bluuebunny/crossref_metadata_2025 huggingface dataset:
De la ville touristique vers la ville cité-loisirs : Évreux, une ville pionnière
Authors: Houllier-Guibert Charles-Edouard , Sohier Alice
Published: July 2022

Le tourisme de proximité s’est développé ces dernières années, notamment en tant que stratégie de repositionnement marketing à Évreux, ce, bien avant la crise sanitaire de la Covid-19. Cette ville rurale normande, pionnière en la matière, a repensé son office de tourisme en ne ciblant plus de manière prioritaire les touristes. La transformation de l’office de tourisme d’Évreux en « Comptoir des Loisirs », à destination des habitants, est étudiée dans cet article. Les éléments théoriques mobilisés (développement et innovations dans les offices de tourisme ; théorie du marketing territorial), ainsi que l’étude qualitative menée (entretiens d’experts) rendent compte des prises de décision des acteurs locaux et des étapes du repositionnement de l’office de tourisme d’Évreux.
Projet culturel de territoire : proposition de lecture à partir de l’innovation managériale ouverte
Authors: Peres Raphaële , Soldo Edina , Arezki Djelloul
Published: July 2022

Les collectivités territoriales s’impliquent de plus en plus dans la stratégie de leur territoire en s’appuyant notamment sur la logique projet. Dans cette démarche, nous nous intéressons au projet culturel de territoire via le concept d’innovation managériale ouverte afin de comprendre son fonctionnement et d’aider les managers territoriaux à mettre en place cet outil stratégique territorial. Pour ce faire, nous nous appuyons sur une étude de cas unique et une méthodologie qualitative avec des entretiens semi-directifs et des observations. Les résultats de cette recherche nous amènent à proposer une grille de lecture à partir de l’innovation managériale ouverte. De plus, nous participons à compléter la définition du projet culturel de territoire en faisant émerger des pratiques gestionnaires innovantes. Cela permettra également d’accompagner les managers territoriaux dans la compréhension et la mise en œuvre d’un tel projet de territoire.
Du barbare au migrant
Authors: Lojkine Stéphane
Published: July 2022

L’étude de la genèse et de l’articulation théorique des notions de crise et de migration, telles qu’elles apparaissent dans les dictionnaires classiques, dans l’Encyclopédie et dans L’Esprit des lois de Montesquieu, révèle quelques surprises. Le migrant a été pensé, non comme l’étranger qui immigre et menace l’autochtone, mais comme la condition même de l’autochtone, dont le peuple a d’abord été migrant. Quant à la crise, ce fut d’abord une notion médicale, désignant l’issue de la maladie, la guérison ou la mort. La crise fait sortir le fluide qui met la santé en péril, alors que nous concevons la crise migratoire comme entrée d’un corps étranger. Nous nous méprenons peut-être aujourd’hui sur la crise parce que nous n’observons pas le bon flux, celui qui, de l’intérieur de notre système social et politique, cherche à sortir. Car dès les Lumières, la notion médicale de crise a pris une signification politique : chez Montesquieu, la crise désigne à la fin de L’Esprit des lois le moment où se constitue le régime féodal. Son origine n’a nullement été une translation pacifique des Romains aux Francs, mais bien une invasion et un asservissement. L’ancien régime romain n’a pas été aboli : une hybridation des systèmes s’est produite. Montesquieu y voit le germe de l’état de droit. Nous sommes, comme Européens, le produit de cette crise migratoire, sans laquelle nos valeurs n’auraient jamais vu le jour.
L’action de l’entrepreneur africain entre émotions et rationalité : l’apport des neurosciences
Authors: Aliouat Boualem , El Ouadoudi Siham , Sabri Mohamed
Published: July 2022

Le processus d’accompagnement des entrepreneurs africains de conviction ou d’opportunités nécessite désormais une approche plus approfondie des processus d’intention et de déclenchement entrepreneuriaux, qui semblent s’inscrire dans des rationalités contingentes et spécifiques. Certains travaux culturalistes apportent des pistes de recherche intéressantes, mais ne déterminent pas précisément et de manière systémique ce qui influence les entrepreneurs africains dans leur modélisation des opportunités d’affaires. L’analyse des déterminants de l’agir entrepreneurial repose essentiellement sur des modèles exclusifs ou composites du comportement planifié et d’événement entrepreneurial. Ce travail de recherche se donne pour projet d’élargir ces modèles à l’approche neuronale de l’entrepreneuriat pour proposer un modèle plus ambitieux fondé sur les apports des neurosciences à une meilleure compréhension des processus de mentalisation des opportunités, des préférences et des normes sociales dans le processus de l’agir entrepreneurial en Afrique, en dépassant les modèles classiques et les seules approches culturalistes.
Protection de l’emploi et procédures de licenciement : une analyse critique du rapport Blanchard Tirole
Authors: Gerber François , Assens Christophe
Published: July 2022

Cet article établit une analyse critique du rapport Blanchard Tirole (2003) consacré aux procédures de licenciement. Ce rapport a le mérite de rompre avec une vision purement politique ou juridique du marché du travail pour introduire la dimension des coûts dans les choix de recrutement ou de licenciement du dirigeant. Néanmoins, ce rapport ne tient pas suffisamment compte des coûts cachés ou différés dans le temps qui dissuadent le dirigeant de recruter ou de licencier. Par exemple, le passif social virtuel constitué au fil du temps par les indemnités de départ est une dette potentielle que supporte l’entreprise. Cette dette potentielle n’est pas prise en compte dans la comptabilité et pourtant elle est devenue déterminante dans la cession d’entreprise et dans la décision de licenciement. L’article introduit ainsi une nouvelle nomenclature des coûts de licenciement pour mieux comprendre les blocages sur le marché du travail français.
Behaviour of two fly species reared for livestock feed: optimising production and insect welfare
Authors: Kortsmit Y. , van der Bruggen M. , Wertheim B. , Dicke M. , Beukeboom L.W. , van Loon J.J.A.
Published: July 2022

The mass rearing of insects as animal feed is a new and rapidly growing component of circular agriculture, which offers the opportunity to develop it in such a way that it promotes insect health and welfare. Behaviour is an important indicator of animal performance and welfare. In this review, we synthesise the current behavioural knowledge on two saprophytic dipteran species that are increasingly being used as mini-livestock, the black soldier fly (Hermetia illucens) and the housefly (Musca domestica). We evaluate which behaviours need to be considered to optimise insect production and welfare under mass-rearing conditions. We distinguish between the different life stages (adults and larvae), and describe their feeding behaviour, social interactions (adult mating, larval aggregation), oviposition behaviour and possible cannibalism. For each species, we review what is known about these behaviours in natural environments, and how this is affected by abiotic factors or interactions with conspecifics and heterospecifics. We also address how the flies’ microbiome and pathogens can influence various aspects of behaviour. Notable differences in natural behaviours between the two species, such as their courtship and mating behaviour and the larval distribution within feed substrates are identified. These behavioural differences have important implications for how we should rear the two fly species in industrial settings, as a mismatch in mass-rearing conditions may induce environmental stress or compromise insect productivity and welfare. Escape behaviour, larval aggregation behaviour, possibly cannibalism in the larval stage and mating frequency and reproduction rate are identified as behaviours providing information on welfare of larval and adult flies. Finally, a number of aspects are identified for which behavioural knowledge is currently still sparse, while this may be important to safeguard insect welfare. We conclude with recommendations for future research to promote insect welfare.
Function of yeast extract in greater wax moth farming: does yeast extract always improve the development and reproduction of insects?
Authors: Xue Q.Q. , Men L.N. , Güncan A. , Zhang Q. , Qi J.Y. , Deng A. , Song F. , Zhang Y.H. , Zhang Z.W.
Published: July 2022

TheGalleria mellonella L. (Lepidoptera: Pyralidae) has great nutritional potential for humans and animals and is currently used as a model organism in many biological studies, despite its damage to the apicultural industry and wild honeybee colonies. Yeast extract that promotes insect development and reproduction by containing many necessary nutrients has always been an important yet expensive ingredient in the majority of artificial diets forG. mellonella. To better understand the influence of yeast extract content onG. mellonella mass-rearing, the life table parameters fromG. mellonella mass-reared on increasing amounts of yeast (0% in control, 2, 4, 6, 7, and 9% of the total diet, respectively) under laboratory conditions were analysed according to age-stage, two-sex life table theory. Harvest rate and recruitment cost to produce 10,000 pupae were also assessed to help identify an economically sustainable rearing system. The intrinsic rate of increase (r) and finite rate of increase (λ) varied among diets. Highest values found in theG. mellonella population reared on a 9% yeast extract diet did not differ significantly from those of diets consisting of 4, 6, and 7% yeast extract, whereas these parameters were lowest in yeast-free artificial diets. The cheapest daily cost of rearing a population was 3,966.57 CNY (Chinese Yuan), and the heaviest pupal weight for both females and males (398.10±9.26 and 316.00±7.92 mg, respectively) were found with an artificial diet of 4% yeast extract. This study demonstrates that excessive dietary yeast extract is not always beneficial toG. mellonella. The most effective yeast extract percentage inG. mellonella mass-rearing diets is about 4% based on life table parameters, computer projection, and harvesting costs.
Acute-Onset Visual Snow Syndrome After LASIK
Authors: Keppel Kevin , Randleman J. Bradley
Published: July 2022

PURPOSE:

To describe a case of acute-onset visual snow syndrome occurring after bilateral myopic laser in situ keratomileusis (LASIK).

METHODS:

Case report.

RESULTS:

A 38-year-old man presented with a 7-month history of constant positive visual disturbances involving his entire binocular visual field after bilateral LASIK. The patient described his symptoms as a “moving texture” present at all times in all lighting conditions that he noticed beginning the evening of the same day he had LASIK. The phenomenon was worse in low lighting and was in fact present in complete darkness, even when his eyes were closed. The patient also endorsed large halos, nyctalopia, and enhanced entoptic phenomena in both eyes, all of which had subjectively worsened after LASIK. Topography-guided customized ablation treatment enhancement had been performed to reduce the patient's symptoms without success. On presentation, uncorrected distance visual acuity was 20/16 in both eyes. Results of slit-lamp examination and corneal imaging were unremarkable in both eyes. The patient was eventually fit with scleral contact lenses, which reduced his halos at night but did not improve his visual snow symptoms.

CONCLUSIONS:

Although visual snow and visual snow syndrome have been known to present suddenly in a subset of cases, this is the first published case report of acute-onset visual snow syndrome immediately after refractive surgery. Visual snow syndrome has reportedly been preceded by specific events, including migraine attacks, medications, and trauma. Because the symptoms are non-ocular in origin, further refractive surgery enhancement is not indicated.

[
Journal of Refractive Surgery Case Reports.
2022;2(3):e51–e54.]
THE IMPACT OF QUANTUM TECHNOLOGIES ON WARSHIP DESIGN
Authors: Rigby J
Published: July 2022

New advancements in quantum technologies look to provide significant improvements in capability for combat platforms in navies across the world. From communications systems to weapon targeting and navigation, there are countless possibilities for enhancements and augmentation of current systems.
GENERATION OF THE DIGITAL TWIN OF A PROCESS PLANT BASED ON DEEP LEARNING
Authors: Grau M , Stjepandić J
Published: July 2022

Nowadays, Digital Twin is used both as a subject of scientific research as well as a buzzword to attract existing commercial products and services. It poses one of key innovations in the IT related products and services in the past years. There are
numerous types of Digital Twin, in particular in the manufacturing domain. Big challenge still remains how to generate the Digital Twin for existing objects in a plant. In this paper, an approach for the generation of Digital Twin in a built environment based on scan and object recognition is presented which is commercialized as an extension of a well-running portal OpenDESC.com. After the theoretical foundation and the practical requirements are described, the functional approach and the practical implementation are explored. The examples from manufacturing plant and process plant are presented. The method for assessment of results is discussed. Finally, conclusions and outlook summarize the insights and give future directions.
Orígenes y relaciones familiares de Raimundo de Borgoña y Hugo de Champaña, promotor del Temple
Authors: Torres Sevilla-Quiñones de León Margarita C.
Published: July 2022

Si hay una orden militar capaz de generar interés pasados siete siglos de su disolución por orden papal, ésta es, sin duda, la del Temple. Sin embargo, sobre sus fundadores todavía existen aspectos que aún deben abordarse. Por ello, con este trabajo se busca trazar una semblanza genealógica de quien es el soporte verdadero de la orden desde sus comienzos, el conde Hugo de Champaña, y sus lazos de parentesco con la familia real de León a través de sus cercanos vínculos de sangre con el conde de Galicia Raimundo de Borgoña, y también con el conde Enrique de Portugal, lo que explicaría la temprana implantación de la orden en el noroeste de Hispania y el apoyo decidido de la corona.
 
[gl]
Se hai unha orde militar capaz de xerar interese pasados sete séculos da súa disolución por orde papal, esta é, sen dúbida, a do Temple. Con todo, sobre os seus fundadores aínda existen aspectos que deben abordarse. Por iso, con este traballo búscase trazar unha descrición xenealóxica de quen é o soporte verdadeiro da orde desde os seus comezos, o conde Hugo de Champaña, e os seus lazos de parentesco coa familia real de León a través dos seus próximos vínculos de sangue co conde de Galicia Raimundo de Borgoña, e tamén co conde Henrique de Portugal, o que explicaría a temperá implantación da orde no noroeste de Hispania e o apoio decidido da coroa.
La socialización de los notarios compostelanos en los siglos XIV-XVI a través de la cofradía de cambiadores de Santiago
Authors: Ares Legaspi Adrián
Published: July 2022

El objetivo de esta investigación es el análisis de las redes y prácticas sociales de los notarios compostelanos en los siglos XIV-XVI a través de su pertenencia a la cofradía de cambiadores de Santiago y del ejercicio de su profesión. Mediante una aproximación desde la diplomática a los Libros dos Cambeadores, a los protocolos notariales, a la legislación y a otros casos peninsulares, comprobaremos que la cofradía de cambiadores se convirtió en punto de encuentro de los distintos tipos de notarios, donde crear y asentar los vínculos familiares y profesionales con el resto de la oligarquía urbana. Una realidad marcada por la endogamia del notariado, su política matrimonial, la patrimonialización de los oficios, la diversificación de sus actividades económicas y, finalmente, la movilidad social de estos profesionales. En suma, los notarios compostelanos se convirtieron en intermediarios imprescindibles dentro de la comunidad en el plano administrativo, social, económico y cultural, gracias a su posición socioeconómica elevada y a su trabajo en el ámbito de la cultura escrita.
 
[gl] Nesta investigación analízanse as redes e prácticas sociais dos notarios composteláns nos séculos XIV-XVI a través da súa pertenza á confraría de cambiadores de Santiago e do exercicio da súa profesión. Mediante un achegamento dende a diplomática aos Libros dos Cambeadores, aos protocolos notariais, á lexislación e a outras casuísticas peninsulares, comprobaremos que a confraría de cambiadores se converteu nun punto de encontro dos distintos tipos de notarios, onde crear e asentar os vínculos familiares e profesionais co resto da oligarquía urbana. Unha realidade marcada pola endogamia do notariado, a súa política matrimonial, a patrimonialización dos oficios, a diversificación das súas actividades económicas e, finalmente, a mobilidade social destes profesionais. En suma, os notarios composteláns convertéronse en intermediarios imprescindibles dentro da comunidade no plano administrativo, social, económico e cultural, grazas á súa posición socioeconómica elevada e ao seu traballo no eido da cultura escrita.
Rhizobia inhabiting Clitoria ternatea L. in Anuradhapura District, Sri Lanka: An assessment of stress tolerance and genetic diversity
Authors: Tennakoon P. T. M. K. C. , Rajapakse S.
Published: July 2022

Legume-Rhizobial symbiosis plays a greater agronomical and ecological significance as it provides fixed nitrogen through Biological Nitrogen Fixation. Clitoria ternatea is a leguminous plant that hosts a wide range of rhizobial strains. Even though it is a widely distributed plant, comprehensive information and studies conducted on the rhizobial - C. ternatea symbiosis is lacking in Sri Lanka. This study aimed to identify different stress-tolerant rhizobial strains inhabiting root nodules of C. ternatea growing in seven selected locations of Anuradhapura district of Sri Lanka. Twenty-eight pure rhizobial colonies were isolated and they were separately grown in ½ Lupin broths and were subjected to four different physiological conditions, pH, temperature, salinity, and drought. Most of the isolates were well-grown within the pH range of 5.0-8.0, the temperature range of 30-35°C and at 0.2% Polyethylene glycol-8000 (PEG) concentration. There was no observable pattern in the growth of rhizobial strains in different physiological conditions. The twelve rhizobial strains which showed high tolerance to extreme physiological conditions were subjected to a combination of physiological stress conditions of pH 8.0, temperature 36°C, 3.0 % NaCl and 0.4 % PEG. The maximum growth in combination physiological study was observed in a strain collected at the Palugaswewa site. According to the dendrogram prepared by the Enterobacterial Repetitive Intergenic Consensus (ERIC) profile, twelve strains are genetically diverse, as they belonged to11 clusters at 69.89 % of similarity level. These stress-tolerant rhizobial strains could be used for further studies on cross-inoculation of crop legumes as an alternative to the nitrogenous fertilizers.
Biochemical characterization and antibacterial potential of lactic acid bacteria from Idli batter and their influences on properties of batter
Authors: Bernard D. , Jeyagowri N. , Madhujith T.
Published: July 2022

Idli is one of the flour-based foods fermented by lactic acid bacteria. This study was designed to characterize the lactic acid bacteria isolated from Idli batter and to determine their antibacterial activity. Physicochemical changes of batter during fermentation and sensory qualities of the final product (Idli) also were determined. Lactic acid bacteria were isolated from Idli batter and characterized up to genus level. Agar well diffusion assay was used to determine the antibacterial activity of isolates against foodborne pathogens (Salmonella enterica, Escherichia coli and Staphylococcus aureus). Changes of pH, lactic acid bacterial count, titratable acidity of batter during fermentation and sensory properties of the final product were measured. Ten isolates (I-1 to I-10) were isolated from Idli batter, of which, six were rod and other four were cocci shaped. All ten isolates were Gram positive, non-motile, non-spore formers and catalase activity negative. It was confirmed that all isolates belong to lactic acid bacteria up to genus level. Based on diameter of the inhibition zone, among ten isolates, I-6 was considered as the highest potential bacteriocinogenic isolate. Inhibition zone diameter of isolates ranged from 7.3±1.53 to 16.3±0.58 mm. The pH dropped steadily from 6.28 to 3.72, while titratable acidity increased from 0.24 to 0.92% throughout the fermentation period (0-32 h). With fermentation, the lactic acid bacterial count was increased, and highest lactic acid bacterial count of 9.88 log10cfu/g was observed after 12 h of fermentation. Idli prepared from Idli batter after 8-12 h of fermentation scored maximum for the sensory quality. From this study it is concluded that all lactic acid bacteria isolates possess antimicrobial activity and physicochemical and sensory qualities of Idli batter changed with duration of fermentation.
National action plan on antimicrobial resistance: An evaluation of implementation in the World Health Organization Africa region
Authors: Fuller Walter L. , Hamzat Omotayo T. , Aboderin Aaron O. , Gahimbare Laetitia , Kapona Otridah , Yahaya Ali A. , Kasambara Watipaso , Nikiema Jean-Baptiste , Ilboudo Didier W. , Mpundu Mirfin M.
Published: July 2022

In line with global instruments, within the last five years, two-thirds of all countries in the WHO Africa Region (WHO AFR) have developed a National Action Plan (NAP) on Antimicrobial Resistance (AMR). We sought to evaluate progress made across the countries implementing NAP for effective response to AMR. A semi-structured survey tool was administered to obtain information from national focal persons on the implementation of strategic elements of NAP on AMR. This was followed by a Lessons Learnt Workshop in June 2019 at Douala, Cameroon, where focal persons made presentations on the country’s progress. Later, a desktop review of the LLW report and other key documents was conducted. Countries in WHO AFR that have set up a national surveillance system and are enrolled into the WHO global antimicrobial resistance surveillance system have progressively increased to 30 (of 47 countries), of which 15 are already submitting surveillance data. Of the 20 countries at the Lessons Learnt Workshop, 14 have infection prevention and control (IPC) policies and functional healthcare facility IPC programs, 15 participate in the commemoration of the annual world hand hygiene days. Although almost all countries surveyed have national standard treatment guidelines, only five have incorporated the WHO AWaRe classification into the national essential medicines list. Fourteen of 20 countries have established an active/functional national secretariat/coordinating center for AMR. Discernible progress is being made on the implementation of NAP in WHO AFR region. Gaps identified in the strategic elements of action plans need to be filled for effective AMR control.
Nutrition knowledge of caregivers working in health and education centers for children with special healthcare needs
Authors: Cheikh Ismail Leila , Abu Qiyas Salma , Mohamad Maysm N. , Osaili Tareq Mohammed Ibrahim , Obaid Reyad Rashid Shaker , Saleh Sheima T. , Kassem Hanin , Al Dhaheri Ayesha S. , Al Daour Rameez , Al Rajaby Radhiya , Hasan Hayder Abbas , Hashim Mona Sharef
Published: July 2022

Background:

Children with special healthcare needs are recognized as a high-risk group for malnutrition. Caregivers have a strong influence on the dietary habits of their students, therefore, adequate nutrition knowledge among caregivers and educators has a great potential in improving the health of children. The purpose of this study is to assess the level of nutrition knowledge and demographic influences of knowledge among caregivers working in health and education centers.

Methods:

a cross-sectional, web-based survey was conducted among educators and caregivers working at Sharjah City for Humanitarian Services to assess their nutritional knowledge using a modified validated general nutrition knowledge questionnaire.

Results:

233 participants completed the survey. The basic recommendations about reducing the intake of sugary, salty, and fatty foods and consuming more water and vegetables were best acknowledged. However, an inadequate level of knowledge was identified regarding specified number portion. For instance, more than half of the participants were aware of the need to consume more vegetables and fruits while only 10% knew the minimum number of servings to consume in a day. The overall nutrition knowledge score was adequate at 46.30 (55.1%). Caregivers with nutrition qualifications and who have four children had a significantly higher knowledge score. Older age was associated with better diet-disease relationship knowledge.

Conclusions:

The level of nutrition knowledge among caregivers and health workers was insufficient. However, periodic nutrition education reinforcement among health caregivers should be considered.
The Use of Blood and Crystalloid Cardioplegia in Adult Open-Heart Surgery on Postsurgical Outcomes
Authors: Putro Bambang Novianto , Hidayat Jefferson K. , Soenarto Ratna Farida
Published: July 2022

Background:

Myocardial ischemia can occur due to hypotension, shock, coronary heart disease, and aortic cross-clamping during open-heart surgery using a cardiopulmonary bypass machine. As the cardioprotective method, cardioplegia is classified into blood or crystalloid base. This systematic review is aimed to describe the effectiveness of blood and crystalloid cardioplegic solutions in adult open-heart surgery procedures by focusing on their effects on cardiac enzymes.

Materials and Methods:

This study investigated the effect of blood and crystalloid cardioplegia on troponin (cTn) and creatinine kinase myocardial bound. The literature search was carried out on several Cochrane, PubMed, PMC, and Google Scholar databases from January 2014 to August 2020 using the MeSH keywords and Boolean operator.

Results:

We obtained 346 articles and identified six prospective randomized studies from four countries. The majority discussed the comparison of blood cardioplegia and crystalloids in coronary revascularization cardiac surgery (coronary artery bypass grafting). Overall, the articles used have a low risk of bias despite their high level of homogenicity.

Conclusions:

The current literatures on cardioplegia in adults do not provide adequate advanced-phase trials. Both types of cardioplegia provide a reasonable protection for myocardium. However, several studies reveal that crystalloid cardioplegia increases cardiac enzymes more significantly than blood cardioplegia. This research has been registered with PROSPERO with the number CRD42022312548.
Anesthcalc™ is Associated with Superior Accuracy and Faster Accomplishment in Simulation-based Anesthesia Drugs Dosage Calculation
Authors: Lestari Mayang Indah , Zulkifli  , Zainal Rizal , Mulia Muhammad Imam
Published: July 2022

Background:

Medication error is one of the barriers to achieving sustainable patient safety. We aim to determine the efficacy and reliability of a smartphone dosage calculator application (AnesthCalc™) when compared with the manual calculation of various anesthetic drugs to prevent medication error.

Materials and Methods:

This is a pre-test–post-test intervention study. There are 52 participants who included residents in anesthesiology, which is divided into two groups. Each group performed two simulation cases in which they had to calculate drugs dosage in anesthesia settings. One set of cases was performed with the app and the other set was performed manually. The order of drugs and simulation patients was randomized. The accuracy and the deviation of administered drug doses were recorded. Accuracy of dosage was categorized as either accurate (80–100% of target dose) or inaccurate (less than 80%), whereas the deviation of dosage was categorized as either deviant (<50% or >200% of target dose) or safe (between the range).

Results:

There is a significant increase in the accuracy of calculation between the manual group and that using the app group (from 46% to 92%, a mean increase of 18.29%, P < 0.005). There is a significant decrease in the duration of calculation between without using the app group and with using the app group (from 32.92 to 18.79 s, a mean decrease of 30.55 s, P = 0.001).

Conclusion:

AnesthCalc™ is a valid and reliable instrument as it increases users’ accuracy and shortens calculating time. AnesthCalc™ may be the potential to reduce calculation errors and may increase patients’ safety.
Factors Influencing Substance use Among Transgender Individuals in India
Authors: Subramanian Karthick , Kavya Muthuraman
Published: July 2022

Background:

Due to various psychological and psychosocial factors, transgender (TG) individuals suffer from psychiatric disorders including substance use disorders (SUDs). Although factors influencing mental illness and stigma in TG persons have been identified, the literature is scarce regarding the factors influencing substance abuse among the TG population. The present review identifies the burden and risk factors for substance use among TG individuals in India.

Methods:

An electronic search of databases such as MEDLINE, ProQuest, and Google Scholar yielded 11 relevant Indian research articles. The factors moderating substance abuse among TG persons were reviewed.

Results:

Studies reveal that alcohol and tobacco use disorders are the most common SUDs among TG persons in India, apart from illicit drug use. Depressive symptoms, anxiety, unemployment, and discrimination in various spheres of life were associated with elevated substance use among TG individuals. Not being married, higher income, often out with family and friends, having more sexual partners, and interpersonal violence with partner predicted harmful and illicit patterns of substance use.

Conclusion:

Various demographics, sexual relationship characteristics, and psychosocial factors tend to influence substance abuse patterns. Future studies are needed to explore the influence of various physical, psychosexual, psychological, and psychosocial factors on the substance use patterns among TG persons in India.
Superior laryngeal nerve block with in-line lignocaine nebulization for awake extubation response
Authors: Jadhav Kashinath K. , Karnalkar Asmita P. , Patil Shailendra B.
Published: July 2022

Background and Aims:

Tracheal extubation is associated with various undesirable hemodynamic and airway responses. Various drugs are used effectively to curb these responses. But these drugs have limitations and produce side effects. Hence, the study was planned to assess the effects of superior laryngeal nerve block with inline lignocaine nebulization on awake extubation responses to suggest an alternative. The aim of this study was to assess the effect of bilateral superior laryngeal nerve block with inline lignocaine nebulization on awake extubation responses.

Material and Methods:

A study was conducted in 35 patients aged 18-60 years, posted for surgery less than 3 h under general anesthesia. The hemodynamic responses like heart rate, arterial blood pressure, and mean arterial pressure were recorded preoperatively and at 1, 5, and 10 min postextubation. Undesirable respiratory responses like bucking, severity of sore throat, and cough response were also assessed. Repeated measures analysis of variance followed by the Tukey HSD test was used to find the significance of hemodynamic parameters. Qualitative data were expressed as percentages.

Results:

Decrease in Systolic Blood Pressure, Diastolic Blood Pressure and Mean Arterial Pressure was statistically significant at 5 mins (T2) and 10 mins (T3) postextubation as compared to baseline (T0). No cough was observed postextubation in 80% patients while 20% had mild Grade 1 cough.

Conclusion:

Superior laryngeal nerve block with in-line lignocaine nebulization for awake extubation is effective in curbing the haemodynamic and respiratory responses of extubation.
Comparative study of Baska mask with proseal LMA in adult patients undergoing elective surgery under general anesthesia with controlled ventilation
Authors: Agrawal Nidhi , Singh Anuradha , Gupta Anju
Published: July 2022

Background and Aims:

Several supraglottic airway devices (SGD) are available nowadays. But none has been found to be better than Proseal laryngeal mask (PLMA) in terms of oropharyngeal leak pressure (OLP). We aimed to compare OLP of newly introduced Baska® Mask with PLMA in patients undergoing elective surgical procedures under general anesthesia.

Material and Methods:

Totally, 80 consecutive adult patients of either sex requiring general anesthesia were randomized into two groups Group B (Baska mask, n = 40) or Group P (PLMA. n = 40). After standardized induction with propofol 2 − 2.5 mg/kg-1 and fentanyl 2 mgkg-1, and muscle relaxation with vecuronium 0.1 mgkg-1 one of the two devices was placed. OLP (primary outcome) was measured 5 minutes and 30 minutes post induction. The time needed to achieve effective airway, anatomical alignment of the device, number of attempts, leak fraction, and postoperative laryngopharyngeal morbidity were noted.

Results:

Both the devices could be inserted in first attempt in all the patients, but the time needed to achieve effective airway was significantly less in Group B (12.58 ± 1.81 sec vs 17.92 ± 2.45 sec, P < 0.001). The mean OLP was better in Group B at 5 min (37.6 ± 2.43 cm H2O vs 30.82 ± 3.96 cm H2O) and at 30 min (38.83 ± 1.72 cm H2O vs 30.82 ± 3.96 cm H2O; P < 0.001). Anatomical alignment of SGD with glottis (FOB grade 3 or 4 view) was significantly better in group B (34/40) as compared to group P (25/40) (p = 0.009). There was no difference in laryngopharyngeal morbidity in the two groups.

Conclusion:

Baska mask provided higher OLP, better alignment to the glottis and faster placement time as compared to PLMA.
Resilience of healthcare professionals involved in anesthesia practice: A cross-sectional questionnaire based pilot study
Authors: Patil Narendra , Manwani Roshani , Vyas Varsha , Vardhan Vikram , Gehdoo R.P. , Patil Surekha
Published: July 2022

Background and Aims:

Resilience of healthcare professionals involved in Anesthesia practice is relatively a new area of research. Improvement of resilience is important for the sustainability of the healthcare workforce. The aim of this study was to evaluate resilience of the health care providers towards intra-operative emergency situation and intensive care unit.

Material and Methods:

In this cross-sectional pilot study, healthcare providers working involved in anesthesia practice responded to a questionnaire consisting of 20 questions related to their regular work profile. Answers were graded as- ”Yes”, “Not often” and “No”. Scores of “Three”, “Two” and “One” were assigned to these responses and total score was calculated. Frequency and percentage of each response were compared based on place of work and roles. Scores were compared based on the designation.

Results:

Out of 103 healthcare workers 56 (54.4%) were from government or charity hospital. Thirty-one (30.1%) were Junior Residents. Comparison of responses based on the role/designation, significant differences were observed for questions- I reach to operation theatre well before the proposed time for the case (0.02994), I personally check operation theatre preparation (p = 0.01966), I check for the consent form every time (p = 0.02018), I can recognize different electrocardiogram (ECG) patterns (p = 0.00231) and I always try to learn from everything (p = 0.01989). Based on the place of work of study participants, there was a significant difference (p = 0.002095) for question, i.e., “I personally check operation theatre preparation.”

Conclusion:

The study results suggested good resilience of healthcare professionals involved in anesthesia and intensive care. Some pointers towards burnout are seen among study population. Early interventions may be useful to improve resilience and reduce risk of burnout.
Effect of caudally administered clonidine on sevoflurane induced emergence agitation—A randomized trial
Authors: Archana K N , Vyshnavi S , Ganesh Vinutha
Published: July 2022

Background and Aims:

Emergence agitation (EA) is an unpleasant problem encountered in children following anesthesia with Sevoflurane. We studied the effectiveness of caudal epidural block (CEB) with ropivacaine 0.2% and clonidine two microgram per kilogram (mcg/kg) on the incidence of EA, with respiratory depression and hemodynamic variables as secondary end points.

Material and Methods:

Ninety children aged one to eight years undergoing infra umbilical surgeries were randomly allocated into two groups. Group RS: Ropivacaine 0.2% one ml/kg + . Saline one ml and Group RC: Ropivacaine 0.2% one ml/kg + Clonidine two mcg/kg made to one ml. They were then administered general anesthesia with endotracheal intubation followed by CEB using test drugs. Post surgery, EA was evaluated by Modified Richmond Agitation Scale at 15-minute intervals for one hour. The results were then analyzed using mean and standard deviation (SD), Chi square test, and Independent t test.

Results:

EA was significantly lower in group RC when compared to group RS (P < 0.0001).Group RC had 12 (28.5%) children with EA at 15 minutes compared to 35 (83.3%) children in Group RS. At 30 minutes, it was seen in five (11.3%) and 27 (64.2%) children in group RC and RS, respectively. No significant respiratory depression was noted in both groups. A significant decrease in heart rate was seen in Group RC (P < 0.001) but was not significant clinically. No adverse events were recorded in both the groups.

Conclusion:

Addition of clonidine (2mcg/kg) to ropivacaine 0.2% offers an advantage over 0.2% ropivacaine alone in decreasing the incidence of sevoflurane induced EA in children undergoing lower abdominal surgery without any adverse effects.
Comparison of haemodynamic changes between propofol and ketofol as induction agents in patients undergoing laparoscopic surgeries under general anaesthesia
Authors: Raman Vikasini , Segaran Sivakumar , Ramyavel T. , George Sagiev Koshy , Zachariah Mamie
Published: July 2022

Background and Aims:

Laparoscopic surgeries are more commonly performed procedure nowadays because of its advantages however generation of pneumoperitoneum causes significant physiological changes. Propofol is the most commonly used induction agent but its use is limited by its side effects like dose-dependent hypotension and myocardial depression. So by combining propofol with ketamine to form ketofol may result in better hemodynamic stability. The aim of this study was to compare the haemodynamic changes in patients undergoing laparoscopic surgery under general anesthesia using propofol and ketofol as induction agents.

Material and Methods:

In this prospective randomized double blind study, 80 patients of ASA I/II undergoing elective laparoscopic surgery were randomized into two Groups. Group A received 1 mg/kg of propofol + 1 mg/kg ketamine made up to a total volume of 20 ml with normal saline and Group B received 2 mg/kg propofol + normal saline to make up to an equal volume. Hemodynamic profiles like HR, SBP, DBP, and MAP were recorded at different time intervals until pneumoperitoneum. Postoperative recovery profile and complications were recorded. All data were entered in MS excel and analyzed using SPSS Version 20.0. Repeated measures ANOVA and Chi-square test were used to test the level of significance.

Results:

Demographic character and duration of surgery were comparable. SBP, DBP, MAP and HR showed statistically significant difference in both groups in various time intervals with P < 0.05 with Group A (ketofol ) having a better hemodynamic stability. Recovery profile in ketofol group took longer duration (4.95 min) compared to propofol group B (1.8 min). Postoperative nausea and vomiting were significant (P = 0.004) in ketofol group.

Conclusion:

We concluded that ketofol had a better hemodynamic stability compared to propofol as an induction agent, however time for recovery in ketofol group took a longer period compared to propofol group, with no complication in either groups.
Topical vs. intravenous administration of tranexamic acid to minimize blood loss in abdominal hysterectomy perioperatively: A randomized controlled study
Authors: Mitra Sukanya , Jain Kompal , Singh Jasveer , Jindal Swati , Mehra Reeti , Singh Swati
Published: July 2022

Background and Aims:

Topical application of tranexamic acid (TXA) to bleeding wound surfaces is rapidly gaining recognition and currently a topic of further research in patients undergoing abdominal hysterectomy.The aim of the study was to compare the efficacy of topical vs. intravenous (i.v.) administration of TXA in reducing perioperative blood loss in patients undergoing abdominal hysterectomy.

Material and Methods:

A double-blinded parallel-group randomized controlled study was conducted in a tertiary teaching institute. Group 1 (n = 25) received 10 mg.kg-1 i.v. bolus of TXA after induction followed by infusion of 1 mg.kg-1.h-1 of TXA, in 50 ml of normal saline (NS), till the completion of surgery and just before closure of peritoneum 100 ml of NS was applied topically over the raw surface. Group 2 (n = 25) received 50 ml of NS over 10 min after induction, followed by infusion of 50 ml of NS, till the completion of surgery and just before closure of peritoneum, 1.5 g of TXA mixed in 100 ml of NS was applied topically over the raw surface. The primary outcome was total perioperative blood loss (intraoperative plus 24 h postoperative). The secondary outcomes included change in hemoglobin concentration postoperatively at 12 h, 24 h; need for blood/blood product transfusion; amount of blood/blood product transfused and side effects of TXA.

Results:

Total perioperative blood loss was 312 ± 106.65 ml in group 1 and 325 ± 89.90 ml in group 2 (p = 0.659). It was found that the mean reduction in hemoglobin was 0.7 g.dl-1 and 0.54 g.dl-1 in group 1 and 0.67 g.dl-1 and 0.44 g.dl-1 in group 2 at 12 h and 24 h respectively, with no significant intergroup difference.

Conclusion:

Administration of TXA topically is as efficacious as TXA administered i.v. to minimize perioperative blood loss in patients undergoing abdominal hysterectomy.
A prospective observational study on changes in endo-tracheal tube cuff pressure and its correlation with airway pressures during various stages of robotic pelvic surgeries
Authors: Gupta Priyanka , Tandon Shipra , Dhar Mridul , Agarwal Ankit , Pathak Sharmishtha , Prabakaran P.
Published: July 2022

Background and Aims:

Robotic surgeries often require a relatively long duration of pneumo-peritoneum and trendelenburg position which may accentuate changes in endo-tracheal tube (ETT) cuff pressure leading to pressure related complications. The aim of this study was to analyze changes in ETT cuff pressures during various stages of pneumo-peritoneum and surgical positioning and its correlation with airway pressure changes.

Material and Methods:

A prospective observational study was planned after approval of institutional review board on 60 patients undergoing elective robotic pelvic surgery requiring head down position. Baseline cuff pressure was adjusted to 25 cm H2O. ETT cuff pressure, peak airway pressure and end tidal CO2 (ETCO2) was measured at various time intervals before and after pneumo-peritoneum and head down. Ventilatory parameters were kept fixed after baseline setting. Those requiring any change were excluded. Pearson’s coefficient was used for correlation and ANOVA for trend of parameters at different time intervals (P value <0.05 was considered significant).

Results:

Baseline cuff pressure after manual inflation was 46.2 ± 17.4 cm H2O. Significant correlation was observed between change in cuff pressure and increase in peak airway pressure at the end of the surgery (r = 0.4, P < 0.05). Serial measurements of ETT cuff pressure, peak airway pressure and ETCO2 were significantly increased compared to baseline (P < 0.05).

Conclusion:

Significant increases in ETT cuff pressure may be seen in robotic surgeries, with a positive correlation between change in cuff pressure and increase in airway pressures. Objective adjusted measurement of cuff pressure and airway pressures is recommended for such surgeries.
Changing trends in assessment: Effectiveness of Direct observation of procedural skills (DOPS) as an assessment tool in anesthesiology postgraduate students
Authors: Kamat Chaitanya , Todakar Mahantesh , Patil Madhumati , Teli Anita
Published: July 2022

Background and Aims:

National Medical commission of India (NMC) has introduced Competency based Medical Education (CBME) following the international trend. Competency based assessment differs from traditional assessment and we need to adopt to newer work place-based assessments (WPBA). Direct Observation of Procedural Skills (DOPS) is one such assessment tool, which assesses procedural skills of a student. Hence this study was conducted to evaluate the effectiveness of DOPS among Anesthesiology postgraduate students.

Material and Methods:

A prospective interventional study was conducted, where in 55 postgraduate students underwent DOPS assessment while performing three routine core skills of Anesthesiology. Observations were documented (Pre-DOPS-Score) and immediate verbal feedback was given. Students were educated through demonstration of all three procedures on actual patients by three faculty members using the DOPS checklist. The students were finally assessed again with proforma and DOPS scores were documented (Post-DOPS Score). Mean Pre-DOPS and Post-DOPS assessment Scores were compared. Student and faculty Perceptions were taken regarding the DOPS assessment.

Results:

There was significant improvement in the procedural skill performance after DOPS with a statistically significant difference. Average time taken for DOPS test was 11 min. Average time taken for giving feedback was 13 min. Students and faculty members gave positive feedback about DOPS.

Conclusion:

DOPS is very feasible and effective assessment tool, improves procedural skills of Anaesthesiology postgraduate students, helps to develop good clinical skills which finally brings good clinical care.