bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vortex keratopathy after photorefractive keratectomy in a patient on long-term clozapine treatment
Authors: Shoughy Samir , Elgemie Hosam , Nasif Waleed 
Published: February 2023

Background: Vortex keratopathy is a corneal entity characterized by corneal deposits at the level of the basal epithelium in the form of a whorl-like pattern in the interpalpebral portions of the cornea. Medications such as amiodarone, chloroquine, hydroxychloroquine, indomethacin, phenothiazines, ibuprofen, and naproxen bind to the cellular lipids of the basal epithelial layer of the cornea, producing a characteristic whorl pattern. Here, we report a case of bilateral central vortex keratopathy with slight vision impairment 3 weeks after uneventful photorefractive keratectomy (PRK) in a woman on long-term clozapine treatment.
Case Presentation: A 42-year-old woman presented to the outpatient clinic for refractive surgery for the correction of bilateral moderate myopia. Her best-corrected distance visual acuity was 20 / 20 in both eyes. She had been on antipsychotic clozapine tablets 400 mg / day for the past 6 years to manage a psychiatric disorder. On detailed preoperative slit-lamp examination, her corneas were clear, with perilimbal conjunctival pigmentations. Other ocular examination results were unremarkable. At the 3-week follow-up after an uneventful PRK, her uncorrected distance visual acuity was 20 / 25 in the right eye and 20 / 20 in the left eye, with complaints of slightly unclear vision in both eyes. Slit-lamp examination revealed bilateral corneal subepithelial deposits in a whorl-like pattern reminiscent of vortex keratopathy. The deposits were restricted to the epithelial and subepithelial regions and did not extend to the stroma without evident stromal haze. Dilated fundus examination results were normal bilaterally. Despite excellent refractive outcomes and visual acuity in both eyes, she was dissatisfied and complained of unclear vision. She was administered with lubricating eye drops and placed on regular follow-ups. At the 4-month follow-up, the vortex lines were cleared centrally, and she reported improvement in vision. Anterior-segment optical coherence tomography of the cornea revealed no epithelial deposits in the central part of the cornea and residual deposits in the temporal peripheral cornea, indicating clearing of the deposits from the central cornea and explaining the subjective improvement in vision. Her final best-corrected distance visual acuity was 20/20 in both eyes with an unremarkable ocular examination.
Conclusions: Our case indicates a potential causal relationship between long-term clozapine treatment and development of temporary, visually significant vortex keratopathy after uneventful PRK. Further large-scale studies are required to verify the causal relationship between the long-term clozapine administration and the development of vortex keratopathy following surface ablation photorefractive procedures.
EFFECTS OF EXCHANGE RATE ON JOB CREATION IN NIGERIA
Authors: Jude Onyinye Okonkwo  , Thaddeus Oforegbunam Ebiringa  , Baldwin Chukwunanu Asiegbu  , Jisike Jude Okonkwo  , Okechukwu Nma Okoronji  , Nonso John Okoye  
Published: February 2023

Job Creation has been the source of social and human engineering towards economic development. Creation of Jobs remains crucial in eradicating social menace, thereby bringing strong connection between macro and micro economic space. The study used annual observation time frame of 2000 to 2018, to reveal effects of exchange rates on job creation. A developing country (Nigeria) was selected as a case study due to its high level of jobless growth, inspite of currency depreciation of Naira against Dollar. The study employed the unit root test, co-integration test, error correction model and the granger causality test. The study found out that exchange rate has positive influence on job creation, though insignificant in the short run, but with 80% error correction model, the variables have the capacity of being significant at the long run. It was further seen that a unidirectional causality exists among exchange rate and job creation. In light of the findings, the study recommended for concerted efforts by stakeholders as regards policies and programmes that provide enabling environment for stable exchange rate and sustainable foreign investment inflow into Nigeria that will lead to increased trend of Job Creation.
Keywords: Exchange Rate, Job Creation, Employment, Foreign Direct Investment and Foreign Portfolio Investment.
Hubungan Tingkat Stres Dan Tingkat Spiritualitas Dengan Kualitas Hidup Pada Penderita DM Tipe 2 Di Puskesmas Cilacap Utara
Authors: Engkartini Engkartini , Rahayu Ningtiyas Anisa , Irawansah Opi 
Published: February 2023

Diabetes Melitus adalah penyakit gangguan metabolik menahun yang lebih dikenal sebagai pembunuh manusia secara diam-diam atau Silent Killer. Pasien DM memerlukan dukungan dari semua aspek termasuk domain spiritual. Spiritualitas mempengaruhi perilaku perawatan diri dan dalam mengontrol kadar gula darah yang pada akhirnya dapat meningkatkan kualitas hidup. Tujuan : Penelitian ini bertujuan untuk mengetahui Hubungan Tingkat Stres dan Tingkat Spiritualitas dengan Kualitas Hidup pada penderita DM tipe 2 di Puskesmas Cilacap Utara 1. Metode : Jenis penelitian ini rancangan cross sectional terhadap 70 pasien DM tipe 2 di Puskesmas Cilacap Utara 1 yang diambil dengan menggunakan purposive sampling. Analisis data menggunakan Rank Spearman. Hasil : menunjukkan bahwa penderita DM tipe 2 di Puskesmas Cilacap Utara 1 sebagian besar mengalami tingkat stres normal (38,6%), yang mengalami tingkat spiritualitas sedang (97,1%), yang mengalami kualitas hidup sedang sebanyak 65 pasien (92,9%). Terdapat hubungan antara tingkat stres dengan kualitas hidup ( p value = 0,039 dan nilai r = -0,247 ). Ada hubungan antara tingkat spiritualitas dengan kualitas hidup ( p value = 0,017 dan nilai r = 0,285 ).
Kata Kunci : Tingkat stres, tingkat spiritualitas, kualitas hidup, penderita DM tipe 2
On the ocean's response to enhanced Greenland runoff in model experiments: relevance of mesoscale dynamics and atmospheric coupling
Authors: Martin Torge , Biastoch Arne 
Published: February 2023

Abstract. Increasing Greenland Ice Sheet melting is anticipated to impact water mass transformation in the subpolar North Atlantic and ultimately the meridional overturning circulation. Complex ocean and climate models are widely applied to estimate magnitude and timing of related impacts under global warming.
We discuss the role of the ocean mean state, subpolar water mass transformation, mesoscale eddies, and atmospheric coupling in shaping the response of the subpolar North Atlantic Ocean to enhanced Greenland runoff.
In a suite of eight dedicated 60- to 100-year-long model experiments with and without atmospheric coupling, with eddy processes parameterized and explicitly simulated and with regular and significantly enlarged Greenland runoff, we find
(1) a major impact by the interactive atmosphere in enabling a compensating temperature feedback,
(2) a non-negligible influence by the ocean mean state biased towards greater stability in the coupled simulations,
both of which make the Atlantic meridional overturning circulation less susceptible to the freshwater perturbation applied, and
(3) a more even spreading and deeper mixing of the runoff tracer in the subpolar North Atlantic and enhanced inter-gyre exchange with the subtropics in the strongly eddying simulations.
Overall, our experiments demonstrate the important role of mesoscale ocean dynamics and atmosphere feedback in projections of the climate system response to enhanced Greenland Ice Sheet melting and hence underline the necessity to advance scale-aware eddy parameterizations for next-generation climate models.
Progress in the validation of rotor aerodynamic codes using field data
Authors: Boorsma Koen , Schepers Gerard , Aagard Madsen Helge , Pirrung Georg , Sørensen Niels , Bangga Galih , Imiela Manfred , Grinderslev Christian , Meyer Forsting Alexander , Shen Wen Zhong , Croce Alessandro , Cacciola Stefano , Schaffarczyk Alois Peter , Lobo Brandon , Blondel Frederic , Gilbert Philippe , Boisard Ronan , Höning Leo , Greco Luca , Testa Claudio , Branlard Emmanuel , Jonkman Jason , Vijayakumar Ganesh 
Published: February 2023

Abstract. Within the framework of the fourth phase of the International Energy Agency (IEA) Wind Task 29, a large comparison exercise between measurements and aeroelastic simulations has been carried out featuring three simulation cases in axial, sheared and yawed inflow conditions. Results were obtained from more than 19 simulation tools originating from 12 institutes, ranging in fidelity from blade element momentum (BEM) to computational fluid dynamics (CFDs) and compared to state-of-the-art field measurements from the 2 MW DanAero turbine. More than 15 different variable types ranging from lifting-line variables to blade surface pressures, loads and velocities have been compared for the different conditions, resulting in over 250 comparison plots. The result is a unique insight into the current status and accuracy of rotor aerodynamic modeling. For axial flow conditions, a good agreement was found between the various code types, where a dedicated grid sensitivity study was necessary for the CFD simulations. However, compared to wind tunnel experiments on rotors
featuring controlled conditions, it remains a challenge to achieve good agreement of absolute levels between simulations and measurements in the field. For sheared inflow conditions, uncertainties due to rotational and unsteady effects on airfoil data result in the CFD predictions standing out above the codes that need input of sectional airfoil data. However, it was demonstrated that using CFD-synthesized airfoil data is an effective means to bypass this shortcoming. For yawed flow conditions, it was observed that modeling of the skewed wake effect is still problematic for BEM codes where CFD and free vortex wake codes inherently model the underlying physics correctly. The next step is a comparison in turbulent inflow conditions, which is featured in IEA Wind Task 47. Doing this analysis in cooperation under the auspices of the IEA Wind Technology Collaboration Program (TCP) has led to many mutual benefits for the participants. The large size of the consortium brought ample manpower for the analysis where the learning process by combining several complementary experiences and modeling techniques gave valuable insights that could not be found when the analysis is carried out individually.
Unilateral Lower Limb Amputations from Traumatic Events: A Systematic Review and Meta-Analysis
Authors: Htet Phyu , Mohammed Lubna , Patel Khushbu K. 
Published: February 2023

Background
Limb amputations are one of the most devastating injuries for young people in traumatic settings. People with lower extremity loss face challenges in performing daily activities and managing life-long complications; thus, rehabilitation and prostheses are critical in improving the quality of life. This systematic review and meta-analysis aims to determine the outcomes of people who had unilateral transtibial and transfemoral amputations in terms of mobility, physical activity, prosthesis usage, and associated pain.
Methods
An in-depth search was conducted on the electronic databases of PubMed and Science Direct databases in September 2022 to find studies that investigated the health outcomes of traumatic unilateral leg amputees. Observational studies, clinical studies, comparative studies, and randomized controlled trials in the English language and within the last 10 years (2012-2022) were thoroughly screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The quality of search results was checked by the Newcastle-Ottawa Scale (NOS). The current meta-analysis included four observational studies which comprised 563 patients, 352 transtibial, and 211 transfemoral amputations. RevMan 5.4 software was used to calculate risk ratios (RRs) with 95% confidence intervals (CI) to conduct this meta-analysis.
Results
The pooled effect estimate showed no statistically significant difference between transtibial and transfemoral amputees(RR = 1.15, 95% CI [0.93, 1.43], P = 0.21) in terms of physical activity. People who had transfemoral amputations used prostheses more frequently than those who had transtibial amputations(RR = 1.21,95% CI [1.09, 1.35], P = 0.0004). There was no statistical difference between the two groups who reported pain during prosthesis wearing (RR = 1.03, 95% CI [0.62, 1.73], P = 0.91).
Conclusion
People who used leg prostheses more frequently were associated with more independent mobility and adequate physical activity. Leg prostheses with better accommodation and mobility benefit people with traumatic unilateral transfemoral amputations.
Health-Care Seeking Pathways Of Psychiatry Patients In North Karnataka of India - A Hospital-Based: Exploratory Cross-Sectional Study
Authors: Khan Alinawaz , Mutalik Narayan R , Kulkarni Harish , R Manjula 
Published: February 2023

INTRODUCTION: Neuropsychiatric disorders contribute for 13% of the total morbidities globally. In 2017, a study revealed that 14% of the Indian Population suffered from psychiatric health problems. The WHO estimates 2443 DALYs (Disability adjusted life years) per 100000 population in India due to psychiatric problems. The non-availability of mental health services, stigma, and superstitions associated with mental disorders, along with the unwillingness or inability of families to care for their mentally ill relatives, appear to be major cause behind delay in approaching a psychiatrist. These factors act as major barriers in the pathways of care for these patients, thereby increasing the unmet need. An understanding of the way people seek care for mental disorders is important for implementing mental health services, and developing effective referral mechanisms. Hence this study was taken up with the objectives.
OBJECTIVEs: To determine health-care seeking pathways of psychiatry patients using WHO pathways of care proforma and to explore the social and cultural determinants of health-care seeking behaviour in them.
METHODOLOGY: This exploratory cross-sectional study includes newly diagnosed psychiatry patients (ICD-10), visiting psychiatry OPD in a private medical college in Bagalkot, North Karnataka, India. Sample size for proportion was calculated to be 340 ~350, taking 33% as P (Pilot study) and at 5% absolute precision at 95% confidence level. Written Informed consent were obtained from the study participants or from the patient attenders, in case of inability to give informed consent. Predesigned and pretested proforma were used for obtaining socio-demographic details of subjects. Patients were examined and diagnosed by the Psychiatrist (Principal Investigator). World Health Organisation (WHO) pathways to care proforma were used to obtain the health-care seeking behaviour of these study subjects. Statistical analysis will be done using SPSS software version19 and appropriate statistical tests will be applied.
RESULTS: In the pilot study, we observed that about 32% of patients firstly approached medical practitioners, followed by psychiatrists and faith healers. An average delay of 24 months was found in reaching psychiatric services.
CONCLUSIONS: There is a substantial delay in health-care seeking of psychiatry patients to psychiatrist, as per the pilot study. Further completion of this study is required to understand the extent of the problem, and socio-cultural factors leading to such delay. Generating awareness among the general public to address cultural myths and stigma related to psychiatric illnesses is required
Harlequin Color Change in a Neonate Positive to COVID-19: Case Report
Authors: Pinel-Guzmán Esther , Martínez-Fernandez Julián , Pinel-Dubón Rafael , Gradis-Santos Olman , Santamaría-Vasquez Mario 
Published: February 2023

Background: Harlequin color change is a benign, idiopathic, self-limiting disorder characterized by an appearance of skin divided into two distinctly colored areas. Its etiology is unknown but thought to be caused by immaturity of hypothalamic regulation of peripheral vascular tone. COVID-19 infection in neonates is infrequent and rarely symptomatic, with only a few cases described in the literature. In isolation, both conditions have low incidence. This is the first case reported in the world literature of harlequin color change in a newborn who tested positive for COVID-19. There isn’t a single publication that links harlequin color change to COVID-19, yet. The Case: Newborn of a 34-year old mother. Who at 3 hours of life presented progressive respiratory distress with whimpering and cyanosis. At 20 hours presented a sudden color change in the right hemibody with unilateral hyperemia and contralateral pallor, simultaneous with a demarcated line separating the left and right sides of the body, involving the trunk, extremities and face, this remained for 10 minutes and then began to fade on its own until it disappeared completely. There were no changes in vital parameters associated with this phenomenon. Only one episode was reported. The transient character and the strict unilateral distribution of the manifestations did not confirm any etiology other than Harlequin phenomenon. Subsequently the patient evolved to respiratory deterioration, multiorgan failure (SOFA: 21), died at 22 days of life due to respiratory arrest.
Conclusion: This is the first ever documented case in worldwide literature of harlequin color change in a neonate positive to COVID-19. Given the low incidence of both entities in isolation and the fact that they were discovered in the same patient, we suggest a strong possibility of SARS-CoV-2 to be the source of the harlequin phenomena in this case and should be considered as an indicator of severe COVID in newborns, but further studies that expand the selection of patients with this condition are needed. There is no literature linking the harlequin phenomenon with COVID-19.
Segmental Phonology in Arabic Dialect Spoken in Kubeisa Town with Reference to Standard English
Authors: Rawaa Saadon Fahad  , Muslih Shwaysh Ahmed  
Published: February 2023

This research investigates an Iraqi dialect used in the western Iraqi town of Kubeisa. It performs a phonological analysis for single phonemes. This study sought to determine whether Kubeisa Iraqi Arabic (KIA) belongs to the "qiltu - dialects" or "gilt - dialects" spoken in Iraq in addition to looking at segmental phonemes in KIA with relation to SE. The phonological analysis of the segmental phonemes of KIA with reference to SE was the focus of the current study's explanatory qualitative design, which involved gathering and analyzing qualitative data. The analysis of taped content, comprising sentences and words said by KIA speakers using a tape-recording equipment, is the focus of the current work. The model adopted for this study was Roach (2009). Modern Standard Arabic (MSA) was also referred. In terms of the data analysis the findings arrived at, relevant conclusions were drawn. There are certain features that characterize KIA and distinguish it from SE. This thesis concluded that speakers of KIA use CCs in medial position of words more than initial or final positions. Vowel sounds in KIA are less in number than in SE, regressive assimilation is used more than progressive assimilation, KIA intrusion is widely used by the native speakers of this dialect. KIA is rich in the use of? Imala (deflexion) process in addition to these conclusions, this study showed that this dialect is considered one of the "qiltu dialect" since KIA pronounced the sounds /q/ and /k/ rather than the phonemes /g/ and /t∫/ in all the data analyzed.
Firms’ Performance in Pakistan: The Impact of Government Policies, Capital Structure, and Board Diversity
Authors: Khan Bilal , Rasheed Muhammad Haroon , Uddin Dr. Sami 
Published: February 2023

The present study has three main objectives. First, to investigate the effect of capital structure on firms' performance. The second is to investigate the effect of board member diversity on firms' performance. Third, given government interest in the thriving business sector, the study aims to access the impact of government support policies on the performance of firms, particularly in the construction and automobile sectors. For this, we selected 40 firms from these sectors from the period 2010 to 2021. The generalized method of movement (GMM) is used to test the relationships. The results of the present study show that capital structure has a significant and positive effect on firms' performance. The diversity of board members, which is divided into two sub-categories i.e. demographic diversity and cognitive diversity has significant negative and positive effects on firms' performance. Lastly, there is a negative relationship between government support policies and firms’ performance. These findings provide unique insight to the government, policymakers, researchers, and managers in the context of Pakistan. The thriving business sector is key for the economic survival of a country and these finding can enable managers and policymakers to utilize capital structure and board composition for ensuring optimal performance and effective policy making.
The Role of Dual Nationality, Financial System Sophistication and Cryptocurrency in Money Laundering
Authors: Hussain Sadia Nazar , Abdul Raheman  , Muhammad Anwar ul Haq  
Published: February 2023

Water always finds its way" so do the money launderers, who are always successful in finding new ways of committing the crime. This study primarily aims to identify opportunities that launderers are exploiting to whitewash their black money. Dual nationality (DN), financial system sophistication (FSS), and cryptocurrency legal status (CCLS) are the advanced opportunities being used by launders to clean their funds. Some studies highlight the link between cryptocurrency and money laundering, but the role of dual nationality and financial system sophistication in money laundering is still a less addressed phenomenon (Ebeke, 2011) and (T. P. and J. Walker, 2011). The objective of this study is to explore the role of these three variables in money laundering by making improvements to the original version of the Walker model. The study's theoretical model was developed by borrowing justifications from Rational Choice Theory (RCT). For quantitative analysis, FGLS was employed over strongly balanced panel datasets. The final dataset of the study was prepared by gathering secondary data from 177 countries for 11 years (2009-2019). The study has found that overall, financial system sophistication is an important factor in choosing a laundering centre around the globe. However, Pakistani launderers do not perceive FSS as an attractive element for laundering their black money. In contrast, dual nationality was identified as a significant element in money laundering from Pakistan to other countries. However, the aspect of cryptocurrency legal status was found to be a significant attractive element for both national and international launders. The findings of the study guide policymakers and practitioners in strengthening the anti-money laundering strategy.