bluuebunny/crossref_metadata_2025 huggingface dataset:
Ophthalmology residency trainers‘ perspective on standardization of residency training in India
Authors: Gogate Parikshit Madhav , Biswas Partha , Honavar Santosh G , Sharma Namrata , Sinha Rajesh , Sachdev Mahipal Singh , Verma Lalit , Nayak Barun Kumar , Natarajan Sundaram
Published: March 2021

Purpose:

The aim of this study was to study the perception of residency trainers about an optimum residency program.

Methods:

A survey, using a pre-validated questionnaire, was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2019-20 with questions directed to teachers in medical colleges and national board of examination‘s ophthalmology residency programs on demography, teaching experience, imparting clinical and surgical skills, ideal academic schedule and dissertation in the post-graduate residency program.

Results:

The response rate in the survey was 47.6%. Valid responses were obtained from 309 residency trainers. Of these, 132 of 309 (42.7%) were females. The mean age was 45.3 ± 9.5 years, range 26-68 years. The trainers believed that on a scale of 0-10, clinical skills teaching should be taught, mean ± SD: slit lamp 9.8 ± 0.7; indirect ophthalmoscopy 9.3 ± 1.3; gonioscopy 9.2 ± 1.5; perimetry 8.9 ± 1.5; OCT 8.4 ± 1.9; applanation tonometry 9.5 ± 1.2 and orthoptic evaluation 8.1 (±1.9). A resident should ideally perform independently surgeries (median, inter-quartile range IQR): SICS 50 (IQR 40-100); phaco 50 (20-60); pterygium excision 20 (10-40); DCR 10 (5-20); chalazion 20 (10-50), trabeculectomy 7 (5-15); strabismus 5 (2-10), LASIK and retinal detachment 0. Ideally there should be four lectures, four seminars, four case presentations, five journal clubs and four wet labs every month.

Conclusion:

Teachers expected their wards to become competent professionals. There was near unanimity about the content of clinical skills training, non-medical skills and academics, but there was a significant variation on extent of surgical training that should be imparted to the residents.
Point-of-care rapid antigen testing for COVID-19 at a tertiary eye care facility
Authors: Tripathy Devjyoti , Roy Avik Kumar , Khanna Rohit C , Jalali Subhadra , Panigrahy Bharat , Parija Deepthi Chandran , Rath Suryasnata
Published: March 2021

Purpose:

The aim of this study was to report the use and the impact of a point-of-care rapid antigen test (PoC-RAT) at a tertiary eye care facility in facilitating commencement of elective surgeries, contact tracing of exposed health care professionals (HCPs) and ancillary hospital staff, and implementation of back-to-work (BTW) policy for them.

Methods:

Retrospective analysis of subjects undergoing PoC-RAT for COVID-19 infection at a tertiary level dedicated eye care facility. Decision making with regard to commencement of elective surgeries post COVID-19 related discontinuation of services, contact tracing of HCPs and ancillary hospital staff exposed to known COVID-19 cases and implementation of back-to-work policy for all staff based upon the results of PoC-RAT were studied.

Results:

A total of 311 subjects (224 patients and 87 hospital staff) were tested. Overall positivity rate was around 7%. Asymptomatic patients who were screened preoperatively had a lower positivity rate at around 3% compared to the staff (who were either known contacts or were symptomatic) at around 17%. Contact tracing found three-quarters of the staff at low risk and only one quarter at medium or high risk. Among patients, 97% of those followed up for at least 2 weeks after the test remained healthy. For staff, this was around 65%.

Conclusion:

Based on our preliminary results, we suggest that PoC-RAT may be considered routinely for indication-based preoperative screening of asymptomatic patients, and for on-campus screening, contact tracing and implementation of BTW policies for HCPs and ancillary hospital staff at a tertiary level eye care facility.
Post-lockdown challenges for ophthalmologists during COVID-19 pandemic in India
Authors: Goel Madhav , Goel Sonu , Sachdev Mahipal Singh , Sharma Namrata , Mishra Deepak , Yadav Gautam , Barua Nabanita , Aggarwal Sulakshna
Published: March 2021

Purpose:

The purpose of this study is to evaluate the post-lockdown challenges during Coronavirus disease 2019 (COVID-19) pandemic amongst the ophthalmologists in India.

Methods:

An online survey was sent to the practicing ophthalmologists across India. Data were collected from the responding ophthalmologists and analysed using Medcalc 16.4 software.

Results:

A total of 794 responses were obtained. Most respondents (51%) were in the age group 30–50 years and were in independent practice (40.05%). Almost three-fourth of ophthalmologists resumed their surgical services after a gap of more than a month post-lockdown. Almost a third of the respondents had significant reduction in their surgical workload during this period. Significant fear of contracting COVID-19 infection in the operation theatres was reported while moderate difficulty was found in procuring protective gear during immediate post-national lockdown period.

Conclusion:

The pandemic has changed the ophthalmic practice significantly, with patient and staff safety becoming areas of major concern. Both financial and psychological concerns affecting healthcare workers need addressing for continued patient care.
Morphological features of focal choroidal excavation and its association with macular pathology in Asian Indian eyes
Authors: Priya B V , Gupta Ishank , Poornachandra B , Jayadev Chaitra , Pereira Arpitha , Mohapatra Ayushi , Krishna Santosh G , Yadav Naresh K
Published: March 2021

Purpose:

To study the characteristics of focal choroidal excavation (FCE) in Indian eyes based on spectral-domain optical coherence tomography (SD-OCT) findings and their association with macular pathologies.

Methods:

Retrospective study of 26 patients diagnosed with FCE. All patients‘ clinical and imaging data were reviewed.

Results:

There were eight females and 18 males aged between 24 and 85 years. FCE was noted in 31 eyes of 26 patients – unilateral in 21 and bilateral in 5. The conforming type was noted in 13 and nonconforming in 19 eyes. The location was extrafoveal in 16 and subfoveal in 15 eyes. The morphology was bowl-shaped in 24, cone-shaped in six eyes, and mixed type in one eye. Associated pathologies were central serous chorioretinopathy in nine eyes, choroidal neovascular membrane in seven eyes, Stargardt‘s disease in three eyes, Best disease in four eyes, other retinal dystrophies in two eyes, polypoidal choroidal vasculopathy and moderate non-proliferative diabetic retinopathy, each in one eye. The mean FCE width was 1667.2 ± 817.7 μ, mean depth was 95.7 ± 46.4 μ, and the mean choroidal thickness under the FCE was 234.8 ± 85.9 μ. No abnormal choroidal tissue was found under any FCE.

Conclusion:

FCE is a relatively common entity and frequently associated with macular pathologies. The presence of an FCE did not alter the course or management of these conditions.
Clear cell odontogenic carcinoma of maxilla
Authors: Jannu Anubhav , Rao Gautam , Kulambi Mithun , Talkal Arun Kumar , Suma M. S. , Deepa K. K. , Srinivas Rachana
Published: March 2021

Clear cell odontogenic carcinoma is a rare, infrequent, aggressive in nature, locally reoccurring odontogenic tumor with a tendency of distant metastasis, occurring during to 4th to 6th decades with a mostly female predilection. Histologically, it is characterized by sheets and islands of vacuolated/clear cells. Till date, only 74 cases have been reported in the literature. We present a case of 45-year-old woman with a tumor mass extending from the maxillary right first premolar till the third molar region measuring 4 cm × 4 cm. The diagnosis was given based on the histopathological findings. Being locally aggressive, the reported data and understanding of this infrequent tumor needs to be strengthened by reporting new cases, and it also demands to be distinguished from other primary and metastatic clear cell tumors of the head-and-neck region.
Surgical scar revision using silicone gel sheet as an adjunct
Authors: Mukherjee Tripti , Chopra Sumit , Aggarwal Ankit , Garg Vipul , Dadwal Himani , Sharma Priyanka
Published: March 2021

Introduction:

Scar is often referred to as an unattractive mark after healing of a wound. An undesirable scar may have negative social, emotional, and functional impact on the patient. It is our job as surgeons to adequately understand the expectations of the patient and counsel them for a successful procedure.

Materials and Methods:

Twelve patients were randomly chosen for the study, of which five were males and seven were females. The scar tissue was removed surgically, and silicone gel sheets (SGSs) were applied on the 14th postoperative day, and the dimensions of the new scar was measured periodically up to 12 months.

Results:

The study comprised of 12 patients- 5 males and 7 females. The descriptive statistics were calculated as median and interquartile range and comparison between time intervals was done using Wilcoxon signed rank test. Out of the 12 patients, 10 showing complete resolution of the scar and 2 patients had partial relapse of scar. However, they were satisfied with the final outcome.

Conclusion:

Our study found that SGSs applied to surgically revised scars significantly improves their appearance. The ease of use of the SGSs also makes it patient friendly. We observed almost complete resolution of the scar in ten patients and two patients exhibited partial relapse of the scar. However, there was a significant improvement in the overall appearance of the scar, and the patients were satisfied with the results of the procedure.
Surgical outcomes in oral cancer involving the central arch of the mandible in elderly patients
Authors: Rajan Shiv , Prakash Puneet , Akhtar Naseem , Kumar Vijay , Gupta Sameer , Chaturvedi Arun , Mahajan Dhruv , Srivastava Resham , Qayoom Sumaira , Chakrabarti Deep , Parveen Shirin
Published: March 2021

Backgrounds:

Oral squamous cell cancer (SCC) is one of the most common cancers. The most common age of presentation is fifth to sixth decade. Management of this disease is dictated by stage, age, and related comorbidities. Elderly patients have their own set of limitations as far as their management is concerned. Carcinoma involving central mandibular arch is a challenging disease for surgeons, especially in the elderly. This article describes our experience with the surgical treatment of oral cancer involving the central arch of the mandible in elderly patients.

Methods:

Forty elderly (≥60 years) patients with histologically proven SCC of the oral cavity in which disease was involving the central arch of the mandible, were included in our study. Demographic, clinical, and treatment-related factors were recorded. The outcome was assessed in terms of postoperative complications, recurrence, and patient survival.

Results:

The median age of the patients was 63 years. The male:female ratio was 7:3. A history of oral tobacco use was present in 95% of patients. The most common site of disease was lower alveolus (80%) followed by carcinoma of the lower lip (20%). Majority of our patients (77.3% [30]) were having Stage IV disease. Mandibulectomy was either segmental (62.5%) or marginal (37.5%). Bilateral neck dissection (37/40, 92.5%) was done in most patients. Among all patients, 62.5% (25) received adjuvant radiotherapy. The local recurrence rate after a median follow-up of 30 months was 15% (6). Two-year disease-free survival and overall survival were 89% and 90%, respectively.

Conclusion:

Central arch of the mandible is a difficult disease to treat. It needs a complex and lengthy reconstructive procedure. Comorbidities such as extreme age, diabetes, and pulmonary and cardiac illnesses make it more challenging to manage. With the proper evaluation of comorbidities and avoiding long, cumbersome procedures, we can provide patients a fairly good chance of survival.
Histological changes at the commissure of the lip on approaching from its cutaneous to the mucosa region in males
Authors: Saxena Swati , Pankaj Arvind Kumar , Panwar Sachin , Rani Anita , Chopra Jyoti , Rani Archana
Published: March 2021

Introduction:

The morphology of the epithelium of the oral lips comprised keratinized external epithelium (anteriorly) and nonkeratinized or sometimes parakeratinized mucous membrane epithelium (posteriorly). Knowledge of morphometry of the lip lining helps in deciding the best site for choosing graft for its better uptake during several dermal grafting procedures following trauma or tumor excision following craniofacial cancers or cosmetic procedures.

Materials and Methods:

Ten human male cadavers were procured at the Department of Anatomy King George's Medical University, Lucknow, Uttar Pradesh. The rectangle-shaped skin specimen through the right commissure of the lip which included the skin, mucocutaneous junction, and mucosa was stained with hematoxylin and eosin stain. A total of 30 slides were prepared. Thus, the readings were obtained for three regions, respectively, with the help of CAT-CAM E-series HD cameras which were installed in a light microscope.

Results:

Thickness of skin (epidermis + dermis) of the lip ranged from 756 μm to 1068 μm among males. Epidermal thickness increases on moving from the cutaneous region to the mucosa region of the lip. The lowest contribution of the stratum corneum in thickness of the epidermis was observed in the vermillion region, while the highest contribution was observed in the skin region. It was found to be absent in the mucosa region of the lip. Rete pegs at the dermoepidermal junction was found to be maximum in the vermillion region and minimum in the skin region. Its depth increased as we move from the skin to the mucosa region of the lip. Depth of the dermis was found to be maximum in the skin region, while minimum in the vermillion region. It ranged between 291 μm and 693 μm.

Conclusion:

Care should be taken while using dermal fillers in lip augmentation surgeries, especially in the vermillion region due to its close proximity to musculature in the core of the lip.
Autotransplantation of a mature mandibular third molar as alternative to dental implant placement
Authors: Tagliatesta Luigi , Guerri Federico , Moscone Simone , Jones Jason Motta
Published: March 2021

Dental autotransplantation is defined as the movement of one tooth from one position to another, within the same patient. Autotransplantation has predictable results; in fact, many studies describe a success rate of over 90%. This article describes a case report concerning the surgical management of this surgical technique. An 18-year-old patient comes for the treatment of her left first mandibular molar (3.6) involved in decay process. An accurate radiological analysis (periapical X-ray and orthopantomographic evaluation) showed an immature left mandibular third molar (3.8), suitable as donor tooth. The mandibular first molar was extracted in an atraumatic way. The intra-alveolar septum was modified with a piezoelectric device. The tooth was slightly depressed in the socket and remained in infra-occlusion. It was stabilized by sutures and a metallic splint. Then, the autotransplanted molar was fixed with a double splinting for 4 weeks. In conclusion, the autotransplantation was followed by endodontic treatment. After 36 months of follow-up, wisdom tooth showed an improvement in clinical features in agreement with radiological examination. The success of this case can be attributed to the atraumatic surgical technique and the immature stage of the transplanted element.
Habit-associated salivary pH changes in oral submucous fibrosis
Authors: Sahu Rohit Kumar , Patro Sangram , Nayak Bikash , Bardhan Debajyoti , Panda Swagat , Rajguru Jagdish Prasad
Published: March 2021

Background:

Salivary pH plays a significant role in the pathogenesis of various oral diseases and conditions. Chewing of areca nut and various tobacco products changes salivary pH.

Aim:

The aim of the study was to measure the effect of habitual chewing of areca nut and various tobacco products on salivary pH.

Materials and Methods:

The present study included 360 individuals (chewers and nonchewers) of age group between 20 and 30 years who visited the Outpatient Department of Hi-Tech Dental College and Hospital. The patient's salivary pH was measured with the help of a digital pH meter before and after chewing areca nut and various tobacco products.

Results:

It was observed that, in all the groups of chewers, pH decreased after chewing except in the gutkha and lime chewing group, where pH increased (pH before chewing was 7.43 ± 0.41 and after chewing was 7.51 ± 0.399), the difference was strongly significant (P < 0.001). pH was found to be less in lime and tobacco chewers (6.83 ± 0.33) and more in tobacco, betel nut, and lime chewers (7.50 ± 0.41) in comparison to other groups before chewing; the difference was strongly significant (P < 0.001). In the mean ± standard deviation, increase in pH was found among chewers (7.32 ± 0.49) as compared to nonchewers (6.99 ± 0.14), which is the control group, and the data were statically significant (P < 0.001).

Conclusion:

pH is altered in areca nut and various tobacco chewers, rendering the oral mucosa vulnerable to the toxic effects of areca nut and various tobacco products.
An extremely rare pseudoaneurysm of posterior superior alveolar artery arising after orthognathic surgery
Authors: Kumar K. P. Manoj , Mullath Aswin , Vijayakumar Depesh , Vinod Aswathi
Published: March 2021

Le Fort 1 osteotomy is one of the most versatile techniques in orthognathic surgery employed for the correction of dentofacial deformities and is considered technically safe. Pseudoaneurysms (PAs) which can cause life-threatening hemorrhage are rare after corrective jaw surgery. Here, we describe a clinical case of delayed postoperative epistaxis secondary to an extremely rare PA of the posterior superior alveolar artery followed by Le Fort 1 osteotomy subsequently managed with endovascular selective embolization.
Evaluation of stability and esthetic outcome following rigid fixation of a new sagittal genioplasty technique – A clinical study
Authors: Ekram Subia , Arunkumar K. V. , Mowar Apoorva , Khera Amit
Published: March 2021

Background:

Routine and popular conventional genioplasty procedure is often curvilinear, requires lower border extension below, and behind the mental foramen, which after advancement has a tendency to produce step deformity, butt contact, hence nonunion, instability, and increased relapse tendencies. The present technique is aimed to study the new sagittal genioplasty technique and its efficacy to overcome the above-mentioned drawbacks of conventional genioplasty. This technique also aids in correcting mild-to-moderate breathing irregularities.

Materials and Methods:

A total of 10 patients included in this study. The comparative analysis of the displacement of the chin in vertical and horizontal directions following surgery was evaluated by measuring the difference between preoperative, immediate postoperative, 3 and 6 months postoperative on lateral cephalometric radiographs.

Results:

The study of new sagittal chin advancement results showed an advantage over conventional technique in terms of esthetics outcome (no jowl), easy to perform without damaging the mental nerve, superior healing with less relapse, and better surface area contact.

Conclusion:

In this study, the new technique of sagittal genioplasty overcomes the disadvantages of conventional genioplasty. However, this technique is best suited for patients who require straight or moderately vertical augmentation advancement genioplasty and is not suitable for asymmetry corrections, i.e., centering genioplasty and double sliding genioplasty.
Awareness among anesthesia residents pertaining to various intubation techniques in craniofacial surgery
Authors: Tuli Malti , Orvakonde Shreyas , Shrinivas T R , Manchikalapudi Jyothsna , Rathod Dhananjay , Patel Jignaben
Published: March 2021

Aim:

This study was intended to evaluate the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery.

Materials and Methods:

A cross-sectional survey research design was employed in this study. A self-administered questionnaire survey was used to validate the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery. In this regard, a preliminary study with a convenience sample of 156 anesthesia residents studying in various medical institutions across South India was conducted so as to assess the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery. This study, while limited in sample size, benefits the craniofacial surgeons and anesthetists as target readers to assess the knowledge and clinical skill of anesthesia residents pertaining to various intubation techniques employed in craniofacial surgery

Results:

The results of this study reveal that majority of the anesthesia residents encountered craniofacial surgery during their residency period. However, only 19.87% have performed various intubation techniques that are employed in craniofacial surgery. Nearly 38.46% of the participants felt that blind awake intubation is the most difficult intubation technique to employ in the head-and-neck region and requires expertise. Nearly 78.84% of the participants felt that special training is required for handling craniofacial surgical cases under general anesthesia.

Conclusion:

The results of this study reveal that there is a dearth of knowledge and clinical exposure among anesthesia residents regarding various intubation techniques employed in craniofacial surgery. Educational and quality improvement initiatives in various intubation techniques could enhance anesthesia residents' knowledge and clinical exposure in managing various craniofacial surgical cases.
Augmentation of the Calf Region with Autologous Fat and Platelet-Rich Plasma-Enhanced Fat Transplants
Authors: Bilkay Ufuk , Bicer Ahmet , Özek Zeyyat Cüneyt , Gurler Tahir
Published: March 2021

Background:

Contour and volume deficiencies in the calf region, either unilateral or bilateral, may raise an esthetic concern in affected individuals. There are numerous methods described for volume augmentation or contour reshaping in this region including implant placement, autogenous tissue transfer, liposuction, and/or fat injections. The authors present their series of patients to whom they performed fat injections with or without platelet-rich plasma (PRP) enrichment for addressing this problem.

Methods:

Fifty-two patients who had undergone calf lipostructuring procedure(s) in our clinic were included in this retrospective study. The procedure was repeated with a fixed value of fat volume per leg until a satisfactory limit for both the patient and the senior author could be achieved. Regarding the analysis of outcome, the number of sessions needed to be repeated was recorded for each patient.

Results:

125 cc of fat was injected per session per leg. Ten patients were treated with PRP enriched fat transplants while 42 were treated with fat only. The mean number of sessions was 2.76 (min. 2, max. 6). For the group treated with PRP-enriched fat grafts a mean 2.00 number of sessions had to be carried out while the mean was 2.95 for the patients in the fat-only group. The mean number of sessions to achieve our goal was significantly lower in the PRP-enriched fat injected group (P < 0.001).

Conclusion:

Addition of PRP significantly reduces the need of repeated operations to achieve the best possible outcome in lipostructuring around the calf region.

Level of Evidence:

Retrospective comparative study, level III.
Complicated Patients with Cleft Lip and Palate
Authors: Demiröz Anil , Celik Ugur , Yalcin Can Ege , Aydin Yagmur
Published: March 2021

Background:

Cleft lip and palate is one of the most commonly seen congenital deformities. The aim of treatment should be providing normal speech, normal nutrition, normal appearance, and adaptation of the child in society. Thus, the importance of multidisciplinary approach in this patient group is high. In this study, we aim to present the patient results obtained from cleft lip and palate meeting records, with the attendance of plastic surgeon, ear, nose, throat surgeon, orthodontist, speech therapist, pedodontist, nutrition nurse and pediatrician, and genetics specialist when needed.

Materials and Methods:

Patient records of cleft lip and palate meeting held between September 1998 and September 2018 were evaluated retrospectively. The patients regarded as complex cases were examined in these meetings.

Results:

Seven hundred and five patients were regarded as complex cases to be examined at the cleft lip and palate meetings in this 20-year period. One hundred and five of these patients (15%) had the history of being inbred. Ninety-eight patients (14%) had additional anomaly of other systems. Thirty-six patients (5%) suffered from the cleft of lip and primary palate only. Cleft palate patient numbers for Veau Class 1, 2, 3, and 4 was 12 (2%), 99 (14%), 297 (42%), and 246 (35%), respectively.

Conclusions:

Creating multidisciplinary teams consisted of specialists from various fields is an accepted method for handling of this patient group. These multidisciplinary teams not only provide the patients to have care by professionals from different specialties at once but also have the benefits of data unification.
To Study the Effect of Activated Platelet-Rich Plasma in Cases of Androgenetic Alopecia
Authors: Kumar Vijay , Sharma Navneet , Mishra Brijesh , Upadhyaya Divya , Singh Arun Kumar
Published: March 2021

Context:

Growth factors released from platelets act on stem cells in the bulge region of follicles and thus stimulate the development of new hair follicles.

Aims:

Primary aim of the study was to assess the efficacy and safety of activated platelet rich plasma in AGA.

Settings and Design:

Prospective double arm non-randomized pre-post study.

Material and Methods:

Activated Platelet-rich plasma was injected in either anterior half of alopecia scalp in first 20 patients and posterior half in next 20 patients (Group I) and the other half was injected with placebo (Group II). Each patient received a total of 5 session of aPRP, 15 days apart.

Statistical analysis used:

Quantitative variables were compared using student T test and Mann-Whitney Test between two groups. A p value of < 0.05 was considered statistically significant.

Results:

40 male patients with a clinical diagnosis of AGA (stage II to VI) were recruited but only 35 patients completed the whole study. At 1 month and 3 months follow-up, Group I showed statistically significant increase in hair count, hair density and anagen/telogen ratio as compared to Group II.

Conclusion:

aPRP is a safe and good alternative to medical treatment. It seems to have a stabilizing effect on hair fall and may be considered as a measure to prevent progression of alopecia in early stages.
A Novel Technique for Trochanteric Region Soft-Tissue Reconstruction
Authors: Bas Soysal , Durgun Mustafa
Published: March 2021

Aims:

Due to the complex anatomical structure of the trochanteric region, the options for reconstruction are relatively limited. This study aims to present a unique reconstruction of trochanter defects using a coxal region perforator flap and geometric planning to standardize the flaps.

Subjects and Methods:

Twelve patients with trochanteric defects that had been repaired with coxal region perforator flap following tumor excision between June 2016 and January 2019 were included in this study. The patients were aged between 20 and 68 years. Patients were evaluated with regard to age, gender, etiology, defect side and size, flap size, number of perforators, and complications.

Results:

Two patients were operated on for squamous cell carcinoma, one for Marjolin's ulcer, two for malignant melanoma, two for malignant fibrous histiocytoma, and five for dermatofibrosarcoma. Defect sizes ranged between 8 cm × 7 cm and 12 × 10 cm. The smallest flap size was 13 cm × 7 cm and the largest flap size was 21 cm × 10 cm. Nine flaps were raised from the single perforator, and three flaps were raised from two perforators. Venous congestion was seen in one patient postoperatively. There was no flap loss, infection, hematoma, suture detachment, and limitation of hip and knee movements in the patients.

Conclusions:

The pedicled perforator flaps are elevated over the major perforators located close to the defect in many parts of the body. Thus, low surgical morbidity is achieved, and surgery time is decreased. Furthermore, as in this study, preserving the muscles and preventing the functional deficits in the movement hip joint the body's major joint of the body, reveal the importance of using coxal region perforator flaps for reconstruction in ambulatory patients.
Double Keystone Flap for Large Lower Thigh Defect
Authors: More Amrita , Dharini Dharini , Sivakumar Anoop
Published: March 2021

Large lower thigh defects are a reconstructive challenge. Keystone design perforator island flap in the lower thigh is not routinely performed as the skin here is less extensible. We present a case of a large anterolateral lower thigh defect wherein we used double keystone flaps from the remaining circumference of the thigh and grafted the donor site in the posterior thigh. Circumferential incision/scarring in the limbs risk damage of superficial lymphatico-venous circulation and distal edema. However, our case demonstrates an uneventful recovery and excellent aesthetic and functional outcome.
Eigenfunctions and the integrated density of states on Archimedean tilings
Authors: Peyerimhoff Norbert , Täufer Matthias
Published: March 2021

We study existence and absence of

\ell^2

-eigenfunctions of the combinatorial Laplacian on the 11 Archimedean tilings of the Euclidean plane by regular convex polygons. We show that exactly two of these tilings (namely the

(3.6)^2

“kagome” tiling and the

(3.12^2)

tiling) have

\ell^2

-eigenfunctions. These eigenfunctions are infinitely degenerate and are constituted of explicitly described eigenfunctions which are supported on a finite number of vertices of the underlying graph (namely the hexagons and 12-gons in the tilings, respectively). Furthermore, we provide an explicit expression for the Integrated Density of States (IDS) of the Laplacian on Archimedean tilings in terms of eigenvalues of Floquet matrices and deduce integral formulas for the IDS of the Laplacian on the

(4^4)

,

(3^6)

,

(6^3)

,

(3.6)^2

, and

(3.12^2)

tilings. Our method of proof can be applied to other

\mathbb Z^d

-periodic graphs as well.
Embedding Deligne's category $\mathrm{\underline{Re}p}(S_t)$ in the Heisenberg category (with an appendix by Samuel Nyobe Likeng, Alistair Savage and Christopher Ryba)
Authors: Nybobe Likeng Samuel , Savage Alistair
Published: March 2021

We define a faithful linear monoidal functor from the partition category, and hence from Deligne’s category

\mathrm{\underline{Re}p}(S_t)

, to the additive Karoubi envelope of the Heisenberg category. We show that the induced map on Grothendieck rings is injective and corresponds to the Kronecker coproduct on symmetric functions.
Co-infection of a mosquito borne arbovirus and parasite in dogs in Kaduna and Zaria metropolis, Kaduna state, Nigeria: A Case Report
Authors: Oluyinka Fasanya , Kabir O. A. , Natala A. J.
Published: March 2021

During a survey in Kaduna and Zaria metropolis for West Nile virus and Dirofilaria in dogs, a single case of co-infection of the two organisms was observed in a dog. These organisms are both mosquito borne and are of great zoonotic importance.Running title: Co-infection of West Nile virus and Dirofilaria in dogs.

Keywords: West Nile virus, dogs, Dirofilaria, co-infection
Effect of site sanitation on the safety performance of workers on construction sites in Minna, Nigeria
Authors: Shittua Abdullateef Adewale , Ahmadb Hawwa Ibrahim , Isahc Alhassan Mohammed , Mohammedd Mohammed Ndagi
Published: March 2021

Studies have shown that site sanitation practices are capable of improving the health and safety (H&S) performance of construction companies. In spite of this, evidence has shown that the level of compliance to these practices by construction firms is still poor. This study evaluated the effect of site sanitation on the safety performance of workers on construction sites. Data were obtained through a well-structured questionnaire. Analysis of data was done using Relative Importance Index (RII), Mean Item Score (MIS) and Spearman’s Rank Correlation. It was found that provision of first aid facilities is the measure most complied with on sites (RII = 0.96); relationship between level of compliance to good sanitation measures and accident rate is not significant; and provision of Personal Protective Equipment is the most effective strategy for minimising rate of accidents (MIS = 4.95). It was concluded that the effect of site sanitation on safety performance of workers on construction sites in Minna is not significant. It was thus recommended that construction firms should always comply with the measures for enhancing good sanitation on sites, especially “Provision of drinking water”, in order to improve safety performance on site.

Key words: Construction, Safety, Sanitation, Performance, Workers.
Principles and Best Practices of Designing Digital Game-Based Learning Environments
Authors: Kucher Tetyana
Published: March 2021

Playing games holds an important role in learning and development. While designing and using digital game-based learning (DGML) environments becomes more appealing to educators, there is a disconnect between the goals that educators try to achieve and the design strategies they utilize to achieve their goals. The inclusion of game elements alone is insufficient to improve students’ learning, and it does not solve educational problems that DGBL environments are aimed to solve. The current state of research on the design of DGBL environments calls for an updated review of the best practices in recent years for developing DGBL environments, which prompted this literature review. It draws from successful examples of educators implementing learning games in classes, and it highlights five key principles that facilitate the effectiveness of DGBL: (1) interactivity, (2) immersiveness, (3) adaptive problem solving, (4) feedback, and (5) freedom of exploration. Practical examples are used to illustrate the effective implementation of these principles in DGBL environments and to underscore the significance of each component.
Understanding Children’s Problem-solving Strategies in Solving Game-based Logic Problems
Authors: Akcaoglu Mete , Jensen Lucas J. , Gonzalez Daisy
Published: March 2021

Problem solving is an essential skill for students to be successful in life and careers. Students need to use efficient strategies to solve problems effectively. In this basic interpretive qualitative study, we aimed to (a) explore children’s problem-solving strategies in a game-based tool (i.e., puzzles), and (b) investigate the troubleshooting strategies they employed while solving the puzzles. We recorded students’ puzzle-solving efforts, and using an observation analysis approach, noted important moments, patterns in puzzle-solving, troubleshooting methods, and other noteworthy events. Our analysis showed that while solving computer-based puzzles, students demonstrated the use of three approaches: varying-one-thing-at-a-time (VOTAT), building all-at-once or change-all (CA), and a mixed approach. CA was the approach used most often, followed by VOTAT, and then the mixed approach. Of the two troubleshooting approaches, starting the sequence over was the preferred method. Others opted to search for the faulty tile in the sequence. We discuss how these findings can inform practice and provide some insights as to the usefulness of the game-based tool, Lightbot.
Innovations in Research with Medically Fragile Populations: Using Bulletin Board Focus Groups
Authors: Cook Karen , Jack Susan , Siden Hal , Thabane Lehana , Browne Gina
Published: March 2021

A new group of medically fragile young adults are graduating from pediatric palliative care programs with limited expectations to live beyond early adulthood, and no comparable adult services to support their complex needs. Accessing this population is difficult because of the complexity of their conditions, the extensive personal and equipment supports that limit feasibility for travel, and divergent communication abilities. Therefore, we undertook a descriptive case study using an asynchronous modification of an online focus group, a bulletin board focus group (BBFG). The greatest strengths of the BBFG are the appeal of this methodology for young adults and the multi day focus group becomes both a community and an intervention. An important limitation of this method was participant follow through on discussion threads. This BBFG provided rich and varied types of data, and very positive participant experiences.
Positionality: Reflecting on the Research Process
Authors: Bourke Brian
Published: March 2021

Through this article, the author provides a reflection on the role of positionality in research, following the completion of a qualitative research project. Through the research project, the White researcher sought to explore the ways in which students of color experience a predominantly White university. Drawing on literature and findings from the research project, the author highlights potential challenges and opportunities of being cognizant of one’s positionality. These reflections illustrate the significance of positionality and serve as a reminder of its potential effects on the research process, as well as on participants and the researcher. The manuscript concludes with recommendations for researchers to carefully consider the potential influence of their positionality in any research setting.
Expanding the Possibilities of Qualitative Inquiry: A Review of Critical Autoethnograpy: Intersecting Cultural Identities in Everyday Life
Authors: Rennels Tasha
Published: March 2021

Critical Autoethnography: Intersecting Cultural Identities in Everyday Life is a groundbreaking collection in which Boylorn and Orbe expand the possibilities of qualitative inquiry by including 13 page-turning chapters that merge autoethnography with critical theory to situate lived experiences within larger systems of power. Throughout this review, I provide a brief overview of the collection, describe the strengths in terms of writing and organization, as well as critique the pragmatic potential. I conclude by describing how and why this collection is a valuable resource for those who practice qualitative methodology for the sake of social change.
"I Heard He Got the Package": African American Men's Experiences of Living with HIV/AIDS
Authors: Baumgartner Lisa
Published: March 2021

The purpose of this study was to investigate the experiences of African American men living with HIV/AIDS. The questions guiding the study were: (a) How do African American men incorporate HIV/AIDS into their identities? and (b) How do contexts affect the incorporation process? Data from this study was taken from a larger study concerning HIV/AIDS identity incorporation. Twelve self-identified African American men living with HIV/AIDS participated in 1.5-2 hour in-depth interviews. Participants traversed through a four or five step incorporation process. In addition, a disclosure process occurred. The contexts that influenced the incorporation process included the interpersonal context (e.g., support and stigma), sociocultural context, (e.g., race, class, sexual orientation), the temporal context (historical time), and situational context (e.g., a personal history of chemical dependency) (Ickovics, Thayaparan, & Ethier, 2001). These contexts intersected and affected participants’ integration of the HIV/AIDS identity into the self. Study findings have implications for HIV/AIDS educators and health professionals.
"I'd Rather Dance Outside": A Phenomenological Examination of Youth Experiences in Outdoor, Noncompetitive Physical Activity
Authors: Christiana Richard , Davis Marsha , Freeman Melissa
Published: March 2021

Research has shown that youth with low levels of fitness or little interest in organized sports and traditional physical education are more likely to participate in noncompetitive outdoor physical activity. However, little is known about what influences youths’ decisions to participate in these activities. This study examined rural young adolescents’ experiences of participating in noncompetitive outdoor physical activity. In depth qualitative interviews were conducted with young adolescents aged 11-13 years (N = 24) from one rural middle school to elicit detailed descriptions of experiences of participation in outdoor physical activities. Interview transcripts were analyzed inductively and emergent themes related to young adolescents’ participation in outdoor, noncompetitive physical activity were identified. Twelve themes were categorized as either respondents’ relationship with the outdoors, activity preferences, and external conditions that determine participation. The results of the study indicate the presence of a complex dynamic relationship of social and physical environmental factors influencing young adolescents’ participation in outdoor activities. These include parental and peer influence, personal choice and enjoyment, spending time outdoors, appreciation for nature, availability of equipment, and previous experiences of participation. More research is needed to corroborate the results of the study and to better understand youths’ preferences for noncompetitive versus competitive physical activity.
Use of Semi-Structured Interviews to Explore Competing Demands in a Prostate Cancer Prevention Intervention Clinical Trial (PCPICT)
Authors: Crocker Theresa , Besterman-Dahan Karen , Himmelgreen David , Castañeda Heide , Gwede Clement , Kumar Nagi
Published: March 2021

In this paper we report on findings from the first known study using qualitative methods to explore factors influencing physicians’ participation in an ongoing federally-funded prostate cancer chemoprevention clinical trial. We sought to identify ways to improve collaboration between researchers and physicians and enhance the success of future projects and employed purposive sampling to recruit physician/investigators who were involved or invited to participate in the trial. Using the data from open-ended semi-structured interviews, we examined patterns in their languaging and created themes. We found that individual and structural factors served as barriers and facilitators to participation. Willingness and desire to participate in the trial (individual factors) were not always enough to result in actual participation due to practice environment (structural) constraints. Our research provides a better understanding of the complex intersection of factors in this setting and through our findings we extend the theory of competing demands into the arena of prostate cancer prevention clinical trials, moving the science towards solutions to current challenges in recruitment to this type of trial.
The Lived Experience of Honduran and USA Nursing Students Working Together in a Study Abroad Program
Authors: Sealey Lorinda , Hathorn Donna
Published: March 2021

Nursing study abroad is one approach to preparing student nurses to work more effectively in international environments as well as at home with culturally diverse clients. These programs foster self-reflection by permitting students to spend considerable time immersed in different cultures, thus exposing them to clients with different health beliefs and values. The authors of this transformational phenomenological study examined the lived experience of American and Honduran nursing students working collaboratively during a nursing study abroad program. One-time audio-recorded semi structured interviews were conducted to gather data from American and Honduran students. Six themes emerged: Communication (i.e., language and communication patterns), the cultural environment, and sharing/learning were common themes to both groups; among Hondurans, validation/empowerment and the nursing experience emerged as important themes, while transformation was the theme unique to American students. These findings support previous research regarding the importance of study abroad programs in the development of cultural competence, and suggest directions for nurse educators to prepare nurses who can function in an increasingly globalized health care environment. These findings also highlight the merits of this collaborative approach to nursing study abroad and they provide the foreign hosts’ unique perspective regarding their experiences working with American nursing students. The study results also indicate the need for further research on collaborative experiences with foreign and American health care partners and the perspective of the participants of other countries.
Exercising Autonomous Learning Approaches through Interactive Notebooks: A Qualitative Case Study
Authors: Jaladanki Vani , Bhattacharyya Kakali
Published: March 2021

Grounded in the theoretical framework of interpretivism, the purpose of this qualitative case study was to explore the experiences of a teacher from an inner city high school in South Texas when using interactive notebooks to inform students’ understanding of physics concepts. The participant for the study was purposefully selected with an intention to gain an in-depth understanding of the experiences. Data collection incorporated multiple methods such as interviews, participant observations, and document analysis. Descriptive, In-vivo, process, and Labovian six-part model of narrative coding were used to reduce and manage data. The codes were grouped into eight categories. Two major themes were identified from the data analysis: Interactive Notebook - A Testimony of Constructive Learning and Interactive Notebook- A Pioneering Approach to Instruction. The findings of this study intersect science education and qualitative inquiry and create space for openended, autonomous, constructivist learning of scientific principles. Additionally, the findings raise implications for transferable aspects of individualized learning processes for any areas of education where concepts are challenging for students to grasp.
The Institutional Review Board (IRB) and Faculty: Does the IRB Challenge Faculty Professionalism in the Social Sciences?
Authors: Musoba Glenda , Jacob Stacy , Robinson Leslie
Published: March 2021

Institutional Review Boards (IRB) were instituted to protect the rights of research participants and due to past (and at times egregious) practices committed in the name of research. We question whether the IRB is currently overstepping its bounds into the domain of the researcher. We illustrate possible ways in which the IRB subtlety and not so subtlety challenge faculty professionalism and limit faculty research independence, highlighting some instances in which qualitative research topics bump up against boards that mistrust or misunderstand the nature of qualitative research. Using case study vignettes from five universities, our concerns focused on mission creep and potentially legitimating censorship. Areas of mission creep can include institutional reputation, methodological design, and chilling/legal language verses accessible language. In addition we consider multisite studies and when committees focus too much on form rather than content.