bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Chinese Competition Causing Deindustrialization in Brazil?
Authors: Jenkins Rhys 
Published: July 2015

There has been a lively debate in Brazil in recent years, involving sectors of business, the labor movement, and academics, over deindustrialization and the future of the manufacturing sector. This is often linked to the growing relation between Brazil and China, which is now the country’s most significant trade partner. Brazil has experienced relative deindustrialization in the sense of a declining share of the manufacturing sector in gross domestic product that is mainly attributable to the changes in the country’s trade balance in manufactures. The direct and indirect impacts of China on Brazilian manufacturing have contributed to this relative deindustrialization and the “primarization” of Brazilian exports through competition in the domestic market and in exports. Nos últimos anos, instaurou-se no Brasil um debate acirrado entre empresários, acadêmicos e sindicalistas sobre a desindutrialização e o futuro do setor manufatureiro. O fenômeno é frequentemente associado aos crescentes laços entre Brasil e China, hoje o mais importante parceiro comercial do país. O Brasil vem passando por uma relativa desindustrialização devida ao intenso declínio da participação do setor de transformação no Produto Interno Bruto. Atribui-se essa queda às mundanças provocadas pelos resultados da manufatura na balança comercial. Os impactos diretos e indiretos exercidos pela China sobre o setor secundário brasileiro têm contribuido para essa relativa desindustrialização, assim como para a primarização das exportações brasileiras por meio da competição no mercado doméstico e nas exportações.
Diagnostic accuracy of cardiothoracic ratio on admission chest radiography to detect left or right ventricular systolic dysfunction: a retrospective study
Authors: Chana Harmeet S , Martin Claire A , Cakebread Holly E , Adjei Felicia D , Gajendragadkar Parag R 
Published: July 2015

Objectives To determine the diagnostic accuracy of the cardiothoracic ratio on postero-anterior or antero-posterior chest radiographs in predicting left ventricular or right ventricular dysfunction on echocardiography in an inpatient population. Design Retrospective study. Setting Two secondary care hospitals in the United Kingdom. Participants Four hundred consecutive inpatient echocardiograms were screened for inclusion along with chest radiographs (both postero-anterior and antero-posterior). The cardiothoracic ratio was calculated from chest radiographs along with quantitative and qualitative measures of left ventricular or right ventricular dysfunction on echocardiography. Main outcome measures Sensitivity and specificity of cardiothoracic ratio across a range of values to detect moderate/severe left ventricular and/or right ventricular dysfunction on echocardiography. Results Overall, 272 records met inclusion criteria. The prevalence of left ventricular/right ventricular dysfunction on echocardiography was 26% in an inpatient population with high clinical suspicion of cardiac disease referred for echocardiography. Over a range of cardiothoracic ratio values on postero-anterior films, a value of >0.55 yielded the best sensitivity (62.5%) and specificity (76.5%) for diagnosing left ventricular/right ventricular impairment (positive likelihood ratio 2.56), with a positive predictive value of 29.5%. Cardiothoracic ratio on antero-posterior film was not predictive of left ventricular/right ventricular impairment on echocardiography. Conclusions In conclusion, in the context of an acute admission, cardiothoracic ratio measured on postero-anterior or antero-posterior films has limited value in detecting moderate left ventricular and/or right ventricular systolic dysfunction. Previously established absolute values may be unreliable by modern standards.
From Settlement to Divorce: An Islamic Judicial Practice in Burkina Faso
Authors: Saint-Lary Maud 
Published: July 2015

AbstractIslamic reconciliation spaces in Burkina Faso take a significant place within the plurality of informal agencies of conflict resolution. Yet this place remains barely visible. This article studies the forms of Islamic justice in the country: it shows how the Islamic authorities dealing with the resolution of family conflicts tend to integrate the Islamic norms with local practices and the demands of justiciable persons. In the Sufi rural environment, the concept of sulufu expresses the need for a friendly conciliation that diverges from literalistic reading of the Quran. In town, the role of the ‘settlement’ plays against the proliferation of divorce: while the Islamic elites agree that the divorce is authorized within the Muslim law, in practice they refuse to endorse it. This shows the force of social injunctions in relation to marriage and to the indissolubility of the couple.
Promoting Breastfeeding-Friendly Hospital Practices
Authors: Freney Emily , Johnson Donna , Knox Isabella 
Published: July 2015

Background: Hospital breastfeeding support practices can affect breastfeeding outcomes. Learning collaboratives are an increasingly common strategy to improve practices in health care and have been applied to breastfeeding in many cases. Objectives: The aims of this study of the Evidence-Based Hospital Breastfeeding Support Learning Collaborative (EBBS LC) were to describe the perceptions of participants regarding the process and effectiveness of the EBBS LC, describe perceived barriers and facilitators to implementing the Ten Steps to Successful Breastfeeding, and identify additional actions and resources needed in future learning collaboratives. Methods: Qualitative, semistructured telephone interviews were conducted with 13 key staff who represented 16 of the 18 participating hospitals. Results: The learning collaborative was perceived positively by participants, meeting the expectations of 9 and exceeding the expectations of 4 persons interviewed. The most beneficial aspect of the program was its collaborative nature, and the most difficult aspect was the time required to participate as well as technological difficulties. The key barriers were staff time, staff changes, cost, and the difficulty of changing the existing practices of hospitals and communities. The key facilitating factors were supportive management, participation in multiple breastfeeding quality improvement projects, collecting data on breastfeeding outcomes, tangible resources regarding the Ten Steps, and positive community response. Participants in the EBBS LC stated that they would like to see the Washington State Department of Health create a resource-rich, centralized source of information for participants. Conclusion: This learning collaborative approach was valued by participants. Future efforts can be guided by these evaluation findings.
Different cagA and vacA Polymorphisms are Found in the Chinese versus the Malay and Indian Populations: An Analysis of Helicobacter Pylori Virulence Genes in Singapore
Authors: Lui Sook Yin , Chuah Sai Wei , Goh Hui Lin , Lee Kar Yee , Lee Victoria Serelli , Ho Bow , Ling Khoon Lin 
Published: July 2015

Aim: Helicobacter pylori causes peptic ulcer disease and gastric cancer. Western studies suggest that polymorphisms in the virulence factors cagA and vacA may determine the ability of bacteria to cause gastroduodenal diseases. Differences in the cagA EPIYA motifs and polymorphisms of the signal (s), middle (m) and intermediate (i) regions of vacA are thought to be important. The aim of this study was to compare the polymorphisms of cagA and vacA of H. pylori isolated from the Chinese, Malay and Indian populations living in Singapore. Method: A total of 104 H. pylori isolates obtained from patients with dyspeptic symptoms were analysed. Of the 104 patients, 80 were Chinese, 9 Malays and 15 Indians. DNA was extracted from the isolates and the vacA allelic types and cagA EPIYA motifs were determined by polymerase chain reaction (PCR) and sequencing, respectively. Results: Differences in the vacA and cagA polymorphisms were found between the Chinese, Malays and Indians. Significantly more non-Chinese patients carried vacA s1/m1 strains versus Chinese patients ( p < 0.05). All 9 Malay patients, 11/15 (73.3%) Indians and 31/80 (38.8%) Chinese patients carried H. pylori strains with the vacA s1/m1/i1. Significantly more Chinese patients carried isolates with East Asian cagA EPIYA motifs versus non-Chinese patients ( p < 0.05). 79/80 (98.8%) of the Chinese isolates, 2/15 (13%) of Indian isolates, and 5/9(55.6%) of Malay isolates possessed CagA with the East Asian ABD type motif. Conclusion: Results from the current study demonstrated marked differences in the polymorphisms of vacA and CagA EPIYA motifs in strains isolated from Chinese versus non-Chinese patients. Epidemiologically, the Chinese are at the highest risk of developing gastric cancer. Work is ongoing to determine if differences found in the CagA EPIYA motifs of isolates from the Chinese patients can contribute to a subject's risk of developing gastric cancer.
Identification of First Case of Neonatal Diabetes in Singapore and Successful Conversion from Insulin to Sulphonylurea
Authors: Vasanwala Rashida , Yap Fabian , Lim Song Hai , Lim Pei Kwee , Lim Soo Ting , Hui Angela 
Published: July 2015

Introduction: To date Neonatal Diabetes Mellitus (NDM) has not been reported in Singapore. Neonatal diabetes is a rare (1 in 100,00–300,000 live births) insulin-requiring form of diabetes with well defined subgroups, permanent neonatal diabetes (PND) and transient neonatal diabetes (TND), each accounting for approximately 50% of patients. Genotyping NDM identifies the exact unique molecular aetiology of very early onset insulin requiring diabetes and has the potential to dramatically alter the management of the patient, who would otherwise be insulin dependent for life. Method: We identified a child who presented at 3 and half months of age with diabetic ketoacidosis and determined the phenotypic and genotypic characteristics. Blood samples for molecular genetic analysis were sent to Royal Devon and Exeter Foundation Trust, UK. We determined her Continuous Glucose Monitoring profiles after initiation of sulphonylurea therapy. Results: The patient was diagnosed as a heterozygous for a missense mutation R201H, in the KCNJ11 gene. Results confirmed a diagnosis of permanent neonatal diabetes due to a mutation in the Kir6.2 subunit of the KATP channel. We initiated sulphonylurea therapy and subsequently ceased insulin treatment successfully. Currently 2 years old, this patient is no longer insulin dependent. Conclusion: This is the first case report of neonatal diabetes in Singapore. It describes the importance of correct identification of the case, and successful conversion of therapy from insulin to sulphonylureas with optimal blood glucose control. We emphasise the need for medical practitioners to consider molecular testing for all patients who present with diabetes below 6 months of age as this will facilitate accurate diagnosis and appropriate therapy.
Effectiveness of Symptom Guided Therapeutic Approach in Treating Discogenic Pain with Radiculopathy Using a Combination of Directional Preference Exercises, Mobilisation and Neural Mobility Exercises — A Case Report
Authors: Joshua Devasahayam Augustine 
Published: July 2015

Researchers have reported various therapeutic approaches to treat patients with low back pain. The mechanical diagnosis and therapy as proposed by McKenzie, has been shown to be effective in diagnostic, therapeutic and prognostic inference. Most often, the treatment options considered in these studies was directional preference exercises and manual procedures utilising movement and positions. But the effectiveness of symptom guided therapeutic approach in treating discogenic low back pain with radiculopathy using directional preference exercises, mobilization and neural mobility exercises is unknown. A case of a forty three-year-old male presenting with discogenic low back pain along with radiculopathy was assessed with McKenzie approach. Appropriate treatment strategy was selected and prescribed based on the initial assessment. The patient was re-evaluated each session, and treatment modification was made according to his symptom presentation during each visit. He proved to be symptom free after seven visits. This could have been due to disc regression and enhanced neural mobility obtained due to treatment. This case report demonstrates the effectiveness of symptom guided therapeutic management to treat patients with discogenic low back pain along with radiculopathy using appropriate treatment strategies. Finally, the report summarizes the treatment offered and discusses the possible explanation of the specific treatment strategies implemented.
Clinical Audit on Hypoglycaemic Symptoms in Type 2 Diabetic Patients in SingHealth Polyclinics
Authors: Quah Hui Min Joanne , Teo Swee Hong Stephanie , Yap Hui Bee Gladys , Lim Hwee Boon , Chow Mun Hong 
Published: July 2015

Introduction: Hypoglycaemia is an important complication of type 2 diabetes mellitus treatment, because it causes recurrent physical and psycho-social morbidity, and it is sometimes fatal. Achieving target glycaemic goals while avoiding hypoglycaemia is a major challenge in the management of patients with type 2 diabetes mellitus. Awareness of hypoglycaemia is a function of the knowledge and experience of an individual, as well as the physiological responses to low glucose concentrations. Our team conducted an audit to identify the prevalence and underlying causes of hypoglycaemic symptoms among type 2 diabetes mellitus patients seen in SingHealth Polyclinics. This data was collected as part of our efforts to improve diabetes care and increase awareness. Methods: Audit in the form of nurse-administered interviews were carried out on 120 type 2 diabetic patients seen in the Family Physician Clinic; they were 20 consecutive patients seen in each of 6 polyclinics. The questionnaire included both patient and nurse components, identifying hypoglycaemic symptoms, causes, related hospital admissions, self-management, current treatment and control. Results: Of the 120 patients audited, 31 (26%) reported hypoglycaemic symptoms. These patients with hypoglycaemic symptoms were more likely to be on insulin treatment than those without symptoms (p=0.000). Majority of patients with symptoms did not use the glucometer when they experienced these symptoms (19/31). The cause of hypoglycaemic symptoms was often meal-related. For patients not on insulin, those with hypoglycaemic symptoms were more likely to own a glucometer than those without symptoms (p=0.033). Conclusion: Hypoglycaemia is a common complication of diabetic treatment, and efforts should be focused especially on insulin-treated patients to prevent hypoglycaemia, including education on hypoglycaemia awareness, self-monitoring of blood glucose and dietary advice.
The Value of the Hearing Education Arcade in Educating Caregivers of Hearing-Impaired Patients
Authors: Low Wong Kein , Phua Mandy 
Published: July 2015

Introduction: Although technological advancements have improved the treatment outcomes of hearing-impaired patients, challenges still exist as caregivers are not able to fully appreciate patients' difficulties in communication. An effective education programme is deemed important, including an experiential learning component where people in contact with the patient could experience the sounds actually heard by the patient. This led to the setting up of the Hearing Education Arcade (HEAR), an interactive gallery which contains information about various aspects of hearing loss. This pilot study aims to assess the usefulness of HEAR as an educational tool for caregivers of hearing-impaired patients. Methods: Two separate surveys were carried out. The first survey sought to find out if HEAR had been informative and educational. The second, a focus-group survey on caregivers of hearing impaired children and adults, gauged knowledge levels before and after experiencing HEAR. Results: Most respondents found HEAR to be very informative (86.4%) and highly educational (75.8%). The respondents in both focus groups recorded improvement in knowledge scores after going through HEAR. Conclusion: This study supports the belief that HEAR is a useful tool in the education of caregivers of hearing-impaired patients about hearing, its disorders, the treatment and the needs of the hearing-impaired. When the family and caregivers are properly educated on matters of hearing loss, it can have a positive effect on management outcomes.
Modular Endoprosthesis for Mandibular Reconstruction — A Thematic Research Study at the National Dental Centre Singapore
Authors: Goh Bee Tin , Lee Shermin , Chanchareonsook Nattharee , Tideman Henk 
Published: July 2015

Introduction: A thematic research project was undertaken by the National Dental Centre Singapore to study the feasibility of using a novel modular endoprosthesis for reconstruction of the mandible. Successful application of this technique potentially eliminates the need for a donor site. Methods: Three sub-projects done in a monkey model are presented. In the first two sub-projects, a titanium modular endoprosthesis was inserted in surgically created defects for reconstruction of the ascending ramus and condyle; and body of the mandible respectively. In the third sub-project, a polycaprolactone scaffold with calcium phosphate (CaP) surface coating modular endoprosthesis was used for reconstruction of the body of the mandible. The animals were sacrificed at three to six months. Microcomputed tomographic and histologic analyses were done. Results: At the time of sacrifice, signs of infection were present in a few animals treated either with the titanium or the polycaprolactone endoprosthesis for replacement of the body of the mandible. None of the animals who received the ascending ramus and condyle titanium endoprosthesis had an infection. New bone formation was noted around the stems of the titanium devices and inflammatory reaction was much reduced from three to six months. For the polycaprolactone device, more de novo bone formation was seen in the group using Human-BMP-2. Conclusion: The use of a modular endoprosthesis for mandibular reconstruction seemed to result in a physiologic replacement of the lost part of the mandible, although the biomechanics of the system need further evaluation so as to improve its long term stability.
Uses of Botulinum Toxin a in Ophthalmology
Authors: Teo Livia , Chee Elaine 
Published: July 2015

Introduction: Botox® (serotype A) is currently available and used to treat various ophthalmological conditions. The aim of our study was to review the current indications, side-effects and updates on the clinical use of botulinum toxin- A (Btx-A) in the field of ophthalmology. Methods: A literature search using the keywords “Botulinum Toxin”, “Botulinum Toxin A”, “Botox” and “Ophthalmology” was performed using Pubmed. Articles describing the use of botulinum toxin A were selected and reviewed. Results: The uses of Btx-A in ophthalmology can be broadly classified into four categories: eyelid, strabismus, cosmetic and others. In the eyelid, it can be used to treat blepharospasm, hemifacial spasm, apraxia of lid opening or induce ptosis in lid retraction and exposure keratopathy. In strabismus management, it can be injected into overacting muscles to realign the eyes. For cosmesis, it can be used to relax facial muscles to reduce wrinkles while other indications include treatment of chronic dry eye, lacrimal hypersecretion and pain relief in acute angle closure attack. Complications of the injection include local effects like ecchymosis, pain or infection and spillover effects like ptosis, diplopia, lagophthalmos, mid facial weakness and dry eyes. Conclusion: The clinical application of botulinum toxin A in ophthalmology is extensive. When considering its application in clinical practice, one should be mindful of the indications, risks and benefits of the procedure. When properly delivered, its potential as an efficacious, minimally-invasive treatment modality can be maximised in patient management.
Eight-Year Developmental Follow-up in Children with Birthweights 1,251–1,500g in KK Women's and Children's Hospital
Authors: Choo Winnie Li Chuen , Lourdes Mary Daniel 
Published: July 2015

Background: Children of very low birth weight (VLBW, birth weight <1,500g) are at risk of developmental disability and learning difficulties. Regular follow-up to a school-going age allows timely diagnosis and intervention. Methods: The duration, developmental assessment and service utilisation of 41 VLBW children with birth weights between 1,251–1,500g born in 2001 were retrospectively analysed. Results: The median follow-up duration was 5 years 11 months. 56% were followed-up till preschool entry. Gross motor, fine motor and language domains were assessed in more than 95% of children. Information on behavioural and learning problems was only sought for in approximately 50% of children. Conclusions: A significant proportion of these high-risk children were either not followed-up long enough or were not adequately assessed for learning and behavioural problems, thus justifying the development of a new standardised follow-up program for larger VLBW children.
Nested Case-Control Study of Children Presenting with First Afebrile Seizure at KKH: Seizure Recurrence and Comorbidities
Authors: Chan Derrick Wei Shih , Long Melody , Kumar Praveen , Kao Martha 
Published: July 2015

Introduction: First afebrile seizures are common in Singapore (incidence 24 per 100,000 person-years). We determined the seizure recurrence risk after first afebrile seizure, the risk factors at presentation and evaluated the quality of life of these children. Methods: Nested case-control study of children presenting with their first afebrile seizure from 2002 to 2004. Risk factors were measured at initial presentation. This follow-up study administered standardised telephone questionnaires to patients/caregivers seven years later. Subjects with only one afebrile seizure (1AS) were compared to those with recurrent afebrile seizures (RAS) for birth history, risk factors, developmental delay, school status, initial electroencephalogram (EEG), neuroimaging and initial seizure episode using Fisher's exact test. Quality of life was screened with a questionnaire. Results: Of 103 eligible subjects, 54 responded with seizures recurring in 21 (38.9%). Initial seizure frequency was yearly at 57.9%. The RAS group had more risk factors ( P=0.013) and greater frequency of abnormal initial development ( P <0.005), abnormal neurological examination in this population ( P=0.033) and abnormal current development ( P=0.028). Quality of life differed in behavioural changes ( P=0.022) and parental relationship with spouses ( P=0.004). EEG and neuroimaging were not predictive. Number of initial seizure episodes showed a significant difference between 1AS and RAS groups ( P=0.037). Conclusion: Abnormal development and neurological examination are risk factors for seizure recurrence after the first afebrile seizure. Children with more than four seizures during the initial seizure presentation may be at an increased risk of seizure recurrence. Recurrent seizures affect quality of life of both the affected child and the family.