bluuebunny/crossref_metadata_2025 huggingface dataset:
Субстратная топонимия окрестностей села Торновое на Самарской Луке
Authors: Belenov Nikolay V.
Published: December 2020

В статье рассматриваются три лимнонима из окрестностей мокша-мордовского села Торновое на Самарской Луке: Каль, Елгуши и Обкан. Для каждого из указанных географических названий, в соответствии с методами и принципами топонимических исследований, проверяется вероятность принадлежности к топонимическому субстрату. В ходе исследования особое внимание уделяется формам бытования топонимов у местного населения, наличию или отсутствию топонимических параллелей к ним на других территориях расселения носителей мордовских языков. К анализу привлекается лексический состав и характеристические особенности торновского говора мокша-мордовского языка, а также других мокша-мордовских говоров Самарской Луки. При оценке этимологических решений учитываются подтверждённые конкретными примерами фонетические законы отображения иноязычных географических названий в мордовских языках. В результате проведённых исследований установлено, что из трёх рассматриваемых лимнонимов достоверные параллели в мордовской топонимии с других территорий имеет только топоним «Каль», который, учитывая этническую историю Самарской Луки, может иметь как мордовское, так и славянское происхождение. Для лимнонима «Елгуши» можно предполагать псевдосубстратное происхождение, в связи с вероятной адаптацией балтского термина в мокша-мордовской среде. В статье высказывается предположение о возможной религиозно-культовой семантике лимнонима. Лимноним «Обкан» с высокой степенью вероятности восходит к иранским языкам, однако здесь также нельзя исключать псевдосубстратное происхождение, с семантически адаптированным заимствованием из тюркских языков в мокша-мордовских говорах Самарской Луки.

Исследование в значительной степени опирается на полевые материалы автора, полученные в ходе сезонов 2017-2018 годов.
Особенности функционирования Волго-Донской переволоки в хазарское время
Authors: Bubenok Oleg B.
Published: December 2020

В раннее средневековье на территории Хазарского каганата существовал водный путь из Черного моря в Каспийское – благодаря сухопутной переволоке для кораблей на месте наибольшего сближения Волги и Дона (60–80 км). Однако до сих пор не существует единого мнения по ряду вопросов, связанных с функционированием данной коммуникации. Поэтому цель статьи – дать ответы на них. В основной части работы был произведен сравнительный анализ данных мусульманских географов IX–X вв. со сведениями христианских авторов о навигации в странах Европы и Западной Азии. Были привлечены также старинные карты и результаты археологических исследований. В результате, удалось установить следующее: уже в 40-е гг. IX в. Волго-Донская переволока снова начала функционировать, что совпало с первыми плаваниями русов; вопреки распространенному мнению, маршрут переволоки мог проходить от истоков одного из притоков Дона к главному течению Волги (20 км); в IX в. русы могли транспортировать свои корабли при помощи специальных приспособлений, а в Х в. – простым волоком; поэтому в IX в. их корабли могли быть и торговыми, а в Х в. – только боевыми и легкими; безопасность кораблей от нападений кочевников на месте переволоки обеспечивалась на переправах через Дон как крепостями, так и военными гарнизонами хазар. Таким образом, в IX в. русы и хазары использовали переволоку как торговые партнеры, а в Х в. русы благодаря переволоке уже стали нападать на хазар.
Мы наш и новый мир накормим: несколько кейсов алиментарных традиций фронтирных регионов. Часть I
Authors: Yakushenkov Serguey N. , Palatkin Vladimir V.
Published: December 2020

Алиментарный ландшафт, то есть совокупность практик, связанных с производством, переработкой и потреблением пищевых продуктов, с одной стороны, является достаточно консервативным, а с другой, больше всего подвержен изменениям. В отдельных случаях на фронтирных территориях алиментарный ландшафт изначально формируется как некое гибридное явление, складывающееся на основе новых пищевых ресурсов и новых подходов к их обработке и потреблению.

В статье анализируется два совершенно различных (и в культурном, и в таксономическом планах) кейса, представленных алиментарными ландшафтами Нижней Волги (Астраханская область) и Республикой Перу. Оба ландшафта формировались на схожих принципах поликультурности и множественности природных зон, позволявших населению заниматься земледелием, рыболовством и скотоводством.

В первой части работы анализируется кейс с Астраханской алиментарной системой. Авторы, на основании различных нарративных источников, прослеживают вкратце основные пути формирования этого ландшафта. На примере нескольких видов сельхозпродукции авторы показывают, что астраханский алиментарный ландшафт отличало многообразие многих уникальных региональных продуктов питания, характерных именно для данного края. Со временем происходило размывание этой специфики, приводившее к утрате некоторых видов, сортов и т.д.

Авторы также анализируют современные культурные процессы и предлагают возможные варианты дальнейшего развития этого сложного социокультурного явления.
Anemia of Chronic Disease: Epidemiology and Pathophysiological Mechanisms – Literature Review
Authors: Ismaiel Abdulrahman , Srouji Nahlah Al
Published: December 2020

Anemia of chronic disease (ACD), also known as anemia of inflammation (AI), is the term used to describe the hypoproliferative anemia. ACD was demonstrated in several conditions including systemic inflammation, acute and chronic infections of bacterial, viral, parasitic or fungal etiologies, cancer and hematological malignancies, chronic diseases such as chronic kidney disease and congestive heart failure, in addition to ageing, graft versus host disease after solid-organ transplantation, critical illness, and obesity. As a result of the possible different etiologies, the pathogenesis of ACD is complex with multiple pathways.

Although the relationship between anemia, chronic inflammation and iron was discovered decades ago, only recently did research describe the role of several pro-inflammatory cytokines, in addition to molecular pathways and the type II acute-phase protein hepcidin involving iron absorption and metabolism, helping in the understanding of new pathophysiological mechanisms which were not previously understood that can lead to ACD. Hence, our understanding of the molecular mechanism related to intestinal iron absorption and metabolism has improved significantly.

The pathophysiology of ACD is thought to be due to three main processes including a decreased erythrocyte survival that creates a demand for a mild increase in bone marrow production of erythrocytes, inability of the bone marrow to respond to the required increased demand due to an altered erythropoietin production or impaired ability to respond to erythropoietin by erythroid progenitor cells and alteration in iron stores’ mobilization through increased uptake and retention of iron in cells of the reticuloendothelial system.

Lately, research advances including hepcidin’s discovery contributed to our understanding regarding iron metabolism and pathophysiological mechanisms in ACD. However, future research remains essential in order to find potential therapeutic strategies, possibly targeting genes coding cytokines to discover optimal therapies in treating ACD more efficiently.
Effect of intermittent hypoxic training on orthostatic tolerance in humans before and after simulated microgravity
Authors: Katuntsev VP , Sukhostavtseva TV , Kotov AN , Baranov MV
Published: December 2020

Reduced orthostatic tolerance (OT) is a serious concern facing space medicine. This work sought to evaluate the effects of intermittent hypoxic training (IHT) on OT in humans before and after 3 days of head-down bed rest (HDBR) used to model microgravity. The study was carried out in 16 male volunteers aged 18 to 40 years and included 2 series of experiments with 11-day and 21-day IHT administered on a daily basis. During the first IHT session, the concentration of oxygen in the inspired gas mixture was 10%; for other sessions it was adjusted to 9%. OT was assessed by a 20-minute-long orthostatic tilt test (OTT) conducted before and after HDBR. Before HDBR, orthostatic intolerance was observed in 3 participants, while after HDBR, it was observed in 9 of 16 volunteers (p < 0.05). During OTT conducted after HDBR, the heart rate (HR) exceeded control values by 26.8% (p < 0.01). Preexposure to any of the applied IHT regimens led to a reduction in the number of volunteers with orthostatic intolerance. After the 11-day IHT program, there was a less pronounced increase in HR during OTT before HDBR; with the extended IHT regimen, less pronounced changes were observed for HR, systolic, diastolic and mean blood pressure (BP). The increase in HR during OTT after HDBR was significantly lower in the group that had completed the 11-day IHT program, while BP remained stable. The changes in HR and systolic BP were less pronounced in the group that had completed the 21-day IHT program than in the control group (p < 0.05). Thus, IHT reduced the risk of orthostatic disorders and mitigated changes in cardiovascular parameters during the orthostatic test.
Psychological Test Feedback: Canadian Clinicians’ Perceptions and Practices
Authors: Zhou Hansen , Hanson William E. , Jacobson Ryan , Allan Angie , Armstrong Diana , Dykshoorn Kristy L. , Pott Terilyn
Published: December 2020

This study explores Canadian clinicians’ perceptions of test feedback (TFB) and how those perceptions influence their practice. This secondary analysis of open-ended qualitative data extends a previous study with similar research questions conducted by Jacobson et al. (2015). A case study design and consensual qualitative research (CQR) data analysis procedure was utilized to enhance the trustworthiness of the results. The findings indicate that clinicians give TFB in a variety of settings. Clinicians emphasize the importance of providing tailored and collaborative TFB, of attending to ethical issues related to TFB, and of improving academic training in TFB. Also, clinicians discuss unique situations in which feedback is provided to a third party rather than to the testing individual. Clinical implications such as increased practical training for providing TFB are discussed. Future research could investigate the outcomes of TFB provision.
The Philosophical Underpinnings of the Enhanced Critical Incident Technique
Authors: McDaniel Matthew M. , Borgen William A. , Buchanan Marla J. , Butterfield Lee D. , Amundson Norm E.
Published: December 2020

Since its introduction in 1954, the critical incident technique (CIT) has been modified for use within counselling psychology and undergone several contemporary enhancements. While the method’s procedures and history have been described thoroughly, its philosophical underpinnings have not. This article seeks to fill this gap by contrasting the most current iteration of the CIT (i.e., the enhanced critical incident technique, or ECIT) across the philosophy of science paradigms. The ECIT is found to contain specific and rigorous post-positive epistemological elements and a flexible ontological position. This makes the ECIT a malleable method that can meet the needs of researchers from multiple perspectives.
Understanding the Link Between Motivational Interviewing and Self-Compassion
Authors: Pastore Olivia , Fortier Michelle
Published: December 2020

In this article, the authors posit that the accepting and compassionate spirit of motivational interviewing (MI), along with specific content-based techniques (i.e., reframing), can help to cultivate a self-compassionate mindset within clients receiving MI. The authors explore this link further while discussing potential moderators that may influence this process as well as practical implications for counselling practice and future research recommendations. This article is innovative in that it could provide a new theoretical foundation for conducting research that supports the effectiveness of MI in enhancing self-compassion, which has been associated with a myriad of improved psychological outcomes. The concepts of this paper and the exploration between specific MI techniques would be valuable to many clinicians with the desire to increase self-compassion in their clients.
Reconciling Relations: Shifting Counselling Psychology to Address Truth and Reconciliation
Authors: Fellner Karlee D. , Ansloos Jeffrey , Ouellette Nevada L. , Villebrun Gwendolyn D.
Published: December 2020

In 2018, the Canadian Counselling Psychology Conference (CCPC) convened a working group to address how the field of counselling psychology ought to respond to the Truth and Reconciliation Commission of Canada. Attendees were asked to share their perspectives on reconciliation, current efforts toward reconciliation in counselling psychology, and recommendations for the future of counselling psychology in relation to reconciliation. The current paper documents the findings and implications of the working group, offering concrete suggestions for how researchers, educators, clinicians, and trainees in the field can support reconciliation in a good way, shifting counselling psychology to serve Indigenous people and communities better.
Internationalization of Canadian Counselling Psychology: A Collaborative Endeavour Grounded in Social Justice
Authors: Sinacore Ada L. , Huminuik Kirby
Published: December 2020

During the Canadian Counselling Psychology Conference held at the University of Calgary in 2018, participants in a working group met to discuss the internationalization of counselling psychology and to articulate the ways in which the values of Canadian counselling psychology can inform international interactions. As an outcome of the working group process, the authors report on the themes that emerged: mapping the territory, movements and tensions, and challenges and opportunities. Taking these themes into consideration, the authors discuss the implications for researchers, educators, and clinicians in Canadian counselling psychology.
Pattern of Congenital Heart Disease In Children Attending Central Teaching Pediatric Hospital, Baghdad
Authors: Al-Zuhairi Husam T
Published: December 2020

Background: Congenital cardiac defects have a wide spectrum of severity in infants. About 30-40% of patients with congenital cardiac defects will be symptomatic in the 1st year of life, while the diagnosis was established in 60% of patients by the 1st month of age.

Objectives: To identify the occurrence of specific types of CHD among hospitalized patients and to evaluate of growth of patients by different congenital heart lesions.

Methods: A retrospective study, done on ninety-six patients (51 male and 45 female) with congenital heart disease (CHD) admitted to central teaching hospital of pediatrics, Baghdad from 1st September 2009 to 30th of August 2010.

Results: The most common congenital heart diseases (CHD) were ventricular septal defect (VSD), tetralogy of Fallot (TOF), patent ductus arteriosus (PDA), transposition of great arteries (TGA), pulmonary Stenosis( PS), and Atrial septal defect (ASD).The most common modes of presentation were respiratory infection and heart failure in acyanotic patients and cyanosis in cyanotic groups. The study showed that only patent ductus arteriosus and atrial septal defects were more common in female while all other lesions were equal male to female ratio or slightly more common in male. The effect of acyanotic congenital heart disease on growth (Wt) is more common than cyanotic congenital heart disease.

Conclusions: VSD is the most common type of congenital heart disease and the most common cause of morbidity, while ASD is the least common cause of morbidity in patients with congenital heart disease. The most common modes of presentation of patients with CHD are respiratory infection and heart failure in acyanotic CHD while cyanosis is the most common presentation in cyanotic group.
Escarificación para la reproducción de la especie ilama (Annona purpurea moc y sesse ex dunal), en la comunidad de san miguel, municipio de Acayucan, Veracruz, México
Authors: Cházari Hernández Roque Emilio , Retureta Aponte Alejandro , Tinoco Alfaro Carlos Alberto , Castillo Capitán Guadalupe , Velázquez Silvestre María Gisela
Published: December 2020

En este trabajo se evaluó la reproducción de la especie Annona purpurea bajo las condiciones que se encuentran en la comunidad de San Miguel municipio de Acayucan, ver. Esto consistió en tener mayor germinación para los siguientes tratamientos de escarificación, (T1 EH) Remojo en agua fría por 24 horas,(T2 EH) Remojo de agua fría por 48 horas, (T3 EH) Remojo de agua fría por 72 horas, (T4 E Q) Escarificación de H2SO4 (ácido sulfúrico) por 1 minuto,   (T5 EQ) Escarificación de H2SO4 (ácido sulfúrico) por 3 minutos, (T6 EQ) Escarificación de H2SO4 (ácido sulfúrico) por 5 minutos, (T7 ET) escarificación H2O caliente por 1 minuto, (T8 ET) Escarificación H2O caliente por 3 minutos, (T9 ET) Escarificación H2O caliente por 5 minutos, (T10 EF) Escarificación física (lijado),(T11 T) Testigo, los cuales se colocaron a un modelo experimental de bloques completamente al azar con 4 repeticiones cada tratamiento en bloques, evaluándose las siguientes variables % de germinación y Evaluar el promedio de días de germinación de cada tratamiento. Esto se empezó a realizar la siembra del 6 de marzo concluyendo el día 14 de junio del mismo año 2016 y como resultado de acuerdo al análisis de varianza tuvo mejor resultado el (T1) con mayor germinación y también teniendo menor días de germinación, aunque se aclara que también en la varianza arroja que no hay una varianza significativa con los demás tratamientos.
EASYC -AN INTERACTIVE TEXT EDITOR FOR C
Authors: PRAKASH.S SURIYA , E MOHANA. , .S MEGALA , BAALAJI.T SAKTHI
Published: December 2020

EasyC is an interactive text editor for C language. It is developed using PHP and JavaScript. So we can upload it as online web application .The basic idea is that instead of making the user to type all the lines of program let them to click options, so that the corresponding syntax will be pasted. EasyC reduces the typing work up to 90% and thus saves the time up to 75%.EasyC provides things which are all related to typing reduction but the compilation area is separate which is standard in TurboC compiler. EasyC removes 99% of syntax errors before submitting the program to the compiler.
RADIO ACCESS NETWORK REQUIREMENT FOR NEW DEPLOYMENT OF WIMAX IN DHAKA
Authors: Kawser Tawhid , AL-AMIN MOHAMMED R. , ISLAM KHONDOKER Z. , MOHAMMAD SIFAT-E-
Published: December 2020

Mobile WiMAX is expected to be the next generation radio-interface, complementing WLAN and challenging EVDO/HSPA/LTE. High speed data rate, reduced latency, better Quality of service, and mobility can allow WiMAX to meet the rapidly growing demand of the users. A study of WiMAX Radio Network Planning (RNP) for an urban area like Dhaka city in Bangladesh is presented in this paper in order to help predetermine the radio access infrastructure requirements. A suitable radio planning tool has been used for this purpose. The simulation results of throughput and Carrier to Interference plus Noise Ratio (CINR) are provided.
A SURVEY ON MOBILE AGENT ITINERARY PLANNING IN WIRELESS SENSOR NETWORKS
Authors: K LINGARAJ. , D ARADHANA.
Published: December 2020

It has been proven recently that using Mobile Agent (MA) in wireless sensor networks (WSNs) can drastically help to obtain the flexibility of application-aware deployment. Normally, in any MA based sensor network, it is an important research issue to find out an optimal itinerary for the MA in order to achieve efficient and effective data collection from multiple sensory data source nodes. In this paper, we firstly investigate a number of conventional single MA itinerary planning based schemes, and then indicate some shortcomings of these schemes, since only one MA is used by them. Having these investigations and analysis, novel Multi-agent Itinerary Planning (MIP) algorithms to address the shortcomings of large latency and global unbalancing of using single MA and its effectiveness is proved by conducting the extensive experiments in professional environment.
VULNERABILITY ASSESSMENT AND PENETRATION TESTING
Authors: UMRAO SACHIN , KAUR MANDEEP , GUPTA GOVIND KUMAR
Published: December 2020

In this modern world, all of the persons are using the facility of internet. SECURITY is one of the major issue of the internet. Everyday highly skilled hackers breach the security and take the advantage of vulnerabilities to access the confidential data. To overcome this problem one solution was suggested named Vulnerability Assessment and Penetration Testing (VAPT). Vulnerability Assessment is the art of finding an open door. Penetration Testing involves a series of activities undertaken to identify and exploit security vulnerabilities. Penetration testing is widely used to help ensure the security of the network. Traditional penetration testing were manually performed by tester according to scheme, the process is usually complex resulting in that it is labor-intensive and requires tester to be familiar with all kind of tools. So it is very desirable to use a unified method to describe the scheme which can be identified by computer, then the computer can be used to substitute for tester to perform penetration testing. This paper gives the overview of VAPT and describes the process & methodology of Vulnerability Assessment and Penetration Testing.
SURVEY OF BOTNETS AND DETECTION TOOLS
Authors: ARYA VIVEK , CHAUHAN ASHISH
Published: December 2020

Botnet meaning bot network is a collection of infected computers under the command and control of a single individual known as a botmaster. Botnets are a current threat to the Internet community and have recently been a root cause of many Internet attacks. Various attacks that include spamming, distributed denial of service attacks, phishing, click fraud, hosting illegal material, key logging etc. are being carried out by hackers using botnets. Botnets are becoming more efficient and more elaborate with time and their use is growing at an exponential rate. In this paper a detailed study of botnet, their topologies, rallying mechanisms and communication protocols used and detection mechanisms both at the network and host level are presented.
FRAMEWORK FOR IMPLEMENTING KNOWLEDGE MANAGEMENT IN ENGINEERING INSTITUTE
Authors: U P NARENDRA , B S PRADEEP
Published: December 2020

Knowledge is the information that is learnt or understood from the education and experience. Knowledge is not just to be shared but also stored for mining new information. The present Indian Technical Education is changing alarmingly and needs to adapt to the rapidly changing technological changes. Also there is a need to bridge the gap between academics and Industry needs. With the ever changing expectations of the learner, we need to adapt to the technology to a larger extent to share knowledge. Knowledge sharing using technology is the need of the hour today. Institutions must manage knowledge effectively in order to take full advantage of the skills and experience inherent in their systems as well as the tacit knowledge belonging to the teachers of the Institute. Knowledge, being the most important resource needs to be managed effectively. Knowledge Management not only retrieves and stores the existing knowledge but also supports the growth of new knowledge. Most educational institutions have some type of Information systems in place to store knowledge, but there is lot of barriers that makes the sharing of knowledge difficult. There should be a proper framework to store assimilate and share knowledge in an institution. To cater to the knowledge needs of the institution, a framework for the knowledge management is designed. This system is designed keeping in mind the requirements of an Indian Technical Institute. This system will be used for creating, assimilating, sharing and overall Knowledge Management of an Institution.
Pengaruh Kepemimpinan terhadap Kinerja Karyawan pada PT. SAMKO Indonesia
Authors: Amirudin Amirudin , Ariyanto Aris
Published: December 2020

Penelitian ini bertujuan untuk mengetahui pengaruh kepemimpinan terhadap kinerja karyawan pada PT. Samko Indonesia. Metode yang digunakan adalah explanatory research dengan sampel sebanyak 74 responden. Teknik analisis menggunakan analisis statistik dengan pengujian regresi, korelasi, determinasi dan uji hipotesis. Hasil penelitian ini variabel kepemimpinan diperoleh nilai rata-rata skor sebesar 3,39 dengan kriteria kurang baik. Variabel kinerja karyawan diperoleh nilai rata-rata skor sebesar 3,79 dengan kriteria kurang baik. Kepemimpinan berpengaruh positif dan signifikan terhadap kinerja karyawan dengan nilai persamaan regresi Y = 11,377 + 0,784X, dan nilai koefisien korelasi 0,762 atau memiliki tingkat hubungan yang kuat dengan nilai determinasi 58,1%. Uji  hipotesis diperoleh signifikansi 0,000 < 0,05.
Pengaruh Earning Per Share dan Return On Asset terhadap Harga Saham pada PT. Gudang Garam, Tbk.
Authors: Nuryani Anum
Published: December 2020

Penelitian ini bertujuan untuk mengetahui Pengaruh Return on Asset dan Debt to Asset Ratio Terhadap Earning Per Share Pada PT. Gudang Garam, Tbk. Metode yang digunakan adalah explanatory research. Teknik analisis menggunakan analisis statistik dengan pengujian regresi, korelasi, determinasi dan uji hipotesis. Hasil penelitian ini Return on Asset tidak berpengaruh signifikan terhadap Earning Per Share sebesar 4,0%, uji hipotesis diperoleh t hitung < t tabel atau (0,577 < 2,306). Debt to Asset Ratio berpengaruh signifikan terhadap Earning Per Share sebesar 66,7%, uji  hipotesis diperoleh t hitung > t tabel atau (4,005 > 2,306). Return on Asset dan Debt to Asset Ratio secara simultan berpengaruh signifikan terhadap Earning Per Share diperoleh persamaan regresi Y = 246,871 + 6,945X1 + 31,668X2 dan nilai determinasi sebesar 77,1%, uji hipotesis diperoleh nilai F hitung > F tabel atau (8,593 > 4,350).

Penelitian ini bertujuan untuk mengetahui Pengaruh Return on Asset dan Debt to Asset Ratio Terhadap Earning Per Share Pada PT. Gudang Garam, Tbk. Metode yang digunakan adalah explanatory research. Teknik analisis menggunakan analisis statistik dengan pengujian regresi, korelasi, determinasi dan uji hipotesis. Hasil penelitian ini Return on Asset tidak berpengaruh signifikan terhadap Earning Per Share sebesar 4,0%, uji hipotesis diperoleh t hitung < t tabel atau (0,577 < 2,306). Debt to Asset Ratio berpengaruh signifikan terhadap Earning Per Share sebesar 66,7%, uji  hipotesis diperoleh t hitung > t tabel atau (4,005 > 2,306). Return on Asset dan Debt to Asset Ratio secara simultan berpengaruh signifikan terhadap Earning Per Share diperoleh persamaan regresi Y = 246,871 + 6,945X1 + 31,668X2 dan nilai determinasi sebesar 77,1%, uji hipotesis diperoleh nilai F hitung > F tabel atau (8,593 > 4,350).
Subarachnoid haemorrhage from Spinal Dural Arteriovenous Fistula in a child
Authors: Ramnarine Narindra , Knight Patrick , Ramnarine Devindra
Published: December 2020

SAH in the paediatric population is an uncommon entity accounting for 1-2% of SAH in all age groups & only 18% of ICH in the paediatric population. Trauma is the most common cause of isolated SAH in the paeditric population, with ruptured intracerebral aneurysms although still rare, being the most common cause of spontaneous SAH in children. AVMs are uncommon source of spontaneous SAH. Although they are 10 times more common than cerebral aneurysms in the paediatric population, they rarely present with isolated SAH. This report aims to present such a rare case presented to a tertiary care hospital in Trinidad.
The global challenge of ageing population – Part I: Definitions, epidemiology and physiological changes
Authors: Sammy Ian , Paul Joanne
Published: December 2020

Background & Objectives
Over the past 50 years, epidemiological data from the World Health Organisation has demonstrated a trend towards population ageing throughout the world. While this is widely recognised in the developed world, the phenomenon has been largely overlooked in the developing world, despite the fact that the rate of ageing in developing countries far outstrips that of developed countries. This global trend towards an increasingly older society has significant implications for healthcare. This article aims to review the definitions of ageing, its epidemiological characteristics and physiological changes associated with ageing.

Methods
A narrative review of the literature was undertaken using Medline, CINAHL and the Cochrane Database, supplemented by manual searches of the literature, and guided by the reference lists of relevant papers identified in the electronic search. No restriction was placed on the type of paper to be included in the study.

Results
The initial electronic search of the three databases included 239 papers, of which 60 were found to be relevant and included in this review. These articles discussed the epidemiology and definition of ageing, the physiology of ageing and its impact on health and illness, and the implications for health services. The overall findings of the studies implicate the clear differences in the physiology of older people, which do create specific challenges for health service provision.

Conclusion
Population ageing is a significant global phenomenon, affecting both developed and developing regions of the world. More work is needed, particularly in the developing world, to better understand the impact of ageing on our population.
The impact of interventions to improve compliance in hand hygiene – a prospective study from Sangre Grande Hospital
Authors: Nagassar Rajeev , Bridgelal-Nagassar Roma , Daniel Keston , Harper Lima
Published: December 2020

Objectives
To assess the compliance of hand hygiene (HH) practices of staff and determine the impact of multimodal interventions to improve hand hygiene practices.

Methods
A prospective study was conducted to determine the hand hygiene (HH) practices of staff according to the World Health Organization’s “5 moments of HH”. During random visits to the general wards, HH practices of staff were observed for 41 weeks during 2014-15. During the first 8 weeks, the basic compliance rate (BCR) was calculated. A BCR of 50% or more was considered compliant. Data were provided to the staff via email. Toolbox talks, posters, and other educational interventions were instituted in a multimodal manner. Wards were visited by infection control staff to reinforce HH practices. During the post-intervention phase, the HH practices were reassessed for 33 weeks to compare the impact of interventions.

Results
A total of 13,120 observations were made. Participants ranged from ages 18 to 65. The overall average BCR before intervention was 34.1%, for the first 8 weeks, while it increased to 62.3%, over the next 33 weeks, after the multimodal interventions (p =0.007). The wards which showed significant improvement include Paediatrics (p <0.0001), Male Surgical (p = 0.001), Female Surgical (p = 0.005), Male Medical (p < 0.0001), Haemodialysis Unit (p < 0.0001), ICU, (p = 0.038), and Accident and Emergency (p = 0.007). Obstetric, Female Medical, and Oncology wards did not show statistically significant improvement.

Conclusion
Hand Hygiene compliance rate of staff can be improved by multimodal interventions in a General Hospital setting.
Missed arteriovenous malformation in the foot
Authors: Budhoo Emerson , Maharaj Dale , Oladiran Adidapo
Published: December 2020

Arteriovenous malformations (AVMs) of the lower limb typically occurs in the thigh, knees and very rarely on the foot, especially on the plantar aspect of the foot. Failure of recognition of this condition and prompt treatment results in complications such as pain, ulceration, bony abnormalities and limb length discrepancies in some cases.

Treatment modalities vary in accordance with the institutional convention as well as the surgeon’s preference. These may range from open resection, sclerotherapy, embolization, and radiosurgery when the lesion is relatively smaller in size.
Adult Noonan’s syndrome and associated severe scoliosis. A case report and discussion of the anaesthetic implications.
Authors: Singh Keevan , Ramdin Candice
Published: December 2020

Noonan’s syndrome is a relatively rare genetic disorder with distinct clinical manifestations. Surgery is usually required early on in life however many of these patients can present for surgery later in life. Specific challenges to the anaesthesia can include, coexistent cardiac abnormalities, risk of difficult intubation, bleeding abnormalities, scoliosis and the potential for triggering Malignant Hyperthermia. Although characteristic phenotypical appearances can become less distinct with age, many abnormalities persist along with new potential problems.
We report a case of an adult male with Noonan’s syndrome who developed severe scoliosis and presented for elective hemorrhoid repair. The procedure was safely performed under low dose spinal saddle anaesthesia. We also review the relevant perioperative issues and the challenges that can be encountered when deciding on the most appropriate mode of anaesthesia.
Toxocara canis in puppies and their public health importance in Grenada
Authors: Schwartz Regan , Bidaisee Satesh , Macpherson Calum
Published: December 2020

Objectives: To determine the prevalence of Toxocara canis in puppies under 1 year of age and to understand the human-puppy relationship and risk behavior and also to determine the knowledge, attitudes and practices regarding its zoonotic potential amongst puppy owners, veterinarians, physicians and 6th term veterinary students

Methods: A cross-sectional prevalence study in puppies less than one year of age was conducted by collecting fecal samples from puppies during the period January through November 2017 from households in all 6 parishes throughout Grenada. These were tested for T. canis positivity. The owners of the puppies as well as veterinarians, physicians and veterinary students were surveyed using a questionnaire.

Results: A total of 306 fecal samples were collected. 147 (48%) puppies were positive for T. canis; of these 142 puppies were < 7 months of age and 5 between 7-10 months. 35 owners never treated puppies, 97% never spayed or neutered their adult dogs, 68% allowed their puppies to roam free and only 9% cleaned up after their puppies. 16.7% of physicians spoke with patients about zoonotic disease potential, none have ever diagnosed toxocariasis in adults or children in Grenada, and 60% cited ‘no concern’ regarding the zoonotic potential of T. canis to their patients. 6.5% of veterinary students ranked a ‘significant concern’ regarding the zoonotic potential of T. canis, 3.3% were aware of four clinical toxocariasis syndromes in humans and 64.5% correctly identified the main route for human transmission.

Conclusion: Puppies present a zoonotic threat to public health in Grenada. The zoonotic nature of T. canis is predominantly unknown to the public and there is a need for educating the general public regarding its public health importance.
Challenges to the implementation of stroke thrombolysis
Authors: Dookeeram D , Sammy I , Pulchan K , Panday A
Published: December 2020

Objectives: Thrombolysis has become the gold standard in the treatment of ischemic stroke that meet specific criteria. While effective, the criteria of suitability are substantial and create an access block for patients. This review seeks to identify the hindrances to the process flow to successful stroke thrombolysis.

Methods: A review of literature was done regarding the challenges facing thrombolysis in stroke patients. All English language papers in the subject matter were reviewed and compared with the local situation in the Caribbean especially Trinidad & Tobago.

Results: The article presents a review of the American Heart Association’s chain of survival for patients presenting with neurological symptoms suggestive of stroke. The achievable outcomes from this paper will be to describe the potential innovations that can be implemented in the Caribbean to overcome these hindrances.

Conclusions: Public health initiatives are an essential part of improving detection. There are many systemic improvements and hospital clinical flow improvements required. It is therefore imperative for health systems managers to appreciate and be aware of all steps in the process given that any impediment abruptly ends the likelihood of successful stroke thrombolysis.
Impact of dropping out of the ‘Sports for Health’ Programme in Grenada
Authors: Bidaisee S , Macpherson C
Published: December 2020

Objective: To determine the reasons for dropping out and if there were any significant differences in body mass index (BMI) and waist-to-hip ratio (WHR) between active participants in the Sports for Health programme and participants who were lost to drop out.

Methods:
Persons who were originally part of the programme and data collection in 2011, but are no longer active participants were evaluated. The evaluation utilized the data from the participants at their last BMI and WHR measurements as programme participants and follow up measurements as non-participants in 2014.

Results:
Data analysis showed that body mass index (BMI) was signficantly higher in persons who no longer participated in the sports for health programme when compared to active programme participants. In addition, non-participation of persons in the Sports for Health programme was found to increase individual risk factors for chronic diseases, which were originally mitigated by participation in the programme. Barriers to participation by many women in the programme included lack of partner support and negative community perceptions, which influenced several women to discontinue their participation in the programme. Recommendations were made in order to address the barriers to participation and to decrease the drop-out rate in the Sports for Health programme in Grenada.

Conclusion:
Withdrawal of participation in the Sports for Health programme adversely affects persons BMI and WHR. Interrupted exercise programme contributes to increasing risk factors for several non-communicable chronic diseases.
An assessment of postoperative cognitive impairment in the elderly patients at the Port of Spain General Hospital
Authors: Ramoutar Colin , Ventour Dale
Published: December 2020

Objectives: Post-operative delirium (POD) is a relatively common occurrence particularly in the elderly, especially after prolonged surgery. This study aimed to determine the incidence of post-operative delirium at the Port of Spain General Hospital, Trinidad, West Indies.

Methods: After obtaining consent, elderly patients (≥ 65 years of age) were prospectively screened using the 4AT questionnaire pre and post-operatively. Post-operative assessment was done on day 0, 1 and 2 between the hours of 18:00 and 22:00. Demographic and clinical data were recorded.

Results: Sixty-one (61) patients were recruited. After exclusion, a total of 42 were included for the study. The incidence of POD in elderly patients at the Port-of-Spain General Hospital in Trinidad was 21.4%. Overall, eighteen (43%) patients displayed cognitive impairment post-operatively. The factors associated with development of POD were duration of anaesthesia, with surgery lasting >120 min having a 17% incidence. Delirium occurred more frequently after general anaesthesia (27%) compared to regional anaesthesia (8%). Vasopressor use and malignancy was also associated with a higher incidence of POD (33%).

Conclusion: Elderly patients had a higher risk of developing postoperative delirium following general anaesthesia compared to regional anaesthesia, and where the surgical duration exceeded 2 hours. Other factors included hypotension requiring vasopressor use and gynaecological malignancy. The 4AT is a useful tool in detecting postoperative delirium in our setting.
A Descriptive Study On The Introduction of a Palliative Care Unit at an Oncological Facility in the Caribbean
Authors: Alleyne-Mike Kellie , Ramkissoon Rishie , Bisnath Jacintha , King David , Jackman Ann-Marie
Published: December 2020

BACKGROUND: Palliative care is a currently undeveloped area with close affiliation to oncology, and its importance is often understated. Early integration is essential but limited in developing countries. OBJECTIVES: To outline unmet needs and emphasize benefits derived from the introduction of a palliative care unit at the main Oncology facility in the country. METHODS: Patient records from the palliative care unit during six months were retrieved manually. Patients needed to have a confirmed malignancy and advanced-stage disease to be included in the review. RESULTS: A total of 73 patients resulted in 162 visits. Gastrointestinal malignancies required the most input. Patients were predominantly female (58%), and the median age was 68 years. Most patients were referred late (more than eight weeks) after diagnosis of advanced-stage disease, with an Eastern Cooperative Oncology Group (ECOG) of three or more, and had a prognosis of fewer than three months. The median number of visits per patient was two, while the mode was one. Only 9.3% of patients required hospital admission. The majority of patients (72.6%) were referred after all treatment options were exhausted, and referrals from the palliative care unit were most commonly for hospice support. CONCLUSION: This introductory experience with a palliative unit outlined key areas for improvement. These included the need for earlier referrals to aid in the timely initiation of interventions addressing end of life care decisions. This has the potential to reduce the financial and low human resource burdens faced by our healthcare system.
Recommendations for antibiotic prescriptions for upper respiratory symptoms in children in Trinidad and Tobago: GRADE-ADOLOPMENT APPROACH
Authors: Nagassar Rajeev , Robinson Elson , Vedula Venkata , Vastrad Soujanya , Singh Aruna , Lochan Angelie , Baird Desiree , Manjunath Madhura , Mangaroo Rampiaree , Giddings Stanley , Seecharan Samantha , Sookraj Druv , Partapsingh Vishwanath , Bolastig Edwin , Elias Vanessa , Reveiz Ludovic , Santesso Nancy
Published: December 2020

Background: In Trinidad and Tobago, 22,329 and 18,594 cases of acute respiratory infections (ARI) in children less than 5 years were recorded for 2016 and 2017 respectively. Often, antimicrobials are over prescribed without proof of bacterial infection. Recommendations for management of ARIs are needed.

Methods: The GRADE-ADOLOPMENT approach was used to formulate recommendations. We established a guideline panel who met in person or by web conferences. We prioritised recommendation questions and searched for guidelines and systematic reviews from 2010 to July 2018 in several medical databases and guideline producer websites. We also searched for patients’ values and preferences, acceptability, resources, and feasibility studies specific to the Caribbean or Trinidad and Tobago. We summarised the evidence in evidence-to-decision frameworks and formulated recommendations by consensus.

Results: The guideline panel developed recommendations including: 1. For children 5 years old or younger who present with fever and respiratory symptoms not suggestive of serious illness, we recommend to either not prescribe antibiotics or to provide a delayed prescription (48 hours later) of amoxicillin or clarithromycin (when children have a history of allergy to penicillin) rather than an immediate prescription; 2. For children with symptoms suggestive of serious illness, we recommend immediate prescription of amoxicillin or clarithromycin (when children have a history of allergy to penicillin); and, 3. We suggest 7-10 days of treatment, depending on the suspected illness and antibiotic used.

Conclusion: Guidelines aid medical practitioners, patients and supply chain managers. This guideline will form the backbone of the 1st national standardisation of treatment using the GRADE-ADOLOPMENT approach.
Antibiotic Resistance in Trinidad: A population-based survey of adults
Authors: Ali Nyeil , Alli Subrina , Ali Ashley , Ali Aleema , Ali Chelsi , Abraham Jada , Abdool Imtiaz , Antoine Azalia , Dialsingh Isaac , Parasram Roshan , Pooransingh Shalini
Published: December 2020

Objectives: Antibiotic resistance (ABR) is a growing public health issue globally. This study aimed to ascertain the public’s knowledge of antibiotic resistance and to determine any associated demographic factors.

Method: A cross-sectional survey was undertaken in Trinidad using a modified version of a World Health Organization questionnaire. Five hundred and fifty participants aged 16 years and older were interviewed. Data were analysed using SPSS Version-22.

Results: The response rate was 91% (502/550). Most responders (53%) reported having taken antibiotics during the 6-month period prior to the survey. Almost 60% of responders believed that sore throat and colds/flu can be treated with antibiotics. Sixty-seven percent of responders believed that they had no individual role in combating the issue. Responders with a primary level education or older respondents were more likely than responders with a higher level of education or younger to agree that antibiotic resistance only affects those who use antibiotics frequently (p= 0.002 and p=0.017 respectively). Income level was also significantly associated with knowledge levels, the higher the income the more knowledgeable the responder.

Conclusion: Our study found that public knowledge of antibiotic resistance is low. Age, income and educational levels were significantly associated with certain knowledge parameters. Much work needs to be done to change the attitudes of responders who believe they have no role to play in the fight against this national and global threat. These findings may be useful to health education professionals and government antimicrobial resistance programmes.
An Epidemiological look into Hamstring Injuries in the Jamaican Athletic Population
Authors: Brown-Calvert Ruchelle , Mansingh Akshai , Roopchand-Martin Sharmella , Singh Praimanand
Published: December 2020

Objective: To take an epidemiological look into hamstring injuries in Jamaican athletes presenting to the University of the West Indies (UWI) Sport Medicine Clinic between 2007 and 2016. The research focused on the contribution of certain demographics and types of sports and activities to the classification, recovery and recurrence of these injuries.

Methods: A retrospective chart review was conducted on all the athletes who presented to the UWI Sports Medicine Clinic between 2007 and 2016. An electronic data extraction sheet was used for data collection. The target population consisted of athletes from 13 to 25 years of age who participated in competitive sports at the time of injury.

Results: Of the 125 dockets reviewed, 92 were males (73.6%), 30 were females (24%) and three were of unknown sex (2.4%). In summary, 62.4% of the injuries occurred in the 17-21 years age group, 24.8% in the 22-25 years age group and 12.8% in the 13-16 years age group. Seventy-six percent of injuries occurred in Track athletes. Running/sprinting activities were culpable for most of the injuries (42%). Of the 134 injuries, 15.7% were low, 7.5% occurred in the muscle belly, 4.5% were high and the others were unspecified. Fifteen athletes (11.2%) had subsequent recurrences with the highest recurrence rate amongst Track & Field athletes. Only 3 of 21 low injuries and 1 of 6 high injuries recovered within 6 weeks.

Conclusion: Hamstring injuries are common in Jamaican athletes with a significant male preponderance. Track & Field athletes, those in the 17 to 21 years age group and those engaging in running or sprinting activities were more likely to sustain injuries. It was difficult to compare the recovery rates of high and low injuries and recurrence rates were found to closely match those in current literature.