bluuebunny/crossref_metadata_2025 huggingface dataset:
Does gender influence the relationship between Self-Image and house purchase intention?
Authors: Karunarathne H. M. L. P. , Sugathadasa N. B. , Somarathne M. C. S.
Published: February 2023

Self-image plays a major role in consumer behavior house purchase domain. Gender influences on self-image and house purchase is ambiguous and uncertain in the literature. The purpose of this study is to investigate the impact of gender moderation on the relationship between self-image and house purchasing intention. The quantitative research method was used for this study. Potential luxury housing buyers in Sri Lanka were used as a population of the study and a structured questionnaire survey was conducted to collect data. The sample size of the study is 100. Four hypotheses were developed for the study and those hypothesized were analysed using Partial Least Square (PLS) analysis. The findings reveal that actual self-image and house purchase intention have a significant positive relationship and there is no relationship between ideal self-image and house purchase intention. Further, the study failed to support that gender moderates the relationship between self-image (actual and ideal) and house purchasing intention. The present findings of the study will be beneficial for real estate developers, real estate marketers/managers, and academia, relating to the house purchase intention in the luxury housing market.
Mapping of Global literature on Digital Divide in Education: A Scientometrics Analysis Based on Scopus Database
Authors: Mashroofa Mohamed Majeed , Patel Ayush Kumar , Singh Kunwar , Thapa Neelam , Patel Avadhesh Kumar , Singh Madan , Senapathy Marisennayya
Published: February 2023

Education is of vital importance for the development and growth of a society. Due to the advancement in educational technologies, there have been significant changes in teaching and learning processes. The digital divide has impacted significantly on teaching and learning, at present, especially after the COVID-19 pandemic. Considering this transformation, a scientometric analysis of the global literature on the digital divide in education was conducted in this study. The bibliographic data was gathered through the Scopus database for the period 2001–2021, and a total of 1865 publications were retrieved. VOSviewer and Gephi visualization software were used to analyze data and create network maps. The findings revealed that the average number of citations per paper (ACPP) for the study period is 15.51, and the relative citation impact (RCI) ranges from 0.21 in 2003 to 19.81 in 2021. Among published articles, the contribution of co-authors is greater than that of single authors. Furthermore, the United States was the leading country, with 613 publications on the digital divide. With 11 publications on the digital divide in education, Pick, J.B., from the School of Business, University of Redlands, United States, was the most prolific author. It is believed that these findings would benefit researchers worldwide, as scientometric mapping is an exciting method that provides a comprehensive overview of a scientific issue and insights for future research.
Preoperative Anemia
Authors: Tu Cheng Hung , Hong San Fu
Published: February 2023

Free flap reconstruction has been the mainstay among reconstruction surgeries for head and neck cancer. Intraoperative and postoperative hemoglobin (Hb) levels were both possible risk factors of flap failure and had been discussed widely. However, few investigations of preoperative Hb were seen in the previous study with its effect to flap condition remain uncertain and no conclusions in the literature. Patients who underwent free flap reconstruction after head and neck surgery in our institution between May 2014 and May 2019 were enrolled. The postoperative flap condition was observed carefully, and re-exploration was performed if necessary. We then retrospectively collected patient data with several intraoperative and postoperative indices. A total of 598 patients were enrolled in our study. The total major flap complication rate was 10.6%, with an overall success rate of 89.4%. They were predominantly male (95%), and most of them underwent free flap reconstruction for the first time (91%). A total of 81 (13%) patients received radiotherapy before reconstruction. Among all factors, the preoperative Hb level and free flap type showed significance in univariate and multivariate analyses. A previous history of radiotherapy, body mass index, nutrition status, or poorly controlled diabetes mellitus showed no significant results in either univariate or multivariate analysis. Our study showed that a lower preoperative Hb level affects free flap survival. Meanwhile, preoperative radiotherapy history has no significant influence in either univariate or multivariate analysis.
Social Protection Interventions for TB-Affected Households: A Scoping Review
Authors: Todd Heather , Hudson Mollie , Grolmusova Natalia , Kazibwe Joseph , Pearman Joseph , Skender Kristina , Tran Phuong B. , Boccia Delia , Shete Priya B. , Wingfield Tom
Published: February 2023

Tuberculosis (TB) and poverty are inextricably linked. Catastrophic costs of TB illness drive TB-affected households into worsening impoverishment and hamper treatment success. The WHO’s End TB Strategy recommends social protection for TB-affected households to mitigate financial shock and improve TB outcomes. This scoping review maps the landscape of social protection interventions for people with TB and their households in low- and middle-income countries with high TB burden. A systematic search of Medline, Embase, PubMed, and Web of Science for relevant articles was performed, supplemented with a gray literature search of key databases. Articles were included if they described social protection available to people with TB and TB-affected households in a low- or middle-income country. Data were synthesized in tabular form, and descriptive narrative outlined the successes and challenges of the social protection interventions identified. The search identified 33,360 articles. After abstract screening, 74 articles underwent full text screening, and 49 were included in the final analysis. Forty-three types of social protection were identified, of which 24 were TB specific (i.e., only people with TB were eligible). Varying definitions were used to describe similar social protection interventions, which limited cross-study comparison. Intervention successes included acceptability and increased financial autonomy among recipients. Challenges included delays in intervention delivery and unexpected additional bank transfer fees. A wide range of acceptable social protection interventions are available, with cash transfer schemes predominating. Use of standardized definitions of social protection interventions would facilitate consolidation of evidence and enhance design and implementation in future.
LMIC Research Centers’ Experiences Hosting U.S. and LMIC Trainees: Evaluation of the Fogarty Global Health Fellows and Scholars Program, 2012 to 2020
Authors: Musa Baba M. , Pierce Leslie , Johnson Leslie C. M. , Du Liping , Dankishiya Faisal S. , Byers M. Shannon , Ingles Donna J. , Heimburger Douglas C. , Aliyu Muktar H.
Published: February 2023

In this mixed-methods study, we explore themes that emerged from a survey assessing the programmatic experiences of mentors and administrators at institutions in low- and middle-income countries (LMICs) hosting trainees supported by the Fogarty International Center’s Global Health Program for Fellows and Scholars. A total of 89 of 170 potential respondents representing 31 countries completed the survey (response rate, 52.4%). There was agreement among respondents that their institutions received sufficient funds to support trainees and had the capacity to manage operational and financial aspects of the program. A majority also agreed that both LMIC and U.S. trainees were beneficial to the host institutions, and that trainee projects were relevant to the needs of the host country. Respondents felt that program benefits to LMIC trainees could be improved by increasing the research consumables budget, increasing the flexibility of program timelines, and increasing engagement between LMIC and U.S. trainees and institutions. Respondents indicated that both U.S. and LMIC trainees behaved professionally (including demonstrating respectful and ethical behavior) and took appropriate initiative to conduct their research projects. Findings from this study will help inform innovations to similar training initiatives that will enhance sustainability and improve program performance, and will be responsive to local needs.
Prediction of LED luminaire spectral power distribution using a mathematical model developed based on interpolation method
Authors: Sikora Roman , Markiewicz Przemysław , Pawlak Andrzej
Published: February 2023

LED luminaires with controllable luminous flux are increasingly used, mainly due to the need to reduce electricity consumption, which is the equivalent of improving the energy efficiency of a lighting installation. Changing the dimming level changes the spectral power distribution of the luminaire or light source. Knowledge of dimming characteristics including spectral power distribution relationships provides the opportunity to optimize control algorithms and predict the impact of lighting parameters on the work surface. The paper presents a mathematical model to calculate the spectral power distribution of an LED luminaire for any level of dimming. Two interpolation methods were used to develop the model, fitted by polynomial functions and spline functions. Validation of the model was performed for two values of control voltage-dimming levels. Full Text: PDF ReferencesJ. Silva, J.F.G. Mendes, L.T. Silva, "Assessment Of Energy Efficiency In Street Lighting Design", WIT Transaction on Ecology and the Environment 129, 705 (2010). CrossRef A. Nardelli, E. Deuschle, L.Dalpaz de Azevedo, J. Lorenço Novaes Pessoa, E. Ghisi, "Assessment of Light Emitting Diodes technology for general lighting: A critical review", Renewable and Sustainable Energy Rev. 75, 368 (2017). CrossRef O. Rabaza, D. Gómez-Lorente, F. Pérez-Ocón, A. Peña-García, "A simple and accurate model for the design of public lighting with energy efficiency functions based on regression analysis", Energy 107, 831 (2016). CrossRef S. Raggiunto, A. Belli, L. Palma, P. Ceregioli, M. Gattari, P. Pierleoni, "An Efficient Method for LED Light Sources Characterization", Electronics 8(10), 1089 (2019). CrossRef I. Rachev, T. Djamiykov, M. Marinov, N. Hinov, "Improvement of the Approximation Accuracy of LED Radiation Patterns", Electronics 8, 337 (2019). CrossRef
Multiphoton scanning laser microscope based on femtosecond fiber laser
Authors: Kwaśny Alicja , Bogusławski Jakub , Soboń Grzegorz
Published: February 2023

We present a multiphoton scanning laser microscope based on a femtosecond frequency-doubled erbium-doped fiber laser. The laser used in the epi-illumination microscope setup generated 95 fs pulses at the wavelength of 780 nm with 44.3 mW average power at 100 MHz pulse repetition rate. The imaging process was controlled by custom software developed in the NI LabVIEW environment. Detection of two-photon fluorescence was proven by acquiring a series of images from various biological samples. Full Text: PDF ReferencesJ.W. Lichtman, J.A. Conchello, "Fluorescence microscopy", Nature methods 2(12), 910 (2005). CrossRef W. Zipfel, R. Williams, W. Webb, "Nonlinear magic: multiphoton microscopy in the biosciences", Nat. Biotechnol. 21, 1369 (2003). CrossRef Coherent, Chameleon Ultra Datasheet (2019). DirectLink J. Boguslawski et al., "In vivo imaging of the human eye using a 2-photon-excited fluorescence scanning laser ophthalmoscope", J. Clin. Invest. 132(2), e154218 (2022). CrossRef M.J. Marzejon et al., "Two-photon microperimetry with picosecond pulses", Biomed. Opt. Expr. 12, 462 (2021). CrossRef A. Fast et al., "Institutional Drivers Influence on CSR Engagement: A Comparison of Developed & Developing Economies", Sci. Rep. 10, 18093 (2020). CrossRef D. Stachowiak et al., "Femtosecond Er-doped fiber laser source tunable from 872 to 1075 nm for two-photon vision studies in humans", Biomed. Opt. Expr. 13, 1899 (2022). CrossRef MenloSystems, T-light Femtosecond Fiber Laser 1560 nm (2013). DirectLink J. Yao, L.V. Wang, "Photoacoustic microscopy", Laser and Photonics Rev. 7, 758 (2013). CrossRef D. Stachowiak et al., "Frequency-doubled femtosecond Er-doped fiber laser for two-photon excited fluorescence imaging", Biomed. Opt. Expr. 11, 4431 (2020). CrossRef B.R. Masters et al., "Mitigating thermal mechanical damage potential during two-photon dermal imaging", J. Biomed. Opt. 9, 1265 (2004). CrossRef
Pengembangan potensi unggulan Distrik Kwamki Narama Kabupaten Mimika
Authors: Bachri Samsul , Suwardi Ishak , Tola Kati , Sonbait Lukas , Kubangun Siti
Published: February 2023

Penelitian bertujuan untuk merekomendasikan potensi unggulan daerah di distrik Kwamki Narama, kabupaten Mimika sebagai salah satu langkah untuk mempercepat pertumbuhan dan perkembangan daerah tersebut, yang dalam jangka panjang dapat mendorong perkembangan Kawasan wilayah dan nasional. Metode penelitian yang digunakan adalah metode deskriptif dengan teknik survey.  Proses pengumpulan data dilakukan dengan menggunakan teknik survey, mencakup data primer dan data sekunder. Teknik analisis dilakukan dengan 2 (dua) tahap. Tahap yang pertama menggunakan analisis kuantitatif, yakni dilakukan perhitungan yang sesuai untuk mencari persebaran komoditas unggulan di lokasi penelitian, juga dilakukan Teknik matching (pencocokan) antara kualitas lahan dengan syarat tumbuh tanaman, sesuai dengan buku Petunjuk Teknis Evaluasi Lahan (2011). Hasil penelitian direkomendasikan bahwa lokasi penelitian dapat diperuntukan untuk tanaman pangan yaitu jagung, ubi-ubian (keladi, ubi kayu, ubi jalar), dan pisang. Selanjutnya peruntukan komoditas unggulan, yakni sayuran dan buah-buahan yaitu cabai merah, cabai rawit, paprika, kubis, buncis, kacang panjang, bayam, mentimun, terung, petsai, pare, brokoli, asparagus, pepaya, tomat buah, tomat sayur, belimbing, semangka, blewah, melon, duku, cempedak, dan nenas, serta untuk perkebunan yaitu kelapa, pinang dan buah merah, dan peruntukan komoditas peternakan yaitu ternak babi
Pengaruh Kalium Nitrat Pada Vermikompos Terhadap Kandungan Hara Jaringan dan Hasil Selada (Lactuca sativa L.)
Authors: Namserna Hangrie Jimmy , Lindongi Linda Ernawati , Suparno Antonius , Tan Theresia , Budiyanto Yohanes Sriyadi
Published: February 2023

Kandungan nitrogen dan kalium dalam selada umumnya rendah, yaitu kurang dari dua persen, sehingga masih memerlukan penambahan sumber lain untuk memenuhi kebutuhan tanaman. Kalium nitrat membentuk ion K+ dan NO3- setelah dilarutkan dalam air sehingga mudah tersedia bagi tanaman. Penelitian ini bertujuan untuk mengetahui pengaruh penambahan kalium nitrat pada media tumbuh terhadap peningkatan pertumbuhan tanaman selada dan mengetahui tingkat kekritisan terhadap konsentrasi atau larutan hara listrik dengan penambahan kalium nitrat pada tanaman selada. Penelitian yang dilakukan berupa percobaan pot menggunakan Rancangan Acak Kelompok (RAK) dengan tiga ulangan. Perlakuan terdiri dari 12 tingkat konsentrasi atau EC larutan nutrisi dengan penambahan kalium nitrat. Hasil percobaan menunjukkan bahwa penambahan KNO3 berpengaruh sangat nyata terhadap peningkatan bobot segar dan berat kering pucuk per tanaman. Berat segar dan kering pucuk per tanaman meningkat secara nyata secara kuadratik dengan meningkatnya konsentrasi KNO3. Konsentrasi KNO3 yang optimum untuk pertumbuhan berat pucuk tanaman adalah 12,23 g dalam 100 L air atau konduktivitas listrik setara dengan 2,01 dS.m-1. Konsentrasi P dan K dalam jaringan pucuk tanaman meningkat nyata secara linier dengan pemberian KNO3. Konsentrasi N, Ca, Mg, S, Na Fe, Mn, Cu, Zn, Al dan B pada jaringan pucuk tanaman tidak terpengaruh KNO3.
Survey on Non-Invasive Blood Group Detection Using Image Processing
Authors: Prasad R. Manjunath , Naikodi Shamashyadabegum M , A Triveni , Gireesh Yeruri Sai , Prakash Tejas , M N Sumaiya
Published: February 2023

Detecting the blood group of people is necessary, before performing a transfusion of blood in an urgent situation or when checking a person’s blood group for donation. Presently, the tests are conducted manually by the lab personnel in the laboratory. This takes time and consequences in human error when determining blood type. This may result in loss of life or seriously affect people’s lives. To overcome this, we propose a non-invasive model using image processing and machine learning algorithms. Image processing is useful in various ways for researchers to succeed in their goals, especially in medical fields. This system displays the corresponding blood type that is A+, A-, B+, B-, AB+, AB-, O+, and O- in a short time. Image matching techniques like ORB are used to extract features from an image. It involves signal extraction processes, spectroscopic information, feature calculation processes, and Photoplethysmographic (PPG) signal. The features extracted are given to a machine learning model to detect the blood type of a person in a short period. This method does not require mixing any antigens like A, B, and O with blood samples. This method does not use any blood samples, does not require any chemicals, and reduces human error.
Desire, Death and Sexual Politics in Gustave Flaubert’s Madame Bovary
Authors: Nuru Aminu Ahmed
Published: February 2023

This paper examines the interface of desire, sexual politics and death through a literary-critical study of Gustave Flaubert’s Madame Bovary. The study focuses on the characterization of Emma which allows for a more in-depth and thorough exploration of her psychology vis-à-vis the concepts of desire and death. Firstly, the study extensively explores the Girardian models responsible for Emma Bovary’s desire within the novel. It brings out to the surface the models or mediators (such as romantic fictions, or fashion magazines, or the luxurious life of the rich) responsible for Emma’s desire. These mediators create a void or vacuum in Emma, which need to be filled. This, as the study has shown however, is difficult to do because of sexual politics. Flaubert here suggests that a woman’s desire ends only with death – a patriarchal creed that preordains woman to live without desire. Here, then, lies the intersection between Emma’s desiring pleasure and the instinct of death drive. Therefore, the study examines, from Jonathan Dollimore’s paradigm, the extent to which Emma Bovary’s desire, as portrayed by Girard, creates an “ideal” in her mind and causes her death. The implication of this is that a woman only ascertains a freedom from the trauma of unfulfilled desire in death, a tragic irony that surrounds Emma’s moment of departure from the world as a conscious being.
Correlation between Students’ Metacognitive Strategy and their Reading Comprehension in Higher Education
Authors: Haling Siti Nurul Ilmi
Published: February 2023

Numerous studies have been undertaken on metacognitive awareness and reading comprehension at the secondary school level. Consequently, this study focuses on these characteristics within the higher education level. This study aims to reveal students' metacognitive awareness in reading strategies, the levels of their reading comprehension, and how these two variables are correlated in higher education. To achieve the mentioned objectives, quantitative method, particularly descriptive and correlational approaches were employed. This study's sample consisted of the fifth-semester English Education students at IAIN Bone throughout the 2020/2021 academic year. Cluster random sampling is the sampling method utilized in this study. In order to collect the necessary data, two instruments were used, which were questionnaire to reveal students’ metacognitive reading strategy, and reading test to find out students’ reading comprehension. The result showed that most students routinely employed reading strategies while reading English material, and among the three metacognitive reading strategies, Problem-solving Reading Strategies was the most popular option. Besides, the result indicates that students' reading comprehension is characterized as weak. Furthermore, students’ metacognitive reading strategy has an effect on reading comprehension since they involve the use of self-awareness and intentional motivation to employ one or more techniques for keeping tabs on how well one is grasping what they're reading. It can be concluded that students who employ metacognitive reading strategy have a greater chance of understanding a text, when compared to students with poor metacognitive reading strategy.
Gambaran Karakteristik Kejadian Intrauterine Fetal Death ( IUFD) di Rumah Sakit Umum Daerah (RSUD) Berkah Pandeglang Tahun 2021
Authors: Asfia Fida
Published: February 2023

IUFD is one event that contributes to perinatal mortality. IUFD has a percentage of 29.5% as a cause of death in the perinatal group. Indonesia is in the 10 countries with the highest number of maternal and newborn deaths in the world, there are 2 mothers and 6 neonatal or newborn babies die every day in Indonesia. Meanwhile, the perinatal mortality rate in Indonesia is 21 deaths per 1000 pregnancies (Juwita et al., 2021). This research was conducted at Berkah Pandeglang Hospital, data collection was carried out in April 2022 with research subjects being pregnant women with IUFD in 2021. The sampling technique was total sampling with a total sample of 43 respondents. Data analysis technique used univariate analysis technique with cross sectional descriptive design. The results of the study found that the majority of respondents experienced Advanced IUFD events (gestational age> 24 weeks), namely as many as 62.8%, with the characteristics of respondents having a non-risk age category (20-35 years) namely as many as 58.1%, multipara parity, namely as many as 60.5% and Mass Index Body (BMI) Normal is as much as 65.1%.
Literatur Review: Dampak Implementasi Electronic Health Records (EHR) di Pelayanan Kesehatan
Authors: Pertiwi Tria Saras , Supryatno Adi
Published: February 2023

Document management using electronic/computer-based systems in the scope of health services is becoming a global trend, one of which is Electronic Health Records (Electronic Health Records or EHR). The purpose of this study was to determine the impact of implementing Electronic Health Records in health services. The method used is Literature Review from databases originating from PubMed and ScienceDirect. After the articles were screened, 15 articles were selected to be used as a Literature Review. The results of a review based on 15 articles show that the impact of implementing Electronic Health Records in health services is obtained from various aspects including aspects of efficiency, communication, workload, quality and accuracy of data, economy, quality of care for patients. All articles show different results. There is an increasing impact in a positive direction, but there are some negative impacts such as workload, communication, and dysfunctional workflow. There were also findings of perceived barriers to EHR use, for example poor training and lack of user knowledge.
Potensi Penerimaan Perawatan Kesehatan Mental di Antara Orang Dewasa Bukan Lansia Berpenghasilan Rendah Dengan Penyakit Mental
Authors: Saputro Donny Wiratma
Published: February 2023

Kesehatan mental menjadi isu hangat di Indonesia khususnya dikalangan dewasa nonlansia sehingga penelitian bertujuan untuk menguji perbedaan dalam penerimaan perawatan kesehatan mental antara orang dewasa nonlansia berpenghasilan rendah yang tidak diasuransikan dengan penyakit mental serius (SMI) yang memenuhi syarat untuk Medicaid di bawah Undang-Undang Keperawatan  (ACA) dan Medicaid. Menilai perbedaan-perbedaan ini mungkin memperkirakan dampak dari upaya perluasan Medicaid di bawah ACA pada penerimaan perawatan kesehatan mental di antara orang dewasa bukan-lansia yang tidak diasuransikan dengan SMI. Metode yang dipergunakan mengambil sampel sebanyak 2000 orang berusia 18 hingga 64 tahun yang berpartisipasi dalam Survei Nasional Penggunaan Narkoba dan Kesehatan tahun 2018, memiliki pendapatan di bawah 138% dari tingkat kemiskinan federal, memenuhi kriteria SMI, dan tidak memiliki asuransi (n = 1000) atau memiliki cakupan Medicaid saja (n = 1000). Definisi SMI menurut Alkohol, Penyalahgunaan Narkoba, dan Undang-Undang Reorganisasi Administrasi Kesehatan Mental dengan menggunakan analisis deskriptif dan pemodelan regresi logistik. Hasil penelitian didapatkan pada 28 daerah di Indonesia bagian yang saat ini memperluas Medicaid, prevalensi yang disesuaikan model (MAP) untuk menerima perawatan kesehatan mental di antara pendaftar Medicaid saja dengan SMI (MAP = 71,3%; 95% interval kepercayaan [CI] = 65,74%, 76,29%) adalah 30,1 % lebih besar dari rekan mereka yang tidak diasuransikan (MAP = 54,8%; 95% CI = 48,16%, 61,33%). Di Jakarta, MAP menerima perawatan kesehatan mental antara Medicaid-satunya pendaftar dengan SMI (MAP = 70,4%; 95% CI = 65,67%, 74,70%) adalah 35,9% lebih tinggi daripada rekan mereka yang tidak diasuransikan (MAP = 51,8%; 95 %CI = 46,98%, 56,65%) sehingga dapat ditarik kesimpulan perkiraan peningkatan penerimaan perawatan kesehatan mental karena mendaftar di Medicaid di antara orang dewasa berpenghasilan rendah yang tidak diasuransikan dengan SMI dapat membantu menginformasikan upaya perencanaan dan implementasi untuk perluasan Medicaid di bawah ACA.
Adolescents Mental Health During Covid-19 Pandemic
Authors: Sitohang Elysa Dwi
Published: February 2023

Since the end of 2019, people in various countries, including Indonesia has experience the Covid-19 pandemic. The measures to prevent the spread of the Covid-19 from the government limited people’s physical activity. In education, the policies leads to the implementation of Online Distance Learning for students ranging from elementary school to higher education levels. The purpose of this study was to obtain an overview of the mental health of adolescents during the Covid-19 pandemic and to identify sociodemographic factors that influence adolescent mental health. The study involved 205 participants aged 15-18 years. The data were collected using a validated General Health Questionnaire (GHQ-12) self-assessment measurement tool in Indonesian language adapted version. The results showed that 59.5% of adolescents experienced psychological problems in the form of psychological distress and social dysfunction. Girls and adolescents who experience changes in sleep hours have a greater tendency to experience psychological problems. So that during the pandemic, teenage girls need more attention than boys. In addition, sleep patterns also need to be considered to reduce impact on psychological distress and social dysfunction during the pandemic.
Pemeriksaan Puskesmas di Daerah Terpencil terhadap Fasilitas Kesehatan
Authors: Wahyuni Sri , Ferial Linardita
Published: February 2023

Kemajuan menuju kesehatan untuk semua harus didukung oleh fasilitas kesehatan berkualitas yang tersedia untuk semua orang. Namun, fasilitas kesehatan di daerah terpencil dan tertinggal, perbatasan, dan pulau-pulau terpencil, atau daerah terpencil, tertinggal, perbatasan dan kepulauan (DTPK), menghadapi kendala terkait akses jaminan kesehatan. Penelitian ini bertujuan untuk memberikan gambaran yang komprehensif tentang kesiapan Puskesmas sebagai penyedia utama pelayanan kesehatan primer yang berlokasi di daerah terpencil. Pengamatan dilakukan di 18 Puskesmas di lokasi yang teridentifikasi sebagai daerah terpencil dan tertinggal, perbatasan, dan pulau terluar di tiga provinsi: Bengkulu, Nusa Tenggara Timur (Nusa Tenggara Timur), dan Sulawesi Selatan. Temuan mengungkapkan bahwa banyak fasilitas di pusat kesehatan primer masih tidak memadai. Secara khusus, jalan menuju pusat kesehatan primer dalam kondisi fisik yang buruk, jam operasional terlalu pendek, dan dokter serta teknisi laboratorium tidak tersedia. Namun, puskesmas telah berhasil melakukan banyak kegiatan di dalam dan di luar ruangan seperti kelas pendidikan kesehatan dan deteksi penyakit prioritas di masyarakat. Mengenai keuangan pusat kesehatan primer, mereka sangat bergantung pada dana publik untuk mendukung pengeluaran mereka yang meningkat untuk menyediakan layanan kesehatan, membayar gaji pekerja, dan melakukan kegiatan di dalam dan di luar ruangan, sehingga didapatkan beberapa kendala yang dihadapi puskesmas di DTPK antara lain sulitnya akses fasilitas dan tenaga kesehatan sementara. Informasi ini memberikan masukan berharga bagi pembuat kebijakan dalam membangun infrastruktur kesehatan dan SDM kesehatan di DTPK.
Early Deep Vein Thrombosis: Incidence in Asian Stroke Patients
Authors: Tan Susanna SS , Venketasubramanian N , Ong Peck-Leong , Lim Tchoyoson CC
Published: February 2023

Introduction: Deep venous thrombosis (DVT) is thought to be less common in Asians than in the Caucasian population. The incidence of asymptomatic DVT in high-risk groups in the Asian population has not been well studied. While DVT incidence among Caucasian stroke patients has been extensively studied and the need for prophylaxis established, the lack of data in Asian patients leaves physicians with no firm basis for adopting prophylactic protocols in the local population. Our aim was to prospectively establish the incidence of early DVT in immobilised stroke patients in a heterogenous Asian population.

Materials and Methods: We screened 44 patients with significant hemiplegia from acute stroke. Doppler ultrasound, the currently accepted method of investigation for DVT, was used to study patients on admission and at 1 week post-stroke. While there was no standard prophylactic regime in use, none of the patients received heparin and only 2 were given compression stockings.

Results: The incidence of DVT at 1 week was 2.4%. Review at 1 month detected another patient with DVT, bringing the overall incidence at 1 month to 4.8%. This is lower than in Caucasian populations, but is similar to another local study on a different group of high-risk patients.

Conclusion: The low incidence of early DVT in hospitalised stroke patients of Asian ethnicity does not justify routine screening for this population. Further research to validate this should ideally include a comparison test for DVT as ultrasound may have inherently lower sensitivity in an asymptomatic population.

Key words: Doppler ultrasound
Intramedullary Fixation of Subtrochanteric Fractures with Long Proximal Femoral Nail or Long Gamma Nail: Technical Notes and Preliminary Results
Authors: Jiang Lei-Sheng , Shen Lei , Dai Li-Yang
Published: February 2023

Introduction: The objective of this study was to prospectively evaluate the clinical outcome of traumatic subtrochanteric fractures fixed with long proximal femoral nail (PFN) or long gamma nail with particular emphasis on our experience of surgical techniques.

Materials and Methods: We reviewed the results of 49 consecutive patients who had undergone intramedullary fixation specifically with a long PFN or a long gamma nail for traumatic subtrochanteric fractures in our hospital during a 2-year period from January 2003 to December 2004. The average age of the patients was 53 years. Clinical and radiographic analyses were performed when follow-up was made at 6 weeks, 12 weeks, 6 months, 1 year and 2 years.

Results: All the 49 traumatic subtrochanteric fractures healed uneventfully except 1 case of delayed union. Walking and squatting ability was completely restored in every case at follow-up examination 6 months postoperatively. Among them, 32 fractures were successfully reduced with traction on a fracture table under fluoroscopy, but cerclage wiring or cable bandage through a small incision was needed in the other 17 cases. The average operative time was 46 minutes (range, 21 to 98). Eighteen Seinsheimer type II fractures were left unlocked distally, and static distal interlocking with 1 bolt was carried out in the other 31 cases. No complications such as cutout or breakage of the implants were encountered.

Conclusions: This study suggests that long PFN or long gamma nail is a reliable implant for subtrochanteric fractures, leading to high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the operation is technically demanding. Gradual learning and great patience is needed in order to make this method truly minimally invasive.

Key words: Bone nails, Femoral fractures, Femur, Follow-up studies, Fracture fixation
Child Development Programme in Singapore 1988 to 2007
Authors: Ho Lai-Yun
Published: February 2023

Early childhood intervention programmes can shift the odds toward more favourable outcomes
in development, especially for children at risk. However, there is no quick fix in the world for
early childhood interventions. Programmes that work are rarely simple, inexpensive, or easy to
implement. Each country must decide its own model and strategies and develop its resources
based on existing infrastructures. Since its independence to become a sovereign nation in 1965,
Singapore has undergone significant socio-economic changes. The infant and under-5 childhood
mortality rates are among the lowest in the world. A number of “new morbidities” have been
identified to pose major challenges to child health in the next decades. They are chronic medical
illnesses, developmental disabilities, learning problems, injuries and neglect, behavioural
disturbances and disorders, sequelae associated with unhealthy life-styles, and social and
emotional disorders. The need for a comprehensive child development programme is therefore
obvious. The main objectives are identification and treatment of children with developmental and
behavioural problems so as to correct developmental dysfunctions, minimise the impact of a
child’s disability or of prevailing risk factors, strengthen families, and establish the foundations
for subsequent development. A child development programme has evolved in Singapore over the
last 20 years. The programme is multi-disciplinary, community-based, family-focused, and childcentric, with partnership and integration between government and voluntary community
organisations.
Key words: Children with special needs, Developmental problems, Early childhood intervention
EUS-FNA of the Left Adrenal Gland is Safe and Useful
Authors: Ang Tiing Leong , Chua Tju Siang , Fock Kwong-Ming , Tee Augustine KH , Teo Tee , Mancer Kent
Published: February 2023

Introduction: There are limited data on the use of endosonography-guided fine-needle aspiration (EUS-FNA) to determine the nature of left adrenal lesions. We described our experience in performing EUS-FNA of left adrenal lesions.

Clinical Picture: During a 20-week period, data on consecutive patients who underwent EUS with or without EUS-FNA were prospectively captured. Patients with a left adrenal mass and who underwent EUS-FNA formed our study population.

Treatment: EUS-FNA.

Outcome: A total of 119 consecutive patients underwent diagnostic EUS +/- FNA, during which the left adrenal gland was routinely examined. Twelve of these patients underwent EUS as part of lung cancer staging and among these 12 lung cancer patients, 2 had left adrenal masses detected by computed tomography (CT). EUS detected left adrenal nodules in 2 other patients which were not visualised by CT. The overall prevalence of a left adrenal mass was 3.4%; in the subgroup with confirmed lung cancer, the prevalence was 33.3%. All 4 patients were male, with a mean age of 76.3 years (range, 67 to 87). The mean size of the left adrenal lesion was 30.4 mm (range, 9 to 84.8). EUS-FNA of the left adrenal lesions was performed under Doppler guidance. The mean number of needle passes was 2 (range, 1 to 4). A cellular aspirate was obtained in all patients. No procedural complications occurred. Metastatic non-small cell lung cancer was diagnosed in 2 patients, including a lesion missed on CT. For the other 2 cases, EUS-FNA revealed benign adrenal cells.

Conclusions: EUS-FNA appears safe and useful for the evaluation of left adrenal masses.

Key words: Adrenal gland neoplasms, Endosonography
Can a Flexible Medical Curriculum Promote Student Learning and Satisfaction?
Authors: Jelsing Elena J , Lachman Nirusha , O’Neil Angela E , Pawlina Wojciech
Published: February 2023

Introduction: Medical education is trending towards an outcome-based curriculum that prepares medical graduates to excel in a rapidly evolving, team-centred healthcare delivery system. The Mayo Medical School (MMS) has recently redesigned its curriculum to introduce early clinical relevance, optimise course integration, provide flexibility and promote active learning. This study aims to evaluate the role that curricular flexibility plays in students’ perceived learning, satisfaction and performance.

Materials and Methods: First-year students completed a 5-point Likert scale survey regarding satisfaction with and perceived learning from various components of the flexible curriculum during 2 different academic blocks. Students’ academic performance was assessed by a National Board of Medical Examiners (NBME) Subject Examination after each block.

Results: In comparing student-rated satisfaction and perceived learning from didactics versus other curricular components for Block 3 (Pathology and Immunology) and Block 5 (Gross Anatomy and Radiology), students rated didactics higher in all cases in which there was a statistically significant difference in the ratings. There was a statistically significant positive correlation between the amount learned and satisfaction for all curricular components with the exception of Block 5 independent study. During Block 3, only interest in the subject matter correlated positively with the NBME score, while during Block 5, only time spent in class correlated negatively with the NBME score.

Conclusions: Although various components of the flexible curriculum do not appear to affect satisfaction and perceived learning, their potential influence on graduate outcomes, in terms of delivering healthcare providers who are patient-centred, creative thinkers and compassionate leaders should not be discounted.

Key words: Curriculum reform, Medical curriculum, Outcomes-based education, Student satisfaction
From a “Generalist” Medical Graduate to a “Specialty” Resident: Can an Entry-level Assessment Facilitate the Transition? Assessing the Preparedness Level of New Surgical Trainees
Authors: Bansal Payal K , Saoji Vivek A , Gruppen Larry D
Published: February 2023

Introduction: Concerns have been raised in the literature about how well the undergraduate curriculum prepares medical students for residency. An assessment was designed and administered to entering postgraduate residents in surgery to test their preparedness vis-a-vis the competence level expected of them at the beginning of their training. This paper explores the role and place of such an assessment in the medical education continuum.

Materials and Methods: Faculty members from the Department of Surgery at Bharati Vidyapeeth University Medical College (BVUMC), Pune, India and experts from the Department of Medical Education, University of Michigan Medical School, Ann Arbor designed and administered an assessment based on the multiple-choice question examination (MCQE) and objective structured clinical examination (OSCE) in June 2005 to 24 examinees from 3 different training levels at BVUMC.

Results: All subsections of the MCQE showed significant correlation except the breast and endocrine section. The test showed an overall reliability of 0.8 (Cronbach’s alpha). The scores and level of difficulty of the OSCE were inversely related. There was a significant difference in performance between the 3 groups and these differences were more pronounced for more complex tasks, specifically the procedural skills station, where the intern performance was particularly poor. Clinical skills reliability was 0.85. The communication skills score correlated well with the clinical skills score and also showed good reliability. Four out of the 5 new residents had below-satisfactory levels of competence for this level.

Conclusion: This pilot study reveals definite educational gaps in both knowledge and skills among the residents studied. Such an intervention can be very informative, providing immense educational benefit to the learner, faculty and programme, and has an important place in the continuum of medical training.

Key words: Competence, Education, Postgraduate, Surgery
The Association Between Parental Socioeconomic Status (SES) and Medical Students’ Personal and Professional Development
Authors: Fan Angela PC , Chen Chen-Huan , Su Tong-Ping , Shih Wan-Jing , Lee Chen-Hsen , Hou Sheng-Mou
Published: February 2023

Introduction: In order to commit to their mission and placement requirements, medical education policy-makers are required to understand the background and character of students in order to admit, cultivate and support them efficiently and effectively.

Materials and Methods: This study sample consisted of 408 homogeneous medical students with the same level of education, occupation, school and societal environment. They differed mainly in their family background. Therefore, this study used part of a multidimensional “student portfolio system” database to assess the correlation between family status (indexed by parental education and occupation) and medical students’ mental health status and characters. The controls were a group of 181 non-medical students in another university.

Results: The parents of the medical students were from a higher socioeconomic status (SES) than the parents of those in the control group. This showed the heritability of genetic and environment conditions as well as the socioeconomic forces at play in medical education. Students’ personal and professional development were associated with their parents’ SES. The mother’s SES was associated with the student’s selfreported stress, mental disturbances, attitude towards life, personality, health, discipline, internationalisation and professionalism. The fathers’ SES did not show a statistically significant association with the above stress, physical and mental health factors, but showed an association with some of the personality factors. The greater the educational difference between both parents, the more stress, hopelessness and pessimism the student manifested.

Conclusions: Medical educators need to be aware that socioeconomic factors have meaningful patterns of association with students’ mental and physical health, and their characters relating to personal and professional development. Low maternal SES negatively influences medical students’ personal and professional development, suggesting that medical education policy-makers need to initiate support mechanisms for those with latent vulnerability.

Key words: Risk factors, Stress
A Study on the Personal Traits and Knowledge Base of Taiwanese Medical Students Following Problem-based Learning Instructions
Authors: Luh Shi-Ping , Yu Min-Ning , Lin Yen-Ru , Chou Ming-Jen , Chen Jia-Yuh , Chou Ming-Chih
Published: February 2023

Introduction: Problem-based learning (PBL), a pedagogic concept using a student-centred approach and problem-solving through small group discussions, has been adopted in varying degrees for years at all 11 medical institutes in Taiwan. Much evidence has shown that a number of factors can seriously affect student performance in PBL courses, such as the design of PBL scenarios, the tutors’ character and students’ attitudes and efforts.

Materials and Methods: The aim of this study was to examine how the personal characters or knowledge base of Taiwanese medical students influence their performance in a hybrid-PBL curriculum. A total of 309 (234 male, 75 female) high-school entry undergraduate medical students participated in this survey. Self-assessed personal traits were presented in a 44-item questionnaire with a Big Five factor structure. Knowledge base was assessed by students’ score point average (SPA) based on their previous 4-year education in medical school. Peer-assessed performance of students in the PBL curriculum was carried out using a well-developed, reliable and validated evaluation form.

Results: Each student’s peer-evaluated PBL performance can be divided into 5 principal components, which included control-lead, assist-coordinate, written organisation and compromise-comply (Eigen value >1). The consistency and reliability of the Big Five questionnaire on personal traits was analysed and discordant items were deleted (Cronbach’s alpha = 0.72 to 0.86 after deletion). The relationship between the personal traits, knowledge base and PBL performance, as analysed by simple regression, showed that “extraversion” and “openness to experience” were positively related to the “assist-coordinate” characteristic in PBL performance, and “conscientiousness” was positively related to the “control-lead” characteristic in PBL performance. The SPA was positively related to the “assist-coordinate” or “control-lead” characteristic in PBL performance. The “agreeableness” was negatively correlated with the “control-lead” characteristic in PBL performance. After stepwise regression between the Big Five and each component of PBL performance, only the correlation between conscientiousness and control/lead, and between extraversion and assist/coordinate remained significant.

Conclusion: Knowledge and personality characteristics appear to be associated with student performance in a hybrid-PBL curriculum. The implications of this study on the future development and application of this assessment tool in medical schools are presented.

Key words: Big-Five, Performance, Score point average
An End to “See One, Do One and Teach One” Residency Training Programme – Impact of the Training, Education, Surgical Accreditation and Assessment (TESA) Programme on Medical Care and Patients’ Safety†
Authors: Tan Thiam-Chye , Tan Kim-Teng , Tee John CS
Published: February 2023

Introduction: The delivery of optimal and safe medical care is critical in healthcare. The traditional practice of “See one, do one and teach one” residency training programme is no longer acceptable. Materials and Methods: In the past, there was no structured residency training programme in our hospital. There were several cases of organ injuries from surgeries performed by the residents. In 2005, we conducted a pilot study to organise a structured teaching, education, surgical accreditation and assessment (TESA) residency programme for 15 residents in the Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital. We performed a written questionnaire survey of the residents on the new programme and patients’ expectation (n = 2926) as subjective outcomes in the 1-year follow-up. We also studied the complication rates of all minor and major surgeries performed by the residents in 2004 and 2005 as an objective outcome. Results: All the residents (n = 15) surveyed supported the TESA programme. Patients’ expectation improved significantly from 71% in 2004 (n = 1559) to 83% in 2005 (n = 1367) (P = 0.03). There were 10,755 surgeries in 2004 and 10,558 surgeries in 2005 performed by our residents, with 6 cases (5.6%) of organ injuries in 2004 compared to 3 cases (2.8%) in 2005. This reduction was not statistically significant. Conclusion: The TESA residency programme in our hospital has an impact on the delivery of optimal and safe medical care while ensuring the training of residents to be competent specialists. Key words: Complication rate, Residents, Safe medical care, Surgery