bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Implant-Related Anatomical Landmarks in the Mandibular Interforaminal Region in an Iranian Population Using Cone-Beam Computed Tomography
Authors: Nikkerdar Nafiseh , Golshah Amin , Mahmoodivesali Razieh , Falah-Kooshki Sepideh
Published: June 2022

Background:

This study was aimed to assess the implant-related anatomical landmarks in the mandibular interforaminal region in an Iranian population using cone-beam computed tomography (CBCT).

Methods:

In this retrospective cross-sectional study, 378 CBCT images of the mandible were evaluated for the presence of the incisive canal, anterior loop of the inferior alveolar nerve (IAN), mandibular canal, mental foramen, and incisive canal. The effect of age and gender of patients on the abovementioned variables was also evaluated. Data were analyzed using independent t-test, analysis of variance, and Chi-square test.

Results:

The anterior loop and the incisive canal were present in 36.24% and 97.62% of the cases, respectively. The mean length of the anterior loop and the incisive canal was 2.70 ± 1.20 mm and 12 ± 3.29 mm in the right, and 2.86 ± 1.24 mm and 12.21 ± 3.38 mm in the left side, respectively. The mean diameter of the mental foramen and incisive canal was 4.25 ± 1.08 mm and 1.89 ± 0.46 mm in the right, and 4.21 ± 1.02 mm and 1.94 ± 0.45 mm in the left side, respectively. The descending path was the most common path of the incisive canal. The distance from the incisive canal to the buccal plate and inferior border of the mandible was significantly shorter in females (P < 0.001).

Conclusion:

Considering the high variability and clinical significance of the incisive canal and anterior loop of the IAN, and their high prevalence, it is recommended to assess the presence/absence of these structures in the interforaminal region of the mandible on CBCT scans before surgical procedures in this region.
Factors Affecting the Outcome of Traumatic Brain Injured Patients with Acute Epidural Haematoma in National Hospital, Abuja
Authors: Ayogu Obinna Mmadukaku , Onobun Daniel Efeomo , Igbokwe Kenechukwu Kizito , Ugwuanyi Charles Ugochukwu , Mordi Chizim Otitodilichukwu , Ibeneme Sandra A.
Published: June 2022

Objective:

The objective is to determine the prognostic factors affecting the surgical outcome of patients surgically treated for acute epidural haematoma.

Materials and Methods:

A retrospective review of 71 consecutive patients who underwent neurosurgery for acute epidural haematomas over a 5-year period (from January 2015 to December 2019) was conducted. Clinical characteristics and the time intervals were investigated to determine the interactions between all these factors and the outcome. The outcome was graded according to the Glasgow Outcome Scale (GOS) at subsequent follow-up clinic visits.

Results:

The severity of traumatic brain injury using the Glasgow Coma Scale score (chi-square test, P = 0.033) had a statistically significant relationship with the outcome. The patients’ age, gender, and total length of time until surgical intervention (P > 0.05) were of no statistical significance in relation to the outcome. The mortality rate of patients presenting at our centre is 16.9%. Overall, after surgery, 47 of 71 with epidural haematoma had good recovery (GOS 5). Twelve of 71 patients had GOS of 2–4. Twelve patients died. The median duration from injury to presentation was 15 hours with an interquartile range of 15 hours.

Conclusion:

Our results indicate that the severity of brain injury is an independent risk factor in determining the outcome of epidural haematoma in traumatic brain injury.
Quivers with potentials for Grassmannian cluster algebras
Authors: Chang Wen , Zhang Jie
Published: June 2022

We consider a quiver with potential (QP)
$(Q(D),W(D))$
and an iced quiver with potential (IQP)
$(\overline {Q}(D), F(D), \overline {W}(D))$
associated with a Postnikov Diagram D and prove that their mutations are compatible with the geometric exchanges of D. This ensures that we may define a QP
$(Q,W)$
and an IQP
$(\overline {Q},F,\overline {W})$
for a Grassmannian cluster algebra up to mutation equivalence. It shows that
$(Q,W)$
is always rigid (thus nondegenerate) and Jacobi-finite. Moreover, in fact, we show that it is the unique nondegenerate (thus rigid) QP by using a general result of Geiß, Labardini-Fragoso, and Schröer (2016, Advances in Mathematics 290, 364–452).

Then we show that, within the mutation class of the QP for a Grassmannian cluster algebra, the quivers determine the potentials up to right equivalence. As an application, we verify that the auto-equivalence group of the generalized cluster category
${\mathcal {C}}_{(Q, W)}$
is isomorphic to the cluster automorphism group of the associated Grassmannian cluster algebra
${{\mathcal {A}}_Q}$
with trivial coefficients.
Is Lobbying Effictively Regulated in the Regional Self-governments in Poland? The Cases of Opolskie and Podkarpackie Regional Self-governments
Authors: Olejnik Maciej
Published: June 2022

The goal of the paper is to examine whether lobbying is effectively regulated in the regional self-governments in Poland. The article analyses two cases: Opolskie and Podkarpackie regional self-governments (2014-2020). For the purpose of the article, three types of material were gathered 1) A legislation regulating lobbying in Poland (the Law on Lobbying); 2) The results of the semi-structured interviews with sixty councilors from both regional chambers; 3) The websites and public social media accounts of the legislators and major lobbyists and the correspondence with heads of the regions’ organizational departments. Two scientific methods were adopted (institutionally-legal analysis and comparative method) to examine the material.

An outcome of the research revealed that lobbying is ineffectively regulated. A law does not provide the state with instruments allowing to control the prevailing type of lobbying (“lobbying activity”). Furthermore, neither councilors, nor lobbyists adopted ethical codes of conduct that would establish clear behavioral standards. Moreover, lobbyists have equal access only to the rank-and-file councilors, whereas solely the strongest ones can contact the legislators constituting the regional government.
The Problem of the Admissibility of Modifications to Public Procurement (and Concession Contracts)
Authors: Mužina Aleksij
Published: June 2022

The central part of the scientific article is the analysis of the problem of the admissibility of modifications of public procurement contracts and concession contracts. After the awarding of a concession or a public procurement contract, these may not be substantially changed by an agreement between the contracting authority and the successful tenderer. The research is initially focused to an analysis of the development of the legal institute in the case law of the Court of Justice and its transposition into secondary legislation of the European Union. This is followed by a comparison of the regulation in the acquis communautaire with the regulation in Slovenian positive law. The problems of the admissibility of modifications to public procurement contracts/concessions (this is the central part of the article) should be supplemented by formulating a thesis on the possible extension of comparable standards of interpretation of admissibility from the contractual (implementation) to the tendering stage of public procurement/concession.

In this scientific paper, I therefore point out (which was the purpose of the scientific paper) the hypothesis that all modifications in public procurement procedures and concession award procedures must be treated equally, regardless of the stage a relationship creation or implementation process. A different position would be administrative and contrary to the necessary functional interpretation of EU law. The modification cannot becomes admissible at the time of the conclusion of the contract, while prior to that, this modification (which would already form part of the contractual relationship) is not admissible.
Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort
Authors: Jeitziner Marie-Madlen , Moser André , Wendel-Garcia Pedro D , Exl Matthias Thomas , Keiser Stefanie , Schuepbach Reto A. , Pietsch Urs , Cereghetti Sara , Boroli Filippo , Marrel Julien , Sigg Anne-Aylin , Ksouri Hatem , Schott Peter , Dullenkopf Alexander , Fleisch Isabelle , Heise Antje , Laurent Jean-Christophe , Jakob Stephan M. , Hilty  Matthias P. , Que Yok-Ai
Published: June 2022

STUDY AIM: The surge of admissions due to severe COVID-19 increased the patients-to-critical care staffing ratio within the ICUs. We investigated whether the daily level of staffing was associated with an increased risk of ICU mortality (primary endpoint), length of stay (LOS), mechanical ventilation and the evolution of disease (secondary endpoints).
METHODS: We employed a retrospective multicentre analysis of the international Risk Stratification in COVID-19 patients in the ICU (RISC-19-ICU) registry, limited to the period between March 1 and May 31, 2020, and to Switzerland. Hierarchical regression models were used to investigate crude and adjusted effects of the critical care staffing ratio on study endpoints. We adjusted for disease severity and weekly caseload.
RESULTS: Among the 38 participating Swiss ICUs, 17 recorded staffing information. The study population included 437 patients and 2,342 daily assessments of patient-to-critical care staffing ratio. Median of daily patient-to-nurse ratio started at 1.0 [IQR 0.5–1.5; calendar week 9] and peaked at 2.4 (IQR 0.4–2.0; calendar week 16), while the median of daily patient-to-physician ratio started at 4.0 (IQR 2.1–5.0; calendar week 9) and peaked at 6.8 (IQR 6.3–7.3; calendar week 19). Neither the patient-to-nurse (adjusted OR 1.28, 95% CI 0.85–1.93; doubling of ratio) nor the patient-to-physician ratio (adjusted OR 1.07, 95% CI 0.87–1.32; doubling of ratio) were associated with ICU mortality. We found no association of daily critical care staffing on the secondary endpoints in adjusted models.
CONCLUSION: We found no association of reduced availability of critical care staffing resources in Swiss ICUs with overall ICU length of stay nor mortality. Whether long-term outcome of critically ill patients with COVID-19 have been affected remains to be studied.
COVİD-19 PANDEMİ SÜRECİNİN AKADEMİSYEN BABALARIN YAŞAMINA YANSIMALARI: NİTEL BİR ARAŞTIRMA
Authors: GÜNGÖR Şefika Dilem , DAŞBAŞ Serap , AKÇAY Sinan
Published: June 2022

Bu araştırma COVİD-19 sürecinde evden çalışan akademisyen babaların; çocuk bakımı, ev içi rollere katılımları ve iş yaşamlarına dair deneyimlerini keşfetmek amacıyla, nitel araştırma yöntem ve teknikleri kullanılarak yapılmıştır. Amaçlı örneklem ve kartopu örneklem modelleri kullanılarak, 2-10 yaş arası çocuğa sahip olan 16 akademisyen baba ile derinlemesine görüşmeler yapılmıştır. Görüşmeler neticesinde elde edilen veriler MAXQDA programı ile analiz edilmiştir. Analiz sonucunda “pandeminin kişisel yaşama yansımaları, babalığın ifade ettiği anlam, pandemi sürecinin çocukla ilişkiye yansımaları, pandemi sürecinin eşle ilişkiye ve ev içi rollere yansımaları, pandemi sürecinin iş yaşamına yansımaları” olmak üzere beş temaya ulaşılmıştır. Katılımcıların COVİD-19 sürecinde babalığa dair düşüncelerinin ve babalık rollerinin; katılımcı baba olma doğrultusunda olumlu bir ivme kazandığı fakat uzaktan çalışma sürecinin devam etmesi nedeniyle de birtakım sorunlar yaşadıkları sonucuna ulaşılmıştır. COVİD-19 sürecinde sosyalleşmenin azalması ile evlerinden çalışan babalar, çalışma saatlerini minimum düzeyde tutarak ailelerine daha fazla zaman ayırdıklarına dikkat çekmişlerdir. Katılımcıların bu süreçte zaman zaman sosyal destek mekanizmalarına ihtiyaç duydukları ve süreçle ilgili eğitimlere açık oldukları sonucu ortaya çıkmıştır.
Welding Order and Welding Penetration Levels’ Impact on Product Life Cycle For GMAW
Authors: BİLGİLİ Ceren , UYGUN Sibel , YILMAZ Gizem
Published: June 2022

Gas metal arc welding is a high-speed, economical process that is also called as "metal inert gas welding" or "metal active gas welding" which are sub-types of gas metal arc welding. This method is used for production of different parts in many industries. In this paper, the focus will be on automotive applications of this process and the impact of the parameters of this production method on the durability performance of the axle component of a vehicle. Experiments have been conducted on the axles that have been produced in serial life production conditions and have been investigated under real life road load conditions to determine their performance levels. After theoretical calculations and physical tests, each measured improvement had been documented for every parameter of the welding process. All this data had been analyzed in detail and these parameters’ projected impacts on the axle life cycle had been evaluated with respect to the serial life usage condition expectations.
DTMF BASED LOAD CONTROL SYSTEM
Authors: Sandeep Kumar Dehuri  , Vikas Kumar Sahu  , Piyush Sahu  , Rahul Pandey
Published: June 2022

The paper presents the design of a DTMF based home automation system. DTMF means Dual Tone Multiple Frequency. Now a
day’s mobile phones are a part of our day-to-day life, since the price is also getting low, they are widely used in home automation. Key benefit
of a DTMF based system is that it may remotely be controlled from a far place which minimizes human stress. The DTMF-based system
consists of 2 mobile phones, one mobile is used as a remote and the other as a receiver. The DTMF decoder MT8870 decodes the DTMF tones
and hence the appliances are operated.
KİŞİSEL BAŞARI ALGISININ BELİRLENMESİNE YÖNELİK BİR ARAŞTIRMA: ORDU İLİ NOVADA ALIŞVERIŞ MERKEZİ MAĞAZA YÖNETİCİLERİ ÖRNEĞİ
Authors: CORA İhsan , AYDIN Sinem
Published: June 2022

Günümüzde teknolojide yaşanan gelişmelerle birlikte dünya yeni bir durum almaktadır. Dünyada yaşanan bu değişim ve gelişmeler iş hayatıyla birlikte bireyleri de etkilemektedir. Bu değişimden etkilenen iş dünyası daha kalifiye, daha bilgili, daha idealist ve daha çalışkan bireyleri tercih etmeye başlamıştır. Buradan hareketle, yöneticilerin kişisel başarı algılarının belirlenmesi önem arz etmektedir. Bu kapsamda Ordu ili Novada alışveriş merkezindeki 85 mağaza yöneticisine anket uygulanmıştır. Anket formları bizzat araştırmacı tarafından dağıtılmış ve toplanmıştır. Anketlerden elde edilen veriler SPSS 21.0 paket programında analiz edilmiştir. Analiz sonuçlarına göre; yöneticiler yaptıkları işe hâkim olduklarını, kendilerine verilen görevi yerine getirmek için çok çalıştıklarını, yaptıkları işi kusursuz bir biçimde yaptıklarını, iş ile ilgili ortaya çıkan sorunlarla baş edebileceklerini, ikna edici ve etkileyici olduklarını ve insanları kolay organize edebileceklerini düşünmektedirler. Bunun yanı sıra yöneticilerin demografik özellikleriyle kişisel başarı algıları arasında istatistiksel olarak anlamlı bir farklılığın bulunmadığı tespit edilmiştir.
ON THE QUESTION OF THE “BEGINNINGS” OF HISTORIOGRAPHY IN THE RUSSIAN SCIENCE OF UNIVERSAL HISTORY
Authors: Ahmadiev Farit N.
Published: June 2022

The paper presents the results of the study on the importance of the historiographical component in the Russian science of universal history at the beginning of the second half of the XIX century. Special attention is paid to the study by Russian historians of the European science of universal history, which had a significant impact on the formation of the Russian science of universal history, starting with the university lecture courses by T.N. Granovsky and P.N. Kudryavtsev in the middle of the XIX – the beginning of the XX century. Special attention is paid to the first historiographical works by Mikhail Nazarovich Petrov (“The Latest National Historiography in Germany, England and France”) and Vladimir Ivanovich Guerrier (“Essay on the Development of Historical Science”), due to whom the European historiography of universal history turned into a research field. These two works, one of which was published in Kharkov in 1861, and the other – in 1865 in Moscow, laid the “beginnings” of historiography per se, i.e. historiography as an independent scientific discipline with its own research subject, methods, methodology, etc. In fact, there was rethinking of historiography as a historical phenomenon, and consequently, there was a need to find the “point” where knowledge about the history of science acquired its internal logic and thus turned from historiographical experience into systematized knowledge. The essence of this “point” (or moment) is that a system or organized knowledge (in other words, a concept) appeared in historiography, which turned knowledge about the history of science into a scientific discipline. The questions when and how this happened remain open. In any case, M.N. Petrov and V.I. Guerrier were the first Russian historians who sought to turn the “beginnings” of historiography into a scientific discipline. The question of the priority of the first Russian professional historiographer is still unresolved. V.E. Illeritsky expressed an opinion that it belongs to S.M. Solovyov, according to R.A. Kireeva – to M.O. Koyalovich.
Arka Prakasha of Ravana: A Book Review
Authors: Gaitonde Vrashank  , Katti Anand
Published: June 2022

Arka prakasha is a text written by Ravana in the series of Sanskrit works by Ravana, the devotee of Lord Shiva. In this book there is extensive conversation between Ravana and his wife Mandodari. He explains each and every detail of the method of preparation of Arka (Distillate), the apparatus and different varieties of substance which is used for preparing Arka. He has explained everything in 10 chapters with each chapter containing 100 Shlokas in each chapter. Since each chapter contain 100 Shlokas, it is titled as Shataka. Arka is considered as one among the five basic principles (Pancha Vidha Kashaya Kalpana). The present work is an attempt to summarize the key feature of Arka Prakasha to highlight its utility and contribution in the development of Rasa Shastra and Bhaishajya Kalpana. And also, to study & summarize the important comprehensive and specific points mentioned in Arka prakasha. Thereby, to elaborate the contribution of Arka prakasha in the field of Rasashastra and Bhaishajya Kalpana.
A Review on Guggulu [Commiphora Wightii (ARN.) Bhand.], its Phytochemical Constitution and Mode of Action
Authors: Shaikh Mohammad Azharhusain  , Birendra Shrivastava  , Aamer Quazi  , Mohammad Arshad Javed Shaikh  , Mohsina Patwekar
Published: June 2022

The history of human medicine goes back theoretically to the sheer onset of civilizations and evolved with the corresponding circumstances. Natural ingredients, that are plant based, animal based or mineral based have been incorporated since ages in the management of health and disease. The presently popular and universally accepted modern medicine has developed slowly and methodically, over generations of scientists with their application of scientific studies and an enormous amount of research. The popularity and acceptance of modern medicine may be huge today; however, the base of its research and resources stay put in traditional system of medicine itself. Even today the future of medicine in general has a tremendous scope for natural product-based drug and formulations and hopefully will prove to be more holistic, customized with a wise amalgamation of ancient and modern medicinal fundamentals and skills so as to give maximum benefit to the present and future human generations. Ayurveda, translated as the “Science of Life”, the ancient medicinal system of the Indian subcontinent, remains the oldest of all form of medications. Ayurveda incorporates a holistic approach to medicine and makes it highly personalized. There are around 45,000 species of plants with various medicinal properties attributed to them. This paper aims at understanding the composition, chemical constitution and exact mode of action of Guggulu.
Efficacy of Draksadi Phantam in Generalized Anxiety Disorder- An Uncontrolled Clinical Trial
Authors: Ayushlal PM  , Satheesh K  , Vinod R  , Jithesh M
Published: June 2022

Anxiety disorders are one of the most prevalent class of mental disorders in the general population. Generalized anxiety disorder (GAD) is a common anxiety disorder that comprises continuous and long-lasting worrying, tension, which making normal life problematic and relaxation impossible

The prevalence rate of GAD disorder is increasing constantly in modern era. Though many different types of modern medications used currently to treat anxiety disorders provide temporary relief, they come with various side effects, Drug dependence and safety concerns. In Ayurveda the symptoms of this disease show resemblance with the condition. Cittodvega (excited state of mind) which is one among the Manovikara in Ayurveda caused by dysfunction of increased Vata and Pitta dosha.

The present study was conducted as an Uncontrolled clinical trial to study the Efficacy of Drakshadi Phantam in 38 diagnosed participants of Generalized Anxiety Disorder with the age group 20–50 were administered with 100ml of Drakshadi Phantam twice daily before food continuously for a period of 45 days.

Five assessments were done staring from 0th day of treatment to 60 the day of the study with a gap of 15 days, using Hamilton anxiety rating scale and Rajas Tams rating scale. The assessment scores of different intervals were statistically analysed using RM ANOVA. Effect of the therapy were statistically analysed in each domain of HAM – A rating scale in different intervals of the study. The therapy was found statistically significant in reducing the symptoms of GAD in all the 14 domains of the HAM- A Rating scale.             

Based on results it has been concluded that Drakshadi Phantam has statistically significant effect in reducing the symptoms of all the 14 domains of Hamilton anxiety rating scale and reducing the Rajasika and Tamasika qualities of the study participants.
An American Investor in the Theatre Industry of Budapest
Authors: Heltai Gyöngyi
Published: June 2022

In the interwar period, an American theatre and film entrepreneur had a determinantimpact on the private theatre sector of Budapest. Ben Blumenthal (1883–1967) ran the Vígszínház(Comedy Theatre) in 1920–1926 and owned its building in 1920–1949. In addition, Blumenthalfinanced the operation of the Fővárosi Operettszínház (Budapest Operetta Theatre) in 1922–1926.Although from a global perspective, Blumenthal does not belong to the group of legendaryUS theatre or movie producers, in the context of Hungarian theatre culture, he was the mostinfluential mediator in Hungarian–American cultural relations. The study aims to piece together theundiscovered elements of Blumenthal’s personal and professional biography and to discuss how hisactivities were evaluated from the American and the Hungarian perspectives.Special emphasis will be given to the US and Hungarian entertainment press: Blumenthal’sinterviews on his Hungarian theatres, articles on Blumenthal’s position in the transnationalproducers’ hierarchy, and representation of the Vígszínház in the US entertainment press. The aim isto assess the significance of Blumenthal’s Budapest business activities within his entire career.
Musical Theatre as an Object of Transnational Political Exchange
Authors: Frank Vojtěch
Published: June 2022

The paper focuses on the ways Czech-language theatres in Czechoslovakia were dealingwith the obligatory presence of Soviet operetta titles in their repertoire, dating from about 1950to 1989. The reform of Czech musical theatre began right after World War II. In search of the right,nationalized form of operetta, Czech theatre organs soon understood that the example must bedrawn from the hegemonic Soviet culture. In the Soviet discourse, mainly Isaac Dunayevsky’soperettas were considered masterpieces, and Czech theatre politicians were soon paying theirattention to them. After some initial difficulties in obtaining material for the operettas, Dunayevsky’spieces entered Czech theatre and stayed on the repertoire to the beginning of the 1960s. Afterthe Warsaw Pact Invasion in 1968, Soviet operettas re-entered the theatres’ repertoire; however,their reception and staging circumstances were much more complicated. The paper focuses on themain tendencies in staging Dunayevsky’s operettas in Czechoslovakia, the political and culturalbackground of productions, and the various ways of presenting it in Czech society and culture. Thecultural and historical microprocesses analysed may then throw light on a wider range of historicaland cultural phenomena, including cultural transfers and relations between Czechoslovakia and theSoviet Union, the discrepancies between the official and unofficial discourse, as well as the role ofpopular musical theatre in a socialist society.
A Comparative History of Local Resilience?
Authors: Egry Gábor
Published: June 2022

The classic accounts of the history of the Habsburg Empire emphasized the importance of the conflict of nationalities and alleged that national oppression was the root cause of the Empire’s dissolution in 1918. Based on new results, however, the Nepostrans ERC project has raised two important issues: caution against the idea of all-pervasive nationalisms, and the perspective that the disappearance of Austria–Hungary was not a clear and sharp break and that continuities were just as important as ruptures. Built on concepts like ‘phantom boundaries’ (Phantomgrenzen) and New Imperial History, the focus of the Nepostrans ERC project is a dual one. The first aspect centers on the transformation of imperial society, governance, and institutions that emerged due to the war effort, and the second on the transition out of the imperial framework as the key consequence of the latter, with special attention given to social and institutional consequences and the enabling of new statebuilding efforts at a local level. The fundamental issues addressed by the project—running from 2018 to 2023—are the various relations between statehood and society at the local and regional levels that are examined in nine cases: Tyrol,  Hradec Králové (Königrätz), southern Banat, Znojmo (Znaim), Prekmurje (Muravidék), Rijeka (Fiume), Kolomiya (Kolomea), Baia Mare (Nagybánya), and the outskirts of Budapest. The cases were primarily selected to represent typical variations in  the social and political configuration during investigated period, 1917–1930.
Determinants of Health-Related Quality of Life Among Community Dwelling Elderly
Authors: George Pradeep P , Heng Bee Hoon , Wong Lai Yin , Ng Charis WL
Published: June 2022

Introduction: This study determines the associations between self-reported chronic conditions, limitations in activities of daily living and health-related quality of life (HRQoL) among community dwelling elderly in Singapore. Materials and Methods: A populationbased cross-sectional survey was conducted among a random sample of 4200 residents from 58 blocks of dwellings in Marine Parade housing estate between April and May 2011. A structured questionnaire was used to collect data on demographic characteristics; chronic disease profi le, health screenings, healthcare utilisation, physical activity, activities of daily living (ADL) and functional ability and health related quality of life. Quality of life was assessed using European Quality of life 5 Domain (EQ-5D). Ordinary least squares (OLS) regression was used to identify independent predictors of health related quality of life. Results: A total of 2454 respondents for included for analysis. Most of the respondents were females (57.2%) and aged between 65 and 74 years (48.5%). Among them, 79.1% of the respondents were Chinese. Approximately three-fourth (77.5%) of the survey respondents reported having at least one of the 13 chronic medical conditions; high blood pressure (57.7%), high blood cholesterol (51.6%), diabetes (22.9%) were the most commonly reported conditions. Independent predictors of HRQoL with greatest decrements in EQ-5D index and visual analog scores (VAS) were unemployment, selfreported depression, arthritis and osteoporosis and ADL limitations for activities such as “unable to shower”, “unable to do housework” and elderly with depressive symptoms (GDS score ≥ 5). Conclusion: The study had identifi ed predictors of HRQoL in elderly Singapore residents and also provides community-based EQ-5D index and VAS scores associated with a wide variety of chronic conditions and ADL limitations. Key words: Activities of daily living, Chronic conditions, EQ-5D, Health-related quality of life, elderly, Predictive factors, Singapore, Utility values
Diagnostic Value of Ultrasound-detected Calcification in Thyroid Nodules
Authors: Wang Zhihong , Zhang Hao , Zhang Ping , He Liang , Dong Wenwu
Published: June 2022

Introduction: This study analyses the diagnostic value of ultrasonography (US) detection
for calcification in thyroid nodules. Materials and Methods: We analysed the preoperative
US findings and clinical characteristics of 577 malignant and 3434 benign thyroid
patients who underwent surgery in our hospital. Results: The malignant rate in patients
with microcalcification hyperechoic and tiny calcification foci ≤2 mm in diameter was
significantly higher than the non-calcification and other calcification group (P <0.001). The
malignant rate in single calcification nodule was significantly higher than that in multiple
nodule group (P <0.01). Most of the patients (37/39) with lymph node calcification were
malignant. The malignant rate of calcification and microcalcification was significantly
higher in patients <45 years old than in older patients (P <0.05). Conclusion: Compared
with other calcifications, microcalcification should be a better predictor of thyroid
carcinoma. Malignancy should be highly suspected in patients with single calcification
nodule, especially with lymph node calcification. Patients younger than 45 years of age
with calcification or microcalcification have a greater risk for thyroid carcinoma.

Key words: Age, Single nodule, Thyroid carcinoma, Ultrasonography
The Golden Hours in Paediatric Septic Shock—Current Updates and Recommendations
Authors: Chong Shu Ling , Ong Gene YK , Venkataraman Anantharaman , Chan Yoke Hwee
Published: June 2022

Introduction: Paediatric sepsis is a global health problem. It is the leading cause of mortality in infants and children worldwide. Appropriate and timely initial management in the first hours, often termed as the “golden hours”, has great impact on survival. The aim of this paper is to summarise the current literature and updates on the initial management of paediatric sepsis. Materials and Methods: A comprehensive literature search was performed via PubMed using the search terms: ‘sepsis’, ‘septic shock’, ‘paediatric’ and ‘early goal-directed therapy’. Original and review articles were identified and selected based on relevance to this review. Results: Early recognition, prompt fluid resuscitation and timely administration of antibiotics remain key in the resuscitation of the septic child. Use of steroids and tight glycaemic control in this setting remain controversial. Conclusion: The use of early goal-directed therapy has had significant impact on patient outcomes and protocolised resuscitation of children in septic shock is recommended.

Key words: Child, Early goal-directed therapy, Emergency, Sepsis
Creation and Validation of the Singapore Birth Nomograms for Birth Weight, Length and Head Circumference Based on a 12-year Birth Cohort
Authors: Poon Woei Bing , Fook-Chong Stephanie MC , Ler Grace YL , Loh Zhi Wen , Yeo Cheo Lian
Published: June 2022

Introduction: Both gestation and birth weight have significant impact on mortality and morbidity in newborn infants. Nomograms at birth allow classification of infants into small for gestational age (SGA) and large for gestational age (LGA) categories, for risk stratification and more intensive monitoring. To date, the growth charts for preterm newborn infants in Singapore are based on the Fenton growth charts, which are constructed based on combining data from various Western growth cohorts. Hence, we aim to create Singapore nomograms for birth weight, length and head circumference at birth, which would reflect the norms and challenges faced by local infants. Materials and Methods: Growth parameters of all babies born or admitted to our unit from 2001 to 2012 were retrieved. Following exclusion of outliers, nomograms for 3 percentiles of 10th, 50th, and 90th were generated for the gestational age (GA) ranges of 25 to 42 weeks using quantile regression (QR) combined with the use of restricted cubic splines. Various polynomial models (second to third degrees) were investigated for suitability of fit. The optimum QR model was found to be a third degree polynomial with a single knotted cubic spline in the mid-point of the GA range, at 33.5 weeks. Check for goodness of fit was done by visual inspection first. Next, check was performed to ensure the correct proportion: 10% of all cases fall above the upper 90th percentile and 10% fall below the lower 10th percentile. Furthermore, an alternative formula-based method of nomogram construction, using mean, standard deviation (SD) and assumption of normality at each gestational age, was used for counterchecking. Results: A total of 13,403 newborns were included in the analysis. The new infant-foetal growth charts with respect to birth weight, heel-crown length and occipitofrontal circumference from 25 to 42 weeks gestations with the 10th, 50th and 90th were presented. Conclusion: Nomograms for birth weight, length and head circumference at birth had significant impact on neonatal practice and validation of the Singapore birth nomograms against Fenton growth charts showed better sensitivity and comparable specificity, positive and negative predictive values. Key words: Fenton, Percentile, Prematurity, Preterm growth charts, Very low birth weight
Sun Exposure and Sun Safety Habits Among Adults in Singapore: A Cross-Sectional Study
Authors: Cheong Kah Wai , Yew Yik Weng , Seow Wei Jie
Published: June 2022

Introduction: Sun exposure increases skin cancer risk. Studies have shown that demographic factors influence sun safety behaviour but there is a paucity of such data in Singapore. We aimed to identify sociodemographic predictors of sun safety habits in Singapore. Materials and Methods: A total of 2328 adults participated in a cross-sectional survey on time spent under the sun and sun safety habits (using protective headgear, body attire, umbrellas and sunscreens). A composite Sun Protection Score (higher scores represented better habits [range, 0–15]) and the average daily hours (ADH) of sun exposure were derived from the data. The relationship between the Sun Protection Score and ADH of sun exposure with sociodemographic factors was analysed using univariate (Mann-Whitney U or Kruskal-Wallis tests), multiple linear and logistic regression analyses. Results: The following statistically significant variables predicted a lower Sun Protection Score: men (β = -1.48, P <0.001), Indians (β = -1.04, P <0.001), history of diabetes (β = -0.60, P = 0.007) and people who do not consume alcohol (β = 0.31, P = 0.03). Younger adults (β = -0.2, P <0.001), men (β = 0.80, P <0.001), darker skin type (β = 0.27, P <0.001) and lower education level (β = -0.18, P <0.001) were statistically significant variables that predicted a longer ADH of sun exposure. Conclusion: The study has identified sociodemographic predictors of sun safety habits in Singapore. Key words: Skin cancers, Ultraviolet radiation
Ethnic Differences and Trends in ST-Segment Elevation Myocardial Infarction Incidence and Mortality in a Multi-Ethnic Population
Authors: Zheng Huili , Pek Pin Pin , Ho Andrew FW , Wah Win , Foo Ling Li , Li Jessie Q , Utravathy Vasuki , Chua Terrance SJ , Tan Huay Cheem , Ong Marcus EH
Published: June 2022

Introduction: This study aimed to compare the incidence and mortality of ST-segment elevation myocardial infarction (STEMI) across the 3 main ethnic groups in Singapore, determine if there is any improvement in trends over the years and postulate the reasons underlying the ethnic disparity. Materials and Methods: This study consisted of 16,983 consecutive STEMI patients who sought treatment from all public hospitals in Singapore from 2007 to 2014. Results: Compared to the Chinese (58 per 100,000 population in 2014), higher STEMI incidence rate was consistently observed in the Malays (114 per 100,000 population) and Indians (126 per 100,000 population). While the incidence rate for the Chinese and Indians remained relatively stable over the years, the incidence rate for the Malays rose slightly. Relative to the Indians (30-day and 1-year all-cause mortality at 9% and 13%, respectively, in 2014), higher 30-day and 1-year all-cause mortality rates were observed in the Chinese (15% and 21%) and Malays (13% and 18%). Besides the Malays having higher adjusted 1-year all-cause mortality, all other ethnic disparities in 30-day and 1-year mortality risk were attenuated after adjusting for demographics, comorbidities and primary percutaneous coronary intervention. Conclusion: It is important to continuously evaluate the effectiveness of existing programmes and practices as the aetiology of STEMI evolves with time, and to strike a balance between prevention and management efforts as well as between improving the outcome of “poorer” and “better” STEMI survivors with finite resources. Key words: Chinese, Indian, Malay, STEMI
Megatrends in Infectious Diseases: The Next 10 to 15 Years
Authors: Wong Sin Yew , Tan Ban Hock
Published: June 2022

It has been about 100 years since the Spanish influenza pandemic of 1918-19 that killed an estimated 50 million individuals globally. While we have made remarkable progress in reducing infection-related mortality, infections still account for 13 to 15 million deaths annually. This estimate is projected to remain unchanged until 2050. We have identified 4 megatrends in infectious diseases and these are “emerging and re-emerging infections”, “antimicrobial resistance”, “demographic changes” and “technological advances”. Understanding these trends and challenges should lead to opportunities for the medical community to reshape the future. Further inroads will also require broad approaches involving surveillance, public health and translating scientific discoveries into disease control efforts. Key words: Antimicrobial resistance, Demographic changes, Emerging infections, Technological advances
Screening Tools for Sarcopenia in Community-Dwellers: A Scoping Review
Authors: Mohd Nawi Siti N , Khow Kareeann SF , Lim Wee Shiong , Yu Solomon CY
Published: June 2022

Introduction: Sarcopenia is characterised by a progressive and generalised loss of skeletal muscle mass, strength and/or performance. It is associated with adverse health outcomes such as increased morbidity, functional decline and death. Early detection of sarcopenia in community-dwelling older adults is important to prevent these outcomes. Our scoping review evaluates validated screening tools that are used to identify community-dwelling older individuals at risk of sarcopenia and appraises their performance against international consensus definitions. Materials and Methods: A systematic search on MEDLINE, PubMed and EMBASE was performed for articles that evaluated the predictive validity measures of screening tools and validated them against at least 1 internationally recognised diagnostic criterion for sarcopenia. Results: Of the 17 articles identified in our search, 8 used questionnaires as screening tool, 2 utilised anthropometric measurements, 3 used a combination of questionnaire and anthropometric measures and 1 used a physical performance measure (chair stand test). The questionnaire Strength, Assistance with walking, Rising from chair, Climbing stairs and Falls (SARC-F) has the highest specificity (94.4-98.7%) but low sensitivity (4.2-9.9%), with the 5-item questionnaire outperforming the 3-item version. When SARC-F is combined with calf circumference, its sensitivity is enhanced with improvement in overall diagnostic performance. Although equation-based anthropometric screening tools performed well, they warrant external validation. Conclusion: Our scoping review identified 6 candidate tools to screen for sarcopenia. Direct comparison studies in the community would help to provide insights into their comparative performance as screening tools. More studies are needed to reach a consensus on the best screening tool(s) to be used in clinical practice. Key words: Low muscle function, Low muscle mass, Older adults, Sensitivity, Specificity
The Nexus between Shepherd Leadership and Modern Leadership Models: A Systematic Literature Review
Authors:   Senior Lecturer, Business Department, ZICT University Ndola, Zambia & Doctorate in Business Administration Student, Department of Business Administration, School of Business, ZCAS University, Lusaka, Zambia
Published: June 2022

Leadership theorists’ have time immemorial endeavoured to conceptualise the best leadership models that would meet the challenges of our ever-changing business landscape. Many theorists have postulated theories on human behaviour that seek to provide insight in effective leadership practices. Lamentably, few have sought to inquire what biblical ancient wisdom has to say on this very important subject. Thus, the purpose of this study is to conduct a systematic review of the shepherd metaphor as a leadership model. Data for this study were gathered from databases of Google Scholar, EBSCO, and JSTOR. A total of 83 articles were identified in these databases while 36 articles were discovered in other sources. 76 articles remained after deleting duplicates, 71 of these articles were examined, 37 articles were excluded, 34 complete articles were chosen to be evaluated, and after 13 complete articles have been excluded, 21 articles ultimately remained for inclusion in the synthesis. Overall, the review revealed that shepherd leadership is a potent metaphoric illustration of leadership relevant to contemporary leadership practice. The metaphor is effective today as it was some 2,000 years ago when it was first practiced.
Tolerância de híbridos de milho Bt em cultivos comerciais a enfezamento, cigarrinha e lagarta
Authors:   , Bessa Katyuscia Ferreira Lavrins
Published: June 2022

Os enfezamentos de milho (Zea mays), causados por patógenos (molicutes) disseminados pela cigarrinha do milho Dalbulus maidis (Hemiptera: Cicadelidae), têm sido um desafio para a defesa sanitária vegetal de muitos países americanos. Isso se deve às perdas causadas na produção do cereal, problema que também representa um risco fitossanitário para outras regiões do mundo. A maioria dos híbridos de milho cultivados no Brasil atualmente expressa transgenes de Bacillus thuringiensis (Bt), visando controle de lagarta do cartucho (Spodoptera frugiperda), mas muitas das lavouras requerem proteção extra contra a cigarrinha do milho para controlar a epidemia de enfezamentos do milho. Objetivou-se neste trabalho avaliar a tolerância dos híbridos comerciais de milho Bt aos enfezamentos ou infestação pela cigarrinha e lagarta. Durante a segunda safra (safrinha) de 2019/2020, foram estudados campos de milho em três localidades (fazendas) no sudoeste de Goiás para selecionar híbridos de milho tolerantes aos enfezamentos entre oito daqueles híbridos comumente cultivados no país. A densidade populacional da cigarrinha do milho, a intensidade da injúria foliar pela lagarta do cartucho e a produção das plantas foram contabilizadas. Os níveis populacionais do inseto vetor nas lavouras de milho foram relativamente baixos, 11–14 cigarrinhas por 10 plantas. Maior densidade populacional do vetor ocorreu nas plantas dos híbridos DKB335PRO3, DKB360PRO3 e AG8480PRO3. Os híbridos com maior incidência (porcentagem de plantas sintomáticas) de enfezamento foram MG593PWU, NK555VIP3 e B2401PWU. Aqueles de maior produtividade foram DKB360PRO3, KB335PRO3 e DKB2550PRO3. Não se observou correlação significativa entre os níveis populacionais da cigarrinha com a incidência de enfezamentos, mas esta última correlacionou-se negativamente com a produtividade de grãos. As plantas de milho que possuíam as tecnologias transgênicas Bt PWU e VIP3 praticamente não apresentaram injúrias da lagarta do cartucho. As plantas de milho com a tecnologia Bt PRO3 apresentaram raspagens nas folhas, com nota ≤ 3 na escala Davis, mas essa injúria não interferiu na produtividade de grãos pelas plantas. Esses resultados são importantes para atualizar o conhecimento sobre tolerância de híbridos de milho aos enfezamentos, fornecendo informações que auxiliarão produtores e profissionais a escolher híbridos adequados dependendo do risco de epidemia de enfezamento na região ou safra. Palavras-chave: Zea mays. Resistência. cigarrinha do milho. Molicute. Vírus. Infestação. incidência/severidade. produtividade de grãos.
A impotância taxonômica e ecológica dos osmóforos em Chamaecrista Moench (Leguminosae)
Authors:   , Rufino Priscila de Castro
Published: June 2022

Apoucouita é uma das seções de Chamaecrista Moench (Leguminosae) que, diferencia das outras seções, é caracterizada por reunir espécies de porte arbóreo que ocorrem em florestas tropicais. Adicionalmente, nas anotações das fichas de exsicatas das espécies desta seção, é comum o registro sobre a presença de um odor adocicado perceptível ao olfato humano que é exalado pelas flores. Tricomas secretores, coléteres, nectários, cavidades, canais, idioblastos e osmóforos já foram reportados para representantes de Leguminosae, mas carecem de estudos anatômicos sobre estruturas secretoras florais na seção Apoucouita. Objetivando contribuir com informações sobre estruturas secretoras florais em Leguminosae, este trabalho descreveu anatomicamente e histoquimicamente a região responsável pela produção e liberação de odor nas flores de uma espécie da seção Apoucouita, Chamaecrista ensiformis var ensiformis (Vellozo). Espécies pertencentes às outras seções do gênero também foram avaliadas comparativamente. As amostras foram obtidas em coletas de campo e posteriormente processadas conforme metodologias usuais para avaliar a caracterização estrutural das glândulas, bem como a natureza química da secreção produzida. As análises anatômicas juntamente com os resultados dos testes histoquímicos permitiram identificar a epiderme da antera como a região responsável pela produção e liberação do aroma em C. ensiformis var ensiformis (Vellozo). Nas demais espécies avaliadas não foram reconhecidas regiões secretoras anatomicamente equivalentes. Os dados obtidos contribuíram efetivamente para a inferência da presença de osmóforos somente para a espécie da seção Apoucouita. Palavras-chave: Anatomia. Antera. Histoquímica. Osmóforos