bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Influence of Culture on Website Design in Canadian and Chinese E-Commerce
Authors: Merbah E. D.
Published: April 2023

E-commerce has experienced tremendous growth in recent years, and with the rapid adoption of the internet, this industry, particularly small and medium enterprises (SMEs), has gained access to the global market. However, reaching consumers with different cultures may not be straightforward, as consumers may react differently to the same service. Knowing how to effectively communicate with consumers is crucial for generating revenue. Therefore, simply translating a website is not a solution and may create a negative impression among consumers, particularly since cultural thinking differs significantly between Western and Eastern countries. This research aims to confirm the existing literature that suggests western consumers are different from eastern ones. To do this, the structures of 90 e-commerce enterprises in Canada and China were compared. This study used Python to compare CA and CN e-commerce websites and investigate the impact of culture on their website design. The model analyzed 90 websites and was able to clearly demonstrate the distinct designs of the websites.
It Takes Two to Tango
Authors: Schneider Sabrina
Published: April 2023

Business ecosystems have emerged as an increasingly popular and powerful mode of inter-firm collaborations. As such, business ecosystems are highly complex forms of joint value creation and capture activities between actors who, while partly loosely connected, depend on one another. Building on a combination of stakeholder and paradox theories, this chapter provides insights into two emerging paradox tensions: (1) The ecosystem engagement paradox (balancing the diverging interests of the focal firm and the overall ecosystem); and (2) the ecosystem coopetition paradox (balancing competition and cooperation with other ecosystem actors). This view allows displaying the complementary nature of both theoretical perspectives and their joint contribution to the ecosystem context. Further, by identifying two paradox tensions inherent to the business ecosystem context, this chapter offers insights for managers on how to engage in business ecosystem and how to deal with ecosystem competitiveness.
The Circular Business Model
Authors: Saxena Priti , Saxena Abhineet , Sharma Garima
Published: April 2023

Technological disruptions, hyper innovation, and a more globalized world has changed the way businesses were done. Competitive pressure in today's world is ever increasing; one of the most effective ways of staying competitive in these challenging times is through building efficient business ecosystems. This economic community leverages the services of its members to offer value to customers. Over time, they co-evolve their capabilities and roles and tend to align themselves with the directions set by one or more central companies. With growing concern towards environment safety more and more companies are putting effort to include element of sustainability in their business ecosystem. This chapter will be structured around how to build sustainable business ecosystem through circular business model.
The Importance of Innovation Diffusion in the Renewable Energy Sector
Authors: Esposito Luca , Brahmi Mohsen , Joshi Mihir
Published: April 2023

In the last decade, one of the most discussed topics globally concerns the difficult management of climate change and the need for an energy and cultural transition that pays attention so as not to increase territorial inequalities. This chapter aims to provide a clear and comprehensive picture of the importance of innovation in the renewable energy sector and the role of their deployment to ensure climate change mitigation and sustainable growth. The authors will start from the environmental Kuznets curve (EKC) and then examine the metabolism of current societies, focusing on the trend of the diffusion of technological innovation and its contribution to the energy transition.
A Pre-Telecollaboration Training Course for Japanese EFL Learners
Authors: Tsubota Yasushi , Inagaki Tsutomu , Nozawa Takayuki , Ishikawa Yasushige
Published: April 2023

This chapter aims to explore the effectiveness of a newly designed pre-telecollaboration training course in helping Japanese EFL learners improve their speaking skills and enhancing their learner agency. A pre-telecollaboration training framework was constructed and implemented using an original audience design to increase effectiveness. As the course progressed, the number and type of audiences were expanded. To effectively integrate the framework into the course, a reflection activity was conducted. The analyses of scores on the versant speaking test and the results of questionnaires using the foreign language classroom anxiety, willingness to communicate, and shyness scales revealed that students' speaking skills in English improved, their foreign language anxiety was alleviated, and their willingness to communicate improved. Furthermore, monitoring results of the students by the teacher in charge indicated that their attitude toward participating in the course became more positive than before.
Reviewing Spanish Students' Responses to the Implementation of a Virtual Exchange Project in EFL Literature
Authors: Bellot Andrea Roxana
Published: April 2023

This chapter will review the responses of a group of Spanish undergraduate students who participated in an intercultural online exchange in the area of English as a foreign language (EFL) literature. The main objectives in this international online collaboration have been to enhance cross-cultural understanding, build skills in the field of English-language literary analysis, and foster the use of English for academic purposes. Data collected from the students' opinion polls will be analyzed, the students' pre-conceptions will be explored, along with their final feedback from the overall experience. Findings suggest that this project has proved beneficial for the participants, as it has offered a meaningful way to develop intercultural competence in the English literature classroom while promoting intercultural awareness.
Process Modeling as a Support to Decision-Making for Productive Development Partnerships
Authors: Lima de Magalhães Jorge , Cristina de Freitas da Silveira Carla , Figueiredo Tatiana Aragão , Guzzo Felipe Gilio
Published: April 2023

The 21st century brings great challenges in the information and knowledge areas. The information society boom and market globalization have opened up new ways of using the concept which has been in existence for a long time. Thus, it is urgent to find new ways for information management, mainly how several knowledge bases can contribute to generation of new approaches and results as well as assist in better decision making by managers of private and public companies and governments. Pharmaceutical companies are increasingly looking for better production techniques and aim to reduce drug spending. Thus, information science technologies are great allies for the management of your internal and external processes. For example, the productive development partnerships (PDP) are initiatives that aim to strengthen the health complex and aim, among others, to expand access to medicines for the population. Thus, this chapter contributes to linking information technologies and the effectiveness of PDP and provide greater access to medicines for the population.
Leveraging Blockchain Technology in the Construction Industry
Authors: Shah Mushtaq Ahmad , Uddin Furquan
Published: April 2023

Taking into account the significance and hurdles of blockchain technology in construction work, the current study examines the potential of blockchain technology in the construction industry and how this disruptive technology could revamp construction projects. Using blockchain to simplify the contractual processes and paperwork associated with these complex projects could save money, free up valuable resources, and accelerate project completion. The blockchain records are tamper-proof, which will help enforce work compliance and discourage potential record fabrication. As a result, it makes sense to begin focusing on blockchain convergence efforts in these sectors and then extend them as the technology improves.
Transformation of Financial Trading With Blockchain Technology in India
Authors: Bagchi Sadhna , Mohanty Debasis , Girdhar Ram
Published: April 2023

Blockchain technology is creating triumph all over the world with its presence, and the combination of artificial intelligence and blockchain technology will prove to be more impactful in the coming decades. The various countries of the world are assimilating blockchain technology in the financial trading system because it is robust and secure. It has been observed that after the pandemic, Indian consumers have overcome the fear of using online transaction systems. The usage of smart gadgets, speedy networks, increased product services, and the flood of startups has created a conducive ecosystem for online financial transactions. This study attempts to assess the use of blockchain in financial sectors by various countries. Blockchain is the next generation of technology for any field that needs security, privacy, speed, and accuracy. Financial systems is a field facing problems like financial fraud, data theft, late settlement, and data manipulation. The use of blockchain technology on a large scale will create a secure financial ecosystem in India.
Applications of Blockchain Technology in Finance
Authors: Madaan Geetika
Published: April 2023

For data analysis and processing, blockchain is a revolutionary technology that has the potential to combine financial resources efficiently and effectively. Data, rules, and application layers are used to design new financial forms or service models based on client needs to enhance the banking system's overall efficiency and the quality of financial services. As blockchain technology automates and improves the accuracy of customer credit conditions, financial markets may be transformed. Other uses include improving the efficiency of cross-border financial operations, amongst others. In this study, the authors comprehensively scrutinized the structure of blockchain technology and its use in the financial sector. The final section of the chapter included constructive suggestions to help the development of blockchain technology in cryptocurrencies, smart contracts, initial coin offerings, the clearing and settlement of financial market transactions, and the implications of these developments for the governance of publicly traded companies.
Technologies Behind Crypto-Based Decentralized Finance
Authors: Kaur Guneet , KrishnaKumar ArunKumar
Published: April 2023

A new breed of consumer-facing financial applications called decentralized financial applications (DeFi) is structured using smart contracts and runs on permissionless blockchain technologies. In this chapter, the authors contextualize the DeFi idea within the theoretical framework of blockchain and related technologies and their potential real-world applications. In addition, the authors looked at the basic DeFi concepts and application scenarios for DeFi today and pinpointed distributed ledger technologies, artificial intelligence, machine learning, and zero-knowledge proofs as the three key technologies that help revolutionize DeFi. The authors concluded that blockchain is the foundation of DeFi, and AI and ML capabilities help organizations deliver crypto insights to their users to cope with the market volatility, and zero-knowledge proofs ensure the security of digital transactions in an unregulated, decentralized finance world.
Blockchain Technology
Authors: Chaudhury Sushovan , Dhabliya Dharmesh , Madan Suman , Chakrabarti Sudakshina
Published: April 2023

To encourage industry discussion of cutting-edge blockchain applications, this chapter was written. This chapter provides an introduction to blockchain technology as well as details on how to secure transactions using technology and how the secure element works. It examines common implementation worries and provides use cases for current commercial or trial projects. The following paragraphs go over the concept of a blockchain, how bitcoin transactions operate, and how to finish a transaction. The network of Marco Polo will be highlighted. In this chapter, the authors show how to use blockchain and cloud technology with Marco Polo to remove corporate pain problems. The chapter goes on to give a full overview of blockchain, including its function, traits, and applications.
Blockchain's Data Integrity and Reliability
Authors: Kumbhare Ashish , Thakur Piyush Kumar , Patnaik B. Ravi Kiran , Midiyam Kiran
Published: April 2023

Services for online storage have expanded quickly with the quick rise in cloud computing technology. The fact that online storage servers are insufficient to properly store and retain data has drawn specific attention in relation to such distant storage solutions, which significantly undermines consumers' trust in acquiring and using cloud storage solutions. The centralised nature of conventional information integrity auditing methodologies for cloud-based storage creates significant security concerns owing to only a few failure points and server flaws. Customers constantly have good standards for the integrity and protection of personal data. This crucial guarantee of data integrity is provided by blockchain technology thanks to its advanced security capabilities. Integrity of data, privacy protection, accessibility of the information, security, and effectiveness are all guaranteed by the blockchain solution's cryptography encryption, which shields data from intruders, thwarts fraudulent activity and exploitation, and lessens the likelihood that information will be stolen or damaged.
Teacher-Led, Student-Focused, and Unleashing the Power of Teacher Empowerment for School Improvement and Success
Authors: Abdallah Asma Khaleel
Published: April 2023

Teacher leadership is a school improvement and professional development model that addresses the learning needs of both students and teachers. In modern times, the professional growth and development of teachers are critical to impart effective knowledge to students. The responsibility of teachers is to enhance the classroom experience of students, and school leaders are encouraging new teaching strategies that underpin teachers' professional development. This study focuses on teacher leadership and its impact on school improvement and effectiveness by developing leadership skills to amend the quality of education. The research highlights how schools are developing teacher leaders and their significance, along with the challenges associated with the concept. Effective leadership in academic institutions fosters a motivating and positive study culture, leading to high-quality experiences for learners.
The Art of Assuring Quality Education
Authors: Ismail Osama A. S. , AlRiyami Rashid M. , Alhosani Mohamed
Published: April 2023

With the economic expansion and globalization, there are several disputes raging over how to enhance education quality. Conventional education systems do not give students the necessary information and skills; hence, there has been a shift in the education industry with customized learning, in which schools and universities build teaching models adapted to students' learning preferences. In general, each institution has its own framework for growing student competency; so, the research reveals how UAE educational institutions are enhancing learning elements for students as part of the quality education process. Quality assurance and the notion of continuous improvement are inextricably linked since both are associated with outcome-based education in the academic sphere. As a result, the chapter comprehensively explores the measures utilized by UAE educational institutions to ensure academic excellence. In addition to this, the research sheds light on the steps being implemented by the UAE government in regard to enhancing the quality of education for kids.
Building a Better Future
Authors: Ramadan Rana S. , Ismail Osama A. S.
Published: April 2023

This chapter investigates the function of school inspections as a strategy for educational system improvement. School inspections are conducted to assess the academic quality and verify that schools adhere to specified criteria. The inspection process entails a thorough assessment of different areas of a school, such as the curriculum, teaching quality, facilities, and resources. The inspection results are used to assign a rating to the school and offer input on areas for improvement. The chapter explores how school inspections assist both schools and the education system. School inspections give valuable insights into educational quality and can assist schools in identifying areas for improvement. Furthermore, they act as a benchmark for schools, allowing them to compare their performance to other schools and establish development targets.
STEM and Leadership in the Future
Authors: Ibrahim Hosam Rashad , Alghfeli Aysha Hamad , Alnuaimi Fatima Saeed , Alshamsi Nasra Naser , Alkaabi Ahmed M.
Published: April 2023

This chapter aims to explore the role of leaders in shaping STEM education to better equip teachers with the necessary tools to instill vital STEM components into student learning. The authors argue that future leaders require a solid foundation in STEM fields and leadership qualities to promote innovation, sustainability, and entrepreneurship in a rapidly changing world. The chapter delves into how STEM education can help students develop creative, analytical, and critical thinking skills necessary for success in the workplace. The authors also emphasize the importance of leadership traits such as adaptability, teamwork, and communication in building a sustainable and creative future. In conclusion, the chapter stresses the need for educational systems to cultivate the next generation of STEM leaders who can pave the way for a prosperous and sustainable future.
Technological Determinism and African Public Diplomacy
Authors: Endong Floribert Patrick C.
Published: April 2023

Although a galaxy of research works have focused on diplomacy in the COVID-19 period, very little attention has particularly been given to the idea of comparing the state of African digital diplomacy in the pre and the post COVID-19 period. Also, the literature available suggests that most studies on digital diplomacy in the COVID-19 period are Eurocentric and the COVID-19 pandemic as an opportunity for the future growth of digital diplomacy in Africa is still virtually understudied. In view of filling the above-mentioned gap in knowledge, this chapter deploys secondary sources and observations to attain three principal objectives. First, the chapter explores the state of digital diplomacy before the outbreak of the COVID-19 pandemic. Second, it examines how the pandemic positively affected the conduct of digital diplomacy in Africa, putting to question the myth of digital divide between the West and Africa. Lastly, the chapter explores implications for the practice of public diplomacy in post-COVID Africa as well as for future research on African digital diplomacy.
Psychological beneficence as part of the principle of beneficence in non-reconstructive aesthetic surgeries
Authors: Garcia-Sánchez Emilio
Published: April 2023

The beneficence of the patient in non-reconstructive aesthetic surgeries must always include not only the physical well-being, but the psychological well-being of the patient as well. This issue has been proven to be effectively targeted with the use of psychological consulting in those cases where the medical team ascertains the existence of psychological alterations. In said cases, for the beneficence and best interest of the patient, the ethical and medical choice is not to undergo the surgical procedure. Applying the Principle of Beneficence in aesthetic patients with stringency demands the use of psychological treatment to target the cause of the corporal discomfort or unsatisfaction. If the wrong can be treated it must always be eliminated as the seed that causes the damage, the complex or discontent and not merely attain the effects through surgery. There has been an increase of cases where the root of the problem is not of physical nature but psychological. In these cases, the use of a scalpel would not achieve beneficence.
La riscoperta del limite come via etica alla discussione sull’aborto
Authors: Iacone Ignazio
Published: April 2023

La sentenza del giugno 2022 della Corte Suprema USA sull’aborto è stata letta da molti organismi politici e associazioni pro-choice come un passo indietro nel cammino dei diritti civili, trascurando le sue implicazioni etiche pericolose in senso opposto e confermando un’idea della gravidanza difficile come problema da eliminare e non come opportunità da proteggere. Tanto il caso americano come il dibattito italiano sulla legge 194 chiamano in causa il concetto filosofico del limite, del quale andrebbe riscoperto il valore per la conoscenza umana, come per la prima volta dichiarato da Kant. Quanti si schierano a difesa della vita, e tra costoro la Chiesa, chiedono politiche in grado di tutelare tanto la madre quanto il figlio, e insieme gli obiettori di coscienza. L’etica ha il compito di cercare vie di dialogo realmente aperto, in direzione di una verità che trascenda le diversità di opinioni e culture e guidi l’umanità nel progresso verso il Bene.
Activity of cefiderocol against NDM-producing Enterobacterales from a regional outbreak in the Tuscany region, Italy
Authors: Bartolini A. , Niccolai C. , Coppi M. , Andreoli E. , Bianchi L. , Brunelli T. , Fornai C. , Montenora I. , Nardone M. , Parisio E. M. , Riccobono E. , Valentini S. , Mantengoli E. , Antonelli A. , Giani T. , Rossolini G. M.
Published: April 2023

Not available.
Rilevamento di Mycobacterium chimaera tramite Real-Time PCR su campioni di acqua sanitaria ottenuti da scambiatori di calore HCU
Authors: Borghi M. , Bisognin F. , Lombardi G. , Faccio M. , Ferraro V. , Dal Monte P.
Published: April 2023

Not available.
Utilizzo di un nuovo saggio molecolare per la rilevazione diretta di specie di Candida clinicamente rilevanti da emocolture positive
Authors: Ivagnes V. , Menchinelli G. , De Carolis E. , Torelli R. , De Lorenzis D. , Recine C. , Sanguinetti M. , Posteraro B.
Published: April 2023

Not available.
Seroprevalence of torch infections in childbearing age women: 2019-2022 time span results from a teaching hospital in Southern Italy
Authors: Pavia G. , De Angelis G. , Giancotti A. , Zangari C. , Laratta E. , Colosimo E. , Mancuso E. , Prestagiacomo L. , Mirello C. , Gigliotti S. , Licata F. , Angelillo S. , Trecarichi E. M. , Costa C. , Torti C. , Marascio N. , Quirino A. , Matera G.
Published: April 2023

Not available.
Advanced Mapping and Ablation Strategies for Redo Ablation of Accessory Pathway Conduction
Authors: Loricchio Maria Luisa , Castro Antonio , Malacrida Maurizio , Granatelli Antonino
Published: April 2023

Atrioventricular reentrant tachycardia (AVRT) is an integral part of the circuit for accessory pathways (APs), whose anatomical location and activation characteristics can influence ablation failure and arrhythmia recurrence. This manuscript describes a case of redo AVRT performed using the Rhythmia™ mapping system, while the index procedure was mapped through the CARTO 3™ system. The use of the automated Lumipoint™ algorithm, an innovative tool provided by Rhythmia™, allowed more rapid and precise identification of the AP location, leading to a successful ablation procedure.
Extradigital glomus tumor – A rare case report
Authors: Ratnakar Ashwini V. , Gosavi Manasi A. , Bhat Pratik P.
Published: April 2023

Glomus tumor is benign vascular tumors arising from modified smooth muscle cells of the glomus bodies and accounting for 1.6% of all soft-tissue tumors. The presence of glomus tumors at sites other than fingertips is a very rare occurrence. We present a rare case of a 68-year-old male with a history of painful nodules over the interscapular region for the last 10 years which was excised and sent to our department of pathology. On gross examination, the lesion was 1 × 1 cm, nodular. Cut section was gray and brown with areas of hemorrhage seen. Histopathological examination revealed a circumscribed lesion in the dermis comprising small dilated vascular spaces surrounded by sheets and clusters of glomus cells having round–oval, bland nucleus with moderate-abundant eosinophilic cytoplasm. No areas with increased mitosis, no atypia, and no necrotic areas were seen. There was no area with ductal/mucin differentiation. Glomus tumor is very rare at extradigital sites and may be often missed clinically. However, the presence of the characteristic microscopic picture of perivascular sheets of bland, uniform glomus cells should help us arrive at the correct diagnosis and provide appropriate management to the patient.
Leech therapy and adjuvant Ayurveda treatment in the management of diabetic foot ulcer with atherosclerosis
Authors: Sonani Snehal R. , Dudhamal Tukaram S.
Published: April 2023

Diabetic patients are more prevalent to atherosclerosis (29.1%); however, its pathophysiology is still unclear. Such cases mostly convert into either amputation due to rapid spread or lifelong anticoagulant. Ayurveda is famed to be a tool in prevention and management of such fatal or disabling surgeries by parasurgical procedure, i.e., leech therapy, Agnikarma, etc. This study presents a case of postdiabetic atherosclerosis (male/54 years old) with a complaint of blackening of the great toe of the right lower limb and and other associated symptoms such as intermittent claudication (Garde 4), Burning in sole, occasional numbness in the foot. this case was managed by the Ayurveda para-surgical procedure (Leech therapy). The patient was a known case of DM and taking medication for it for the last 1 year, but his blood sugar level was found to be uncontrolled (HB1Ac: 9.90). The patient had surgical history of coronary artery bypass graft before 8 years. His bilateral lower limb computed tomography angiography was suggestive of diffuse atherosclerotic fibrocalcified wall plaques in abdominal aorta, iliac, femoral, and both leg arteries. Clinical examination revealed black right greater toe with line of demarcation and on palpation, feeble femoral artery and downstream non-palpable arteries. As a part of treatment, leech application along with some rejuvenating oral drugs i.e. Sanjvani vati and pippali churna was given to the patient. On 2nd week of treatment protocol, black gangrenous great- toe was amputed which afterwards become open wound(approx.2cm x 2 cm). Afterward, daily wound dressing was done with Apamarga kshar taila or Thumari taila (As per the status of the wound) after cleaning with Triphala Kwath. After completion of treatment protocol, the patient got 85-90% relief in clinical symptoms and also previously feeble arteries were felt with full volume.
Immunogenicity studies of nucleic acid-based antirabies vaccines in BALB/c mice
Authors: Rathnadiwakara Hasanthi , Cliquet Florence , Abeykoon Chandrindu , Jayawardena Ranil , Wasniewski Marine , Gunatilake Mangala , Thibault Jean-Christophe
Published: April 2023

Improved vaccine efficacy has a major impact on future rabies prevention and control. In this systematic review, a comparative assessment of different nucleic acid-based antirabies vaccination tools developed using different methods, in different countries, was undertaken. The comprehensive search was done in three databases. Articles were carefully selected based on predetermined inclusion/exclusion criteria and eight articles were included in this systematic review. Studies have demonstrated dose-dependent immune response following intramuscular vaccination and improved immune response following intranasal vaccination and gene-gun delivery method. Nucleic acid-based antirabies vaccines have shown higher immune response and protective levels in Bagg's albino (BALB/c) mouse models than cell culture-derived vaccines. It has been demonstrated that the route/method of administration and the vaccine formulation could be improved in various ways to enhance immune response following vaccination. These new vaccine tools and their implementation in pre- and postexposure prophylaxis could be further evaluated and to be adopted by rabies endemic countries.
Maternal health services available to pregnant women and nursing mothers domiciled in the internally displaced persons' camp
Authors: Osunde Ngozi Rosemary , Olorunfemi Olaolorunpo
Published: April 2023

BACKGROUND:

Insurgent activities have displaced lots of people and compelled them to flee or leave their towns and home, making women vulnerable to morbidity and mortality. Assessing maternal health services available to pregnant women and nursing mothers in internally displaced camps can help improve their health status and reduce maternal and neonatal death.

AIMS:

This study aimed to assess maternal health services available and their associated factors among pregnant women and nursing mothers in an internally displaced person's camp.

DESIGN:

A cross-sectional descriptive research design was used for this study.

METHODS:

The availability sampling technique was adopted to recruit women who have assessed maternal health services in the camp. A self-structured questionnaire was utilized as the research instrument and the data were presented using descriptive statistics.

RESULTS:

A mean age of the respondents was 32 ± 7.18. The majority are multigravida (53.8%), with four (7.7%) having their first baby in the health facility available in the camp and the maternal health services available seem to be adequate for now, but the country may soon run out of space, because of the constant increase in the number of displaced persons.

CONCLUSION:

To further improve services, the study recommends that government should intervene in the funding of maternal health-care services, proper documentation of mortality rate in the camp and make an ambulance available for emergency cases.
Correlation of Endogenous Pain Modulation Function with Physical Activity in Elders Having Chronic Pain
Authors: Sirohiwala Alifiya S. , Alva Gloria , Verma Shaswat
Published: April 2023

Context:

Chronic pain is a major predicament of the elderly population and lacks appropriate treatment. In normal healthy individuals, physical activity (PA) shows an effect on endogenous pain modulation (EPM) function by producing central opioids and producing exercise-induced analgesia.

Aims:

This study aimed to determine a correlation between EPM function and PA of the elderly having chronic pain.

Methodology:

This was a cross-sectional study of 45 elderly individuals who were between 60 and 80 years of age, suffering from chronic pain. The EPM function was tested using conditioned pain modulation test and PA levels were obtained using Yale Physical Activity Survey (YPAS). In addition, we collected demographic details, duration of pain, and site of pain from the study population. Descriptive statistics was depicted in terms of frequency. Categorical variables were indicated as the mean and standard error of mean. The Spearman's rank correlation (r) test was used to find the correlation between conditioned pain modulation (CPM) and YPAS score.

Results:

A positive moderate correlation was found between EPM function and PA of elderly having chronic pain (r = 0.05; P = 0.0002). Analysis of EPM function based on the gender of the study population showed that both females (22.54 ± 23.92) and males (6.24 ± 29.19) had similar EPM function values. YPAS score was found as a significant predictor of CPM (P = 0.0003).

Conclusion:

There is a positive moderate correlation between EPM function and PA levels of elderly having chronic pain.
Spiritual Knowledge and Practices to Conquer Chronic Pain
Authors: Salgaonkar Sweta Viraj , Shetty Yashashri , Singh Vishal
Published: April 2023

Understanding of pain as multidimensional experience has improved quality of life of many sufferings from chronic pain. Addressing spiritual dimension in chronic pain patients can improve outcome. The purpose of the present study was to systematically review literature from 1994 to 2018 using PubMed search engine to correlate between spirituality and pain management. The review included 25 randomized controlled trials (RCT). Positive correlation with spiritual healing was proved in 7 RCTs that included patients of idiopathic chronic pain syndromes. Patients with cancer pain, showed improvement in quality of life, visual analog scores with various spiritual techniques in 4 out of 6 RCTs. Pray meditation was recommended as one of management techniques for reducing pain after cesarean surgery in 1 RCT. Migraine medication usage decreased in spiritual meditation group improving the pain tolerance with significant improvements in anxiety, depression, and reduction in muscle tension in 3 RCTs. A study of cognitive behavioral therapy of 8 weeks, done in fibromyalgia patients recommended second generation mindfulness as a therapy to control their symptomatology in 1 RCT. In 2 RCTs involving students, the cold pressor task and the length of cold immersion seemed to be longer in those receiving spiritual intervention. One RCT, involving hospitalized patients concluded that spiritual healing was effective in promoting a state of muscle relaxation, reducing anxiety and depression, and raising the perceptions of wellness in patients. In a RCT involving chronically ill patients, encouraging spiritual coping was associated with better psychosocial and health outcome. Three RCTS involving patients of rheumatoid arthritis, neurofibromatosis, and chronic pain states not responding to conventional therapy did not show any significant correlation with spiritual intervention. Pain physicians can use better understanding of spiritual knowledge with non-pharmacotherapy techniques.
Redefining the Efficacy of USG-Guided Pudendal Nerve Block in Pudendal Neuralgia in the Vulnerable Section of the Society
Authors: Saxena Ashok Kumar , Saboo Surekha S. , Choudhary Suman , Banerjee Anwesha , Bahl Aakanskha
Published: April 2023

Regional anesthetic blocks play a significant role not only in perioperative management but also in the holistic management of chronic intractable pain including cancer pain. Pudendal neuralgia can hamper daily life functions such as sitting, standing and sexual functions thus affecting patient's quality of life. Pudendal nerve arises from ventral divisions of S2,3,4. The nerve lies medial to the internal pudendal vessels at the level of ischial spine and is accompanied by the internal pudendal artery through the lesser sciatic foramen into the pudendal (Alcock's) canal. Pudendal Nerve is 80% sensory and 20% motor. Techniques are dependable on the precise identification of important anatomic landmark structures positioned in the close proximity of the pudendal nerve. These techniques are nerve stimulator guided, Conventional C-arm fluoroscopy guided, CT guided, Ultrasound-guided and latest being ultrasound guided accompanied with Pulsed radiofrequency. Pudendal nerve block may be performed through one the approaches: Anterior/perineal or Posterior/trans gluteal. It has got important role to play in acute and chronic perineal pain which is frequently encountered after gynecologic surgery, obstetric surgery, urologic surgery and gastrointestinal surgery. Ultrasound guided pudendal nerve block has advantages such as no radiation exposure, real time needle insertion guidance with the visualization of spread of local anesthesia. It helps to visualize not only bony structures but also vascular structures, ligaments (interspinous ligament) as well as soft tissues. However, since a lot many multi-institutional trails are needed to conducted to explore the efficacy and safety of ultrasound guided blocks for chronic pelvic pain, as it happens to be highly challenging condition to manage.
Efficacy of Sterile Water Block with or Without Antispasmodics for Labor Analgesia
Authors: Mubin Sayeka , Tauheed Nazia , Hasan Muazzam , Haleem Shahla
Published: April 2023

Background:

Universal provision of safe, effective, and inexpensive analgesia for labor remains a challenge. In India, antispasmodics, especially drotaverine, are widely used as an adjunct to decrease labor pain and duration. Therefore, we aimed to determine the efficacy of sterile water block (SWB), with or without drotaverine.

Materials and Methods:

This study was a randomized, triple arm, controlled trial on 105 patients in active labor, assigned to receive either intramuscular drotaverine (Group D), Intradermal SWB (Group B), or drotaverine with SWB (Group DB). SWB was given in Michaelis Rhomboid, in active phase of the first stage of labor. Primary outcomes were extent of pain relief, as measured by the numeric rating scale (NRS). Other outcomes included patient's satisfaction, duration of active phase of first stage of labor, APGAR scores, incidence of instrumentation or cesarean section, and any adverse effects.

Results:

One hundred and five patients were randomized into three groups of 35 patients each. At 30 min postintervention, mean (± standard deviation) NRS score was 7.30 (±1.03), 4.88 (±0.68), and 5.04 (±0.75) in Group D, B, and DB, respectively; (P < 0.001). Two hours' postintervention, NRS was 7.61 ± 0.89, 6.66 ± 0.91, and 6.95 ± 0.85 in Groups D, B, and DB respectively with P < 0.01. Number of patients satisfied in Group D, B, and DB were 0, 24, and 25, respectively. The duration of active phase of 1st stage of labor was 144.80 (±47.46), 198.88 (±92.16), and 142.50 (±50.77) minutes in Group D, B, and DB, respectively (P < 0.01). APGAR score was comparable in three groups. No adverse effect was seen on mother or fetus except burning sensation at the time of giving SWB. The occurrence of cesarean section was 8 in Group B, 8 in Group D, and 6 in Group DB.

Conclusion:

SWB is a safe modality for labor analgesia, causing a significant reduction in labor pain, both with and without drotaverine. Although not always effective as a sole modality, it may be effective in reducing the requirement of other analgesics when used in conjunction with other modalities for labor analgesia. Drotaverine may not significantly lower the labor pain alone or in conjunction with SWB. Yet, it significantly decreases the duration of active phase of first stage of labor (CTRI/2019/09/021125).
Impact of Central Sensitization on Pain Intensity, Pain-Related Symptoms, and Health-Related Quality of Life in Chronic Pain Outpatient Department
Authors: Lall Deep Divanshu , Gupta Rajat , Dadu Nandini , Jain Ashu
Published: April 2023

Context:

Central sensitization (CS) has been proposed as a common underlying pathophysiology to explain poorly understood pain-related syndromes. This is termed under central sensitivity syndromes (CSSs), for which no specific organic cause has been found.

Aims:

The aim of the present study was to investigate whether there is an association between the CS Inventory (CSI) score, pain-related symptoms, pain-related disability, health-related quality of life (QOL), and poorly understood pain-related syndromes and whether they differed by disease type. This study also evaluated the association between severity of CS and the associated CSSs.

Methods:

A total of seventy patients who attended a pain clinic (chronic pain outpatient department) were assessed randomly. CSI score, CSSs, EuroQOL-5 Dimension-5 Level, Brief Pain Inventory, and Fibromyalgia (FM) Severity Scale were assessed and compared.

Statistical Analysis:

Univariate correlation analysis was performed in each group to evaluate: (1) severity of CS, (2) presence/absence of CSSs, (3) pain intensity and pain interference, and (4) CSI score and FM Severity Scale.

Results:

CSI score has a significant association with CSSs, pain-related symptoms such as pain/discomfort, anxiety/depression, mood, and sleep.

Conclusions:

In our study, CS has been shown to have a significant impact on mean pain score and QOL by strongly impacting mobility, mood, and sleep. CS is the underlying root cause of various CSSs. This study concludes that CS should be evaluated as a routine in all chronic pain patients.
Ultrasound-Guided Radiofrequency Ablation in a Patient with Resistant Intercostal Neuralgia Secondary to Chronic Osteomyelitis of Anterior end of Ribs
Authors: Kale Natasha , Shah Sheetal , Mehta Hemant
Published: April 2023

Intercostal neuralgia is a complex painful disorder characterized by intense, sharp shooting, or burning pain, along the distribution of intercostal nerve. It is difficult to treat condition in which pharmacological modalities of treatment often fail. We report a case of a 56-year-old female with postoperative sternal wound infection, following coronary artery bypass grafting, involving the left costochondral junction and left anterior ends of 7th, 8th, and 9th ribs. She presented with severe excruciating pain over left T7, T8, and T9 dermatomes for 3 months. Conservative management failed to provide significant improvement in pain relief. Hence, intercostal nerve block was performed and it provided good pain relief for 3 weeks. It was then followed by radiofrequency ablation (RFA) that provided good symptomatic pain relief at 9-month follow-up. Thus, ultrasound-guided RFA can be effectively and safely used in patients suffering from resistant intercostal neuralgia for providing quick and long-term pain relief.
Effect of High Altitude on the Incidence of Postdural Puncture Headache in Young Males
Authors: Parikh Badal , Pande Tanmay , Dua Amit , Sikdar Indranill
Published: April 2023

Background:

Postdural puncture headache (PDPH) is a serious and debilitating complication and a major cause of postoperative morbidity occurring after spinal anesthesia (SA) or inadvertent dural puncture after epidural anesthesia. The understanding of pathophysiology of PDPH has improved over the last few decades and its occurrence is now on decrease with use of better techniques and smaller gauge needles. Over the past several years, many of the risk factors attributable to PDPH have been identified and studied extensively, but only few studies have evaluated the effect of increasing altitude on the occurrence of PDPH. As a significant proportion of population undergo surgery in such elevations, we retrospectively evaluated the effect of high altitude on the incidence of PDPH following SA.

Materials and Methods:

This study was conducted at a single center, retrospective observational study in the high altitude and cold climate region, for a period of 5 years. The data collected were evaluated for the occurrence of PDPH.

Results:

The total number of cases undergoing surgery under SA in our center was 440 over a period of 5 years. The cumulative incidence of PDPH in this cohort was 6.6%. The incidence was 7.15% and 5.56% with use of 26G and 27G Quincke needle, respectively, which is higher than that observed in the low-lying areas.

Conclusions:

The incidence of PDPH is higher in patients undergoing surgery under SA at high altitude.
A Cross-Sectional Study for Correlation of Kinesiophobia with Low Back Disability and Health-Related Quality of Life in Elderly Patients with Chronic Low Back Pain
Authors: Mishra Manisha , Naik V. Rajashree
Published: April 2023

Context and Aim:

Evasion of activity is an elemental reaction that normally allows an injury to heal, but among patients with chronic pain, avoidance behavior is found to persist longer than it takes for the actual injury to heal. This may lead to kinesiophobia which is an irrational, weakening, and devastating fear of movement and activity stemming from the belief of fragility and susceptibility to injury. Studies have shown that older people with low back pain (LBP) demonstrate high levels of kinesiophobia with prevalence ranging up to 80%. Despite the pain and fear that they experience, advising them to avoid painful movements or activities may actually be counter-productive as it will decrease their functional independence. Hence, the aim of the present study was to assess the impact of kinesiophobia on disability and quality of life (QOL) in elderly LBP patients.

Subjects and Methods:

With ethical permission and informed consent from 125 elderly patients with chronic LBP fulfilling the inclusion and exclusion criteria, three scales were administered to assess kinesiophobia (Tampa Scale of Kinesiophobia), disability (Oswestry Disability Index), and QOL (WHO QoL scale).

Statistical Analysis Used:

Data were collected and statistically analyzed for correlation using Spearman's correlation coefficient.

Results:

Sixty-five percent of the study population were male of which 82% had clinically significant kinesiophobia and 45% were female of which 85% had clinically significant kinesiophobia. Kinesiophobia was found to have a moderate positive correlation with disability (r = 0.6061) and a strong negative correlation with QOL (r = −0.7598).

Conclusions:

Kinesiophobia has a moderate-to-severe impact on disability and QOL and should be addressed as a separate symptom and adequate intervention strategies should be incorporated so as to minimize its impact.
Evaluation of Knowledge, Attitude, and Practices of Nurses Regarding Pain Management
Authors: Khetarpal Monica , Dubey Rashmi , Dey Samarjit , Arora Prateek
Published: April 2023

Background:

Pain is the primary symptom that brings patients to seek health care and is considered a global health problem. Thus, pain control is a fundamental goal in the management of the hospitalized patients. Despite the development of analgesics and advancement in pain management, the pain remains undermanaged. The untreated pain has a detrimental effect on the patient's quality of life, affects their outcomes, delays recovery, and increases the hospital stay. Nurses play a significant role in pain management as they spend a considerable portion of their time with the patients and deal with all their complaints, including pain. One of the significant obstacles to effective pain management among nurses is their limited knowledge and negative attitudes towards pain management. The primary purpose of this study was to explore nurses' knowledge, attitude, and practices toward pain management.

Methods:

An online survey was conducted for 224 nurses of various departments to assess their knowledge, attitude, and practices regarding pain management using a 30-item questionnaire in Google Forms.

Results:

Our survey shows a deficiency in knowledge related to the basics of pain, opioid use, and pain management in the elderly and pediatric age group.

Conclusions:

It may be prudent to consider training programs regarding opioid use and pain management as a part of continuous education and nursing undergraduate curricula.
Recent Updates in Obstetric Analgesia
Authors: Beg Tazeen , Daoud Bahaa Eldin , Angelo Tiffany E.
Published: April 2023

Analgesia for a parturient is an important element of care provided by an anesthesiologist as a member of the multidisciplinary team. Neuraxial anesthesia is considered the gold standard. With increasing evidence of safety and efficacy of various available techniques and equipment, including ultra-short–acting opioids, local anesthetics, newer combined spinal–epidural needles, monitors, patient-controlled infusion pumps, and point-of-care ultrasound, obstetric care has become less challenging with higher patient satisfaction rates and better safety profiles. Recent articles spanning the last few years on important related topics, including care of the parturient during COVID, newer developments, enhanced recovery after cesarean (ERAC) protocols, and patients with unique profiles, are discussed in this update on obstetric analgesia.