bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation
Authors: Woodward Hilary
Published: October 2022

Simulation helps learners conceptualize and apply knowledge through experiential learning and shared reflection. Children and families, as well as professionals who work with these populations, can benefit from simulation-based education. Child life specialists' skills in interprofessional collaboration, developmentally appropriate language and preparation, child- and family-centered care, and emotional safety provide them with a solid foundation as simulation educators and facilitators. By developing their knowledge of the learning theories underpinning simulation as well as scenario design, simulation environments and modalities, psychological safety, and debriefing, child life specialists can incorporate simulation into their roles. This chapter provides an overview of simulation concepts and methods while exploring the intersection of simulation with child life practice. The chapter also identifies ways that child life specialists can contribute to simulations for children and youth, parents and caregivers, child life students and professionals, and interprofessional teams.
Child Advocacy Center
Authors: Isaacson Victoria , Ainsworth Samantha
Published: October 2022

The nature of a visit to a child advocacy center (CAC) following an allegation of child abuse has the potential to be challenging for children and their non-offending caregiver for a variety of reasons. Within a CAC, Certified Child Life Specialists are able to call upon their unique skill set to support children throughout the many elements of a forensic evaluation process. In an effort to reduce anxiety, enhance coping, and provide developmentally appropriate play and education opportunities for children in this setting, child life specialists serve as integral members of the multidisciplinary team (MDT). In their active role, child life specialists are able to collaborate with community MDT members to creatively and effectively support children throughout the forensic evaluation process. The need for child life involvement in CACs and during the investigative forensic evaluation process is highly valuable when reflecting on the benefit and overall experience for children and their families.
Therapeutic Photography
Authors: Ribbens Megan
Published: October 2022

As the child life profession extends beyond the hospital setting, new opportunities unfold to utilize the profession's strengths of empowering children and families through stressful life experiences. This chapter proposes that therapeutic photography is a fitting and effective tool to be used in any child life setting to promote well-being and describes Through Their Eyes, a child life practice centered on therapeutic photography in a non-traditional setting in South Africa. Differentiations are made between therapeutic photography and phototherapy and therapeutic photography is expounded. The underpinning framework of therapeutic photography with a child life scope of practice is outlined and the therapeutic photography program, Through Their Eyes, is explained. Outcomes give evidence of the ways therapeutic photography programs can connect us to ourselves and to each other, strengthening sense of self, relationships, and family function.
Sustainable Digital Marketing
Authors: Arantes Luzia
Published: October 2022

The purpose of this chapter is to contribute to the gap in the literature of digital marketing and sustainability as joint areas of knowledge and thus contribute to the discussion of the use of digital marketing as a tool to promote sustainability. In addition, this chapter was formulated as a guiding question: to what extent can the use of digital marketing contribute to the adoption of more sustainable behaviors by different audiences? The chapter will include an exhibition on the concept and perceptions of digital marketing, sustainable consumer behavior, and the climate crisis. Subsequently, a renewed concept of sustainable digital marketing is presented as an area of joint action that focuses not only on changing consumer behavior in terms of sustainability, but also on changing the mechanisms of production, transportation, materials used and use of non-sustainable resources renewable by brands/organizations.
Determinants of Purchase Intention for Sustainable Fashion
Authors: Morais Cláudia Filipa Silva , Pires Paulo Botelho , Delgado Catarina
Published: October 2022

Social media has become a crucial point for brands to establish a connection with their consumers and potential consumers, being many times responsible for developing the need and converting it into a purchase. Thus, it is worth highlighting the role of influencers in social media that affect fashion purchase. Given the growth of sustainable fashion, it is necessary to verify the relationship between influencers and social media and the intention to purchase sustainable fashion. A conceptual model that aims to understand the effect of influencers' characteristics in the intention to purchase sustainable fashion is presented. The results show that consumer knowledge and willingness to pay more are the only factors that positively affect the purchase intention of sustainable fashion. Furthermore, the authors highlight that consumer knowledge is the construct that has a distinctly greater impact on the intention to purchase sustainable fashion.
The Internet of Things in the Tourism Industry
Authors: Hassan Azizul
Published: October 2022

The internet of things (IoT) is probably one of the most relevant concepts in the present tourism industry. This becomes widely popular in terms of ease of use and familiarity of the user. As predicted by relevant tourism industry experts, the IoT can influence the future tourism industry when users become more innovative and technology-centric. This chapter critically analyses the IoT artifacts in relation to their current position and future applications in the tourism industry. The research then addresses some relevant queries regarding the use of the IoT in tourism. The IoT is defined here in the tourism industry context followed by the feature analysis, application, issues, and challenges identification major issues and offers some suggestions as likely remedies to overcome or minimize the effects of the identified issues. This research presents data and information and on the basis of findings predicts that the future of the IoT in tourism is rather encouraging.
Juxtaposition of Traditional and Modern Methods of Performance Appraisal in Organizations
Authors: Hamid Zainab , Shah Shawkat Ahmad
Published: October 2022

Performance appraisal systems are very effective and invaluable tools for ensuring the smooth performance and progress of any organization. Human resources in any organization cannot be fully functional until their performance is evaluated. Robert Half has rightly said that there is something that is much more scarce, something rarer than ability, that is the ability to recognize ability. In this backdrop, this chapter gives a detailed account of what performance appraisal systems stand for apart from focusing on their importance and evolution across time. The traditional and modern methods of performance appraisal systems have been juxtaposed so as to get key insights regarding what way the appraisal systems should go ahead so as to survive the test of time. It has been recommended that researchers should gear their efforts for fine-tuning the appraisal systems in a way that proper indicators are brought into consideration so as to increase their efficacy as tools of organizational effectiveness.
Governance of Digital Business in Industry 4.0
Authors: Kashyap Amit , Saraswat Pranav
Published: October 2022

The importance of digital technologies for social and economic developments and a growing focus on data collection and privacy concerns have made the internet a salient and visible issue in global politics. The internet has transformed how we do business and created new opportunities for cross-border trade and investment, enabling small businesses worldwide to connect with customers and suppliers in the global market. In this chapter, the author conceptualizes the digital media business in India, which utilizes the internet to create the biggest platform for commerce worldwide. The author discusses regulations that are required in the cyber law and the safe harbour rule of cyber law, which is constantly harnessed by the digital media and e-commerce companies that act as intermediaries to protect them from the actions of the end-user on their platform.
Cyber Security Policy in India
Authors: Kalra Kush , Tanwar Bhanu
Published: October 2022

Cyber security policies can be defined as a formal set of rules that help regulate all the aspects of data and information exchange over the internet. These cyber policies are made with the goal to ensure the necessary regulations to protect people over cyber space and to allow a social freedom. It is necessary to maintain a balance between the two. Progress to expand the legislation to criminalize certain activities that pose as a threat to the society is rather a remarkable step for most countries. The first step is the introduction of a policy to the country. A policy is mostly used as a strategy to define different objectives and methods to address the issue of concern. Developing a policy helps the government to understand and define a required response to a problem. The battle against cybercrime cannot be solely won by introducing legislation. Certain strategies and measures that strengthen the fight against such crime and resolve conflicts are also needed.
Cybersecurity Management in South African Universities
Authors: Netshakhuma Nkholedzeni Sidney
Published: October 2022

The study aimed to assess cyber security at South African universities. The researcher will use literature to assess the state of cybersecurity at South African universities. The results from the literature review revealed poor implementation and adherence of cyber security strategy and standards by employees and students; poor cyber security awareness relative to information communication technology (ICT) infrastructures and assets; and lack of strategy and framework to implement cyber security management. The study recommends continuous monitoring and evaluation of information management systems at various South African universities with the view to assess the state. A replica of the study may be studied in other part of the world.
Strip Casting of Al-4.7%Mg with Impurity Fe Using a Single Roll Caster with a Scraper
Authors: Haga Toshio , Oida Keisuke , Yamazaki Kazuki , Watari Hisaki , Nishida Shinichi
Published: October 2022

Fe was added to Al-4.7%Mg to make model alloys of recycled Al-Mg alloy. The effect of Fe addition on the mechanical properties of the Al-4.7%Mg strip cast using a single-roll caster equipped with a scraper was investigated. The added Fe content was 0.2, 0.4, 0.6, and 0.8%. The as-cast strip cast at 30 m/min was cold rolled down to a thickness of 1 mm thick annealed to conduct a tensile test and a cup test. The as-cast strip could be cold rolled without cracking. The tensile stress and the 0.2% proof stress were only slightly affected by the addition of Fe. The elongation gradually decreased as the Fe content increased. When the Fe content was 0.8%, the elongation in the casting direction was 27.7%. The limiting drawing ratio did not deteriorate until the Fe content was 0.4%. When the Fe content was 0.4% and 0.8%, the limiting drawing ratios were 2.0 and 1.7, respectively.
Potential Assessment of Combustible Municipal Wastes in Morocco and their Ability to Produce Bio-Oil by Pyrolysis
Authors: El Kourdy Sara , Aboudaoud Souad , Abderafi Souad , Cheddadi Abdelkhalek
Published: October 2022

Pyrolysis of combustible municipal solid waste (MSW) is an environmentally friendly waste to energy process that produces an ecological bio-oil with a high-energy value. However, the challenge is to obtain the desired products in considerable quantities, of good quality, and at low cost. The present work objective is to evaluate combustible MSW potential available in Morocco and their recovery in bio-oil produced by pyrolysis. An evaluation was conducted based on the MSW characterization for different Moroccan cities. It shows that Morocco has significant potential in good quality RDF, having a high calorific value and a low environmental impact. The yield of bio-oil that can be produced by pyrolysis of the dry part of municipal waste for different Moroccan cities was estimated using an appropriate model. The average total bio-oil yield estimated for each city is 45 wt%. Besides, the high calorific value fraction of bio-oil derived from Moroccan RDF will cover ~45% of the country's fuel-oil needs.
Luminescence Properties of Eu-Doped BaLaAlO4 Phosphors for Solid State Lighting
Authors: Etafo Nelson Oshogwue , Garcia Carlos Eduardo Rodriguez , Uc Jorge Oliva , Viesca-Villanueva Efraín , Lobato Marco Antonio Garcia , Torres Ramírez Roberto Constancio
Published: October 2022

In this study Barium Lanthanum Aluminate BaLaAlO4 and BaLaAlO4:xEu red phosphors were produced at different x at.% Eu concentration (x = 0,1,3,5 and 7 at.% of Eu) by combustion synthesis method and post-annealing. The X-ray diffraction (XRD) patterns shows that all samples present the orthorhombic phase (JCPDS # 44-0164). Scanning electron microscopy (SEM) shows that the grains size diminished and then increases as a function of Eu-doping concentration addition. Photoluminescence spectra of the samples, under UV excitation, show a maximum strong red emission at lem= 615 nm attributed to the 5D0®7F2 Eu3+ ion transition. The Eu-doped BaLaAlO4 sample that present the highest luminescence intensity was with the x= 1.0 at.% of Eu doping concentration. The quenching in photoluminescence spectra was detected for the Eu doping concentrations of x= 5 and 7 at%, which was ascribed to due to dipole-quadrupole (d-q) interactions. Because the strong red emission of Eu-doped BaLaAlO4 phosphor it could be used UV activated LEDs.
Co-Pyrolysis of Disposable Mask with Sugarcane Bagasse
Authors: Hidayat Arif , Dimas Daffa , Sidiq Ichwanul
Published: October 2022

Using disposable masks to protect against coronavirus 19 (COVID-19) has become a habit during the pandemic. However, the emergence of contaminated mask waste causes environmental problems because recycling is difficult. This research carried out the co-pyrolysis of disposable masks waste with sugarcane bagasse in a tubular reactor. The temperature and blend ratio of sugarcane bagasse to disposable mask was varied to investigate the product distribution. The maximum liquid product yield was obtained at 54.3% at 400 °C using a blend ratio of sugarcane bagasse to disposable mask 1/2. Based on the Gas Chromatography Mass Spectrophotometry (GS-MS) analysis, the liquid products consists of alkanes, alkenes, acids, alcohols, ketones, and aromatic compounds.
KIR2DL2, KIR2DL5A and KIR2DL5B genes induce susceptibility to dengue virus infection while KIR3DL3 and KIR2DS5 confers protection
Authors: TAPSOBA Aziz Sidi Aristide , Djigma Florencia Wendkuuni , BAYALA Bagora , SORGHO Pegdwendé Abel , TRAORE Lassina , ZOHONCON Théodora Mahoukèdè , BELLO Shoukrat Ohuwa Toyin , BADO Prosper , BAZIE Bapio Valérie Elvira Jean Télesphore , YOUGBARE Fiffou , SETOR Marius Ayaovi , TRAORE Esther Mah Alima , OBIRI-YEBOAH Dorcas , YONLI Albert Théophane , SIMPORE Jacques
Published: October 2022

Background/objective: Dengue, an emerging and re-emerging viral disease, is a major public health problem. The aim of this study was to investigate the influence of KIRs genes polymorphism and KIRs genotypes in susceptibility of dengue virus infection and disease severity in a population from Burkina Faso through a case-control study.Methods: KIRs genes determination were performed using PCR-SSP in 50 patients infected by dengue virus (DENV) and 54 Healthy controls (HC) subjects which never having infected by DENV.Results: Data analysis showed significant association between frequencies of three KIR genes and dengue virus infection (DF): KIR2DL2 (OR: 7.32; IC: 2.87-18.65; P < 0.001); KIR2DL5A (OR: 15.00, IC: 5.68-39.59; P < 0.001) and KIR2DL5B (OR: 11.43; IC: 4.42-29; P < 0.001). While, KIR3DL3 (OR: 0.13, IC: 0.052-0.32; P < 0.001) and KIR2DS5 (OR: 0.12; IC:  0.04-0.30; P < 0.001) were associated with protection against DF.  KIR2DL4 (OR: 9.75; IC95%: 1.33-70.97; p: 0.03) and KIRD3DL1 (OR: 12.00; IC95%: 1.60-90.13; p: 0.02) were associated with an increased risk in the development of secondary dengue infection (SDI).Conclusion: The results suggest a contribution of KIR2DL2, KIR2DL5A and KIR2DL5B genes in the susceptibility of DF development. While, KIR3DL3 and KIR2DS5 were found to be associated with protection against DF development by enhancing both the innate and acquired immune responses.
The subsurface sulfur system following hydraulic stimulation of unconventional hydrocarbon reservoirs: assessing anthropogenic influences on microbial sulfate reduction in the deep subsurface, Alberta
Authors: Kingston A W , Ardakani O H , Scheffer G , Nightingale M , Hubert C , Meyer B
Published: October 2022

Hydraulic fracturing is a reservoir stimulation technique that involves the injection of high-pressure fluids to enhance recovery from unconventional hydrocarbon reservoirs. Often this involves the injection of surface waters (along with additives such as
biocides) into formational fluids significantly different isotopic and geochemical compositions facilitating geochemical fingerprinting of these fluid sources. In some instances, the produced fluids experience an increase in hydrogen sulfide (H2S) concentration over the course of production
resulting in an increased risk to health and safety, the environment, and infrastructure due to the toxic and corrosive nature of H2S. However, questions remain as to the origin and processes leading to H2S formation following hydraulic fracturing. In this study, we analyzed a series of produced
waters following hydraulic fracturing of a horizontal well completed in the Montney Formation, Western Canada to evaluate variations in geochemical and microbiological composition over time and characterize potential sulfur species involved in the production of H2S. Initially, sulfur isotope ratios
(d34S, VCDT) of dissolved sulfate in produced water had a baseline value of 27per mil similar to the d34S value of 25per mil for solid anhydrite derived from core material. Subsequently, d34S values of sulfate in produced fluids sequentially increased to 35per mil coincident with the appearance of
sulfides in produced waters with a d34SH2S value of 18per mil. Oxygen isotope values of dissolved sulfate exhibited a synchronous increase from 13.2per mil to 15.8per mil VSMOW suggesting sulfate reduction commenced in the subsurface following hydraulic fracturing. Formation temperatures are
<100°C precluding thermochemical sulfate reduction as a potential mechanism for H2S production. We suggest that microbial reduction of anhydrite-derived sulfate within the formation is likely responsible for the increase in H2S within produced waters despite the use of biocides
within the hydraulic fracturing fluids. Initial assessments of microbial communities indicate a shift in community diversity over time and interactions between in situ communities and those introduced during the hydraulic fracturing process. This study indicates that biocides may not be fully
effective in inhibiting microbial sulfate reduction and highlights the role anthropogenic influences such as hydraulic fracturing can have on the generation of H2S in the subsurface.
Effective concentration of remifentanil for successful i-gel insertion during remimazolam induction
Authors: Choi Jung Ju , Jung Wol Seon , Chang Young Jin , Yoo Seungbeom , Kwak Hyun Jeong
Published: October 2022

Background: Remifentanil can be used as adjuvants during remimazolam induction without neuromuscular blockade. We evaluated the 95% effective concentration (EC) of remifentanil effect-site concentration (Ce) for the successful insertion of an i-gel using the biased-coin up-and-down method in adult patients during remimazolam induction. Methods: Forty 19–65 year-old patients scheduled to undergo surgery using i-gel were enrolled. Anesthesia was induced using remimazolam infusion (12 mg/kg/h). Simultaneously, remifentanil was infused at a predetermined Ce. After 5 min of anesthesia induction, the i-gel was inserted. The 95% EC (EC95) of remifentanil in each patient was determined using a biased-coin up-and-down method based on a successful insertion in a preceding patient. The step size of remifentanil Ce was 0.4 ng/ml. If the insertion failed, remifentanil Ce was increased in the next patient. Following successful insertions, the corresponding concentration decreased in subsequent patients with a probability of 1/19 or was maintained with a probability of 18/19. The time from remimazolam infusion initiation to a bispectral index (BIS) < 60 (time to BIS60) and hemodynamic variables were measured and recorded.Results: The EC95 (95% CI) of Ce was 2.07 (1.94, 2.87) ng/ml. The overall time to BIS60 was 154.0 ± 39.9 s. No patient experienced significant hypotension or bradycardia during remimazolam induction.Conclusions: The EC95 of remifentanil Ce was 2.07 (1.94, 2.87) ng/ml for successful i-gel insertion during remimazolam induction at 12 mg/kg/h without hemodynamic instability in adult patients. Future studies should measure remifentanil Ce in elderly patients or using remimazolam at various infusion doses.
Global prevalence, mortality, and main risk factors for COVID-19 associated pneumocystosis
Authors: Khodadadi Hossein , Ahmadpour Ehsan , Nami Sanam , Mohammadi Rasoul , Hosseini Hanieh , Behravan Mahsa , Morovati Hamid
Published: October 2022

Objective:

Pneumocystis pneumonia (PcP) is a life-threatening infection caused by the opportunistic fungi Pneumocystis jirovecii. The emergence of the COVID-19 pandemic forced the focus of attention of health policymakers on these two infections due to their clinical and paraclinical similarities, which cause diagnostic dilemmas. This study was undertaken to evaluate and estimate the global prevalence and main leading risk factors of coronavirus-associated pneumocystosis (CAP).

Methods:

We searched related databases between December 2019 and May 2022 for studies reporting CAP. Meta-analysis was performed using StatsDirect software (version 2.7.9) according to the DerSimonian and Laird method applying the random-effects model. We evaluated heterogeneity using the χ2-based Q statistic (significant for P<0.05) and the I2
statistic (>75% indicative of “notable” heterogeneity). Moreover, an odds ratio (OR) analysis was performed for eligible data.

Results:

Our meta-analysis included eight studies with 923 patients hospitalized with COVID-19; among them, 92 were PcP cases. The overall pooled prevalence of CAP was estimated at 11.5%. The mortality among CAP patients was lower than that of non-PcP patients (OR 1.93; 95% CI 0.86-4.31). Long-term corticosteroid therapy (OR 28.22; 95% CI 0.54-1 480.84) was the most predisposing factor for PcP among COVID-19 patients, followed by pulmonary diseases (OR 1.46; 95% CI 0.43-4.98), kidney diseases (OR 1.26; 95% CI 0.21-7.49), and acute respiratory destruction syndrome (OR1.22; 95% CI 0.05-29.28).

Conclusions:

The prevalence of PcP among the COVID-19 population is almost similar to the pre-COVID era. However, PcP-related mortality was decreased by the emergence of the COVID-19 pandemic. Women with COVID-19 are more susceptible to PcP than men. Acute respiratory distress syndrome, kidney diseases, pulmonary diseases, and long-term corticosteroid therapy increased the risk of PcP; however, transplantation and malignancy decreased the risk for PcP among COVID-19 patients. Further retrospective, case-control, prospective, and more precisely systematic review and meta-analysis studies are needed in this field.
Monkeypox awareness, knowledge, and attitude among undergraduate preclinical and clinical students at a Malaysian dental school
Authors: Lin Galvin Sim Siang , Tan Wen Wu , Chan Daryl Zhun Kit , Ooi Kai Shen , Hashim Hasnah
Published: October 2022

Objective:

To evaluate the awareness, knowledge, and attitude on monkeypox viral infection among preclinical and clinical dental students in Malaysia.

Methods:

A cross-sectional study was conducted among 229 preclinical and clinical dental students via an online self-reported questionnaire. The questionnaire included 3 items on awareness, 15 items on knowledge, 9 items on attitude and 2 open-ended questions. Data were presented as frequencies and percentages. Chi-square test was used to compare knowledge and awareness scores between preclinical and clinical dental students and content analysis was performed for open-ended responses.

Results:

Preclinical and clinical dental students were aware of the existence of monkeypox (89.5% and 94.4%, respectively), that the disease emerged in non-endemic countries (81.0% and 87.1%, respectively) and that it was declared a public health emergency of international concern by the World Health Organization (73.3% and 79.0%, respectively). Clinical dental students’ overall knowledge level was significantly higher than preclinical dental students (P=0.014). Both preclinical (95.2%) and clinical (96.8%) dental students demonstrated positive attitudes toward monkeypox with no significant difference (P=0.736) noted between them. Three themes emerged from the open-ended questions: (1) reimplementation of nationwide lockdown, (2) impact on the economy and health, and (3) disruption to the educational system. Students also anticipated their face-to-face learning to be reduced should there be a new outbreak.

Conclusions:

Both preclinical and clinical dental students showed comparable awareness and attitudes, while the latter demonstrated greater satisfactory knowledge toward the re-emergence of monkeypox during the COVID-19 pandemic. Nonetheless, efforts to improve dental students’ understanding of this alarming outbreak are required, to safeguard their health and minimise transmission.
Bone Health after Bariatric Surgery
Authors: Sayadi Shahraki Masood , Mahmoudieh Mohsen , Kalidari Behrouz , Melali Hamid , Mousavi Maryam , Ghourban Abadi Mohammad Raisi , Mirhosseini Seyed Hossein , Mirhosseini Dehabadi Seyed Ali
Published: October 2022

One of the most critical complications of bariatric surgery (BS), which has been widely discussed recently, is its adverse effects on the health of the bones and skeletal system. Studies show that bone mineral density (BMD) decreases significantly in the early years after BS Nutritional deficiencies are a common complication of BS that can last for months to years after surgery. For example, calcium absorption will significantly reduce after BS The role of gut hormones, endocrine factors, and adipokines in altering bone metabolism should never be overlooked. The available information and guidelines emphasize the periodic evaluation of BMD in patients undergoing BS The method of measuring BMD after BS is essential. DXA and quantitative computed tomography (QCT) are two convenient methods for measuring BMD. Many studies indicate a more detailed study of microarchitecture and cortical and trabecular bone mass with the help of QCT. The overall risk of fractures increases years after BS There are some recommendations for overcoming the adverse effects of BS on bone health. Endurance and resistance exercise after BS can help to mitigate BMD reduction and bone changes. In this review, we will explain each of these points in detail.
Optimization of Culture Media for Ex vivo T-Cell Expansion for Adoptive T-Cell Therapy
Authors: Rahimmanesh Ilnaz , Tavangar Mehrsa , Zahedi Seyedeh Noushin , Azizi Yadollah , Khanahmad Shahreza Hossein
Published: October 2022

Background:

Adoptive T-cell therapy is a promising treatment strategy for cancer immunotherapy. The ability of immunotherapy based on the adoptive cell transfer of genetically modified T cells to generate powerful clinical responses has been highlighted by recent clinical success. Techniques which are used to expand large numbers of T cells from different sources are critical in adoptive cell therapy. In this study, we evaluated the expansion, proliferation, activation of T lymphocytes, in the presence of various concentrations of interleukin-2, phytohemagglutinin (PHA), and insulin.

Materials and Methods:

The effect of different supplemented culture media on T cell expansion was evaluated using MTT assay. The expression level of the Ki-67 proliferation marker was evaluated by real-time polymerase chain reaction. In addition, flow cytometry analysis was performed to access T cell subpopulations.

Results:

Our results showed that supplemented culture media with an optimized concentration of PHA and interleukin-2 increased total fold expansion of T cells up to 500-fold with approximately 90% cell viability over 7 days. The quantitative assessment of Ki-67 in expanded T cells showed a significant elevation of this proliferation marker. Flow cytometry was also used to assess the proportion of CD4+ and CD8+ cells, and the main expanded population was CD3+ CD8+ cells.

Conclusions:

Based on these findings, we introduced a low-cost and rapid method to support the efficient expansion of T cells for adoptive cell therapy and other in vivo experiments.
The Effect of Caudal Anesthesia Block on Perioperative Pain Control and Reduction of the Anesthetic Agent in Pediatric Infraumbilical Surgery
Authors: Gawe Zeana Amer , Isa Hasan Mohamed , Almashaur Muatasem Mohamed , Haider Fayza , Almulla Khadija
Published: October 2022

Background:

Caudal epidural block (CEB) is a commonly performed neuraxial block to provide effective pain relief and analgesia in pediatric patients undergoing infraumbilical surgery.

Aims:

This study aimed to compare the effectiveness of adding CEB to general anesthesia (GA) in terms of intra- and postoperative pain management.

Design:

Prospective, randomized case-controlled trial study.

Setting:

Operation theater, and postoperative recovery rooms at Salmaniya Medical Complex, Bahrain.

Materials and Methods:

A total of 74 patients aged 2 months to 6 years with American Society of Anesthesiologists physical status classification I were recruited over a 6-month period between December 2019 and May 2020. Patients were allocated into two groups (Group A, with CEB) or (Group B, without CEB). Both groups were compared based on hemodynamic stability, pain scores, level of sedation, analgesia need, and parental satisfaction.

Statistical Analysis:

Data were analyzed using SPSS program. Categorical and numerical variables of both the groups were compared.

Results:

Patients with CEB had better hemodynamic stability during the surgical procedure based on heart rate (P = 0.039). Pain intensity scores were less in patients with CEB than those without (P < 0.001). Fentanyl consumption was lower in Group A compared to Group B at the end of surgery (P = 0.002). They were also ambulated earlier and discharged sooner than those without CEB. Parental satisfaction was 92.1% in Group A compared to 63.9% in Group B (P = 0.012).

Conclusions:

Adding CEB to GA for intraoperative and perioperative pain control in pediatric patients undergoing infraumbilical surgery makes it more effective, safe, and with better parental satisfaction.
A Randomised Control Study Comparing C-MAC D-Blade Video Laryngoscope (Hyper Angulated Blade) and Macintosh Laryngoscope for Insertion of a Double-Lumen Tube in Patients Undergoing Elective Thoracotomy
Authors: Mathew Amit , Mathai Roy Rajan , Theodore Bernice , Chandy Jacob , Yadav Bijesh , Singh Georgene , Sahajanandan Raj
Published: October 2022

Background:

The use of a double-lumen endotracheal tube is one of the common anesthetic techniques for operations in the thoracic cavity. However, when compared to a single-lumen tube, placement of a double-lumen tube is technically more difficult as a result of which it takes more time to insert and is associated with more complications such as mucosal injury, hoarseness, and sore throat, even in patients with no anticipated airway difficulty. The CMAC D-blade that is usually used in patients with anticipated airway difficulty, could assist in smooth and quick placement of double-lumen tube (DLT) even in patients with no anticipated airway difficulty.

Aim of the Study:

This study aimed to evaluate the effectiveness of the C-MAC D-blade in reducing the time taken to visualize the glottis and intubate patients with normal airway with a double-lumen tube.

Setting and Design:

This was a prospective open-label randomized control trial in a tertiary hospital.

Materials and Methods:

Seventy-three consenting adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective thoracotomy, were randomly allocated to receive either C-MAC D-blade (Group D) or Macintosh blade (Group M). The primary objective was to compare the time taken for visualization of the glottis and intubation.

Statistical Analysis Used:

Chi-square/Fisher's exact test and t-test were used for statistical analysis.

Results:

Seventy-three patients were randomized (Group D = 36; Group M = 37). Time to visualize the glottic structures (4.56 ± 2.396 s vs. 7.27 ± 4.891 s, P = 0.01) was significantly better in Group D; however, the mean intubation time was comparable (55.92 ± 18.749 s vs. 51.08 ± 15.269 s, P = 0.61).

Conclusion:

C-MAC D-blade videolaryngoscope offers a better glottic view and lesser time to visualize glottis when compared with the Macintosh laryngoscope. However, the time taken to insert the DLT after visualization was longer. We infer that there is no advantage in the routine use of C-MAC D-blade for DLT insertion in patients with no anticipated airway difficulty.
A Comparative Study of Dexmedetomidine versus Nalbuphine Used as an Adjuvant to Chloroprocaine for Daycare Surgeries Performed under Subarachnoid Block
Authors: Gupta Priyamvada , Suthar Amit , Deganwa Mangilal , Goyal Vigya , Devgan Sonali
Published: October 2022

Backgrounds and Aims:

Nalbuphine or dexmedetomidine when used as an adjuvant to local anesthetic agents may alter the characteristics of subarachnoid block. The study aimed to compare the effect of adding these drugs as an adjuvant to chloroprocaine for spinal anesthesia.

Settings and Design:

This prospective, randomized, double-blind study was conducted at a tertiary care center.

Materials and Methods:

After obtaining permission from the institutional ethical committee and informed patient consent, patients scheduled for surgeries under subarachnoid block were randomized into three groups of 50 each: Group C: Injection 1% chloroprocaine 40 mg (4 mL) with 1 mL normal saline, Group DC: injection 1% chloroprocaine 40 mg (4 mL) with dexmedetomidine 10 μg diluted to 1 mL in normal saline, and Group NC: injection 1% chloroprocaine 40 mg (4 mL) with nalbuphine 0.4 mg diluted to 1 mL in normal saline. Onset, peak, duration, and time to complete regression of sensory and motor blockade were noted. Side effects, if any, were noted and managed appropriately.

Statistical Analysis:

Qualitative data were analyzed using Chi-square test and quantitative data were analyzed using Student's t-test and two-sided Mann–Whitney U-test. P < 0.05 was considered statistically significant.

Results:

Group DC had prolonged time to onset, duration, and complete regression of sensory and motor block compared to Group NC and Group C (P < 0.001). Hemodynamic parameters, sedation score, and side effects were comparable in all groups.

Conclusion:

Thus, nalbuphine is a better adjuvant to chloroprocaine than dexmedetomidine when administered intrathecally for daycare surgeries performed under spinal anesthesia.
A Successful Treatment of Rhesus Positive Transfusion in Traumatic Brain Injury Patient with Rhesus Negative
Authors: Maulydia Maulydia , Hendriana Dewi Rosita
Published: October 2022

Management of Traumatic Brain Injury (TBI) aims to prevent secondary brain injury from factors such as hypoxia, hypotension, and anemia. Transfusion is one of the treatments for anemia in patient with TBI. However, unexpected side effects might occur as a result of transfusion, especially transfusion using different rhesus (Rh). Herein, we reported a 33-years-old male Rh(-) patient who suffered from TBI and anemia, receiving a different Rh transfusion due to stock unavailability and emergency condition. A Focused Abdominal Scan for Trauma (FAST) examination did not discover any fluid in the abdominal cavity. Head CT-scan found intracerebral hemorrhage (ICH) in the right frontotemporal. Legs x-ray found inter trochanter fracture on the right femur. Open reduction and internal fixation (ORIF) plating surgery was conducted to manage the intertrochanter fracture. This patient received 4 bags of blood product type B with Rh(+). After undergoing intensive observation and several more surgeries, the patient survived. In an emergency, patient with Rh(-) who requires blood transfusion but is faced with stock unavailability should considered using Rh(+) blood transfusion to prevent worsening of their condition. Blood product transfusions with different rhesus must be given with the utmost caution and close monitoring to avoid triggering a transfusion reactions.
Multidrug-Resistant Organism Infections Correlate with Increased Mortality in COVID-19 Patients
Authors: Sumardika I Wayan , Cokro Frederick , Suranadi I Wayan , Pinatih Komang Januartha Putra
Published: October 2022

Background:

The uncontrolled use of antibiotics is a big problem that will lead to antibiotic resistance. One of the recommendations for Corona Virus Disease 2019 (COVID-19) therapy is antibiotics. This study aimed to present the incidence of multidrug-resistant organism (MDRO) infections in COVID-19 patients and the risk of mortality in COVID-19 patients in the Indonesian population.

Materials and Methods:

A retrospective cohort study was conducted at a tertiary medical center in Indonesia. A total of 120 subjects were included in this study and divided equally into group M (COVID-19 patients with MDRO infections) and group N (without MDRO). The culture was conducted between the 17th and 10th days of treatment. A 2 × 2 table and chi-square test calculated the relative risk (RR) of MDRO causing mortality in COVID-19 patients.

Results:

The median age was 52 and 51 years old in groups M and N, respectively (P = 0.599). Based on the documented data related to microbiological culture to detect the types of microorganisms, carbapenem-resistant Acinetobacter baumannii was found to be the most MDRO isolated (30%), followed by extended-spectrum beta-lactamase (26.6%). Bivariate analysis showed that MDRO infection strongly correlates with the incidence of death with a RR of 4.167 (P < 0.001).

Conclusion:

MDRO infection is significantly correlated with mortality in COVID-19 patients. MDRO infections pose a four-fold chance of mortality compared to those without MDRO infections.
Pulmonary Complications and 30-Day Mortality Rate in COVID-19 Patients Undergoing Surgery
Authors: Widnyana I Made Gede , Senapathi Tjokorda Gde Agung , Cindryani Marilaeta , Juwita Nova , Jeanne Bianca
Published: October 2022

Hundreds of surgeries are postponed every day during the global COVID -19 pandemic. The hospital and clinicians are in dilemma scheduling elective procedures during the pandemic. The current study was designed to evaluate postoperative pulmonary complications and mortality in COVID-19 patients in a systematic review and meta-analysis of globally published peer-reviewed literatures. A systematic literature search was conducted using the selection criteria in five databases. A quality assessment was made with a validated Newcastle-Ottawa Scale. The meta-analysis worked as a generic inverse variance meta-analysis. A total of 308 articles were identified from different databases and 5 articles with a total 1408 participants were selected for evaluation after successive screenings. The meta-analysis revealed a high global rate of postoperative mortality among COVID-19 patients, as high as 23% (95% CI: 15 to 26), and high postoperative pulmonary complications including pneumonia and acute respiratory distress syndrome. The 30-days mortality rate and prevalence of pulmonary complications were high. There was one death for every five COVID-19 patients undergoing surgical procedures, indicating the need for mitigating strategies to decrease perioperative mortality, transmission to healthcare workers, and non-COVID-19 patients. Larger samples and/or multicenter trials are needed to explore the perioperative mortality dan morbidity rate of patients with COVID-19 undergoing surgeries, and in particular, factors with the highest impact on perioperative mortality. There should be a clinical guideline to determine when to operate or not to operate on patients with COVID-19 for elective and emergency surgeries.
Correlation of Syndecan-1 Level and Fluid Overload in Children with Sepsis
Authors: Hartawan Nyoman Budi , Riandra Ni Putu Indah Kusumadewi
Published: October 2022

Background:

Fluid resuscitation is one of the basic principles for managing sepsis, but excessive fluid causes the shedding of the endothelial glycocalyx (syndecan-1) and can cause capillary leakage and tissue edema. This study aimed to determine the correlation between the syndecan-1 level and fluid overload in children with sepsis.

Materials and Methods:

This was an analytic, cross-sectional study conducted in a pediatric intensive care unit. A total of 49 children aged 0–18 participated in this study. Factors investigated were age, gender, nutritional status, the site of infection, organ dysfunction, the severity of sepsis, outcome, blood culture, procalcitonin level, and Pediatric Logistic Organ Dysfunction-2 score. The syndecan-1 level was measured by examining the subject’s blood serum. Statistical analysis was done using the Spearman correlation test.

Results:

Forty-nine sepsis children aged 0–18 were enrolled, with a median age of 12 months. The respiration system was the most common site of infection, and dysfunction of the respiration system was the most common found in the subjects. The median of fluid overload was 8.3%, and the median of procalcitonin and syndecan levels was 17 ng/mL (interquartile range [IQR] = 1.97–64.03 ng/mL) and 372 ng/mL (IQR = 223.5–1389 ng/mL), respectively. The Spearman’s correlation test found a moderate correlation between syndecan-1 and fluid overload (r = 0.469, P = 0.001).

Conclusion:

The plasma concentrations of syndecan-1, a marker of endothelial glycocalyx shedding, were moderately correlated with the fluid overload in patients with sepsis, indicating the link between the fluid overload and the shedding of the glycocalyx.
Evaluation of maternal cortisol-to-highly sensitive C-reactive protein ratio and glucocorticoid receptor resistance at 11–14 weeks of pregnancy to predict pre-eclampsia
Authors: Jhansi K , Harsoda JM
Published: October 2022

Background:

Preeclampsia (PE) is a disorder of pregnancy with a worldwide prevalence of about 5-8% and 4.6% in India. It is the second leading cause of direct maternal and foetal adverse outcomes, resulting in about 50,000-60,000 deaths annually worldwide. Cortisol is a stress hormone, that suppresses the immune system and inhibits the production of pro-inflammatory substances to reduce inflammation. During pregnancy cortisol levels raise to three-fold of nonpregnant level by the third trimester, it is due to changes in HPA axis regulation, raised oestrogen levels and raised maternal CRH levels through placental secretion.

Aims:

The objective of this study is to evaluate the cortisol (CORT)-to-highly sensitive C-reactive protein (HS-CRP) ratio and glucocorticoid receptor resistance (GCR) in early pregnancy to understand the pathophysiology of pre-eclampsia (PE) and to test whether these parameters have a role in the prediction of PE. CO + RT: HS-CRP ratio evaluates the interrelationship between the hypothalamic–pituitary–adrenal axis (HPA-axis) and the inflammatory response system. It is a new concept and an integrated approach to understand the pathophysiology of PE.

Materials and Methods:

In this prospective case–control study, we recruited 250 healthy pregnant women at 11–14 weeks of pregnancy and followed them. Those who developed PE after the 20th week according to the American College of Obstetricians and Gynecologists guidelines were considered study participants and the remaining served as controls. CORT was estimated through the ELISA method and HS-CRP was measured by autoanalyser through the turbidimetric method. The CORT-to-HS-CRP ratio was calculated manually. GCR was measured indirectly through leucocytes subsets, neutrophil-to-lymphocyte ratio (NLR) and neutrophil-to-monocyte ratio (NMR); individual leucocytes were obtained from complete blood counts. Data were analysed using the SPSS version 20, Pearson's correlation test was used to correlate the results and receiver operator characteristic (ROC) was used to test the predictive capacity of parameters.

Results:

Low CORT: HS-CRP was associated with PE, having a significance of P < 0.00, but it did not show any specificity and sensitivity under ROC. NLR and NMR were elevated in cases who developed PE, especially NMR with P < 0.008. NMR showed good specificity and sensitivity under ROC with the area under curve 0.74, cutoff value is 23.

Conclusion:

Low CORT: HS-CRP ratio has an association with PE, the uncontrolled inflammation during early pregnancy in pregnant women who were destined to develop PE. This is due to low-CORT secretion due to dysregulation of the HPA-axis. GCR also has an association with PE, but it was not fully clarified. HS-CRP and NMR can be used to screen in early pregnancy for the prediction of PE.
Chronic Cough Etiology Within a Tertiary Care Center
Authors: Supapannachart Krittin J. , Fryd Amanda S. , Shelly Sandeep , Warrier Anjali , Tkaczuk Andrew , Hatcher Jeanne L. , Dixit Adviteeya N. , Van Nostrand Keriann M. , Jain Anand S. , Gillespie Amanda I , Kalangara Merin K. , Klein Adam M.
Published: October 2022

Purpose:

Chronic cough occurs in 12% of the population and is associated with significant morbidity and healthcare utilization. Little is known about chronic cough patients requiring referral to higher level care facilities; such knowledge may improve primary care physician chronic cough referral algorithms.

Methods:

A retrospective study was conducted on patients with primary complaints of chronic cough presenting to Emory Healthcare, Atlanta between 2009 and 2020. Data on socio-demographics, etiology, treatment, and health behavior were extracted from the electronic medical records of patients with chronic cough that had been seen by at least by 1 cough specialist at a tertiary care center. The Chi-square test and analysis of variance helped determine differences in socio-demographic variables between patients with different primary cough etiologies.

Results:

A total of 1152 patients met the inclusion criteria for this study. Common etiologies of chronic cough were found to be neurogenic (n = 196, 17%), gastroesophageal reflux disease (n = 114, 9.9%), asthma (n = 93, 8.1%), and chronic obstructive pulmonary disease (n = 80, 6.9%). A multifactorial etiology was found in 213 (18.5%) patients and 99 (8.6%) patients were still undergoing further work up. Significant differences in age, sex, race, smoking status, and chronic cough duration were noted based on the underlying etiology. Interestingly, although nonsignificant, patients with pulmonary etiologies tended to live in areas with higher poverty rates.

Conclusion:

The most common etiology was neurogenic cough, typically a diagnosis of exclusion that goes undiagnosed in primary care settings. Primary care physicians should have a low threshold for referral to otolaryngologists and academic institutions should consider establishing multidisciplinary cough clinics to facilitate work up and treatment.