bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comparison of Patient Satisfaction When Using the Insured and Non-insured in Public Health Center (Puskesmas Kasihan 1) Bantul, Indonesia
Authors: Fatimah Fatma Siti , Mars Sumarni , Sarwadhamana Raden Jaka , Mulyani Rizka , Handayani Putri Daru
Published: April 2022

BACKGROUND: In Indonesia, the health sector has experienced a very significant development. Fair and equitable health care is one way to fulfill the health rights of each individual. Therefore, puskesmas are required to provide good service quality through conformity to standards with customer needs. The creation of service quality will certainly create customer satisfaction for service users when using health assurance and non-assurance. AIM: This study was to know a comparison of patient satisfaction when using the insured and non-insured in Public Health Center (Puskesmas Kasihan 1) Bantul, Indonesia. METHODS: This study was a cross-sectional study, with 222 samples with 111 respondents using health assurance and 111 non-assurance. Samples were collected with a cluster sampling technique taken from nine service polyclinics in Puskesmas Kasihan 1 Bantul. Data were analyzed using independent sample t-test. RESULTS: The study found that the average patient satisfaction with health insurance was 34.76 more than the average patient satisfaction with non-health insurance was 29.10. Based on the results of the analysis, the mean ± sd of patient satisfaction with health insurance was 29.10 ± 3.04 compared to the satisfaction of non-health insurance patients, namely, 34.76 ± 3.61 with a Sig value of 0.000, which means that there is a significant difference between patient satisfaction using the insured and non-insured. CONCLUSIONS: Patients when using the health insured are more satisfied than patient’s non-insured.
Tectaria danangensis (Tectariaceae), a new fern species from Vietnam
Authors: Pham Van The , Li Shu-Han , Dong Shi-Yong
Published: April 2022

A new fern species, Tectaria danangensis (Tectariaceae) from Vietnam, which had long been misreported as T. crenata, is described and illustrated. The new species resembles T. poilanei, a species long neglected in the fern flora of Indochina, in the frond shape and sori arrangement, but differs by its irregularly 2-rowed sori (versus regularly 2-rowed, distantly and evenly arranged) between lateral veins of pinnae, fronds being more or less dimorphic (versus monomorphic) and basal pinnae each with a base-joined (versus free) lobe. Phylogenetic analyses of five plastid regions (atpB, ndhF + ndhF-trnN, rbcL, rps16-matK + matK and trnL-F) suggested T. danangensis has a close affinity to T. harlandii. Tectaria danangensis appears to be an intermediate species between T. harlandii and T. poilanei.
Vaccinium bangliangense, a new species of Ericaceae from limestone areas in Guangxi, China
Authors: Huang Yu-Song , Nong Shi-Yue , Li Xing-Kang , Xie Gao , Tong Yi-Hua
Published: April 2022

Vaccinium bangliangense, a new species from limestone areas in Guangxi, China, is described and illustrated. It is morphologically most similar to V. pseudotonkinense and V. sciaphilum in having small and dense obovate leaf blades with a retuse apex, hairy young branches and calyx and campanulate corollas, but can be distinguished from them by the distance of basal gland from petiole, the length of peduncle, pedicle and filaments, the indumentum of calyx tube and corolla and the existence of apical glands on calyx lobes. A table to distinguish the new species from other morphologically similar Vaccinium species, as well as colour plates of comparison of key characters, is also provided.
Primula longipilosa (Primulaceae), a new species from Yunnan, China
Authors: Wang Ze-Huan , Wang Yi , Chen Li , Peng Hua , Wu Zhi-Kun , Guo Guang
Published: April 2022

Primula longipilosa from SW Yunnan, China, is described as a species new to science and illustrated. The systematic placement of this new species is also discussed based on an nrITS molecular tree. It is morphologically most similar to P. mollis, but differs from the latter in its racemose inflorescence, green calyx tube, pink to pink rose corolla, stamens at 1/3 length above the base of the corolla tube and applanate globose capsule.
Gibbs measures for hyperbolic attractors defined by densities
Authors: Parmenter David , Pollicott Mark
Published: April 2022

In this article we will describe a new construction for Gibbs measures for hyperbolic attractors generalizing the original construction of Sinai, Bowen and Ruelle of SRB measures. The classical construction of the SRB measure is based on pushing forward the normalized volume on a piece of unstable manifold. By modifying the density at each step appropriately we show that the resulting measure is a prescribed Gibbs measure. This contrasts with, and complements, the construction of Climenhaga-Pesin-Zelerowicz who replace the volume on the unstable manifold by a fixed reference measure. Moreover, the simplicity of our proof, which uses only explicit properties on the growth rate of unstable manifold and entropy estimates, has the additional advantage that it applies in more general settings.
Mean dimension theory in symbolic dynamics for finitely generated amenable groups
Authors: Wang Yunping , Chen Ercai , Zhou Xiaoyao
Published: April 2022

In this paper, we mainly show a close relationship between topological entropy and mean dimension theory for actions of polynomial growth groups. We show that metric mean dimension and mean Hausdorff dimension of subshifts with respect to the lower rank subgroup are equal to its topological entropy multiplied by the growth rate of the subgroup. Meanwhile, we prove that above result holds for rate distortion dimension of subshifts with respect to a lower rank subgroup and measure entropy. Furthermore, we present some examples.
Carnivore Occupancy within the Early Successional Habitat of New England Cottontails
Authors: Testerman Kyle , Hapeman Paul
Published: April 2022

Predation pressure from carnivores can shape ecological communities and has significant consequences for prey species that are declining or recovering from historical declines. New England cottontails Sylvilagus transitionalis are a species of greatest conservation need in Connecticut and are experiencing continued decline associated with habitat loss. Restoration of early successional habitat is underway to address the most significant threat to their populations. However, one of the largest documented sources of mortality is associated with several key predators and remains a threat to recovery efforts. We sought to develop species-specific occupancy estimates of carnivores in early successional habitat and relate our findings to the potential recovery of New England cottontails. We conducted camera surveys at 34 sites in early successional habitat in or near New England cottontail focus areas throughout Connecticut and used the program MARK to estimate occupancy and detectability from detection data. We found key predators in early successional habitat, but their detectability was generally low. Occupancy was highest for coyotes Canis latrans, and regional occupancy differed only for bobcats Lynx rufus. Covariates that influenced parameter estimates in our models included high road densities and the intensity of New England cottontail and eastern cottontail Sylvilagus floridanus detections. Expanding carnivores, particularly coyote and bobcat, may place additional pressure on New England cottontail recovery in the state, but restoration efforts that promote contiguous habitat and reduce isolated patches where predation risk is higher will improve their chances of a long-term recovery.
Transformational Pedagogy, or Teaching While Trans
Authors: Councilor KC
Published: April 2022

This chapter is a reflection on teaching as a trans person and as a cartoonist. It focuses largely on two pedagogical practices: coming out and using drawing in the non-art classroom. Both are embodied acts that involve risk-taking and invite trust. They offer the possibility of community-building radical self-actualization in the classroom. The chapter considers how a trans identity underscores a visceral experience of transformation that can inform the kind of radical transformation that is needed in higher education.
Teaching and Identity
Authors: Dixon-Montgomery Jessie D.
Published: April 2022

Educators have a notable role in shaping and impacting students in their understanding of diverse people and cultures as we engage them to be critical thinkers and global citizens. As the population of the United States becomes increasingly diverse, the Academy's commitment to diversity, equity, and inclusion becomes increasingly more important in order to successfully serve all students. This chapter examines the intersectionality of race, class, and gender and sexual orientation with our role as teacher. The author discusses the ways in which identity shapes and informs one's teaching, approaches notions of power and privilege, and brings underrepresented groups from margin to center while engaging, enlightening, and empowering students. Given the increasingly more diverse backgrounds of my students, the identity of the author plays an essential role in her philosophies and pedagogies, and how she is able positively impact students with a transformative experience that takes into consideration diverse viewpoints.
Culturally Relevant Pedagogy and Praxis of a Latina
Authors: Mata Sara
Published: April 2022

This chapter explores how the intersectionality of identity becomes a vital component of teaching and learning. Pedagogy infused with practices to include the background and understanding of the student can serve as an empowering approach of critical consciousness. Drawing from the work of Paolo Freire and Gloria Anzaldua, the author weaves the fundamentals of their theoretical perspectives with personal experiences and stories to provide insight into the foundational approach of educational purpose and philosophy.
A Review on Big Data and Artificial Intelligence for the Healthcare Domain
Authors: Kumar A. V. Senthil , V. Kavitha , B. Malavika , S. Parameshwari
Published: April 2022

Big data analytics is frequently termed as the complicated operation of analysing the big data to unfold the information like market trends, correlations, customer preferences, and hidden patterns which might be helpful for the organisations to make decisions. On the other hand, data analytic techniques and technologies provide organisations methods to analyse data sets and to collect new data. With right garage and analytical tools in hand, the data and insights derived from big data could make the critical social infrastructure additives and offerings. In healthcare the usage of artificial intelligence has the capability to help healthcare companies in lots of factors of administrative processes and patient care. Artificial intelligence has converted companies across the world and has the capability to appreciably regulate the sphere of healthcare. Most of the AI and healthcare technology have strong relevance to the healthcare field; however, the procedures they help can range significantly.
Prediction and Prevention of Malicious URL Using ML and LR Techniques for Network Security
Authors: Mythreya S. , Dakshina Murthy A. Sampath , Saikumar K. , Rajesh V.
Published: April 2022

Understandable URLs are utilized to recognize billions of websites hosted over the present-day internet. Opposition who tries to get illegal admittance to the classified data may use malicious URLs and present them as URLs to users. Such URLs that act as an entry for the unrequested actions are known as malicious URLs. These wicked URLs can cause unethical behavior like theft of confidential and classified data. By using machine learning algorithm SVM, we can detect the malicious URLs. One of the essential features is to permit the benevolent URLs that are demanded by the customer and avoid the malicious URLs. Blacklisting is one of the basic and trivial mechanisms in detecting malicious URLs.
Univariate and Multivariate Filtering Techniques for Feature Selection and Their Applications in Field of Machine Learning
Authors: Patel Dharmendra Trikamlal , Honest Nirali , Vyas Pranav , Patel Atul
Published: April 2022

Machine learning's feature selection technique aids in the selection of a subset of original features in order to decrease high-dimensional data space. As per the literature, there are two basic strategies for feature selection: supervised and unsupervised. This chapter will focus on supervised filtering approaches only. Filter, intrinsic, and wrapper are the three types of supervised filtering algorithms. Filtering strategies are the subject of this chapter. The chapter covers the most popular univariate filtering algorithms with examples, advantages and downsides, and R implementation. The chapter compares univariate filtering techniques with number of parameters. The chapter also depicts two popular multivariate filtering techniques: minimum redundancy and maximum relevance (mRMR) and correlation-based feature selection (CFS) using appropriate example and implementation with R programming. Finally, the chapter deals with prominent applications of filtering techniques in context to machine learning.
Do We Need a Digital Data Exorcism?
Authors: Braman James , Dudley Alfreda
Published: April 2022

Considering the many interactions we have with technology over our lifetime, many data points, records, files, and other content are recorded in many digital forms. We inevitably construct a narrative of various life events in a digital format that often lasts well beyond the expiration date of our physical form. This construction of a digital narrative is especially true regarding education records and their use for data mining as our files can be used for analysis. In this chapter, the authors discuss the idea of a digital data exorcism as the potential ability to purge educational records if it is the desire of the individual. A data exorcism can be seen as the needed process for removing or expelling data, done so to protect those from which it was derived. Many forms of data will be discussed in this chapter; however, the focus will be on educational records related to end-of-life considerations. The main theme of this chapter is that facet that we have the right to be forgotten. The right to be deleted or, in other words, “exorcised” from the various systems in which our data resides.
The COVID-19 Pandemic and Agricultural Futures in the USA
Authors: Pata Ugur Korkut , Ozgur Onder , Yilanci Veli , Gorus Muhammed Sehid
Published: April 2022

This study aims to examine the impact of the COVID-19 pandemic on various agricultural commodity futures (cocoa, coffee, corn, cotton, soybean meal, soybeans, sugar, and wheat) in the United States for the period from January 24, 2020, to July 6, 2021, considering oil prices as a control variable. Specifically, the study employs a novel Fourier quantile causality test and its time-varying form. The results show that the causal relationships between COVID-19 cases and agricultural commodity futures are highly time-varying. The empirical findings also demonstrate that COVID-19 has the strongest causal effect on coffee futures, followed by sugar, soybeans, and corn. In contrast, the impact of COVID-19 on cocoa and cotton futures is relatively limited. The causal effect of COVID-19 on agricultural futures is more pronounced at lower quantiles and in the spring and summer months. In general, COVID-19 has significant predictive power for the six agricultural commodity futures over 100 days in the analysis period, with the exception of cocoa and cotton.
Investigation on the Wear Resistance of Ni-B-TiO2 Composite Coatings for Dry Crushing Application
Authors: Kallel Mouna , Bahri Amir , Elleuch Khaled
Published: April 2022

To achieve a more important service life of hammers, used in crushing process, a Ni-B-TiO2 composite coating was electrodeposited on heat treated AISI P20 using conventional and novel methods. The prepared coatings underwent different tribological tests to quantify the coating that offers the best resistance against wear. For this reason, abrasive wear tests such as pin-on-disk test and multi-pass scratch test were performed to evaluate the abrasive wear resistance of the coatings under a round counterbody (alumina ball) and a sharper contrerbody (sphero-conical indenter), respectively. In addition, the impact-sliding test was also performed to assess the impact resistance of the composite coatings. The obtained results showed that the novel method promotes the best mechanical and tribological properties of the elaborated Ni-B-TiO2 composite coating. This is attributed to the fact of adding TiO2 sol into Ni-B electrolyte which enhances the dispersive strength of the formed TiO2 nanoparticles, contrary to adding solid TiO2 nanoparticles into the electroplating bath.
Oppositional GOA Applied to Renewable Energy-Based Multi-Objective Economic Emission Dispatch
Authors: Hazra Sunanda , Roy Provas Kumar
Published: April 2022

The renewable economic emission transmit is a significant and new assignment in the modern power system. This article develops oppositional grasshopper optimization algorithm (OGOA) which depends on the social dealings of the grasshopper in nature, to solve renewable energy based economic emission dispatch (EED) considering uncertainty in wind power availability and a carbon tax on emission from the thermal unit. To speed up the convergence speed and advance the simulation results, opposition based learning (OBL) is integrated with the fundamental GOA in OGOA algorithm. To show the nonlinearity of wind power availability the Weibull distribution is used. A standard system, containing of two wind farms and six thermal units is used for testing the dispatch model for three different loads. The statistical outcomes of the applied OGOA technique are compared with basic GOA and quantum-inspired particle swarm optimization (QPSO) optimization. It is observed OGOA is more skillful than basic GOA technique for significantly reducing the computation time and developing hopeful outcomes.
Intelligent and Data-Driven Reliability Evaluation Model for Wind Turbine Blades
Authors: Aikhuele Daniel Osezua , Periola Ayodele A. , Aigbedion Elijah , Nwosu Herold U.
Published: April 2022

Wind energy is generated via the use of wind blades, turbines and generators that are deployed over a given area. To achieve a higher energy and system reliability, the wind blade and other units of the system must be designed with suitable materials. In this paper however, a computational intelligent model based on an artificial neutral network has been propose for the evaluation of the reliability of the wind turbine blade designed with the FRP material. The simulation results show that there was a reduction in the training mean square error, testing (re–training) mean square error and validation mean square error, when the number of training epochs is increased by 50% such that the minimum mean square error and maximum mean square error were 0.0011 and 0.0061, respectively. The low validation mean square error in the simulation results implies that the developed artificial neural network has a good accuracy when determining the reliability and the failure probability of the wind turbine blade.
Dealing with Islamophobia: Expanding religious engagement to civic engagement among the Indonesian Muslim community in Australia
Authors: Safei Agus Ahmad , Ali Mukti , Himayaturohmah Emma
Published: April 2022

The increasing Islamophobia in the Western world is worsened not only by global political issues but also by the stance of Muslims, who are perceived as exclusive and ethnocentric, particularly in the Australian context. This article outlines the strategies used by Indonesian Muslims in Australia to deal with the Islamophobic discourse, namely enhancing religious engagement to enhance solidarity and social cohesion between them and increasing civic engagement as an assimilation attempt with Australians. Religious engagement is carried out through enhancing Islamic lecture activities to promote a more moderate and open understanding of Islam. Meanwhile, civic engagement activities included increasing social involvement as a form of community service, collaborating more with other communities as a form of collective action, jointly proposing political policies as a form of political involvement, and working with Australians to create a better future as manifestations of civic engagement in the context of social change.Contribution: Although Islamophobia is mostly a political issue, the Indonesian Muslim community in Australia views it as a chance to open up and demonstrate to the Australian community that they can work together in a broader kind of civic engagement.
From small country churches to explosion into megachurches: A modern Pentecostal cultural fit for the Assemblies of God in South Africa
Authors: Resane Kelebogile T.
Published: April 2022

This article examines the evolutionary journey of Assemblies of God in South Africa from small country churches into explosion of megachurches. This Pentecostal denomination is categorised as a classical Pentecostal church that evolved as a missionary church from the early twentieth century. It was officially registered in South Africa in 1917. Historically, it developed as small fellowships in small structures; however today, it has exploded into a huge denomination spread in some geographical locations as local megachurches. Through literature reviews, the objectives are to reveal the rationale behind this explosion, which are the church organisation, emphasis on education, entrepreneurship spirit, apostolic heritage and local church autonomy based on the group system. Results of this explosion are accounted to vigorous evangelism, and Bible-oriented religion such as kerygma, diakonia, koinonia and rhetorics to be culturally and contextually relevant. Assemblies of God embrace African gregarious worldviews and apostolic practices of ecclesial life. This apostolic outlook invokes the discussions on leadership principles. It also influences the church polity exercised by many African megachurches. Shifts from orthodox Pentecostal doctrines such as glossolalia, divine healing and eschatological expectations are examined. The conclusion is while the neo-Pentecostal movement replaces these doctrines by prosperity gospel, personal prophecies and motivational rhetorics instead of sound biblical hermeneutics, Assemblies of God in South Africa remain rooted in their evangelical and classical Pentecostal tradition.Intradisciplinary and/or interdisciplinary implications: This research study is a historical reflection based on Church History, Missiology, Pentecostal Studies, and invokes Practical Theology by referring to strong leadership principles, which leads to church stability. It further calls for Pentecostals to carry out self-examination regarding their fundamental doctrines that are invaded and influenced retrogressively by the neo-Pentecostal movement.
Cardiac tamponade due to right atrial rupture
Authors: Rajendran Gunaseelan , Babu Guguloth Ramesh , Chandrasekar Vinodha , Kagne Rajeshwari , Nathan Balamurugan
Published: April 2022

Cardiac tamponade is a cardiac emergency that requires urgent intervention. Cardiac tamponade due to penetrating cardiac injury requires urgent thoracotomy. As per the guidelines, pericardiocentesis can be done as a bridge to thoracotomy. However, no clear guidelines exist on the management of cardiac tamponade due to blunt cardiac injury. In the following case report, we propose a management plan for blunt cardiac injury in the emergency department. In the following case report, we describe a patient with a road traffic accident who had a blunt cardiac injury and had cardiac tamponade for whom we did not do emergency pericardiocentesis. Instead, we managed the patient with iv fluids and blood transfusion and the patient was taken up for immediate emergency thoracotomy. Not all cardiac tamponade requires pericardiocentesis. Cardiac tamponade due to injury to the low-pressure system can be best managed by initial resuscitation followed by emergency thoracotomy. We also propose a management plan for managing a patient with cardiac tamponade due to blunt cardiac injury when the injury can be visible in the low-pressure chambers.
Association between calcium administration and outcomes during adult cardiopulmonary resuscitation at the emergency department
Authors: Wongtanasarasin Wachira , Ungrungseesopon Nat , Namsongwong Nutthida , Chotipongkul Pongsatorn , Visavakul Onwara , Banping Napatsakorn , Kampeera Worapot , Phinyo Phichayut
Published: April 2022

OBJECTIVES:

Calcium administration during cardiac arrest is limited in some circumstances, mainly due to lack of consistent evidence. This study aims to investigate whether calcium therapy administered during cardiac arrest at the Emergency Department is associated with good outcomes, including the probability of return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and favorable neurological outcome at discharge.

METHODS:

We retrospectively reviewed 599 consecutive adult cardiac arrest events between 2016 and 2018. The primary outcome was the ROSC rate. Secondary outcomes included survival to hospital admission, survival to hospital discharge, and favorable neurologic outcome at hospital discharge. Multivariable logistic regression with inverse probability of treatment weighting was analyzed to examine the association between calcium administration and outcomes.

RESULTS:

Of 599 events, calcium was administered in 72 (12%) cases. The use of calcium during cardiopulmonary resuscitation (CPR) after adjusting for confounding factors was not associated with any better outcomes, including ROSC (adjusted odds ratio (aOR) 0.53, 95% confidence interval [CI] 0.24–1.17), survival to hospital admission (aOR 1.07, 95% CI 0.47–2.41), survival to hospital discharge (aOR 1.93, 95% CI 0.43–8.56), and favorable neurological outcome (aOR 6.60, 95% CI 0.72–60.74). Besides, calcium use in traumatic cardiac arrest patients was associated with unfavorable outcomes, including ROSC (aOR 0.02, 95% CI 0.00–0.09) and survival to hospital admission (aOR 0.16, 95% CI 0.03–0.84).

CONCLUSION:

The use of calcium during an adult cardiac arrest was not associated with better outcomes. Although associations drawn from this study did not indicate the causality, given calcium during CPR was linked to poorer outcomes in traumatic cardiac arrest patients, including ROSC and survival to hospital admission.
Epidemiology of mass casualty incidents in a tertiary care trauma center in eastern India
Authors: Mohanty Chitta Ranjan , Radhakrishnan Rakesh Vadakkethil , Stephen Shine , Jain Mantu , Shetty Asha P , Issac Alwin , Shaji Ijas Muhammed , Chakola Sebastian
Published: April 2022

OBJECTIVES:

Disasters and mass casualty incidents (MCIs) that cause substantial mortality and morbidity have been increasing worldwide. The emergency department (ED) services manage MCIs by optimizing triage and providing health care with required resources. The present study attempted to describe the epidemiological characteristics and outcomes of MCIs presenting to the ED.

METHODS:

The present retrospective observational study was conducted at the ED of a tertiary care hospital on patients of MCI for 4 years from 2017 to 2021. The data were extracted from the ED disaster records and other paper-based patient records. Information on patient demography, date and time of arrival, mode of transport, method of arrival (direct or referral), type and mechanism of MCI, ED management, and outcome were recorded. Statistical analysis was performed using R, version 4.1.0.

RESULTS:

Analysis of 21 MCIs was conducted. Road traffic accidents (RTAs) were the predominant cause of MCIs. The majority of MCI victims, except for those of blast injuries, were men. The victims in medical emergencies were significantly younger than those in other MCI groups (P < 0.001). The majority of patients were brought to ED through ambulance services (n = 120 [47.1%]), followed by private vehicles (n = 112 [44.2%]). Most of the MCI victims (n = 143 [56.2%]) were brought to the ED during evening hours (4 pm–8 pm). The majority of victims belonged to the “Red” triage category (n = 110 [43.3%]). The injury severity score was significantly higher (P = 0.014) in the disaster group than in other trauma MCI groups (20 vs. 17). Autorickshaw occupants were the most common victims of mass casualty RTAs (n = 38 [40%]). Suturing (n = 97 [50%]) and dressing (n = 167 [88%]) were the most common ED procedures required by the victims of trauma MCIs. Of the total, 167 (66%) patients were discharged from the ED, 47 (19%) patients were admitted to wards, 13 (5%) patients were admitted to intensive care units, and 24 (9%) patients got referred to other centers. In addition, two patients died in the ED during treatment, whereas one patient was brought dead.

CONCLUSIONS:

RTAs dominate the MCIs and are affecting the young producative male population. The present study exhibited the severity of the cases in MCIs and their impact in the health-care setting, therefore signifying the importance of standardized MCI management protocols.
A case report on rectus sheath hematoma in an intubated COVID-19 patient
Authors: Nagaretnam Bhasyani
Published: April 2022

Rectus sheath hematoma (RSH) is a life-threatening condition. Its pathology lies behind its unique anatomy. Critically ill COVID-19 patients are managed in the emergency department for longer periods while awaiting critical care admission. Therefore, more complex procedures such as prone positioning are performed in the emergency department to ensure patient care continues. We report this case of RSH in an intubated critically ill COVID-19 patient requiring prone position. During her stay in the Emergency Department Acute Care Unit, she developed anemia, uremia, and worsening hypoxia. Emergency contrast-enhanced computed tomography leads to our diagnosis of RSH. She was treated with a conservative approach and blood transfusion. We would like to highlight this case for its diagnostic complexity since this ventilated patient required both biochemical and radiological markers to diagnose RSH in combination with high suspicion levels. RSH must be considered in patients with risk factors such as prone position and anticoagulant usage. Last, a holistic approach to critically ill patients will not only benefit patients but also health-care profession. The direction of care should be decided based on the patient's condition, imaging, and hospital resources.
Manual versus mechanical chest compression in in-hospital cardiac arrest
Authors: Şener Alp , Günaydın Gül Pamukçu , Tanrıverdi Fatih , Özhasenekler Ayhan , Gökhan Şervan , Çelik Gülhan Kurtoğlu , Sağlam Özcan , Ertürk Nihal
Published: April 2022

OBJECTIVE:

Mechanical chest compression (CC) devices are frequently used in in-hospital and out-of-hospital settings. In this study, mechanical and manual CC in in-hospital cardiac arrest was compared in terms of survival.

METHODS:

Adult patients who were admitted to the emergency department (ED) for 2 years period and had cardiac arrest in the ED were included in this retrospective, observational study. Return of spontaneous circulation (ROSC), 7-day and 30-day survival and hospital discharge data were compared between the two groups of patients who underwent manual CC and those who had mechanical CC with the Lund University Cardiac Assist System-2 device.

RESULTS:

Although the rate of ROSC in the mechanical CC group was lower than in the manual CC group, this difference was not statistically significant (41.7% vs. 50.4%; P = 0.133). The 7-day survival rate was found to be statistically significantly higher in the mechanical CC group (19.4% vs. 8.9%; P = 0.012). The 30-day survival rate was also found to be high in the mechanical CC group, but this difference was not statistically significant (10.6% vs. 7.3%; P = 0.339).

CONCLUSION:

In the light of these results, we can say that the use of piston-based mechanical CC devices in ED may be beneficial. More reliable results can be obtained with a prospective study to be performed in the ED.
Auricular avulsion injuries
Authors: Al-Ali Mohamed A. , Abu-Zidan Fikri M.
Published: April 2022

Traumatic ear avulsion (TEA) may have tremendous psychological consequences if not managed properly. There are no clear guidelines on the surgical management of these injuries, especially in developing countries where microsurgical facilities are lacking. We aimed to review the literature on surgical management of TEA with the main focus on direct re-attachment (DR) so as to develop a surgical management algorithm that can be applied in the absence of microsurgical facilities. We performed an extensive review of the relevant English literature on papers indexed in PubMed describing TEA repaired with DR without restriction to a specific publication time window. A total of 28 cases in 18 publications were reviewed and analyzed. Our results indicate that in the acute setting with no available microvascular expertise, DR of auricular avulsion injuries can be better than other nonmicrosurgical techniques in generating good esthetic results, especially in incomplete auricular avulsion and small segment avulsion. The operative approach depends on the clinical setting. DR of the auricular avulsion injuries is an accepted approach. It produces good cosmetic outcomes while preserving the auricular area for future reconstruction in case of re-attachment failure.
The effect of calcium gluconate in the treatment of hyperkalemia
Authors: Celebi Yamanoglu Nalan Gokce , Yamanoglu Adnan
Published: April 2022

OBJECTIVES:

Intravenous (IV) calcium salts are routinely recommended as a cardio-protective therapy in the emergency treatment of severe hyperkalemia. However, this recommendation is supported by a low level of evidence and is anecdotal. The aim of this study is to determine the effectiveness of IV Calcium (Ca) gluconate in the treatment of hyperkalemia.

MATERIALS AND METHODS:

Patients with hyperkalemia and with the electrocardiogram (ECG) changes due to hyperkalemia over a 1 year period were included in this prospective observational study. Patients’ ECGs were measured, before and after IV Ca-gluconate treatment and after normalization of potassium levels. Wilcoxon test and McNemar's test were used to compare the ECG parameters before and after Ca-gluconate therapy.

RESULTS:

The mean potassium value of 111 patients who met the inclusion criteria was 7.1 ± 0.6 mmol/l. In this study, a total of 243 ECG pathology related to hyperkalemia, 79 of which included main rhythm disorders, and the remaining 164 were nonrhythm disorders in ECG parameters, were analyzed. No statistically significant changes were determined in patients’ nonrhythm ECG disorders with IV Ca-gluconate treatment (P = 0.125). However, nine of the 79 main rhythm disorders due to hyperkalemia improved with calcium gluconate treatment and this change was statistically significant (P < 0.004).

CONCLUSION:

IV Ca-gluconate therapy was found to be effective, albeit to a limited degree, in main rhythm ECG disorders due to hyperkalemia, but it was not found to be effective in nonrhythm ECG disorders due to hyperkalemia. Therefore, Ca-gluconate may be effective only in the main rhythm disorders due to hyperkalemia.
Epidural Analgesia and Abnormal Coagulation in Patients Undergoing Minimal Invasive Repair of Pectus Excavatum
Authors: Media Ara S. , de Paoli Frank V. , Pilegaard Hans K. , Hvas Anne-Mette , Juhl-Olsen Peter , Christensen Thomas D.
Published: April 2022

Background:

Epidural analgesia (EA) is effective in patients undergoing minimal invasive repair of pectus excavatum (MIRPE) but is associated with major complications such as epidural hematomas. It is recommended to assess coagulation status in patients receiving anticoagulant therapy prior to EA, although no consensus exists in patients without a history of bleeding tendency or anticoagulant therapy. Thus, the aim of this paper was to assess 1) the prevalence of abnormal routine coagulation parameters, i.e., international normalized ratio (INR) and platelet count, and 2) the safety of EA in patients undergoing MIRPE.

Methods:

In this retrospective study, we identified 1,973 patients undergoing MIRPE at our center between 2001 and 2019. Complications related to EA were registered for all patients. Information on coagulation parameters was present in 929 patients. Patients with spontaneously elevated INR ≥1.5 were referred for assessment of coagulation factor VII in order to assess the cause of the elevated INR.

Results:

Of 929 patients with coagulation information available, 18 patients had spontaneously elevated INR ≥1.5 (1.9%). In patients with INR ≥1.5, 12 patients underwent further assessment of factor VII, with all patients having a slightly reduced factor VII close to the lower reference range. The majority of the 1,973 patients undergoing MIRPE received EA (99.6%) with very low complication rates (0.2%) and no incidence of epidural hematomas.

Conclusion:

In patients undergoing MIRPE, coagulation screening prior to EA should not be mandatory as it revealed no clinically relevant consequences. EA is safe with very low complication rates.
The Neurocognitive Outcomes of Hemodilution in Adult Patients Undergoing Coronary Artery Bypass Grafting Using Cardiopulmonary Bypass
Authors: Soliman Rabie , Saad Dalia , Abukhudair Walid , Abdeldayem Sabry
Published: April 2022

Objective:

The study aimed to evaluate the effect of mild and moderate hemodilution during CPB on the neurocognitive dysfunction in patients undergoing coronary artery bypass grafting.

Design:

A randomized clinical study.

Setting:

Cardiac center.

Patients:

186 patients scheduled for cardiac surgery with cardiopulmonary bypass.

Intervention:

The patients were classified into 2 groups (each = 93), Mild hemodilution group: The hematocrit value was maintained >25% by transfusion of packed-red blood cells plus hemofiltration during CPB. Moderate hemodilution group: the hematocrit value was maintained within the range of 21-25%.

Measurements:

The monitors included the hemofiltrated volume, number of transfused packed red blood cells, and the incidence of postoperative cognitive dysfunction.

Main Results:

The hemofiltrated volume during CPB was too much higher with mild hemodilution compared to the moderate hemodilution (p = 0.001). The number of the transfused packed red blood cells during CPB was higher with mild hemodilution compared to the moderate hemodilution (p = 0.001), but after CPB, the number of the transfused packed red blood cells was lower with the mild hemodilution group than the moderate hemodilution (p = 0.001). The incidence of total postoperative neurological complications was significantly lower with the mild hemodilution group than moderate hemodilution (p = 0.033). The incidence of neurocognitive dysfunction was significantly lower with mild hemodilution group than moderate hemodilution (p = 0.042).

Conclusions:

The mild hemodilution was associated with a significant decrease in the incidence of neurocognitive dysfunction compared to moderate hemodilution in patients undergoing coronary artery bypass grafting. Also, the transfused packed red blood cells increased during CPB and decreased after CPB with the mild hemodilution than moderate hemodilution.
Surgical Embolectomy in a 34-Week Pregnant Woman with High Risk Pulmonary Embolism and Haemodynamic Instability
Authors: Maj Giulia , Strobelt Nicola , Audo Andrea , Arena Anna Maria , Parodi Giovanni , Aguggia Vittorio , Serra Massimo , Giribaldi Maria , Martuscelli Ermelinda , Racca Fabrizio
Published: April 2022

Pulmonary embolism represents the leading cause of maternal mortality in developed countries. The optimal treatment of high-risk pulmonary embolism with cardiovascular instability and at high hemorrhagic risk is still debated but surgical embolectomy represents an effective option. We describe the case of a 35-year-old woman in week 34 of pregnancy who was referred to our hospital because of exertional dyspnea and tachycardia and a few hours later became hypotensive and hypoxic. Pulmonary embolism was detected by performing an angio-computed tomography (CT) scan. After a successful cesarean section, emergent embolectomy was performed without inducing uterine hemorrhage. Both mother and the newborn recovered without postoperative sequelae.
Perioperative Management of Myasthenia Gravis Patient for off Pump Coronary Artery Bypass Surgery and Thymectomy
Authors: Nagre Amarja S. , Kabade Abhijeet , Chaudhari Mahesh
Published: April 2022

Myasthenia gravis (MG) is an autoimmune disorder characterized by antibody-mediated immunologic reaction striking the acetylcholine receptors. The anesthesia concerns for patients with MG include the disease state, drug interactions, and the anesthetic medications particularly the neuromuscular blocking agents (NMBAs). The anesthesia management in these patients is meticulous and requires appropriate execution of knowledge. Besides, such patient for off-pump coronary artery bypass surgery is quite uncommon; hence, we report this case.
Prospective National Audit of Major Gastrointestinal Complications of Transesophageal Echocardiography Studies in Children
Authors: Murphy Tim , McCheyne Alan
Published: April 2022

Background:

Perioperative trans-esophageal echocardiography ('TEE') is widely used for the assessment of anatomy/repair of congenital cardiac defects. It is recognised that there are risks associated with its use.

Aims:

We wished, by means of a contemporaneous prospective national audit over a six-month period, to establish what proportion of TEE studies in children are complicated by major upper gastrointestinal or upper aerodigestive tract trauma.

Methods:

After obtaining appropriate local institutional ethics committee approval, a national prospective audit of the rate and severity of gastrointestinal complications of trans-esophageal echocardiography studies in anaesthetised adult cardiology and cardiac surgical patients was conducted by the Association of Cardiothoracic Anaesthesia and Critical Care in the United Kingdom and Ireland during the twelve months of 2017. During the second six months of the audit, the Congenital Cardiac Anaesthesia Network (an organisation including anaesthetists with a paediatric cardiac anaesthetic practice in all the United Kingdom cardiac surgical centres) prospectively audited the incidence of such complications of TEE studies in children.

Results:

A total of 1,059 studies were included in this six-month paediatric audit. There were no reports of the specified major complication.

Statistical Analysis:

The zero incidence of the major complication is consistent with a worst possible incidence of five per thousand TEE examinations.

Conclusions:

Such potentially reassuring information could be included in discussions with patients or families about the risk of trans-esophageal studies in children.
The ProtekDuo as Double Lumen Return Cannula in V-VP ECMO Configuration
Authors: Maybauer Marc O. , Koerner Michael M. , Mihu Mircea R. , Harper Michael D. , El Banayosy Aly
Published: April 2022

We present a case of acute respiratory distress syndrome (ARDS) secondary to COVID-19 who required venovenous extracorporeal membrane oxygenation (V-V ECMO). Initially, a right ventricular assist device (RVAD), the ProtekDuo with an oxygenator, was placed in an outside heart center and the patient was transferred to us for ECMO management. Due to severe hypoxia, the configuration was later modified, and a 25 Fr femoral drainage cannula was inserted for venous drainage only. The arterial return tubing was spliced and using a Y-connector, arterialized blood was returned through both limbs of the ProtekDuo resulting in a significantly increased oxygenation and flow.
HIV oral self-screening test among HIV/STD/TB clinic attendees: A mixed-method pilot investigation examining merit for larger evaluation
Authors: Rao Amrita , Patil Sandip , Nirmalkar Amit , Bagul Rajani , Ghule Ujjwala , Panchal Narayan , Panda Samiran
Published: April 2022

Background & objectives:

Globally, several countries consider HIV self-test as an important element in the toolbox to end AIDS by 2030. Against this background, the present investigation was conducted to pilot test the performance of an indigenous HIV oral self-test (HIVOST) and explore its acceptability. The overall purpose was to examine if this kit could serve as a promising tool and merit future larger clinical evaluation.

Methods:

A concurrent mixed-method investigation was undertaken during March-October 2019. One hundred and thirty two consecutive HIV/sexually transmitted diseases/tuberculosis clinic attendees were invited for participation; of whom, 100 were enrolled, and among them, 40 provided consent for qualitative in-depth interviews. The HIVOST kit assessed for its performance served as the ‘index test’, which worked on the principle of lateral flow chromatography. The results of the HIVOST were interpreted independently by the study physicians and participants at 20 min. HIVOST kit performance was assessed against the HIV confirmatory blood test result based on the national algorithm (3 rapid test or 1 ELISA and 2 rapid test) serving as the ‘reference’. Sensitivity, specificity, positive predictive value, negative predictive value and inter-rater agreement were estimated. The voices and concerns of the study participants were coded followed by identification of qualitative themes and ideas.

Results:

The sensitivity and specificity of the index test at the end of 20 min as interpreted by the participants were 83.3 per cent [95% confidence interval (CI): 69.8 to 92.5] and 98 per cent (95% CI: 89.4 to 99.5), respectively. Study physicians and participants independently interpreted HIVOST results with substantial inter-rater agreement (kappa value 0.88; 95% CI: 0.78-0.97). All HIVOST test strips were valid. Majority of the participants preferred saliva over blood for HIV self-test. ‘Comfort’, ‘confidentiality’ and ‘convenience’ were the perceived advantages of HIVOST. Some of the participants wished the package inserts contained ‘how-to-do instructions in local languages’, ‘expiry date (if any)’ and ‘contact helpline number’. A few of them highlighted the need for a confirmatory HIV result following oral self-test. Concerns of the participants revolved around potential self-harm following HIVOST-positive result and safe disposal of kits.

Interpretation & conclusions:

Two major highlights of the present investigation are (i) high level of concordance in HIVOST results interpreted by participants and physicians, and (ii) encouraging level of acceptance of HIVOST. These findings and encouraging HIVOST performance statistics lend support towards large-scale clinical evaluation of this index test.