bluuebunny/crossref_metadata_2025 huggingface dataset:
Passion, générosité, chute : les tragédies dynastiques de Claude Boyer
Authors: Ding Ruoting
Published: May 2023

Claude Boyer exploite, dans ses tragédies dynastiques, un mécanisme dramatique qui lui est spécifique. Il consiste d’une part à faire de la passion du héros un élément s’opposant frontalement au caractère que son rôle politique exige, et d’autre part à introduire brusquement la chute au moment où le personnage s’élève intérieurement. Cette dramaturgie explique certains traitements particuliers des thèmes littéraires et des notions politiques chez Boyer. Elle entretient un rapport complexe avec les écrits contemporains et témoigne avec force de la diversité du théâtre classique.
Le silence à l’adolescence : du vacarme dans la rue, au silence chez l’analyste
Authors: Benoit Jean-Pierre
Published: May 2023

La jeunesse est bruyante. Les pulsions de vie, ses besoins d’amitié, sa nécessaire affirmation narcissique se font entendre. Les groupes, les fêtes, la musique, tout est prétexte à occuper l’espace sonore. Au contraire, l’élaboration pubertaire se fait dans le silence d’une intimité qui permet que les éprouvés du corps et les premières relations amoureuses prennent sens, loin des adultes, sans commentaire. Lorsque des symptômes apparaissent à l’adolescence, et que des soins sont nécessaires, la relation thérapeutique se heurte très souvent au silence des adolescents. Le psychothérapeute prendra soin de s’ajuster, pour que le silence ne soit pas source d’angoisse dans les premiers entretiens, et qu’il puisse devenir un espace de subjectivation au cours du processus thérapeutique.
Troubles neurodéveloppementaux et TSA : un silence si particulier
Authors: Legendre Florent
Published: May 2023

En voulant réunir les notions de troubles neurodéveloppementaux ( tnd ) ou de troubles du spectre autistique ( tsa ) en particulier et le silence, on se heurte à plusieurs notions apparemment contradictoires mais si complémentaires. En passant du silence inexistant et stressant, lorsque l’on évoque les atypies perceptives des personnes tsa, comme l’hypersensibilité auditive, par exemple, au silence incompréhensible et destructeur lié à l’absence de transmission des connaissances, des savoirs et aux manques des formations initiales. Sans oublier le silence pesant, angoissant et tout aussi inexplicable induit par ce manque de mise à jour des connaissances et des avancées sur l’autisme dans les formations et la communication. Cet article traitera donc chacun de ces éléments en apportant, malgré beaucoup d’interrogations, certaines réponses pour à la fois rompre ce silence si déroutant et destructeur et rendre plus facile sa perception et sa compréhension.
Les aléas du silence transgénérationnel en périnatalité
Authors: Darchis Élisabeth
Published: May 2023

Le temps périnatal est une période de nécessaires réaménagements psychiques qui réveillent l’héritage ancien. Mais, dans certaines familles, la loi du silence a organisé des alliances aliénantes de génération en génération, pour éviter le retour de la honte ou de l’effroi traumatique. Des éléments en souffrance de symbolisation, maintenus longtemps sous silence, vont tenter de s’exprimer alors dans des effets fantômes, des bizarreries ou des délires, dont les contenus déguisés tentent de dire l’irreprésentable qui n’a pas été parlé autrefois. Cette période sera aussi une chance pour transformer le passé, notamment dans l’accompagnement psychanalytique de la famille.
Impact de la rencontre de service assistée par la technologie vendeur
Authors: Bendjaballah Madiha
Published: May 2023

Face à la concurrence des pure players, les points de vente physique doivent en permanence se réinventer. Pour cela, nombre d’entre eux se sont engagés dans un processus de numérisation plus ou moins marqué : présence d’écrans géants, de tablettes numériques à disposition des clients ou encore des vendeurs connectés, présents pour assurer des fonctions logistiques et de conseil. Si plusieurs recherches ont été menées sur l’utilisation du Mobile Sales Assistant (MSA) par le vendeur, aucune ne s’est intéressée, à notre connaissance, à la perception qu’en avait le client. La présente étude tente d’apporter une réponse à cette délicate question en s’intéressant plus particulièrement à la création et la destruction de valeurs que cet outil est susceptible de générer. Les résultats de notre étude qualitative montrent ainsi que si le MSA conduit à une amélioration de la valeur de magasinage fonctionnelle, il peut générer dans certains cas une détérioration de la valeur de magasinage relationnelle. L’étude offre également quelques pistes de réflexion quant à la valeur de magasinage hédonique. Ces résultats offrent une première contribution intéressante sur la valeur perçue du point de vue du consommateur.
France (Europe) et Afrique : comment améliorer le partenariat ?
Authors: Mara Moussa
Published: May 2023

La France, avec l’Europe, doit revoir sa façon de travailler avec l’Afrique qui est plurielle et appelle à de vrais partenariats basés sur l’équilibre et le respect. Ce travail doit s’inscrire dans la durée et avec une approche pluridisciplinaire, y compris dans les domaines de la culture et de l’éducation.
La pénétration du groupe Wagner en Afrique
Authors: Klen Michel
Published: May 2023

La Russie est très active en Afrique, en s’appuyant sur les mercenaires du groupe Wagner, notamment en République centrafricaine (RCA) et au Mali. La campagne anti-française est aisément relayée par certaines élites locales, peu regardantes sur les exactions commises par Wagner et sur le pillage des ressources comme l’or.
Histoire militaire
Authors: Lecoq Tristan
Published: May 2023

À partir de 1943, la reconstruction des armées françaises est à la fois un enjeu militaire mais aussi politique. L’appui des Alliés est indispensable avec une subordination opérationnelle stricte. Le général de Gaulle sut forcer la main à trois reprises, dont pour la Libération de Paris, mais comprit les limitations imposées à la souveraineté française.
Amérique latine
Authors: Drouhaud Pascal
Published: May 2023

Si les années 1990 et 2000 ont été celles d’une croissance commune pour l’Amérique centrale, différentes crises ont mis un frein à la dynamique de l’intégration régionale. Le Salvador de Nayib Bukele qui va prendre en juin la présidence du SICA espère lui donner un second souffle.
Space-time decay rate of high-order spatial derivative of solution for 3D compressible Euler equations with damping
Authors: Ye Qin
Published: May 2023

We are concerned with the space-time decay rate of high-order spatial derivatives of solutions for 3D compressible Euler equations with damping. For any integer $ \ell\geq3 $, Kim (2022) showed the space-time decay rate of the $ k(0\leq k\leq \ell-2) $th-order spatial derivative of the solution. By making full use of the structure of the system, and employing different weighted energy methods for $ 0\leq k \leq \ell-2, k = \ell-1, k = \ell $, it is shown that the space-time decay rate of the $ (\ell-1) $th-order and $ \ell $th-order spatial derivative of the strong solution in weighted Lebesgue space $ L_\sigma^2 $ are $ t^{-\frac{3}{4}-\frac{\ell-1}{2}+\frac{\sigma}{2}} $ and $ t^{-\frac{3}{4}-\frac{\ell}{2}+\frac{\sigma}{2}} $ respectively, which are totally new as compared to that of Kim (2022) [1].
Lie symmetry analysis, particular solutions and conservation laws of a (2+1)-dimensional KdV4 equation
Authors: Tao Sixing
Published: May 2023

In this paper, a (2+1)-dimensional KdV4 equation is considered. We obtain Lie symmetries of this equation by utilizing Lie point symmetry analysis method, then use them to perform symmetry reductions. By using translation symmetries, two fourth-order ordinary differential equations are obtained. Solutions of one fourth order ordinary differential equation are presented by using direct integration method and $ (G'/G) $-expansion method respectively. Furthermore, the corresponding solutions are depicted with appropriate graphical representations. The other fourth-order ordinary differential equation is solved by using power series technique. Finally, two kinds of conserved vectors of this equation are presented by invoking the multiplier method and Noether's theorem respectively.
Multilevel marketing: Pyramid‐shaped schemes or exploitative scams?
Authors: Antler Yair
Published: May 2023

Motivated by the growing discussion on the resemblance of multilevel marketing schemes to pyramid scams, we compare the two phenomena based on their underlying compensation structures. We show that a company can design a pyramid scam to exploit a network of agents with coarse beliefs and that this requires the company to charge the participants a license fee and pay them a recruitment commission for each of the people that they recruit and that their recruits recruit. We characterize the schemes that maximize a company's profit when it faces fully rational agents, and establish that the company never finds it profitable to charge them a license fee or pay them recruitment commissions.
Equilibrium existence in games with ties
Authors: Olszewski Wojciech , Siegel Ron
Published: May 2023

We provide conditions that simplify applying Reny's (1999) better‐reply security to Bayesian games and use these conditions to prove the existence of equilibria for classes of games in which payoff discontinuities arise only at “ties.” These games include a general version of all‐pay contests, first‐prize auctions with common values, and Hotelling models with incomplete information.
Characterizing the top cycle via strategyproofness
Authors: Brandt Felix , Lederer Patrick
Published: May 2023

Gibbard and Satterthwaite have shown that the only single‐valued social choice functions (SCFs) that satisfy nonimposition (i.e., the function's range coincides with its codomain) and strategyproofness (i.e., voters are never better off by misrepresenting their preferences) are dictatorships. In this paper, we consider set‐valued social choice correspondences (SCCs) that are strategyproof according to Fishburn's preference extension and, in particular, the
top cycle, an attractive SCC that returns the maximal elements of the transitive closure of the weak majority relation. Our main theorem shows that, under mild conditions, the top cycle is the
only non‐imposing strategyproof SCC whose outcome only depends on the quantified pairwise comparisons between alternatives. This result effectively turns the Gibbard–Satterthwaite impossibility into a complete characterization of the top cycle by moving from SCFs to SCCs. We also leverage key ideas of the proof of this statement to obtain a more general characterization of strategyproof SCCs.
Student Adoption of E-Learning in Higher Education Institutions in Saudi Arabia
Authors: Hasan Asif , Habib Sufyan , Khan Mohammed Arshad , Hamadneh Nawaf N.
Published: May 2023

This study aims to explore the various factors influencing students in adopting e-learning in educational institutions in Saudi Arabia and analyze the relationship between factors of students' adoption of e-learning and student behavior intention. The study also analyzes perceived opportunities and challenges faced by students in adopting an e-learning system in higher education. A well-structured questionnaire was developed, and information was collected from 509 respondents. The study found that students' behavioral intention to adopt e-learning is highly influenced by performance expectancy, effort expectancy, social influence, facilitating conditions, computer self-efficacy, and internet knowledge. The study confirms the mediating role of student engagement that can act as an alternate path for strengthening the relationship between factors of adoption of e-learning and behavioral intention. In addition, several implications and new lines of investigation are recommended for meeting the educational transformation needs and future sustainability.
Parameters Describing Student Learning Environments Through Experiential Learning Technologies for Entrepreneurial Creativity
Authors: Lakshmi Dara Vijaya , Saradha M.  , Karthik R. , Sandeep Kumar M.  , Babu J. Chinna , Vilcekova Lucia
Published: May 2023

The proposed explorative study utilizes the partial least squares-structural equation modeling (PLS-SEM) for the testing of the auxiliary relationship lies in the factors focusing on the respondent's pioneering aim. This study examines student's learning desire in entrepreneurship, the value addition on student, impact on the student career path from employment to ownership, the impact on society, and the state-of-the-art practices for training thereby getting the suitable aptitudes and related information. This assists the communities to change their focus from employment to entrepreneurship. Hence, creating enterprises encompassing personality enrichment and better insights through training will promote significant benefits to the growing society.
Predicting Patient Length of Stay Using Artificial Intelligence to Assist Healthcare Professionals in Resource Planning and Scheduling Decisions
Authors: Alnsour Yazan , Johnson Marina , Albizri Abdullah , Harfouche Antoine Harfouche
Published: May 2023

Artificial intelligence (AI) significantly revolutionizes and transforms the global healthcare industry by improving outcomes, increasing efficiency, and enhancing resource utilization. The applications of AI impact every aspect of healthcare operation, particularly resource allocation and capacity planning. This study proposes a multi-step AI-based framework and applies it to a real dataset to predict the length of stay (LOS) for hospitalized patients. The results show that the proposed framework can predict the LOS categories with an AUC of 0.85 and their actual LOS with a mean absolute error of 0.85 days. This framework can support decision-makers in healthcare facilities providing inpatient care to make better front-end operational decisions, such as resource capacity planning and scheduling decisions. Predicting LOS is pivotal in today's healthcare supply chain (HSC) systems where resources are scarce, and demand is abundant due to various global crises and pandemics. Thus, this research's findings have practical and theoretical implications in AI and HSC management.
Environmental Practices, Digitalization, and Green Innovation in Multinational Firms
Authors: Li Changbo , Zhang Zuoqian , De Sisto Marco , Liu Yanxinkai , Lau Sara Choi Ping
Published: May 2023

This study examines the diverse environmental practices of multinational firms, the degree of digitalization among parent firms, and green innovation. Using data from multinational listed firms from 2007 to 2018 as a sample, this article uses regression analysis to show that the more widely distributed the subsidiaries of multinational firms, the more heterogeneous the environmental knowledge acquired by the parent firm. The more diverse the environmental practices, the worse the green innovation performance of the parent firm. The degree of digitalization of the parent firm can effectively mitigate this negative effect. The more digital the parent company is, the more quickly it can process the large amount of complex information that helps the parent firm to achieve green innovation. These findings provide a new perspective on innovation in firms.
The Plasma Cell Infiltrate Populating the Muscle Tissue of Patients with Inclusion Body Myositis Features Distinct B Cell Receptor Repertoire Properties
Authors: Jiang Roy , Roy Bhaskar , Wu Qian , Mohanty Subhasis , Nowak Richard J , Shaw Albert C , Kleinstein Steven H , O’Connor Kevin C
Published: May 2023

Inclusion body myositis (IBM) is an autoimmune and degenerative disorder of skeletal muscle. The B cell infiltrates in IBM muscle tissue are predominantly fully differentiated Ab-secreting plasma cells, with scarce naive or memory B cells. The role of this infiltrate in the disease pathology is not well understood. To better define the humoral response in IBM, we used adaptive immune receptor repertoire sequencing, of human-derived specimens, to generate large BCR repertoire libraries from IBM muscle biopsies and compared them to those generated from dermatomyositis, polymyositis, and circulating CD27+ memory B cells, derived from healthy controls and Ab-secreting cells collected following vaccination. The repertoire properties of the IBM infiltrate included the following: clones that equaled or exceeded the highly clonal vaccine-associated Ab-secreting cell repertoire in size; reduced somatic mutation selection pressure in the CDRs and framework regions; and usage of class-switched IgG and IgA isotypes, with a minor population of IgM-expressing cells. The IBM IgM-expressing population revealed unique features, including an elevated somatic mutation frequency and distinct CDR3 physicochemical properties. These findings demonstrate that some of IBM muscle BCR repertoire characteristics are distinct from dermatomyositis and polymyositis and circulating Ag-experienced subsets, suggesting that it may form through selection by disease-specific Ags.
Analysis of Key Indicators of Research, Development, and Innovation in Blood Establishments and Their Impact on the Delivery of Improved Quality Health Products and Services
Authors: Manchanayake Geethika Sajeewani , García-López Joan , Vives Joaquim
Published: May 2023

Background and Objectives:

The contribution of blood establishments (BEs) on Research, Development, and Innovation (R + D + I) is minimally addressed in the literature. Herein, we present an analysis of key indicators of R + D + I in BEs and discuss the impact of their R + D + I interests and priority areas, resources, and outcomes on the delivery of quality health products and services.

Methods:

Data from a worldwide representation of BEs were collected and analyzed in 2020. We assessed R + D + I areas studied, budget allocations, collaborations with other institutes, number of research staff available, and scientific production of BEs.

Results:

Details of 15 BEs from four continents were included in the study. All of them conducted R + D + I on a better understanding of their products and product safety. Other areas focused on were donors and donations (87%), bone marrow transplantation (80%), transfusion practices (80%), and immunogenetics (80%). 1%–11% (median of two points five %) of staff and 35–238 (median of 70, n = seven) in number, were involved in R + D + I. In 2018–2019, the budget allocated for R + D + I varied from € two point 6 to €13.7 million (median €seven point 6 million, n = 8) and it was zero point eight–10.5% (median of two points one %) of the total budget of BEs. Twelve (80%) and 11 (73%) BEs collaborated with academic institutes and hospitals, respectively. All centers generated publications and conference presentations, whereas only 4 (27%) hold patents.

Conclusion:

Research is an essential component in BEs that further potentiates R + D + I by partnering with research centers and universities as well as establishing specialized networks. A strong commitment to allocate resources and establish dedicated facilities or strategic alliances may generate world-class innovations in this ever-growing field.
Paid Plasma versus Voluntary Nonremunerated Plasma Collection for Plasma-Derived Medicine
Authors: Pourfathollah Ali Akbar , Shamsasenjan K. , Dehshal M. Hadipour
Published: May 2023

Iranian Blood Transfusion Organization (IBTO) established in 1975 has been the sole responsible entity for blood adequacy and safety in Iran. It has been the same in case of providing recovered plasma. At the same time, the first commercial plasma center was authorized by IBTO to operate in the capital Tehran to contribute to the main purpose that was the investment of the private sector in fulfilling fractionation purposes and the construction of a fractionation plant. The goal that unfortunately did not materialize. To make remedies based on a well-calculated plasma document, in 2015, a plasma program developed in Iran by IBTO by which new donor centers were opened or already blood center were equipped to allow for the collection of voluntary nonremunerated source plasma. It had in it capacities of plasma collection for IBTO recovered, commercial source, and IBTO voluntary source. The latter third was a gradually growing program that lasted just 3 years and showed progress but the managerial changes and invalid arbitrary and sudden decisions brought it to the end. Whilst the paid private centers grew and ruined the voluntary nonremunerated sense that IBTO always pursued and was against the Ministry of Health requirements for what the commercial private sectors should have abided by. Safe voluntary nonremunerated source plasma collection that almost all countries pursue to grow along with existing recovered plasma share was terminated with consequences that are detailed in the present article.
Clinicopathological spectrum of lumps and bumps on the hand: A 5-year retrospective study
Authors: Konkay Kaumudi , Neelima Poola , Sindhura Nugala , Chaganti Padmavathi Devi
Published: May 2023

Background:

Diverse lesions ranging from infective, inflammatory to neoplastic can occur in the hand. Almost all lesions that occur elsewhere in the body can affect the hand as well.

Methods:

This was a hospital-based retrospective study of 5 years done between January 2016 and December 2020. We enumerated the clinical and histopathological spectrum of lesions of the hand. The details were collected from the patient requisition forms and pathology records.

Results:

Of the 80 cases seen during the study period, 25 (31.3%) were non-neoplastic and 55 (68.8%) were neoplastic; male: female ratio was 0.95:1. The most frequent lesions identified were ganglion cysts (n = 13), followed by giant cell tumour (GCT) of tendon sheath (n = 11). Common non-neoplastic lesions included were ganglion cyst (n = 13), pyogenic granuloma (n = 3); epidermoid cyst, fungal granuloma, pigmented seborrhoeic keratosis (n = 2 each) and cutaneous horn, molluscum contagiosum and granulomatous inflammation. Amongst neoplastic lesions, mesenchymal lesions were 49 (89.1%) and epithelial lesions were 6 (10.9%); they were GCT of tendon sheath 11 (22.4%) lipomas and nerve sheath tumours 9 (18.36%) cases each, arteriovenous malformations/haemangiomas 5 (10.2%), fibromas 2 (4.08%) and one (2.04%) case each of myolipoma, fibrolipoma, benign fibrous histiocytoma, calcifying aponeurotic fibroma and benign spindle cell tumour, palmar fibromatosis. Malignant mesenchymal neoplasms included synovial sarcoma (n = 3), epithelioid sarcoma, malignant peripheral nerve sheath tumour and high-grade spindle cell sarcoma (n = 1 each). Amongst epithelial, benign lesions were 2, malignant lesions were 4, of which 3 were squamous cell carcinoma and one was melanoma and the two benign lesions were skin adnexal tumours, of which one was a case of eccrine poroma and the other was pilomatrixoma.

Conclusions:

In patients presenting with lumps and bumps on the hand, common non-neoplastic lesions included ganglion cyst and pyogenic granuloma. Amongst neoplastic lesions, mesenchymal lesions and epithelial lesions were most commonly seen.
Adaptation of case report guidelines on published case reports in the Indian Medical Journals from 2020 to 2021: A cross-sectional study
Authors: Anushree D. , Muraraiah Sushma
Published: May 2023

Background:

Case reports are detailed reports of a patient’s specific medical problem and its clinical management. They serve as the initial evidence for the generation of hypothesis for any novel disease. However, incomplete reporting results in false inferences.

Methods:

The objective of this study was to assess the adherence of case reports published in Indian Medical Journals (IMJs) to Case Report (CARE) 2016 guidelines, to assess the extent of endorsement of these guidelines by the selected IMJs and its impact on the completeness of reporting (COR) score. The journals published by the Associations of 12 Indian medical specialities, namely, Indian Journal of Dermatology, Venerology and Leprology, Indian Journal of Anaesthesia, Indian Journal of Ophthalmology, Indian Journal of Orthopaedics, Indian Journal of Otorhinolaryngology and head and neck surgery, Indian Paediatrics, Indian Journal of Pharmacology, Indian Journal of Psychiatry, Indian Journal of Surgery, Journal of Association of Physicians India, Journal of Obstetrics and Gynaecology and Lung India between 2020 and 2021 were accessed for completeness as per CARE guidelines. The effect of CARE endorsement on the COR was determined.

Results:

None of the 590 case reports met all the CARE guidelines.: Major areas of reporting deficiencies were title, timeline, patient perspective and informed consent. No association between COR and the impact factor of the journal.

Conclusions:

The quality of case reporting with respect to CARE 2016 checklist is not satisfactory. The endorsement of the CARE checklist in the journal must be made mandatory to generate high-quality case reports.
Microalbuminuria in hypertension and its relationship to target organ damage: A cross-sectional observational study in a tertiary hospital in Eastern India
Authors: Bhowmick Diptak , Chakraborty Sisir , Ali M. D. Hamid , Ghosh Kaushik , Acharyya Amitava , Karmakar Partha Sarathi , Banerjee Swati
Published: May 2023

Background:

Microalbuminuria (MA) is an independent risk factor in association with fatal cardiovascular and cerebrovascular outcomes among patients with hypertension (HTN).

Methods:

An observational study was conducted among 100 randomly selected hypertensive patients January 2013 to January 2014 to observe the proportion of MA among hypertensive patients and the proportion of presence of various target organ damages (TODs) in them.

Results:

The frequency of MA was 36% among participants. The frequency in males was slightly more than females (38.2% vs. 33.3%). The frequency of MA increased linearly with the duration and severity of HTN. It was more commonly found in smokers than in non-smokers. Diastolic dysfunction (42%) and Grade 2 hypertensive retinopathy (60.7%) were associated with MA. TOD was frequently observed in MA-positive patients.

Conclusions:

The proportion of patients with MA was in increasing trend with increasing age of hypertensive participants and duration of history of HTN. Hypertensive retinopathy, regional wall motion abnormality and neurological deficit emerged to be sensitive surrogate markers for MA in patients with HTN.
High-flow nasal cannula (HFNC) oxygenation for sclerotherapy of facial and upper airway vascular malformations in pediatric patients: Case series
Authors: Zadkar Sanjeevani , Ranjitha Y. S. , Mishra Poonam , Saraf Rashmi
Published: May 2023

We report anesthesia management of sclerotherapy for vascular malformations (VMs) of the upper airway and face of pediatric patients conducted under sedation using a high-flow nasal cannula (HFNC) oxygen delivery system. Sclerotherapy procedures were carried out in six patients (five males, one female; age group: 5–12 years). The patients were sedated with midazolam, fentanyl, ketamine, and graded doses of propofol along with continuous oxygen delivery using HFNC. There were no episodes of oxygen desaturation, tongue fall or obstruction of the airway, interruption of procedure for assisted ventilation, and postoperative nausea and vomiting (PONV). Only two patients showed transient apnea for 10 and 15 s but did not require ventilatory assistance. HFNC provides effective oxygenation in pediatric patients undergoing sclerotherapy of VMs of the upper airway and face under sedation.
Reduction in postoperative sore throat by preoperative nebulization with dexmedetomidine, ketamine or saline: A prospective, randomized-controlled trial
Authors: Ittoop Amanta L. , Gupta Priyanka , Jain Gaurav , Tyagi Nidhi , Eda Jhansi , Shajahan Shafiq
Published: May 2023

Background and Aims:

Postoperative sore throat (POST) is a minor but distressing complication following general anesthesia. The current literature on the effect of preoperative nebulization with dexmedetomidine, or ketamine on POST is, however, sparse. So, we compared the effect of preoperative nebulization with these drugs on POST.

Material and Methods:

One hundred and thirty-two American Society of Anaesthesiology (ASA) grade I-II patients undergoing elective laparoscopic surgeries under general anesthesia were randomized into three equal groups: D, K, or C to receive dexmedetomidine, ketamine, or saline as preoperative nebulization, respectively. The primary objective was to compare the incidence and severity of POST, as inferred from the patient interviews at 2, 6, 12, 24-h postoperatively.

Results:

Group D had a significantly lower incidence (29.5%) and severity (12: mild; 1: moderate) of POST compared to group K (54.5% [21: mild; 3: moderate]) and group C (56.8% [19: mild; 6: moderate]), at 2-h postoperatively. The same trend was observed at 6-h postoperatively (group D: 22.7% [9: mild; 1: moderate]); group K: (40.9% [17: mild; 1: moderate]); group C (50% [17: mild; 5: moderate]). The mean arterial pressure was significantly lower in group D at 15 min intraoperatively (84.09 mmHg, P = 0.018) and immediate postoperatively (97.60 mmHg, P = 0.034). The postoperative sedation, nausea, and vomiting was not statistically significant.

Conclusion:

Preoperative nebulization with dexmedetomidine is effective in the reduction of the incidence and severity of early POST.
Ropivacaine pharmacokinetics in the arterial and venous pools after ultrasound-guided continuous thoracic paravertebral nerve block
Authors: Matsota Paraskevi , Karalis Vangelis , Saranteas Theodosios , Kiospe Fay , Markantonis Sophia Liberty
Published: May 2023

Background and Aims:

Although thoracic paravertebral blockade (TPVB) is employed in thoracic surgery to ensure satisfactory postoperative analgesia, large doses of anesthetics are required and manifestations of local anesthetic systemic toxicity (LAST) may appear. Currently, there are limited data on the pharmacokinetics of ropivacaine after continuous TPVB. The aim of this prospective study was to investigate ropivacaine kinetics, in the arterial and venous pools, after continuous TPVB and assess the risk of LAST.

Material and Methods:

Immediately after induction of general anesthesia, an ultrasound-guided continuous TPVB at T5 or T6 or T7 thoracic level was performed in 18 adult patients subjected to open thoracotomy. A 25-ml single bolus injection of ropivacaine 0.5% was administered through thoracic paravertebral catheter, followed by a 14 ml/h continuous infusion of ropivacaine 0.2% starting at the end of surgery. Quantification of total ropivacaine concentrations was performed using a validated high-performance liquid chromatography method. Population pharmacokinetic models were developed separately for arterial and venous ropivacaine data.

Results:

The best model was one-compartment disposition with an additional pre-absorption compartment corresponding to thoracic paravertebral space. Gender had a significant effect on clearance, with females displaying lower elimination than males. Some patients had ropivacaine concentrations above the toxic threshold, but none displayed evidence of LAST. Continuous thoracic paravertebral nerve blocks provided adequate postoperative analgesia.

Conclusion:

Ropivacaine doses at the upper end of clinical use (800 mg/d) did not inflict the manifestations of LAST and provided adequate postoperative pain control. Pharmacokinetic models were developed, and the effect of gender was identified.
The effects of subtenon and intravenous dexmedetomidine on patients undergoing cataract surgery: A comparative randomized controlled double-blind study
Authors: Saad Ashraf Magdy Eskandr , Abd-Allah Elmorsy Osama , Abd-Elmaseeh Sadik Sadik
Published: May 2023

Background and Aims:

This prospective randomized study designed to evaluate the efficacy of dexmedetomidine either added to LA mixture or administered IV during subtenon block for cataract surgery.

Material and Methods:

75 patients, undergoing cataract surgery with subtenon anesthesia, were assigned randomly into three equal groups, Group I received subtenon bupivacaine 0.5% (1 ml) + lidocaine 2% (1 ml) + saline 0.9% (0.5 ml) and IV infusion of normal saline. Group II received subtenon bupivacaine 0.5% (1 ml) + lidocaine 2% (1 ml) + 0.5 μg/kg dexmedetomidine (0.5 μl) and IV infusion of normal saline. Group III received subtenon bupivacaine 0.5% (1 ml) + lidocaine 2% (1 ml) + saline 0.9% (0.5 ml) and IV infusion of 0.5 mg/kg dexmedetomidine over 10 min. before subtenon block. We recorded onset and duration of sensory and motor block, pain during subtenon injection, intraoperative hemodynamics, intraocular pressure, sedation and postoperative pain score.

Results:

There was a significant decrease in the onset of action and an increase in the duration of sensory block in Group II. Pain during subtenon injection was significantly less in group III. Sedation Score was higher in Group III, while heart rate showed a significant reduction in the same group. The VAS was significantly decreased in group II. After the end of surgery, the intraocular pressure was significantly decreased in Groups II and III.

Conclusion:

Subtenon dexmedetomidine shortens onset time, prolongs sensory block durations and significantly decreases the postoperative pain score with hemodynamic stability, while, IV dexmedetomidine substantially reduces pain during subtenon block and produces intra-operative sedation.
Assessment of potential predictors affecting preoperative anxiety in Indian children- A prospective observational study
Authors: Mathew Preethy J. , Gopinath Arun M. , Gupta Aakriti , Yaddanapudi Sandhya , Panda Nidhi B. , Kohli Adarsh
Published: May 2023

Background and Aims:

Preoperative anxiety is a common problem among children undergoing surgery. The aim of the study was to assess the incidence and identify various predictors of preoperative anxiety in Indian children.

Material and Methods:

A prospective, observational study was conducted on 60 children of the American Society of Anesthesiologists Physical status 1/2, aged 2–6 years and scheduled for elective surgery under general anesthesia in a tertiary care teaching hospital. Preoperative parental anxiety was assessed using the State-Trait Anxiety Inventory questionnaire. The children’s anxiety was assessed in the preoperative room, at the time of parental separation, and at the induction of anesthesia using modified Yale Preoperative Anxiety Scale (mYPAS) scoring by an anesthesiologist and a psychologist. Sedative premedication was employed prior to parental separation. Logistic regression analysis was carried out to identify the possible predictors of anxiety.

Results:

The incidence of high preoperative anxiety among the studied children was 76% in the preoperative room, 93% during parental separation, and 96% during anesthetic induction. Among the nine possible predictors identified on univariate regression, the presence of siblings was found to be a significant independent predictor on multivariate regression analysis (P = 0.04). The inter-rater agreement was excellent for the assessment of preoperative anxiety using mYPAS by the anesthesiologist and psychologist (weighted Kappa, k = 0.79).

Conclusion:

The incidence of preoperative anxiety in Indian children in the age group of 2–6 years is very high. The preop anxiety escalates progressively at parental separation and induction of anesthesia despite sedative premedication. The presence of siblings is a significant predictor of preoperative anxiety.
Clinical evaluation of preoperative three -item questionnaire and pain experienced on infiltration of local anesthetics to predict severity of acute pain after caesarean section
Authors: Gupta Divya , Kerai Sukhyanti , Saxena Kirti N. , Gaur Saurabh
Published: May 2023

Background and Aims:

Several studies have attempted to identify patients at risk of developing severe pain after caesarean section (CS) by utilizing preoperative experimental pain application and clinical tests. The three-item questionnaire and reported pain intensity on infiltration of local anesthetic (LA) on the back of patient just before administration of spinal anesthesia, are two simple tests previously shown to be promising. We aimed to study utility of these two tools in Indian patients undergoing CS and find their correlation with postoperative pain and analgesic consumption.

Material and Methods:

A total of 150 parturients undergoing elective CS were enrolled. Preoperatively patients were asked to rate their level of anxiety, anticipated postoperative pain and analgesic need after surgery (three-item questionnaire). The pain intensity reported by patient upon LA injection for spinal anesthesia were recorded. In the postoperative period, pain intensity at rest, evoked pain and need for rescue analgesics were recorded. The correlation between three item questionnaire and pain on LA infiltration to postoperative pain were evaluated. To see relationship between the predictor variables to outcome, a multiple regression analysis was performed.

Results:

The predictors variables and postoperative pain were found to have mild correlation (r = 0.124 to 0.239). The predictor variables were significantly correlated with postoperative pain at rest but their association was not significant to evoked pain intensity. Multiple regression analysis showed that change in the predictors explains only 7-8% variance in postoperative pain outcomes.

Conclusion:

The three -item questionnaire and pain intensity reported upon LA infiltration for spinal anesthesia have mild correlation to postoperative pain in Indian parturients undergoing CS. As these variables predicts only 8% variance in pain experienced after CS, further studies are required for accurate prediction and targeted treatment of post CS pain.
Surveillance of central line associated bloodstream infection (CLABSI) – comparison of current (CDC/NHSN) and modified criteria: A prospective study
Authors: Rai Durgesh , Kumar Pravin , Gupta Poonam , Verma Pardeep K.
Published: May 2023

Background and Aims:

There is a huge load of central line–associated bloodstream infection (CLABSI) being reported in developing countries, with increased mortality and healthcare costs. Effective surveillance is a must to reduce the incidence of CLABSI. The current criteria (Centre for Disease Control and Prevention/National Healthcare Safety Network [CDC/NHSN]) for CLABSI surveillance have their own shortcomings. For diagnosing CLABSI, current CDC/NHSN CLABSI surveillance criteria are laborious and time consuming with low predictive power. Hence, modified criteria have been postulated, which are simple and implementable at resource-constrained setups. The primary objective was to compare modified criteria with CDC criteria. The secondary objective was to determine the prevalence of CRBSI.

Material and Methods:

A total of 98 patients with central line in situ or having the central venous line removed ≤24 hrs prior to the date of the event were enrolled. Paired blood cultures were obtained and results were analyzed using differential time to positivity.

Results:

The incidence of CLBSI was 8.16% and the device utilization rate was 11.6%. The negative predictive value of both the surveillance criteria was found to be excellent and comparable (96.2% for modified criteria and 97.1% for CDC criteria), therefore both can be used for screening purposes. AUC for current CDC/NHSN criteria was better than modified criteria (0.76 versus 0.66, P < 0.0001), suggesting it to be a better criterion for surveillance of CLABSI.

Conclusion:

Modified criteria were not superior to CDC/NHSN criteria for surveillance. Thus, there is a scope of improving the modified criteria for the purpose of surveillance. CLBSI load was higher; CLABSI bundle for prevention is thus highly recommended.
Nerve blocks for occipital headaches: A systematic review and meta-analysis
Authors: Evans Adam G. , Joseph Kardeem S. , Samouil Marc M. , Hill Dorian S. , Ibrahim Maryo M. , Assi Patrick E. , Joseph Jeremy T. , Kassis Salam Al
Published: May 2023

Migraine surgeons have identified six “trigger sites” where cranial nerve compression may trigger a migraine. This study investigates the change in headache severity and frequency following nerve block of the occipital trigger site. This PRISMA-compliant systematic review of five databases searched from database inception through May 2020 is registered under the PROSPERO ID: CRD42020199369. Only randomized controlled trials utilizing injection treatments for headaches with pain or tenderness in the occipital scalp were included. Pain severity was scored from 0 to 10. Headache frequency was reported as days per week. Included were 12 RCTs treating 586 patients of mean ages ranging from 33.7 to 55.8 years. Meta-analyses of pain severity comparing nerve blocks to baseline showed statistically significant reductions of 2.88 points at 5 to 20 min, 3.74 points at 1 to 6 weeks, and 1.07 points at 12 to 24 weeks. Meta-analyses of pain severity of nerve blocks compared with treatment groups of neurolysis, pulsed radiofrequency, and botulinum toxin type A showed similar headache pain severity at 1 to 2 weeks, and inferior improvements compared with the treatment groups after 2 weeks. Meta-analyses of headache frequency showed statistically significant reductions at 1 to 6-week follow-ups as compared with baseline and at 1 to 6 weeks as compared with inactive control injections. The severity and frequency of occipital headaches are reduced following occipital nerve blocks. This improvement is used to predict the success of migraine surgery. Future research should investigate spinous process injections with longer follow-up.
The analgesic efficacy of ultrasound-guided transversus abdominis plane block vs. local anesthetic infiltration technique in major gynecologic surgery: A randomized controlled trial
Authors: Ismail Samina , Mistry Akbar A. , Siddiqui Ali S. , Aziz Aliya , Zuberi Nadeem F.
Published: May 2023

Background and Aim:

Transversus abdominis plane (TAP) block and local anesthetic infiltration (LAI) technique are used as part of the multimodal analgesic regimen after abdominal surgery. Postoperative opioid consumption and analgesic efficacy was compared using TAP and LAI techniques in patients undergoing gynecologic surgery in a randomized, controlled clinical trial.

Material and Methods:

Total of 135 patients scheduled for major gynecological surgeries were allocated into three groups: group T received bilateral TAP block with bupivacaine 0.25%; group I received LAI with 0.25% bupivacaine with epinephrine 5 μ/mL in the peritoneum and abdominal wall, and group C was control group. Anesthesia and postoperative analgesia were standardized. Outcome measures were cumulative and rescue tramadol consumption, numerical rating score (NRS) for pain and side effects in post-anesthesia care unit (PACU) at 4, 8, 12 hours postoperatively.

Results:

Tramadol consumption, need for rescue analgesia, and NRS for pain between three groups at 4, 8, and 12 hours postoperatively had no statistically significant difference (P < 0.05). In PACU, median tramadol consumption used for rescue analgesia between group T (15 (15–30)) and group C (30 (15–45)) (P = 0.035), and between group T (15 (15-30)) and group I (30 (15-52)) was statistically significant (P = 0.034). In PACU, the percentage of patients having NRS >4 on movement in group C (72%) compared to group T (46.5%) and group I (46.5%) was significant (P = 0.034). No statistically significant difference was observed in the incidence of side effects among study groups (P > 0.05).

Conclusion:

Except for the immediate postoperative period, neither TAP block nor LAI had added benefit to the multimodal analgesia regimen in patients undergoing gynecological surgeries.
Pattern and Predictors of Internet Addiction among Secondary School Adolescents in Enugu, Nigeria
Authors: Odinka JI , Chinawa AT , Nduagubam OC , Ossai EN , Odinka PC , Ugwunna NC , Chinawa JM
Published: May 2023

ABSTRACT

Background:

Internet addiction has negative effects on adolescents. These range from psychological and social impediments to school absenteeism.

Aim:

To ascertain the pattern of Internet addiction and the factors that predict Internet addiction among secondary school adolescents in southeast Nigeria.

Subjects and Methods:

This was a cross-sectional study that involved 796 secondary school adolescents drawn from six secondary schools in Enugu, Nigeria. The data were analyzed using IBM Statistical Package for Social Sciences (SPSS) software.

Results:

The highest proportion of the respondents (36.3%) had a moderate level of Internet addiction, while the least proportion (2.1%) had severe dependence on the Internet. Adolescents who were less than 15 years of age have 1.1 odds of having Internet addiction when compared to those who were 20 years and above (AOR = 1.1; 95% CI: 0.4–2.8). The respondents who were of the low socioeconomic class were 1.2 times more likely to have Internet addiction when compared with those in the high socioeconomic class (AOR = 1.2; 95% CI: 0.9–1.7). About 20.1% of adolescents were always depressed when they are not using the Internet, while 16.3% of adolescents who were addicted to the Internet developed insomnia.

Conclusion:

There is a rising prevalence of Internet addiction among secondary school adolescents. Younger adolescents tend to be more addicted to the Internet than their older counterparts. A small number of them had severe Internet addiction. A subpopulation of adolescents who were addicted to the Internet presents with depression and sleep disorders.
The Impact of Meteorological Factors on the Spread of COVID-19
Authors: Topaloglu MS , Sogut O , Az A , Ergenc H , Akdemir T , Dogan Y
Published: May 2023

ABSTRACT

Background:

Clinical studies suggest that warmer climates slow the spread of viral infections. In addition, exposure to cold weakens human immunity.

Aim:

This study describes the relationship between meteorological indicators, the number of cases, and mortality in patients with confirmed coronavirus disease 2019 (COVID-19).

Patients and Methods:

This was a retrospective observational study. Adult patients who presented to the emergency department with confirmed COVID-19 were included in the study. Meteorological data [mean temperature, minimum (min) temperature, maximum (max) temperature, relative humidity, and wind speed] for the city of Istanbul were collected from the Istanbul Meteorology 1st Regional Directorate.

Results:

The study population consisted of 169,058 patients. The highest number of patients were admitted in December (n = 21,610) and the highest number of deaths (n = 46) occurred in November. In a correlation analysis, a statistically significant, negative correlation was found between the number of COVID-19 patients and mean temperature (rho = −0.734, P < 0.001), max temperature (rho = −0.696, P < 0.001) or min temperature (rho = −0.748, P < 0.001). Besides, the total number of patients correlated significantly and positively with the mean relative humidity (rho = 0.399 and P = 0.012). The correlation analysis also showed a significant negative relationship between the mean, maximum, and min temperatures and the number of deaths and mortality.

Conclusion:

Our results indicate an increased number of COVID-19 cases during the 39-week study period when the mean, max, and min temperatures were consistently low and the mean relative humidity was consistently high.