bluuebunny/crossref_metadata_2025 huggingface dataset:
La psychiatrie périnatale, sortir du silence
Authors: Ronen Karine , De Laage Hélène , Grégoire-Taieb Élisabeth , Dugravier Romain
Published: May 2023

La psychiatrie périnatale est une spécialité encore jeune, en pleine structuration dont l’objet est de prendre soin des bébés et de leurs parents. Actuellement, la définition retenue est celle de soins conjoints, c’est-à-dire de soins centrés sur les échanges, les interactions, réelles, imaginaires ou fantasmatiques entre le bébé et ses parents. La symptomatologie du bébé est ainsi parfois différée, inapparente ou « en creux » et elle ne peut pas toujours être un moteur suffisant pour une demande de soins. Longtemps, les parents fragilisés (déprimés ou même présentant des troubles psychiatriques plus sévères) n’ont pas formulé de demande de soin, par honte, par culpabilité ou par crainte du regard des autres, d’une stigmatisation liée à leurs ressentis ou à leur diagnostic. Certains parents, aussi, expriment leur immense sentiment de solitude et le silence de leur entourage face à leur détresse (nous pensons, ici, aux parents endeuillés, par exemple). Les professionnels de la périnatalité (sages-femmes, obstétriciens, pédiatres, puéricultrices), quant à eux, s’ils sont toujours plus sensibilisés aux enjeux psychiques de la période sont encore en difficulté pour aborder certains sujets (symptomatologie dépressive et potentielles idées suicidaires du parent, troubles de la parentalité et souffrance du bébé) surtout s’ils craignent de ne pas pouvoir s’appuyer sur des professionnels de santé mentale.
L’enfant qui avait perdu sa langue
Authors: Châtelet Isabelle
Published: May 2023

« Mutisme » est un mot qui fait du silence un symptôme, une pathologie. En tant qu’atteinte durable de la parole dans certaines situations et vis-à-vis de certaines personnes, lui est attribuée une origine, ou une cause, qui n’appartient pas à l’enfant, même s’il en est l’agent. Parce que ce silence est adressé, fait énigme et suscite l’agacement, il est soupçonné d’être volontaire, intentionnel. Or on ne choisit pas de ne pas parler : il a perdu sa langue, on lui a coupé la langue, dit-on en français. Quelle est cette instance qui lui a ôté subitement et parfois pour longtemps l’usage de cet organe et qui agit à ses dépens ? L’enfant en serait le sujet, au sens d’une soumission à un maître qu’il ignore et avec lequel il collabore. C’est à cette violence subie que réagit le témoin de cette mutité partielle, sans lésion mais persistante. Il voudrait la panser, restituer à l’enfant ce qu’il a perdu. Au risque d’un affrontement avec un fantôme auquel l’enfant mutique est attaché et qu’il semble ne pas vouloir lâcher.
Et le silence fut : origines et filiation chez l’enfant adopté
Authors: Bocquillon Mélissa
Published: May 2023

Si le langage structure la pensée, le silence a une part fondatrice dans la plénitude de la parole ; le silence participe à la construction psychique du sujet mais il peut aussi devenir une entrave, un frein à l’identité narrative. Ainsi, le secret familial, l’amnésie, le silence, le non-dit, correspondent à l’énigme de la naissance de l’enfant adopté, à son histoire originelle. L’affiliation filiative à l’œuvre dans l’adoption peut se concevoir comme l’exigence d’un travail psychique nécessaire aux transmissions et aux héritages générationnels afin de permettre à chacun la construction de sa propre identité, l’élaboration de sa subjectivité et de son destin. Nous aborderons la question du silence dans sa dimension organisatrice mais aussi bouleversante – quelle part prend le silence dans le développement psychique de l’individu et son corollaire sur la transmission inter- et trans-générationnelle ? Si la parole est fondatrice et fait surgir le visible en le dévoilant, le silence se réduit-il à ce qui n’est pas ou ne peut pas être, pris dans les filets de la négation ? Nous étayerons notre propos à partir du contexte de l’adoption, plus particulièrement des consultations de dossier ; processus « révélateur », parfois réparateur sur les origines et l’histoire familiale.
Clinique de l’inceste Le silence des mots est un aveu des plus graves
Authors: Lemitre Samuel
Published: May 2023

L’inceste est un trouble grave de la filiation qui entraîne un véritable chaos générationnel. Il se caractérise par une sexualisation atypique du lien à l’enfant qui désorganise l’attachement, aliène la tendresse et attaque l’identité subjective. Certains parlent de crime généalogique ou de crime contre l’humanisation dont les conséquences sont graves et impactent la santé physique et psychique des victimes durant la vie entière. Les anthropologues parlent d’un phénomène d’invisibilisation du sujet, l’inceste ne suscitant aucun intérêt scientifique, et ce, malgré les premières études de prévalence qui en font une réalité traumatique épidémique. Le discours anthropologique fait émerger un autre néologisme, celui de silenciation , mécanisme d’emprise par lequel les auteurs génèrent chez les enfants un conditionnement par la peur qui bloque les capacités de parole et de mentalisation du traumatisme. En clinique li (Lifespan Integration) , la réponse de stress majeur déclenché par l’activation de mémoires traumatiques permet de situer le trouble de l’inceste dans le cadre des modèles neurobiologiques du stress, de la communication et de l’attachement. Cette approche offre l’intérêt de dégager le trouble de ses enjeux idéologiques et moraux pour l’appréhender comme un nouveau paradigme d’étude des mécanismes de traumatisation complexe.
Favoriser et accompagner en justice la sortie du silence sur les « violences de l’intime »
Authors: Bégon-Bordreuil Laurence
Published: May 2023

Les violences intrafamiliales ou les violences sexuelles au sein d’une institution, comme entre inconnus, touchent intrinsèquement à l’intimité du corps. Elles seront ainsi ici nommées « violences de l’intime ». Elles constituent des atteintes si graves à l’intégrité physique, psychique et à la dignité des personnes qu’elles conduisent aux mêmes réflexes de silence. La libération actuelle de la parole met au défi la justice. Peut-elle favoriser la sortie du silence ? Comment peut-elle établir les faits et accompagner les victimes ? A-t-elle vocation à réparer et si oui comment ?
Le silence et la parole : ennemis ou alliés ?
Authors: Le Fourn Jean-Yves , Douville Olivier
Published: May 2023

Tenter un dialogue sur le thème du silence : quel paradoxe ! Les auteurs, en refusant de réduire le silence à l’absence de parole et au mutisme, vont éclairer les différences entre ce qu’il en est du silence comme condition de la parole et du non-dit qui interdit la parole et le dialogue. La référence à des champs esthétiques et anthropologiques permet d’envisager plusieurs qualités de silence : celui qui accompagne des chorégraphies contemporaines où se montre le corps retrouvant son envol et ses rythmes, celui du candidat à l’initiation, se préparant à affronter le mystère de la tradition et le mystère de son corps à venir.
Propos d’enfants de cycle 1 et 2 collectés lors d’ateliers de réflexion sur « la nature »
Authors: Frappart Sören
Published: May 2023

Cette étude vise à décrire ce que des enfants de cycle 1 et 2 évoluant dans un contexte bénéficiant d’une certaine proximité aux êtres vivants non-humains disent de « la nature » lorsqu’ils sont invités à en discuter lors d’ateliers de réflexion menés à l’école. L’analyse des discussions montre que les préoccupations sociétales liées aux diverses crises environnementales sont évoquées par les enfants de cycle 1 et 2. Néanmoins, en cycle 1, lorsque le concept est opérationnalisé, ce sont des expériences vécues et imaginaires qui sont mises en mots. Un registre qui n’est pas retrouvé au cycle 2. Lors de prochaines études, l’exploration de la spécificité des propos ici rapportés au regard des caractéristiques de la niche de développement des enfants pourrait être approfondie.
The use of social media for crisis communication during the COVID-19 pandemic: The case of Lebanon
Authors: Aoun Georges , Aoun Barakat Karine
Published: May 2023

La crise sanitaire du COVID-19 a créé de nombreux défis pour les gouvernements, notamment en ce qui concerne l’utilisation de communications appropriées sur la pandémie et du renforcement de la confiance du public dans les décisions du gouvernement. L’étude adopte une approche qualitative pour explorer l’utilisation des médias sociaux par les autorités libanaises durant la pandémie de COVID-19 et analyser ses communications à partir de la théorie de la réparation d’image ( image repair theory ). Les résultats montrent que pendant la pandémie de COVID-19, le gouvernement libanais, qui a souffert de crises majeures dans le pays et du manque de confiance de la majorité de la population, a été confronté au dilemme de préserver la liberté individuelle tout en recherchant le bien commun. Pour cela, il a utilisé un ensemble d’outils de communication visant à inquiéter, à expliquer et à rassurer la population. En outre, les médias sociaux ont été utilisés pour dissiper les rumeurs et combattre les fake news.
Avis de consommateur en ligne : essai de clarification et proposition d’une définition
Authors: Lombard Gautier , Herrmann Jean-Luc , Kacha Mathieu
Published: May 2023

L’objectif de cet article est de proposer une définition de la notion d’avis de consommateur en ligne. Après la présentation de l’ensemble de la démarche adoptée pour la construire, sont explicités chacun des sept « critères discriminants absolus » élaborés. Ces sept critères conduisent à la proposition de la définition suivante : un avis de consommateur en ligne est un message émis par un consommateur qui partage des informations ou réactions affectives consécutivement à son expérience de consommation d’un objet, publié sur une plateforme internet, accessible à tout public, et non contrôlé par l’organisation sujette. En conclusion sont soulignées les contributions potentielles de cette définition sur le double plan académique et managérial.
Circular food economy: A new perspective on food waste
Authors: Diekmann Larissa , Germelmann Claas Christian
Published: May 2023

Pour relever les défis mondiaux actuels (changement climatique, pénurie de ressources naturelles et insécurité alimentaire), il faut opérer un changement fondamental dans la production et la consommation alimentaire. Ce changement peut être réalisé par la transition de l’économie linéaire traditionnelle vers une économie circulaire tournée vers l’avenir. Sur la base des caractéristiques clés de l’économie circulaire, cet article propose un cadre conceptuel pour une économie alimentaire circulaire. En faisant passer la logique sous-jacente des processus de production et de consommation de linéaire à circulaire, l’économie alimentaire circulaire favorise un changement dans la façon dont le gaspillage alimentaire est perçu : d’inutile, il devient précieux. Le remplacement de l’élimination des ressources alimentaires par la prévention, la réutilisation, le recyclage ou la récupération permet cette transition. Outre les changements internes, l’économie alimentaire circulaire nécessite un réseau de valeur à plusieurs niveaux qui facilite l’échange de ressources alimentaires et d’informations au sein et entre les acteurs du système alimentaire aux niveaux micro, méso et macro.
Le sentiment anti-français en Afrique
Authors: Pouillieute Antoine
Published: May 2023

Le sentiment anti-français s’est développé au même titre que celui anti-occidental. Mais avec plus de force, voire de haine pour de multiples raisons, avec des responsabilités partagées. Le manque de prise en compte des aspirations de la jeunesse alimente le rejet de la France dont le modèle n’apparaît plus comme attractif.
France, redevenir une vraie puissance d’équilibre !
Authors: Clément-Bollée Bruno
Published: May 2023

Face aux mutations actuelles, la France doit réinvestir en Afrique en comprenant la profondeur du changement en cours, en particulier au sein de la jeunesse qui mérite d’être la priorité. Des projets crédibles et réalistes sont déjà en cours et doivent être soutenus par l’ensemble des partenaires y compris européens.
Plaidoyer pour une nouvelle politique africaine
Authors: Michaïlof Serge
Published: May 2023

La France a connu plusieurs échecs en Afrique. Il faut en tirer les leçons en travaillant différemment pour restaurer une confiance aujourd’hui fragilisée. Sans laisser la place par naïveté à une Russie agressive dont les milices pillent sans vergogne les ressources du Mali et de la Centrafrique.
La France et la guerre d’Ukraine
Authors: Kempf Olivier
Published: May 2023

La France n’est pas restée en retrait avec la guerre d’Ukraine. Cependant, sa position n’a pas toujours été bien comprise par nos partenaires, même si le soutien envers Kiev est solide et convaincant. Cette incompréhension résulte de l’exception stratégique défendue depuis longtemps par Paris.
Histoire militaire
Authors: Franc Claude
Published: May 2023

Le sabordage de la Flotte à Toulon en 1942 est venu s’ajouter aux traumatismes de Mers el-Kébir et de Dakar. Les bâtiments qui restent sont endommagés et/ou dépassés. Grâce aux Alliés américains et britanniques, la Marine se remet en ordre de bataille pour participer aux opérations de la fin de la guerre.
Histoire maritime
Authors: Franc Claude
Published: May 2023

La Marine a été durement éprouvée et son réarmement à partir de 1943 n’a pas été simple, même si les marins surent reprendre le combat aux côtés des FNFL engagées depuis la fin juin 1940. Les cessions de marines par les Alliés furent indispensables pour reconstruire la Marine après le sabordage de Toulon.
Existence and blowup of solutions for non-divergence polytropic variation-inequality in corn option trading
Authors: Li Jia , Bi Changchun
Published: May 2023

This paper focuses on a class of variation-inequality problems involving non-divergence polytropic parabolic operators. The penalty method is employed, along with the Leray Schauder fixed point theory and limit progress, to determine the existence of solutions. The study also delves into the blow-up phenomena of the solution, revealing that under certain conditions, the solution will blow up in finite time.
Blockchain-based multi-authority revocable data sharing scheme in smart grid
Authors: Yang Xiao-Dong , Liao Ze-Fan , Shu Bin , Chen Ai-Jia
Published: May 2023

In view of the problems of inefficient data encryption, non-support of malicious user revocation and data integrity checking in current smart grid data sharing schemes, this paper proposes a blockchain-based multi-authority revocable data sharing scheme in the smart grid. Using online/offline encryption technology with hybrid encryption technology enhances the encryption performance for the data owner. The use of user binary tree technology enables the traceability and revocability of malicious users. The introduction of multiple attribute authorization authorities eliminates the threat of collusive attacks that exist in traditional data-sharing schemes. In addition, the semi-honest problem of third-party servers is solved by uploading data verification credentials to the blockchain. The security analysis results show that the scheme can resist selective plaintext attacks and collusion attacks. The performance analysis results show that the proposed scheme has lower computational overhead and better functionality than similar schemes, which is suitable for secure data sharing in smart grids.
Optimal redistribution with a shadow economy
Authors: Doligalski Pawel , Rojas Luis E.
Published: May 2023

We extend the theory of optimal redistributive taxation to economies with an informal sector. In particular, in our model, workers can supply labor simultaneously to the formal and the informal sectors, which we call moonlighting. The optimal tax formula contains two novel terms capturing informality responses on an intensive and an extensive margin. Both terms decrease the optimal tax rates. We estimate the model with Colombian data and find that informality strongly reduces tax rates at all income levels. The possibility to migrate to entirely informal employment restricts tax rates at low and medium income levels, while the possibility of moonlighting is relevant at higher earnings.
Distance on matchings: An axiomatic approach
Authors: Can Burak , Pourpouneh Mohsen , Storcken Ton
Published: May 2023

Matchings in a market may have varying degrees of compromise from efficiency, fairness, and or stability. A distance function allows to quantify such concepts or the (dis)similarity between any two matchings. There are a few attempts to propose such functions; however, these are tailored for specific applications and ignore the individual preferences completely. In this paper, we construct a normative framework to quantify the difference between outcomes of market mechanisms in matching markets, while endogenizing the preferences of the individuals into the distance concept. Several conditions are introduced to capture natural and appealing behavior of such functions. We find a class of distance functions called
scaled Borda distances, which is the only class of distance functions that satisfies these conditions simultaneously.
An Efficient Method to Decide the Malicious Traffic
Authors: Kumar Ajay , Singh Jitendra , Kumar Vikas , Shrivastava Saurabh
Published: May 2023

To address the high rate of false alarms, this article proposed a voting-based method to efficiently predict intrusions in real time. To carry out this study, an intrusion detection dataset from UNSW was downloaded and preprocessed before being used. Given the number of features at hand and the large size of the dataset, performance was poor while accuracy was low. This low prediction accuracy led to the generation of false alerts, consequently, legitimate alerts used to pass without an action assuming them as false. To deal with large size and false alarms, the proposed voting-based feature reduction approach proved to be highly beneficial in reducing the dataset size by selecting only the features secured majority votes. Outcome collected prior to and following the application of the proposed model were compared. The findings reveal that the proposed approach required less time to predict, at the same time predicted accuracy was higher. The proposed approach will be extremely effective at detecting intrusions in real-time environments and mitigating the cyber-attacks.
A Historical Text-Based Game Designed to Develop Critical Thinking Skills
Authors: de Vero Ivo , Barr Matthew
Published: May 2023

Designing an intervention that can effectively develop critical thinking skills is challenging because of the problems of transfer and domain specificity. The authors describe the design and development of a text-based game that could teach players important critical thinking skills in the domain of history. This was achieved by combining Schon's reflective practitioner model with game-based learning principles. The work contributes to the existing literature because the combination of the models employed allowed the game design to address the problem of transfer, as well as developing critical thinking skills. The instrument used to evaluate the effectiveness of the game was a questionnaire based on the reflective practitioner model. The gathered qualitative data were analysed through affinity diagramming. The results show that the game that was developed has the potential to encourage advanced levels of historical thought, as well as critical thinking skills.
Finite Capacity Material Requirement Planning System for a Three-Stage Supply Chain Under Manufacturer-Managed Scheduling Concept
Authors: Paopongchuang Benyaphorn , Yenradee Pisal
Published: May 2023

Supply chain management (SCM) is critical to the success of manufacturing industries. Advanced production planning and scheduling functions capable of coping with activities in a supply chain (SC) are presently needed. A finite capacity material requirement planning (FCMRP) system for a three-stage SC, defined as “3-SC FCMRP,” is presented herein. The system aims to generate feasible production and transportation schedules for the SC based on the manufacturer-managed scheduling concept, which allows the main manufacturer to manage the production schedule by considering the finite capacities of the factory work centers, suppliers, as well as customers. The system is based on a modular design concept that allows each module to be modified easily and independently. Experimental results show that all subsystems have statistically significant effects on the total cost of the SC, and schedules generated by the 3-SC FCMRP system are more realistic than those generated by the FCMRP system for the single or two-stage SC.
Teachers' Technology-Enhanced Remote Teaching Competency in an Arctic Ubiquitous Pedagogical Context
Authors: Frangou Satu-Maarit , Länsman Unni , Keskitalo Pigga
Published: May 2023

This article presents the findings of a survey (N = 35) conducted among teachers working above the Arctic Circle in Northern Finland, specifically in the Sámi Domicile Area educational institutions (the Utsjoki, Enontekiö, Inari, and Sodankylä municipalities). The survey's goal was to determine what types of premises instructors worked in when working in online environments, as well as what types of developmental needs they indicated. The survey was designed around a technology integration framework that focuses on and combines technological, pedagogical, and content knowledge, and technological-pedagogical content knowledge (TPACK) by Mishra and Koehler for the effective and meaningful integration of technology in teaching and learning activities. The findings suggest that digital education is still being implemented at a variety of levels in Northern schools and that greater efforts should be made to ensure that appropriate techniques and equal learning opportunities are available to all students.
Single-Phase High-Entropy Carbides Synthesized from a Mixture of Pre-Mechanically Alloyed TiZrHfTaNb HEA Powders and Carbon
Authors: Razumov Nikolay G. , Makhmutov Tagir Y. , Kim Artem , Popovich Anatoly A.
Published: May 2023

In this paper, single-phase chemically homogeneous high-entropy ceramics (HEC) were synthesized from a mixture of pre-mechanically alloyed TiZrHfTaNb high-entropy alloy (HEA) powders and carbon. Mechanical alloying (MA) of a TiZrHfTaNb alloy with different process times made it possible to obtain a powder with uniform distribution of chemical elements and with the main phase in the form of a body-centered cubic (BCC) solid solution. HEC with the chemical formula MeC and space group Fm-3m begins to form at temperatures of about 1600 °C in the process of sintering a mixture of pre-mechanically alloyed HEA powders and carbon. A detailed study of the diffraction patterns revealed peaks of mixed zirconium-hafnium oxide (ZrHf)O2, which is also confirmed by the microstructure analysis results and distribution elements. Increasing the process temperature to 2000 °C leads to the formation of a single-phase and chemically homogeneous (TiZrHfTaNb)C HEC.
The Effects of Citric Acid as Crosslinking Agent on Selected Properties of Cassava Starch Films
Authors: Ramos Ana Rose , Manalo Ronniel D. , Ong Hui Lin , Herrera Marvin U. , Balela Mary Donnabelle L.
Published: May 2023

Materials made from renewable resources offer a promising strategy for reducing environmental problems. Starch is a well-known alternative among several biodegradable materials due to its availability, cheap cost, and degradability. This research aims to develop a degradable film from cassava starch and use citric acid as the crosslinker. Light transmittance measurement reveals that the films produced have high UV barrier capacity in the UV region and above 80% transmittance values in the visible region. Additionally, it was found that the film with 10% citric acid had a favorable balance of tensile strength, elongation, and fracture stress.
On the Effect of Monomeric and Polymeric Plasticizer on Polybutylene Succinate (PBS), Polyhydroxybutyrate (PHB), and Polylactic Acid (PLA) Films with 20wt%PCL for Flexible Packaging Application
Authors: Govindan Srinivasan , Ramos Maximiano , Al-Jumaily Ahmed M.
Published: May 2023

Nowadays, biodegradable polymers such as Polybutylene succinate (PBS), Polyhydroxybutyrate (PHB), and Polylactic acid (PLA) are widely used commercially, especially in flexible packaging applications, but these polymers have certain limitations in their properties. The main aim of this study was to develop biodegradable polymer films with improved performance characteristics. This paper focused on developing and enhancing the characterization such as tensile properties, water barrier properties, and biodegradation properties of PBS-PCL(Polycaprolactone), PHB-PCL, and PLA-PCL blends, with the addition of 5wt% of plasticizer [GTA (Triacetin/ glycerol triacetate), a monomeric plasticizer P1, Ultramoll, a polymeric plasticizer P2; and mixed plasticizer P3 (1: 1 mix of P1 and P2)] for flexible packaging application. The plasticized polymer films (thickness 0.25mm) was prepared by injection molding and hot pressing method, and analyze the characterization such as tensile properties (ASTM D882-18 method), water vapor barrier properties (ASTM E96-16 method), and the biodegradation properties in compost (ASTM D5338-15 method), and seawater (ASTM D6991-17 method) medium, and analysis the effect of plasticizers on plasticized polymer blends. The research shows that compared to polymers blends such as PBS, PHB, and PLA, with 20wt% of PCL, there was a significant increase in tensile elongation by 22%,76.6%, and 139.3%, respectively and an increase in biodegradability by 19.5%, 3.6%, and 38.9% in compost medium, and 22.1%, 1.8%, and 41.0% in seawater medium, respectively, with the addition of all three 5wt% plasticizers (Ultramoll), though the tensile strength and water vapor properties were decreased. The plasticizer study shows that plasticized polymer blends using mixed plasticizer (P3) provide the best overall performance enhancement.
Evaluation of Appropriateness of Red Blood Cell Transfusions
Authors: Desai Priti , Navkudkar Anisha , More Nileema , Rajadhyaksha Sunil B.
Published: May 2023

Background and Objectives:

Red blood cells (RBC) transfusion is an important medical therapy in modern medicine. Blood is a scarce resource used in large numbers; therefore, it is very essential for its components to be used appropriately and judiciously. It is necessary to monitor, assess, and evaluate the existing trends and appropriateness of blood utilization. The establishment of criteria for blood transfusion and strict adherence to such criteria may be necessary to improve blood usage. The objective of this study was to understand the utilization pattern of RBC transfusions based on indications and to evaluate the appropriateness of RBC transfusion at a tertiary care oncology center.

Methods:

This was a prospective observational study conducted over a period of 4 months. A total of 4413 RBC transfusion events in 2012 adult oncology patients were analyzed for appropriateness as per institutional guidelines. Data were obtained from the blood requisitions, issue records of the Department of Transfusion Medicine and from the Electronic Medical Records of the patients.

Results:

Total of 83% of transfusion events were found to be appropriate with Anemia being the most common indication for RBC transfusion in medical and surgical oncology units. Appropriateness was significant (P < 0.05) in medical oncology as compared to surgical oncology units. Appropriateness was highest and statistically significant (P < 0.05) in operation theatres while inappropriateness was more and significant in the daycare facility (P < 0.05).

Conclusion:

Total 83% of RBC transfusions were found to be appropriate indicating that clinical practices of RBC transfusions in the hospital were rational with adherence to institutional guidelines.
Undiagnosed Dual Blood Disorder – Thalassemia with Acute Myeloid Leukemia
Authors: Nirwan Rekha , Mannur Ketaki Prashant , Singh Divya
Published: May 2023

Thalassemia syndromes represent a group of inherited disorders characterized by decreased synthesis of one or more of the four globin chains in hemoglobin. The clinical spectrum ranges from asymptomatic carrier state to transfusion-dependent severe disease. The availability of better treatment options has increased the life expectancy in these patients and consequently paved the way to develop malignancies. Although many studies are published on the association of solid organ and lymphoid malignancies, only one case has been reported so far for acute myeloid leukemia (AML) coexisting with thalassemia syndromes. Herein, we report the first case of AML associated with beta-thalassemia in an adult Indian expatriate woman in Qatar. She presented with prolonged bleeding after a dental procedure. She was diagnosed as concurrent AML and beta-thalassemia trait on the laboratory evaluation. This case signifies the use of peripheral blood film evaluation for any abnormal hemograms in the modern era of automation. It also warrants caution for clinicians in suspecting malignancies in thalassemia although direct genetic linkage or associated risk is a matter of research.
Dual Red Cell Alloimmunization with Anti-c and anti-E Antibodies
Authors: Pahuja Sangeeta , Chauhan Richa , Sharma Geetika , Singh Deeksha , Singh Manisha , Yadav Ram Vilash
Published: May 2023

Background and Objectives:

Alloimmunization can lead to difficulty in arranging compatible, antigen-negative blood units for the patients. Alloimmunization by coexisting “c” and “E” antibodies, though common, is frequently missed. Both “c” and “E” antigens are highly immunogenic and have the potential to cause hemolytic disease of newborn and hemolytic transfusion reactions. The objective of this study is to discuss different clinical scenarios of concomitant and singular presence of anti-c and anti-E along with the diagnostic approach and transfusion management in resource-limited settings.

Methods:

Column agglutination gel technology in low ionic strength solution phase was used for initial antibody identification. Detailed immunohematological workup was done by the use of select cells (c+, E− and c−, E+) and adsorption elution studies using a commercially available acid elution kit.

Results:

Out of 16 patients, detailed immunohematological workup was available for 14 patients, whereas two patients were lost to follow-up. Among 14 patients, 12 had CCDee (R1R1) phenotype, whereas two patients had CcDee phenotype (possible R1r) with anti-E antibody. In 12 patients with R1R1 phenotype, 6/12 (50%) had dual coexisting anti-c and E, whereas 3/12 (25%) had only anti-c and 3/12 (25%) had only anti-E. In R1R1 patients having anti-E, coexisting anti-c was found in 6/9 (66.66%) of patients.

Conclusion:

The study emphasizes the use of both “c” and “E” negative red cells (R1R1) in R1R1 patients having either anti-c or anti-E. Thus, in India, there is a need to develop our own red cell panels having an adequate representation of indigenous antigens and phenotypes.
Low-titer O Whole Blood in Management of Massive Bleeding
Authors: Pahuja Sangeeta
Published: May 2023

The management of massively bleeding patients has undergone paradigm shift. With the evolution of bundle of care in form of damage control resuscitation, early blood-based resuscitation has emerged as one of the pillars of treatment; focused at preventing shock, coagulopathy, and thrombocytopenia. Military has always relied on low-titer O whole blood (LTOWB) to provide balanced hemostatic resuscitation for bleeding patients in combat casualties. Good results from military practice have led to questioning of practices followed in civilian bleeding trauma patients. With the realization that cold-stored platelets are functionally superior for immediate hemostasis, there is renewed interest in role of LTOWB in providing early hemostatic resuscitation to massively bleeding patients. Not only does LTOWB provide all the components but it also has an advantage of simplifying resuscitation logistics by providing all the components in one bag instead of three, in situations where delay of every minute leads to increased mortality. It can provide blood-based resuscitation in scenarios where it may not otherwise be possible. It can be used across all blood groups. This review explores the concerns regarding the use of LTOWB, historical perspective, advantages, and disadvantages. Several studies have shown that LTOWB is noninferior, as compared to components, and is a safe practice, without significant transfusion-related adverse events. The use of LTOWB in bleeding patients needs further studies to explore its efficacy and safety versus component therapy.
A Rare Case of Bm (Bweak) Phenotype Detected in a Healthy Blood Donor from Eastern India
Authors: Reddy Mahua , Basu Sabita , Basu Debapriya , Datta Suvro Sankha
Published: May 2023

A 52-year-old male repeats voluntary blood donor donated at our blood center for the first time. Historical blood group was O, Rh (D) positive. Initial blood grouping was done on the fully automated immunohematology analyzer using column agglutination technique (CAT). Discrepant results (forward as group O and reverse as group B) were observed while performing the ABO blood grouping by CAT. Repeat testing by conventional tube technique showed the same discrepancy. Antibody detection test and direct antiglobulin test results were negative. After adsorption-elution, the eluate reacted only with group B red cells. Saliva testing for secretor status shows the presence of B and H substances. Finally, it was classified as a case of Bm (now called Bweak) phenotype. As a precautionary measure, the donor was recalled and a special blood group card was issued with a clear mention of his respective donor and recipient status. This case showed the importance of ABO subgroup determination that can help blood centers to establish defined transfusion protocol and prepare an elaborate rare blood donor registry.
Is Indirect Coombs Test by Pooled Cells Sufficient for Antibody screening? An Eye-Opening Case Series
Authors: Sriraman P. , Sahoo Dibyajyoti , Basavarajegowda Abhishekh , Noushad Shahida , Toora Esha , Kulkarni Rajendra G.
Published: May 2023

The ideal way to screen for the presence of alloantibodies is by antibody screening panels which represent all clinically significant antigens in appropriate dosage. Most centers use pooled O-cells for antibody screening as it has antigens of non-ABO blood group systems that are prevalent in a representative population. Pooled O-cells sometimes fail to detect antibodies to less prevalent red blood cell antigens with reduced expression or show a dosage phenomenon. Despite pooling 4 to 5, O-donor segments, sometimes, it is difficult to detect clinically significant antibodies. False-negative indirect Coombs test by pooled O-cells may delay getting a compatible unit for elective cases where type and screen policy is used. Donor units with weak antigenic expression or units showing dosage can come compatible despite being antigen positive and lead to a hemolytic reaction. We report two cases where antibody screening by pooled O-cells was negative; still, cross-match was incompatible. Antibody screening with a three-cell panel was positive. Antibody identification with 11-cell panels confirmed the alloantibody to be anti-E. The present cases emphasize the importance of three-cell panels over pooled O-cells.
A Knowledge, Attitudes, and Practices Survey concerning Blood Donation among Libyans
Authors: Goldsmith A J , Gebril N M , Thull D S , Abdella Y E , Barski L , Malgor P Y , Bossolini F , Aldaher O , Smit Sibinga Cees Smit
Published: May 2023

Background and Objectives:

Libya's blood transfusion system suffers from chronic blood shortages due to low rates of voluntary, nonremunerated blood donors (VNRBDs). Over 90% of blood donations are for family members or friends of donors, and only 1% of donors are women. This study aimed to understand the barriers and motivations for blood donation in Libya to support sensitization campaigns.

Methods:

A knowledge, attitudes, and practices survey was conducted with 896 people in seven Libyan cities where blood banks are located. Key informant interviews were conducted with blood donors, staff, and experts across all seven cities. Thematic content analysis was conducted for the qualitative data, and SPSS was used to produce descriptive statistics.

Results:

There was a strong awareness of blood donation and the uses of donated blood within the surveyed population. Most respondents who had not donated blood had considered donating. The association between blood donation and Hijama, the traditional medical bloodletting practice, was cited as a sensitization experience for some VNRBDs. The common barriers for potential female donors included misconceptions about female eligibility, social norms, and constraints based on the opinions of their husbands.

Conclusion:

Sensitization campaigns can encourage people to donate for the first time to dispel fears and reinforce the connection between blood donation and altruistic/religious giving. Religious institutions, including mosques and Hijama centers, must be engaged to emphasize that blood donation is ethically compatible with Islam. Campaigns should also highlight that women are eligible to donate blood.
Immunohematology Red Cell Serology Testing Reference Laboratory
Authors: Pandey Prashant , Kumari Supriya , Setya Divya , Mandal Saikat , Marik Arghyadeep , Singh Mukesh Kumar
Published: May 2023

Immunohematology reference laboratory (IRL) is defined as a fully equipped advanced laboratory that receives samples from various parts of the country for workup. This is a specialized center, where other centers experiencing difficulty in resolving immunohematological tests, refer samples for further workup and resolution. To complete the workup process, ABO RhD typing, antibody screening, identification (ID), antigen phenotyping, and direct antiglobulin tests are performed. In our retrospective observational study 528 cases, worked up from October 2019 to March 2022 were included. The prevalence of alloimmunization found in this evaluation was 68.1%. Among the different alloantibodies, anti-D was most common followed by anti-E and anti-M. In our study, most of the autoantibodies were of Immunoglobulin G (IgG) class (79.31%). Out of the 528 samples, ABO discrepancy was found in 48 samples (9%). Of these, none belonged to Group I or Group III discrepancy types. Group II discrepancies were noted in 28 cases (58.3%) and Group IV discrepancies were found in 20 cases (41.6%). Our study clearly indicates that there is an important role of IRL which is not only limited to ID of alloantibodies or resolution of ABO discrepancies but also supports all the hospitals and transfusion centers in the region by providing phenotype-matched or compatible units and advice for safe transfusion practices.
Analysis of Blood Collection of National Blood Transfusion Service, Sri Lanka
Authors: Senavirathna Samantha Kumara , Abeynayake Nishanthi Rupika
Published: May 2023

Background and Objectives:

Blood transfusion is a widely accepted treatment modality in modern medical practice and it has no substitute. Therefore, blood is a scarce resource, and proper management of bloodstock is essential. Transfusion service is responsible to maintain an adequate blood stock to ensure the supply of blood for hospitals while minimizing blood wastage due to postexpiry. To achieve efficient bloodstock management, the pattern of blood collection should be identified. This study was designed to establish a time series model for monthly blood collection of Sri Lanka.

Methods:

Data on monthly blood collection of Sri Lanka were collected from the year 2010 to 2020 and time series models were developed using “R” statistical software.

Results:

Time series data clearly exhibited an increasing trend with seasonality in blood collection. Therefore, seasonal time series models were fitted and the best seasonal autoregressive integrated moving average (ARIMA) model was selected as ARIMA (0, 1, 1) (0, 1, 2) (12) which showed the lowest Akaike information criteria value.

Conclusion:

It is suitable for forecasting the monthly blood collection.
Comparison of apoptotic bodies’ count & mitotic index in oral squamous cell carcinoma with regional lymph node involvement
Authors: Yousefi Maede , Naderi Noushin Jalayer , Muhammadnejad Ahad
Published: May 2023

Background & objectives:

In early stages of oral cancers, 20-40 per cent of cases have occult metastasis in cervical lymph nodes. Biologic imbalance between cellular proliferation and death culminates in metastasis. The importance of cell cycle dysregulation in relation to lymph node involvement in oral squamous cell carcinoma (OSCC) has not been established yet. The aim was to determine the association between apoptotic bodies count and mitotic index in relation to regional lymph node involvement in OSCC.

Methods:

Thirty two methyl green-pyronin stained slides from paraffin-embedded sections of OSCC were evaluated for apoptotic bodies count and mitotic index in relation to regional lymph node involvement using light microscopy. Number of apoptotic bodies and mitotic figures were counted in 10 randomly selected hot spot areas (×400). Average count of apoptotic bodies and mitotic figures were determined and compared with regard to the presence/absence of lymph node involvement.

Results:

The count of apoptotic bodies in cases without metastasis to the regional lymph node was significantly higher than in cases with regional lymph node involvement. The mitotic index was not significantly different between groups in terms of regional lymph node involvement (P=0.24). No significant correlation was found between the apoptotic bodies count (r=−0.094, P=0.72) and mitotic index (r=−0.08, P=0.75) to the number of regional lymph nodes involved.

Interpretation & conclusions:

Based on the results, it is suggested that apoptotic cell count can be a good parameter for showing the possibility of regional lymph node involvement in people with OSCC who do not have clinical symptoms of lymph node involvement.
E-learning in medical education: Challenges and benefits in the perception of medical students during COVID-19 pandemic
Authors: Archana Banur Raju , Sangeetha Sampath
Published: May 2023

Background:

The Government of India declared nationwide lockdown due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) pandemic. In order to continue regular classes, educational institutions tried various teaching, learning methods and started online classes.

Methods:

A descriptive, online questionnaire-based survey was conducted among undergraduate medical students studying at a medical college to evaluate the effectiveness, advantages and disadvantages of e-learning classes conducted for medical students during the COVID-19 pandemic. A questionnaire was prepared using Google Forms and students were asked to answer questions with the most appropriate response.

Results:

A total of 560 MBBS undergraduate students took part in the study. The survey was carried out after 6 months of online classes. The study result shows that e-learning is equally effective as regular face-to-face learning in increasing knowledge, social competences, understanding subject and meeting individual learning needs. However, e-learning is ineffective in increasing clinical skills and effective communication compared to regular face-to-face learning. Major advantage of e-learning is the ability to stay at home and lack of clinical skills is a major disadvantage.

Conclusions:

Implementation of distance e-learning in medical education is challenging, especially in developing countries like India. E-learning reported increasing knowledge, easy access, better environment. But lack of clinical skills, technical problems, mental health are major barriers to e-learning in medical education. Although e-learning is the best alternative in the present scenario, it cannot replace traditional teaching method. It can be used along with regular face-to-face learning to make teaching more effective.
End-of-life dignity in palliative care, pandemic COVID-19 and telemedicine
Authors: Mesquita Pedro Eduardo Pires , Abejas Abel García , Vergès Àngels Salvador
Published: May 2023

Dying with dignity is a right, defined as a process with the following characteristics. Dying with minimal suffering from symptoms and limited invasive treatment. The study aimed at understanding how the pandemic changed the way of dying in end-of-life care and what we can then add to what was done previously. A search was carried out in the PUBMED/Medline database to find articles that answered the research question. We carried out this research between December 2019 and June 2021. Articles with original data written in English, Portuguese and Spanish were used as keywords: ‘end of life’; ‘palliative care’; ‘COVID-19’; ‘dignity’ and telemedicine’. Twenty-two studies met the inclusion criteria. There was significant heterogeneity in the origin of these studies conducted in 12 different countries. Five themes were found from the articles: Palliative care during the COVID-19 pandemic; end of life during the COVID-19 pandemic; the evolution of telemedicine during the COVID-19 pandemic; use of telemedicine in palliative care; and the use of telemedicine and dignity at the end of life. The results were relatively positive in terms of some parameters; however, some suggestions for improvement stood out. Telemedicine has enormous potential to improve care at the end of life in terms of quality of life, autonomy and adherence to pharmacological and non-pharmacological treatment. However, more intervention studies are needed to create protocols for monitoring these patients at home.
Impact of sensitisation programme on screening tests for latent tuberculosis infection among health-care workers: A questionnaire-based study
Authors: Haritsa Kanthishree , Sangeetha P. , Lakshminarayana S. A. , Holla Narayana , Prakash R.
Published: May 2023

Background:

Timely and accurate identification of people with latent tuberculosis infection (LTBI) is essential for controlling Mycobacterium
tuberculosis. Hence, it is important that health-care workers have the latest and adequate knowledge about the existing diagnostic modalities.

Methods:

In this prospective, questionnaire-based study, various health-care workers were asked to respond to a 25-item questionnaire before the sensitisation programme (workshop) regarding knowledge, procedure and interpretation of screening tests for LTBI (tuberculin skin test [TST] and interferon-gamma release assay [IGRA]). The same questionnaire was repeated on the completion of the workshop to assess its impact.

Results:

The mean baseline knowledge among technicians, nurses, postgraduates and interns was 42.9%, 42.1%, 51.9% and 53.6%, which improved significantly to 84.2%, 83.4%, 89.4% and 89.5%, respectively after the workshop. Statistically, a significant difference was observed between pre- and post-workshop proprtion of all health-care workers with respect to the knowledge of TST and IGRA (P < 0.05).

Conclusions:

This questionnaire-based study highlights the importance of training various health-care workers on diagnostic modalities for LTBI since the current study findings revealed that training increased the knowledge scores of the participants significantly.