bluuebunny/crossref_metadata_2025 huggingface dataset:
On pandemics and pivots: a COVID-19 reflection on envisioning the future of medical education
Authors: Han Heeyoung , Clithero-Eridon Amy , Costa Manuel João , Dennis Caitriona A. , Dorsey J. Kevin , Ghias Kulsoom , Hopkins Alex , Jabeen Kauser , Klamen Debra , Matos Sophia , Mellinger John D. , Peters Harm , Pitama Suzanne , Smith C. Leslie , Smith Susan F. , Suh Boyung , Suh Sookyung , Zdravković Marko
Published: December 2021

The required adjustments precipitated by the coronavirus disease 2019 crisis have been challenging, but also represent a critical opportunity for the evolution and potential disruptive and constructive change of medical education. Given that the format of medical education is not fixed, but malleable and in fact must be adaptable to societal needs through ongoing reflexivity, we find ourselves in a potentially transformative learning phase for the field. An Association for Medical Education in Europe ASPIRE Academy group of 18 medical educators from seven countries was formed to consider this opportunity, and identified critical questions for collective reflection on current medical education practices and assumptions, with the attendant challenge to envision the future of medical education. This was achieved through online discussion as well as asynchronous collective reflections by group members. Four major themes and related conclusions arose from this conversation: Why we teach: the humanitarian mission of medicine should be reinforced; what we teach: disaster management, social accountability and embracing an environment of complexity and uncertainty should be the core; how we teach: open pathways to lean medical education and learning by developing learners embedded in a community context; and whom we teach: those willing to take professional responsibility. These collective reflections provide neither fully matured digests of the challenges of our field, nor comprehensive solutions; rather they are offered as a starting point for medical schools to consider as we seek to harness the learning opportunities stimulated by the pandemic.
Medical students’ satisfaction on online flipped learning by learning styles
Authors: Chae Su Jin
Published: December 2021

Purpose: The purpose of this study was to examine the differences in the medical students’ satisfaction on online flipped learning by the learning style.Methods: A total of 42 second-year medical students were participated in this study. As study tools, Felder and Soloman’s Index of Learning Styles and the Korean Educational Development Institute’s National Assessment of Student Engagement in Learning were utilized. Data analysis was conducted with the Kruskal-Wallis test, a nonparametric statistical method.Results: Results showed that there were statistically significant differences within active–reflective types and sensing–intuitive types. The active–reflective type has been shown to have statistically significant differences for the three effects of learning, such as problem solving and understanding, active participation, and self-directed learning attitudes. For sensing–intuitive type, active participation showed a significant difference from other effects of learning.Conclusion: The learning style is an important concept in understanding the diverse ways in which students process and absorb new information. Hence research is needed to conduct successful small group activities through online. In the future, it is necessary to find the factors that can lead to successful online classes in medical schools.
Detection of earthflow dynamics using medium-resolution digital terrain models: Diachronic perspective of the Jovac earthflow, Southern Serbia
Authors: Milošević Marko , Štrbac Dragoljub , Ćalić Jelena , Radovanović Milan
Published: December 2021

The paper presents and discusses the landslide research procedure related to the topography before and after its occurrence, using the comparative analysis of two medium-resolution digital terrain models. The case study is the Jovac mega-landslide—the largest landslide to occur in Serbia in the last 100 years, active for three days in February 1977. The indicators used to determine the volume and movement mechanism were the spatial distribution of elevation differences within the two digital terrain models (DTM), and the analysis of geomorphological features before the landslide. The obtained elevation differences allowed the definition of the approximate landslide volume: 11.6 × 106 m3. All the data obtained indicate that the movement mechanism falls into the category of earthflow.
The influence of climate change on discharge fluctuations in Slovenian rivers
Authors: Oblak Janij , Kobold Mira , Šraj Mojca
Published: December 2021

In recent decades, an increase in the number of extreme flood events as well as extreme drought events has been observed in Slovenia. This rise the need for a comprehensive analysis of trends in discharge data series. In the study, statistical trends in seasonal and annual mean, maximum, extreme and low discharge values were investigated using the Mann Kendall test. The results show a temporal and spatial variability of trends in discharge. In general, a decreasing trend in water quantities in the rivers was observed. However, results at some gauging stations indicate statistically significant increasing trends, especially for maximum and extreme discharges. Additional analyses show that the discharge trends depend on the location of the gauging station.
Unfinished Business
Authors: Knutzen Jonathan
Published: December 2021

According to an intriguing though somewhat enigmatic line of thought first proposed by Jonathan Bennett, if humanity went extinct any time soon this would be unfortunate because important business would be left unfinished. This line of thought remains largely unexplored. I offer an interpretation of the idea that captures its intuitive appeal, is consistent with plausible constraints, and makes it non-redundant to other views in the literature. The resulting view contrasts with a welfare-promotion perspective, according to which extinction would be bad because it would come at a massive opportunity cost in terms of feasibly achievable welfare over the lifetime of our species.
Combattre « pour Dieu et pour la patrie » : le recrutement des volontaires de l’Ouest en 1870-1871
Authors: Nouaille-Degorce Patrick
Published: December 2021

Après la chute de Rome, en septembre 1870, les zouaves pontificaux français, rapatriés, se reforment sous le nom de volontaires de l’Ouest et se mettent sans réticence au service des nouvelles autorités républicaines, pourtant plutôt anticléricales, du gouvernement de la Défense nationale. En 10 mois d’existence, le régiment a recruté plus de 5 000 hommes de toutes conditions, dans toute la France, mais massivement dans l’ouest du pays, essentiellement sur des bases confessionnelles. Convaincus que la défaite de la France était une punition divine, ils n’ont pas hésité à se sacrifier au sein des armées de la Loire dans une démarche d’expiation.
Arthur de La Borderie, Conlie et la Bretagne (1870-2021)
Authors: Lagadec Yann
Published: December 2021

Alors que Conlie n’est qu’un des onze camps régionaux créés à l’automne 1870 pour accueillir les troupes de l’armée de la jeune République en cours de reconstitution, sans doute est-il celui dont la mémoire est encore la plus vive aujourd’hui. Si, à y regarder de plus près, rien se passe ici qui soit très différent de ce que l’on peut observer dans les dix autres camps, l’instrumentalisation des événements de novembre-décembre 1870 et, plus encore peut-être, des accusations portées contre certaines unités de mobilisés bretons du fait de leur comportement lors de la bataille du Mans, en janvier 1871 ont constitué cet épisode en « abcès mémoriel ». Élu député d’Ille-et-Vilaine à l’Assemblée nationale en février 1871, l’historien Arthur de La Borderie, monarchiste convaincu, contribue largement à faire de « l’affaire de Conlie » ce qu’elle est depuis.
La représentation de la campagne des armées de la Loire dans la peinture française
Authors: Lecaillon Jean-François
Published: December 2021

La guerre de 1870 a donné lieu à une abondante production de représentations picturales. Avec une soixantaine d’œuvres au moins, la campagne des armées de la Loire y occupe une place honorable, la seconde après les représentations liées au siège de Paris. Chacune de ces œuvres est unique. Il y a toutefois moyen de les classer en fonction de la démarche qui a présidé à leur création. Les intentions qui ont guidé les artistes sont riches d’enseignements sur ceux qui leur commandent ces tableaux, les commentent ou diffusent. Ces œuvres traduisent les sentiments des Français face au désastre militaire, l’effort de résilience entrepris pour se relever du traumatisme collectif, puis la façon dont ils en ont entretenu la mémoire. Créés par des artistes originaires de la région, quelques-uns adoptent un style susceptible de renvoyer à une identité régionale. De la représentation de la guerre telle qu’elle a été vue à celle qui montre la guerre telle qu’il faut la voir, l’analyse témoigne surtout d’une bataille des images, reflet des débats qui animaient la vie politique française dans les années 1890-1914.
Le travail de l’irrégularité. Les migrant·e·s sans papiers et l’économie morale de l’emploi
Authors: Chauvin Sébastien , Le Courant Stefan , Tourette Lucie
Published: December 2021

En plaçant en leur cœur la question de la vulnérabilité et la raison humanitaire, les travaux récents sur les nouveaux flux migratoires ont sous-estimé la place du travail comme source de légitimité et d’accès aux droits. Or, s’il reste officiellement un moyen minoritaire d’obtention d’un titre de séjour, l’emploi est pourtant un élément déterminant de l’existence des migrant·e·s au statut civique précaire. À partir du cas français, cet article décrit les différentes manières dont l’économie morale de l’emploi structure les moments successifs de l’irrégularité migratoire. Il examine les effets de la précarité administrative sur une diversité de relations d’emploi, les stratégies documentaires qui les permettent et les arrangements moraux qui en résultent entre les travailleurs et travailleuses sans papiers et leurs patron·ne·s. Il met ensuite en lumière les différentes formes d’emploi et d’acteur·rice·s entrant en jeu dans les dynamiques d’accès à un statut légal. Enfin, il questionne les effets de la régularisation, pointant les évolutions biographiques qu’elle suscite tout en mettant en évidence les conséquences durables de l’irrégularité passée. La conclusion réintroduit la question de la performance économique dans l’analyse critique de l’humanitarisme en rappelant que ce dernier est lui aussi traversé par une raison néolibérale valorisant les victimes prometteuses. En soulignant la place du travail au sein de l’économie morale du lien migration-citoyenneté, l’article met en évidence les ambiguïtés de l’injonction à la performance économique dans la construction de la légitimité migratoire.
S’engager bénévolement pour les papiers. La mise au travail associatif des interprètes de l’asile
Authors: Clappe Maureen
Published: December 2021

À partir d’une enquête ethnographique auprès d’interprètes bénévoles dans une association de soutien aux demandeurs d’asile, cet article interroge la fabrique du consentement autour de la mise au travail gratuit des publics de l’asile. Alors que les acteurs associatifs recherchent le soutien et la loyauté des interprètes par la mise en place d’un recrutement sélectif et préférentiel, ces derniers trouvent dans cette relation privilégiée des protections ponctuelles nécessaires à leur survie financière et administrative. Le fait d’exercer une activité bénévole pour les exilés peut être motivé par le versement d’une indemnité financière, mais aussi par la promesse d’obtenir un jour une régularisation pour celles et ceux qui se sont vu refuser le statut de réfugié. L’article montre de quelles manières les structures associatives se construisent en garants de la « bonne conduite » des exilés dans leurs démarches de régularisation en produisant des attestations de bénévolat, tout en participant dans leur recrutement, au tri et à la sélection des individus susceptibles d’être les plus employables par la suite sur le marché du travail.
Au début était la grève. Les grèves du travail des sans-papiers : l’appropriation de routines conflictuelles
Authors: Zougbédé Emeline
Published: December 2021

À travers le cas de quatre grèves ethnographiées entre 2017 et 2019, cet article questionne les grèves du travail des sans-papiers soutenues et organisées par la CGT. Longtemps, ces grèves ont pu apparaître comme des « mobilisations improbables ». Il est ici proposé de les expliciter en montrant combien elles tiennent de l’appropriation de routines conflictuelles. Les grèves dessinent un paysage institutionnel qui intègre la question du travail des sans-papiers à un fonctionnement économique, social et réglementaire, en le mettant à l’agenda syndical et politique. Dans le même temps qu’elle permet la levée de certains obstacles à la protestation collective pour les sans-papiers, l’appropriation de routines conflictuelles autorise l’accumulation de ressources militantes et la conversion d’espaces de négociation. Les récentes grèves du travail des sans-papiers apparaissent donc moins improbables que davantage caractéristiques d’une action stratégique, en l’absence de réelles politiques migratoires de travail.
Migrant Counterspaces: Challenging Labour Market Exclusion through Collective Action
Authors: Mittmasser Christina , Stingl Isabella
Published: December 2021

Recent debates in migration studies and labour geographies emphasise the need to acknowledge migrants’ agency and their ability to challenge regulatory migration regimes and precarious working relations. Contributing to this literature, this article examines the activities of a migrant-run organisation in Switzerland in its collective response to labour market barriers mobilised by the state, employers, and society at large. Building on ethnographic and participatory methods, our findings reveal that the organisation’s strategies focus strongly on the individual level and thus risk losing sight of broader power relations. Yet, our analysis also shows that the strategies employed can be transformative on the personal scale, creating a meaningful counterspace to dominant experiences of social and economic exclusion. In conclusion, we contend that an analysis of migratory movements needs to take into account the social and relational dimensions of agency as well as the differentiated effects of collective action.
Mieux comprendre le développement de la créativité de l’élève : apports d’une analyse micro-didactique du couple milieu-contrat en danse
Authors: Arnaud-Bestieu Alexandra
Published: December 2021

Dans cet article, nous montrerons comment, dans une approche clinique du didactique de l’ordinaire des classes, le croisement entre l’analyse extrinsèque du jeu didactique et l’analyse intrinsèque de l’activité de l’élève peut éclairer ce qui se joue dans les jeux d’apprentissage créatifs en danse (improvisation). L’article traite la question de la créativité comme impensé et contrainte du couple milieu-contrat dans les enseignements artistiques de danse et contribue à la compréhension des dimensions environnementales dans les modèles de la créativité.
« On n’y comprend rien ! » Dispositifs pédagogiques en ligne et inégalités d’accompagnement parental pendant le confinement
Authors: Delès Romain
Published: December 2021

Les plateformes pédagogiques en ligne ont été largement mobilisées par les enseignants pendant le confinement du printemps 2020. Le confinement a aussi été une période exceptionnelle du point de vue de l’accompagnement parental : les parents sont intervenus au quotidien, presque en remplacement des enseignants, pour transmettre le savoir scolaire. Sur la base de l’analyse de contenus en ligne et d’entretiens semi-directifs avec des parents d’élèves, cet article tente de mettre en avant les « malentendus », mais aussi les techniques de « décryptage » mises en place par les parents face à des contenus en ligne « composites ». L’article montre que, sous certaines conditions, l’enseignement à distance intermédié par des outils numériques peut contribuer à renforcer les inégalités d’accompagnement parental et donc les inégalités scolaires.
Les conseillers principaux d’éducation saisis par la « crise ». Enquête sur des agents scolaires dans l’ombre de la « continuité pédagogique »
Authors: Douat Étienne , Michoux Clémence
Published: December 2021

Prenant principalement appui sur une enquête auprès de Conseillers principaux d’éducation (CPE) réalisée au cours de l’épidémie de coronavirus au printemps 2020, cet article analyse la manière dont cette séquence a reconfiguré les pratiques professionnelles de ces agents scolaires à l’heure de la « continuité pédagogique ». Oubliés dans les discours publics et n’ayant pas reçu de consignes officielles sur le rôle qu’ils devaient jouer lors de la fermeture des établissements, les CPE se sont pourtant retrouvés en première ligne pour faire face aux élèves mis le plus en difficulté par « l’école à la maison ». Le travail relationnel qu’ils ont accompli (l’écoute, le soin et la prise en compte renforcée des conditions matérielles d’existence d’une partie des familles) a produit une confrontation exacerbée avec des situations déstabilisatrices et parfois éprouvantes. Sa montée en puissance a néanmoins permis de renouer avec ce que les CPE considèrent comme leur « cœur de métier », ce dont témoigne une certaine satisfaction professionnelle qu’ils ont pu exprimer pendant la période.
Classes de niveau : variations internationales dans les regroupements d’élèves et la constitution de classes au collège
Authors: Mazenod Anna
Published: December 2021

Cet article synthétise les apports récents de la recherche internationale sur les pratiques liées à la constitution de classes de niveau au collège. L’article explicite les usages terminologiques anglo-saxons courants dans ce domaine et défend la pertinence de ces recherches pour les politiques éducatives en France. L’article s’appuie en particulier sur les résultats d’une importante étude, menée récemment en Angleterre, sur la mixité sociale, les expériences scolaires et la pédagogie dans les classes de niveau. L’article explore également les raisons expliquant la prédominance de ces pratiques dans le contexte anglais et les difficultés rencontrées pour les faire évoluer.
Genre et cursus scientifiques : un état des lieux
Authors: Blanchard Marianne
Published: December 2021

Cette note de synthèse présente les recherches, conduites au cours des trente dernières années, relatives à la place respective des filles/femmes et des garçons/hommes dans les cursus scientifiques. Le corpus intègre 140 publications, en sociologie, sciences de l’éducation, psychologie sociale, histoire et économie. La première partie interroge les enjeux – scientifiques et sociaux – associés à cette thématique. La partie suivante analyse les attitudes des élèves/étudiant.es face aux sciences. La troisième partie présente la façon dont se façonnent ces attitudes différenciées face aux sciences. Elle analyse également les travaux qui considèrent les sciences comme une construction sociale fondamentalement genrée. Enfin, un dernier temps expose des pistes de recherches moins explorées.
Étudier et enseigner les musiques actuelles : les frontières floues d’une expertise en devenir
Authors: Trottier Danick
Published: December 2021

Suite à un rappel de l’expérience que j’ai acquise à titre de musicologue dans les médias écrits et à la radio, l’article questionne la façon dont l’expertise musicale est perçue puis partagée, autant dans les disciplines ayant pour principal sujet la musique que les disciplines s’y intéressant comme la sociologie et les communications. Le cas des musiques actuelles est au cœur de la réflexion dans la mesure où l’actualité musicale est éloignée de la quête scientifique du musicologue. En outre, le passé musical retient davantage son attention, ce qui s’explique par sa formation universitaire et son travail scientifique. Ce faisant, je rappelle les défis que j’ai dû surmonter lors de la mise sur pied en 2018 d’un cours intitulé Musiques actuelles et scènes pop au Département de musique de l’Université du Québec à Montréal (UQAM). À la lumière de cette expérience et celle acquise dans les médias, il appert que l’expertise en matière de musiques actuelles est davantage le fruit d’une construction et d’un partage au présent entre différentes disciplines et différents groupes d’individus (membres de l’industrie musicale, journalistes, étudiants, fans, etc.) que l’unique chasse gardée des sciences consacrées à la musique, en l’occurrence la musicologie. La réflexion approfondit plusieurs enjeux dans cette perspective et en arrive à la conclusion que le binôme entre experts et non-experts perd de sa consistance dans la connaissance des musiques actuelles.
« Maybe it’s the third world / Maybe it’s the first time around » : variations autour du terme world music chez Paul Simon, de Graceland à Songs from the Capeman
Authors: Fraysse Claire
Published: December 2021

En 1986, l’album Graceland de Paul Simon provoque un engouement mondial pour les musiques extra-occidentales, en particulier la pop music sud-africaine : ce succès sans précédent et le bourgeonnement parallèle d’autres collaborations musicales multiculturelles permettent la création d’une nouvelle catégorie commerciale, la world music. Mais cette catégorie ne reflète pas un style unifié et ses définitions mouvantes posent de nombreux problèmes de classement musical, de détermination artistique, esthétique, voire sociologique et politique. L’étude des albums Graceland (1986), The Rhythm of the Saints (1990) et Songs from the Capeman (1997) permet toutefois de saisir trois approches différentes de la world music, tout en mettant en lumière le travail de créateur-enquêteur de Paul Simon. Ce dernier joue avec l’ambiguïté définitionnelle de la world music pour proposer différentes productions musicales, chacune centrée sur une problématique intrinsèque à cette catégorie : l’articulation pop locale/pop internationale dans Graceland, le brouillage des pistes entre pop music, folk music, et musique savante dans The Rhythm of the Saints et la déconstruction puis la réactualisation d’influences considérées comme pleinement assimilées à la musique nord-américaine dans Songs from the Capeman.
How Genuino Applies Blockchain Technology in the Collectibles Industry
Authors: Ruzza Daniel , Bernasconi Gabriele , De Giovanni Pietro
Published: December 2021

This chapter analyses the blockchain implemented by Genuino in the collectibles industry. Since collectibles are subject to high risk of counterfeiting and fake replications, blockchain technology can help substantially to ensure transparency, originality, ownership, and data security and protection. Two methods to use blockchain in the industry seem to be the most widespread today: creating digital native collectibles on blockchain and transposing physical objects into the blockchain by creating digital twins. By using blockchain, new consumer clusters emerge, highlighting the need to modernize both the traditional economies and the current business models.
Optimized Robotic WAAM
Authors: Ramadan Aya Abd Alla , Elatriby Sherif , El Ghany Abd , Barakat Azza Fathalla
Published: December 2021

This chapter summarizes a PhD thesis introducing a methodology for optimizing robotic MIG (metal inert gas) to perform WAAM (wire and arc additive manufacturing) without using machines equipped with CMT (cold metal transfer) technology. It tries to find the optimal MIG parameters to make WAAM using a welding robot feasible production technique capable of making functional products with proper mechanical properties. Some experiments were performed first to collect data. Then NN (neural network) models were created to simulate the MIG process. Then different optimization techniques were used to find the optimal parameters to be used for deposition. These results were practically tested, and the best one was selected to be used in the third stage. In the third stage, a block of metal was deposited. Then samples were cut from deposited blocks in two directions and tested for tension stress. These samples were successful. They showed behavior close to base alloy.
Artificial Intelligence in Digital Mental Health
Authors: Martins Constantino Lopes , Martinho Diogo , Marreiros Goreti , Conceição Luís , Faria Luiz , Simões de Almeida Raquel
Published: December 2021

The prevention of diseases considered a scourge of our society, as for example mental illness, particularly anxiety disorders and depressive states, is a primary and urgent goal today and a priority axis of the EU. Mental illness includes many clinical conditions associated with several changes that include limitations related with social interaction or several tasks such as sleeping through the night, doing homework, making friends, thinking capacity and reality understanding, deficits in communication skills, and difficulties in developing appropriate emotional and behavioural response. Artificial intelligence has gained a prominent role in the management and delivery of healthcare. There is a growth in mobile devices applied to health with high mobility, connectivity, and processing capacity. This chapter provides an analysis of the actual trends regarding the main problems that can be dealt with using AI in mental healthcare and the corresponding main techniques used to deal with these problems. Additionally, some case studies for using AI for mental health care are described.
Virtual Reality and Forensic Mental Health
Authors: Tereso Isabel Maria , Ramos Ana Lúcia Gonçalves , Santos Bruna Ribeiro , Costa Jéssica Patrícia Moreira
Published: December 2021

This chapter provides an overview of virtual reality (VR) treatment and rehabilitation for mentally ill patients who have committed a crime or are at risk of relapse. The authors focus on the forensic mental health field since this area relates to any individual dealing with a psychiatric condition that is in trouble with the law, whether they be inpatient offenders, outpatient offenders, or inmates at a regular prison. Virtual reality (VR) and its current uses, as well as its benefits and barriers, are presented as a successful and individualized eHealth treatment. In addition, some examples of VR studies that were recently done with these individuals will be presented to show the results of their current approaches, demonstrate their limitations, and figure out possible ways of improvement.
Virtual Reality Environments in Pain Management
Authors: Pinho Inês , Santos Cindy , Brito Inês , Coelho João , Simões-Silva Vítor , Marques António
Published: December 2021

Pain is a distressing and subjective feeling that occurs in different intensities and may result from the stimulation of a nerve due to injury, illness, or emotional disturbance. This chapter aims to understand how VR can contribute to pain management. To this end, the authors will address topics such as: pain – types of pain and its consequences in everyday life, as well as ways to relieve it; virtual reality – what it consists of, its functionalities and components, as well as its application to health and well-being, its advantages and limitations; and virtual reality in pain management. It is intended to emphasize the importance of pain management for the daily lives of individuals and the consequent improvement in the quality of life of those who benefit from this type of intervention.
Practical approach to linear EUS examination of the mediastinum
Authors: Okasha Hussein Hassan , El-Meligui Ahmed , Pawlak Katarzyna M. , Żorniak Michał , Atalla Hassan , Abou-Elmagd Amr , Abou-Elenen Sameh , El-Husseiny Ramy , Alzamzamy Ahmed
Published: December 2021

EUS has become a substantial diagnostic and therapeutic modality for many anatomical regions. The extent of endosonographic assessment is wide, and among others, allows for the evaluation of the mediastinal anatomy and related pathologies such as mediastinal lymphadenopathy and staging of central malignant lung lesions. Moreover, EUS assessment has proved more accurate in detecting small lesions missed by standard imaging examinations such as computed tomography or magnetic resonance. Endosonographically, various mediastinal anatomical landmarks and stations can be visualized by transesophageal scanning, thus providing arranged systematic examination of the mediastinum. In addition, the correct position during the examination is crucial for EUS-guided procedures such as tissue sampling and drainage of mediastinal abscesses. The evolution of EUS-guided diagnostic and interventional procedures has contributed to the increasing importance of understanding the mediastinal anatomy during the EUS examination.
Efficacy of ultrasound-guided erector spinae plane block following breast surgery – A double–blinded randomised, controlled study
Authors: Thiagarajan Prathiba , Thota Raghu S. , Divatia J.V.
Published: December 2021

Background and Aims:

Regional anaesthesia has been used to reduce acute post-operative pain as well as opioid-related side effects in breast cancer surgery. Erector spinae plane (ESP) block is a relatively new fascial plane block being tried in various surgical procedures. Our study is a double-blind randomised trial, designed to prove the efficacy of this block in breast surgeries.

Methods:

Seventy female patients scheduled for unilateral breast surgery were enroled in this prospective, randomised, double-blind study. Patients were randomised to group A and group B. All patients received general anaesthesia while group B received additional ultrasound-guided erector spinae block given at thoracic level—T5 with 20ml of 0.25% bupivacaine. Time to first rescue analgesia was the primary outcome. Secondary outcomes were total intraoperative opioid consumption, pain scores over 24 h, post-operative nausea and vomiting and patient satisfaction score at discharge. The Shapiro–Wilk test was used to check the normality of each variable. A comparison was done using Mann–Whitney test and the level of significance was set at 0.05.

Results:

The median time to first rescue analgesia in group A versus group B was 1 h (1–12h) versus 8 h (1–26h), respectively, with a P value of 0.044. Group B patients had lower pain scores post-operatively and better satisfaction scores at discharge. There was no statistically significant difference in intraoperative fentanyl consumption.

Conclusion:

Ultrasound-guided ESP block with general anaesthesia offers superior post-operative analgesia compared to general anaesthesia alone in patients undergoing unilateral nonreconstructive breast cancer surgeries.
Multi-Modality Medical Image Fusion Using Cross-Bilateral Filter and Neuro-Fuzzy Approach
Authors: Kaur Harmeet , Kumar Satish , Behgal Kuljinder Singh , Sharma Yagiyadeep
Published: December 2021

Context:

The proposed technique uses the edge-preserving capabilities of cross-bilateral filter (CBF) and artificial intelligence technique adaptive neuro-fuzzy inference system (ANFIS) to fuse multi-modality medical images.

Aims:

The aim is to present the unlike information onto a single image as each modality of medical image contains the unalike domain of information.

Settings and Design:

First, the multi-modality medical images are decomposed using CBF by tuning its parameters: radiometric and geometric sigma producing CBF component and detail component. This detail is fed to ANFIS for fusion. On the other hand, the sub-bands obtained from DWT are fused using average rule. Reconstruction method gives final image.

Subjects and Methods:

ANFIS is used to train the Sugeno systems using neuro-adaptive learning. The fuzzy inference system in the ANFIS is used to define fuzzy rules for fusion. On the other hand, bior2.2 is used to decompose the source images.

Statistical Analysis Used:

The performance is verified on the Harvard database with five cases, and the results are equated with conventional metrics, objective metrics as well as visual inspection. The statistics of the metrics values is visualized in the form of column chart.

Results:

In Case 1, better results are obtained for all conventional metrics except for average gradient (AG) and spatial frequency (SF). It also achieved preferred objective metric values. In Case 2, all metrics except AG, mutual information, fusion symmetry, and SF are better values among all methods. In Cases 3, 4, and 5, all the metrics have achieved desired values.

Conclusions:

Experiments conclude that conventional, objective, visual evaluation shows best results for Cases 1, 3, 4, and 5.
A cross-sectional study of pre- and posttraining evaluation of inhaler use technique among outpatients with bronchial asthma or chronic obstructive pulmonary disease at a tertiary care hospital in India
Authors: Nitya Selvaraj , Kiruthika Sivagourounadin , Meenakshi R. , Suriya H. , Yuvarajan S.
Published: December 2021

Context:

Management of asthma and chronic obstructive pulmonary disease (COPD) includes use of inhalers as an integral component of drug delivery. Awareness about inhaler devices along with demonstration of the usage of inhaler technique aids in the optimization of therapeutic outcome.

Aim:

This study aimed to assess the correct use of inhaler technique following pre- and posttraining sessions for the management of COPD and asthma among pulmonary outpatients at a tertiary care hospital.

Settings:

This prospective cross-sectional study was carried out among patients diagnosed with asthma or COPD and prescribed with inhaler medication in the form of pressurized metered-dose inhaler (pMDI), MDI with spacer, or dry powder inhaler (DPI).

Subjects and Methods:

The inhaler device use by the patients was assessed initially, followed by a demonstration on inhaler device technique, and reassessed post training using a checklist.

Statistical Analysis:

Comparison of the median total score of pretraining and posttraining inhaler technique was analyzed by Wilcoxon signed rank test. P < 0.05 was considered statistically significant.

Results:

Out of 144 patients, 55.6%, 27.7%, and 16.7% of them were prescribed pMDI, MDI with spacer, and DPI, respectively. Post inhaler technique training, about 79.2% of the patients were able to demonstrate the inhaler technique correctly compared to 52.1% prior to training. A statistically significant difference in the median score of inhaler technique has been observed before and after training.

Conclusions:

This study reports a significant improvement in the correct use of inhaler technique post training. In addition, the most frequent error among inhaler users was revealed to be in the breath actuation.
Biphasic Change in Renal Function after Radical Cystectomy and Urinary Diversion
Authors: Attawettayanon Worapat , Anukoolphaiboon Apiwich , Chalieopanyarwong Virote , Pripatnanont Choosak
Published: December 2021

Purpose:

Radical cystectomy (RC) with urinary diversion has been established as the gold standard treatment for muscle invasive bladder cancer. This provides excellent local control and increases the survival rate. The postoperative renal function (RF) usually declines, especially with those with risky conditions such as increasing age, hypertension, diabetes, or the presence of preoperative hydronephrosis (HN). However, there are limited data about the potential preoperative factors to predict the postoperative RF following the RC. The current retrospective article aims at reviewing patients treated with RC with urinary diversion presenting demographics data, assessing the RF after performing the operation and identifying the associated factors that reduce the RF.

Materials and Methods:

Bladder cancer patients who underwent RC with a urinary diversion from January 2001 to December 2017 were reviewed. RF was assessed by using the estimated glomerular filtration rate (eGFR) through the MDRD formula. Multivariate analysis was performed to evaluate the association of the changing of RF.

Results:

One hundred and fifty-six patients were included in the study. The median age was 65 years (interquartile ranges [IQR] 57, 72), and the median follow-up time was 16.4 months (IQR 7.1, 33.4). Overall, 86 patients (55.12%) had HN at the initial treatment of RC. Baseline mean eGFR was 57.7 mL/min/1.73 m2 (standard deviation [SD] = 23.7). The value of eGFR observed at 1, 12, and 60 months was 67.2 (SD = 29.5), 55.7 (SD = 26.3), and 55.8 (SD = 21.4) mL/min/1.73 m2, respectively. At 1 month, female gender, no HN, and neobladder were independently associated with worse RF outcomes in both univariate and multivariate analysis (P < 0.05). The factors associated with eGFR under 60 mL/min/1.73 m2 at 1 year were age, presence of HN, and adjuvant treatment.

Conclusion:

RF after cystectomy and urinary diversion improves for 1 month after the procedure, especially in patients with the presence of preoperative HN and then RF gradually decreases. There are no significant differences in preoperative and postoperative RF after a 5-year follow-up.
Key Steps in Performing Robotic-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion and the Evidence that We Have So Far
Authors: Teoh Jeremy Yuen-Chun , Yee Chi-Hang , Chiu Peter Ka-Fung , Chan Vinson Wai-Shun , Chan Erica On-Ting , Ng Chi-Fai , Chan Eddie Shu-Yin
Published: December 2021

Robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) has been proposed as the most minimally invasive surgical approach in performing radical cystectomy for patients with bladder cancer. However, iRARC is a highly technical and complex procedure with a steep learning curve. Without appropriate training and adequate experiences, iRARC may become a lengthy procedure and may lead to significant morbidities with a prolonged hospital stay. Essentially, the robotic approach in performing RARC is to replicate what is being done in the open approach, and the key steps in performing iRARC were described in this article. There were five randomized controlled trials (RCTs) comparing between RARC and open radical cystectomy (ORC). RARC has been shown to have a lower blood transfusion rate and short hospital stay than ORC. When compared to ORC, RARC had a similar positive surgical margin rate and time of recurrence. Given such potential benefits, a decision-analytic model has shown that RARC might be a more cost-effective treatment approach than ORC. On the other hand, previous RCTs focused mainly on RARC with extracorporeal urinary diversion; high-quality studies on the total intracorporeal approach are lacking. The iROC trial is a multicenter study comparing between iRARC and ORC. Preliminary results showed that iRARC is well tolerated by patients. The iROC trial has completed patient recruitment and the final results are eagerly awaited. By then, hopefully, we will be able to understand the true value of iRARC in managing patients with bladder cancer.
Efficacy of Bladder Instillations with Mitomycin or Bacillus Calmette–Guérin in Patients with T1 High-Grade Bladder Cancer
Authors: Chang Li-Wen , Hung Sheng-Chun , Li Jian-Ri , Chen Chuan-Shu , Yang Cheng-Kuang , Cheng Chen-Li , Ou Yen-Chuan , Ho Hao-Chung , Chiu Kun-Yuan , Chang Chao-Hsiang , Wang Shian-Shiang
Published: December 2021

Objectives:

To evaluate the efficacy of instillations with mitomycin C (MMC) or bacillus Calmette–Guérin (BCG) in patients with T1 high-grade bladder cancer (BC).

Patients and Methods:

From 2007 to 2015, 186 patients admitted to Taichung Veteran General Hospital with new diagnosis of T1 high-grade BC receive transurethral resection of the bladder tumor (TURBT) and 6 weekly adjuvant instillation following. Histological stage followed the WHO grading system. End point evaluation was recurrence and progression to muscle invasive BC.

Results:

A total of 118 patients received 6 weekly intravesical instillation chemotherapy with MMC and 68 with BCG. Above all, 93 patients received immediate intravesical MMC after TURBT. The mean follow-up period was 46.78 ± 19.05 months in the MMC group versus 50.13 ± 24.18 months in the BCG group (P = 0.512). The BCG group showed better outcomes with longer 5-year recurrence-free survivals (64.6% vs. 50.0%, P of log rank = 0.008*) and progression-free survivals (94.1% vs. 87.3%, P of log rank = 0.023*). The treatment efficacy of BCG in comparison to MMC was further adjusted in uni-multivariate analysis model (recurrence: Hazard ratio [HR] =0.511, 95% confidence interval [CI] = 0.304–0.858, P= 0.011*; progression: HR = 0.216, 95% CI = 0.068–0.683, P= 0.009*). We also explore smoker, multiple lesions, and tumor diameter >3 cm to be risk factors for recurrence.

Conclusions:

For patients with T1 high-grade nonmuscle invasive BC, the adjuvant therapy with BCG, as opposed to MMC, resulted in better outcomes based on recurrence and progression with tolerable complications. For immediate single instillations, in comparison, the efficacy was lower in preventing tumor recurrence and progression in the current stage.
Circulating miR-210 and miR-23b in Bladder Cancer
Authors: Hany Normeen , Bahgat Amal , Youssef Omnya , Fayyad Amr , Kotb Amira , Al-Khatib Sara , Fathy Mona
Published: December 2021

Purpose:

This study is aimed to assess the serum expression levels of miR-210 and microRNA-23b (miR-23b) in bladder cancer (BC) patients to evaluate their potential as noninvasive biomarkers.

Materials and Methods:

This study included 93 subjects divided into the following three groups: Group Ia, 31 patients newly diagnosed with BC; Group Ib, Group Ia patients 6 months after medical and/or surgical treatment; and Group II, 31 healthy controls. The gene expressions of miR-210 and miR-23b were determined using quantitative SYBR Green reverse transcription real-time polymerase chain reaction.

Results:

The expression of miR-210 was significantly higher in BC patients compared to the controls (P = 0.012), while miR-23b did not show any difference. miR-210 expression in BC patients did not differ before and after treatment (P = 0.89). Area under the curve of the receiver operating characteristic analysis for miR-210 in distinguishing BC from controls was 0.686 (95% confidence interval, 0.553–0.818) with 71% sensitivity and 61% specificity.

Conclusion:

miR-210 can serve as a noninvasive diagnostic marker for BC; however, it cannot be used during treatment follow-up. miR-23b cannot be used as a diagnostic nor prognostic marker for BC.
Useful Tips and Tricks for Secure Circumcision
Authors: Huang Ching-Wei , Wang Ta-Min , Weng Li-Chueh , Chen Hsiao-Wen
Published: December 2021

Introduction:

The study aimed to find a secure procedure for circumcision, using monopolar diathermy with several key steps of technique to facilitate the surgical process and minimize the postoperative complications.

Methods:

Patients who underwent the secure technique for circumcision, due to different reasons, from 2012 to 2016 were retrospectively reviewed. A monopolar coagulator with a needle point probe with energy ranging from 10 to 15 W was used to perform the circumcision by following several key steps. In addition, tissue glue was applied to the wound to provide operative wound care. All data referring to patient demographics were recorded. The outcomes and complications associated with the secure technique for circumcision were assessed.

Discussion:

One hundred and ten children underwent this technique, carried out by a senior teaching staff member and several senior residents. All patients were followed with a mean of 29.5 ± 30.1 days postoperatively. All these patients were satisfied with the operation and had no major complications, and no second revisions were needed during the follow-up period. Two patients (1.8%) had a minor wound infection, which was resolved with oral antibiotics within 1 week. However, the study limitations included its retrospective nature and the heterogeneity of the study population.

Conclusion:

Modified diathermy circumcision with the secure technique protects the penile phallus and urethra, and it is associated with a low rate of complications, as hemostasis can be simultaneously ensured. The technique is feasible, simple, and easy to learn. In addition, tissue glue was proved to facilitate postoperative wound care.
The Simple Solution for Infertile Patients with Aspermia in the Modern Era of Assisted Reproductive Technique
Authors: Fan Le-Wei , Shao I-Hung , Hsieh Ming-Li
Published: December 2021

Purpose:

The purpose is to investigate the feasibility and outcomes of loupe-assisted vasostomy for sperm retrieval in male infertility due to anejaculation or retrograde ejaculation.

Materials and Methods:

We retrospectively reviewed the vasal sperm aspirations of 9 patients with anejaculation or retrograde ejaculation from 2015 to 2017. We collected preoperative serum hormone data (testosterone, follicle-stimulating hormone, luteinizing hormone, and prolactin) and comorbidities of each patient. The patients underwent standard loupe-assisted modified vasostomy by a single surgeon with immediate specimen interpretation, with follow-up at the clinic.

Results:

Of the 9 patients, 4 had retrograde ejaculation, and 5 had anejaculation. Seven patients had controlled diabetes mellitus; of them, one had an ejaculating duct stone, and only one had no comorbidity. Aspirations were performed for sequential assisted reproductive techniques in 7 patients and cryopreservation in another two. The average total sperm count was 213 × 106, with motility between 9% and 67% and normal sperm morphology between 4.5% and 50.0%. One patient had undergone microsurgical epididymal sperm aspiration before vasal aspiration, but the semen analysis indicated poor sperm quality and could not be used for in vitro fertilization. In total, 7 of the 8 aspirations (87.5%) resulted in pregnancy. No complications have been observed to date.

Conclusion:

Vasal sperm aspiration is a simple and effective alternative method for sperm retrieval, with the advantage of a high success rate and less invasiveness and destruction of the reproductive system. It may be performed before sperm retrieval from the epididymis or testis in infertile men with aspermia.
Comparison of the Effects of Tamsulosin, Silodosin, and Alfuzosin on Catheter-Free Trials after Acute Urinary Retention Due to Benign Prostatic Hyperplasia
Authors: Parikh Aditya , Yagnik Vipul D , Contractor Rajivkumar , Vyas Jigish , Dawka Sushil
Published: December 2021

Purpose:

We compared tamsulosin, silodosin, and alfuzosin in catheter-free trials after acute urinary retention (AUR) due to benign prostatic hyperplasia (BPH). This study aims at assessing the efficacy of tamsulosin, silodosin, and alfuzosin, and the factors affecting the success of catheter-free trials.

Materials and Methods:

An observational, prospective, randomized study of 49 men with AUR due to BPH was performed from July 2015 to August 2017. Participants were catheterized after the assessment of prevoid urine volume. The prostate size was measured, and IPSS at presentation was calculated. The participants were divided into tamsulosin, silodosin, and alfuzosin groups and were given a catheter-free trial after administration of alpha-blockers for three doses. Descriptive analysis, independent t-test, and Chi-square test were used for data analysis. Univariate and multivariate analyses were done using STATA software version 14.2. P < 0.05 was considered to indicate statistical significance.

Results:

The overall success of trial without catheter (TWOC) was 62.5% (30 out of 49). There was no difference in the efficacy of tamsulosin, silodosin, and alfuzosin in catheter-free trials after AUR due to BPH. The success of TWOC was affected by median lobe enlargement, and patients with Grade 3 intravesical protrusion of prostate were less likely to have a successful TWOC.

Conclusion:

TWOC after administration of three doses of alpha-blockers was shown to be useful in most patients irrespective of prostate size. There was no difference in the efficacy of tamsulosin, silodosin, and alfuzosin in catheter-free trials.