bluuebunny/crossref_metadata_2025 huggingface dataset:
Le DPA-PC : de l’évidence au processus réflexif vecteur de changement
Authors: Harrar Muriel
Published: September 2022

Une praticienne du travail social livre son expérience de l’approche centrée sur le Développement du Pouvoir d’Agir des Personnes et des Collectivités (DPA-PC), au travers de deux mises en pratique. L’une concerne un collectif d’étudiants en formation au travail social, l’autre concerne l’accompagnement d’une personne en situation d’impuissance liée à une image de soi dépréciée et à une addiction à l’alcool. Les obstacles à surmonter dans le renversement d’une posture professionnelle visant à accompagner pas à pas le cheminement de personnes, et son apport réflexif, font l’objet de ce témoignage.
Développement du pouvoir d’agir de personnes présentant une déficience intellectuelle
Authors: Pélissier Jérôme
Published: September 2022

Cet article présente une expérience d’accompagnement d’une personne en situation de déficience intellectuelle, avec l’approche centrée sur le Développement du Pouvoir d’Agir des Personnes et des Collectivités (DPA-PC). Accompagner des personnes en situation de grande dépendance confronte souvent à cette question : « Je veux décider par moi-même ! » La dépendance, qui plus est lorsqu’elle est associée à une forme de déficience intellectuelle ou à des incapacités cognitives, est appréhendée comme paradoxale au regard du pouvoir d’agir ou de l’autodétermination. Les professionnels ont un rôle crucial à jouer, en tant que facilitateurs certes, mais aussi en tant qu’acteurs visant à agir pour une transformation de représentations et de dogmes enfermant les sujets dans des situations incapacitantes et de non-décision. L’approche DPA-PC permet de participer à une déconstruction de ces représentations paradoxales, et ouvre une réflexion sur les potentialités d’un processus de désinstitutionnalisation de personnes en situation dite de « grande dépendance ».
Accompagner l’initiative entrepreneuriale par le récit biographique. Proposition d’une méthode
Authors: Ciobanu-Gout Varvara
Published: September 2022

Cette contribution présente une démarche exploratoire d’accompagnement de l’entrepreneuriat par le récit biographique. Cette méthode originale qui articule l’autobiographie raisonnée et les conversations narratives, vise à éclairer le porteur d’un projet entrepreneurial sur la place qu’il souhaite donner à son projet dans sa vie, en concordance avec ses valeurs et ses préoccupations. Elle répond ainsi aux besoins spécifiques des nouvelles formes d’entrepreneuriat nées de la montée des valeurs existentielles caractéristiques de la postmodernité. Par les questions qu’elle soulève, cette contribution ouvre une piste de recherche sur les possibilités d’un multi-accompagnement avec l’intégration des techniques narratives. Cet accompagnement qualifié d’existentiel valorise la vie entière du sujet, ouvrant ainsi une piste de réflexion sur l’éducation à l’esprit d’entreprendre dans la logique d’un apprentissage tout au long de la vie.
La responsabilité au cœur de la protection des données : ce que les données disent de l’être humain
Authors: Tabouy Laure
Published: September 2022

L’accélération des innovations rend indispensable une réflexion sur les enjeux sociétaux, éthiques et juridiques liés à l’exploitation des données, en particulier sur la notion de responsabilité. La conception de garde-fous interdisciplinaires et de systèmes d’évaluation et de suivi, ainsi que la définition d’une gouvernance adaptée aux valeurs sociologiques, éthiques et juridiques des différents pays émergent actuellement dans le monde entier. C’est autour de la nécessité de s’accorder sur la notion de responsabilité sociale que, par exemple, se construit la neuroéthique appelée de ses vœux par le Conseil de l’OCDE à travers sa recommandation n°0457 de 2019 sur l’innovation responsable dans les neurotechnologies. Dans la réflexion sur la notion de responsabilité, la philosophie peut apporter un éclairage non négligeable sur cette question. C’est donc en convoquant Hans Jonas et Hannah Arendt, mais également en utilisant l’éthique de la recherche et la neuroéthique ainsi que les lois et les recommandations existantes, que ce travail autour de la responsabilité sociale concernant les données s’est dessiné.
Une rupture dans le rapport au travail ? La pandémie de Covid-19 et les temporalités de gestion de leur parcours par les salariés
Authors: Laurent Marie-Élodie , Taskin Laurent , Ughetto Pascal
Published: September 2022

La crise sanitaire est réputée avoir provoqué une rupture dans le rapport au travail de beaucoup de salariés, qui en auraient tiré les conséquences à travers une inflexion marquée de leur parcours. L’article interroge cette hypothèse en se basant sur quinze récits de salariés d’entreprises privées et publiques belges, collectés au début de l’année 2021 dans le cadre d’une recherche transdisciplinaire. Il appréhende le rapport au travail et les choix effectués par les individus dans leurs parcours en les inscrivant à la croisée des normes organisationnelles, professionnelles et familiales que les individus s’emploient à accorder. Nos résultats montrent que, si elle a pu constituer un choc, la crise sanitaire a surtout amplifié et précipité des réflexions qui s’inscrivent dans des temporalités plus longues en matière de rapport au travail. La distance avec l’entreprise et la fréquentation continue des membres de la famille a imposé un poids accru des normes familiales et forcé à la recomposition d’équilibres avec des normes organisationnelles, désormais davantage obligées de composer avec les premières.
An enhanced whale optimization algorithm for DNA storage encoding
Authors: Wang Sijie , Zhou Shihua , Yan Weiqi
Published: September 2022

Metaheuristic algorithms have the drawback that local optimal solutions are prone to precocious convergence. In order to overcome the disadvantages of the whale optimization algorithm, we propose an improved selective opposition whale optimization algorithm (ISOWOA) in this paper. Firstly, the enhanced quasi-opposition learning (EQOBL) is applied to selectively update the position of the predator, calculate the fitness of the population before and after, and retain optimal individuals as the food source position; Secondly, an improved time-varying update strategy for inertia weight predator position is proposed, and the position update of the food source is completed by this strategy. The performance of the algorithm is analyzed by 23 benchmark functions of CEC 2005 and 15 benchmark functions of CEC 2015 in various dimensions. The superior results are further shown by Wilcoxon's rank sum test and Friedman's nonparametric rank test. Finally, its applicability is demonstrated through applications to the field of biological computing. In this paper, our aim is to achieve access to DNA files and designs high-quantity DNA code sets by ISOWOA. The experimental results show that the lower bounds of the multi-constraint storage coding sets implemented in this paper equals or surpasses that of previous optimal constructions. The data show that the amount of the DNA storage cods filtered by ISOWOA increased 2–18%, which demonstrates the algorithm's reliability in practical optimization tasks.
On some control problems for Kolmogorov type systems
Authors: Hofman Alexandru , Precup Radu
Published: September 2022

The paper deals with some control problems related to the Kolmogorov system for two interacting populations. For the first problem, the control acts in time over the per capita growth rates of the two populations in order for the ratio between their sizes to follow a prescribed evolution. For the second problem, the control is a constant which adjusts the per capita growth rate of a single population so that it reaches the desired size at a certain time. For the third problem the control acts on the growth rate of one of the populations in order that the total population to reach a prescribed level. The solution of the three problems is done within an abstract scheme, by using operator-based techniques. Some examples come to illustrate the results obtained. One refers to a system that models leukemia, and another to the SIR model with vaccination.
Sociocultural Inequalities and Economic Abuse in Intimate Partner Violence in Rural America
Authors: Qi Ziwei , McBlair Garrett , Shepard Megan
Published: September 2022

Intimate partner violence (IPV) is a significant public health crisis that affects a large proportion of the population in the U.S. It profoundly influences the economy, health, the well-being of victims and their families, and the community and society. Most importantly, the underlying causes of IPV are complex and deeply entrenched in places permeated with patriarchal values and gender stereotypes. IPV is maintained and even abetted, varying by space, place, and time. The chapter focuses on the process of maintaining and reproducing socioeconomic inequality in relationship violence in rural areas. It examines the varied challenges and obstacles experienced by rural IPV victims. It also provides strength-based solutions to break the cycle of generational violence.
Meeting His Needs
Authors: Krueger Julie Christine
Published: September 2022

Based on 13 months of ethnographic field work, this research interrogates male customers' motivations for patronizing strip clubs as well as gendered functions of strippers' labor outside of sexual arousal. More broadly, this research examines the relationship between male customers, masculinity, and female strippers' labor. The author makes the argument that strip clubs provide a “safe space” for male customers to experience emotional intimacy and receive “stripper therapy.” Through their labor, strippers fulfill the emotional needs of male patrons and enable them to express their emotions, often concerning that which compromises their masculinity. The hypersexualized, masculinized environment of the strip club, however, shields customers from the fear of being “insufficiently” masculine or failing to adhere to masculine ideals of stoicism and self-control. Thus, this research highlights the extent to which men rely on strippers' labor to meet the demands of masculinity and cope with the pressure it exerts.
A Comparative Study With Linear Regression and Linear Regression With Fuzzy Data for the Same Data Set
Authors: Khan Mufala , Kumar Rakesh , Dhiman Gaurav
Published: September 2022

Regression analysis is a quantitative research tool that is used to model and analyse multiple variables in a dependent-independent relationship in order to create the most accurate forecast. These models do not forecast the real value of the data due to uncertainty. As a result, fuzzy regression is critical in overcoming or addressing this type of problem. In this chapter, the authors presented a comparative study of LR models and LR models using fuzzy data and real experimental data. The computational results demonstrate the best linear models for the data set.
A Comparative Study of Fuzzy Linear and Multi-Objective Optimization
Authors: Gulia Pinki , Kumar Rakesh , Kaur Amandeep , Dhiman Gaurav
Published: September 2022

A new paradigm for the solution of problems involving single- and multi-objective fuzzy linear programming is presented in this chapter. As opposed to complex arithmetic and logic for intervals, the method offered uses basic fuzzy mathematical operations for fuzzy integers instead. Using fuzzy numbers to express variables and parameters in a fuzzy linear programming issue (FLPP) is common. However, the authors only talked about FLPP with fuzzy parameters here. Triangular fuzzy numbers are used as fuzzy parameters. Ranking functions are used to convert fuzzy problems into clear ones. Crisp optimization techniques have been used. The proposed solution is tested on a variety of real-world examples that address both of these concerns.
Clustering and Regression Analysis on COVID-19 in India Using Python
Authors: Bhattacharya Uma , Kumar Rakesh , Kaur Amandeep , Dhiman Gaurav
Published: September 2022

Since 2019, the world has been dealing with an outbreak of the COVID-19 virus. A highly transmissible new coronavirus causes a severe acute respiratory illness. Every country, including India, took steps to battle the virus, such as announcing a phased lockdown. The COVID-19 pandemic has wreaked havoc on India. In reality, the third COVID-19 wave has already begun. The development of COVID-19 vaccinations aided in the healing of the planet. Multiple nations are conducting clinical tests on potential COVID-19 vaccines. India initiated the world's largest vaccination campaign on January 16, 2021. The Indian government has made significant progress in both vaccinating everyone and developing the COVID-19 vaccine. The use of Covaxin and Covishield dosages in different Indian states is investigated in this chapter.
Leading Inclusive Schools
Authors: Gómez-Hurtado Inmaculada Gómez , González-Falcón Inmaculada , García-Rodríguez María del Pilar , Coronel-Llamas Jose Manuel
Published: September 2022

The aim of the chapter is to learn how the management team promotes openness to the community and collaboration to develop an inclusive culture. This study is framed within the R+D+I project “School Management Leadership and Its Contribution to Improving Inclusion in Compulsory Education.” In a mixed research approach, the project develops and implements a tool for the evaluation of inclusive education in schools through participatory methodologies. In this chapter, the authors discuss the different ways of understanding inclusive leadership and the main elements intertwined in it, focusing later on the participation of management teams as catalysts of the educational community for the development of inclusive practices in schools. To this end, from the teachers' perspectives, they analysed the data gathered through the LEI-Q-Profesorado questionnaire. The main outcomes and conclusions indicate that the teaching staff of the schools surveyed have a positive perception of the actions taken by the management teams in the exercise of their inclusive leadership.
Industry 4.0
Authors: Zalte Sheetal , Deshmukh Smita , Patil Prajkta , Patil Minal , Kamat Rajanish K.
Published: September 2022

The fourth technological revolution, which is widely called Industry 4.0, works by incorporating the critical features like physical (object in existence), digital, and biological worlds. The attributes related to Industry 4.0 are more important as they change from producing a large amount of standardized products by using manual assembly, semi-automated assembly, or fully automated assembly with customization based on different product manufacturing. The fourth technological revolution is not progressing to modification; however, “it can modify us” and revolutionize societal life. The chapter elucidates the essential technologies behind Industry 4.0 and how they are shaping smart manufacturing and digital supply chain management. It also throws light on the policy frameworks required to be adopted to inculcate Industry 4.0 in the walks of societal life and reviews the upcoming trends.
A Comparative Analysis of Urban Transport Using K-Means Clustering and Multi-Class Classification
Authors: Cherukuri Aswani Kumar , Bhowmick Karan , Kamalov Firuz , Thong Chee Ling
Published: September 2022

The transportation planning process requires a comprehensive study of the regions that need development. This study is an extension of the methodology of transportation planning. The authors use real-time data from Foursquare API to map out the number of transportation facilities and infrastructure available for each city. This study will shed light on areas that need the most development in terms of intra-neighbourhood and inter-neighbourhood transportation. We use k-means clustering to organize and visualize clusters based on a calculated metric called “Availability Factor” that they have defined, and the number of transportation facilities available in each neighbourhood. Finally, they use the data at hand to create a model for multiclass classification to segregate new data into the predefined classes produced by the unsupervised learning model. The information procured in this work can be used to assess the quality of transportation available in the neighbourhoods of a location and help identify key areas for development.
Technology Innovation and Adoption in the Modern Workplace
Authors: Wibbenmeyer Kelly
Published: September 2022

Understanding the various types of innovation technology that are currently disrupting organizations around the globe is an important endeavor. Various innovative technologies are defined, and related ethical challenges are explored that organizations face in today's technology climate. Additionally, key methods are examined for an organization to manage employees when they refuse to change, including unfreezing, transition, and refreezing. The importance of alignment of innovation strategy to organizational resources is reinforced, with the best methods to align organizations with innovation success, including when it is okay to say no to innovation within an organization.
Is Digital Nudging an Ethical Marketing Strategy?
Authors: Tse Po Man
Published: September 2022

Consumption through mobile applications is becoming popularized especially after consumers' adaption of the “new normal” due to the COVID-19 pandemic. The same as other marketing strategies, nudges are often applied digitally through the design of smartphone applications to nudge consumers into performing the marketer's preferred actions subconsciously. The study aims to contribute to the existing literature on the acceptance of digital nudges by exploring its ethicalness as a marketing strategy as seen through the consumers' perspective. Eighteen semi-structured interviews were conducted, and thematic analysis was applied to analyze the data.
Leadership and Business Ethics for Technology Students
Authors: Khun Jennie Lee
Published: September 2022

Technology ethics is a sub-field of ethics education addressing the dilemmas that are specific to the information technology age and encompasses a societal shift as technological devices provide a more efficient transfer of information. The use of technology poses unique ethical dilemmas and is an important topic to explore. Corruption in society is a problem and is further segmented by focusing on the technology industry. An overview of ethics in academia is discussed to impact a person's ethical values before entering the workforce. A review of business and technology ethics provides the background on the differences between topics. Ethical concerns about the use of the internet, security, biometrics, data, cryptocurrency, and elevated privileges for technology professionals are also explored. An overview of leadership ethics is included and the impact it has on culture. A curriculum approach to teaching ethics to technology students through practical ethics education in the program through simulation, case study, and real-world approaches is also provided.
Privacy and Data Rights for Adult English as a Second Language (ESL) Students
Authors: Rehak Kimberly M.
Published: September 2022

In the USA, instructors need to ensure the user privacy and data rights of their adult English as a second language (ESL) students. The ways in which educational technology (EdTech) companies track user activity and sell user data to third parties raises ethical concerns for student privacy and data rights. ESL students are particularly vulnerable because of the vague language in privacy policies and user agreements, differences in terms of state surveillance, and insufficient user privacy and data protections. In addition to a discussion on the ethical concerns within EdTech and higher education, one method and two tools to help ESL instructors and educators are provided. These assist with ESL or international students in their classrooms as a means to evaluate EdTech tools and make decisions on whether to adopt or require a digital tool.
Facial Recognition Technology
Authors: Raineri Ellen Marie , Brennan Erin A. , Ryder Audrey E. B.
Published: September 2022

Facial recognition technology (FRT) is a type of biometric technology that uses a digital image of one's face and uses algorithms to match that image in a database. This type of technology has been adopted by individuals when using their mobile devices and automobiles and to access restricted areas or events. FRT has also been adopted by law enforcement and the government to support crime detection and prevention. In addition to the benefits, the associated cyber security problems, legal issues, and ethical challenges of privacy and discrimination are explored. Understanding ethical theories permits the public and decision-makers to make informed choices to influence changes in law to support the changing environment for FRT. Recommended solutions are included along with future research that addresses face connect in automobiles, state law, and ethical comparisons.
Cross-Cultural Competence
Authors: Chamberlain Jean , Nakabembe Eve , Guinness Sophia
Published: September 2022

In the time since World War II, the world has witnessed a massive expansion in cross-border trade, travel, and communication. In the more recent decade, tensions surrounding international relations, treatment of refugees, exchange of world financial currencies, tensions over East-West and North-South relations have captivated the energy and innovation of both governments and private institutions. A through-line to all these situations is how to best interact with people very different from ourselves. This chapter highlights a skill set that is critical to this end.
Trauma Care in Low Resource Settings
Authors: Elder Brandon Aaron , Krempels Ryan , Serreyn Jeremy R.
Published: September 2022

From a global perspective, it is estimated that nearly six million people per year die from traumatic injury and millions more are left with significant disability. Trauma accounts for approximately 10% of the world's deaths and is 32% greater in number than tuberculosis, malaria, and HIV/AIDs combined. Concerningly, approximately 90% of these deaths occur in low resource settings. With a standardized, teachable approach and skills, the authors believe that there is great potential for improvement and establishing trauma care equity in low resource settings. The emphasis of this chapter is not to replace formal trauma resuscitation training, but to highlight the nuances of low-resource trauma care, gaps in care equity, and identify actionable items to improve initial trauma care.
International HIV-AIDS Medicine
Authors: Gautney Brad
Published: September 2022

Many developing nations and low-income communities possess both large numbers of HIV-positive citizens and very limited resources with which to respond. HIV management in such settings demands a unique skill set that often differs from those skills acquired in high-resource settings. This chapter prepares healthcare professionals to lead effective low-resource HIV prevention and intervention. Included is content addressing prevention of mother-to-child transmission, management of pediatric HIV infection, treatment of opportunistic infections, and understanding of how sociocultural attitudes and values impact HIV/AIDS care.
A Comprehensive Study of Multi-Drug Resistance in Tuberculosis
Authors: Sharma Mani , Kansal Sakshi
Published: September 2022

Tuberculosis is the second most fatal infectious disease after AIDS. It is caused by the mycobacterium tuberculosis. There are numerous factors responsible for the emergence of multi-drug resistance and extensively drug resistance cases of tuberculosis, which involves high pill burden, prolonged treatment, low compliance, and stiff administration schedules. Continuous efforts have been done to develop unique antibodies and nanocarrier-based drug delivery systems that can overcome drug resistance, reduce the treatment regimen, and elevate the compliance to treatment. Therefore, there is a need for a robust system to subdue these technological drawbacks in the urge to develop therapeutically active system in terms of pharmaceutical technology. It is difficult to treat prolonged multi-drug-resistant tuberculosis giving higher side effects and expenses and more unsuccessful results. In short, the authors tried to uncover all the urgent needs in the treatment and prevention of multi-drug-resistant tuberculosis through adequate strategies.
A Review of Aluminum-Super Extended Graphite Based Metal Matrix Composite Material
Authors: Sakthideepan M. , Nagendran P.
Published: September 2022

Graphene is a wonder material, and it has remarkable mechanical property not only limited to few kind of mechanical properties. This included electrical, optical, thermal capability and resistivity. It is hypothetically an excellent method to approach with Reinforcement in metal matrix composites. This paper totally depends on review of Aluminum – super extended graphite material, super extended graphite is commonly known as a ‘Graphene’. This paper focuses on the review about fabrication methodology and problems faced in fabrication of Al-Graphene based composite, and we analyzed flexible and high possible path to economic consideration. This article covers a step-by-step process for enhancing a composite material for a commercial application. In this study analysis, the mechanical behavior of aluminum-graphene composite is made by potentially reinforced metal matrix method with particulate stir casting method. The main objective of this study is to provide the functional process of graphene based composite effectively. The aluminum (Al-7075 Alloy) is a metal matrix and has 1% of graphene. In recent decades, a hype of graphene material and carbon nano tubes have come due to technological advancement as it leads to commercial establishment. Composite material played the important role in the recent years to replace the traditional material in the easiest manner. Graphene based composite has wide variety of uses and enormous applications to drive for a better future.
Fetal Pontine Tegmental Cap Dysplasia - A Case Report
Authors: Priyanka C. , Rangasami Rajeswaran , Suresh Indrani
Published: September 2022

Pontine tegmental cap dysplasia (PTCD) is a very rare hindbrain malformation recently described and the affected children show a bad prognosis. We present this case to increase the awareness of this rare condition and to highlight the importance of early prenatal diagnosis. A 25 years old female with 22 weeks gestation was referred after sonography for fetal magnetic resonance imaging (MRI) in the evaluation of cerebellar hypoplasia. Prenatal MRI confirmed cerebellar hypoplasia. Follow up postnatal MRI showed flattening of the ventral pons, beak-like tissue in the posterosuperior pons suggesting the diagnosis of PTCD. In retrospect the fetal MR images revealed features consistent with PTCD. To the best of our knowledge, this is the fifth prenatal case and with the earliest gestational age of 22 weeks.
Near-Infrared Spectroscopy–Guided Hyperventilation for Transient Intracranial Pressure Control during Anesthesia Induction in a Patient with Impending Uncal Herniation
Authors: Varma Salini , Praveen Ranganatha , Hrishi Ajay P. , Sethuraman Manikandan
Published: September 2022

Near-infrared spectroscopy (NIRS) is known to determine the adequacy of regional cerebral oxygen supply. NIRS values during anesthetic induction depends upon various factors such as anesthetic agents, inspired oxygen fraction, blood carbon dioxide levels and systemic blood pressure. Also high intracranial pressure (ICP) can lead to reduced NIRS values, secondary to increased cerebral vascular resistance induced decrease in cerebral blood flow. However optimal hyperventilation instituted as a bridge to definitive ICP management is difficult to ascertain as hypocapnia due to poorly titrated hyperventilation can potentially worsen ICP. Here we describe a novel application of NIRS-guided hyperventilation during anesthesia induction in a brain tumor patient with raised ICP features and impending uncal herniation as suggested by computed tomography (CT) scan, with ipsilateral baseline reduced NIRS values. These ipsilateral NIRS values further reduced significantly during anesthesia induction even before profound bradycardia occurred, which promptly improved to baseline following hyperventilation.
Cone Beam CT to Guide Transorbital Treatment of a Cavernous Sinus Dural Arteriovenous Fistula in a Patient with Middle Meningeal Artery Origin of the Ophthalmic Artery
Authors: Balaguruswamy Madan Mohan , Palanisamy Sampathkumar , Mohanasundaram Praveen Kumar , Madeswaran Karuppannaswamy
Published: September 2022

Transorbital puncture to embolize cavernous sinus (CS) dural arteriovenous fistulas (DAVF) is a useful strategy when conventional transvenous routes are inaccessible. We report a case of bilateral CS DAVF associated with bilateral middle meningeal artery (MMA) origin of ophthalmic arteries (OA) who had recently undergone transvenous coil embolization. She presented with persistent symptoms of conjunctival congestion and proptosis in the left eye. Angiogram revealed residual left CS DAVF with dilated SOV. Inferior petrosal sinus or facial vein access was not possible. Transorbital access of the SOV was planned. Cone-beam CT (CBCT) angiography was used to delineate the relationship between the variant OA and SOV and also to plan a safe trajectory. Using fluoroscopy guidance, the SOV was punctured and embolization was done using Onyx-18. CBCT is a valuable tool in planning and executing transorbital treatment of CS DAVF, especially in the setting of variant OA.
Short-Term Efficacy Outcomes of Tenecteplase versus Alteplase for Acute Ischemic Stroke
Authors: Requião Leticia E , Oliveira Roberto S , Reis Lorena S , B Assis Ana P , G Moreno Beatriz N , Cordeiro Luisa R , Solla Davi F
Published: September 2022

Tenecteplase (TNK) has been shown to be noninferior to Alteplase (ALT) for long term efficacy and safety outcomes. Whether this also applies to short term efficacy outcomes such as early clinical improvement and recanalization is unknown. To compare TNK and ALT regarding the short term efficacy outcomes: early neurological improvement and recanalization. The PRISMA was used to conduct a meta analysis, adapted to noninferiority analysis. The primary outcome was early (24–72 h) neurological improvement, defined as either NIHSS score 0 or reduction of at least 8 points compared to baseline. Recanalization was a secondary outcome. The noninferiority margin was set at 6.5%. Search strategy yielded 5 randomized clinical trials (1585 patients: 828 TNK, 757 ALT). Mean age was 70.8, 58.8% were men, mean baseline NIHSS was 7, and mean onset to treatment time was 148 min. Patients in intervention group received TNK at doses of 0.1 mg/kg (6.8%), 0.25 mg/kg (24.6%), and 0.4 mg/kg (68.6%), while all ALT patients received 0.9 mg/kg. In random effects meta analysis, TNK was noninferior to ALT for the primary outcome, early major neurological improvement (risk difference 8% in favor of TNK, 95% CI 1%–15%). Recanalization was also noninferior for the TNK compared to the ALT group (risk difference 9% in favor of TNK, 95% CI 6% to 23%). Fixed effects models yielded similarly noninferior results and signaled for a possible TNK superiority for both early neurological improvement and recanalization. TNK is noninferior to ALT at the short term efficacy outcomes: early neurological improvement and recanalization.
X-linked Myopathy with Excessive Autophagy - A Rare Cause of Vacuolar Myopathy in Children
Authors: Rajeshwari Madhu , Dhiman Neena , Chakrabarty Biswaroop , Gulati Sheffali , Shamim Uzma , Faruq Mohammed , Suri Vaishali , Sharma Mehar Chand
Published: September 2022

X-linked myopathy with excessive autophagy (XMEA) is a rare, recently characterized type of autophagic vacuolar myopathy caused by mutations in the VMA21 gene. It is characterized by slowly progressive weakness restricted to proximal limb muscles and generally has a favorable outcome. The characteristic histological and ultrastructural features distinguish this entity from other mimics, notably Danon disease. XMEA is an under recognized disease and should be considered in the differentials of slowly progressive myopathy in children. Awareness of this rare entity is also important for the pathologists in order to distinguish it from other causes of vacuolar myopathy in view of its favourable prognosis. We report the first genetically confirmed case of XMEA from India in an 8-year-old boy which was diagnosed based on the characteristic light microscopic and ultrastructural findings on muscle biopsy and subsequently confirmed by mutation analysis. The differential diagnostic considerations are also discussed.
Neuromyelitis Optica Spectrum Disorders in North Indian Population
Authors: Sachdeva Julie , Goyal Manoj K , Singh Ramandeep , Kapila Aastha T , Singh Paramjeet , Saikia Biman , Lal Vivek
Published: September 2022

Introduction:

To understand neuromyelitis optica spectrum disorders (NMOSDs) better we need to study them in different populations. This prospective study was conducted to characterize clinical, serological, radiological, and therapeutic profile of NMOSDs in a North Indian population.

Materials and Methods:

This study included 81 patients with NMOSDs. All patients underwent detailed history and examinations and were followed at 3 monthly intervals. They were evaluated using standard investigations including gadolinium-enhanced magnetic resonance imaging (MRI) of the brain and spine with thin section optic nerve cuts and treated as per the standard guidelines. Data were recorded meticulously.

Results:

The mean age was 33.7 ± 13.4 years. The mean age at disease onset was 31.2 ± 13.5 years. Female-to-male ratio was 1.9:1. About 32.1% of patients presented with optic neuritis (ON), 56.8% with transverse myelitis (TM), and 11.1% with both ON and TM. The mean time from disease onset to diagnosis was 16.17 ± 23.09 months. Muscle atrophy, Lhermitte symptom, and tonic spasms were common. Foster–Kennedy syndrome-like presentation was seen in 8.6%. NMO antibodies were positive in 41 patients. MRI revealed involvement of <4 vertebral segments in 16.4% of patients with TM. Patients were managed as per standard guidelines. The mean follow-up duration was 15.3 ± 6 months. Approximately 88.9% had good functional outcome.

Conclusion:

NMOSDs are a common cause of demyelinating illnesses in Northern India. The response to treatment is excellent and most patients recover without residual disability.
Raised Blood Urea Nitrogen–Creatinine Ratio as a Predictor of Mortality at 30 Days in Spontaneous Intracerebral Hemorrhage
Authors: Dev Priya , Singh Varun Kumar , Kumar Amit , Chaurasia Rameshwar Nath , Kumar Anand , Mishra Vijaya Nath , Joshi Deepika , Pathak Abhishek
Published: September 2022

Background:

Spontaneous intracerebral hemorrhage (SICH) accounts for 7.5%–30% of all strokes and carries higher morbidity and mortality. Raised blood urea nitrogen and creatinine ratio (BUNR) is a marker of dehydration and related to poor outcome in stroke patients. However, the ratio varies between 15 and 80 in different studies. The aim of the present study was to assess BUNR as an independent predictor of mortality and its sensitivity and specificity in predicting outcome in the SICH population.

Materials and Methods:

Patients above the age of 18 years with SICH who were admitted in the Department of Neurology at Sir Sunderlal Hospital, Banaras Hindu University between January 2018 and July 2020 were enrolled in the study and prospectively followed up. Demographic, clinical, radiological, and outcome parameters were recorded.

Results:

A total of 217 patients were included. Of these, 137 (63%) were males. Seventy-one patients died during the initial 30 days. Number of patients with intraventricular hemorrhage (IVH; P = 0.003), higher mean intracerebral hemorrhage (ICH) volume (P < 0.001) and midline shift (P = 0.021), and poor Glasgow Coma Scale (GCS) score (<9) (P = 0.040) was more in the group which did not survive. Mean level of urea was significantly lower among survivors than in those who died (P = 0.001). BUNR was also significantly higher in those who died than in those who survived (P = 0.001). BUNR with a cutoff value of 39.17 was significantly associated with mortality at 30 days with a sensitivity and specificity of 61.97% and 62.33%, respectively. On performing two different multivariable logistic studies, it was found that model B with BUNR ratio as a predictor of mortality out performed model A (without BUNR).

Conclusions:

The study showed that SICH was associated with significant mortality. Independent predictors of death at 30 days were lower GCS on admission, larger hematoma volume, and BUNR of more than 39.17.
Trans-cranial Doppler Flow Characteristics of a Child with Paroxysmal Sympathetic Hyper-activity
Authors: Datta Debajyoti , Chandran Vipin , Bansal Sumit , Sahu Rabi Narayan
Published: September 2022

Background:

Paroxysmal sympathetic hyper-activity (PSH) is a syndrome characterized by excessive activity of the sympathetic nervous system. The cerebrovascular flow dynamics during the episodes of paroxysmal hyper-activity has also not been clearly examined in the literature.

Case History:

A 12-year-old boy with operated exophytic brain stem pilocytic astrocytoma was diagnosed with paroxysmal sympathetic hyper-activity. The trans-cranial Doppler flow characteristics of the bilateral middle cerebral artery and anterior cerebral artery are described in this report.

Conclusion:

The diagnosis of PSH requires an index of suspicion on the part of the clinician. The episodes of sympathetic hyper-activity are associated with significant changes in physiologic parameters in the patients including changes in cerebrovascular flow dynamics.
Antegrade Subperiosteal Temporalis Muscle Elevation and Posterior Retraction Technique Avoiding Muscle Incision for Pterional Craniotomy
Authors: Rai Survendra Kumar R , Dandpat Saswat K , Ranjan Shashi , Shah Abhidha , Sudarshan Nishchith , Mancarella Cristina , Pathak Harish M , Goel Atul H
Published: September 2022

Background:

The current technique of pterional craniotomy involves temporalis muscle incision followed by retrograde elevation. Feasibility of antegrade temporalis muscle elevation without any direct incision over its bulk is evaluated.

Objective:

Incisionless “antegrade, subgaleal, subfascial, and subperiosteal elevation” of temporalis muscle preserves vascularity and muscle bulk. Posterior maneuvering of “bare” temporalis muscle bulk either above (out rolling) or under (in rolling) the scalp for pterional craniotomy is discussed.

Material and Methods:

Technique of antegrade, subfascial, subperiosteal elevation, and posterior rotation of temporalis muscle without incising in its bulk by “out rolling” or “in rolling” along the posterior aspect of the scalp incision was carried out in 15 cadavers and later in 50 surgical cases undergoing pterional craniotomy. Postoperatively, patients were evaluated for subgaleal collection and periorbital edema. Operated side cosmesis and temporalis muscle bulk was compared with nonoperated temporalis muscle at 6 months interval.

Results:

Antegrade subperiosteal dissection of temporalis muscle was possible in all cases. “In-rolling” or “out rolling” technique provided adequate surgical exposure during pterional craniotomy. Postoperative subgaleal collection and periorbital edema was prevented. Facial nerve paresis or temporalis muscle-related complications were avoided.

Conclusion:

Antegrade, subgaleal, subfascial, and subperiosteal dissection techniques of temporalis muscle elevation without any direct incision in its bulk enables neurovascular and muscle volume preservation. Posterior maneuvering of elevated temporalis muscle with “out rolling” or “in-rolling” technique is easy, quick, and provides adequate exposure during pterional craniotomy. Opening and closing of scalp layers without violating subgaleal space prevent postoperative subgaleal hematoma and periorbital edema.
Rapid Recovery from Subacute to Chronic Ischemic Stroke Following Revascularization by Carotid Stenting
Authors: Ghatge Sharad B , Surya Nirmal , Modi Dhaval
Published: September 2022

Background:

Rapid neurological recovery from subacute to chronic ischemic stroke in subset of patients following carotid revascularization was observed.

Objective:

Retrospective analysis of data of the patients who had shown rapid recovery from subacute to chronic ischemic stroke following revascularization by Carotid stenting.

Materials and Methods:

We retrospectively analyzed pooled data from our carotid stenting patients done during January 2009 to January 2020. The inclusion criterion of the study was patients with rapid recovery within 24 h following revascularization by carotid stenting. There were total of 12 such patients. There were 8 males and 4 females. Apart from NIHSS, stroke severity was measured on MRI by ASPECTS score and cognitive function by MMSE. Each of these patients has undergone Carotid Stenting with distal protection for high-grade stenosis.

Results:

All of these 12 patients had Prestenting ASPECTS score ranging 8-10. Prestenting NIHSS score was ranging from 6-12 with an average of 8. Postprocedure NIHSS score was decreased to a range of 0-4 with average of 3. Prestenting MMSE was ranging 14-20 with an average of 18 score which turned into Post-stenting MMSE scale ranging 24-28 with an average of 26. Each of these patients shows decrease in NIHSS score by at least 50% in 24h to be called rapid recovery or Lazarus phenomenon. Additionally, they show significant improvement in cognitive function on MMSE scale.

Conclusion:

Rapid recovery from subacute to chronic ischemic stroke following revascularization by Carotid Stenting is potentially feasible in subset of patient who has mild to moderate deficit but high ASPECTS score.
Are the Pre-internship Expectations of Interns in Medical Field Met During Internship?
Authors: Sohal Karpal S , Owibingire Sira S , Garinga Philipo F , Wilson Evarist M , Shaban Shaban D
Published: September 2022

Background:

The transition period from an undergraduate student to an independent practitioner across healthcare professionals is challenging as new graduates experience a social, professional, and economic life that may be different from their prior expectations.

Objective:

The aim of this article is to determine the pre-internship expectations of the interns and to what level these expectations were met during internship.

Materials and Methods:

The study participants were interns posted at the Muhimbili National Hospital who had completed at least 6 months of internship training. A structured questionnaire was used to collect data regarding their social, economic, and career expectations before and during the internship. Data were analyzed using Statistical Package for Social Sciences version 23. The χ2 test was used to assess the association between variables, and the significance level was set at P < 0.05.

Results:

The median age of participants was 26 years, and the male-to-female ratio was 1.7:1. The overall mean pre-internship expectation score was 9.6 ± 3.6, whereas the mean scores were 3.6 ± 2.0, 3.7 ± 1.5, and 2.2 ± 1.4 for social, career, and economic expectations, respectively. The overall average expectation score during the internship was 6.1 ± 4.2. The mean scores were 1.9 ± 2.2, 3.0 ± 1.5, and 1.2 ± 1.5 for social, career, and economic expectations, respectively. There was a significant average difference between the expectation scores before and during the internship period.

Conclusion:

The pre-internship expectations of students in the field of health sciences are not met during the internship. The career expectations are relatively better met; however, social and economic expectations are largely not achieved during the internship period.
Facial chondroid syringoma
Authors: Elbalka Saleh S. , Hassan Amany , Hamdy Mohamed , Metwally Islam H.
Published: September 2022

Chondroid syringomas (CSs) are benign adnexal skin tumors usually affecting adolescent females in the periorbital region, and may have calcifications. Malignant transformation is very rarely encountered. There is a tendency to either medical treatment or intralesional injection of these lesions when confirmed benign especially if multiple. We herein describe a female with a periorbital benign CS. The presurgery cytology failed to predict the diagnosis, but surgical excision was attempted with good result. Both pathologists and surgeons are encouraged to add this differential in their diagnostic package of facial subcutaneous swellings.
Change of neutrophil-to-monocyte ratio to stratify the mortality risk of adult patients with trauma in the intensive care units
Authors: Tsai Ching-Hua , Liu Hang-Tsung , Hsieh Ting-Min , Huang Chun-Ying , Chou Sheng-En , Su Wei-Ti , Li Chi , Hsu Shiun-Yuan , Hsieh Ching-Hua
Published: September 2022

Background:

The subtypes of circulating white blood cells undergo relative changes under systemic inflammation; thus, the derived ratio may reflect patients' immunoinflammatory status. Under the hypothesis that change in segmented neutrophil-to-monocyte (SeMo) ratio, delta-SeMo ratio, may reflect the host's immunoinflammatory response against illness, this study aims to investigate the effectiveness of using delta-SeMo ratio to assess the mortality risk of patients with trauma and critical illness.

Materials and Methods:

A total of 1476 adult patients with trauma admitted to the intensive care unit (ICU) between January 1, 2009, and December 31, 2020, were enrolled in this study. Delta-SeMo ratio was defined using the following formula: SeMo ratio at day 3 (72–96 h after admission into ICU) – SeMo ratio at admission (at admission into ICU). The primary outcome was inhospital mortality.

Results:

There was no significant difference in the SeMo ratio at admission between death and survival patients (18.7 ± 11.0 vs. 18.7 ± 18.4, P = 0.974); however, SeMo ratio at day 3 (20.3 ± 15.5 vs. 15.7 ± 16.0, P = 0.002) and delta-SeMo ratio (1.6 ± 19.5 vs.–3.0 ± 24.2, P = 0.034) of the patients who died were significantly higher than those of the patients who survived. The patients with delta-SeMo ratio ≥1.038, an estimated cutoff value for best predicting mortality by the plotted receiver operating characteristic curve, sustained an approximately 2-fold adjusted mortality (adjusted odds ratio [AOR]: 1.84, 95% confidence interval [CI]: 1.27–2.66, P = 0.001) than those with a delta-SeMo ratio <1.038. Furthermore, when the delta-SeMo ratio was set at 0, a threshold value indicating a condition with an increase or decrease in the SeMo ratio at day 3 than the SeMo ratio at admission, there was a 1.7-fold higher adjusted mortality (AOR: 1.70, 95% CI: 1.18–2.46, P = 0.004) of the patients with delta-SeMo ratio ≥0 than those with delta-SeMo ratio <0.

Conclusion:

Following trauma injury, critically ill patients with an increased SeMo ratio present with a higher rate of mortality and longer stay in the hospital and ICU than those with a decreased SeMo ratio. The use of the delta-SeMo ratio may help physicians quickly identify patients at higher risk of inhospital mortality.
Atypical Presentation of Cystic Fibrosis in An Infant
Authors: Sahoo Bandya , Jain Mukesh Kumar , Mishra Reshmi , Patnaik Sibabratta
Published: September 2022

Dermatitis as an initial manifestation of cystic fibrosis (CF) is unusual. The eruption is usually first noted in the perineum anywhere from several days to few months after birth. It subsequently spreads to the extremities and trunk. We report a 2-month-old male baby who presented with failure to thrive, hypoproteinemia, anemia, and a cutaneous eruption resembling acrodermatitis enteropathica. Oral zinc supplementation resulted in temporary resolution of the dermatitis. A further workup revealed the diagnosis of CF. The rash was responsive to nutritional and pancreatic enzyme supplementation.