bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of High-Density Vitreous Substitutes in the Removal of Posteriorly Dislocated Lenses or Intraocular Lenses
Authors: Liu Kwan-Rong , Peyman Gholam A , Chen Muh-Shy , Chang Kuo-Bin
Published: April 2021

ABSTRACT

We successfully used high-density vitreous substitutes to remove four dislocated crystalline lenses and three dislocated intraocular lenses (IOLs) from the vitreous cavity. Fluorosilicone oil (300 cs) was used to remove the four lenses and one of the IOLs. Perfluorophenanthrene (Vitreon®! was used to remove the other two dislocated IOLs. The dislocated lenses or 1OLs were floated by the high-density vitreous substitutes and removed safely without damaging the retina; there were no intraoperative complications. Postoperative residual fluorosilicone oil droplets were found in one case.
Using Healon® to Identify the Lumen of the Sac in Dacryocystorhinostomy
Authors: Shiwa Toshihiko , Tazawa Yutaka
Published: April 2021

ABSTRACT

Sodium hyaluronate (Healon®) injected into the lacrimal sac, facilitates a full-thickness cut of the lacrimal sac in cases in which it is difficult to identify the lumen of the sac. The sodium hyaluronate does not stain tissues, is effective for hemostasis, and is easily irrigated.

A full-thickness cut of the lacrimal sac is required to ensure exact mucosal suturing in dacryocystorhinostomy. However, in cases involving a hypertrophic sac wall, a small lumen of the sac, or earlier perforation of the sac, it is sometimes difficult to identify the lumen during surgery. We describe how sodium hyaluronate, injected into the sac via a canaliculus, can facilitate identifying the lumen in this situation.
Resiting Molteno Implant Tubes
Authors: Billson Frank , Thomas Ravi , Grigg John
Published: April 2021

Abstract. The authors describe a surgical technique for resiting Molteno implant tubes. The indications for this intervention are a blockage of the tube that cannot be resolved by other means; erosion of the scleral flap and conjunctiva by the tube; and pediatric cases in which enlargement of the eye causes retraction of the tube from the anterior chamber. [Ophthalmic Surg Lasers 1996;27:801-803.]
Resilient Sustainable Education for the Future of Education
Authors: Ossiannilsson Ebba S. I.
Published: April 2021

In 2020, the COVID-19 pandemic affected all economic sectors and disrupted many areas of our lives, especially education. More than 1.7 billion learners in over 200 countries around the world were affected, and these numbers will continue to increase in 2021 and beyond. Therefore, the effects of the COVID-19 pandemic must be understood in order to be better prepared for future disruptions. There is a need to recognize that education is an investment in rebuilding. The key lessons learned are that the future of education needs to be rethought without forgetting the past. Certainly, there is room for improvement in the technical area, but most importantly, it is critical to recognize the social dimensions of learning and education. This conceptual chapter provides a review of the literature on several global initiatives to shape the futures of education by focusing on resilient open education for all in the context of social justice, human rights, and democracy.
Best Practices for Emergency Remote Teaching
Authors: Dennis Michelle
Published: April 2021

Unforeseen events, such as the global pandemic COVID-19, have the potential to necessitate abrupt closures of the physical campuses of higher education institutions. In these situations, emergency remote teaching procedures may be implemented to enable the continuation of courses and reduce the magnitude of disruptions to the learning process for students and faculty members. In this chapter, the author will evaluate best practices for the design of emergency remote teaching, faculty preparation, and student support. Further, the author will explore effective communication strategies for the delivery of information regarding procedural changes to students and faculty.
An Ethnographic Phenomenology of Pandemic Pedagogy
Authors: Rodgers Devery J.
Published: April 2021

This chapter aims to serve a constructive purpose from pandemic pedagogy by presenting practice-driven pedagogical strategies for online teaching and learning. Through phenomenological HelpDesk analysis from a K12 school district's Education Technology Department, their Education Technology Specialist presents an ethnographic empirical study on what advice was sought and given during emergency remote teaching of 2020. Using the Technology Acceptance Model (TAM-2), it shows how teachers defaulted to practices which connected them with their students, helped them stay organized for synchronous and asynchronous instruction, and gave them “eyes on” student learning with easily accessible data. The value of this study lies in its ability to help understand the professional learning effects of the COVID-19 pandemic and provide a guide for those who need a deeper understanding of teachers' instructional choices during emergency remote education.
Enacting Care-Ful Engagement in the (Post)Pandemic Care-Less University
Authors: Grant-Smith Deanna , Payne Ryan
Published: April 2021

There is a strong link between student engagement and successful educational outcomes which is driven by the actions of and interactions with educators. In the context of pandemic pedagogies, many educators have taken on additional responsibility for the wellbeing and engagement of their students. The performance of this emotion work is strongly connected to an educator's professional and philosophical stance about the role of caring in teaching and learning. Building on the principles of care ethics with autoethnographic reflection of emergency remote teaching, this chapter presents a model of student engagement which reflects the additional needs and demands of care-based education on both educators and students. This model outlines for the enactment of deliberate, sustainable, and care-ful engagement based on an assessment of learner needs as well as educator investment and contributes insights for shaping (post pandemic) pedagogical practices.
Renting Cars and Trucks
Authors: Akay Bayram
Published: April 2021

Tourism is a fragmented and information-oriented sector covering tour operators, travel agencies, hotel sales representatives, associations, meeting offices, transportation, car rental, airlines, cruise, souvenirs, restaurants, hotels/motels, and entertainment. The car rental sector, which is an important part of the tourism sector, is growing day by day, and the number of customers is increasing rapidly. The success of the car rental sector, which produces support services within the growing tourism sector, is considered very important for the development of tourism. The COVID-19 pandemic has engulfed the globe and has already had an enormous impact on life as we once knew it. With airplanes grounded, millions of people in quarantine, and hundreds of travel bans in place, COVID-19 has brought the global tourism industry to a grinding halt along with the rental industry. The study determines the current situation of the car rental sector and presents some suggestions.
Metamorphosis of Labour in Digital Societies
Authors: Lisdero Pedro
Published: April 2021

In a global context of social metamorphosis, it is important to understand how and why the reconfiguration of work experiences comes about in relation to the modifications produced by the digitalisation of society. All areas of people's lives are colonised by the logic of the digital, and the different work experiences are affected. This chapter aims to explore the connections between these two critical dimensions of the social structuration process in Latin America, which have reached a superlative role in the context of the COVID-19 pandemic. In order to do that, it considers “digital labor” and particularly the work of deliveries by platforms as a paradigmatic experience that condenses the tendencies mentioned. The selected argumentative strategy proposes to contextualize the expansion of “digital labor” in the region by drawing from the analysis of secondary data, and from primary data generated through virtual ethnography oriented to capture the experiences of workers (deliveries by platforms).
Action Research Approaches
Authors: Watkins Karen E. , Nicolaides Aliki , Marsick Victoria J.
Published: April 2021

The contemporary use of action research draws on the exploratory, inductive nature of many qualitative research approaches—no matter the type of data collected—because the type of research problems studied are complex, dynamic, and located in rapidly changing contexts. When action research is undertaken to support social and organizational change, support from stakeholders affected by the research problem is essential, creating further complexity. Action research may serve as an alternative to more traditional views of social science. In this chapter, the authors describe action research as envisioned by Kurt Lewin, its originator. They show how two variants of action research—action science and collaborative developmental action inquiry—advance insight into how action research can be used to develop personal capability to address system changes that action research seeks to unveil. They conclude with reflections on criteria for rigor and relevance in action research in today's post-modern, complex world.
An Emerging Methodological Approach to Anti-Racist Design and Implementation
Authors: Kier Meredith , Khalil Deena
Published: April 2021

This chapter is about introducing critical race design (CRD), a research methodology that centers race and equity at the center of educational opportunities by design. First, the authors define design-based implementation research (DBIR) as an equity-oriented education research methodology where teaching and learning is informed by robust, iterative, evidence-based research conducted by multiple stakeholders. Next, they provide a brief overview of critical race theory in education (CRT) as a theoretical and methodological approach that aims to unpack and disrupt the structural inequities experienced by disenfranchised racial groups. They then describe how both education methodologies inform CRD, the authors' emerging anti-racist critical design methodology. Finally, they provide an example where they used CRD to design an online service-learning course that aims to situate the narratives of underrepresented STEM professionals as a curricular resource for nondominant adolescents.
Android Botnets
Authors: Karim Ahmad , Chang Victor , Firdaus Ahmad
Published: April 2021

Mobile botnets are gaining popularity with the expressive demand of smartphone technologies. Similarly, the majority of mobile botnets are built on a popular open source OS, e.g., Android. A mobile botnet is a network of interconnected smartphone devices intended to expand malicious activities, for example; spam generation, remote access, information theft, etc., on a wide scale. To avoid this growing hazard, various approaches are proposed to detect, highlight and mark mobile malware applications using either static or dynamic analysis. However, few approaches in the literature are discussing mobile botnet in particular. In this article, the authors have proposed a hybrid analysis framework combining static and dynamic analysis as a proof of concept, to highlight and confirm botnet phenomena in Android-based mobile applications. The validation results affirm that machine learning approaches can classify the hybrid analysis model with high accuracy rate (98%) than classifying static or dynamic individually.
A Systematic Study and Analysis of Security Issues in Mobile Ad-hoc Networks
Authors: Swain Jhum , Pattanayak Binod Kumar , Pati Bibudhendu
Published: April 2021

A Mobile Ad Hoc Networks (MANETs) is an assortment of a variety of portable nodes that are linked collectively in a greater number in a wireless medium that has no permanent infrastructure. Here, all the nodes in the network act as both router and host and is in charge for accelerating and forwarding packets to other nodes. Due to the frequent link failure and high speed of mobile nodes, there are many challenges in MANET. As security is the basic challenge in a MANET, this article discusses the various protocols developed for security issues in MANET and IoT and presents a comparative analysis on their performance. After detailed analysis and comparison, it was observed that when security features are imposed at different levels during routing, various protocols perform in different ways. Also, the network performance and network life times vary from one approach to another. So, this article also presents the effect of security features on data drop and delay of prominent protocols after simulation.
Smartphone Confrontational Applications and Security Issues
Authors: Kumar Abhishek , Chatterjee Jyotir Moy , Rathore Pramod Singh
Published: April 2021

In today's society, there is a high volume of smartphones, with Android being the most popular and most commonly used smartphones. In the last few years, the Android market has been booming, making lots of developers join the industry so as to create various mobile applications that are a benefit to people's lives. However, its over-popularity has brought many crime issues, including security. One of the major common incidents to mobile users is having their mobile phones lost or stolen. Since most mobile users want to find their lost phones, they are looking for the most reliable features that can help them locate their smartphones. Luckily, there are some developed applications and services that have been designed to track down and locate lost or stolen smartphones. In this work, the authors tried to identify a collection of these applications and the information they send to the user in aiding them to find their phone. Since some applications are able to send location information or a photo, this work will look at what metadata is usually sent with the message.
Native vs. Hybrid Mobile Applications as Society Enters the Internet of Things
Authors: Heard Irvin Renzell , Ardila Norman R
Published: April 2021

For nearly two decades, desktops dominated as the primary means of accessing the internet until 2007, the era of mobile phones with touchscreens capability entered the market by Apple Inc. Currently, the high demand of accessibility and mobility through mobile technology is adding more pressure on application developers leaving them to focus more on “meeting deadlines than application security,” which is a critical component as hybrid applications play a significant role in the advancement of IoT and cross-platform compatibility. New technologies are adopting unresolved security issues from the latter. This article aims to initiate discussions within the development and research community regarding hybrid mobile app security, market, role in IoT, advantages, disadvantages, security challenges and the best practices as society enters into a new paradigm envisioned as a ubiquitous global network.
Mobile Commerce Technologies and Management
Authors: Kasemsap Kijpokin
Published: April 2021

This chapter reveals the prospect of mobile commerce (m-commerce); m-commerce and trust; m-commerce, privacy, and security issues; m-commerce adoption and technology acceptance model (TAM); and the significant perspectives on m-commerce. M-commerce is used for business transactions conducted by mobile phones for the promotional and financial activities using the wireless Internet connectivity. M-commerce is the important way to purchase the online items through online services. The main goal of m-commerce is to ensure that customers' shopping experience is well-suited to the smaller screen sizes that they can see on smartphones and tablets. Computer-mediated networks enable these transaction processes through electronic store searches and electronic point-of-sale capabilities. M-commerce brings the new possibility for businesses to sell and promote their products and services toward gaining improved productivity and business growth.
A Study of e-Commerce Transaction Risk Assessment Model in Mobile Internet
Authors: Huang Zhihong
Published: April 2021

With the continuous development of information technology, mobile e-commerce as a new economic and industrial mode has brought great benefits to the society. Mobile e-commerce does not need to bear the constraints of time and place, which has brought great benefits to the enterprise, from the point of trading, mobile e-commerce relies on convenient mobile terminal devices to provide convenience and unlimited trading environment for the user. However, there is a certain risk, mobile e-commerce is different from traditional e-commerce. It may bring many new problems and risks, and may lead to serious economic loss. So how to make reasonable assessment of mobile e-commerce transaction risk and then select strategy to minimize the risk is very important for the development of mobile e-commerce. In this paper, the risk of mobile e-commerce transactions is analyzed firstly, and then it uses a reasonable evaluation system to build a mobile e-commerce transactions risk assessment model. Finally, with the fact, it shows that the model has good feasibility and practical application value.
A Framework for Designing Interaction and Transgression Zone
Authors: Utkan Muharrem Melih
Published: April 2021

Interaction and transgression zones are the buffer zones between urban development area and conservation area. In Turkey, regulations do not draw the quantitative approach to interaction and transgression zones, that conservation area borders create sharp passes. In order to smooth these passes, this research was planned. Regulations are very rigid written rules; however, in order to keep pace with contemporary world, they need to be adaptive in the 21st century. Thus, this research aims to be respectful to historic sites and proposes smoother passes to urban development areas. In order to adopt, any historical site parameters should come from common features of towns. Another point to understand the characteristic of a town is statistical data for each parameter. In order to blend the statistical data with parameters, k-means clustering method is used. This method gives the distribution of each categorical data into the main clustering. As a result, the algorithm gives flow of flexible rules in order to apply development in the interaction and transgression zones.
Novel Correlation Coefficient for Intuitionistic Fuzzy Sets and Its Application to Multi-Criteria Decision-Making Problems
Authors: Augustine Ejegwa Paul
Published: April 2021

Correlation coefficient is an essential measuring operator in an intuitionistic fuzzy environment use in solving MCDM problems. In this paper, Xu et al.'s correlation coefficient for IFSs is generalized for an improved output. The objectives of this work are to generalize the triparametric correlation coefficient for IFSs proposed by Xu et al. and unravel its applicability in some MCDM problems. The generalized correlation coefficient for IFSs is characterized with some number of results. Some numerical illustrations are supplied to validate the preeminence of the generalized correlation coefficient for IFSs over some existing correlation coefficient measures. In addition, some MCDM problems such as determination of suitable lecturer for course allocation and personnel promotion exercise captured in intuitionistic fuzzy pairs are discussed with the aid of the proposed correlation coefficient.
Road Traffic Congestion (TraCo) Estimation Using Multi-Layer Continuous Virtual Loop (MCVL)
Authors: Sankaranarayanan Manipriya , Mala C.  , Mathew Samson
Published: April 2021

Any road traffic management application of intelligent transportation systems (ITS) requires traffic characteristics data such as vehicle density, speed, etc. This paper proposes a robust and novel vehicle detection framework known as multi-layer continuous virtual loop (MCVL) that uses computer vision techniques on road traffic video to estimate traffic characteristics. Estimations of traffic data such as speed, area occupancy and an exclusive spatial feature named as corner detail value (CDV) acquired using MCVL are proposed. Further, the estimation of traffic congestion (TraCo) level using these parameters is also presented. The performances of the entire framework and TraCo estimation are evaluated using several benchmark traffic video datasets and the results are presented. The results show that the improved accuracy in vehicle detection process using MCVL subsequently improves the precision of TraCo estimation. This also means that the proposed framework is well suited to applications that need traffic characteristics to update their traffic information system in real time.
Coronavirus Pandemic (COVID-19)
Authors: Alowibdi Jalal S. , Alshdadi Abdulrahman A. , Daud Ali , Dessouky Mohamed M. , Alhazmi Essa Ali
Published: April 2021

People are afraid about COVID-19 and are actively talking about it on social media platforms such as Twitter. People are showing their emotions openly in their tweets on Twitter. It's very important to perform sentiment analysis on these tweets for finding COVID-19's impact on people's lives. Natural language processing, textual processing, computational linguists, and biometrics are applied to perform sentiment analysis to identify and extract the emotions. In this work, sentiment analysis is carried out on a large Twitter dataset of English tweets. Ten emotional themes are investigated. Experimental results show that COVID-19 has spread fear/anxiety, gratitude, happiness and hope, and other mixed emotions among people for different reasons. Specifically, it is observed that positive news from top officials like Trump of chloroquine as cure to COVID-19 has suddenly lowered fear in sentiment, and happiness, gratitude, and hope started to rise. But, once FDA said, chloroquine is not effective cure, fear again started to rise.
Optimal User Association of LTE/Wi-Fi/Wi-Gig Bands in 5G Cellular Networks
Authors: Hussain Aziza Ibrahim , Sayed Ahmed Zakaria
Published: April 2021

One hypothesis of 5G cellular networks architecture is using three tiers: Macro BS, Wi-Fi Pico BS, and Wi-Gig Femtocell. The challenge addressed in this paper is to associate the user requirement (UE) to the best BS/tier to achieve the optimal operation for the network and maximum data rate for all UE. There are two proposed types of association in this paper; the first one is to find the best BS in the three tiers and then associate the UE to one of them based on the association algorithm, and the second proposed type is to decide the best tier for the UE and then associate the UE to one of the BS of this tier based on the association algorithm. The opportunistic user association problem is worked out as an optimization problem which is solved by the Nash bargaining solution (NBS). The proposed algorithms presented in this paper achieve optimality, 7% and 2% increase in total system data rate (SDR) for the first and second proposed algorithms respectively. They also achieved 6% and 2% increase in total Jain's fairness index (JFI) for the first and second proposed algorithms respectively.
Probabilistic-QoS-Aware Multi-Workflow Scheduling Upon the Edge Computing Resources
Authors: Tang Tao , Ma Yuyin , Feng Wenjiang
Published: April 2021

Edge computing is an evolving decentralized computing infrastructure by which end applications are situated near the computing facilities. While the edge servers leverage the close proximity to the end-users for provisioning services at reduced latency and lower energy costs, their capabilities are constrained by limitations in computational and radio resources, which calls for smart, quality-of-service (QoS) guaranteed, and efficient task scheduling methods and algorithms. For addressing the edge-environment-oriented multi-workflow scheduling problem, the authors consider a probabilistic-QoS-aware approach to multi-workflow scheduling upon edge servers and resources. It leverages a probability-mass function-based QoS aggregation model and a discrete firefly algorithm for generating the multi-workflow scheduling plans. This research conducted an experimental case study based on varying types of workflow process models and a real-world dataset for edge server positions. It can be observed the method clearly outperforms its peers in terms of workflow completion time, cost, and deadline violation rate.
Risk of dyslipidemia among children undergoing routine medical examinations in a secondary health care facility in Benin City, Edo State
Authors: Enato Izehiuwa G. , Akhimienho Kingsley I. , Atoe Kenneth
Published: April 2021

Dyslipidemias in children are a diverse group of disorders that include monogenic disorders as well as dyslipidemias caused by a variety of factors. Although cholesterol levels in healthy children differ with age, a potential link to the development of dyslipidemia may be important to determine the likelihood of an early diagnosis. In this cross-sectional study, 220 seemingly healthy children aged 1 to 12 years were studied in Benin City, Nigeria, to determine the pattern of lipid profile. An enzymatic method was used to analyze serum lipids from blood samples obtained from the participants. The level of dispersion of data needed to assess the risk of early childhood dyslipidemia was described using the 95th percentile scale. In the 1-3 years old age group, at least 95 percent of the boys had total cholesterol levels below 132 mg/dL, compared to 124 mg/dL among the girls of the same age. Similarly, total cholesterol levels in the 7-9 year old age group were 127 mg/dL in boys and 110 mg/dL in girls. These levels could serve as a guideline for children of the study’s age group who appear to be in good health. Elevated triglycerides levels were found in male children under the age of three years, as well as in the 10-12 age brackets. Increases in triglycerides in the girls, on the other hand, were not age- or time-dependent. In general, the lipid profiles shown in the results were low, particularly in the 4-6 year old age group. A significant modifiable risk factor for cardiovascular disease in children is elevated lipid levels. The results of this study demonstrate the importance of routinely screening children for dyslipidemia. Elevated lipid levels are a major modifiable risk factor for cardiovascular disease in children. The findings of this research can be used as a basis for screening children for dyslipidemia because it provides a 95th percentile in lipid profiles of seemingly healthy children.
A bicentric approach evaluating the combination of a hemispheric cup with a novel ceramic head in total hip arthroplasty
Authors: Busch André , Wassenaar Dennis , Zinser Wolfgang , Jäger Marcus
Published: April 2021

Medical ceramics are frequently used biomaterials as a liner in total hip arthroplasty. Strong efforts have been made to improve material properties over the last decades. Alumina toughened zirconia ceramics seem to be promising alternatives to further reduce fracture rates and squeaking phenomena. To answer the question if alumina toughened zirconia ceramic liners in combination with a cementless, hemispheric cup are able to reduce squeaking phenomena and fracture rates, we initiated a bicentric, mid-term trial. Noise phenomena will be recorded using MONA Score (Melbourne Orthopaedic Noise Assessment). Functional outcome (Harris Hip Score, University of California-Los Angeles, Forgotten Joint Score, EQ-5D Score, Visual Analogue Scale) and radiographic parameters will serve as secondary parameters. The study has been set up for 5 years, with follow-ups after 6-14 weeks, 12, 24 and 60 months.
Long-term results of the custom- made hip endoprostheses Evolution K® and Adaptiva®: A prospective cohort study
Authors: Axt Steffen , Kirschniak Andreas , Axt Lena , Braun Manuel , Beltzer Christian , Leichtle Carmen , Leichtle Ulf
Published: April 2021

The aim of our study is to evaluate clinical long-term results and determine changes in periprosthetic bone density of the custom-made hip prostheses Evolution-K® and Adaptiva®. Periprosthetic bone density were evaluated by means of DEXA (LunariDXA- Prodigy® bone densitometer) with a long-term follow-up of 16 (15-18) years (Evolution-K®) in 24 patients and 13 (13-15) years (Adaptiva®) in 41 patients. Evolution- K® had a survival rate of 92% and yielded 79/100 points in Harris Hip Score, a mediocre result. Adaptiva® had a survival rate of 99% and achieved a good score of 88/100 points. Bone density measurements demonstrated the greatest loss of bone density in the proximal regions of interest (ROI) for both prosthesis types (Evolution-K®: -25.8% ROI 1, -40.3% ROI 7; -8.3% ROI 2, -10.4% ROI 6; Adaptiva®: -29.8% ROI 7, -6.8% ROI 6, +14.3% ROI 3, +3.1% ROI 4). Adaptiva® yielded a good clinical result as compared to Evolution-K® with only average clinical results. Both prostheses clearly showed signs of “stress shielding”. Here, the Adaptiva® achieved reduced bone density loss as compared to the Evolution-K®.
Surgical treatment for persistent second carpometacarpal joint pain
Authors: Hatta Taku , Goto Hitoshi , Sonofuchi Kazuaki , Nobuta Shingo , Toh Satoshi , Itoi Eiji
Published: April 2021

The purposes of this study were to demonstrate the clinical characteristics of patients with persistent second carpometacarpal (CMC) joint pain without bony abnormalities known as the carpal boss, and to assess the clinical efficacy of surgical stabilization of the second CMC joint. Eleven patients had persistent wrist pain with characteristic symptoms, including tenderness over the second CMC joint, increased symptoms when the involved hand was placed on the ground or gripped strongly with the involved hand, a positive metacarpal stress test and temporary pain relief with the intra-articular injection of the lidocaine. The patients underwent arthrodesis of the second CMC joint. All cases showed radiologically confirmed fusion of the second CMC joint. At the final followup examination, 10 of 11 patients resulted in satisfactory clinical outcomes, excepting one patient with remnant pain and restricted range of wrist motions. This report highlights the importance of conducting a careful assessment of patients who present with persistent second CMC joint pain without the bony abnormalities, such as carpal bossing. Surgery to stabilize the second CMC joint may be an option to improve their symptoms when conservative treatment fails.
An assessment of variable sample thickness for pXRF analysis of unconsolidated sediment
Authors: Holdsworth E , Knight R D , Valiquette L
J , Landon-Browne A R R , Russell H A J
Published: April 2021

For optimal results manufactures of pXRF spectrometers recommend analyses of samples that meet the criteria of infinite thickness, which for unconsolidated sediments is approximately 25 mm in thickness and compacted to ensure there are no air gaps.
To quantify individual elemental response and the theoretical required infinite sample thickness Certified Reference Materials (CRM's) Till 1 to 4, ranging in thickness from 1 to 40 mm, were analysed in Soil and Mining mode.
Results show a relationship between filters used to process data and sample thickness. For samples less than infinite thickness, pXRF analyses often returned results that were substantially greater than, or less than, results returned from samples of infinite thickness. For these samples post data
collection correction factors can be applied to adjust results for greater accuracy.
Erector Spinae Plane Block
Authors: Choudhury Arindam , Sarkar Sourangshu , Magoon Rohan , Sahoo Subhajit
Published: April 2021

Pain emanating from pleurodesis is significantly distressing and presents an important management concern. Despite encouraging evidence on the application of fascial plane blocks for cardiothoracic surgery, the literature on the use of erector spinae block for pleurodesis remains scarce. We describe a case of bilateral recurrent pleural effusion following congenital heart surgery where erector spinae block was employed as an analgesic technique for pleurodesis. Finally, we discuss its regional analgesic effects in comparison to the conventional intravenous/systemic analgesia in a cross over fashion.
Perioperative Care of Heart Transplant Recipients Undergoing Non-Cardiac Surgery
Authors: Navas-Blanco Jose R. , Modak Raj K.
Published: April 2021

The life expectancy of patients with end-stage heart disease undergoing Orthotopic Heart Transplantation (OHT) has increased significantly in the recent decades since its original introduction into the medical practice in 1967. Substantial advances in post-operative intensive care, surgical prophylaxis, and anti-rejection drugs have clearly impacted survivability after OHT, therefore the volume of patients presenting for non-cardiac surgical procedures is expected to continue to escalate in the upcoming years. There are a number of caveats associated with this upsurge of post-OHT patients requiring non-cardiac surgery, including presenting to healthcare facilities without the resources and technology necessary to manage potential perioperative complications or that may not be familiar with the care of these patients, facilities in which a cardiac anesthesiologist is not available, patients presenting for emergency procedures and so forth. The perioperative care of patients after OHT introduces several challenges to the anesthesiologist including preoperative risk assessments different to the general population and intraoperative management of a denervated organ with altered response to medications and drug-drug interactions. The present review aims to synopsize current data of patients presenting for non-cardiac surgery after OHT, surgical aspects of the transplant that may impact perioperative care, physiology of the transplanted heart as well as anesthetic considerations.
Incidental Finding of Interrupted Inferior Venacava During Minimally Invasive Cardiac Surgery
Authors: Singh Subash Sundar , Palangadan Shaji , Yadav Manish
Published: April 2021

We report a case of 44-year-old female patient with congenital heart disease, ostium secundum atrial septal defect (ASD) with moderate mitral regurgitation for minimally invasive ASD repair along with mitral valve repair. Venous cannulations were performed through right internal jugular vein and right femoral vein (RFV) and arterial cannulation was accomplished through right femoral artery. Intraoperative transesophageal echocardiography (TEE) could not visualize venous cannula through RFV. However, cardiopulmonary bypass (CPB) was initiated and surgery was proceeded. During surgery, patients abdomen became tense and distened, ontable ultrasound examination of abdomen was done after completion of the surgery to rule out hemoperitoneum but was inconclusive, patient was evaluated further under fluoroscopy in cathlab and found to have interrupted inferior vena cava. Postoperative course of the patient was uneventful. We discuss the importance of preoperative evaluation and the role of TEE in placement of cannulas during minimally invasive cardiac surgery.
A Comparison of Sevoflurane versus Sevoflurane-Propofol Combination on Renal Function in Patients Undergoing Valvular Heart Surgery—A Prospective Randomized Controlled Pilot Study
Authors: Jose Reshmi L. , Damayanathi Deepa , Unnikrishnan Koniaparambil P. , Suneel Puthuvassery R.
Published: April 2021

Aim:

The objective of the present study was to compare the effect of sevoflurane with the sevoflurane-propofol combination on renal function in patients undergoing valvular heart surgery. The renal protective effect was assessed using a novel marker called neutrophil gelatinase-associated lipocalin (NGAL).

Materials and Methods:

This was a prospective randomized controlled pilot study conducted at a tertiary care center in India. The study enrolled 36 patients undergoing elective valvular heart surgery, but only 31 were included. All the patients were randomized into two groups, that is, 15 in the sevoflurane group (S-group) and 16 in the sevoflurane–propofol group (SP-group). The baseline NGAL level and test NGAL level at 4 h after cardiopulmonary bypass were measured.

Results:

There was a significant rise in the test NGAL levels compared to baseline in both the groups. The test NGAL level in the S-group was significantly high compared to that of the SP-group (P = 0.034). The number of patients with acute kidney injury was less in the SP-group without reaching statistical significance (P = 0.210).

Conclusion:

Renal function was better preserved in patients anesthetized with a combination of sevoflurane and propofol. This could be due to the enhanced protective effect on renal function by both sevoflurane and propofol.
Comparative Study of Intranasal Dexmedetomidine v/s Midazolam for Sedation of Pediatric Patients During Transthoracic Echocardiography
Authors: Panda Suvendu , Pujara Jigisha , Chauhan Ankit , Varma Abhishek , venuthurupalli Rajesh , Pandya Himani , Patel Sanjay
Published: April 2021

Background:

Procedural sedation required to improve the quality of Transthoracic Echocardiography (TTE) in infants and children. The ideal drug and route for sedation in children should have a rapid and reliable onset, atraumatic, palatable with minimal side effects, and rapid recovery. So, the aim of our study to evaluate and compare the efficacy and safety of intranasal midazolam and intranasal dexmedetomidine in pediatric patients for sedation during TTE.

Materials and Method:

Hundred children under three year of age, belonging to the American Society of Anaesthesiologists class-I and II, scheduled for TTE were divided into two groups by standard randomization technique. Patients in group-M received intranasal midazolam 0.2 mg/kg, whereas patients in group-D received intranasal dexmedetomidine 2 μg/kg prior to TTE under an adequately monitored anesthesia care. Onset and duration of sedation, heart rate, oxygen saturation, sonographer's, and parent's satisfaction scores were recorded.

Results:

All patients were successfully sedated for TTE. The average onset time, sedation time, awakening time and total time for Group-M were 7.3, 18.8, 29.51, 51 min and group-D were 10.1, 14.2, 24.9, 46.3 min, respectively and all were statistically significant (P < 0.001). TTE scan time of Group-M is 8.84 min and Group-D is 9.18 min and was statistically significant. Sonographer's and Parent's average satisfaction score for Group-M was 9.88, 10 and for Group-D was 7.64, 8.76, respectively, which were statistically significant (P < 0.001).

Conclusion:

Intranasal midazolam and dexmedetomidine are safe and effective for sedation in TTE. Intranasal midazolam was found to be comparatively more effective in view of onset of action, sonographers, and parental satisfaction score, while sedation time, awakening time and total duration was significantly higher as compared to intranasal dexmedetomidine.
Aortic Valve and Coronary Artery Bypass Surgery in a Patient with Factor VII Deficiency
Authors: Henze Larissa , Junghanss Christian , Öner Alper , Dohmen Pascal M. , Alozie Anthony
Published: April 2021

Congenital factor VII (FVII) deficiency is a rare bleeding disorder (RBD) with phenotypes ranging from asymptomatic state to life threatening bleeding episodes. There is no established recommendation for the perioperative management of patients scheduled for cardiac surgery. We have described the perioperative management of a patient with FVII deficiency treated for aortic valve stenosis, coronary artery disease, and atrial fibrillation. Balancing perioperative bleeding risk and risks of thrombotic events thereafter in such patients is difficult and requires a multidisciplinary approach.
Combined off Pump Coronary Artery Bypass Graft and Liver Transplant
Authors: Juneja Rajiv , Kumar Ajay , Ranjan Rajeev , Hemantlal P M , Mehta Yatin , Wasir Harpreet , Vohra Vijay , Trehan Naresh
Published: April 2021

Background:

Prospective recipients of liver transplant (LT) have a high prevalence rate of coronary artery disease (CAD) requiring revascularization. In patients of Child Turcot Pugh Class B and C performing LT prior to cardiac revascularization on cardiopulmonary bypass leads to a high risk of major adverse cardiovascular events (MACE). Whereas, isolated cardiac surgery prior to LT has perioperative risk of coagulopathy, sepsis, and hepatic decompensation. We present four cases of end stage liver disease who underwent concomitant living donor liver transplant (LDLT) with off pump coronary artery bypass graft (OPCAB) in an effort to decrease the morbidity and mortality.

Methods:

The cases were performed in a tertiary care centre over two years. Four patients scheduled for LDLT, who were diagnosed with significant CAD, underwent single sitting OPCAB and LDLT. Cardiac surgery was performed first and once patient was stable, it was followed by LDLT. The morbidity parameters in terms of duration of intubation, blood transfusion, hospital stay, ICU stay, requirement of dialysis, atrial fibrillation and sepsis was compared with similar studies.

Results:

The blood transfusion requirement (median 8 units PRBC), incidence of atrial fibrillation (25%), sepsis (25%), and renal dysfunction (0%) was less than the combined surgery conducted on cardiopulmonary bypass. The rate of median intubation time, length of ICU stay, hospital stay, and one year mortality rate was comparable with other studies.

Conclusions:

Morbidity with combined OPCAB and LDLT is less than combined on pump coronary artery bypass surgery with LDLT. Combined CABG with LDLT may be performed with acceptable outcomes in CTP class B and C cirrhosis.
Factors Associated with Delirium after Cardiac Surgery
Authors: Ordóñez-Velasco Lina Maria , Hernández-Leiva Edgar
Published: April 2021

Background:

Delirium is a frequent complication after cardiac surgery and is associated with a higher incidence of morbidity and mortality and a prolonged hospital stay. However, knowledge of the variables involved in its occurrence is still limited; therefore, in this study, we evaluated the perioperative risk factors independently associated with this complication.

Methods:

This study was conducted in a referral tertiary care university hospital with a cardiovascular focus. A total of 311 consecutive adult patients undergoing any type of cardiac surgery were evaluated. The subjects were examined at regular intervals in the postoperative period using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) tool.

Results:

The incidence of postoperative delirium (PD) was 10%. Among the 18 pre-, intra- and postoperative variables evaluated, the logistic regression analysis showed that low education level, history of diabetes or stroke, type of surgery, prolonged extracorporeal circulation, or red blood cell transfusion in the intra- or postoperative period were independently associated with delirium after cardiac surgery. An increased body mass index was identified as a protective factor.

Conclusions:

The aforementioned risk factors are significantly and independently associated with the presentation of PD. Because some of these factors can be treated or avoided, the results of this study are highly relevant to reduce the risk of this complication and improve the care of patients undergoing cardiac surgery.
Anesthetic and Intensive Care Management of Left Main Coronary Artery to Main Pulmonary Artery Fistula Diagnosed in Postoperative Case of Tetralogy of Fallot
Authors: Panda Suvendu , Gandhi Hemang , Surti Jigar , Mishra Amit , Champaneri Bhavik
Published: April 2021

Cases of coronary to pulmonary artery fistula are seen in patients of pulmonary atresia with ventricular septal defect (VSD). These fistulas are rarely seen in patients of Tetralogy of Fallot (TOF). In this case report, we have presented ICU management of a postoperative case of TOF, with missed diagnosis of left main coronary artery (LMCA) to main pulmonary artery (MPA) fistula.
Impact of Frailty in Cardiac Surgical Patients—Assessment, Burden, and Recommendations
Authors: Shanker Akshay , Upadhyay Preeti , Rangasamy Valluvan , Muralidhar Kanchi , Subramaniam Balachundhar
Published: April 2021

Elderly patients undergoing cardiac surgery are at an increased risk of adverse postoperative outcomes. Frailty, a state of decreased physiological reserve, is highly prevalent among elderly patients. Despite being associated with adverse surgical outcomes, no universally accepted definition or measurement tool for frailty exists. Moreover, regardless of all the recommendations, a routine perioperative frailty assessment is often ignored. In addition to complications, frailty increases the burden to the healthcare system, which is of particular concern in Southeast Asia due to its socioeconomically disadvantaged and resource limited settings. This narrative review focuses to develop clinical practice plans for perioperative frailty assessment in the context of a cardiac surgical setting.
Blood donation among university students: Practices, motivations, and barriers in Saudi Arabia
Authors: Mahfouz Mohamed Salih , Ryani Majed , Nawar Hamzi Ahmed Saleh , Zaeri Dhaifallah Abdullah , Dahdoh Abdullah Abdulrahman , Almalki Abdulaziz Jaber , Jubran Hakami Ahmed Ali , Abkr Aqeeli Abdu Ahmed , Tawashi Ibrahim Hussien
Published: April 2021

Context: Blood transfusion is an essential medical procedure conducted with various purposes to provide patients with blood needed. The procedure saves patients’ lives, as blood cannot be manufactured artificially and can only be obtained from human blood sources. Aims: To assess the awareness of, perceptions of, motivations regarding, and barriers to blood donation among a sample of Jazan University students in the Kingdom of Saudi Arabia (KSA). Settings and Design: An observational cross-sectional study was conducted among the undergraduate students of Jazan University. Materials and Methods: Stratified random sampling was used to collect information from 440 students, and a predesigned, structured questionnaire was used to collect data on the study variables. Statistical Analysis: Involved descriptive statistics and inferential statistics. SPSS was used for data analysis. Results: The prevalence of blood donation was 29.0% (95% CI, 25.0–33.3), significantly higher for males at 44.3% (95% CI, 38.3–50.4) than for females at 10.5% (95% CI, 7.3–16.0; P < 0.001), and with odds ratio (OR) = 6.8; [95% CI, 4.1–11.2] than females. Students’ level of knowledge regarding blood donation was low. The main barriers to blood donation were identified as being unqualified for blood donation (57.5%) and risk of contracting infectious disease (48.7%) and the desire to donate in the future to a close friend (38.6%). The main motivations for donating blood were identified as religious reasons (77.5%), altruism (77.5%), and to serve the homeland and meet the call of need (77.5%). Conclusions: The prevalence of blood donation was found to be low, and students’ knowledge regarding blood donation appeared to be lacking. The development of awareness programs among the university’s students will address students’ misconceptions about blood donation and encourage them to join donation campaigns.

Key Messages: Students’ knowledge regarding blood donation appeared to be lacking. The prevalence of blood donation was also not satisfactory. Being unqualified for blood donation and fear and misconceptions regarding blood donation were observed to be the main causes of non-donation. The development of awareness programs among the university’s students will encourage them to join donation campaigns.