bluuebunny/crossref_metadata_2025 huggingface dataset:
Educational Virtual Reality (VR)
Authors: Mahmoudi-Dehaki Mohsen , Nasr-Esfahani Nasim
Published: September 2024

Virtual reality (VR) is an immersive technology that simulates three-dimensional environments, allowing users to interact with virtual worlds through specialized hardware and software. This chapter explores the evolution of VR, its applications in education, and the integration of artificial intelligence (AI) to enhance user experience. VR's immersive capabilities foster active learning by enabling students to engage with content in ways that traditional methods cannot replicate. Theoretical foundations such as constructivism and experiential learning support the use of VR in educational settings, while practical applications include virtual field trips, simulations, and language learning environments. However, challenges such as high costs and potential accessibility issues must be addressed. This chapter concludes by emphasizing the need for ongoing research and collaboration to fully harness VR's potential in future education and other sectors.
Effective Learning Outcomes Through Virtual Reality
Authors: Hussain Shaik Mazhar , Mesti Saadia , Hakro Ahmed Nawaz
Published: September 2024

This chapter delves into the comparative effectiveness of virtual reality (VR) against the traditional educational methods, underscoring not only the initial financial outlays associated with VR—such as hardware acquisition and content development—but also evaluating these against the recurrent costs inherent in conventional education systems. The intent is to provide comprehensive long-term economic and educational benefits of investment in VR. The chapter offers VR's ability to enhance learning outcomes through immersive, interactive experiences that traditional methods alternatively might not offer. This includes a detailed examination of VR's scalability and its capacity to reach diverse learners across geographical boundaries without the recurring costs associated with physical infrastructures. Moreover, the economic evaluation may provide the extended assessment of VR's potential for reducing costs associated with learning delays, educational disparities, and the provision of customized learning experiences, which are often more logistically and financially demanding within traditional frameworks. In addition to this, the chapter is likely going to address the broader societal and educational benefits, such as increased accessibility for disadvantaged and differently abled students, and the potential for global classrooms that offer unified learning experiences to students from varying socio-economic backgrounds. Through these discussions, the chapter will argue that VR does not merely replace traditional learning methods but significantly enhances educational value, thereby justifying its adoption as a forward-thinking educational technology.
Exploring VR and AI Adoption With Microsoft Copilot
Authors: Menon Vishnu Achutha , Thomas Juby , Thomas Lijo P. , Kunnumpurath Biju , Mathew Romy
Published: September 2024

This study explores how postgraduate students utilize Microsoft Copilot in a virtual reality (VR) environment. From January to February 2024, 125 students participated in the experiment, tasked with crafting assignments directly within Copilot. Using three scales for data collection, including the technology readiness index, extended reality presence scale, and AI technology adoption, the study found positive correlations between technology readiness and both extended reality presence and AI technology adoption. Linear regression analysis showed technology readiness as a significant predictor for both extended reality presence and AI technology adoption, explaining approximately 20.6% and 42.1% of the variability, respectively. These findings emphasize the crucial role of technology readiness in shaping student engagement with emerging technologies.
Mapping Virtual Learning in Distance Education
Authors: Kumar Narendra
Published: September 2024

Smart learning in virtual worlds refers to the use of virtual reality (VR) and other immersive technologies to enhance the learning experience. Smart learning in virtual worlds has the potential to revolutionize education and training by providing engaging, adaptive, and immersive experiences in various domains. For this study, the literature on smart learning in distance education has been mapped through Vosviewer. In this research, bibliometric visualizing methods are used with the help of Vosviewer to analyze the different outcomes. Co-occurrences of author keywords and bibliographic couplings of the countries, authors, journals, and institutions are depicted via the software. The initial search on Scopus was performed with “smart learning or virtual learning” and “distance education” which fetched 645 documents. Based on the language of the article, the authors found 587 articles which were published in English. The second basis was the source type that included Journal articles, conference proceedings and book chapters and the authors found 440 articles for the study.
VR Headset Selection via CODAS Based on Pythagorean Fuzzy Set
Authors: Büyükselçuk Elif Çaloğlu
Published: September 2024

Thanks to the developing technology, innovative activities emerge in the education sector, as in every sector. Contrary to traditional teaching and learning methods, novel models have started to be used in the education sector with the opportunities offered by virtual reality (VR), augmented reality (AR) or mixed reality (MR) technologies used in many different sectors. In this study, a model developed for use in the education sector in Turkey, which is named MEB-VR, has been introduced and the solution of a problem encountered in this model has been discussed. MEB-VR has been developed especially for applied and laboratory courses. The problem of determining the best headsets to be used in the model, in which the VR-based education approach is adopted, has been tried to be solved in this study. For this purpose, the most suitable VR headset was determined using the combinative distance based assessment (CODAS) method based on circular pythagorean fuzzy sets (C-PFS).
Research on the Interactive Technology of 6G Network Online Classroom for Ideological and Political Education Infiltration
Authors: Chen Jia
Published: September 2024

Aiming at the application of 6G network technology in online classroom interaction of ideological and political education, this paper first analyzes the challenges faced by online classroom interaction of ideological and political education; and discusses the advantages of 6G network technology in education and its role in improving online classroom interaction. Through literature research and case analysis, this study studies the application and realization of 6G network technology in online classroom interaction of ideological and political education. Then, this paper puts forward a framework of 6G network classroom interaction technology for ideological and political education. This mode can provide more diverse interactive ways for online ideological and political classroom, thus enhancing students' interest and enhancing teaching effect. Finally, this study puts forward the future research direction of 6G network classroom interaction technology. This paper can provide useful reference for the development of interactive technology in online classroom of ideological and political education.
Cross-Domain Image Classification via Multimodal Augmentations and Bacterial Foraging Optimization
Authors: Singh Pushpendra , Singh Arun Kumar , Choudhary Pushpa , Singh Mahesh Kumar , Azar Ahmad Taher , Haider Zeeshan , Tounsi Mohamed
Published: September 2024

Identification of diseases from body scans requires design of pre-processing, filtering, segmentation, feature representation, classification & post-processing operations. Existing deep learning-based classification models use context-specific segmentation followed by convolutions or transformer-based classification techniques. However, the majority of these models do not perform correlative analysis between different disease types. This limitation restricts their scalability and applicability in clinical scenarios. To address these limitations, this research work proposed IMAC-MOC, a model that integrates multimodal augmentations to enhance performance in cross-domain and multi-organ image classification. The proposed model initially collects large-scale scans at organ-level like MRI, CT scan, Kidney Scans, etc. and represents them via multimodal feature sets. These feature maps are combined and processed via a Bacterial Foraging Optimizer (BFO) which assists in identification of high variance inter-class feature sets.
Comparative Performance Analysis of Reclaimed Asphalt Pavement and Virgin Aggregates as Base Layer Materials in Flexible Pavement
Authors: Rinya Taba , Pal Dibyendu
Published: September 2024

Natural virgin aggregate (VA) has been the conventional material of choice for base layer construction in flexible pavements. However, the ever-increasing demand for VA has put a lot of strain on its supply, therefore leading to indiscriminate mining operations. The present practice is not only unsustainable but also expensive. Switching to recycled aggregate materials as an alternative construction material could prove to be both sustainable and cost-effective in the long run. Two pavement sections were analyzed to compare the performances of VA and reclaimed asphalt pavement (RAP) treated with bitumen emulsion as the base layer material. The pavement sections were modeled and analyzed in a finite element analysis (FEA) program called FlexPAVETM. Pavement response analysis was carried out to obtain the critical strains. Pavement performance analysis was accomplished to assess the fatigue cracking performance at the end of the service life of 20 years for both pavement sections. The simulation results revealed that RAP outperformed VA as a base layer material. The pavement section shows a 55.81% increase in its fatigue performance with the replacement of VA by RAP. The total predicted rut depth also decreased by 8.88%.
Vertebral bone quality score as a new tool for osteoporosis diagnosis in patients undergoing lumbosacral fusion surgery: a single center cohort study
Authors: Najafi Arvin , Baradaran Bagheri Ali , Hadavi Dorsa , Mobedi Aidin , Azarsina Salman , Chaghamirzayi Pouria
Published: September 2024

Osteoporosis, a common bone disorder, increases fracture and spinal surgery complications risk. This study evaluates the potential of the Magnetic Resonance Imaging (MRI)-based Vertebral Bone Quality (VBQ) score as an alternative for assessing bone density in lumbosacral fusion surgery patients. In a prospective cohort study from April 2021 to November 2022, 134 patients with lumbar degenerative diseases underwent lumbar Dual-Energy X-ray Absorptiometry (DXA) and lumbosacral non-contrast T1-weighted MRI. VBQ scores were calculated and analyzed using IBM SPSS Statistics and MedCalc software. Osteopenia/Osteoporosis patients exhibited significantly higher VBQ scores than normal bone mineral density patients (3.37 ± 0.51 vs. 2.99 ± 0.44, P<0.001). VBQ correlated significantly with lumbar DXA T scores (r value= -0.415, p<0.001). Receiver Operating Characteristic (ROC) analysis showed VBQ AUC values of 0.730 (CI 95% 0.647-0.803, P<0.001) and 0.839 (CI 95% 0.765-0.897, P<0.001) for Osteopenia/Osteoporosis and osteoporosis diagnosis, respectively. The study suggests MRI-derived VBQ scores may benefit pre-lumbosacral fusion surgery bone density assessment, potentially improving patient care and aiding osteoporosis detection in spinal surgery candidates.
Antipsychotics and chronic dystonia at a Botulinum Toxin clinic
Authors: Thosago Mahlatse , Asmal Laila
Published: September 2024

Background: Chronic dystonia, characterised by sustained muscle contractions and abnormal postures, poses clinical challenges, especially when associated with antipsychotic medication use.Aim: To delineate the demographic and clinical profiles of adults with dystonia and examine the association with antipsychotic medication.Setting: Botulinum Toxin Clinic at Tygerberg Hospital, Cape Town, South Africa.Methods: We conducted a retrospective cohort study of adult patients seen at the Botulinum Toxin Clinic between January 2018 and June 2022.Results: Of the 119 patients studied, those assessed with antipsychotic-induced dystonia (32.69%) presented at a younger age (p  0.001), were more likely female (p = 0.04), received higher average dose of Botulinum toxin (p  0.001), and incurred a higher estimated Botulinum toxin treatment cost (p = 0.01) compared to those with primary dystonia. Logistic regression identified age and Botulinum toxin dose as factors associated with psychotropic-related dystonia (p = 0.005 and p = 0.012, respectively).Conclusion: Clinical and demographic factors are associated with dystonia in adults taking antipsychotic medication. These patients generally manifested symptoms at an earlier age, had a higher male prevalence, and required prolonged treatment with Botulinum toxin, leading to increased costs. In those assessed with antipsychotic-induced dystonia, a comorbid diagnosis of a mood disorder was more common than that of a psychotic disorder.Contribution: By identifying the demographic and clinical profile of individuals with dystonia because of antipsychotic medication, this study provides a basis for preventative strategies and enhanced patient care.
Diagnostic Performance of Grayscale Ultrasonography in the Evaluation of Mass-forming Breast Lesions
Authors: Madhuri H , Aruna Devi M , Sravani G
Published: September 2024

In our study, we evaluated the diagnostic performance of grayscale ultrasonography (USG) in risk stratification of mass-forming breast lesions. Our study included 90 cases, in which 88 were females and 2 cases were male with age ranging from 16 to 73 years. Out of 90 lesions, 51 (58%) lesions were benign and 39 (39%) lesions were malignant. High-resolution USG done in all 90 lesions revealed sensitivity (90.2%), specificity (74.36%), positive predictive value (PPV) (82.14%), negative predictive value (NPV) (85.29%), and accuracy (83.33%). Calculated weighted kappa value 0.665, indicating better level of agreement in predicting malignant lesions compared to gold standard. Our study revealed that USG is sensitive and specific test in detecting malignant lesions with high PPV and NPV; the calculated weighted kappa value was 0.665, indicating better level of agreement in predicting malignant lesions compared to gold standard.
Correlation of Pseudocholinesterase Level with Clinical, Biochemical Parameters Including Cardiac Profile and the Outcome in Organophosphorus Poisoning
Authors: Kumar Arvind , Chaudhary Shyam Chand , Usman Kauser , Kumar Vivek , Sawlani Kamal Kumar , Patel Munna Lal , Singh Abhishek , Kumar Amit , Sonkar Gyanendra Kumar , Rathore Shiuli
Published: September 2024

Background:

Poisoning is a significant health hazard and a leading cause of morbidity and mortality worldwide. India, being a predominantly agrarian country, routinely employs organophosphate (OP) pesticides in farming, and they are readily available “over the counter.” OPs exert their toxicity by interfering with the normal function of acetylcholine, an essential neurotransmitter throughout the autonomic and central nervous systems. Due to the limited availability of facilities and resources in health-care systems, and economically restraining patients, it is necessary to rely more on clinical features to assess the severity of poisoning and manage the condition properly.

Methodology:

It was a hospital-based prospective observational study that included patients aged >13 years in a tertiary care hospital. All patients were clinically evaluated based on their history and examination. The diagnosis was made based on characteristic clinical manifestations or evidence of exposure to organophosphorus compounds (corroborative evidence such as empty containers and the odor of gastric aspirates). Clinical severity was assessed and categorized according to the Peradeniya Organophosphorus Poisoning Scale (POP scale). A score of 0–3 is considered mild poisoning, 4–7 as moderate poisoning, and 8–11 as severe poisoning.

Results:

Out of the 50 patients enrolled in the study, 17 (34.00%) were aged <20 years, 19 (38%) were in the 20–30 years age group, and 14 (28%) were aged >30 years. Ingestion is the only mode of exposure to poisoning. None of the patients had history of contact or inhalational exposure. Of the 50 cases, 12 (24.0%) were in the mild category, 26 (52.0%) in the moderate category, and 12 (24%) in the severe category on the POP grading. A comparison of the mean serum pseudocholinesterase, troponin-T, and pro-BNP levels with severity was performed. In mild OP poisoning, the mean serum PChE level was 2766.58 ± 1120.44; in moderate, it was 1969.35 ± 1330.07, and in severe, it was 701.83 ± 961.17. Pseudocholinesterase levels decreased progressively with increasing clinical severity from mild-to-severe cases, and this association was statistically significant (P < 0.001). Two-dimensional echocardiography screening done in all patients did not show any significant abnormalities.

Conclusion:

This study shows that serum PCE is reduced in OP poisoning and correlates with the clinical severity grading done by the POP scale and is also associated with an increase in the duration of intensive care unit stay. No significant evidence of direct cardiac injury was observed in this study. A low Glasgow Coma Scale score and an increased respiratory rate at presentation are associated with poor outcomes.
Utility of Various Activation Procedures in Provoking Ictal and Interictal Patterns, during Routine Electroencephalogram (rEEG) Recording
Authors: Nazish Saima , Shariff Erum , Zafar Azra , Aljaafari Danah , Alshamrani Foziah , Alkhaldi Norah A. , Alsulaiman Feras , Shahid Rizwana , Albakr Aishah , Alsulaiman Abdullah , Alabdali Majed , Soltan Nehad , Alkhaldi Modhi
Published: September 2024

Background:

Activation procedures (APs) are adopted during routine electroencephalography (rEEG) to provoke interictal epileptiform abnormalities (EAs). This study aimed to observe interictal and ictal (EAs) of different EEG patterns, provoked by various APs.

Methodology:

This cross-sectional study was performed in the neurology department of King Fahd hospital of university, Saudi Arabia. The EEGs and medical records of patients who presented for EEG recordings were screened initially, then 146 EEGs provoked EAs due to utilization of APs, were included for analysis.

Results:

Among all EEGs with provoked EAs, Non-rapid eye movement sleep (NREM) provoked EAs in 93 (63.7%) patients with following patterns, focal spike wave discharges (FSWDs) 45 (P= 0.01), focal spike wave discharges with bilateral synchrony (FSWDBS) 27 (P=0.03) and generalized spike wave discharges (GSWDs) 46 (P=0.01). Intermittent photic stimulation (IPS) most significantly provoked FSWDs in 07 patient (P =0.01) and GSWDs in 30 patients (P=<0.001) 7 patients (P = 0.01) and GSWDs in 30 patients (P < 0.001). Hyperventilation (HV) was associated with a higher occurrence of GSWDs in 37 patients (P =0.01). Female sex 7 (P = 0.02), provoked GSWDs 3 (P = 0.03), NREM sleep 8 (P = 0.04), prolonged EEG record 3 (P = 0.02), clinical events during recording 5 (P ≤ 0.01), diagnosis of genetic 05 (P = 0.03), and immune-mediated epilepsies 2 (P = 0.001) were associated with the provocation of ictal EAs; however, in multiple logistic regression analysis, no statistically significant association of these variables (P ≥ 0.05 each) was noted.

Conclusion:

The provocation of EAs in rEEG with different APs varies according to circumstances, including seizure types, epilepsy etiology, and the type of AP applied. These clinical and procedural parameters affect the diagnostic yield of rEEG and need careful consideration during rEEG recordings. APs adopted during rEEG recording can induce FSWDs, FSWDBS, and GSWDs in the form of either interictal or ictal EAs in various etiologies of epilepsy. Ictal EAs may appear in the form of GSWDs, during NREM sleep, in prolonged EEG records; however, their independent association needs to be evaluated in larger sample studies. Further, prospective cohort studies with adequate sample sizes are warranted.
Chronic Psychosis in a Patient with Usher Syndrome
Authors: Bhat Abhay Keshava , Meshram Sheetal Reshram , Umate Maithili S. , Jain Prakhar D.
Published: September 2024

Usher syndrome refers to a group of inherited disorders characterized by visual and auditory impairment. The risk of psychosis in Usher syndrome is higher than that in the general population and is difficult to approach and treat in light of sensory impairment. We present a case of a male with continuous psychotic symptoms for 20 years, in the setting of undiagnosed progressively deteriorating visual and auditory function, with details of treatment given. Possible underlying mechanisms of psychosis in such cases are discussed in brief.
Predictive Value of the Postural Difference in Antero-Posterior Diameter of Renal Pelvis on Ultrasonography of Unilateral Ureteropelvic Junction Obstruction in Determining the Need For Surgery
Authors: Suman Bijay Kumar , Singh Ram Jeewan , Manekar Aditya Arvind , Sahoo Subrat Kumar , Tripathy Bikasha Bihari , Mohanty Manoj Kumar , Mohakud Sudipta
Published: September 2024

Background:

Ureteropelvic junction obstruction (UPJO) is the most common cause of antenatal hydronephrosis. Although majority of them improve with time, none of the existing diagnostic modalities can accurately predict which hydronephrotic kidney is at the risk of progressive renal damage and will benefit from early surgery. Postural variations in the anteroposterior pelvic diameter (APPD) of the hydronephrotic kidney in children during follow-up postnatal ultrasonography (USG) reflect the intrapelvic tension, which might help in predicting the need of surgery amongst these patients.

Materials and Methods:

We designed this prospective observational study in all unilateral UPJO patients on postural variation in the APPD of renal pelvis on ultrasonography. The mean age of all patients were 2.15 years (0-5 years) and managed at our institute at All India Institute of Medical Sciences, Bhubaneswar. The study duration was from July 2019 to May 2021. The management of these patients was done as per the standard institutional protocol and there was no deviation due to inclusion in this study. We documented the variations in postural APPD both amongst the conservatively managed group and the surgically managed group of patients. Linear correlation between two continuous variables was explored using Pearson’s correlation (if the data were normally distributed) and Spearman’s correlation (for non-normally distributed data).

Results:

We found a higher prone APPD than supine APPD in all these patients indicating the obstruction at ureteropelvic junction. However, in the surgical group, there was less variation in the postural APPD compared to the conservative group, and when there was no variation in the postural APPD, the need of surgery was 100%. The limitation of our study was the small sample size (n = 36). A study involving a larger population or involving multiple institutions may further add significance to our findings.

Conclusion:

We found less postural variation in APPD on USG to be more likely associated with severe UPJO requiring early surgery. This may indicate a non-compliant renal pelvis. However, it was statistically not significant.
Staged Shoulder and Elbow Reconstruction in a Child with Obstetric Brachial Plexus Palsy: Six-year Follow-up
Authors: El-Beshry Shady Samir , Aly Ahmad Saeed , El-Sobky Tamer A.
Published: September 2024

The management of obstetric brachial plexus palsy (OBPP) can be challenging, particularly in neglected patients. We report the long-term results of the surgical management of a late-presenting adolescent girl with severe left shoulder and elbow flexor paralysis secondary to OBPP. She was subjected to staged shoulder and elbow reconstruction in the form of trapezius transfer and latissimus and teres major transfer to enhance shoulder abduction and lateral rotation, and flexor-pronator transfer to the anterior distal humerus to enhance elbow flexion. Flexor-pronator plasty was successful in restoring elbow flexion and function and maintaining joint stability in the long term in a patient with severe OBPP. This further consolidates its role as a feasible secondary reconstructive procedure in carefully selected patients with elbow flexor paralysis. Shoulder function improved less remarkably, yet it augmented the overall upper extremity function and correlated with pre-operative residual shoulder function. Fulfilling the candidacy for each surgical procedure is important to a successful outcome.
Interference screw-dependent internal bracing for anterior cruciate ligament reconstruction: a comparative study
Authors: Badawy Ehab R. , Ismaeil Ali H. , Abououf Alaa A. , Gaarour Osama S.
Published: September 2024

Background

The internal brace augmentation technique was introduced to protect the graft till the completion of the ligamentization process. This was achieved by adding a synthetic implant to the anterior cruciate ligament (ACL) graft. However, the rarity of reports comparing this principle to the traditional ACL reconstruction represents an obstacle to reaching a consensus about the effectiveness of this technique. Herein, we compared a simple economic modification of the internal brace augmentation technique during the ACL reconstruction with the traditional ACL reconstruction.

Patients and Methods

The study included skeletally mature patients diagnosed with ACL tears who underwent reconstruction surgery between January 2022 and January 2023 (46 patients were included). They were allocated into two groups: the case group, the internal brace group (IB), which included 21 patients, and the control group, the graft only group (GO), which included 25 patients. The patients were followed up for at least 1 year regarding the time of return to the previous level of activity, the International Knee Documentation Committee Subjective Knee Evaluation score at 1 year, the Lachman test, the pivot shift test, and the associated complication rate.

Results

Although both groups scored an excellent International Knee Documentation Committee Subjective Knee Evaluation score (>80), there was a higher statistically significant improvement in the IB group with a mean and SD of 94.8 ± 1.9 compared to the GO group with a mean and SD of 90.6 ± 2.54. Regarding the return to the preinjury activity level, the IB group showed statistically significant earlier return compared with the GO group with a mean and SD of 9 ± 1.6 months compared to 11.8 ± 1.5 months. Furthermore, the IB group showed a statistically significant superior improvement in the anteroposterior knee stability evaluated by the Lachman test.

Conclusion

The interference screw-dependent internal bracing for ACL reconstruction has shown better short-term patient-reported outcome measurements, faster return to preinjury level, and better objective anteroposterior knee stability at 1 year when compared to the traditional technique with adding no extra cost at all.
Functional outcomes after re-insertion of posterior root tear of medial meniscus using a simple economic technique
Authors: Abdelrazek Begad H. , Younis Mohamed , Misbah Hisham , Soliman Alaa M.E.-D. , Waly Mohamed R.
Published: September 2024

Background

Root avulsions of the meniscus cause loss of hoop stresses and therefore loss of the meniscal function. This in return is associated with increased peak contact stresses and risk of osteoarthritis. Root repair is therefore crucial to preserve normal biomechanics and kinematics. Many techniques have been used and expensive fancy equipment made the procedure easier, however, cost is of great importance.

Aim

To demonstrate the results and functional outcomes after root re-insertion using simple economic tools.

Patients and methods

Between March 2022 and May 2023, 25 patients with root tears were operated upon and followed-up for a mean of 12 months. Patients with acute traumatic tears, degenerative tears with grade 1–2 osteoarthritis, associated genu varum less than 5º and a BMI less than or equal to 35 were included in the study. All patients underwent diagnostic arthroscopy as part of the procedure. Pie-crusting of the medial ligament was performed routinely to facilitate visualization and instrumentation in the medial compartment. Bed preparation was performed using a motorized shaver. This was followed by passing polydioxanone suture (PDS) shuttling sutures through a grey cannula and into the posterior root meniscal tissue, this was then used to shuttle heavy poly-braided nonabsorbable suture material. A tunnel was created through the anterior tibial cortex using the anterior cruciate ligament (ACL) guide. The sutures are then tied over a post (4.5 mm screw). Lysholm, International Knee Documentation Committee (IKDC), and Tegner activity scores were used to evaluate the patients at 6 and 12 months.

Results

The mean Lysholm score improved from 50.16 ± 12.51 preoperative to 82.08 ± 12.90 postoperative. The mean IKDC score improved from 51.24 ± 11.06 to 84.36 ± 10.18. The mean Tegner activity score improved from 3 ± 1.32 ranging from 1 to 5 to 5.20 ± 1.53. Traumatic tears showed greater improvement as compared with degenerative tears.

Conclusion

Simple outside techniques can be used to perform adequate reliable root repair. This yields comparable results to other techniques described in the literature.
A comparative study of local application versus intravenous application of tranexamic acid preoperatively in cases of total hip arthroplasty
Authors: Ghanem Mohamed , Sabry Ahmed O. , Sameh Ahmed , Ahmed Ahmed A. , Younnes Mohamed , Salama Mohamed
Published: September 2024

Background

One of the biggest issues associated with total hip arthroplasties is the amount of blood loss and the need for blood transfusions. Tranexamic acid (TXA) has been proven to decrease the amount of blood loss associated with these operations. However, there is no consensus regarding the best method of TXA application. Classically, TXA had been given through the intravenous route, however, recent papers have advocated local usage. This study aimed to compare the outcomes between both local and intravenous applied TXA and determine which had less blood loss and adverse effects.

Results

Fifty patients were included in this study and were split into two groups. Group A was given local TXA, while group B took intravenous TXA. Blood loss showed no significant difference between the two groups. There were no significant differences in the incidence of adverse effects however, group B had one case of deep venous thrombosis and one case of superficial thrombosis.

Conclusion

Both local and intravenous applied TXA help decrease blood loss. There is no significant difference between the two groups in blood loss however deep venous thrombosis cases were observed in the intravenous group. In cases with a high risk of vascular thrombosis undergoing total hip arthroplasty, we would suggest applying TXA locally.
Health-related quality of life after anterior-only fixation of lower cervical spine fractures: long-term follow-up
Authors: Sleem Ahmed Saleh , Said Elsayed , Tammam Hamdy
Published: September 2024

Background

The management of lower cervical spine fractures at the cervicothoracic junction is challenging and the selection of suitable approach is a matter of debate. The results of anterior fixation of those injuries in the available literatures are ambiguous due to the heterogeneity of the studied groups and lacking long-term follow-up. Moreover, the assessment of patients’ quality of life was not taken into consideration. Our aim was to assess the health-related quality of life and long-term follow-up of a homogenous group of patients of unstable lower cervical spine fractures managed by anterior-only fixation and iliac autograft.

Patients and methods

Data from hospital records of 13 cases of lower cervical spine fracture managed by anterior fixation and graft were examined and analyzed. All cases were operated as the Subaxial Injury Classification (SLIC) score was greater than or equal to 5. The International Standards for Neurological Classification of Spinal Cord Injury and American Spinal Injury Association (ASIA) scores were used to assess patients’ neurologic status; segmental kyphosis angle for cervical kyphosis and short-Form 36-item was used for health-related quality of life assessment.

Results

Thirteen cases were included in this series with a mean age of 36.15 ± 7.82 years. C6 was fractured in 3 cases (24%), C7 in 5 cases (38%) and both C6 and C7 in 5 cases (38%). All cases have a SLIC score more than 5 with a mean of 7.0 ± 1.53 (range 5:9). The mean follow-up was 75.54 ± 22.33 months. The operative time was 90.62 ± 20.67 min The total motor score was improved from 72 ± 33.44 preoperatively to 76.92 ± 31.80 at the final follow-up. The segmental kyphosis angle was improved from 15.62 ± 3.25° preoperatively to −9.84 ± 1.77° directly postoperative and −1.30 ± 2.32° at the final follow-up and the short-Form 36-item total score was 75.04 ± 24.26.

Conclusion

The procedure proved to be safe and has yielded excellent results. The late patient outcome from the quality-of-life perspectives was not affected by loss of cervical lordosis, but on the contrary improved significantly in correlation with improvement of patients’ motor power.
Etiology for Cholestatic Jaundice: Bolt from the Blue
Authors: Gunaranjan J. Sai , Ganesh P. , Sandhya S. , Leena D. , Priyathersini N. , Shankar S. , Karthikeyan Mu , Venkataraman Jayanthi
Published: September 2024

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder (GB) that is characterized by a focal or diffuse destructive inflammatory process. We present a patient with chronic liver disease with portal hypertension who had features of obstructive jaundice due to choledocholithiasis and a palpable mass in the right hypochondrium masquerading as an empyema/carcinoma of the GB. This presentation was preceded by cholestatic jaundice due to acute hepatitis E virus infection.
Gastric Carcinoma - The Indian Perspective
Authors: Kannan Deepak , Venkatesh Seshadri , Kumar Aishwarya Mahesh
Published: September 2024

The overall incidence of gastric carcinoma has decreased worldwide. India’s diverse geographical and socioeconomic landscape contributes to the unique characteristics of this disease. Understanding the specific risk factors and epidemiological patterns is crucial for effective prevention and management strategies. This review examines the epidemiological trends, etiologic risk factors, types, and diagnostic approaches to gastric carcinoma in the Indian context.
Deranged Liver Biochemistry in a Non-Liver Intensive Care Unit: A Prospective Study
Authors: Prasad B. Rajendra , Mahadevan B. , Verghese Joy , Venkataraman Jayanthi
Published: September 2024

Introduction:

Common indications for admission to a liver intensive care unit (LICU) are often due to complications of an underlying chronic liver disease or to an acute insult to the liver either by bacterial or viral infections, alcohol or drugs. Secondary or acquired liver injury occurs in patients with systemic disease in patients who are admitted to a non-LICU setting. These patients are often hemodynamically unstable with multiorgan failure. The aim of the study was to understand the pattern of liver injury in patients admitted to a non-LICU for issues unrelated directly to the liver.

Materials and Methods:

Patients admitted to medical, neuro and cardiac ICU of the institution were included. All patients had liver biochemistry at admission. R factor (RF) criteria (alanine aminotransferase: S. Alkaline phosphatase ratio) was used for stratifying the liver injury as hepatocellular (HC) (RF-HC; ≥5), cholestatic (RF-C; ≤2) and mixed type (RF-HC+C; 2–5). Patients were followed up in the ICU until discharge.

Statistical Analysis:

SPSS v26 (IBM Corp.) was used for analysis. Chi-square test was done for categorical variables and Fisher’s exact test, when the expected frequency in the contingency table was <5 in more than 25% of the cells. P < 0.05 was considered as statistically significant.

Results:

108 (43.9%) of 246 admissions had liver injury (43.9%). The elevation in liver enzymes were <2 times the upper limit of normal range. There were no significant differences in enzyme elevations in the 3 ICUs. The most common type of liver injury was RF-C (67; 62%) followed by RF-HC+C (34; 31.5%) and RF-HC (7; 6.48%). There was no difference in the disease specific liver injury. Patients with RF-C needed significantly more inotrope support (P = 0.001); 76% survived (P = 0.023). Those with RF-HC required hemodialysis (P = 0.001) with poor survival outcome (42.9%).

Conclusions:

Liver enzymes are not significantly elevated in non-LICU patients. RF criteria is useful in not only predicting the type of liver injury but also predicting the likely outcome.
Evaluation of Stresses Generated with Two Different Self-Ligating Orthodontic Bracket Systems – A Finite Element Analysis
Authors: Awaradi Mohit , Sagarkar Roshan M. , Shivamurthy Prashantha G , Mathew Silju , Sabrish Sharanya , Bhaduri Nirajita
Published: September 2024

Aim:

To determine stresses generated in the posterior teeth region by two different self-ligating systems, 3M Unitek SmartClip and Damon Q Self-ligating brackets, using the finite element method (FEM).

Methodology:

Computed tomography (CT) scan of maxilla was taken using Mimics software, and the Dicom data were imported into Hypermesh 13.0 software to convert it into a geometric model and then into FEM. Physical models of both the brackets were constructed and positioned on the teeth. Post archwire modeling, contact is defined between the bracket slot and 0.014” NiTi arch wire. The final assembled model was exported to ANSYS 12.1 for analysis, and 60 grams of load was applied at the ends of the arch wire.

Results:

On using 0.014” CuNiTi in both the bracket systems, stresses generated on the root surface were found to be maximum on the first molar region, followed by the first premolar, second molar, canine, and second premolar regions. Comparison between the two bracket systems showed differences in the stresses generated, where higher stresses were generated at all regions in the Damon Q bracket system, except the inter-second premolar region.

Conclusion:

Maximum stresses were observed with the 3M Unitek SmartClip bracket system at the second premolar cervical region when compared to the Damon Q system. In both the cortical bone and cancellous bone, maximum stresses were observed at the second premolar cervical in the Damon Q bracket system region.
“Garima Means to Live with Pride:” A Case Study on Provider Perspectives and Local Government Response to Health of Internal Migrant Laborers in Kerala
Authors: Gopakumar Ramachandran Saraswathy , Babu Sonu S. , Gopakumar Soumya , Divya C. S. , Varma Ravi Prasad
Published: September 2024

Background:

Addressing the health needs of interstate migrants in India is a complex challenge. We undertook a case study of Garima, a migrant health intervention in Kozhikode district, Kerala, and explored the perspectives of the health system and the role of local governments with regard to the programs targeting the health of migrant laborers in Kerala.

Methods:

We used a qualitative descriptive case study approach as described by Baxter and Jack and used Braun and Clarke’s intermediate Q thematic analysis approach. We conducted one key informant interview (KII) and one in-depth interview (IDI) and review of 23 documents obtained from the corporation health department and online sources, including media and social media review. We also did two KIIs with experts and nine IDIs with field workers of the health department of the state.

Results:

Intervention execution was mainly through inspectorial health teams comprising representatives from multiple sectors, including local governments, law enforcement, and health. Actions included registration, screening, disease surveillance, and care provisioning through regular medical camps. Referral and follow-up through regional health-care centers were consistently made available in Garima. Migrant health programs increasingly focus on living conditions, including hygiene and sanitation, and employers, contractors, or building owners are to take responsibility for these.

Conclusions:

The Garima project for the health of interstate migrant laborers reflected a shift in the Kerala health system toward welfare rather than disease control and intersectoral coordination. Local governments hold the promise of advancing such interventions and scaling them up across the state.
Diagnosis of Tubercular Pleural Effusion in a Tertiary Care Hospital of Western India: Role of Cartridge-based Nucleic Acid Amplification Test and other Laboratory Parameters
Authors: Mukhida Sahjid , Khan Sameena , Vyawahare Chanda , Gandham Nageswari R.
Published: September 2024

Introduction:

Tubercular pleural effusion (TPE) is a paucibacillary disease, and mycobacterial culture positivity from pleural fluid samples is rare and time-consuming, leading to considerable delay in initiating antibiotic therapy. However, in high-burden settings, the diagnosis is presumed in individuals based on adenosine deaminase (ADA) level and a lymphocytic-predominant exudate on presentation. The current study was conducted to screen clinically TPE-suspected patients by cartridge-based nucleic acid amplification test (CBNAAT) as well as culture and to evaluate whether TPE correlates with pleural fluid laboratory counts.

Materials and Methods:

This observational study was done at a tertiary care hospital from January 2019 to June 2021 on 157 TPE-suspected patients. CBNAAT was performed for both pleural fluid and sputum specimens while solid culture was processed on pleural fluids only as per routine microbiological procedures. Pleural fluid was sent for biochemical analysis and investigation of ADA, total leukocyte count, and differential leukocyte count because of lymphocyte predominance.

Results:

A total of 314 specimens (pleural fluid and sputum) from 157 patients were processed for CBNAAT. Mycobacterium tuberculosis was detected in 22 (14.01%) of 157 sputum specimens and 19 (12.10%) of 157 pleural fluid specimens. A total of 25 pleural fluid specimens have growth on solid media. CBNAAT sensitivity was found 52% in the current study. A total of seven patients were detected with pulmonary tuberculosis (PTB) along with TPE. In TPE diagnosis, all laboratory parameters were found statistically significant (P < 0.5).

Conclusion:

The use of two tests for patient screening, such as the CBNAAT and supporting marker test, improves the early detection of TPE and stops the progression of problems from untreated, long-standing TPE. This study also reveals the significant correlation of PTB in clinically TPE-suspected patients.
A Systematic Approach to Evaluation of Delivered AI
Solutions
Authors: Wells David , Fowler Stuart , Walters Josh , Elrod Ivy , Foley Jacob
Published: September 2024

An approach to performance assessment and evaluation of robustness' of delivered
AI (artificial intelligence) solutions (e.g., Aided Target Detection and
Recognition (AiTDR) or ground vehicle autonomy behaviors) is presented. The
initial development assumes the AI solution is delivered as a blackbox solution
taking specified inputs and delivering output or outputs per stated
requirements. The methods developed seek to not only confirm that requirements
are met but to confirm performance in a manner that provides supporting evidence
of which input information contributed to the AI output. Methods are developed
for both AI solutions that take a single sample input as well as AIs that take a
sequence of inputs to produce an output. Examples are included for convolutional
neural networks (CNN). Planned extensions to the blackbox methods are discussed.
Extensions include adaptations to support Residual Network (ResNet) solutions,
evaluation of solution robustness when hidden layer activations are exposed, and
development of metrics and methodologies to support AI solution training by
ensuring the AI solution is properly trained, not over trained, or undertrained.
A process is proposed for assessment of the AI solution with metrics to identify
primary contributing inputs to the solution and an approximate indication of
where the solution falls along the training scale.
Synchronizing MBSE Models and Software Development in Robotic
Autonomous Systems
Authors: Cheung Calvin , Pfeil Andrew , Griffith Shannon , Petrotta Mark , Brooks Mitchell , Moore Michael , Dennis Doyle , Grunwald Reagan
Published: September 2024

MBSE and Agile software development are both vital approaches used by the DoD to
facilitate development at reduced cost and a rapid pace for high priority
efforts, such as Robotic and Autonomous Systems. Despite the common goals
however, the expertise needed to apply both approaches are often separated
between different groups of personnel with different skillsets, such as systems
engineers and software developers. To bridge the gap between MBSE and Agile
software development, we developed toolchains that help synchronize software
development with SysML models. These toolchains leverage an XML-based,
developer-maintained Model Import File (MIF) schema that we created. The MIFs
are based upon Robot Operating System concepts and can be used to create
additional toolchains in the future based on program needs.
How Did General Veers Get His AT-AT? Product Line Engineering (PLE),
Of Course!
Authors: Gagliardi Matthew , Hause Matthew
Published: September 2024

MBSE and architecture frameworks were created to help systems engineers cope with
the complexity of systems and systems of systems (SoS). Using these modeling
languages, systems engineers can define the system, its context, connecting
systems, internal components and behaviors, constraints, how the system changes
over time, etc. However, when dealing with a family of systems or a product line
of systems, one needs to understand the system variability, common components
and behavior across the product line. This can decrease costs for development,
maintenance, supply chains, and shorten development lifecycles. Product Line
Engineering (PLE) is the engineering and management of a group of related
products using a shared set of assets and a means of design and manufacturing.
PLE can include system and software assets and involves all aspects of
engineering including electrical, electronic, mechanical, chemical, etc.
Model-based Product Line Engineering combines the best of MBSE and PLE. Using an
example system from Star Wars, this paper will describe MB-PLE, the process for
creating product lines, and the benefits of this approach as applicable to the
military ground vehicle domain. Finally, it will show how the adoption of MB-PLE
provides analysis of alternatives for candidate architectures.
MBSE Strategies: Avoiding Cyclic Project Usage Dependencies by using
Black Box and White Box Models
Authors: Kolligs Jason , Masterson Stuart , Thome Eric , Knutson Christian
Published: September 2024

Every digital engineering framework and modeling approach will include benefits
and concerns. It is important to customize the response, within reason and based
on the available resources, to the needs of the project and contract. For this
case, the consideration of a large, singular model was overturned for a
distributed model. The potential for a cyclic usage, which can be catastrophic
in both performance issues and data loss, was mitigated by an innovative
approach that allowed for two (2) systems models – one (1) Black Box and
one (1) White Box – using a novel model federation strategy. The
concerns of having two (2) system models were mitigated via acceptance and
understanding that each system model would play its part appropriately based on
model function, system development, and contract deliverables.