bluuebunny/crossref_metadata_2025 huggingface dataset:
Aligning (In)Congruent Chatbot–Employee Empathic Responses with Service-Recovery Contexts for Customer Retention
Authors: Fan Hua , Han Bing , Wang Wangshuai
Published: September 2023

The use of artificial intelligence (AI) technologies in service recovery is transforming the frontline interfaces across the tourism industry, as AI chatbots are now being designed to show empathy. Using a multi-method approach combining survey, experimental, and field data obtained from hotel guests, this study explores the effects of chatbot–employee collaborative empathic responses on customer retention under various service-recovery contexts. It finds that congruence (vs. incongruence) and higher (vs. lower) levels of congruence in chatbot–employee empathic responses more effectively retain customers. Further, the effects of incongruence and congruence on customer retention diminish when the chatbot’s identity is disclosed but are strengthened when employees’ acceptance of a chatbot increases. Only the negative effects of empathic response incongruence correspondingly increase when chatbot efficiency and flexibility (ambidexterity) increase. These findings suggest that tourism practitioners can rely on chatbot–employee collaboration to accomplish service-recovery tasks but should pay attention to chatbot-side and employee-side uncertainties in a service triad, especially chatbot ambidexterity.
From Tourist Experience to Satisfaction and Loyalty: Exploring the Role of a Sense of Well-Being
Authors: Bagheri Fatemeh , Guerreiro Manuela , Pinto Patrícia , Ghaderi Zahed
Published: September 2023

Drawing on the authentic happiness theory, the aims of this article are three-fold: first, to propose a refined measurement scale for tourists’ sense of well-being; second, to investigate the impact of four categories of tourist experience on tourists’ sense of well-being; and third, to explore the effect of the sense of well-being on tourists’ satisfaction and loyalty. Data were collected from tourists spending their holidays in the Algarve, Portugal. To address the lack of an integrated measurement scale for assessing tourists’ sense of well-being, an exploratory factor analysis was initially conducted. Subsequently, the data were analyzed using structural equation modeling in WarpPLS 8.0. The findings reveal a three-dimensional scale for tourists’ sense of well-being, consisting of meaningfulness, active pleasure, and release. The results also show a significant positive impact of the four realms of tourists’ experiences on the sense of well-being. Finally, positive relationships between well-being, tourist satisfaction and loyalty are confirmed. The theoretical and practical implications, limitations, and potential directions for future research are discussed.
Can I do My Job in Peace? Hotel Employees’ Wellbeing in the Face of Sexual Harassment Awareness and Organizational Commitment
Authors: Oriade Ade , Osinaike Adesola , Adebayo Adenike D.
Published: September 2023

Workplace sexual harassment, particularly in hospitality, is a significant issue with many implications. For decades, assessing its scope and impact has drawn the attention of scholars, but some gaps still exist. Based on Rational Choice Theory, this paper explored employee conformance behavior to sexual harassment in relation to organization strategic commitment and employee wellbeing in the global south context. A total of 712 completed questionnaires were collected from Nigeria and Ghana. WarpPLS version 8.0 partial least squares structural equation structural modeling was employed to assess the research model. Results revealed that hotel workers’ behaviors toward awareness and management of sexual harassment are nonlinear and complex. Conformance behavior, despite conceived by employees as an economic coping strategy, proved to be a temporary measure and is disadvantageous to wellbeing. An important managerial implication of this study is the need for education about what sexual harassment is and how it impacts employees’ wellbeing.
Parent–toddler play talk: Toddler speech is differentially associated with paternal and maternal speech in interaction
Authors: Quigley Jean , Nixon Elizabeth
Published: September 2023

Children’s speech is influenced by the speech they hear, in particular by the parental speech addressed directly to them. The aim of this study was to analyse toddlers’ speech with their parents and to investigate the influence of specific characteristics of child-directed speech on child speech in real time during mother–child and father–child dyadic interactions. Eighty-four children ( M = 24.11 months, SD = 1.37, 42 girls) and their parents were video-recorded in dyadic freeplay. Parent and child speech was compared on measures of quantity (number of words), quality (vocabulary diversity, proportion, and composition of nouns/verbs) and productivity or complexity. Overall findings reveal very similar speech produced by mothers and fathers with their toddlers and by toddlers with each parent, with the exception of vocabulary diversity patterns. Furthermore, the child-directed speech of mothers and fathers was differently associated with child speech in interaction. Findings suggest that children may be exposed to different lexical sets by mother and father and there may be added value for the child of engaging in separate dyadic interactions with mother and father. Implications for research include sampling child speech across contexts and conversational partners.
Challenges and potentials of evaluating platform work against established job-quality measures
Authors: Gundert Stefanie , Leschke Janine
Published: September 2023

Working conditions in platform work are often, yet rarely explicitly, assessed according to criteria similar to those applied to the quality of jobs outside the gig economy. In this article the authors argue that future research would benefit from analytical schemes that enable a systematic analysis of working conditions in platform work. They discuss the advantages and challenges of applying existing job-quality frameworks to platform work and present a suggestion for modifications that consider the particularities of platform work. The use of such a novel analytical framework could help systematise evidence from qualitative research, promote the heretofore rare initiatives of quantitative representative data collection, and inspire theoretical developments at the interface of job quality and platform work.
Trapped in contradiction: Precariousness and the ideological orientations of younger workers in hospitality-related occupations
Authors: Ioannou Gregoris
Published: September 2023

This article explores the ideological orientations of ‘younger workers’ in relation to their experience of precarious employment in Scotland and Greece. Based on 60 semi-structured interviews with workers in hospitality-related occupations in two national settings, it counterposes their actual material conditions to their ideational conceptions, values and worldviews. By interrogating stances on issues such as flexibility, future plans, collectivism and trade unionism, on the ideals of freedom and fairness and on their thoughts about what is possible in their field of work, it enquires about the impact of prevailing market-centred values and neoliberal axioms on younger workers. It identifies tensions, unease and contradictions in workers’ ‘subjective’ articulations and explains how these are not a product of ideology per se but have their causes in the ‘objective’ realm, the socio-economic conditions prevailing since the financial crisis.
Syndrome of Inappropriate Antidiuretic Hormone Release Secondary to Ectopic Olfactory Neuroblastoma: Case Report and Review of Literature
Authors: Saffarzadeh Mohammadali , Alim Bader M. , Hernaiz-Leonardo Juan Carlos , Lee Lik Hang , Javer Amin
Published: September 2023

Ectopic olfactory neuroblastoma (ONB) is a rare neuroendocrine sinonasal malignancy which arises from sinonasal regions where olfactory neuroepithelium does not exist. Presentation of syndrome of inappropriate antidiuretic hormone release (SIADH) in patients with ectopic ONB is extremely rare. We report a case of a 22-year-old patient with ectopic ONB and paraneoplastic SIADH that was managed at our center. The ONB was arising from the left lamina papyracea and extending into the maxillary and ethmoid sinuses and filling the nasal cavity. Correction of sodium levels occurred within 24 hours of endoscopic resection via a combined trans-nasal transorbital approach. To avoid negative sequela secondary to rapid sodium correction, the patient was managed by desmopressin to obtain gradual sodium correction, which was achieved on the fourth postoperative day. Ectopic presentation of ONB with paraneoplastic SIADH is extremely rare with only 7 cases reported in the literature to date. Management via surgical resection and/or radiotherapy for these patients requires the managing clinician to be vigilant of serum sodium levels. A multidisciplinary approach is essential for optimal outcomes.
The Effects of a ‘New Generation’ of Heat and Moisture Exchangers in Laryngectomized Patients with Previous Heat and Moisture Exchanger Experience
Authors: Almajali Omar , Balk Matthias , Rupp Robin , Allner Moritz , Sievert Matti , Iro Heinrich , Schützenberger Anne , Gostian Antoniu-Oreste
Published: September 2023

Objectives: To evaluate the effects of a new generation of heat and moisture exchangers (NG-HMEs) on pulmonary rehabilitation, quality of life, patient satisfaction, and usage patterns. Methods: A prospective observational study on 23 laryngectomized patients with prior HME experience from June 1, 2021 to November 30, 2021. Patients were interviewed at inclusion, after 6 weeks and after 12 weeks after the introduction of NG-HMEs. Two validated questionnaires were used to report pulmonary complaints and quality of life: the Cough and Sputum Assessment Questionnaire (CASA-Q), the European Quality of Life 5 Dimensions Index Score (EQ-5D Index Score), and the European Quality of Life 5 Dimensions Visual Analog Scale (EQ-5D-VAS). Usage patterns and patient satisfaction were reported using study-specific questionnaires. Results: The patients had an average age of 65.7 ± 6.8 years, with 87% being male, on average 33.7 ± 35.3 months after total laryngectomy (TLE). NG-HMEs were used for a mean of 21.87 ± 4.63 hours/day ( P = .034). After 12 weeks of use, patients reported the following changes in the CASA-Q domains: cough symptoms (+5; P = .663), cough impact (0; P = .958), sputum symptoms (+8; P = .13), and sputum impact (+3; P = .489). The EQ-5D index score increased (+0.024; P = .917) as well as the EQ-5D VAS (+0.8; P = .27). All patients rated their experience with NG-HMEs with ≥3 out of 5. The patients who used NG-HMEs as instructed (n = 13) reported more profound changes in the CASA-Q domains: cough symptom (+11; P = .129), cough impact (+7; P = .209), sputum symptom (+11; P = .123), and sputum impact (+10; P = .102). Conclusions: Our results show that NG-HMEs could have a positive clinical impact on pulmonary rehabilitation after TLE, even in HME-experienced patients. The use of NG-HMEs does not affect the quality of life. The possible effects of NG-HMEs require further evaluation in long-term studies to fully assess their efficacy.
Analysis of 3 Surgical Approaches for the Treatment of Cerebrospinal Fluid Otorrhea: A Case Series Report
Authors: Sun Shasha , Yu Hongbing , Li Yanling , Wang Kai , Jiang Hongqun , Zhang Zhiyuan , Luo Wugen , Yu Rong
Published: September 2023

Background: This case series report aimed to present three surgical approaches used for the treatment of cerebrospinal fluid (CSF) otorrhea, providing less invasive surgical options for managing this condition. Methods: Clinical data of 26 patients with CSF otorrhea, who underwent treatment using three surgical methods between June 2012 and June 2022, were retrospectively analyzed. The study collected information on patients’ basic demographic characteristics, chief complaints, location of the defect, results of otorrhea endoscopic examination, findings from skull base thin-slice computed tomography (CT) examination, and causes of CSF otorrhea. Postoperative outcomes of CSF otorrhea were followed up. Results: Among the 26 cases of CSF otorrhea, there were 13 (50%) males and 13 (50%) females who underwent treatment using the three surgical methods. The etiology of CSF otorrhea included 10 (38%) cases of spontaneous CSF otorrhea, including 2 (8%) cases of congenital inner ear deformity and 8 (31%) cases without obvious inducement. Additionally, there were 5 (19%) cases of trauma, 6 (23%) cases of cholesteatoma complications, 3 (12%) cases of postoperative complications of brain tumor, 1 (4%) case of radiotherapy, and 1 (4%) case of a malignant tumor. A total of 12 (46%) cases of CSF otorrhea were treated by local repair of the defect. Furthermore, 3 (12%) cases underwent local repair of the defect combined with sealing of the tympanic sinus entrance, while 11 (42%) cases underwent local repair of the defect combined with sealing of the eustachian tube and the external auditory canal. No recurrence of CSF otorrhea was observed during the 6-month to 10-year follow-up period after surgery. Conclusion: The three methods for CSF otorrhea, including local defect repair, local defect repair combined with sealing of the tympanic sinus entrance, and sealing of the eustachian tube and the external auditory canal, demonstrated successful outcomes in appropriately selected patients.
Outcome and Safety of Insulin in the Management of Smell Loss: A Systematic Review
Authors: AlBilasi Thamer M. , Alanazi Rawan Mahmoud , AlDhawi Lama F. , Albathi Abeer Ali
Published: September 2023

Background: Olfactory dysfunction can negatively impact the quality of life and increase the risk of danger from warning odors. Various factors can cause olfactory dysfunction, including COVID-19 infection, which has increased anosmia cases. No medications are approved; however, recent studies have suggested that intranasal insulin could effectively treat olfactory dysfunction. Aim: To comprehensively evaluate the effectiveness and safety of intranasal insulin in treating olfactory dysfunction. Materials and Methods: PubMed, Google Scholar, and CENTRAL databases were searched using specific keywords, and the outputs were screened using the Rayyan AI system. Original research articles published without time frame limitations that reported the relevant outcomes were included. The reviewers performed the screening and data extraction, and any disagreements were resolved by a third senior author. Results: This systematic review identified 66 references from 3 databases, with 45 articles meeting the criteria for review after duplicates were removed. Six articles met the inclusion criteria and were selected, including 177 subjects. The selected studies consisted of various study designs, including pilot studies, placebo-controlled trials, crossover studies, and randomized clinical trials. The findings showed that intranasal insulin therapy had beneficial effects on olfactory function. Specifically, improvements were observed in olfactory detection and discrimination in patients with post-COVID-19 anosmia, olfactory threshold performance in healthy participants, and odor identification in hyposmic patients. However, there were variations in the observed effects based on different doses of insulin administered and gender differences. It also shows that using insulin provides good outcomes. Using it intranasally was safe and did not cause any complications. Conclusion: Intranasal insulin has shown promising results as a potentially safe treatment for olfactory dysfunction. Studies suggest that it can improve olfactory thresholds. Further studies are needed to investigate optimal doses and potential gender differences in response.
Diffuse Large B-cell Lymphoma (Leg Type) Originating in the Skin of the Right Cheek Region: A Case Report and Literature Review
Authors: Wei Yubo , Liu Liyan , Bu Lingxue , Zhan Xiaohong , Xu Haoyue , Wang Shuangyi
Published: September 2023

Primary diffuse cutaneous large B-cell lymphoma, leg type (PCDLBCL-LT), usually affecting one or both lower legs, with a 5-year disease-free survival rate of less than 60%. Solitary facial lesions are extremely rare. Our report is about a 93-year-old woman whose clinical examination revealed a 4 cm × 5 cm × 3 cm mass with a soft texture and smooth margins on the right side of her cheek. Immunohistochemical analyses were consistent with a diagnosis of PCDLBCL-LT. The surgical method for this patient was: extensive resection of the tumor and repair of the defect with an adjacent flap. Neither local recurrence nor systemic invasion was observed during postoperative follow-up (8 months). The clinician must be very careful when making a correct diagnosis based on the clinical and immunohistochemical findings of PCDLBCL-LT. For this type of PCDLBCL-LT isolated in 1 site without invasion of the rest of the body, extensive surgical resection may result in a favorable prognosis.
Prognostic Correlation of Immune-Inflammatory Markers in Sudden Sensorineural Hearing Loss: A Retrospective Study
Authors: Zhang Xu , Wang Ying , Yan Qi , Zhang Wentao , Chen Li , Wang Maohua , Guan Bing
Published: September 2023

Background:

The mechanism of sudden sensorineural hearing loss (SSNHL) remains incompletely understood, but immune cell infiltration has been identified as a crucial component in the sickness. The patients with SSNHL may benefit from investigating markers related to inflammation.

Methods:

From April 2022 to 2023, 80 patients who were diagnosed with SSNHL in the Department of Otolaryngology at Yangzhou University’s Clinical Medical College were enrolled in the SSNHL group. And patients were separated into effective and ineffective groups based on the degree to which their hearing had recovered prior to discharge. As the control group, 80 healthy volunteers were chosen from hospital’s physical examination center. Neutrophils, lymphocytes, platelets, and white blood cells were counted. Additionally, quantified and statistically examined were the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII). The risk variables for prognosis were identified using logistic regression models, and the prediction accuracy of the model was calculated using the receiver operating characteristic (ROC) curves.

Results:

The SSNHL group had higher levels of white blood cells, neutrophils, platelets, NLR, PLR, and SII than the control group. While the PLR lacked statistical significance, the NLR and SII of the patients in the ineffective group were noticeably higher than those in the effective group.

Conclusion:

Patients with SSNHL exhibit inflammatory immune responses. Patients with SSNHL can have their prognosis determined by the simple peripheral blood indicators NLR and SII, particularly SII, which is significant for predicting prognosis and directing treatment.
Do Family Firms Issue More Readable Annual Reports? Evidence From the United States
Authors: Liao Qunfeng , Srinidhi Bin , Wang Ke
Published: September 2023

Using a sample of 22,442 firm-year observations for 3,721 U.S. listed firms, we show that family firms, on average, issue annual reports with higher readability than non-family firms. Higher readability could occur due to lower obfuscation or less information conveyance. By controlling complexity and choosing readability measures linked to obfuscation, we attribute the higher readability to lower obfuscation. Our investigation into the heterogeneity in family firms shows that the positive effect of family control on reporting readability exists for eponymous family firms but not for non-eponymous family firms. We also find that family firms managed by founders or heirs issue more readable 10-K reports than non-family firms, but family firms managed by outsiders do not exhibit such a difference. Cross-sectional analyses show that the difference in readability between family and non-family firms diminishes for firms with more earnings manipulation, weaker board governance, and dual-class shares. Further, we find that investors perceive family firms’ annual reports with higher readability to be more informative. Finally, we use state-level succession tax cuts as an exogenous shock to link the higher readability to family insiders’ incentives and preferences. Our findings are consistent with the view that family insiders’ incentive to maintain family reputation contributes to lower obfuscation in 10-K narrative disclosures.
Keepers of the Flame: Gender, Race, and the Myth of Meritocracy in K–12 Educational Leadership
Authors: Odell Sarah Margaret
Published: September 2023

Purpose:

This study is part of a larger study of 18 aspiring school leaders that aims to understand how gender identity and gender performance impacted their experience in the K–12 independent school leadership pipeline. One of the key findings was that meritocracy played an important role in how individuals understood what the outcomes of their ascent to leadership should be. This article focuses on that finding through the voices of aspiring K–12 independent school leaders who have tried to enter the pipeline or have come through the pipeline.

Method:

This study uses Carol Gilligan’s Listening Guide method of data analysis. It was important to use a method and frame the study in a methodology that enabled marginalized voices to be heard. The Listening Guide requires the research to go through three “listenings” of the data: listening to the landscape, where the researcher takes note of everything that was said in the interview and what was not said; listening for the I, where the researcher makes I poems out of all of the I statements in the interview to hear for a deeper layer of consciousness; and finally, listening for contrapuntal voices, which acknowledges that people speak in multiple voices. Through these three listenings, a voice emerged from the data of the keepers of the flame: White women believed that specific work would guarantee them access to leadership.

Findings:

White women believe and are complicit in upholding meritocracy while White men articulated meritocracy as a lie that they benefit from. One of the interviewees, Joe, was unique among the men I interviewed—he was the only sitting head of school that I interviewed, and he was the only man who spoke so pointedly about the leadership pipeline advantaging someone like him. Black women, on the other hand, have always known from their racialized and gendered experience of the world that their hard work will be overlooked. This also came through in study interviews with Black women aspiring to leadership. For them, keeping silent is an issue of survival. As Carol Gilligan wrote, the story of women’s voices and women’s silences is not a simple one: It is not a question of one gender or race being above another. Rather, it is a story about resistance. An individual’s belief about how much work is necessary to gain access to leadership proves how White patriarchy centers the pipeline and either enforces silence or enables voice in one’s ability to move up. Meritocracy, and whether or not the individual believed it, turned out to be explicitly tied to one’s gender and racial identities. More diverse school leadership may lead to more equitable independent schools.
Interracial romances and colorblindness in Shondaland’s Bridgerton
Authors: Hanus Stephanie L.
Published: September 2023

Previous literature has considered Shondaland and portrayals of interracial romances for depicting post-racial and post-feminist utopias. Given mass media’s ability to create/reproduce ideologies, Shondaland’s most popular and most recent installment, Bridgerton, offers an opportunity for assessing narratives related to race and gender. The current study considers these narratives in Bridgerton, as well as the role of colorblind casting techniques for constructing those narratives. The current study uses a critical race theory approach, incorporating Black feminist thought and intersectionality. Season one of Bridgerton reveals three themes as they relate to race and gender, (1) romance, love, and who is worthy of love, (2) the body and historical context, and (3) dark corrupting light. Specifically, Black women are depicted in various positions of power that minimize racism and yet are simultaneously depicted in positions of oppression that serve to naturalize oppression of Black women, offering support for Bonilla-Silva’s colorblind racism in media.
Emotional Benefits of Leader Legitimacy
Authors: Johnson Cathryn , Gibson Ryan , Hawks Kate , Hegtvedt Karen A.
Published: September 2023

Leaders with legitimacy attain substantial benefits in the workplace, like cooperation and minimal dissension from workers. We argue that legitimacy also benefits leaders by enhancing workers’ positive emotions and displays and reducing negative emotions and displays to their behaviors. Employed, adult study participants took the role of a worker and responded to a vignette description of a leader’s behaviors (use of fair/unfair decision- making procedures; high/low use of power benevolently) and status characteristics (Study 1, three months/three years of experience; Study 2, Black male/White male). Results confirm the expected patterns of effects of legitimacy on positive and negative emotions. Perceived legitimacy also largely mediates the effects of the leader’s behaviors and experience (but not race) on emotional responses. Legitimated leaders benefit from a flow of positive emotions and displays and are largely protected from negative emotions and displays that could jeopardize their legitimacy and ultimately the functioning of the work group.
Mutual Futurity: Rethinking Incommensurability between Indigenous Sovereignty and Black Freedom
Authors: Quizar Jessi
Published: September 2023

Engaging feminist and queer of color theory as well as work emerging from social movements, this piece critically examines narratives of impasse between Black Studies and Native Studies in the US, particularly assertions of incommensurability between the goals of Black freedom and Native sovereignty. The article outlines some of the theoretical debates between Black and Indigenous Studies that have calcified into impasses, focusing particularly on Afropessimist and Settler Colonial Studies’ framings of either slavery/anti-Blackness or settler colonialism as the foundational violence around which a racist/settler modernity is structured. This article argues that approaches that emphasize relationality and the co-determination of settler colonialism and anti-Black racism can help us to think beyond a Black/Native impasse and towards a mutual futurity for both Black and Indigenous people in living in the place we currently call the United States.
Helicopter parenting and first-semester students’ adjustment to college: A self-determination theory perspective
Authors: Shin Matt , Adame Elissa A.
Published: September 2023

In this study, we examined the relationship between helicopter parenting and first-semester students’ ( N = 211) adjustment to college. It was hypothesized that first-semester students who report higher amounts of helicopter parenting would also report higher levels of basic psychological need frustration and lower levels of educational, relational, and psychological functioning. Results of a structural regression model suggested that helicopter parenting had negative indirect associations with educational, relational, and psychological functioning through competence frustration. Helicopter parenting also had a negative indirect association with psychological functioning through autonomy frustration. No significant indirect associations were found through relatedness frustration. Findings from our study highlight the particular importance of both autonomy and competence needs as potential mechanisms through which helicopter parenting might negatively impact students’ optimal functioning and well-being during their transition to college.
Individualized heparin monitoring and management reduces protamine requirements in cardiac surgery on minimal invasive extracorporeal circulation; A prospective randomized study
Authors: Gkiouliava Anna , Argiriadou Helena , Antonitsis Polychronis , Goulas Antonis , Papapostolou Evangelia , Sarridou Despoina , Karapanagiotidis Georgios T , Anastasiadis Kyriakos
Published: September 2023

Introduction

Individualized heparin and protamine management is increasingly used as a strategy to reduce coagulation activation and bleeding complications. While it is associated with increased heparin requirements during Cardiopulmonary Bypass (CPB), the impact on protamine administration remains controversial. We aim to investigate the effect of heparin level-guided monitoring on protamine dosing during cardiac surgery where low-anticoagulation protocols are implemented.

Methods

This is a prospective, randomized, controlled trial. A total of 132 patients undergoing elective full-spectrum cardiac surgery with Minimal Invasive Extracorporeal Circulation (MiECC) were recruited. All patients were managed by the same anaesthetic, surgical and perfusion team. Patients were randomly allocated in two groups; the individualized heparin-protamine titration (IHPT) group and the conventional heparinization and reversal group by using ACT (cACT) with a 0.75:1, protamine: heparin ratio. Titration was accomplished with the Hepcon HMS Plus (Medtronic, Minneapolis, MN) system. The primary outcome of the study was the total protamine dose used. Secondary outcomes comprised of the total heparin dose, the percentage of patients achieving target ACT, 24-h transfusion requirements, postoperative bleeding, duration of mechanical ventilation, major morbidity and length of hospital stay. Patients in each group were divided in two subgroups according to the target ACT; those operated for coronary artery bypass grafting (CABG) using a target ACT >300 s and the rest (non-CABG) patients operated with a target ACT >400 s, respectively.

Results

Protamine requirements were significantly reduced when IHPT was implemented; CABG (118 ± 24 mg vs 163 ± 61 mg; p < 0.001) and non-CABG cases (151 ± 46 mg vs 197 ± 45 mg; p < 0.001). Moreover, heparin requirements were significantly higher in the non-CABG subgroup managed with IHPT (34,539 ± 7658 IU vs 29,893 ± 9037 IU; p = 0.02). In overall, no significant differences were detected with respect to postoperative bleeding, transfusion of RBC or other blood products.

Conclusions

Individualized heparin monitoring and management reduces protamine requirements in cardiac surgery with MiECC implementing reduced anticoagulation strategy.

Trial registration

clinicaltrials.gov; NCT04215588.
Effect of glucocorticoid for patients with type A aortic dissection undergoing surgical repair with deep hypothermic circulatory arrest: A single-center, retrospective study
Authors: Luo Ming-hao , Chen Jia-qi , Luo Jing-chao , Li Jia-kun , Zhang Yi-jie , Xu Xin , Su Ying , Wang Chun-sheng , Lai Hao , Sun Yong-xin , Li Jun , Tu Guo-wei , Luo Zhe
Published: September 2023

Background

Postoperative patients with Type A aortic dissection (TAAD) often experience severe inflammatory responses caused by multiple factors perioperatively. However, the effect of postoperative glucocorticoid (GC) use, which is a potent anti-inflammatory agent, on complications or all-cause mortality is unclear.

Methods

Patients with TAAD who underwent surgical repair requiring deep hypothermic circulatory arrest between January 2020 and December 2021 were included in the study. Characteristics of patients treated with and without GCs were compared. The primary outcome was in-hospital mortality, and a composite secondary outcome was defined as in-hospital death or any major complications. Propensity score matching was used to balance baseline differences between groups. Kaplan-Meier curves were used to compare survival probability.

Results

A total of 393 postoperative patients with TAAD were included in the study. Forty of them (10.2%) received GC treatment at a median daily methylprednisolone-equivalent dose of 0.6 mg/kg (0.4–0.7) for a median period of 2 (1–3) days. Patients on GCs had more intraoperative blood transfusions, higher postoperative APACHE II (12 vs 9, p = .004) and SOFA (9 vs 6, p < .001) scores, worse perioperative hepatic, renal and cardiac function. The in-hospital mortality in the matched cohort did not differ between groups [GC n = 11/40 (27.5%) versus Non-GC n = 19/80 (23.8%); p = .661].

Conclusions

The propensity to use GCs correlated with the critical status of the patient. However, low dose and short-term postoperative GC treatment did not reduce in-hospital mortality rates among patients with TAAD. A more appropriate regimen should be further investigated.
The Fragment of a Model of a Tower House from Kom el-Gir, Central Northwestern Delta
Authors: Schiestl Robert
Published: September 2023

This article discusses a fragment of a model of a tower house found on the surface at Kom el-Gir in the central northwestern Delta. The settlement of Kom el-Gir, which was used at least from the Ptolemaic to the Late Roman Periods, showed a dense occupation of tower houses, based on magnetic prospection. A reconstruction of what the house model may have looked like is suggested and the possible uses of such house models are discussed.

[Formula: see text]
Impact of Ball Bank Indicator on Predicting Rural Curve Crashes
Authors: Knezevich Ronald , Yang Zhongyu , Yu Pingzhou (Lucas) , Tsai Yi-Chang (James)
Published: September 2023

The ball bank indicator (BBI) measures the lateral forces on a vehicle. It is used to establish the advisory speed limit as outlined in the American Association of State Highway and Transportation Officials (AASHTO)’s Green Book. BBI values respond to roadway geometry and driver behavior. Currently, BBI data are available from various curves across the U.S. However, the relationship between BBI and curve lane departures is unknown. Therefore, the objective of this paper is to assess the impact of BBI as an explanatory variable for curve lane departures within a safety performance function (SPF) (i.e., a crash prediction model). To accomplish this objective, a study is conducted on rural curves in Districts 1, 2, and 6 of Georgia Department of Transportation in the U.S. BBI is integrated into a negative binomial model alongside other common explanatory variables used in the Highway Safety Manual. This SPF, with BBI incorporated, is compared with a baseline SPF without the BBI. The results show BBI is a statistically significant variable under a 99.9% threshold. Additionally, it was found that the model with BBI has 2.78% and 2.83% less mean absolute error and route mean squared error, respectively. Though the improvement in the model is minor, this finding is notable because BBI data may already be available for a transportation agency to leverage to assess risk on curves. Furthermore, this data could be even more beneficial if it were crowdsourced to gauge real-world behaviors.
Obstacle Detection Method of Underground Electric Locomotive Rail Based on Instance Segmentation
Authors: Tong Jiale , Wang Shuang , Guo Yongcun , Wang Wenshan , Yang Tun , Zong Shuqi
Published: September 2023

Real-time and accurate obstacle detection is a vital technology for electric locomotives, especially as driverless vehicles are introduced. A method of obstacle detection for underground electric locomotive rail based on instance segmentation is developed to solve the problems of misdetection and missing detection, low detection accuracy, and slow detection speed of rail obstacles. The method of locating the track mask, demarcating the effective driving boundary, expanding the track mask, and forming the effective driving area is adopted to verify whether the target is an obstacle based on whether the target is located in the effective driving area, to avoid the problem of misdetection and missing detection of the target obstacle. The YOLACT++ (You Only Look At CoefficienTs) model is improved, and path augmentation and target classification loss function replacement strategies are adopted to enhance the model’s ability to detect target details and increase the accuracy of target segmentation. Compared with traditional image processing, this method can detect both straight rail and turnout. The mean average precision of boundary box mAP0.5(box) and mask mAP0.5(mask) of the improved YOLACT++ model reaches 98.52% and 98.55%, which is higher than that of the YOLACT++ model, and the detection frame rate reaches 21.9 frames per second.
Comparison of Knee Pain and Difficulty With Kneeling Between Patellar Tendon and Hamstring Tendon Autografts After Anterior Cruciate Ligament Reconstruction: A Study From the New Zealand ACL Registry
Authors: Rahardja Richard , Love Hamish , Clatworthy Mark G. , Young Simon W.
Published: September 2023

Background:

The bone–patellar tendon–bone (BTB) autograft is associated with difficulty with kneeling after anterior cruciate ligament (ACL) reconstruction; however, it is unclear whether it results in a more painful or symptomatic knee compared with the hamstring tendon autograft.

Purpose:

To identify the rate and risk factors for knee pain and difficulty with kneeling after ACL reconstruction.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Primary ACL reconstruction procedures prospectively recorded in the New Zealand ACL Registry from April 2014 to May 2021 were analyzed. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to identify patients reporting consequential knee pain (CKP), defined as a KOOS Pain subscore of ≤72 points, and severe kneeling difficulty (SKD), defined as a self-report of “severe” or “extreme” difficulty with kneeling. Absolute values of the KOOS Pain and Symptoms subscales were also compared.

Results:

A total of 10,999 patients were analyzed. At 2-year follow-up, 9.3% (420/4492) reported CKP, and 12.0% (537/4471) reported SKD. The most important predictor of CKP at 2-year follow-up was having significant pain before surgery (adjusted odds ratio, 4.10; P < .001). The most important predictor of SKD at 2-year follow-up was the use of a BTB autograft rather than a hamstring tendon autograft (21.3% vs 9.4%, respectively; adjusted odds ratio, 3.12; P < .001). There was no difference between the BTB and hamstring tendon grafts in terms of CKP (9.9% vs 9.2%, respectively; P = .494) or in absolute values of the KOOS Pain (mean, 88.7 vs 89.0, respectively; P = .37) and KOOS Symptoms (mean, 82.5 vs 82.1, respectively; P = .49) subscales.

Conclusion:

At 2-year follow-up after primary ACL reconstruction, 9.3% of patients reported CKP, and 12.0% reported SKD. The BTB autograft was associated with difficulty with kneeling, but it did not result in a more painful or symptomatic knee compared with the hamstring tendon autograft.
A comparative study between one step dilatation and serial dilatation technique in percutaneous nephrolithotomy
Authors: Gupta Naveen Kumar , Huda Noushim Akram , Pal Dilip Kumar
Published: September 2023

Background:

Percutaneous nephrolithotomy (PCNL) is the first line treatment for treating kidney stones larger than 2 cm size with the advantages of lower morbidity and faster post-operative recovery. Creation of a nephrostomy access is one of the major steps of PCNL. It can be done either by single-step dilatation or by multi-step serial dilatation technique.

Objectives:

To compare the outcome and evaluate the efficacy of percutaneous nephrolithotomy done by single-step versus serial dilatation technique with specific reference to access time, fluoroscopy time, rate of blood transfusion, length of hospital stay (post-op) and complication rate.

Methods:

It was a prospective study with a sample size of 100 where 50 patients underwent one-step dilatation and other 50 patients underwent serial-dilatation technique. These patients were analysed on the basis of their demographic profile, renal access time, total fluoroscopy time for access, post-operative haematuria, duration of post-operative hospital stay and complications after operative procedure. Data was analysed and reported using statistical tools.

Results:

Demographic profile of the patients and stone characteristics were equivalent between two groups. Mean access tract dilatation time, mean total fluoroscopy time were significantly less in one of the groups. Requirement of blood transfusion, and post-operative complications rate were not significant between two groups.

Conclusion:

Both methods are safe and effective for tract dilatation. However, PCNL can be successfully performed by one-step dilatation with the added advantages of lesser time of renal access, lesser radiation exposure. Blood loss and hospital stay after operative procedure were not statistically significant between two groups.
A retrospective cohort study, analyzing trends in management of upper urinary tract stones in the adult Israeli population
Authors: Golomb Dor , Cooper Amir , Raz Orit
Published: September 2023

Objective:

To assess trends of surgical intervention in adults with upper urinary tract stones in Israel.

Methods:

A retrospective cohort study utilizing administrative databases held at Clalit Health Services, to identify all adults (⩾18 years) who underwent their first surgical treatment for upper tract urolithiasis. Descriptive statistics were employed to summarize baseline patient demographics and surgical trends were analyzed using the Cochrane-Armitage test for trend.

Results:

Between 2003 and 2020, 36,624 adult patients were treated surgically for upper tract urinary stones. Mean age was 53.6 years (SD16.1). During the period investigated, the number of insured by Clalit Health Services increased by 25% and the total number of surgically treated stones increased by 98.7%. By type of procedure: Ureteroscopy (URS) increased by 351%, percutaneous nephrolithotripsy (PCNL) increased by 67%, shockwave lithotripsy (SWL) declined by 79%. The number of procedures per 100,000 population grew from to 37.5 in 2003 to 58.05 in 2022. The percentage increase in total number of surgical procedures was 103% and 90% in males and females, respectively.

Conclusions:

Our findings reveal significant increases in the total number of surgically treated stones over the investigated period. Notably, this increase far outpaced the growth in the number of individuals insured by Clalit Health Services. Further research and interventions are warranted to explore the underlying factors driving these trends and to develop targeted approaches for prevention, early detection, and minimally invasive treatment of upper urinary tract stones in Israel.
Role of cystoscopy as primary initial investigation in interstitial cystitis/bladder pain syndrome
Authors: Singh Angadjot , Priyadarshi Shivam , Bansal Somendra , Nandwani Sanyam
Published: September 2023

Introduction:

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic painful bladder condition characterized by pelvic pain and urinary symptoms without another identifiable cause. Cystoscopy as primary initial investigation for IC/BPS has not been accepted yet and needs more studies to definitely conclude.

Aims and objectives:

We aimed to assess cystoscopy findings in patients of interstitial cystitis/bladder pain syndrome and to prove role of cystoscopy as primary initial investigation for interstitial cystitis/bladder pain syndrome.

Materials and methods:

Our prospective observational study included 35 female patients aged 18–69 years presenting to the Urology OPD at SMS Hospital with suprapubic or pelvic pain for 6 months, bladder pain that worsens with bladder filling and reduced with voiding, dysuria, urinary frequency and urgency, nocturia, dyspareunia. Those with history of bladder capacity more than 350 ml, duration of symptoms less than 6 months, day time frequency less than eight times per day, diagnosis of bacterial cystitis or prostatitis, bladder or ureteral calculi, active genital herpes, any existing urological malignancy, radiation cystitis were excluded from the study. They were then subject to cystoscopy and the findings of the cystoscopy were analyzed.

Results:

Out of the 35 patients, 11 (31.43%) had a normal cystoscopy. Of the 24 patients (68.57%) who had a positive cystoscopy, cystoscopy in seven patients (20.0%) revealed an ulcer. All these seven patients underwent fulguration. In the remaining 17 patients the abnormal findings were petechiae, large submucosal bleed. The sensitivity of cystoscopy in detecting the ulcerative type of Interstitial cystitis was found to be 20.0%.

Conclusion:

Our study found that Cystoscopy, if employed in initial investigation can help early detection of ulcerative variety of IC/BPS and can act as therapeutic modality by using fulguration plus hydrodistension. Larger comparative studies are needed for diagnostic/Therapeutic value of cystoscopy.
Assessing pentafecta outcomes post radical cystectomy: A tertiary care center study
Authors: Singh Vikram , Sarangi Shakti Swarup , Bhirud Deepak Prakash , Sharma Kartik , Tripathi Shashank Shekhar , Choudhary Gautam Ram , Singh Mahendra , Navriya Shiv Charan , Sandhu Arjun Singh
Published: September 2023

Introduction:

Bladder cancer is a common and serious disease globally, often requiring radical cystectomy as the preferred treatment. However, this procedure carries substantial risks and complications. To evaluate its success, pentafecta, a five-component measure, was introduced. This study investigates the attainment of pentafecta following radical cystectomy and examines factors that influence its achievement.

Methodology:

This retrospective, single-group study was conducted at AIIMS Jodhpur. The study population included 42 patients who underwent radical cystectomy for bladder cancer. Various data, including demographic characteristics, clinical features, surgical techniques, and postoperative outcomes, were collected from medical records. The primary outcome measure was the rate of achieving pentafecta, which comprises five parameters.

Results:

Out of 42 patients, 26 (61.9%) achieved pentafecta. Age, gender, comorbidities and surgical approach did not significantly affect the attainment of pentafecta. Negative surgical margins were achieved in 95.2% of cases, and adequate lymph node dissection (>16 lymph nodes) was performed in 85.7% of cases. The absence of Clavien-Dindo grade 3–5 complications and recurrence was observed in 80.9% and 90.47% of cases, respectively. Uretero-enteric stricture was absent in 95.2% of cases.

Conclusion:

The study emphasizes the significance of negative surgical margins, thorough lymph node dissection, absence of complications, recurrence, and uretero-enteric strictures in evaluating the success of radical cystectomy as pentafacta outcomes. Patients with higher drain output and wound infections are less likely to achieve pentafacta outcome and indicates poorer outcome. By considering these factors, clinicians can assess patient outcomes and identify areas for improvement.