bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Cultural and Personal Trauma in Heather Raffo’s Play Noura
Authors: Enas Subhi Amer Asst. Prof. , Esraa Jalal Jawad Al-Gawahari Rese.
Published: February 2025

The paper delves into the examination of trauma portrayals in Heather Raffo's “Noura” (2019). Raffo examines the challenges faced by two Iraqi women, Raffo and Maryam, in relation to parenthood following the capture of Iraq by “ISIS”. The paper is concerned with the various depictions of trauma that Raffo accomplishes in the text then delves in the way she cocooned her characters’ identity in order to recover their traumas. Initially, Noura is a trauma tale, illustrating the recurrent and repetitive nature of trauma from mother to daughter. The narrative reflects the interactions and dynamics between the mother and daughter and their function as substitutes for memory and recounting personal narratives. Moreover, examining the capture of Mosul by “ISIS” highlights Noura's account as a portrayal of historical trauma. Subsequently, Noura is analyzed via the lens of cultural trauma, shedding light on the several personas that Raffo adopts throughout the story. As each character has their own unique perspective on how the fall of Iraq affected their life, Raffo has used a variety of identities to show how trauma can take many forms depending on cultural context. The personal anguish portrayed by Raffo, as well as her own connection to both Iraqi and American identity, which is explored through the main character and the storyline, is also revealed. This analysis sheds light on the experiences of Iraqi women in America, highlighting how their cultural affinity with these stories serves as a catalyst for creative expression.
A Feminist Apology for Contemporary Romance Literature-Exploring Masochism and the Internalized Male Gaze in Todd’s After
Authors: Ziead Dhirgham Al-Khafaf Lect. Dr.
Published: February 2025

The unprecedented popularity of the After series by Anna Todd has prompted a space for conversations surrounding popular contemporary romance fiction for young adults and the factors guaranteeing its success. This research paper sets out to explore how the popularity of After must ring certain alarm bells for the contemporary feminist discourse since it directly undermines everything that the feminists criticize when it comes to representations of women by male authors. The analysis section reveals how despite being a woman herself, Todd has penned her novel from an internalized male gaze that divests the female protagonist Tessa of any agency and reduces her to the position of spectacle for the male character’s masochistic fantasy. In doing so, Tessa unwittingly and self-detrimentally adopts the role of “the three women” that Giles Deleuze speaks of in his seminal text on masochism. The paper affirms the need for a criticism of the internalized male gaze amongst women authors in contemporary feminist discourse to combat such derogatory representations of women and promote more nuanced and agential portrayal of women in future contemporary romance literature.
مؤشر التعليم في دليل التنمية البشرية (دراسة تطبيقية عن قضاء الكوت)
Authors: ميادة كاظم عبد قمبر أ.م.د
Published: February 2025

يعد التعليم احد المرتكزات الأساسية للتنمية البشرية بل هو جوهر التنمية البشرية؛ لذا فهو يحظى بالأولوية عند ترتيب مهامها , فالتعليم كناتج يجعل السكان أكثر قدرة على الابتكار والتطور وقوة فاعلة بإسهامها في عمليات الإنتاج والاستثمار وتطوير أوضاع المجتمع ونمط حياته ومستوى معيشته لمواجهة التحديات التي تعترض مساره , وانطلاقا من تلك الأهمية تناول البحث مؤشر التعليم في قضاء الكوت المركز الإداري لمحافظة واسط بمؤسساته التعليمية كافة ابتداء من رياض الأطفال وصولا الى التعليم الجامعي للعام الدراسي 2023-2024 ضمن أربعة مباحث تناولت واقع مؤشر التعليم في قضاء الكوت وقياسه في دليل التنمية البشرية باستعراض نسبة القيد الإجمالي للمراحل التعليمية (الابتدائي, الثانوي, الجامعي) ونسبة الإلمام بالقراءة والكتابة للبالغين, وأخيرا التنبؤ بمستقبل مؤشر التعليم في القضاء. وتوصل البحث الى عدة نتائج أهمها أن ارتفاع معدلات النمو السكاني أدى الى التباين في مؤشرات التنمية البشرية بين الوحدات الإدارية في القضاء ومنها مؤشر التعليم بالتالي تباين دليل التعليم ودليل الحرمان فيه وانتهى البحث بعدد من التوصيات والمقترحات التي نامل ان تعالج المشكلات والعوائق التي تواجه طريق التنمية البشرية في القضاء .
Deconstructing the Ideological Frame of President Vladimir Putin’s Rhetoric: A Socio-Cognitive Analysis
Authors: Farah Abdul-Jabbar Al-Manaseer Asst. Prof. Dr.
Published: February 2025

This paper investigates the world of politics, focusing on the ideological frames that President Vladimir Putin used in his exclusive interview on NBC News in December 2024. The paper aims to explore Putin’s framing of Russia's political agenda and policies and investigate the strategies he employs to deconstruct his ideological frames. The data is limited to the transcript of President Vladimir Putin’s interview with the host Keir Simmons on NBC News in which three extracts are analyzed. The analysis is carried out through the qualitative content analysis approach based on an eclectic model including Van Dijk’s (2006) Socio-Cognitive Theory, Fairclough's (1995) Three-dimensional model of discourse, and Goffman’s (1974) Frame Theory. The paper concluded that President Vladimir Putin uses “Us” versus “Them” as a cognitive framing tool to justify his foreign and domestic policies. Moreover, he positions Russia as a stabilizing actor rejecting interference and calls for legality, reasonableness, and cooperation highlighting mutual benefit dialogues and compromise among countries.
Fleeting Time and Endless Yearning: A Study of T.S. Eliot's Ash Wednesday
Authors: Shaymaa Saleem Yousif Lect. Dr.
Published: February 2025

This research aims at exploring the theme of time and existential agony in Thomas Stearns Eliot’s (1888-1965) Ash Wednesday (1930). It highlights how Ash Wednesday marks Eliot's deep examination of both time and mortality, uncovering the deep aspects of his existential reflections. Through placing this poem within a broader literary and spiritual perspective, this research illustrates Eliot’s "chromophobia" fears and meditations on progress in age, loss, and spiritual ascent; not only does it mirror his personal struggles but also engage with philosophical questions about existence and the mortal condition. Therefore, this study contributes to understanding Eliot's poetic career and highlighting how it deals with time that informs his pursuit for meaning and improvement in a fragmented world.
أطر معالجة مواقع الصحف العراقية للقضايا الاقتصاديةدراسة تحليلية لموقع جريدة الصباح للمدة من ١/٨/٢٠٢٤ إلى ١/١١/٢٠٢٤
Authors: الباحثة ريام سعدي شرشاب شرشاب الباحثة
Published: February 2025

تناولت الدراسة تحليل أطر المعالجة الصحفية للقضايا الاقتصادية في الموقع الإلكتروني لصحيفة الصباح العراقية خلال المدة من 1 أغسطس إلى 1 نوفمبر 2024. اعتمدت الدراسة على منهج المسح الإعلامي التحليلي، مستخدمة استمارة تحليل المضمون لرصد وتحليل المحتوى الاقتصادي المنشور. وركزت على دراسة القضايا الاقتصادية وأطر معالجتها وآليات تناولها، مع التركيز على نظرية تحليل الأطر الإعلامية كإطار نظري للدراسة.
كشف التحليل عن تركيز واضح على قضايا الاستثمار والتنمية بنسبة 23.7%، تلتها موضوعات الدفع الإلكتروني والتحول الرقمي بنسبة 16.9%، ثم الصناعة والتجارة الخارجية بنسبة 14.7%.
اعتمدت الصحيفة بشكل رئيس على المسؤولين الحكوميين كمصدر للمعلومات بنسبة 43%، يليهم الخبراء الاقتصاديون بنسبة 27.1%. وغلب الطابع الإخباري على التغطية بنسبة 44.1%، مع وجود تحليلات معمقة بنسبة 27.1%.
تصدرت الأطر الإصلاحية والتنموية التغطية، مع التركيز على الموضوعية والشمولية في المعالجة. واتسمت التغطية بالمحايدة بنسبة 47.9%، والإيجابية بنسبة 30.5%.
The impossible heap? A review of Reflections on language evolution: From minimalism to pluralism by Cedric Boeckx
Authors: Houghton Conor
Published: February 2025

Cedric Boeckx’s monograph 'Reflections on language evolution: From minimalism to pluralism' is an entertaining and useful introduction to recent advances in biological approaches to the evolutionary origin of our language ability. It can be read as a reminder of the need for more tolerance and diversity in our approach to linguistic research. However, its central thesis is more ambitious and controversial than this: it seeks to reformulate the field by suggesting that linguistics should be centred on the problem of how our language ability evolved. It also promotes the belief that this language ability is best studied as a collection of individual skills and it suggests that the method best suited to this problem is the use of paleo-genetic evidence. This review highlights this interpretation of the monograph and offers a critique of this perspective by suggesting that the structure and cognitive properties of language should remain our focus. [This is an expanded version of a book review which has appeared in Linguist List].
Tracking conceptual refinement in development: The role of embodied and linguistic systems
Authors: Li Luan
Published: February 2025

This study investigates how embodied and linguistic representational systems influence developing conceptual organization. Conceptual structures for household items (HHIs) and vegetables & fruits (VFs) of three Chinese child groups (ages 3-4, 5-6, 8-9, N = 196, 100 females) and adults (N = 40, 25 females) were inferred from a spatial arrangement task and compared to those encoded by embodied (sensorimotor, social-cognitive) and language models. Findings indicate that influences of embodied and linguistic systems on conceptual organizations grow with age, showing increased alignment with adults and greater consistency within age groups. VFs mature earlier with stronger language influence, while HHIs rely more on embodied information. The findings advance understanding of conceptual refinement, highlighting continuous embodied and linguistic influences across development.
A “field map” of the field of mindset
Authors: Buchanan Ash
Published: February 2025

This paper presents a “field map” of the field of mindset, that includes an overview of some of today’s contemporary communities, a range of lineages and traditions these communities are connected to, and several voices that speak to the emerging future for mindset psychology and practice. This field map is being offered to help readers develop a broad and diverse view of the collective wisdom that exists in the mindset field.
Cybersecurity Challenges and Regulatory Compliance in Neobanking in India
Authors: Vaishnavi R. , Sandeepthi Robert M
Published: February 2025

Neo-banking, a fully digital approach to banking, has redefined the financial landscape in India by offering seamless, user-friendly services without the need for physical branches. This transformation has enabled cost efficiency, 24/7 accessibility, and innovative financial solutions tailored to tech-savvy customers. However, the digital-first nature of neo-banking also introduces significant cybersecurity challenges, such as phishing attacks, data breaches, and identity theft, which threaten customer trust and operational stability. Neobanks must strictly adhere to RBI guidelines, the Data Protection Bill, and global compliance standards like PCI DSS and GDPR to safeguard customer data, prevent cyber crimes, and ensure secure digital transactions. Compliance with these regulations helps mitigate data breaches, fraud, and unauthorized access, reinforcing trust in digital banking services. This article explores the dual cybersecurity and regulatory compliance challenges that neobanks face in India. It highlights the importance of robust security measures, advanced authentication systems, and adherence to legal frameworks in fostering a secure and trustworthy neo-banking ecosystem. Addressing these challenges is critical for the sustainable growth and success of neobanks in India's competitive financial market.
EXAMINING THE INTEGRATION OF TIKTOK-BASED LEARNING IN SECONDARY BUSINESS STUDIES EDUCATION: A SOUTH AFRICAN PERSPECTIVE ON DIGITAL TEACHING INNOVATION
Authors: Elizabeth Oluwakemi Ayandibu
Published: February 2025

As an increasing number of South African universities begin to consider and implement artificial intelligence systems, there is an accompanying concern about the ethical aspects that these innovations could have on society. Public discourse and scholarly research that raise concerns about AI’s impact on important societal systems, such as political and gender biases, are numerous. Current policies on higher education in South Africa are silent when it comes to how AI ethical implications may be addressed. The paper explores higher education’s current focus on AI and what external policies say about ethical AI and related technologies in the context of their applications. Robotic process automation, as one of the earlier forms of AI, is being used in South African higher education to automate administrative operations. Through a combination of a policy analysis method and case study approach, we analyze the policy framework. The paper then shows how the policy neither explicitly addresses ethical AI nor critical ICT applications like artificial intelligence and mimics systems. The paper concludes that policy framework development for addressing ethical challenges related to AI should become an immediate priority. These findings emerge from an ongoing empirical study on the South African higher education sector regarding artificial intelligence. This study contributes to policy formulation in higher education to stimulate an ethically responsible AI environment. The study’s research focus on South African higher education provides a gap in current literature that is mainly focused on AI policy developments in developed nations, which currently do not have a comparative acceleration of AI and related technologies.
Pharmacy Students’ Views on Pilot Interprofessional Learning at a Teaching Hospital in Pahang, Malaysia
Authors: Mohd Taufek Nor Hidayah , Ab Rahman Norny Syafinaz , Tengku Mohd Kamil Tengku Karmila , Nik Mohamed Mohamad Haniki , Mohd Faisal Nur Amni ‘Afifah , Turner Christopher John
Published: February 2025

Introduction: Interprofessional learning (IPL) has been practiced in pharmacy curricula worldwide. The unique approach and design for IPL must be tailored within the context of practice to be effective. This study aimed to explore the reflection of experiences by pharmacy students regarding a pilot interprofessional learning activity at a teaching hospital in Malaysia. Methods: Data were collected from 21 pharmacy students using reflective diaries to explore actual experiences, perceived challenges, and learning. All students completed a four-week pilot IPL activity in a clinical setting at a teaching hospital. Data were extracted, analysed sorted, and coded using Atlas.ti® version 9 and subjected to thematic analysis. Results: Four themes emerged from the data: 1) Professional development and interdisciplinary insight 2) Favourable interprofessional engagement, 3) Valuing the application of IPL, and 4) Operational flaws in IPL implementation. Conclusion: The pilot IPL has become a useful platform for pharmacy students to develop metacognitive skills during interprofessional experiences with students, healthcare professionals, and patients. Improvement in its implementation requires strategies tailored to contextual needs. Future studies are required to ensure continuous assessments of improvised IPL components to prepare competent pharmacists for patient-centred care.
Tehnični vidik izboljšave prostorske identite Slovenije v letalskih simulatorjih
Authors: Alessio Leon , Janež Miha
Published: February 2025

Virtualna različica letanja je popularna alternativna osvajanju neba, uporabljajo jo od amaterskih navdušencev za zabavo do profesionalcev in pilotov za usposabljanje ter izboljšavo njihovih sposobnosti. Za boljšo izkušnjo in učinkovito usposabljanje je zelo pomembna pokrajina, v kateri uporabnik znotraj simulatorja leti, žal pa je podoba Slovenije v simulatorjih klavrna in pomanjkljiva. Zato se je podjetje AformX, ki med drugim tudi usposablja bodoči letalski kader, skupaj z dvema članicama Univerze v Ljubljani podalo v projekt Prostorska identitete Slovenije v letalskih simulatorjih. Cilj je bil izdelava pokrajinskega dodatka za letalske simulatorje, ki dobro predstavlja Spodnjesavinjsko dolino ter Celjsko kotlino in tako omogoča potopitveno izkušnjo letenja v tej pokrajini znotraj simulatorja. Za dosego zadanega cilja smo v ekipi z raznolikimi predznanji pod mentorstvom profesorjev raziskali značilnosti te pokrajine in specifikacije delovanja simulatorja. S pomočjo odprtokodnih podatkov in programov, katere je bilo za naše potrebe potrebno predelati, smo nato razvili virtualno okolje za letalski simulator Xplane, ki izboljša uporabniško izkušnjo in učinkovitost usposabljanja.
Isolated Pulmonary Mucormycosis as a Complication of SARS CoV-2 Pneumonia-Case Report and Review of Literature.
Authors: Singh Supriya
Published: February 2025

SARS-CoV-2 pneumonia is associated with multiple complications. Mucormycosis secondary to SARS-Cov-2 is however a less common entity and isolated lung involvement of mucor is even rarer. We present a case of SARS-CoV-2 infection in a pregnant young female with complicated pulmonary mucormycosis that lead to significant deterioration. We also describe series of similar reported cases after literature review, most of which had poor outcome despite effective treatment. We highlight the importance of timely imaging and diagnostic tests including bronchoscopy to diagnose and treat pulmonary mucor.
KEPERCAYAAN DIRI DAN GAYA BELAJAR TERHADAP MOTIVASI BELAJAR MAHASISWA MATA KULIAH FISIKA DASAR PRODI TEKNIK INFORMATIKA
Authors: Dewanthikumala
Published: February 2025

Penelitian ini adalah penelitian korelasi dengan tujuan untuk mendeskripsikan kepercayaan diri, gaya belajar dan motivasi belajar mahasiswa pada mata kuliah fisika dasar; menganalisis hubungan antara kepercayaan diri dengan motivasi belajar mahasiswa pada mata kuliah fisika dasar; menganalisis hubungan antara gaya belajar dengan motivasi belajar mahasiswa pada mata kuliah fisika dasar; dan menganalisis hubungan antara kepercayaan diri dan gaya belajar dengan motivasi belajar mahasiswa pada mata kuliah fisika dasar. Dengan variabel penelitian adalah kepercayaan diri, gaya belajar, dan motivasi belajar mahasiswa pada mata kuliah fisika dasar. Subjek dalam penelitian ini adalah mahasiswa Prodi Teknik Informatika Fakultas Ilmu Komputer Universitas Tomakaka tahun ajaran 2024/2025 yang berjumlah 40 mahasiswa. Berdasarkan hasil analisis statistik deskriptif diperoleh bahwa kepercayaan diri, gaya belajar, dan motivasi belajar berada dalam kategori cukup baik. Sementara hasil analisis uji hipotesis mengemukakan terdapat hubungan positif yang signifikan antara kepercayaan diri dan gaya belajar terhadap motivasi mahasiswa mata kuliah fisika dasar.
Penerapan Metode Simpleks Yang Direvisi Dalam Menentukan Solusi Optimum
Authors: Langowuyo Agustinus
Published: February 2025

Metode simpleks yang direvisi merupakan prosedur matematika untuk  menentukan sulusi optimum dalam masalah program linear.  Penentuan solusi optimum dengan menggunakan metode simplkes yang direvisi adalah dengan mengubah masalah dalam bentuk standart, menentukan pecahan dasar awal, menentukan variabel masuk  dengan menghitung , selanjutnya dengan menentukan variabel keluar  dengan diketahui vektor masuk . Solusi optimum diperoleh dengan  dan  . Algoritma metode simpleks yang direvisi mengarah pada lebih sedikit perhitungan dari pada algoritma tabel pada metode simpleks biasa.
O Optimalisasi Penerapan Asas Black dalam Proses Pertukaran Kalor melalui Inovasi Material Nanokomposit (Kajian Literatur dan Perspektif Teknologi Modern)
Authors: Nadya Putri  , Adelyna Oktavia Nasution  , Ameliya Putri  , Raka Syahfaqih Silalah  , Ajeng Noviyanti  , Alfia Delmi Siregar  , Rahma Damayanti Azzahro
Published: February 2025

Asas black memegang peranan penting sebagai prinsip dasar, yang menyatakan bahwa energi panas yang dilepaskan oleh suatu benda bersuhu tinggi akan sepenuhnya diserap oleh benda bersuhu lebih rendah hingga tercapai keseimbangan termal. Salah satu kendala utama adalah bagaimana memastikan bahwa efisiensi transfer energi tetap tinggi tanpa mengorbankan stabilitas material pada siklus termal yang panjang. Penelitian ini bertujuan untuk mengkaji secara komprehensif penerapan asas Black dalam proses pertukaran kalor dengan fokus pada material nanokomposit dan teknologi termal terbaru. Metode penelitian ini menggunakan studi literature. Penelitian ini menunjukkan bahwa nanokomposit dapat bertahan lebih dari 1000 siklus pemanasan dan pendinginan tanpa mengalami penurunan performa termalnya. penerapan asas Black dalam nanokomposit dengan kapasitas kalor spesifik yang dapat disesuaikan tidak hanya meningkatkan pemahaman kita tentang pertukaran energi, tetapi juga membuka banyak kemungkinan baru untuk aplikasi teknologi di masa depan.
La competencia digital y la autoeficacia en docentes de educación superior, el rol de las variables de edad y género
Authors: Roy Sadradín Damarys , Céspedes Carreño Cristian , Chacana Yordá Carolina , Vera Carreño Hugo
Published: February 2025

Introducción: Este manuscrito analiza datos recopilados de estudiantes del Magíster en Docencia en Educación Superior de la Universidad Andrés Bello, Chile. La revolución tecnológica ha transformado la educación superior, destacando su relevancia durante la pandemia de COVID-19. Metodología: La investigación cuantitativa comparó la autoeficacia y la competencia digital percibida entre 333 egresados del programa, evaluando su confianza en la capacidad para realizar tareas tecnológicas y su percepción de competencias digitales. Resultados: Los resultados revelaron una correlación positiva significativa entre la autoeficacia y la percepción de competencia digital, sin que el género ni la edad moderaran estos efectos. Discusión: El estudio destaca la importancia de fortalecer la autoeficacia en los programas de formación docente, mejorando las competencias digitales de los educadores y su capacidad para adaptarse a los cambios educativos contemporáneos. Conclusiones: Es crucial integrar el desarrollo de la autoeficacia en la formación docente, capacitando a los educadores en el uso de tecnologías digitales para una enseñanza más efectiva y adaptativa.
The effects of educational digital escape games on achievement and motivation in Mathematics courses
Authors: Işık Hatice Kubra , Liman Kaban Aysegul
Published: February 2025

Educational digital escape games (EDEGs) are digital versions of escape rooms where players solve puzzles and complete challenges to achieve educational goals. This study investigates the effects of EDEGs on the academic achievement and motivation of elementary school students in mathematics. Using an explanatory sequential mixed-method design, 45 third-grade students from a private school in Istanbul were divided into experimental and control groups. The experimental group used an EDEG designed with the ADDIE model over four weeks, while the control group followed traditional teaching methods. Results show the experimental group’s academic achievement significantly improved compared to the control group, but no significant difference in motivation was observed. The study highlights EDEGs as effective tools for enhancing mathematics learning while emphasizing the need for further research on their long-term impacts.
Burden of pediatric hydrocephalus in a Latin American upper-middle-income country: a nationwide ecological study in Colombia
Authors: Ramos-Márquez Alexandra , Norato Karen E. , Garrido Diana V. , Mejía-Michelsen Isabella , Gómez Diego F. , Mejía Juan A. , Jiménez Enrique , Hakim Fernando , Porras Alexandra , Ramón Juan F.
Published: February 2025

OBJECTIVE

Pediatric hydrocephalus is a common complex condition, in which late diagnosis can cause irreversible sequelae. The prevalence worldwide is estimated to be approximately 88/100,000, but the literature suggests it is higher in developing countries, with predominantly postinfectious etiologies. The incidence has been found to be inversely associated with a country’s income level. South America is among the regions considered most affected by this disease, but very few recent prevalence studies exist. This is the first prevalence study of pediatric hydrocephalus in Colombia, an upper-middle-income country. This study aimed to estimate the prevalence of pediatric hydrocephalus (ages 0 to 17 years) in Colombia between 2017 and 2022 and to determine its national distribution.

METHODS

A search of the Colombian System of Integrated Information of Social Protection was performed, using International Classification of Diseases, 10th Revision codes to extract the Individual Registries for Provision of Health Services. These data were compared to those in the population registries of the National Administrative Department of Statistics. Prevalence for each code was calculated, and distribution according to age group, sex, and department was made. Yearly and overall prevalence rates were graphed on nationwide maps throughout the study period years.

RESULTS

The authors found a nationwide prevalence of 57.2/100,000, with an underreporting rate for all cases of 31.3%. The adjusted prevalence for underreporting was 83.0 cases per 100,000. A total of 55% of cases were in male patients. The reported causes of hydrocephalus were as follows: 24.9% of cases were due to postinfectious etiologies, 9.9% were attributed to CNS malformations, 0.3% were posttraumatic, and 0.3% were neoplastic. In most cases, etiology was not reported. The maps created show a heterogeneous prevalence distribution through the years. The adjusted prevalence rate map shows a prevalence distribution with higher rates in lower-income regions.

CONCLUSIONS

In this study, the estimated prevalence of pediatric hydrocephalus in Colombia was lower than the prevalence estimated worldwide, and even lower than that estimated for high-income areas. This is explained partially by a significant rate of underreporting; however, even accounting for the underreporting, the prevalence remains considerably lower than that estimated for developing regions like South America. This may suggest a trend of decreasing prevalence in developing countries whose economies have grown in recent years. These findings can guide public policy for adequate surveillance and prevention of pediatric hydrocephalus in Colombia and highlight the importance of further updated research in the region.
Multicenter study on 2-year outcomes of dual application of hydroxyapatite cranioplasty and a nasoseptal flap following endoscopic endonasal surgery for tuberculum sellae meningiomas or craniopharyngiomas
Authors: Kong Doo-Sik , Kim Yong Hwy , Hong Sang Duk , Ryu Gwanghui , Kim Ji Heui , Hong Chang-Ki , Kim Young-Hoon
Published: February 2025

OBJECTIVE

The authors evaluated the intermediate-term outcomes of a skull base reconstruction technique using hydroxyapatite cranioplasty combined with a nasoseptal flap following endoscopic endonasal surgery (EES) for suprasellar tumors. Specifically, the evaluation focused on the avoidance of lumbar CSF drainage, prevention of CSF leakage, and incidence of postoperative complications, including meningitis and nasoseptal flap necrosis, during a minimum follow-up of 2 years.

METHODS

This multicenter study included patients who met the following criteria: 1) underwent EES for tuberculum sellae meningiomas or craniopharyngiomas, 2) received dual application of hydroxyapatite cranioplasty and reconstruction using a nasoseptal flap, 3) had a follow-up duration of at least 2 years, and 4) did not undergo lumbar drainage of CSF postoperatively. The success rate of reconstruction was determined based on postoperative CSF leakage, associated complications, meningitis, postoperative hospital length of stay (LOS), and would dehiscence.

RESULTS

A total of 198 patients from three institutions diagnosed with tuberculum sellae meningioma (86 patients) or craniopharyngioma (112 patients) were included in this study. The median follow-up duration was 39 months. No patient underwent postoperative lumbar drainage of CSF. Postoperatively, only 3 patients (1.5%) experienced CSF leaks requiring reoperation. The median hospital LOS after surgery was 5 days. Other postoperative complications included atypical meningitis in 5 patients and wound dehiscence in 3 patients during the follow-up period. All patients with nonbacterial meningitis were treated with intravenous antibiotics and dexamethasone medication for 2 weeks.

CONCLUSIONS

The combination of hydroxyapatite cranioplasty and a nasoseptal flap in reconstruction following EES decreased the requirement for postoperative lumbar CSF drainage and shortened hospital LOSs with minimal morbidities. Nevertheless, careful attention to the risks of meningitis and central necrosis of a nasoseptal flap is crucial for optimizing patient outcomes.
Use of TachoSil for durotomy repair in spine surgery: a single-center retrospective review
Authors: Chaliparambil Rahul K. , Kemeny Hanna R. , Mukherjee Shreya , Krushelnytskyy Mykhaylo , Wolinksy Jean-Paul , Swong Kevin , Dahdaleh Nader S. , Ahuja Christopher S. , El Tecle Najib E.
Published: February 2025

OBJECTIVE

A significant complication of spine surgery is persistent postoperative CSF leak secondary to intentional or incidental durotomy. Traditionally, the gold standard for repair of simple durotomy has been primary surgical repair; however, this technique alone may not be possible for more complex durotomy and is often supplemented with sealants or fibrin glues. The authors add to the literature the largest series of spine surgery patients treated with TachoSil, a synthetic collagen patch containing human fibrinogen and human thrombin, for the management of incidental or intentional durotomy.

METHODS

The authors identified all patients who underwent a spinal operation and were billed for operative use of TachoSil at their institution between January 1, 2023, and November 3, 2023. Demographic, clinical, and outcome variables were collected and analyzed using standard statistical methods. Categorical variables were reported as number (%), and continuous variables were reported as median (range).

RESULTS

The authors retrieved 55 patients meeting their inclusion criteria. The population consisted of 29 (52.7%) females, had a median age of 52 years, and had a median BMI of 28.3 kg/m2. Of the repaired durotomies, 37 (67.3%) were intentional to the operation and 18 (32.7%) were incidental or secondary to trauma. Abnormal residual fluid collections were appreciated in 1 (1.8%) patient. Wound breakdown was observed in 2 (3.6%) patients. Thirty-day readmission was observed in 6 (10.9%) patients, and 30-day reoperation was necessary in 2 (3.6%) patients. Ninety-day readmission was observed in 7 (12.7%) patients and 90-day reoperation was necessary in 3 (5.5%) patients. One (1.8%) case of 30-day readmission was related to CSF leak, and no cases of 30-day or 90-day reoperation were related to dural closure failure.

CONCLUSIONS

This study is a brief examination of the demographic characteristics, surgical variables, and outcomes of durotomy repair in spine surgery with TachoSil and provides encouraging results for the continued use of the material in this context. This study provides the impetus for examination of TachoSil in larger, multi-institutional studies to establish it as a standard of care in spinal dural repair.
Frontal sinus mucosa suture closure technique for prevention of cerebrospinal fluid rhinorrhea after bifrontal craniotomy: long-term follow-up results
Authors: Matano Fumihiro , Nounaka Yohei , Murai Yasuo
Published: February 2025

OBJECTIVE

Bifrontal craniotomy often involves the bony opening and mucosal disruption of the frontal sinus (FS), which can lead to cerebrospinal fluid (CSF) leakage and meningitis. These complications are particularly associated with surgical treatments for skull base tumors and anterior cerebral artery aneurysms. The authors initially reported on the basic technique in 2014 with 51 cases. This study presents a detailed description of their technique and postoperative management for sealing the exposed FS during bifrontal craniotomy, including long-term follow-up results and outcomes. To objectively evaluate the effectiveness of suturing FS mucosa in preventing CSF leakage during bilateral frontal craniotomy, the authors focused only on anterior cerebral artery aneurysms. This limitation was necessary as other conditions, like extensive tumors or trauma, might lack intact FS mucosa or require its removal due to infection.

METHODS

The records of 34 consecutive patients (median age 62.0 years, mean 60.4 years, range 33–78 years) who underwent bifrontal craniotomy for anterior cerebral artery aneurysms between January 2014 and December 2023 were retrospectively analyzed. All patients had bony opening and mucosal injury of the FS (with exposure to the nasal cavity) that required mucosal suturing. This technique for sealing the exposed FS involves careful dissection of the mucosa from the entire sinus, sterilization with iodine-soaked surgical cotton, and preparation for closure. After the microsurgical procedure is completed, the exposed mucosa is sealed with 6-0 nylon sutures and further secured with fibrin glue–soaked Gelfoam. The bony exposure is covered with an autologous bone flap created from the inner table of the craniotomy bone flap. Finally, the frontal periosteal flap is sutured to the frontal base dura mater. Patients were instructed not to blow their noses for 2 months postoperatively.

RESULTS

Two patients experienced transient non-CSF leakage from the nasal cavity, likely due to irrigation fluid, which resolved within 2 days postoperatively. No recurrence was observed during a mean follow-up period of 52.8 ± 41.7 months (median 49 months, range 3–127 months). No cases of meningitis or other intracranial infections were reported.

CONCLUSIONS

The long-term results demonstrate the sustained effectiveness of this technique in preventing postoperative complications related to FS exposure during bifrontal craniotomy.
Which type of duraplasty is best for Chiari type I malformation surgery?
Authors: Valentini Laura Grazia , Saletti Veronica , Moscatelli Marco , Ferrari Emma , Farinotti Mariangela , Barbotti Arianna , Vetrano Ignazio Gaspare , Galbiati Tommaso Francesco
Published: February 2025

OBJECTIVE

This study investigated whether the selection of different dural substitutes and distinct dural repair techniques correlates with the incidence rate of postoperative CSF leak in a mixed population of adults and children with Chiari type I malformation (CM-I) who underwent posterior fossa decompression with enlargement duraplasty (PFDD) as the first surgical approach.

METHODS

A retrospective analysis was conducted on all patients admitted to the authors’ institution between 2006 and 2023 for PFDD to treat syringomyelia and/or symptoms due to CM-I. Clinical, radiological, and surgical data were extracted from a prospectively maintained database. Demographic information was collected from medical records. Surgical procedures were also scrutinized, specifically focusing on the type of dural graft used for duraplasty, alongside perioperative complications and the necessity for subsequent surgeries. Lastly, during follow-up, the occurrence of a CSF leak was assessed and analyzed in relation to the type of dural graft used during surgery. The type of dural substitute chosen changed over the years to reduce CSF fistulas, while the technique of PFDD remained the same. Consequently, large sequential homogeneous groups differing only by dural substitutes were available for comparison.

RESULTS

The data from 409 patients with CM-I undergoing PFDD were analyzed. A total of 368 cases had complete surgical data and were included. Thirty patients received autologous duraplasty. The remaining 338 cases with heterologous duraplasty from equine and bovine pericardium were considered for the comparative statistical analysis. The mean follow-up duration ranged from 39 months in adults to 45 months in children. The CSF complication rate requiring revision was 6.5% in the total cohort, with a higher incidence in children (10.5%) compared with adults (3.9%). There was no significant difference in adverse events (CSF leak, revision surgery, or ventriculoperitoneal shunt placement) between the different dural patches by univariate analysis if applied to the total cohort, although the trend neared significance (p = 0.06). In pediatric cases, this value was significant (p = 0.01) in favor of equine pericardium, particularly when combined with a collagen matrix inlay graft.

CONCLUSIONS

This study on a large and homogeneous series of patients with CM-I undergoing PFDD with heterologous duraplasty demonstrated that CSF complications may be kept low. The dural substitutes derived from equine pericardium, particularly when combined with a collagen matrix inlay graft, exhibited a reduced rate of CSF leaks compared with substitutes derived from bovine pericardium.
The use of dural sealant patches for reinforcement of durotomy repair: a systematic review
Authors: Shah Rahul , Huda Shayan , Ward Max , D’Amico Randy S. , Caridi John , Ben-Shalom Netanel
Published: February 2025

OBJECTIVE

Dural sealant patches (DSPs) are a useful adjunct when closing the dura during cranial or spinal surgery to avoid cerebrospinal fluid (CSF) leakage or infection. Authors of this paper systematically review the outcomes and incidence of CSF leakage and infection with the use of a DSP versus conventional practice.

METHODS

The MEDLINE, Embase, Cochrane Library, and Scopus databases were searched, and clinical trials and prospective or retrospective case-control and cohort studies with a low-risk of bias and involving any solid DSP used in adults for cranial or spinal cases were included. Studies that used a DSP in combination with another method of dural sealant closure, used a DSP as a dural substitute rather than an adjunctive closure device, or used hydrogel or polymer gel (i.e., nonsolid) dural sealant "patches" were excluded. A meta-analysis of comparative studies reporting outcomes relating to CSF leakage was performed together with a subgroup analysis for each DSP type. For comparative studies reporting outcomes relating to infection, a separate meta-analysis was conducted.

RESULTS

Across the 7 noncomparative studies included, 669 patients received TachoComb (n = 421, 1 study), TachoSil (n = 8, 1 study), Liqoseal (n = 40, 1 study), TissuePatchDural (n = 144, 2 studies), or Hemopatch (n = 56, 2 studies). Across the 6 comparative studies included, 1013 patients received TachoSil (n = 784, 3 studies), TissuePatchDural (n = 147, 2 studies), or Hemopatch (n = 82, 1 study). When considering the rates of CSF leakage or infection, 2/6 comparative studies found DSPs to be significantly more effective than current practice, while the remaining 4/6 demonstrated noninferiority compared to current practice. All studies considered the DSPs to be safe. A meta-analysis revealed significant improvements in the incidence of CSF leakage with the use of a DSP overall, but the improvements in CSF leak rates for the TachoSil and TissuePatchDural subgroups did not reach statistical significance. The single study evaluating Hemopatch did find statistically significant improvements in CSF leak rates. There were no significant differences in infection between the DSP groups.

CONCLUSIONS

There was a significant improvement in the incidence of CSF leaks with the use of DSPs. Comparisons among DSP types and evaluations of outcomes relating to infection should be the focus of further research in this area.
Evaluation of diversity, equity, and inclusion information on US neurosurgery residency program websites
Authors: Kabangu Jean-Luc K. , Fowler Danny L. , Dugan John , Hernandez Amanda , Graham Delaney , Newsome-Cuby Takara , Bah Momodou G. , Eden Sonia V.
Published: February 2025

OBJECTIVE

The objective of this study was to determine the prevalence of diversity, equity, and inclusion (DEI) information on neurosurgery residency program websites and examine the association between program size, ranking, and DEI information presence.

METHODS

A cross-sectional review of 115 US neurosurgery residency program websites was conducted from January 1 to March 2, 2024. Websites were evaluated based on six DEI criteria: 1) diversity commitment in mission/leadership statements, 2) separate diversity mission statement, 3) rotations/fellowships for underrepresented minority students, 4) diversity initiatives, 5) diversity page/section, and 6) appointed diversity leadership positions. Associations between program size, ranking, and DEI information were analyzed.

RESULTS

Among the 115 programs, only 35 (30.43%) met at least one DEI criterion. Specifically, 18.26% had a separate diversity mission statement and 15.65% included a DEI statement in mission/leadership messages. Programs with more than 13 residents were significantly more likely to meet at least one DEI criterion (OR 2.96, 95% CI 1.16–7.56; p = 0.022) and to include a DEI statement in mission/leadership messages (OR 5.38, 95% CI 1.71–24.72; p = 0.018). Top 25–ranked programs by U.S. News & World Report were more likely to have diversity initiatives (OR 6.23, 95% CI 1.78–23.97; p = 0.007). Programs meeting any DEI criterion had a higher percentage of female (29.67% vs 22.55%, p = 0.013) and Black (7.85% vs 4.49%, p = 0.019) residents. There was no statistically significant difference in the percentage of White residents (p = 0.206) across programs, and programs with a mention of DEI in the mission statement had a lower percentage of Asian residents (24.08% vs 33.29%, p = 0.042).

CONCLUSIONS

Most US neurosurgery residency programs lack DEI information on their websites. Larger programs and those with higher rankings are more likely to include DEI content, particularly standalone statements. Programs meeting DEI criteria tend to have a higher representation of female and Black residents. These findings highlight the need for greater transparency and commitment to DEI in neurosurgery residency programs, ensuring prospective applicants have access to comprehensive DEI information.
Clinical outcomes and patient-reported outcome measures among patients undergoing posterior lumbar fusion procedures with varying insurance payor status: a propensity score–matching study
Authors: Shah Aaryan , Schonfeld Ethan , Haider Ghani , Marianayagam Neelan J. , Sadeghzadeh Sina , Stienen Martin N. , Veeravagu Anand
Published: February 2025

OBJECTIVE

Posterior lumbar fusion (PLF) is a routinely used procedure for treatment of spinal pathology. Several studies have highlighted disparities in reoperation and postoperative complications and demonstrated associations between differing insurance providers, complication rates, and hospital resource utilization in spine surgery. Previous studies have examined broad spinal procedures but have not extended to uninsured patients, or adjusted for sociodemographic factors or comorbidity history. Understanding relationships between payor status and outcomes following fusion procedures is vital to promoting healthcare equity. The objective of this study was to assess whether patients’ insurance impacts postoperative outcomes and patient satisfaction following PLF procedures.

METHODS

The Stanford University Medical Center inpatient registry was used to retrospectively analyze patients who underwent PLF procedures between 2016 and 2022. Propensity score matching was used to compare privately insured with Medicaid patients, as well as comparing uninsured patients with Medicaid patients based on age, sex, and comorbidities. Outcomes data, including 90-day postoperative complications, reoperation, and patient-reported outcome measures scores (Oswestry Disability Index and Patient Health Questionnaire) were collected.

RESULTS

A total of 1904 patients fulfilled the inclusion criteria. In unmatched comparisons, statistically significant differences existed within specific types of complications including altered mental status, delirium, neurological complications, and pulmonary complications. A total of 292 privately insured patients were matched to 292 Medicaid patients. Within matched patient groups, the Medicaid group had higher rates of altered mental status (6.2% vs 2.7%, p = 0.042); delirium (9.9% vs 5.1%, p = 0.035); renal dysfunction (6.9% vs 4.1%, p = 0.020); and pulmonary complications (8.9% vs 3.8%, p = 0.049) compared to privately insured patients. Privately insured patients had lower postoperative Oswestry Disability Index scores (30.2 vs 34.4, p = 0.018) compared to Medicaid patients. Following propensity score matching of 88 Medicaid patients to 88 uninsured patients, large but not statistically significant differences existed for neurological complications (12.5% vs 5.7%, p = 0.165) and 5-year revision rates (3.4% vs 1.1%, p = 0.353).

CONCLUSIONS

The findings indicate that the treatment outcomes, care quality, and patient satisfaction following PLF procedures differ between Medicaid and privately insured patients. Further investigation is warranted to explore relationships between insurance payor status and clinical outcomes in multicenter populations.
Pediatric Appendicitis Score and Ultrasound in children with Acute Appendicitis: An Observational Study
Authors: Simkhada Suyog , Thapa Bijay , Basnet Anupama Thapa , Karki Sijan
Published: February 2025

Introduction: Acute appendicitis is a common surgical emergency encountered in pediatric population. Differential diagnosis in this age group present with similar signs and symptoms. Clinical scoring system and Ultrasound imaging are helpful in diagnosing acute appendicitis and ruling out its differential diagnosis. This study was done to assess the findings of presence or absence of appendicitis in children based on the Pediatric Appendicitis Score (PAS) and ultrasound scan. Methods: An observational cross-section study was done from November 2023 to May 2024, in a tertiary level hospital, Kathmandu. All children between the ages of five and 14 years undergoing surgery for the provisional diagnosis of acute appendicitis were included in the study. The provisional diagnosis was based on a Pediatric appendicitis score and ultrasound. The diagnosis was confirmed by histopathology. Ethical approval was taken from Institutional Review Committee (Reference number: 811/2080/81).Results: A total of 50 children were included during the study period. A pediatric appendicitis score of more than seven, which is considered a high risk, was observed in 43 (86%) patients, and a score between four and six, which was considered an intermediate risk, was observed in 6 (12%) patients Similarly, 39 (78%) of the patient had appendix diameter more than six mm and 10 (20%) had less than six in ultrasound measurement.Conclusions: Both Pediatric Appendicitis Score and Ultrasonography can be used to diagnose acute appendicitis in children.
Dengue and Scrub Typhus Co-infection at a Tertiary Care Centre in Nepal: A Case Series in Pediatric Patients
Authors: KC Sriram , Pradhan Bulbul , Khanal Inesh , Shrestha Aakripa Rani
Published: February 2025

This case series highlights four pediatric patients with coinfection of dengue fever and scrub typhus, presenting at Patan Hospital. Dengue fever is caused by flavivirus transmitted by Aedes mosquitoes, and scrub typhus is caused by Orientia tsutsugamushi transmitted by Leptotrombidium mites, which share overlapping symptoms such as fever, headache, and abdominal pain, complicating the diagnosis. The cases were from different geographical regions of Nepal with varied presentation: from febrile illness to severe manifestations like meningoencephalitis and raised intracranial pressure. Two patients presented with hepatosplenomegaly, one with severe rash, and another with pneumonia-like symptoms. Laboratory findings confirmed coinfection, and management included IV antibiotics, antipyretics, and supportive management. Complications such as thrombocytopenia, transaminitis, and allergic reactions required interventions. This case series highlights the importance of early suspicion and treatment of coinfection to reduce prolonged hospitalization and prevent end-organ dysfunction, and mortality, especially in endemic regions.