bluuebunny/crossref_metadata_2025 huggingface dataset:
An Update of Third Place Theory
Authors: Vaux Dana E. , Langlais Michael R.
Published: September 2021

Responding to a perceived decline in social capital in America, sociologists Oldenburg and Brissett offer the third place as a solution. While traditionally defined as social gathering places in the physical environment, recent studies have demonstrated that virtual environments may also serve as third places. This study analyzes the social media website Facebook to identify current socializing patterns. The goals of the present study are twofold: 1) to examine the characteristics of third places in virtual contexts as evidenced in existing literature and 2) to identify new third place characteristics that illustrate the evolution of third place characteristics using Facebook as a model. Findings provide support for updating third place characteristics in order to encompass both virtual and physical environments. Results reinforce the idea that present-day socializing trends better represent a different paradigm than existing theories and provide definitions for new evolving third place characteristics.
An Exploration of Antecedents of Initial Trust in M-Payments
Authors: Bulsara Hemantkumar P. , Pandya Esha A.
Published: September 2021

This study aims to investigate factors influencing the formation of consumers' initial trust in m-payments in a developing country such as India. Despite being considered a significant pre-adoption factor, initial trust in m-payments has remained underexplored. To fulfill this research gap, a cross-sectional survey of 1,087 respondents has been conducted, and the analysis has been done using factor analysis and structural equation modeling. Results indicate that consumers' awareness about m-payments and perceived integrity of mobile service providers positively influence initial trust, whereas perceived risks have a significant negative influence, and perceived opportunism of service provider has a marginally significant influence on the formation of initial trust. The findings will be helpful to the m-payment vendors, mobile network operators, and technology providers to enhance trust-building mechanisms in mobile payment systems that can have a positive impact on the adoption and usage of m-payments.
Sustainable Remediation of Soils Contaminated with Petroleum Products
Authors: Albu Madalina
Published: September 2021

In nature, it acts, simultaneously or successively, synergistically or antagonistically, on small or larger spaces, for a long or very short time, numerous natural or artificial processes that pollute, leading to the alteration of the quality of the environment. The basic activity carried out within the oil scaffolding consists in the extraction of crude oil and gases from the deposits in their exploitation, their collection, separation of phases (crude oil, reservoir water, gas), crude oil treatment, storage and sending to users. Contamination of the field related to drilling-extraction wells with crude oil, heavy petroleum products, salt water, various chemicals, etc. has a random character, but with undesirable implications on soil, surface water and / or groundwater, depending on the nature of the pollutant, its quantity and area of spread Pollution sources in the oil industry, both systematic and accidental, have a greater or lesser spread, depending on the size of the field, the type and composition of the extracted fluids, the extraction technology used, the age of oil exploitation in the area, relief and hydrographic network. Having available the data provided by the pollution diagnosis, it is possible to assess the risk that the investigated pollution represents for the people on the site and for the natural environment. If it turns out that the risk is significant, then the decision is made to switch to depollution works. The choice of an appropriate depollution path is made on the basis of relevant technical and economic criteria, which is a feasibility study. The proposed depollution technology must be the most appropriate for the case at hand and, at the same time, be available on the technology market. The most important part of the paper is dedicated to presenting the results of an experimental study on the depollution of soils contaminated with liquid petroleum products by sparging technologies, in order to ensure a sustainable remedy. The results of the soil analysis used in the experimental determination are presented, as well as the physic - chemical characteristics of the main soil pollutants. In the experimental part, laboratory decontamination of systems consisting of polluted soils was performed at the laboratory level, using air as a depollution agent. The processing of the data obtained from the experimental determinations allowed obtaining qualitative and quantitative information related to the decontamination speed depending on the nature of the soil, the nature and concentration of the pollutant and the temperature of the decontamination air. Estimating the cost places this technology at a low level compared to thermal technologies and slightly higher than microbiological technologies.
The Role of Innovative Projects for Sustainable Development of Enterprises
Authors: Militaru Andreea Maria G. , Fleacă Bogdan , Simion Cristina , Popescu Mirona
Published: September 2021

Today, sustainability is identified more than just an environmental issue, being part of the enterprise strategies for a connected and efficient structure. More and more enterprises become aware of the challenges of sustainability in society. The purpose of this paper is to determine and discuss the role of projects for the sustainable development of enterprises by researching the existing literature. This paper focuses on what means sustainable development within the enterprises, the main characteristics and examples of innovative projects leading towards sustainable development inside/outside the enterprise.
Researches about the Dynamic Behavior of Green Composites Reinforced with Rush and Bulrush
Authors: Rădoi Alexandru Ioan , Miriţoiu Cosmin Mihai , Bogdan Mihaela , Stănescu Marius Marinel , Bolcu Dumitru , Geonea Ionuţ Daniel
Published: September 2021

The paper presents some researches about the dynamic mechanical properties for some green composites made as follows: the reinforcement is made from rush and bulrush and the matrix is from epoxy resin Resoltech 1050 with its hardener Resoltech 1055. The dynamic parameters were determined from the bars free vibrations. In the first part of the paper, there are presented the mathematical calculus formulas used for the dynamic parameters determination based on the experimental recordings for the free vibrations. The next experimental montage was used: the bars were clamped at one end and were left free at the other end. At the free end, a Bruel&Kjaer accelerometer with 0.04 pC/ms-2 sensitivity was placed in order to record the beams dynamic response. A force was applied at the free end to bend the beams and after bending, the force was cancelled and the beams were left to freely vibrate. The accelerometer was connected to a signal conditioner Nexus and the signal conditioner was connected to a data acquisition system SPIDER 8 made by Hottinger Baldwin Messtec. The acquisition system was connected to a notebook ant the experimental parameters were obtained through CATMAN EASY software. From the free vibrations recording, the following mechanical parameters were determined: the eigenfrequency of the first eigenmode and the damping factors per unit mass. With these values, we have determined some direct calculus formulas for the damping factor per unit mass.
Effect of Aqueous Milling on the Total Carbon Content of Hard Metal Powders
Authors: Chicinaş Horea Florin , Jucan Darius Ovidiu , Contiu Glad , Popa Cătălin
Published: September 2021

Materials consisting of a hard phase, usually WC, and a tough binder, traditionally Co, form the most successful class of composite materials, also known as Hard Metals (HM) or Cemented Carbides. Powder metallurgy routes are employed generally for the production of such [1]. The typical processing route of such materials involves mixing the components, kneading and consolidation. Alcohols, alkanes and alkenes are commonly used to limit any excessive heating and oxidation of powders during mixing the components. In this study, we report the results of milling in a more environmentally friendly aqueous milling media. The obtained results are presented comparatively with milling under a traditional media, such as isohexane and acetone. The characterization of the milled samples has been done from the structural, compositional and morphological point of view. Considering our previous results, an important aspect of the milled powder is the carbon content, which dictates the sintering behavior of such parts. The carbon balance investigation performed on a carbon analyzer has revealed no significant differences upon changing the milling media. This work emphasizes the influence of the milling media on the HM powder. HM powders with similar properties have been obtained both by traditional and aqueous milling. The comparative study has revealed that the substitution of the traditional milling media does not influence the carbon content in the HM powder.
About the Mechanical Properties for Composites Reinforced with Felt
Authors: Rădoi Alexandru Ioan , Miriţoiu Cosmin Mihai , Bolcu Alexandru , Ionică Valeriu , Romanescu Alina Elena , Pădeanu Adriana Paula
Published: September 2021

In this paper we present some researches about the static mechanical properties for some composites made in this way: the reinforcement is made from two types of felt and the matrix is from epoxy resin Resoltech 1050 with its hardener Resoltech 1055. There are built some plates from felt/epoxy resin and from these plates there are cut some samples. The samples are tensile loaded on an universal testing machine Instron 1000 HDX which is assisted by a BlueHill software. There are determined the next mechanical properties: Young modulus, yield strength, elongation at break and breaking strength. By using an optical microscope, there are presented some images with the breaking sections.
Experimental Stand to Investigate the Injection Process in Diesel Engines
Authors: Tutunea Dragoș , Dumitru Ilie , Racilă Laurenţiu
Published: September 2021

The objective of this paper is to investigate the fuel injection system in diesel engines by using inline pumps. In a diesel engines, the fuel injection pressure plays an important role in the combustion process in order to obtain high performance and low fuel consumption. The experiments in this paper are been performed on a 6 cylinder inline pump which is actioned by an electric motor with variable r.p.m.-s The quantity of the fuel injected by each injector is measured function of time and the speed of electric motor. The experiments show the degree of non-uniformity of the fuel delivered by the pump to injectors.
Novel Therapies in Oncology: An Individualized Approach
Authors: Gregory Stephanie , Kelley Margaret , Lalani Tanya
Published: September 2021

For decades, oncology treatments revolved around chemotherapeutic regimens that have been relatively nonspecific in their approach to cancer cell death. With advancements in genomics and personalized medicine, however, knowledge of the immune system has dramatically increased and methods for treating cancers have become much more individualized. With this increase in knowledge, vast arrays of novel therapies have entered the oncology realm. Nurses are expected to administer these therapies and ultimately manage the resulting toxicities and side effects. Such effects sometimes lead to severe illness, which may require intensive care unit admission. This article reviews novel therapies in oncology and nursing considerations pertaining to these treatment approaches as they relate to solid tumors.
Oncologic Surgical Care Using an Enhanced Recovery Approach
Authors: Brophy Lynne , Birkhimer Danette , DeVilliers Allison , Davis Loletia , Meade Karen , Pervo Valerie
Published: September 2021

Enhanced recovery programs are multimodal, evidence-based perioperative programs designed to improve a patient’s functional recovery after surgery. Enhanced recovery programs promote standardized, multidisciplinary care throughout the perioperative course to improve patient outcomes, rather than focusing on surgical technique. It is important for nurses working in acute and critical care to be aware of the paradigm shift created by the trend toward the enhanced recovery approach. By learning more about facets of the approach, the nurse will be better prepared to adopt whatever aspects of enhanced recovery their institution implements for the surgical oncology population. An overview is provided of the potential components of enhanced recovery.
ECMO During a Pandemic: A COVID-19 Quality Improvement Process
Authors: Tukacs Monika , Singh Darshani , Halliday Catherine A.
Published: September 2021

Extracorporeal membrane oxygenation is a modified form of cardiopulmonary bypass and a complex adult critical care therapy. No evidence appears to exist on sustaining relevant quality nursing standards during a pandemic. The aim for this quality improvement process was to address nursing provision in real time related to extracorporeal membrane oxygenation in a pandemic, providing fundamentals for future readiness. The Ishikawa fishbone diagram and a Plan-Do-Study-Act cycle were methods used. Process changes included implementation of a communication algorithm, an alternative nursing care model, increased nursing staffing and leadership visibility, use of perfusion services for nursing task support, and minimized nursing documentation. Changes applied were successful. We recommend increasing nursing staffing volume and support resources, applying a communication algorithm, and minimizing documentation requirements. These strategies are generalizable to other clinical nursing areas in similar pandemics or disasters.
Thermal and Reliability Characterization of an Epoxy Resin-Based Double-Side Cooled Power Module
Authors: Cheng Tzu-Hsuan , Nishiguchi Kenji , Fukawa Yoshi , Baliga B. Jayant , Bhattacharya Subhashish , Hopkins Douglas C.
Published: September 2021

Wide-Band Gap (WBG) power devices have become a promising option for high-power applications due to the superior material properties over traditional Silicon. To not limit WBG devices’ mother nature, a rugged and high-performance power device packaging solution is necessary. This study proposes a Double-Side Cooled (DSC) 1.2 kV half-bridge power module having dual epoxy resin insulated metal substrate (eIMS) for solving convectional power module challenges and providing a cost-effective solution. The thermal performance outperforms traditional Alumina (Al2O3) Direct Bonded Copper (DBC) DSC power module due to moderate thermal conductivity (10 W/mK) and thin (120 mm) epoxy resin composite dielectric working as the IMS insulation layer. This novel organic dielectric can withstand high voltage (5 kVAC @ 120 μm) and has a Glass Transition Temperature (Tg) of 300°C, which is suitable for high-power applications. In the thermal-mechanical modeling, the organic DSC power module can pass the thermal cycling test over 1,000 cycles by optimizing the mechanical properties of the encapsulant material. In conclusion, this article not only proposes a competitive organic-based power module but also a methodology of evaluation for thermal and mechanical performance.
PERFORMANCE OF THE SEPSIS‑3 DEFINITIONS IN A MIDDLE INCOME COUNTRY INTENSIVE CARE UNIT
Authors: Hajjej Zied , Ben Mahmoud Kalthoum , Rebai Aicha , Gharsallah Hedi , Labbene Iheb , Ferjani Mustapha
Published: September 2021

Background: Since the first publication, of 2016, Sepsis-3 definitions have not been universally accepted, rather, they have become a source of controversy. Because clinical and laboratory parameters used had been derived mainly from patients hospitalized in United States’ Intensive Care Units (ICU).

Purpose: the aim of this study was to evaluate the performance of the Sepsis‑3 definitions for the prediction of ICU-mortality in a Tunisian ICU population as compared to 2003 Consensus Definitions (Sepsis-2 definitions)

Methods: It was a retrospective study conducted in an 18-bed medical surgical intensive care unit at the military hospital of Tunis (Tunisia).  From January 2012 to January 2016, all patients admitted to the ICU for sepsis, severe sepsis or septic shock as defined according to 2003 Consensus Definitions (Sepsis-2 consensus) were eligible for this study. The new Sepsis-3 definition was secondly used to classify included patients. The primary area of interest was ICU mortality defined as death before ICU discharge

Results: A total of 1080 patients were included during the recruitment period. . When the Sepsis-2 definitions were used there had been a difference in mortality only between septic shock and sepsis patients. While Sepsis-3 definitions show that mortality increased from 16 % among no-dysfunction-infected patients to 30 % among patients with qSOFA ≥ 2 and 44% or 46% for sepsis or septic shock patients, respectively.

Conclusions: Sepsis-3 was better than sepsis-2 definitions at stratifying mortality among septic patients admitted to an ICU of a middle income country (Tunisia).
Concurrent diagnosis of acute myeloid leukemia and symptomatic COVID-19 infection: a case report successfully treated with Azacitidine-Venetoclax combination
Authors: Taurino Daniela , Frigeni Marco , Grassi Anna , Cavallaro Gianluca , Salmoiraghi Silvia , Spinelli Orietta , Rambaldi Alessandro , Lussana Federico
Published: September 2021

SARS-COV2 pandemic has caused profound challenges in health care systems worldwide. Patients affected by hematological neoplasms appear to be particularly at risk of developing COVID-19 complications, with unfavorable outcomes.

Here, we present the case of a 57-years-old woman diagnosed with severe COVID-19 pneumonia and concurrent acute myeloid leukemia (AML). At the time of diagnosis, it was decided to postpone leukemia therapy to enable adequate COVID-19 pneumonia treatment. When her conditions related to pneumonia improved, the combination of Azacitidine-Venetoclax was used as first-line treatment, instead of conventional intensive chemotherapy. At the end of the first two cycles, the patient showed complete remission, and a post-remission consolidation with allogeneic hematopoietic stem cell transplantation has been planned.

This case suggests that Azacytidine-Venetoclax induction may represent a valid and safe alternative to intensive chemotherapy in the challenging setting of patients with a concomitant diagnosis of AML and severe COVID-19 infection.
First technical report of a pediatric case with thoracic Langerhans cell histiocytosis
Authors: Erdogan Koral , Solmaz Serdar , Dogan Ihsan
Published: September 2021

Background:

Langerhans cell histiocytosis (LCH) is a rare nonmalignant disease characterized by a clonal proliferation of mononuclear cells called Langerhans histiocytes and infiltrates surrounding tissues, mostly self-limiting and usually occurring in the first two decades of life. Vertebral involvement is rare, mostly seen in the thoracic region, and involves the anterior elements of the corpus. In the literature, several treatment options and surgical approaches have been reported concerning the treatment of this disease and surgery.

Case Presentation:

We report an 18-month-old male with thoracic LCH who underwent surgery due to progressive neurological deficit. Gross total removal of the tumor with one level corpectomy in this patient was achieved via a posterolateral approach with postoperative functional improvement. The surgical cavity was supported by corpectomy cage and unilateral screw-rod fixation system at the same stage.

Conclusion:

Gross total tumor removal, corpectomy, and 360° stabilization via posterolateral approach at a single stage are safe, effective, and definite neurosurgical methods in terms of providing neurological recovery, long-term tumor-free survival, and spinal stability.
Surgical treatment outcome on a national cohort of 176 patients with cervical manifestation of rheumatoid arthritis
Authors: MacDowall Anna , Barany Laszlo , Bodon Gergely
Published: September 2021

Purpose:

Rheumatoid arthritis (RA) affecting the cervical spine results in instability and deformity that can be divided into the subtypes C1–C2 horizontal (atlantoaxial instability), C0–C2 vertical (basilar invagination), subaxial, and combined instabilities. The aim of this study was to compare the surgical treatments and outcomes of RA-related deformity and instability in a population-based setting.

Patients and Methods:

All patients with RA in the national Swespine register from January 1, 2006, to March 20, 2019, were assessed. Baseline characteristics, surgical treatments, European Myelopathy Scale (EMS), Neck Disability Index, the Visual Analog Scale for neck and arm pain as well as pre- and postoperative imaging were analyzed. The follow-up time points were at 1-, 2-, and 5 years after surgery.

Results:

A total of 176 patients were included. There were 62 (35%) patients with C1–C2 horizontal instability, 48 (27%) with C0–C2 vertical instability, 19 (11%) patients with subaxial instability, 43 (24%) patients with combined instability, and 4 patients without instability served as controls. The EMS improved in the C1–C2 horizontal instability group after fusion surgery (Δ =2.6 p) but remained within baseline confidence intervals in the other groups. All patients regardless of instability improved in pain. The subaxial instability had the highest risk of death within 5 years after surgery (11/19, 58%). The most dangerous complications due to implant failure were seen in patients instrumented with laminar hooks.

Conclusion:

The neurological outcome after fusion surgery is poor and the death rate is high in patients with cervical RA-related instability and deformity.
The impact of the lower instrumented level on outcomes in cervical deformity surgery
Authors: Passias Peter Gust , Alas Haddy , Pierce Katherine E. , Galetta Matthew , Krol Oscar , Passfall Lara , Kummer Nicholas , Naessig Sara , Ahmad Waleed , Diebo Bassel G. , Lafage Renaud , Lafage Virginie
Published: September 2021

Background:

The lower instrumented vertebrae (LIVs) in cervical deformity (CD) constructs may have varying effects on patient outcomes that are still poorly understood.

Objective:

The objective of the study is to compare outcomes in CD patients undergoing instrumented correction according to the relation of LIV with primary driver (PD).

Methods:

Patients who met radiographic criteria for CD were included in the study. Patients were stratified by PD of deformity: cervical (C) through AMES classification (TS-CL >20 or cervical sagittal vertical axis >40) and thoracic (T) through hyper/hypokyphosis (TK) from T4-T12 (60 < TK < 40). Patients were further stratified by LIV in relation to curve apex (above/below). Univariate and multivariate analyses identified group differences in postoperative health-related quality-of-life and distal junctional kyphosis (DJK) (>10° LIV and LIV + 2) rate up to 1 year.

Results:

Sixty-two patients were analyzed. Twenty-one patients had a C-PD and 41 had a T-PD by definition. 100% of C-PDs had LIVs below CL apex, while 9.2% of T-PDs had LIVs below (caudal) to TK apex and 90.8% had LIVs above TK apex. By 1 year, C patients trended lower Neck Disability Index (NDI) (21.9 vs. 29.0, P = 0.245), lower numeric rating scales neck pain (4.2 vs. 5.1, P = 0.358), and significantly higher EuroQol five-dimensional questionnaire Visual Analog Scale (69.2 vs. 52.4, P = 0.040). When T patients with LIVs below TK apex were excluded, remaining T patients with LIV above apex had significantly higher 1-year NDI than C patients (37.5 vs. 21.9, P = .05). T patients also trended higher rates of postoperative DJK than C (19.5% vs. 4.8%, P = 0.119).

Conclusions:

Stopping before apex was more common in patients with a primary thoracic driver (T) and associated with deleterious effects. Primary cervical driver (C) tended to have LIVs inclusive of CL apex with lower rates of DJK.
Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes
Authors: Alas Haddy , Passias Peter Gust , Diebo Bassel G. , Brown Avery E. , Pierce Katherine E , Bortz Cole , Lafage Renaud , Ames Christopher P. , Line Breton , Klineberg Eric O. , Burton Douglas C. , Uribe Juan S. , Kim Han Jo , Daniels Alan H. , Bess Shay , Protopsaltis Themistocles , Mundis Gregory M. , Shaffrey Christopher I. , Schwab Frank J. , Smith Justin S. , Lafage Virginie
Published: September 2021

Introduction:

Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), though patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD-corrective surgery with regards to HK and hyperlordosis (HL).

Materials and Methods:

Operative CD patients (C2-C7 Cobb >10°, cervical lordosis [CL] >10°, cervical sagittal vertical axis [cSVA] >4 cm, chin-brow vertical angle >25°) with baseline (BL) and 1Y radiographic data. Patients were stratified based on BL C2-7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (−6.96° ±21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (≤28.43°) depending on directionality. Patients within 1 SD were considered the control group.

Results:

One hundred and two surgical CD pts (61 years, 65%F, 30 kg/m2) with BL and 1Y radiographic data were included. Twenty pts met definitions for HK and 21 pts met definitions for HL. No differences in demographics or disability were noted. HK had higher estimated blood loss (EBL) with anterior approaches than HL but similar EBL with the posterior approach. Op-time did not differ between groups. Control, HL, and HK groups differed in BL TS-CL (36.6° vs. 22.5° vs. 60.7°, P < 0.001) and BL-sagittal vertical axis (SVA) (10.8 vs. 7.0 vs. −47.8 mm, P = 0.001). HL pts had less discectomies, less corpectomies, and similar osteotomy rates to HK. HL had × 3 revisions of HK and controls (28.6 vs. 10.0 vs. 9.2%, respectively, P = 0.046). At 1Y, HL pts had higher cSVA, and trended higher SVA and SS than HK. In terms of BL-upper cervical alignment, HK pts had higher McGregor's-slope (16.1° vs. −3.3°, P = 0.001) and C0-C2 Cobb (43.3° vs. 26.9°, P < 0.001), however postoperative differences in McGregor's slope and C0-C2 were not significant. HK drivers of deformity were primarily C (90%), whereas HL had primary computed tomography (38.1%), upper thoracic (23.8%), and C (14.3%) drivers.

Conclusions:

Hyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1Y postoperative, perhaps due to undercorrection compared to kyphotic etiologies.
Risk-benefit assessment of major versus minor osteotomies for flexible and rigid cervical deformity correction
Authors: Passias Peter Gust , Passfall Lara , Horn Samantha R. , Pierce Katherine E. , Lafage Virginie , Lafage Renaud , Smith Justin S. , Line Breton G. , Mundis Gregory M. , Eastlack Robert , Diebo Bassel G. , Protopsaltis Themistocles S. , Kim Han Jo , Scheer Justin , Burton Douglas C. , Hart Robert A. , Schwab Frank J. , Bess Shay , Ames Christopher P. , Shaffrey Christopher I.
Published: September 2021

Introduction:

Osteotomies are commonly performed to correct sagittal malalignment in cervical deformity (CD). However, the risks and benefits of performing a major osteotomy for cervical deformity correction have been understudied. The objective of this retrospective cohort study was to investigate the risks and benefits of performing a major osteotomy for CD correction.

Methods:

Patients stratified based on major osteotomy (MAJ) or minor (MIN). Independent t-tests and Chi-squared tests were used to assess differences between MAJ and MIN. A sub-analysis compared patients with flexible versus rigid CL.

Results:

137 CD patients were included (62 years, 65% F). 19.0% CD patients underwent a MAJ osteotomy. After propensity score matching for cSVA, 52 patients were included. About 19.0% CD patients underwent a MAJ osteotomy. MAJ patients had more minor complications (P = 0.045), despite similar surgical outcomes as MIN. At 3M, MAJ and MIN patients had similar NDI, mJOA, and EQ5D scores, however by 1 year, MAJ patients reached MCID for NDI less than MIN patients (P = 0.003). MAJ patients with rigid deformities had higher rates of complications (79% vs. 29%, P = 0.056) and were less likely to show improvement in NDI at 1 year (0.95 vs. 0.54, P = 0.027). Both groups had similar sagittal realignment at 1 year (all P > 0.05).

Conclusions:

Cervical deformity patients who underwent a major osteotomy had similar clinical outcomes at 3-months but worse outcomes at 1-year as compared to minor osteotomies, likely due to differences in baseline deformity. Patients with rigid deformities who underwent a major osteotomy had higher complication rates and worse clinical improvement despite similar realignment at 1 year.
Pure Cutaneous Rosai Dorfman Disease
Authors: Jain Manjula , Pujani Mukta , Sidam Dipti , Wadhwa Ruchira , Passi Shanta , Uikey Deepika
Published: September 2021

RosaiDorfman disease (RDD) is a rare, self-limiting disease of uncertain etiology involving lymph nodes as well as extranodal sites. Isolated or pure cutaneous RDD (PCRDD) without lymph node involvement is very unusual accounting for only 3% of all described cases of RDD. The clinical features of PCRDD are quite different from RDD according to the literature on extranodal RDD, thereby emphasizing that PCRDD is a distinct clinical entity. Histopathology remains the gold standard for the diagnosis of both systemic and PCRDD with the presence of characteristic emperipolesis observed in histiocytes while immunohistochemistry (IHC) (S100, CD 68 positive, and CD 1a-negative) serves as a useful adjunct. We hereby report a case of a 36-year-old female who presented with a tender, indurated plaque on the left forearm with a clinical differential diagnosis of borderline tuberculoid leprosy/sarcoidosis and lupus vulgaris. However, on histopathology, a diagnosis of RDD was performed and confirmed on IHC. This case highlights the need to create awareness among young pathologists and clinicians about PCRDD to prevent overzealous treatment.
Adenoid Cystic Carcinoma – A Case of an Aggressive Ulcerated Lesion of the Upper Lip
Authors: Gotmare Swati Shrikant , Babu Cathy , Shetty Subraj , Pereira Treville
Published: September 2021

Adenoid cystic carcinoma (ACC) is an unusual slow growing salivary gland malignancy with higher chances of recurrence. It is characterized by the proliferation of ductal (luminal) and myoepithelial cells in cribriform, tubular, solid, and cystic forms. Standard treatment, including surgery with postoperative radiation therapy, has attained reasonable local control rates, but distant metastases do not allow any improvement in the survival rate. We present a case of a 50-year-old female diagnosed with ACC involving almost the whole of the upper lip, with an aim to highlight its histologic evolution from it being clinically seen as severely ulcerated and necrotised upper lip mimicking a case of squamous cell carcinoma and its prognosis.
Reevaluation of the Electroencephalogram Recordings of Patients with Nonconvulsive Status Epilepticus by Using Salzburg Consensus Criteria
Authors: Timer Emin , Yılgor Abdullah , Oguz-Akarsu Emel , Bebek Nerses , Baykan Betul
Published: September 2021

Objective:

Nonconvulsive status epilepticus (NCSE) is a challenge to diagnose in some cases, and recently, Salzburg consensus criteria for NCSE (SCC-NCSE) were developed to contribute to clinical practice. We aimed to investigate their validity and usefulness by reevaluating the electroencephalogram (EEG) examinations of our patients in this study.

Materials and Methods:

We retrospectively evaluated all EEG recordings of patients diagnosed with NCSE by experienced clinical neurophysiologists in our EEG laboratory over a period of 2 years. Two neurologists trained in EEG reanalyzed all EEG data and categorized these patients as NCSE, possible NCSE, or non-NCSE using the SCC-NCSE.

Results:

Twenty-nine patients with a mean age of 31.5 ± 25.9 were reanalyzed. According to the SCC-NCSE, 24 patients (82.7%) were diagnosed as NCSE. Eighteen patients (62%) who fulfilled all SCC-NCSE were diagnosed as NCSE, whereas six patients (20.7%) were diagnosed only as possible NCSE. Five patients (17.3%) did not fulfill SCC-NCSE; the reasons are the lack of additional secondary criteria in 2 patients with encephalopathy, the absence of full compliance with the criteria in other 2 patients, and a diagnosis of electrical status epilepticus during sleep in the last patient.

Conclusion:

The results of our study show that SCC-NCSE is highly consistent with clinical practice to decide for the diagnosis of NCSE. The evaluation of NCSE according to a set of new standardized criteria is thought to be difficult in practice, but it provides a more objective assessment. Therefore, we believe that its use should be encouraged to increase experience and the possibility of correct diagnosis.
An Adaptive Intervention Trial Design for Finding the Optimal Integrated Strategies for Malaria Control and Elimination in Africa: A Model Simulation Study
Authors: Zhou Guofa , Lee Ming-chieh , Wang Xiaoming , Zhong Daibin , Hemming-Schroeder Elizabeth , Yan Guiyun
Published: September 2021

There are a number of available and emerging malaria intervention tools that require innovative trial designs to find the optimal combinations at given epidemiologic settings. We simulated intervention strategies based on adaptive interventions, which included long-lasting insecticidal nets (LLINs), piperonyl butoxide–treated LLINs (PBO-LLINs), indoor residual spraying (IRS), and long-lasting microbial larviciding (LLML). The aims were to determine if PBO-LLINs or LLIN+IRS combination is more effective for initial interventions than LLINs and to identify the most effective intervention. We used a clustered, randomized adaptive trial design with malaria infection prevalence (MIP) as the outcome variable. The results indicate that during the initial stage of interventions, compared with regular LLINs, PBO-LLINs (relative reduction [RR]: 29.3%) and LLIN plus IRS with alternative-insecticide (RR: 26.8%) significantly reduced MIP. In the subsequent interventions, adding alternative insecticide IRS (RR: 23.8%) or LLML (RR: 31.2%) to existing PBO-LLIN was effective in further reducing MIP. During the next stage of interventions, adding LLML on top of PBO-LLIN+IRS (with alternative insecticides) had a significant impact on MIP (RR: 39.2%). However, adding IRS (with alternative insecticides) on top of PBO-LLIN+LLML did not significantly reduce MIP (11.6%). Overall, in clusters initiated with PBO-LLIN, adding LLML would be the most effective strategy in reducing MIP; in clusters initiated with LLIN+IRS, replacing LLIN+IRS with PBO-LLIN and LLML would be the most effective in reducing MIP. This study provides a new pathway for informing the optimal integrated malaria vector interventions, and the new strategy can be tested in field trials.
Pediatric Hospital Medicine and Global Health: A Fitting Niche for an Emerging Subspecialty
Authors: Haq Heather , Rule Amy R. L. , Coria Alexandra , Thahane Lineo K. , Duperval Regina M. , Barnes Adelaide , Condurache Tania , Ferrer Kathy , Shenoy Michelle J. , Mendoza Joanne , Russ Christiana M.
Published: September 2021

As North American hospitals serve increasingly diverse patient populations, including recent immigrants, refugees, and returned travelers, all pediatric hospitalists (PHs) require foundational competency in global health, and a subset of PHs are carving out niches focused in global health. Pediatric hospitalists are uniquely positioned to collaborate with low- and middle-income country clinicians and child health advocates to improve the health of hospitalized children worldwide. Using the 2018 WHO standards for improving the quality of care for children and adolescents worldwide, we describe how PHs’ skills align closely with what the WHO and others have identified as essential elements to bring high-quality, sustainable care to children in low- and middle-income countries. Furthermore, North American global health hospitalists bring home expertise that reciprocally benefits their home institutions.
Case Report: Gastrointestinal Basidiobolomycosis with Multi-Organ Involvement Presented with Intussusception
Authors: Jafarpour Zahra , Pouladfar Gholamreza , Dehghan Alireza , Anbardar Mohammad Hossein , Foroutan Hamid Reza
Published: September 2021

Gastrointestinal basidiobolomycosis (GIB) is a rare, life-threatening fungal infection affecting immunocompetent individuals in tropical and subtropical regions. A diverse presentation of GIB has been reported, but no report has yet been published on intussusception. We describe a 23-month-old immunocompetent boy from a subtropical area in Iran who presented with intussusception. Prolonged fever, an abdominal mass, hepatomegaly, high erythrocyte sedimentation rate, and peripheral eosinophilia strongly suggested GIB. Accordingly, GIB was diagnosed based on the characteristic histopathology (the Splendore-Hoeppli phenomenon) detected in a liver sample taken via biopsy. Exploratory laparotomy showed several organs, including the colon, gall bladder, liver, and abdominal wall, were involved. Antifungal therapy with trimethoprim/sulfamethoxazole, liposomal amphotericin B, a saturated solution of potassium iodide, and surgical resection of involved tissues were used with improved outcome. The presence of non-septate fungal hyphal elements in the colonic mucosa led to the thickening of the bowel wall, leading to secondary intussusception.
Learning-by-Teaching Approach Improves Dengue Knowledge in Children and Parents
Authors: Hermida Maria Julia , Perez Santangelo Agustín , Calero Cecilia Inés , Goizueta Carolina , Espinosa Manuel , Sigman Mariano
Published: September 2021

There is narrow evidence on which strategies are most effective for disseminating information on dengue prevention. This is particularly relevant because social habits have a great prevention capacity for dengue. We investigated how effective are children as health educators, and how much they learn as they teach. We recruited 142 children and 97 parents in Argentina’s tropical area for two cluster randomized parallel trials. In Study 1, we compared the dynamics of dengue knowledge of 10-year-old children who—after receiving a dengue talk—1) listened to an unrelated topic; 2) read a booklet with information about dengue, 3) taught their parents about dengue, or 4) taught their parents about dengue, using the booklet. In Study 2, we assessed whether the parents’ dengue knowledge changed after interacting with their children, in comparison with parents learning about dengue from an expert or about an unrelated topic. Children that taught their parents what they learned, using a booklet, showed 2.53 more correct responses (95% CI [0.20, 4.85]; P = 0.027) than children who listened to an unrelated topic. This style of teaching also serves to effectively propagate knowledge: parents learned from their children the same as from an expert; and significantly more than parents who learned about an unrelated topic. Parents learned from their children even if they were taught with booklets (1.49, 95% CI [0.01, 2.96]; P = 0.048) or without (1.94, 95% CI [0.44, 3.44]; P = 0.006). Specifically, after being taught by their children, parents showed on average 1.49 (if they were taught with a booklet) and 1.94 (without booklet) more correct responses than parents that learned about an unrelated topic. The simple action of prompting children to teach consolidated their own knowledge and broadcasted it effectively to their parents. This strategy is a potential low to no-cost method for sharing information about dengue prevention.
An Exploration of Knowledge, Attitude, and Practices of Physicians toward Pharmacovigilance at Tertiary Care Hospitals in Khyber-Pakhtunkhwa Province, Pakistan
Authors: Sharif Muhammad Junaid Hassan , Murtaza Ghulam , Kharaba Zelal , Ibrahim Nihal Abdalla , Ismail Mohammad , Mannan Abdul , Buabeid Manal , Huang Xianju , Khan Shujaat Ali , Hayat Khezar
Published: September 2021

Drug safety assures the effectiveness, safety, and security of drugs, vaccines, and other biologicals to protect public health. Medication-related errors coupled with unjudicial medication practices often cause a catastrophic impact on the healthcare system globally. The present study aimed to assess the knowledge, attitude, and practice of physicians toward pharmacovigilance and barriers to adverse drug reaction (ADR) reporting at tertiary care hospitals in Khyber-Pakhtunkhwa (KP) province, Pakistan. A descriptive cross-sectional study was conducted among registered doctors working in seven tertiary care hospitals from seven administrative divisions of KP province of Pakistan from July 2019 to March 2020. During the study period, 358 physicians who fulfilled the inclusion criteria and agreed to participate completed and returned the validated structured questionnaires. Descriptive and inferential statistics were applied for data analysis. The majority of physicians had poor knowledge (81.3%) regarding pharmacovigilance along with poor reporting practices (94.9%), although (96.5%) had a positive attitude toward ADR reporting. A significant barrier identified was the unavailability of reporting forms (95.9%), whereas mandatory ADR reporting (96.2%) was the major factor to encourage ADR reporting. Physicians aged ≥ 41 and experience ≥ 11 years had significantly more knowledge than other categories (P < 0.001). Significant association (P < 0.001) of physicians’ knowledge and practice were found where 77.2% of the participants having poor knowledge reported poor practices. Physicians’ understanding of pharmacovigilance was suboptimal, although they have a positive attitude toward ADR reporting. Thus, there is a need for continuous education and training programs to support pharmacovigilance activities that could improve physicians’ understanding.
Bullous Scabies: Clinical, Dermoscopic, and Pathologic Characteristics of Ten Patients
Authors: Li Feng-Zeng , Jia Meng , Chen Ke-Jun , Ye Qian , Fang Sheng
Published: September 2021

Bullous scabies (BS) is a rare atypical clinical variant of scabies and is easily confused with bullous disorders. The diagnosis of BS is always a challenge, and physicians often misdiagnose BS patients. Patients with BS admitted from 2012 to 2020 were enrolled in this study. The clinical, dermoscopic, and pathological characteristics of the patients were analyzed retrospectively. Ten patients with BS were enrolled in this study. Seven of the 10 patients were male. The bullae were most commonly found on the thighs and arms (80% of patients). Only 30% of patients (3/10) tested positive for mites and/or eggs by the initial skin scraping, but 100% (5/5) of the patients who received dermoscopy tested positive. Among these 10 patients, only five received a skin biopsy. Subepidermal (4/5) and intraepidermal (1/5) bullae with eosinophil and neutrophil infiltration were observed in five patients. Direct immunofluorescence (DIF) indicated linear deposition of IgG in the basement membrane zone in three patients. Physicians should consider the possibility of BS in patients with blisters, pruritus, and poor response to corticosteroids. Dermoscopy should be prioritized for the differential diagnosis of BS to exclude other bullous disorders. Finally, a biopsy should be performed on each patient with bullae.
Salutati, Ficino in Machiavelli: Od jajca do jabolka civilnega humanizma
Authors: Šček Jernej , Škamperle Igor
Published: September 2021

Vprašanje (dis)kontinuitete med etiko in politiko je civilni živec renesančnega humanizma v historični ontogenezi, ki se začne s Salutatijem, razvija s Ficinom in sklepa z Machiavellijem. Tragično sirensko petje človeškega bivanja vseskozi zapeljuje, a nikdar ne preglasi vzgornih upov k praksi usmerjene človeškosti, ki spekulacijo uresničuje skozi dejavnost, kontemplacijo udejanja skozi politiko, sveto izpričuje skozi posvetnost. Humanistična duhovna in filozofska prenova ciceronskega nauka o dobrem delovanju na pragu modernosti nemirno, pa vendar srečno pripelje antropološko vexata quaestio skozi Scilo in Karibdo družbene etike, nihajoče med jajcem in jabolkom (ab ovo usque ad mala) Salutatijevega voluntarističnega optimizma, Ficinovega novoplatonizma in Machiavellijevega antropološkega pesimizma, med zemljo, nebom in breznom. Civilni humanizem še danes budi in bodri vse, ki se v somraku človeškosti še trudijo služiti kvalificiranemu življenju.
Izrekanje resnice v Ogledalu preprostih izničenih duš Margarete Porete
Authors: Jevtić Iva
Published: September 2021

Prispevek obravnava Margareto Porete in Ogledalo preprostih duš skozi prizmo Foucaultovih predavanj o ≫veridikciji≪ oziroma štirih prevladujočih načinih izrekanja resnice: prerokbi, modrosti, poučevanju in pareziji. Tudi v svojih hibridnih oblikah so bili ti načini še vedno vezani na posebne institucije izrekanja resnice, s specifičnimi udeleženci, področji nagovarjanja in načini izrekanja. Besedilo v tem okviru analizira Margaretin proces in osrednje ideje njenega dela ter prepozna mistično misel Margarete Porete kot poskus oblikovanja novega prostora v obstoječih režimih izrekanja resnice; pri tem je njeno orodje medij knjige oziroma strateško preoblikovanje odnosa med telesom in pisanjem.
Metaphyseal Osteopathy in a Caucasian Shepherd Crossbred Dog
Authors: Felix A.K. , Kashoma I.P. , Makungu M.
Published: September 2021

A six-month old, 24 kg, intact male Caucasian Shepherd crossbred dog was presented at the Sokoine University of Agriculture Teaching Animal Hospital with a history of difficulty standing and walking, and bilateral swelling of the distal antebrachial and crural metaphyeal region. The owner also reported prior calcium supplementation in form of dietary tablets. Upon physical examination; the animal was lethargic with fever, bilateral ocular discharge, tachypnea and reduced appetite. Hard painful bilateral swelling of the distal antebrachial and crural metaphyseal region was observed. Differential cell count showed neutrophilia and monocytosis. Sclerosis and paracortical cuffing of the distal antebrachial and crural metaphyseal region were seen on radiographic examination. Similar changes were also visualised in the proximal crural metaphyseal region. Further, cranial bowing of the radius with lateral deviation of the foot (carpal valgus) were also observed. Metaphyseal osteopathy was diagnosed based on the history, clinical and radiographic findings. The exact cause of metaphyseal osteopathy is unknown, however there have been reports linking it to breed predisposition and mineral over supplementation. Administration of corticosteroids and supportive care are recommended in dogs with metaphyseal osteopathy. However, a bony change that is paracortical cuffing requires several months for resorption.