)$ be the set of conjugacy classes sizes of $G$. We prove that if
$N(G)=\Omega\times \{1,n\}$ for specific set $\Omega$ of integers, then
$G\simeq A\times B$ where $N(A)=\Omega$, $N(B)=\{1,n\}$, and $n$ is a power of
prime.
Geodesic Growth of Numbered Graph Products
Authors: Marjanski Lindsay , Solon Vincent , Zheng Frank , Zopff Kathleen
Published: February 2023

In this paper, we study geodesic growth of numbered graph products; these are
a generalization of right-angled Coxeter groups, defined as graph products of
finite cyclic groups. We first define a graph-theoretic condition called
link-regularity, as well as a natural equivalence amongst link-regular numbered
graphs, and show that numbered graph products associated to link-regular
numbered graphs must have the same geodesic growth series. Next, we derive a
formula for the geodesic growth of right-angled Coxeter groups associated to
link-regular graphs. Finally, we find a system of equations that can be used to
solve for the geodesic growth of numbered graph products corresponding to
link-regular numbered graphs that contain no triangles and have constant vertex
numbering.
Characterizing Positionality in Games of Infinite Duration over Infinite Graphs
Authors: Ohlmann Pierre
Published: February 2023

We study turn-based quantitative games of infinite duration opposing two
antagonistic players and played over graphs. This model is widely accepted as
providing the adequate framework for formalizing the synthesis question for
reactive systems. This important application motivates the question of strategy
complexity: which valuations (or payoff functions) admit optimal positional
strategies (without memory)? Valuations for which both players have optimal
positional strategies have been characterized by Gimbert and Zielonka for
finite graphs and by Colcombet and Niwi\'nski for infinite graphs. However, for
reactive synthesis, existence of optimal positional strategies for the opponent
(which models an antagonistic environment) is irrelevant. Despite this fact,
not much is known about valuations for which the protagonist admits optimal
positional strategies, regardless of the opponent. In this work, we
characterize valuations which admit such strategies over infinite game graphs.
Our characterization uses the vocabulary of universal graphs, which has also
proved useful in understanding recent breakthrough results regarding the
complexity of parity games. More precisely, we show that a valuation admitting
universal graphs which are monotone and well-ordered is positional over all
game graphs, and -- more surprisingly -- that the converse is also true for
valuations admitting neutral colors. We prove the applicability and elegance of
the framework by unifying a number of known positionality results, proving new
ones, and establishing closure under lexicographical products. Finally, we
discuss a class of prefix-independent positional objectives which is closed
under countable unions.
Attila de Zamora, un évêque hispanique des ‘temps obscurs’ à la charnière des IXe et Xe siècles
Authors: GARCIA Charles
Published: February 2023

Attila fut le premier grand évêque de Zamora et célébré à ce titre comme saint par le peuple dès sa mort. Connu par son miracle de l’anneau et du poisson, il s’attacha à intégrer la masse des fidèles au plan divin à travers son pèlerinage et ses dons de prophète.
La Controversia judía y judeoconversa en los debates del Cancionero de Baena
Authors: PEREA-RODRÍGUEZ Óscar
Published: February 2023

Este artículo intenta establecer una correlación entre la evolución pública y social de las minorías judía y judeoconversa y su presencia temática en los debates literarios del Cancionero de Baena, la primera y más importante antología de poesía lírica de la Castilla del siglo XV. Su antólogo, Juan Alfonso de Baena, no sólo eligió textos para poner de relieve una poesía lírica, la de los debates públicos cortesanos, que corría el riesgo de desaparecer ante el fenomenal éxito del tema amoroso, sino que incluyó textos poéticos ordenados en un formato de preguntas y respuestas, Entre ellos, los elementos (verdaderos o burlescos) que tratan de la pertenencia a otras religiones o creencias heterodoxas van claramente en aumento hasta la llegada de la Inquisición, que pondrá fin a la presentación de estos debates. Por ello, el Cancionero de Baena puede considerarse la culminación de estas polémicas antijudías y anticonversación.
COMPARING TRUSS SIZING AND SHAPE OPTIMIZATION EFFECTS FOR 17 BAR TRUSS PROBLEM
Authors:   University of Kragujevac, Faculty of Engineering, Kragujevac, Serbia, Petrović Nenad , Kostić Nenad , Marjanović Nenad , Velemir Anja , Spasojević Ljubica
Published: February 2023

This article aims to demonstrate the difference in results for minimal weight optimization for a 17 bar truss sizing and shape optimization problem. In order to attain results which can be produced in practice Euler bucking, minimal element length, maximal stress and maximal displacement constraints were used. Using the same initial setup, optimization was conducted using particle swarm optimization algorithm and compared to genetic algorithm. Optimal results for both algorithms are compared to initial values which are analytically calculated. The individual element lengths are observed, along with the overall weight, surface area and included number of different cross-sections.
The Political Function and Inference of the World Cup 2022 in Qatar Lingua- Franca and Language Chants
Authors: Al Khotaba Eissa
Published: February 2023

The purpose of this paper is to examine the political function and inference of the World Cup 2022 in Qatar Lingua- Franca and language chants, a symbol of Arabs nationalism and unity. This has always been implied in negative concepts, but this research argues that such understanding misrepresents most football chants. The discourse involving football in World Cups’ interaction is frequently positive and integral. Language chants function as a lingua franca amongst football fans. This linguistic coding is however both inclusive and selective. Multilingual football fans/supporters such as Arabs may appreciate the resentful reputation of being nationalists and united as the situation may be, but the jeopardy of political uncertainty when all the language chants are not dealt with justly. The jeopardy of politicizing linguistic bias or disparity is high in multilingual sports arenas where one nation or language is viewed to dominate others. In the World Cup 2022 (in Qatar), Arabic and English are the official languages with equal positions. However, the strong institutionalization of linguistic stance has generated intricacies of superiority and inferiority among Arabs and others (English, French, Spanish, etc.) Arabs interacted in the fight between two language movements: Arabic-only movement performing as defensive nationalism and English-only performing as offensive Westernism. The two movements that involve the origins of nationalism and Westernism are in rivalry for endurance in sports arenas, and in attempting to do so, they recreate national and political identities grounded on language affinities. The research views that the use of lingua franca and language chants can be inferred as a symbol or linguistic umbrella for defensive nationalism and unity, which oblige political claims that may go as further as questioning the spirit of nationalism and unity.
Implementasi Filter Augmented Reality pada Usaha Mikro Kecil Menengah untuk Meningkatkan Penjualan
Authors: Barus Okky , Suliegna Erick , Pangaribuan Jefri Junifer , Jusin Jusin
Published: February 2023

Berpindahnya sebuah usaha ke platform digital atau media sosial dapat membantu pelaku usaha untuk menjangkau pemasaran yang lebih luas dalam meningkatkan penjualan. Namun hal ini dapat menjadi tantangan bagi pelaku usaha yang baru memanfaatkan platform ini. Pasalnya, terdapat pelaku usaha lain yang telah lama memanfaatkan media sosial. Sehingga sebuah usaha perlu menerapkan sebuah strategi yang dapat diterapkan melalui platform sosial media tersebut. Salah satu cara untuk meningkatkan penjualan melalui media sosial adalah dengan memanfaatkan filter Augmented Reality. Penelitian ini dilakukan dengan ADDIE Model yakni Analysis, Design, Development, Implementation dan Evaluation. Adapun filter Augmented Reality tersebut dirancang dengan menggunakan tools Spark AR. Dari data metriks filter Augmented Reality yang diperoleh, terdapat 3.434 impressions, 290 captures, 19 saves dan 16 shares. Berdasarkan data penjualan yang diperoleh, terdapat kenaikan sebesar 61% dibandingkan dengan bulan sebelumnya yang belum memanfaatkan filter Augmented Reality. Implementasi filter AR akan tepat jika dilakukan secara musiman atau seasonal.
Açıklanabilir Yapay Zekâ Tabanlı Denetimsiz Öğrenme ile Ray Kusur Tespiti
Authors: KIRAT Selçuk Sinan , AYDIN İlhan
Published: February 2023

Demiryolları insanı ve yükünü geçmişten günümüze kadar taşımış, artan ilgi ve talep nedeniyle gelecekte de taşımaya devam edecektir. Demiryollarında güvenli seyir için ray sağlamlığının otonom olarak tespit edilip önceden önlem alınması önem arz etmektedir. Yapay zekâ tabanlı bilgisayarlı görü uygulamaları kapsamında derin öğrenme modelleri ile otonom kusur tespiti yapılabilmektedir. Son yıllarda açıklanabilir yapay zeka yaklaşımı kusur (anomali) tespitinde popüler olmuştur. Sistem tarafından tespit edilen kusurun, niçin kusurlu olduğunun asıl karar verici olan insana açıklanması gerekmektedir. Bu çalışmada ray yüzey kusurlarını içeren etiketsiz görüntü veri seti ile sınıflandırıcı katmanları özelleştirilmiş Vgg16 ve MobileNetV3 Small ağları eğitilmiştir. Denetimsiz öğrenme ile etiketsiz verilerden sağlam rayların özelliklerini öğrenen ağlara, test için verilen görüntülerdeki kusurlar tespit ettirilmiştir. Kusurlar açıklama haritaları ile kullanıcıya gösterilmiştir. Ağların sınıflandırma başarısında Vgg16 %98, MobileNetV3 Small %96 doğruluk seviyesine ulaşırken, kusurlu bölgenin işaretlenmesini sağlayan açıklama haritalarında Vgg16’nin daha isabetli çıkarımlar yaptığı gözlemlenmiştir.
In vitro Activities of Antifungal Drugs Against Yeasts Isolated from Blood Cultures and Moulds Isolated from Various Clinically Significant Sites in Singapore
Authors: Tan Ai Ling , Chan Kian Sing
Published: February 2023

Introduction: Fungaemia carries with it high mortality rates and appropriate as well as timely antifungal therapy has been shown to be life saving.

Materials and Methods: We studied the invitro activities of antifungal agents using the Etest method, against 100 Candida isolates from blood cultures, 10 Cryptococcus isolates from blood or cerebrospinal fluid and 50 mould isolates from various clinically significant sites of patients in Singapore General Hospital, from June 2004 to December 2006.

Results: Overall, the yeasts appeared to have low minimum inhibitory concentrations (MICs) for all the 5 antifungal drugs tested except for fluconazole. The overall high MIC90 values of the moulds against the azoles were largely attributed to the non-Aspergillus moulds. Posaconazole, itraconazole, voriconazole and caspofungin appear effective against local strains of Aspergillus species, although there are no interpretive breakpoints.

Conclusions: The results show that the local fungal strains studied appear to be susceptible to the usual antifungal drugs recommended in the literature.

Key words: Antifungal susceptibility, Aspergillus, Candida, Etest, Singapore
Gram-negative Resistance in Singapore: A Historical Perspective
Authors: Koh Tse Hsien
Published: February 2023

In the past 3 decades, classical extended-spectrum β-lactamases (ESBLs) have probably been the main contributors to gram-negative antimicrobial resistance in Singapore. These appear to be being replaced by the newer CTX-M ESBLs. Metallo-β-lactamases are found in Pseudomonas aeruginosa but do not seem to have spread widely in Acinetobacter spp. and Enterobacteriaceae. Carbapenem-hydrolysing oxacillinases are prevalent in multidrug-resistant Acinetobacter spp. More insidious developments include the emergence of plasmid AmpC β-lactamases and multifactorial quinolone resistance in Enterobacteriaceae.

Key words: AmpC, Carbapenemase, Extended-spectrum β-lactamase, Oxacillinase, Quinolone
“Future” Threat of Gram-negative Resistance in Singapore
Authors: Tan Thuan Tong
Published: February 2023

The emergence of multidrug-resistant gram-negative bacteria is challenging the treatment of serious nosocomial infections. This is an international trend that is mirrored in Singapore too. Reports of strains resistant to all currently available agents have surfaced here and possibly have taken root here as well. The direst situation is among the non-fermenters, Pseudomonas aeruginosa and Acinetobacter baumannii. This is followed closely by the Enterobacteriaceae family with their array of extended-spectrum β-lactamases, AmpC β-lactamases and carbapenemases. There are also resistance mechanisms such as efflux pumps and porins downregulation that effect resistance against multiple classes of agents. Potentiating these developments is the dwindling “pipeline” of new agents. Hence, there is a real concern that we are running out of options for our patients. Novel antibiotic combinations, enhanced infection control, antibiotic cycling, computer-assisted programmes, and maybe in the distant future, non-antimicrobial agents is all that we have. Key words: Outcomes, Predictors, Stenotrophomonas maltophilia
The Association of Smoking with Components of the Metabolic Syndrome in Non-diabetic Patients
Authors: Gharipour Mojgan , Kelishadi Roya , Sarrafzadegan Nizal , Baghaei Abdolmehdi , Yazdani Mehrdad , Anaraki Jafar , Eshrati Babak , Tavassoli Ali-Akbar
Published: February 2023

Introduction: There is limited evidence about the association between smoking and metabolic syndrome (MS). The aim of this study was to assess the association of smoking with MS components. Materials and Methods: As part of the baseline survey of a community-based study, we studied 5573 non-diabetic men. All participants were interviewed and underwent physical examinations and blood collection. Results: The study participants comprised 1625 smokers and 3948 non-smokers, with a mean age of 38.07 ± 14.85 years. Serum low-density lipoproteincholesterol (LDL-C) and triglycerides (TG) were higher in smokers than in non-smokers (LDLC: 115.34 ± 39.03 vs 112.65 ± 40.94 mg/dL, respectively, P = 0.015 and TG: 175.13 ± 102.05 vs 172.32 ± 116.83 mg/dL, respectively, P = 0.005). Body mass index, waist circumference and waisthip ratio were lower in smokers than in non-smokers. Mean systolic and diastolic blood pressures were significantly lower in smokers than in non-smokers (systolic: 112.06 ± 15.888 vs 117.25 ± 17.745 mmHg, respectively, P = 0.000; diastolic: 73.66 ± 10.084 vs 76.23 ± 10.458 mmHg, respectively, P = 0.000). The percentage of individuals with 2 MS components was higher in smokers than in non-smokers (39.64% vs 33.00%, respectively, P = 0.000). However, the percentage of non-smokers with 3 MS components was higher than in smokers (49.62 % vs 43.82%, respectively, P = 0.000). Conclusions: Our findings support the hypothesis that lifestyle factors such as smoking can adversely affect MS components. However, we should acknowledge that these differences may have resulted from the large sample sizes studied and may not be clinically significant. The lower prevalence of some MS components in smokers than in nonsmokers might be because of their lower anthropometric measures. Key words: Anthropometric indexes, Biochemical factors
5th College of Physicians Lecture – A Physician’s Odyssey: Recollections and Reflections*
Authors: Chew Chin Hin
Published: February 2023

Some reminiscences of events since the 1930s are presented chronologically. These include sketches of informal introduction to Medicine at the General Hospital (SGH), the amazing spirit of medical professionals during the “Syonan” years at Tan Tock Seng Hospital (TTSH) and of professors of Medicine and training in Hong Kong, Singapore and Britain. An account of practice of Medicine in the Civil Service, of teaching and research and of evolution of specialist training and examinations in the Academy of Medicine, the University’s Post Graduate School (DGMS) and Specialist Accreditation Board (SAB) is given. The over-riding values of our profession are stressed, always contributing to improving the quality and standards of practice in the interests of our patients and fellowmen. Key words: Calling, Doctor, Ethics, Medical student, Medicine, Patient, Research, TB control
Implementation and Evaluation by Formal Assessments and Term End Student Feedback of a New Methodology of Clinical Teaching in Surgery in Small Group Sessions
Authors: Karanth K Veena L , Kumar MV
Published: February 2023

The existing clinical teaching in small group sessions is focused on the patient’s disease. The main dual limitation is that not only does the clinical skill testing become secondary but there is also a slackening of student involvement as only 1 student is evaluated during the entire session. A new methodology of small group teaching being experimented shifted the focus to testing students’ clinical skills with emphasise on team participation by daily evaluation of the entire team. The procedure involved was that the group underwent training sessions where the clinical skills were taught demonstrated and practiced on simulated patients (hear-see-do module). Later the entire small group, as a team, examined the patient and each student was evaluated for 1 of 5 specific tasks – history taking, general examination, systemic examination, discussion and case write-up. Out of 170 students, 69 students (study) and 101 students (control) were randomly chosen and trained according to the new and existing methods respectively. Senior faculty (who were blinded as to which method of teaching the student underwent) evaluated all the students. The marks obtained at 2 examinations were tabulated and compared for tests of significance using t-test. The difference in the marks obtained showed a statistically significant improvement in the study group indicating that the new module was an effective methodology of teaching. The teaching effectiveness was evaluated by student feedback regarding improvement in knowledge, clinical and communication skills and positive attitudes on a 5-point Likert scale. Psychometric analysis was very positively indicative of the success of the module.

Key words: Clinical teaching in surgery, Small group teaching in surgery
World Federation for Medical Education Policy on International Recognition of Medical Schools’ Programme
Authors: Karle Hans
Published: February 2023

The increasing globalisation of medicine, as manifested in the migration rate of medical doctors and in the growth of cross-border education providers, has inflicted a wave of quality assurance efforts in medical education, and underlined the need for definition of standards and for introduction of effective and transparent accreditation systems. In 2004, reflecting the importance of the interface between medical education and the healthcare delivery sector, a World Health Organization (WHO)/World Federation for Medical Education (WFME) Strategic Partnership to improve medical education was formed. In 2005, the partnership published Guidelines for Accreditation of Basic Medical Education. The WHO/WFME Guidelines recommend the establishment of proper accreditation systems that are effective, independent, transparent and based on medical education-specific criteria. An important prerequisite for this development was the WFME Global Standards programme, initiated in 1997 and widely endorsed. The standards are now being used in all 6 WHO/WFME regions as a basis for quality improvement of medical education throughout its continuum and as a template for national and regional accreditation standards. Promotion of national accreditation systems will have a pivotal influence on future international appraisal of medical education. Information about accreditation status – the agencies involved and the criteria and procedure used – will be an essential component of new Global Directories of Health Professions Educational Institutions. According to an agreement between the WHO and the University of Copenhagen (UC), these Directories (the Avicenna Directories) will be developed and published by the UC with the assistance of the WFME, starting with renewal of the WHO World Directory of Medical Schools, and sequentially expanding to cover educational institutions for other health professions. The Directories will be a foundation for international meta-recognition (“accrediting the accreditors”) of educational institutions and their programmes.
A Systems Approach to Teach Core Topics across Graduate Medical Education Programmes
Authors: Varkey Prathibha , Karlapudi Sudhakar P
Published: February 2023

Introduction: Core curricula including Ethics, Medico-legal issues, Socioeconomics, and Quality Improvement (QI) are relevant and significant for graduate medical education programmes, regardless of specialty. A lack of faculty expertise in these content areas is a frequently cited concern among specialty programmes in graduate medical education. We report the results of an institutional systems-approach to assist this challenge. Our institution has 86 post-graduate residency and fellowship training programmes serving 1068 learners. Directors of these programmes expressed the need for a centralised approach to teach learners about insurance systems and the basics of QI.

Materials and Methods: Two subject matter experts in the fields of insurance systems and 1 expert in QI conducted 2 institution-wide didactics on each of the content areas, attended by 192 and 225 learners respectively.
Results: Significant improvement in learner knowledge was noted for all 3 knowledge-based questions for both content areas (P <0.0001). Learner self-assessment of knowledge of insurance systems increased from a pre-session mean of 2.86 to a post-session mean of 3.80 (P <0.0001) and from 3.29 to a post-session mean of 4.17 (P <0.0001) for the QI didactics.
Conclusion: Systems-wide didactic sessions for learners of different residencies has several advantages including the efficient use of content experts, prevention of resource burnout, and cost effectiveness. This strategy may also assist programmes directors in meeting external accreditation requirements.

Key words: Audience response system, Quality improvement, Safety, Systems initiatives
Graduate Public Health Education – Singapore’s Contribution to Strengthening Capacity in the Region and Beyond
Authors: Lim Meng-Kin , Seow Adeline , Wilder-Smith Annelies , Lee Hin Peng
Published: February 2023

The year 2008 marks the 55th anniversary of the graduate public health programme in Singapore. This article traces the evolution of the programme-from the Diploma in Public Health in 1953 to the Master of Public Health in 2007-in response to changing challenges and needs. It also discusses the role Singapore can continue to play in addressing global inequities in access to public health education and in strengthening public health capacity in the region and beyond. Key words: Global Health, Master of Public Health, Public Health Education, Public Health Training, Public Health Workforce
Harnessing the IT Factor in Medical Education
Authors: Lim Erle CH , Oh Vernon MS , Koh Dow-Rhoon , Seet Raymond CS
Published: February 2023

Escalating healthcare costs in Singapore have produced a significant movement of patients into ambulatory care, and the consequent dearth of clinical teaching materials. This deficiency has likewise prompted the creation of ambulatory teaching clinics and the use of standardised patients and simulators. In the last few decades, educators have utilised digital technology, for instance, digitally recorded heart and breath sounds, and digitised video vignettes, in medical education. We describe several pedagogical initiatives that we have undertaken at our university school of medicine. Key words: Clinical material, Digital image, Multimedia
Knee and Ankle Ligaments: Magnetic Resonance Imaging Findings of Normal Anatomy and at Injury
Authors: Tham Seng Choe , Tsou Ian YY , Chee Thomas SG
Published: February 2023

Ligamentous injuries of the lower limb are a common entity sustained during sports activities and military training. Magnetic resonance (MR) imaging of the knee and ankle is playing an increasingly important role in the detection, diagnosis and prognosis of these injuries and their associated complications. MR imaging with its exquisite soft tissue contrast resolution and multiplanar capability is increasingly seen as the modality of choice for evaluating ligamentous injuries of the knee and ankle. Representative knee and ankle MR studies from a tertiary referral hospital are used to illustrate both the normal appearance and typical radiological features of common ligamentous injuries of the knee and ankle. A thorough understanding of the MR appearances of these injuries is crucial to the radiologist and clinicians involved in the management of these patients.

Key words: Anterior cruciate ligament, Anterior talofibular ligament, Sports injury, Sprain
Induction Concurrent Chemoradiotherapy Using Paclitaxel and Carboplatin
Combination Followed by Surgery in Locoregionally Advanced Non-Small Cell Lung Cancer – Asian Experience
Authors: Yap Swee-Peng , Lim Wan-Teck , Foo Kian-Fong , Hee Siew-Wan , Leong Swan-Swan , Fong Kam-Weng , Eng Philip , Hsu Anne AL , Wee Joseph TS , Agasthian Thirugnanam , Koong Heng-Nung , Tan Eng-Huat
Published: February 2023

Introduction: It has been established that combined chemoradiotherapy treatment benefits selected patients with stage III Non Small Cell Lung Cancer (NSCLC). However, locoregional recurrence still poses a problem. The addition of surgery as the third modality may provide a possible solution. We report our experience of using the triple-modality approach in this group of patients.

Materials and Methods: This is a retrospective review of 33 patients with stage III NSCLC treated between 1997 and 2005. Patients have good performance status and no significant weight loss. There were 26 males (79 %) with median age of 63 years (range, 43 to 74) and median follow-up of 49 months. Seventy-six percent had Stage IIIA disease. Chemotherapy consisted of paclitaxel at 175 mg/m2 over 3 hours followed by carboplatin at AUC of 5 over 1 hour. Thoracic radiotherapy was given concurrently with the second and third cycles of chemotherapy. All patients received 50 Gray in 25 fractions over 5 weeks.
Results: The main toxicities were grade 3/4 neutropenia (30%), grade 3 infection (15 %) and grade 3 oesophagitis (9%). Twenty-five patients (76%) underwent surgery. Of the 8 who did not undergo surgery, 1 was deemed medically unfit after induction chemoradiotherapy and 4 had progressive disease; 3 declined surgery. Nineteen patients (58 %) had lobectomy and 6 had pneumonectomy. The median overall survival was 29.9 months and 12 patients are still in remission.
Conclusion: The use of the triple-modality approach is feasible, with an acceptable tolerability and resectability rate in this group of patients.

Key words: Chemoradiotherapy, Neoadjuvant treatment, Surgery
Neuropsychiatry – An Emerging Field
Authors: Lee Tih-Shih , Ng Beng-Yeong , Lee Wei-Ling
Published: February 2023

Neuropsychiatry is an emerging field at the intersection of neurology and psychiatry, driven by the unprecedented advances in neuroscience. The arbitrary demarcation between neurology and psychiatry, which largely existed only in the last century and a half, has become less tenable. We discuss the definition and scope of this emerging field. We also review the development of clinical neuropsychiatry in Singapore in the context of historical developments and recent changes in the field from other countries. At a more practical level, we discuss a few of the clinical settings in which neuropsychiatry operates, in particular, the stigma associated with psychiatric disorders locally, and the significant number of patients with psychiatric or psychosomatic symptoms presenting to neurology and general practice clinics. The stigma may be ameliorated by better understanding of the neurobiological basis of psychiatry. We see the future of neuropsychiatry in Singapore, as in other developed countries, as one approach to understand and manage complex brain disorders. We advocate training for both psychiatry and neurology residents in their counterpart fields, which will lead to greater understanding of both fields, and enhance collaboration in clinical care and research.

Key words: Complex brain disorders, Neurology, Psychiatry
Obstructive Sleep Apnoea in Singapore: Polysomnography Data From a Tertiary Sleep Disorders Unit
Authors: Lim Li Ling , Tham Kwang Wei , Fook-Chong Stephanie MC
Published: February 2023

Introduction: Comprehensive sleep architecture and respiratory event data in local patients with suspected obstructive sleep apnoea (OSA) from overnight polysomnography (PSG), the gold standard for the evaluation of sleep-related breathing disorders, are not widely available. We present 1 year retrospective PSG data with the objective of describing PSG characteristics of patients evaluated for OSA in Singapore.

Materials and Methods: PSG data of patients evaluated for OSA in 1 year (January through December 2005) in the Sleep Laboratory of a public tertiary hospital were retrospectively reviewed.

Results: Five hundred and eighty-four diagnostic PSG studies were performed in patients with symptoms suggestive of sleep-disordered breathing, including snoring, excessive daytime sleepiness, unrefreshing sleep, or recurrent unexplained awakenings. There were 449 male patients (76.9%) and 135 female patients (23.1%), with a mean age of 47.5 years (SD 12.7). Men were on average younger than women, 46.1 years versus 52.0 years (P <0.0005). The mean body mass index (BMI) was 27.9 (SD 6.7), with no significant difference between genders. An association was shown between apnoea-hypopnoea index (AHI) and BMI (Pearson correlation index r = 0.362). Men had overall significantly higher AHI (16.5 vs 9), shorter mean sleep onset latency (11 vs 16.5 minutes), more light sleep (65.5% vs 58.9%), less deep sleep (17.7% vs 23%), and more respiratory event related arousals per hour of sleep (11.6 vs 5.1) (P <0.0005). Severity was classified: AHI <5 (“Normal Overall AHI”) (28.3%), AHI 5-15 (“Mild”) (22.3%), AHI >15-30 (“Moderate”) (18.3%), AHI >30 (“Severe”) (31.2%). There was no significant age difference among the 4 groups. More severe OSA patients were significantly heavier, and had more light sleep, less deep sleep, less REM sleep, more respiratory event related arousals and lower levels of oxygen desaturation.

Conclusion: OSA is predominant in middle-aged, overweight Singapore males and much less common in females who tend to be older. A majority of patients have moderate to severe OSA, which significantly disturbs normal sleep architecture. The relatively lower BMI compared to Caucasian OSA populations may be related to local craniofacial characteristics and/or higher percentage of body fat for BMI which has been described in Singaporeans.

Key words: Body-mass index, Obstructive sleep apnoea (OSA), Polysomnography (PSG), Sleep architecture
Airway and Craniofacial Changes With Mandibular Advancement Device in Chinese With Obstructive Sleep Apnoea
Authors: Poon Kee Hoon , Chay Siew Han , Chiong Kelvin FW
Published: February 2023

Introduction: The objective of this study was to investigate whether a reduction of obstructive sleep apnoea (OSA) severity is associated with significant airway and craniofacial changes with mandibular advancement device (MAD) in Chinese subjects.

Materials and Methods: A total of 14 Chinese subjects (8 males, 6 females) diagnosed with OSA by overnight polysomnography (PSG), were fitted with the MAD. The mean ± standard deviation baseline apnoea-hypopnoea index (AHI) was 38.4 ± 17.2 and minimum arterial oxygen saturation (SaO2) was 75.5 ± 11.1%. The second lateral cephalogram was taken (wearing the MAD) after the second PSG. The second PSG was indicated when symptoms have improved as shown by the Epworth Sleepiness Score and sleep questionnaire after wearing the MAD for 1 month. Comparison of cephalometric variables was done to evaluate the effects of the MAD on the upper airway and anatomical variables. Pre-treatment versus post-treatment variables were compared using Wilcoxon signedrank test to determine the statistical significance at the 5% levels. The changes in airway variables were correlated with the changes in AHI using the Spearman correlation test.

Results: At the second polysomnogram, AHI was significantly reduced to 10.9 ± 14.7. Minimum SaO2 was significantly increased to 86 ± 8.4%. Mean airway dimension was significantly increased at the nasopharyngeal area from 22.7 ± 3.0 mm to 24.8 ± 2.1 mm. The distance of the hyoid bone to the mandibular plane was significantly reduced with the MAD from a mean of 21.2 ± 5.7 mm to 13.9 ± 7.0 mm (P <0.05). This reduction of the distance of the hyoid bone to the mandibular plane was significantly correlated with the reduction in the AHI.

Conclusion: An increase in the nasopharyngeal airway and reduction of the distance of the hyoid bone to the mandibular plane was observed for this sample of Chinese OSA subjects. This study forms the baseline for future studies on the effects of MAD on the airway and craniofacial structures in a larger sample.

Key words: Lateral cephalogram, Mandibular advancement splint, Mandibular advancement device, Obstructive sleep apnoea, Polysomnogram
Effect of Orthognathic Surgery on the Posterior Airway Space (PAS)
Authors: Lye Kok Weng
Published: February 2023

Orthognathic surgery has been used regularly to treat dentofacial deformities. The surgical procedures affect both the facial appearance as well as the posterior airway space (PAS). Our current literature indicates that setback procedures produce an inferior repositioning of the hyoid bone and posterior displacement of the tongue and the soft palate. These movements cause anteroposterior and lateral narrowing of the PAS. Most authors agree that these effects are permanent. The PAS changes in turn produce an adaptive posturing, with an increased craniocervical angle to open up the PAS. Even though most patients do not display snoring and obstructive sleep apnoea (OSA) post-surgery, there is certainly an increased possibility in patients with already compromised airways. Therefore, patients who are undergoing orthognathic surgery should be screened for excessive daytime somnolence, snoring, increased body mass index (BMI) and medical conditions related to OSA and sent for an overnight polysomnography (PSG) if OSA is suspected. Then the proposed treatment plan may be modified according to the risk of potential airway compromise or even to improve it. Conversely, advancement of the maxilla and mandible causes widening of the airway in both the anteroposterior and lateral dimensions. This effect would translate to better airflow and decreased airway resistance. This is supported by the evidence showing high success rates when orthognathic surgery, especially maxillomandibular advancement (MMA), is utilised to treat OSA.

Key words: Airway changes, Cephalometrics, Maxillomandibular advancement, Obstructive sleep apnoea, Orthognathic surgery
Transudates in Malignancy: Still a Role for Pleural Fluid
Authors: Gonlugur Tanseli E , Gonlugur Ugur
Published: February 2023

Introduction: The aims of this study were to determine the distribution of transudates and exudates among pathologically proven malignant pleural effusions, and to demonstrate the necessity for cytologic studies in patients with a transudative effusion.

Materials and Methods: This study is a retrospective review of all subjects diagnosed with malignant or paramalignant pleural effusion over a 10-year period at a tertiary hospital. The study included 67 subjects with malignant mesothelioma, 45 subjects with metastatic disease, and 36 subjects with paramalignant effusions.

Results: There were 55 female and 93 male subjects; the mean age of the sample was 62 years. Malignant pleural effusions were transudative in 1.5% of malignant mesotheliomas, 6.8% of metastatic diseases, and 11.1% of paramalignant effusions.

Conclusions: Cytological examination of pleural fluid in patients with unexplained transudative effusion is essential to rule out malignant processes.

Key words: Biochemical criteria, Pleural malignancy, Pleural neoplasms
Association of Epstein-Barr Virus with Nasopharyngeal Carcinoma and Current Status of Development of Cancer-derived Cell Lines
Authors: Gullo Charles , Low Wong Kein , Teoh Gerrard
Published: February 2023

It is well known that the Epstein-Barr virus (EBV) contributes directly to tumourigenesis in nasopharyngeal carcinoma (NPC), primarily in the undifferentiated form of NPC (WHO type III; UNPC or UC), which is commonly found in South East Asia. Unfortunately, research in NPC has been severely hampered by the lack of authentic EBV-positive (EBV+) human NPC cell lines for study. Since 1975, there have been more than 20 reported NPC cell lines. However, many of these NPC-derived cell lines do not express EBV transcripts in long-term culture, and therefore that finding may dispute the fundamental theory of NPC carcinogenesis. In fact, currently only one EBV+ human NPC cell line (C-666) in long-term culture has been reported. Hence, most of the NPC cell lines may not be representative of the disease itself. In order to better understand and treat NPC, there is an urgent need to develop more EBV+ human NPC cell lines. In this review, we discuss the authenticity of existing NPC cell lines and the impact of our understanding of NPC biology on the treatment of the disease and the relationship of EBV to NPC in the context of cell lines.

Key words: Carcinogenesis, Cell culture, Epstein-Barr virus, Hayflick’s limit
Performance Measures for Mental Healthcare in Singapore
Authors: Chong Siow-Ann , Mythily  , Deurenberg-Yap Mabel , Verma Swapna , Swartz Marvin
Published: February 2023

Mental disorders are both common and costly. The mental health system in Singapore lacks co-ordination as well as being underdeveloped in certain areas. To address these gaps as well to face emerging challenges like an ageing population, and other socioeconomic changes, the Ministry of Health of Singapore has commissioned a Committee to formulate a 5-year Mental Health Policy and Blueprint. A task group has been formed to implement this blueprint and evaluation of these various initiatives with performance measures are inevitable. The choice of these measures, however, can be a daunting task with the various and diverse interests of multiple stakeholders. This paper describes the process of choosing the relevant measures with the appropriate attributes, and suggests a framework, which can serve as a guide for selecting mental health performance measures. Key words: Attributes, Capacity, Outcomes, Process, Quality of care
Analysis of Financial Management in MSEs: Planning, Controlling, Recording (Study at Selorejo Tourism Area, Malang Regency, Indonesia)
Authors:   Faculty of Economy and Business, Gajayana University Malang, Poernamawatie Fahmi , Hastuti Sri ,   Faculty of Economy and Business, Gajayana University Malang, Fitria Nur ,   Faculty of Economy and Business, Gajayana University Malang, Ma’roep Maxi ,   Faculty of Economy and Business, Gajayana University Malang
Published: February 2023

This study aims to analyze financial planning, control, and recording carried out by Micro Small Enterprises (MSEs) in the culinary field in Selorejo Tourism Area, Malang Regency, Indonesia. The research approach used is descriptive quantitative with the aim of describing the implementation of financial planning and control carried out by business actors. To clarify and explore the application of financial planning and control carried out by business actors, the researchers complemented it with a qualitative approach. The analysis was conducted on business owners who are also business managers. Data was collected by means of questionnaires and in-depth interviews. Descriptive analysis is used to obtain data on the implementation of planning and control of small micro-financing handling carried businessmen. The results obtained were explored further based on the results of interviews from several respondents to get a more complete and detailed picture. The results showed that the most financial planning was carried out by business actors, namely 74%, the application of control was 58%, and the lowest was an application of recording business transactions, 33.5%. The most widely applied planning indicator is the preparation of an investment budget, while the setting of sales targets is the least applied. The most applied control indicator is physical and direct financial control, especially the separation of personal money from business money. Control by using records of business transactions historically is still very low, only limited to records of purchases and sales. Meanwhile, recording activities are carried out on a non-routine basis. The implementation of planning and control through business financial records is still low due to the lack of understanding of business actors about recording financial transactions and reporting results of operations and their benefits. The indication of this lack of understanding is shown by the educational background of most business actors who have graduated from elementary and junior high schools.