bluuebunny/crossref_metadata_2025 huggingface dataset:
The Laparoscopic Surgery Revolution
Authors: Page David W.
Published: October 2023

Written by a surgeon with 40 years' experience in practice and instruction, this book provides vital, up-to-date information that explains the strengths and weaknesses of the laparoscopic surgery field to enable potential surgical patients to make the best decisions and choose a surgeon wisely. More than 30 years ago, laparoscopic or "keyhole" surgery suddenly appeared as an operative technique. Laparoscopy quickly grew in the U.S. surgical field, where now more than two million operations annually use the technique. But is the training surgeons receive in laparoscopy sufficient to ensure patient safety? What are the specific situations where laparoscopy is beneficial and justified, and when is it ill-advised due to the additional complexity and risk factors? This is the first book written for general readers—avoiding medical jargon wherever possible—to expose the gritty history and downsides of "minimally invasive surgery." Additionally, it provides the perspective and insights of an esteemed surgeon who was working at the inception of laparoscopy and has a full understanding of this now widely popular procedure across its development and lifespan. Readers will learn about the emergence of laparoscopic techniques in the 1990s, understand how minimally invasive surgery has been a boon to the business of surgery and to patient health and recovery overall, appreciate how the complexity involved in laparoscopic surgery has led to a higher incidence of surgeon "incompetence," and grasp the responsibility of a patient to take steps to assure that the surgeon is qualified before going into the operating room. Examination of eye-opening statistics on the outcomes of laparoscopic procedures documents the high level of capability of most surgeons, as well as the lack of appropriate ability with certain laparoscopic operations in the hands of some surgeons. The author also spells out how informed patients can be prepared to discuss and consider all aspects of an operation—and the surgeon's training and experience—to assure the best outcome for their health.
Libraries Publish
Authors: Katz Stephanie
Published: October 2023

Publishing benefits libraries by providing high-quality content to patrons, showcasing local writers and faculty, and creating buzz for the library. These endeavors can be launched at any type and size of library, often for little to no cost. Libraries Publish teaches libraries how to publish literary magazines, book review blogs, local anthologies, picture books, library professional journals, and even novels. You'll learn how to run a writing contest or writer-in-residence program, form community partnerships with other literary organizations, find funding, navigate legal considerations, market your publication, and more.
Libraries Supporting Online Learning
Authors: Mune Christina D.
Published: October 2023

Using practical examples from librarians in the field, this book lays out current issues in online learning and teaches librarians how to adapt a variety of library services―including instruction, reference, and collection development―to online education.

Recent studies highlighting the challenges faced by online learners show that skills librarians are uniquely qualified to teach, such as information and digital literacy and source evaluation, can improve academic performance in online courses and enhance the online learning experience.

Just as embedded librarianship was developed to answer the needs of online courses when they emerged in the early 2000s, online learning librarian Christina Mune now teaches "online librarianship" as a set of realistic strategies for serving a variety of online education models. Each chapter of Libraries Supporting Online Learning addresses a different strategy for supporting online students and/or faculty, with all strategies derived from real-world practices.

Librarians will find information on best practices for creating digital literacy tutorials and dynamic content, providing patrons with open access and open educational resources, helping patrons to avoid copyright issues, promoting peer-to-peer learning and resource sharing, posting to social media, and developing scalable reference services. The tools and practical examples in this book will be useful for all educators interested in increasing the efficacy of online learning.

Offers practical strategies to librarians responsible for supporting hybrid and online courses and degree programs as well as MOOCs

May be easily adopted as a library science textbook for those teaching instructional design, instructional technology, distance librarianship, or academic library issues courses

Includes case studies on assessment information and grant writing for administrators and library advocates

Informs all educators interested in increasing the efficacy of online leaning in higher education

Is suitable for inclusion in academic collections supporting library and information science
Library Services for Immigrants and New Americans
Authors: Koerber Jennifer
Published: October 2023

This up-to-date guide to developing and implementing a wide variety of services to immigrants and new Americans focuses on the practical steps of creating and promoting programs. Illustrated by success stories in libraries throughout the country, the book discusses both traditional (ESOL and citizenship classes) and transformative (legal aid and workforce development) programs and services in terms of size, type, and local political climate (e.g., sanctuary cities) at a variety of public libraries as well as in select school libraries.

As changes unfold in regard to how the federal government and local communities view and treat immigrants and new Americans in their midst, this topic deserves a fresh take from the profession. The author meets that need, providing practical ideas that range from creating more accessible websites and improving wayfaring and customer service in order to overcome cultural roadblocks to dealing with backlash in communities as libraries extend outreach and partnership-building goals.
Lies
Authors: Smith Rachelle M.
Published: October 2023

This encyclopedia examines the phenomenon of deception from a variety of perspectives and in a multitude of contexts. It offers readers an accessibly written and engaging resource that sheds light on when, why, and how we lie.

Ironically, it seems to be a universal truth that everyone lies. From innocent “white lies” to elaborate deceptions, humans appear to be hard-wired for dishonesty. But what psychological or evolutionary purpose does lying serve? What motivates us to lie, and what effects do such lies have on those around us and on our own physiology and mental health? What are the differences between types of lies, and how do various forms of dishonesty manifest themselves in such areas as politics, advertising, and social media? And, perhaps most importantly, how can we spot liars in our everyday lives and encourage those around us—and even ourselves—to be more honest?

Lies: The Science behind Deception provides a broad and multifaceted introduction to this fascinating topic. More than 175 entries address the many forms of lying, the purpose and development of such behaviors, and their consequences. It also includes practical sidebars that help readers to deal with lying and liars in their own lives.
Life after Foster Care
Authors: Jones Loring Paul
Published: October 2023

This book apprises readers of the present conditions of former and emancipated foster youth, provides evidence-based best practices regarding their experiences, and proposes new policies for ensuring better outcomes for these children upon discharge from foster care

For most American youth, the transition to adulthood is gradual and aided by support from parents and others. In contrast, foster youth are expected to arrive at self-sufficiency abruptly and without the same level of support. Such an expectation may be due in part to what Loring Paul Jones has found in his research: that many of the studies conducted thus far have been fragmented and incomplete, often focusing on a particular state or agency that may follow policies not applicable nationwide.

This book connects the dots between these disparate studies to provide child welfare practitioners, policy makers, and students with a broader picture of the state of American youth following discharge from foster care. It examines not only child welfare policies but also related policies in areas such as housing and education that may contribute to the success or failure of foster youth in society. It additionally draws lessons from successful programs to provide readers with the tools needed to develop foster and after-care systems that more closely mirror the support afforded to youth in the general population.
Makers with a Cause
Authors: Seymour Gina
Published: October 2023

This quick-start guide explains how to use inquiry to promote civic engagement in the school library makerspace and provides ready-to-use ideas for hands-on service projects.

By creating for their community in the school library makerspace, young people not only develop academic and cognitive skills but also learn to value building a culture of caring. Award-winning author Gina Seymour discusses her initiative to empower students to take an active role in making a difference and outlines how to implement similar programs in any school library setting.

The book may be used in school libraries in conjunction with a service learning model to extend the learning that takes place in classrooms and to make youth feel a valuable part of their community. Numerous service project ideas are presented, from simple, low-cost, no-tech, craft-based ideas to high-tech projects including 3-D models, and while the book focuses on youth in middle school and high school, many projects may also be used in elementary school. Detailed project instructions include tips for making programs inclusive for all youth, and money-saving tips to promote sustainability.
Making Surveys Work for Your Library
Authors: Miller Robin , Hinnant Kate
Published: October 2023

Instead of using expensive off-the-shelf surveys or relying on a poorly worded survey, read Making Surveys Work for Your Library and design your own that collect actionable data.

Library listservs and websites are littered with examples of surveys that are too long, freighted with complex language, and generally poorly designed. The survey, however, is a widely used tool that has great potential if designed well. Libraries can implement surveys for a variety of purposes, including planning, program evaluation, collection development, and space design.

Making Surveys Work for Your Library: Guidance, Instructions, and Examples offers librarians a contemporary and practical approach to creating surveys that answer authentic questions about library users. Miller and Hinnant have experience designing, deploying, and analyzing quantitative and qualitative data from large-scale, web-based user surveys of library patrons as well as smaller survey instruments targeted to special populations. Here, they offer library professionals a guide to developing―and examples of―concise surveys that gather the data they need to make evidence-based decisions, define the scope of future research, and understand their patrons.

Create practical surveys you can use immediately in your professional work

Design effective survey questions that will give you the information you need

Develop a survey with a clear objective

Model your surveys on sample surveys and questions
Malignant Narcissism
Authors: Smith Cary Stacy , Hung Li-Ching
Published: October 2023

In this book, a psychologist and a professor detail the history, psychology, and effects of this little-studied condition that has altered individuals and societies worldwide, arguing that the disorder deserves its own classification.

Psychoanalyst Erich Fromm in 1964 developed the term “malignant narcissism,” believing it to be the worst form of psychopathology, a disorder that essentially epitomized evil. Malignant narcissism, however, has never been identified as a clinical condition in the Diagnostic and Statistical Manual of Mental Disorders; instead, it is seen as a conglomeration of several other disorders.

Yet researchers since Fromm have described malignant narcissists as unique in their callous nature and proclivity to extreme violence, with a component of sadism bringing them pleasure when inflicting pain. The largest concern about malignant narcissists is that “some have the ability and wherewithal to rise to great positions of power and influence” and to affect large numbers of people.

Authors Smith and Hung explain the differences between malignant narcissists, “everyday” narcissists, and psychopaths, illustrating these conditions with vignettes of historic public figures and people in popular culture, among others.
Materials, Methods, and Masterpieces of Medieval Art
Authors: Benton Janetta Rebold
Published: October 2023

A comprehensive and informed analysis explores the startlingly diverse and sophisticated fine arts in the Middle Ages. Materials, Methods, and Masterpieces of Medieval Art provides a comprehensive and detailed analysis of the work done by artists in western Europe during the Middle Ages.

Materials, Methods, and Masterpieces of Medieval Art provides a comprehensive and detailed analysis of the work done by artists in western Europe during the Middle Ages. Art historian Janetta Rebold Benton uses examples such as the Book of Kells, Bury Saint Edmunds Cross, and the Bayeux Tapestry, and the work of artists such as Jan van Eyck and Giotto to explore the various media available to medieval artists and the ways in which those media were used to create a stunning array of masterworks.

Although the visual arts of the Middle Ages were extremely colorful, today much of that color has diminished or disappeared, the pigments and threads faded, the gold abraded, the silver tarnished. Materials, Methods, and Masterpieces of Medieval Art allows these works to sparkle once more.
Mindful School Libraries
Authors: Stephens Wendy
Published: October 2023

Learn how to promote mindfulness in your school library. Complement efforts in the classroom to work on social-emotional learning and understand the affective needs of young people in library settings. Given the national climate of anxiety and fear, climbing diagnoses of neurological difference, and overall sensitivity, fewer young people come to school able to self-soothe. Building on the work of Nel Noddings, Lynne Evarts, and Meghan Harper, this book focuses on the deliberation, quiet, and reflection sometimes described collectively as mindfulness. From breathing exercises to meditation, mindfulness exercises can be a coping mechanism for at-risk students, and librarians can create an environment, away from the classroom, in which students can explore their abilities to regulate and control their social and emotional responses, skills that underpin information retrieval and analysis. The role of school libraries in promoting mindfulness in the twenty-first century could parallel the quest for intellectual stimulation and self-improvement that informed the public libraries movement in the late nineteenth century. Providing practical suggestions for working in concert with classroom teachers, school counseling staff, and community partners, this guide will inform librarians' practice by increasing awareness of how to create a nurturing space for students in the school library.

• Highlights how mindfulness strategies have been successfully implemented in classroom and library spaces

• Recommends a range of easy-to-implement, no- or low-cost adjustments to space and services that can make the library experience more inclusive and positive

• Harnesses the increasing interest in social-emotional learning and how that undergirds student readiness to learn and confidence as a learner
Murder Mystery, Graphic Novels, and More
Authors: Benson Thane
Published: October 2023

This book offers step-by-step details on how to plan and execute library workshops and programs to inspire creativity in teens.

Music, movies, graphic novels, and magazines for teens are now commonplace in libraries, and librarians are in a unique position to go beyond simply providing teens with access to them; they can engage teens in creating and sharing their own original content. Written in a light, accessible manner, this book empowers youth services librarians to do just that.

Murder Mystery, Graphic Novels, and More provides instruction on hosting creative workshops dedicated to creating and publishing graphic novels; writing and performing interactive murder mystery events; creating animation films; and more―all within a reasonable budget. The chapter on creating graphic novels is itself an original graphic novel drawn by the author, who is also a comic book artist, and a portion of the book lists and explains different "creativity games" both short and long that may be used as everything from icebreakers to exercises to programs in their own right.
Negotiating at Home
Authors: Kurtzberg Terri R. , Kern Mary C.
Published: October 2023

Why do parents who can pull off multi-million dollar deals at work then go home and stumble with their kids?

Parents spend an awful lot of time negotiating with their kids—over everyday requests, rules and policies, and big decisions, and often end up derailed and frustrated. In Negotiating at Home, Kurtzberg and Kern offer parents a chance to look more closely at what they already do well (and why) and what can be done better. Grounded in decades of research on how to negotiate effectively, parents will learn about how to plan, recognize specific tactics, communicate and work in partnerships with other family members, address fairness, and handle conflict.
A New Psychology Based on Community, Equality, and Care of the Earth
Authors: Blume Arthur W.
Published: October 2023

A biographical encyclopedia of American and British Christian-themed writers from World War II to the present, covering acclaimed literary works and popular evangelical fiction.

Encyclopedia of Contemporary Christian Fiction: From C.S. Lewis to Left Behind spans the entire breadth of Christian-themed British and American writing from World War II to the present—well-known and less familiar authors, acclaimed literary novels, and popular writing in a variety of genres (mysteries, thrillers, romances), works that explore matters of faith, works that challenge orthodoxy and church practices, and works wholly written by and for devout evangelicals.

Encyclopedia of Contemporary Christian Fiction offers 90 alphabetically organized entries covering the field’s most important writers. Each entry includes a brief biography, religious and educational background, a survey of major works and themes, and a summary of critical response, as well as a bibliography of major works and criticism. By examining evocative, sometimes overlooked Christian elements in modern fiction, and by exploring the depth and scope of popular evangelical fiction, Encyclopedia of Contemporary Christian Fiction offers the richest, most complete portrait of the role of faith in modern English writing ever published.
News Literacy
Authors: Luhtala Michelle , Whiting Jacquelyn
Published: October 2023

At a time when misinformation in the media is abundant, this book explains the difficulty in nurturing students to become critical researchers and offers practical lessons that empower students to excavate information that will help them learn.

This guide to teaching news literacy explores a wealth of resources and classroom-tested lessons that educators in grades 7–12 can use in their own libraries and classrooms. To introduce the concept of news literacy, the authors explain the steps of the inquiry and research process in detail and examine the Stanford History Education Group (SHEG) 2016 report "Evaluating Information: The Cornerstone of Civic Online Reasoning" and related research studies.

Lesson plans corresponding to each stage of the process are coordinated to relevant standards from the CCSS and ISTE and are accompanied by rubrics for providing students feedback on their progress as well as samples of student work as it evolved through the stages. Furthermore, the authors' anecdotal insights from their experiences in collaboratively implementing the lessons with colleagues are an invaluable addition for any librarian seeking to work with teachers to help students become critical researchers.
Parenting and Child Development
Authors: Khaleque Abdul
Published: October 2023

This research-based book covers the core components of modern parenting and child development across multi-ethnic and cross-cultural contexts in Asia, Africa, Europe, and North and South America, with a focus on the United States. Parenting and Child Development: Across Ethnicity and Culture is based on a cohesive framework that links physical, psychological, social, cognitive, and emotional aspects of children's lives to their experiences of parental behavior. This book covers the fundamentals of parent-child relationships, including the theoretical perspective of parenting, positive and negative parenting behaviors, and changing patterns of parenting from infancy through adolescence. Explored are parent-child relationships and their implications for children's health, well-being, and quality of life in different family forms, including parenting in drug-addicted families, homeless families, cohabiting families, single-parent families, and LGBT families around the world. Using an array of theories with relevant empirical findings, the practical implications for child development both within the United States and across the globe are highlighted. Also included is specific information about tools and techniques for measuring intimate relationships and intervention strategies for relationship problems.
Partnering with Parents
Authors: Schreiber Mary
Published: October 2023

Libraries offer many programs and services for children, but sometimes caregivers are left out of the equation, especially once children start school. Nevertheless, parents and caregivers are an integral part of literacy development, and libraries are a great place for them to witness modeling practices and participate in engaging family programs that encourage early literacy.

Mary Schreiber combines personal experience and professional research with the programming expertise of youth librarians from across the country in this guide for libraries looking to make an even greater impact on the level of literacy attained by the children they serve.

In Partnering with Parents, readers will find a wealth of information on how to talk to caregivers about the different stages of a child’s reading life, what books to recommend to excite both caregivers and children about reading, and ways to encourage parent and caregiver participation in library programming, with additional information on working with and providing programming for diverse families. Whether you are a veteran in the profession or brand new to working with families, you will find something in this book that will help you to make your library a more integral part of the education community.
The Passive Programming Playbook
Authors: Willey Paula , Amaral Andria L.
Published: October 2023

This book offers 101 passive programming ideas that are extendable, adaptable, customizable, and above all, stealable–so your passive programming never runs dry.

Passive programming is a cheap, quick, fun way to make all library customers feel like part of the community. It can support reading initiatives, foster family engagement, encourage visit frequency, and coax interaction out of library lurkers–while barely making a dent in your programming budget. Passive programming can be targeted at children, teens, adults, or seniors; used to augment existing programs; and executed in places where staff-led programming can’t reach. It can be light-footed, spontaneous, and easily deployed to reflect and respond to current news, media, library events, and even the weather. But even passive programming pros run out of ideas sometimes, and when that happens, they want a fresh, funny source of inspiration.
Patent Law Essentials
Authors: Durham Alan L.
Published: October 2023

This essential desk reference for patent attorneys, engineers, entrepreneurs, innovators, development professionals, and students has been updated with the latest court cases and legislation. In a world in which businesses thrive on innovation, it is more important than ever to understand the sometimes arcane rules through which human ingenuity becomes intellectual property. Although many reference works on patent law exist, they are written for specialists. Through clear writing, specific examples, and focus on the fundamentals, Patent Law Essentials: A Concise Guide makes the basic rules of patent law accessible to businesspeople, engineers, students, and others who need to understand the rules of a notoriously complicated game. Patent Law Essentials begins with an overview of patent law and other aspects of intellectual property and then guides the reader through an example of an actual patent—one literally claiming "a better mousetrap." The chapters that follow discuss the types of inventions that can be patented (recently a subject of much dispute), the process of applying for a patent, the requirements of a valid patent, and the procedures for determining if a patent has been infringed upon. The appendix includes several examples of actual U.S. patents, including the mousetrap patent discussed in detail in the early chapters.
Peak Plastic
Authors: Buffington Jack
Published: October 2023

Shows why plastics, in aggregate, have become a toxin to humans, wildlife, and the planet, and proposes novel solutions that involve neither traditional recycling nor giving up plastic. “Plastics!” In the 50 years since Dustin Hoffman's character in The Graduate was instructed that this was the career field of the future, we have not been able to escape this ubiquitous but poorly understood material. Author Jack Buffington argues that the plastics crisis is careening toward a tipping point from which there will be no return. There is still time, however, to do something about this crisis if we have the imagination and the will to move away from the failed policies of the past.

This book is the first to propose a new model for linking our synthetic world to the natural one, rather than seeking to treat them as separate entities. The key is supply chain innovation. Buffington presents five market-based solutions based on this principle that will allow consumers to continue to use plastic, which has in many ways enabled our way of life. Alongside these proposed solutions, he also addresses the proliferation of plastic as we know it—growth that, if left unchecked, will lead to a “planetary crisis,” according to the United Nations—and considers how the material itself might be adapted for a sustainable future.
The Politics of Loopholes
Authors: Witte John F.
Published: October 2023

What are the implications and likelihood of reform of the income tax system in the United States—specifically, the expansion and scope of the tax “expenditure” (loophole) system embedded in the income tax codes? This book details the tax system that now provides for more than 200 tax expenditures, highlighting the potential lost tax dollars.

Income tax policy and politics is an inherently complex and potentially confusing topic. This book makes the tax loophole system understandable for those without in-depth knowledge about taxes. It explains what our tax system looks like, why it is set up as it is, and what effects it has on raising revenue (and thus deficits) and the furtherance of other policy goals. Additionally, it explains why, despite popular and political desires, a significant overhaul of the tax system is very unlikely to be enacted: because tax expenditures (otherwise known as loopholes) benefit all Americans in some way and are supported as policy by both political parties.

Written by John F. Witte, an established expert in tax policy and policy analysis, the book provides a balanced viewpoint that discusses the implications of reform of the income tax system in the United States, demonstrates the range of individuals who are affected by various provisions, and identifies what effects loopholes have on policy goals. Readers will see how both political parties are responsible for the creation and expansion of various loopholes, understand why many of these provisions make sound policy sense, and grasp how the tax code is affected by political desires and policy goals.
The Power of Story
Authors: Wink Joan
Published: October 2023

Through this book, readers will discover that stories can move the human heart and head in ways that research cannot. Stories bring together readers, writers, librarians, teachers, students, and families in the libraries of today and will continue to do so tomorrow. Written for all those lovers of literacy, this book links libraries and literacies through the power of stories. The book is not filled with data in the form of pie charts, graphs, and tables. Rather, the truth of the research is grounded in authentic stories that reflect not only the interpretation of data, but also the transformative nature of literacies and libraries. The author's primary goal is that readers will come to value and use storytelling in their own professional and personal lives to explain and expand on complex concepts and to make information more accessible for all. The book begins by presenting anecdotes and the author's personal story to lay the foundation for what literacies are, and what literacy is not. An activity, "Spiral of Literacy," allows readers to reflect on their own literacies. Chapters that follow each begin with a story that sets the theoretical foundation. Each chapter concludes with an action section that demonstrates how to turn theory to practice, whether you are in a library, a classroom, or at home. A final chapter envisions what libraries might look like in 10 years, through interviews with librarians, teachers, and others interested in literacy.
AI in Medical Research – Chatgpt and Beyond
Authors: Bhatti Ahsin Manzoor
Published: October 2023

Artificial intelligence (AI) has taken the world by storm and has even been referred to as the “new electricity”.1It powers voice assistants like Apple’s Siri and Google’s Alexa to “understand” and respond to voice commands. Recom-mendation systems in Facebook, Netflix, YouTube, and other social media platforms also use AI algorithms. AI systems are machine and software systems designed to perform functions requiring human intelligence, like face recognition, understanding language, decisionmaking, etc. It analyses large amounts of data and selflearning.2 One of the most interesting advancements in AI is the development and success of Large Language Models (LLM). These algorithms and software are trained to generate human-like language. Currently, the most popular amongst them is Chat GPT (Chat Generative Pre-trained Transformer), developed by Open AI©. While this was initially designed to have enhanced chat capabilities, it was quickly realized that it could do much more. It mesmerized young students, scholars, and researchers in various fields.
The Role of Citicoline in Neuroprotection and Neuro Repair in Acute Stroke
Authors: Shaukat Nabila , Nisar Shazia , Jan Osman Ali , Sajid Usman , Mahmood Amjad , Zahid Huma
Published: October 2023

Objective: To determine the efficacy and safety of Citicoline in acute stroke.

Study Design: Comparative cross-sectional study.

Place of Study and Duration: Combined Military Hospital, Jhelum Pakistan, from Dec 2017 to May 2018.

Methodology: Thirty patients with a new onset of stroke, either ischemic or hemorrhagic, were included in the study. This sample of the population was further categorized into four Groups based on the National Institute of Health Stroke Scale scoring system. Half of the patients were medicated with Citicoline and standard stroke treatment and were examined as cases. The rest of the patients were treated with standard stroke management alone and were examined as Controls. The baseline guidelines of the patients were assessed by the Canadian Neurological Stroke Scale. However, for ease of comparison, the CNSS was converted into the National Institute of Health Stoke Scale using the following formula: NIHSS=23-2xCNSS.

Results: In our study, baseline improvement in NIHSS score was higher in the Citicoline Group than in the Control Group(68% in the case Group vs. 53% in the Control Group). There was a 30% drop in NIHSS score in Cases compared to the ControlGroup (p>0.05).

Conclusion: This study could not prove the effectiveness of Citicoline despite a favourable improvement in NIHSS score in cases. Though Citicoline is a well-tolerated and safe drug, it is ineffective in improving neurological outcomes in patients with acute stroke.
BRCA Associated Protein-1 Immuno-Histochemical Stain in Diagnosis of Malignant Mesothelioma
Authors: Sarwar Saud , Mushtaq Sajid , Hameed Maryam , Hassan Usman , Maqbool Hina
Published: October 2023

Objective: To differentiate malignant mesothelioma from benign mesothelial proliferations and other histological mimickers such as adenocarcinoma and squamous cell carcinoma, utilizing BRCA Associated protein1 (BAP1) immune-histochemical stain.

Study Design: Retrospective longitudinal study.

Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore Pakistan, from 2015 to 2020.

Methodology: We examined BAP1 IHC expression in 82 cases, including 56 malignant mesotheliomas, 12 Adenocarcinomas, and 14 Squamous cell carcinomas. Fifty-six malignant mesotheliomas included 49 epithelioid, 6 Biphasic and one sarcomatoid subtype. Loss of expression was established for cases showing complete loss of nuclear staining.

Results: Of 56 malignant mesotheliomas, 38(67.85%) showed loss of BAP1 expression, whereas 18(32.14%) showed retained expression. Of 12 adenocarcinoma cases, 10(83.33%) showed retained expression. Similarly, out of 14 squamous cell carcinomas, 12(85.71%) showed retained expression.

Conclusion: Loss of nuclear expression of BAP1 IHC serves as a valuable diagnostic ancillary tool in distinguishing malignant mesothelioma from its histological mimickers.Keywords: BAP1, Immunohistochemistry, Malignant mesothelioma.
Diagnostic Accuracy of Ultrasound to Differentiate Neoplastic and Non-Neoplastic causes of Cervical Lymphadenopathy taking Histopathology as the Gold Standard
Authors: Shafi Aqeel , Zameer Shahla , Malik Muhammad Nauman , Liaqat Rabia , Liaqat Bushra , Liaqat Asiya
Published: October 2023

Objective: To evaluate the efficacy of high-resolution ultrasound and colour Doppler in differentiating neoplastic and nonneoplastic causes of cervical lymphadenopathy compared to histopathological diagnosis.

Study Design: Cross-Sectional study.

Place and Duration of Study: Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jan to Jun 2019.

Methodology: The study included 110 patients with palpable cervical lymph nodes undergoing neck ultrasound and Fine needle aspiration cytology/Biopsy. Certain important sonological features were considered to categorize them into nonneoplastic and neoplastic groups. Colour Doppler imaging was employed along with grey-scale imaging. The histopathology results were compared with sonographic findings to determine the diagnostic accuracy of ultrasound in differentiating neoplastic from non-neoplastic causes of enlarged cervical lymph nodes.

Results: Our study revealed that High-resolution sonography has 94.4% sensitivity and 88.8% specificity, differentiating between neoplastic and non-neoplastic causes of cervical lymphadenopathy. At the same time, the overall accuracy of ultrasound is 90.9%. The most consistent grey-scale feature in the non-neoplastic nodal group was preserved central fatty hilum, while its loss was significantly associated with neoplastic etiologies.Conclusion: Due to high sensitivity and negative predictive value, high-resolution sonography can be deployed as a first-line investigating tool for enlarged lymph nodes, and invasive procedures like Fine needle aspiration cytology (FNAC) can be abandoned in non-neoplastic lymphadenopathies.
Clinical Manifestations of COVID-19 Infection in Persons with Disabilities (PWDs) at Inpatient Rehabilitation Center –A Hospital-Based Study
Authors: Khalil Muhammad Tawab , Akhlaque Uzma , Ahmad Khalil , Yasmin Rehana , Younas Umer , Irshad Imran
Published: October 2023

Objective: To describe clinical manifestations of COVID-19 infection in Persons with disability (PWD) in Pakistan.

Study Design: Cross-sectional study.

Place and Duration of Study: Inpatient Rehabilitation Facility (IRF) of Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, from Feb to Oct 2021

Methodology: All PWDs admitted in IRF of AFIRM who tested positive for COVID-19 infection were included by convenience sampling. Patients who tested negative for COVID-19 by PCR were excluded. Data of patients and laboratory and radiological investigations, were recorded. Follow-up after one month was done via phone call.

Results: Twenty patients tested positive for COVID-19, of which 20(95%) were males. The mean age of patients was 38.6 ± 2.5 years. Most patients had Spinal Cord Injuries followed by amputations, and five had co-existing disorders. 11(52.4%) of patients were asymptomatic. Fever, myalgias and cough were common among symptomatic patients. Those who were symptomatic had only one symptom at the time of presentation. All patients had mild disease and recovered gradually without complications at one month of follow-up.

Conclusion: A high index of suspicion of SARs CoV-2 infection should be kept when PWDs present with myalgias or fever inthe current scenario and post-COVID-19 era since PWDs have fewer symptoms of COVID-19 as compared to their peers.Keyswords: Amputations, COVID-19, Pakistan, Persons with disability, Spinal cord injury.
Efficacy of Perineural versus Systemic Dexmedetomidine as an Adjuvant to Bupivacaine for Surgical Anesthesia in Axillary Block
Authors: Majeed Kaukab , Hafiz Amran , Malik Usman Eijaz , Hussain Fayyaz , Saqib Najm Us , Gulraz Amna
Published: October 2023

Objective: To compare the analgesic effect of different routes of Dexmedetomidine when given as an adjuvant to Bupivacaine in the axillary block for surgical correction of radius fracture.

Study Design: Quasi-experimental study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Sep 2021 to Feb 2022.

Methodology: The patients were divided into two equal groups. Group-A (Perineural Dexmedetomidine) and Group B (Intravenous Dexmedetomidine). Group-A received 1ug/kg Perineural Dexmedetomidine along with 30ml of racemic Bupivacaine (0.5%), and Group-B participants received 1ug per kg intravenous Dexmedetomidine after axillary block with 30ml of 0.5% perineural racemic Bupivacaine. The mean duration of analgesia was the primary outcome, and adverse outcomes and sedation were the secondary outcomes.

Results: The duration of analgesia was greater in the perineural Dexmedetomidine Group, with a mean duration of 610.20±29.92 minutes in comparison to the systemic Dexmedetomidine Group, which was 449±39.010 minutes, with pvalue<0.001. Numerical rating scores were higher, and sedation scores were lower in the perineural Dexmedetomidine Group, making it a safer choice.

Conclusion: Perineural Dexmedetomidine is superior to intravenous Dexmedetomidine when used as an adjuvant to Bupivacaine in axillary brachial plexus block. It prolongs analgesia and is a safer alternative to intravenous Dexmedetomidine as an adjuvant.
Comparison of Post-operative analgesia with Bupivacaine versus Ropivacaine for Caudal block in pediatric patients
Authors: Leghari Khursheed Hassan , Ahmed Altaf , Ahmed Usman , Ranjha Ahsan Javed , Tiwana Zaheer Ud Din , Hussain Aftab
Published: October 2023

Objectives: To compare the post-operative pain relief with Bupivacaine and Ropivacaine for caudal block in children in terms of mean duration of analgesia.

Study design: Prospective comparative study.

Place and duration: Department of Anesthesia, Combined Military Hospital Rawlakot from July 2021 till June 2022.

Methodology: A total of 100 patients undergoing infra-umbilical Surgery as circumcision, herniotomy, orchidopexy and of age 1 to 10 years were included. After induction of general anesthesia, caudal block was given. Group B patients were given 1 ml/kg of 0.25% bupivacaine whereas group R patients were given 1 ml/kg of 0.25% ropivacaine. Modified Hnnallah Pain Score was used to observe the post-operative analgesic effects of the block. Score was noted every 30 minutes. Pain free duration was considered from time of caudal block till the modified Hannallah pain score of 4 or more. Injectable paracetamol 10 mg/kg was given as rescue analgesia as required.

Results: Demographic data was comparable in both groups with no statistical significance. In our study, we have found duration of analgesia as 219.78 ± 35.42 minutes in the bupivacaine group compared with 198.24 ± 34.5 minutes in patients with ropivacaine group with p-value of 0.54 which is statistically significant.

Conclusion: In this study, we concluded that the ropivacaine is as effective as bupivacaine in terms of post-operative pain relief for caudal block in children.
Do Hematocrit Levels Differentiate between Complicated and Uncomplicated Dengue Fever?
Authors: Furrukh Muhammad , Ayaz Saeed Bin , Ayaz Fatima , Rahman Fawad , Ambreen Saima , Rahman Fazal Ur
Published: October 2023

Objective: To compare mean hematocrit levels in patients with uncomplicated and complicated Dengue Fever and evaluate the role of hematocrit in differentiating uncomplicated and complicated Dengue Fever.

Study Designs: Prospective longitudinal study.

Place and Duration of Study: Department of Infectious Diseases, Holy Family Hospital, Rawalpindi Pakistan, from Oct 2019 to Sep 2020.

Methodology: Around 240 dengue patients were enrolled. Hematocrit level at presentation was measured using an automated haematology analyzer. The patients were then followed for the development of complications (Dengue hemorrhagic fever and Dengue shock syndrome).

Results: Of 240 patients, 183(76.2%) were male, and 57(23.8%) were female. Dengue Fever was present in 96(40%) patients, whereas 144(60%) patients developed complications (Dengue Hemorrhagic Fever and Dengue Shock Syndrome). The mean hematocrit level at presentation significantly differed among the groups (p=0.012). Following the ROC curve analysis, for the cut-off value of 42.6% of hematocrit Group II had a sensitivity of 56.25% and a specificity of 62.5% at an Area under the curve of 0.589.

Conclusion: The mean hematocrit levels were significantly higher in patients with complicated versus uncomplicated Dengue Fever. Hematocrit could not be projected as a predictor of Dengue Fever severity.
Relationship of Peripheral Vestibular Deficits with Metabolic SyndromesAn Experience at CMH Q
Authors: Ayub Zeeshan , Ahmed Azeema , Saeed Irfan , Bashir Saima , Malik Usman Afzal , Iqbal Hamid
Published: October 2023

Objective: To observe the association between metabolic syndromes and vestibular disturbances.

Study Design: Cross sectional study.

Place and Duration of Study: Departments of ENT & Pathology, Combined Military Hospital, Quetta Pakistan, from Apr 2020 to Jul 2022.

Methodology: The presence of diabetes mellitus and hyperlipidemias was studied in three hundred and twenty-seven cases of peripheral vestibular diseases. Vestibular disorders comprise benign paroxysmal positional vertigo, vestibular neuritis and Meniere’s disease.

Results: In three hundred twenty-seven cases evaluated, glycosylated haemoglobin was raised in 201(61.4%) cases (p-value of0.001), and serum lipid levels were elevated in 180(55%) cases (p-value=of 0.068).

Conclusion: Patients with diabetes mellitus have a significant chance of developing peripheral vestibular disorders.Keywords: Diabetes mellitus, Hyperlipidemias, Peripheral vestibular diseases.
Characteristics and endoscopic ultrasound findings of gastrointestinal lesions: single-center experience
Authors: Kurt İdris , Albayrak Doğan , Kula Osman , Soylu Ali Rıza
Published: October 2023

Aims: We aimed to present the characteristics, indications, endoscopic ultrasonography procedure details, diagnoses and complication rate of patients who underwent endosonpgraphy in a single center.
Methods: Forty six patients admitted to Trakya Unversity Faculty of Medicine and underwent EUS (±FNA) procedure between January 2021 and May 2022 were included in the study. Patients files were analysed retrospectively. Demographic characteristics, presence and types of comorbidity, presence and types of malignancy in the family, use of antithrombotic drugs, laboratory data, details of eus procedure, pathology results, adverse events were recorded. The data obtained in the study were analyzed using Statistical Package for Social Science for Windows 26 package program.
Results: A total of 46 patients were included in the study. 46% (n=21) were women. The median age was 64 (28-87). Antithrombotic use was present in 25% of the patients. Comorbidities were present in 84% of patients. The indications for EUS were predominantly pancreatic lesions (n=31). Aspirations were performed in addition to ultrasonographic examination in 78% (n=36) of the patients. 19 G (Gauge) needles were used in 30 and 25 G needles were used in 6 patients. Biopsy stations were stomach (n=31), duodenum (n=4), esophagus (n=1). Median long axis of the lesions was 34 (7-173) mm and the short axis was 26 (1-76) mm. 42% of the biopsied pancreatic lesions were cystic and 58% were solid. The CA19-9 level in solid lesions was statistically significantly higher than cystic (1512 /28 U/ml; p= 0.008). CA19-9 level was found mean 2061±3295 U/ml in patients with adenocarcinoma (n=8), 71±106 U/ml in cystic neoplasm and 152±338 in benign disorders (p=0.026). Cut-off value predicting adenocarsinoma with %87,5 spesifity and %87,5 sensitivity in our cohort was 174 U/ml (( AUC 0.85 ( 0.63-1)). Spesifity and sensitivity of the level 40 ( nearest level to universaly detected upper limit: 37 U/mL) was %62,5 and %87,5 respectively. Comparing malignant and benign lesions of pancreas overall, no statistical significance was found of CA19-9 level in predicting the diagnosis of tumor (p=0.15). Of the patients who underwent biopsy, 61% were malignant and 39% were benign. Malignant diagnoses were: adenocarsinoma, cystic neoplasm, gastrointestinal stromal tumor, neuroendocrine tumor, mesenchymal tumor, lumphoma, metastasis. Benign diagnoses were: otoimmune pancreatitis, normal cyst, chronic pancreatitis, pseudocyst, walled-off necrosis, polyp, no lesion. Post-procedure complications were not observed in any of the patients.
Conclusion: The availability of endoscopic ultrasonography is expanding nowadays. Endoscopy ultrasonography is a precise, advantageous, and risk-free technique when performed by trained personnel.
ACTUALIZATION OF CONCEPT “EVIL” IN “A SONG OF ICE AND FIRE” BY GEORGE R. R. MARTIN
Authors: BADALYAN LILIT , STEPANYAN MELINE
Published: October 2023

The paper aims to study the concept “Evil” in the book series “A Song of Ice and Fire” by George R.R. Martin. Linguo-stylistic analysis of the selected examples has been conducted, focusing on different manifestations of evil as symbolized by various characters. The extracted examples from the book series are discussed with a special emphasis on the nouns, verbs and adjectives, as well as stylistic devices that manifest evil in figurative ways.