bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial Intelligence Based on IoT for Healthcare
Authors: M. S. Supriya , K. J. Vismaya , B. N. Ramya , P. Nikil Kumar
Published: September 2022

In fields like healthcare, where human intelligence is critical, the introduction of new AI-powered applications is becoming increasingly popular. Technologies have reduced expenses, accelerated drug research, and improved wellness outcomes. AI has become increasingly cognizant of its potential to disrupt the business, as seen by growing funding for the sector in recent years from important stakeholders in both healthcare and risk capital. Traditional approaches include human participation and direct interaction with patients, which are now obsolete due to the advancement of technologies such as messaging bots and intelligent virtual assistants. On the other hand, the internet of things (IoT) is making significant contributions to healthcare, and its gadgets may collect complete health data. Machine intelligence collects and analyses data in established protocols in search of possible health-related predictions. The chapter delves into the aspects of combining AI and IoT to improve efficiency in healthcare systems.
AI-Enabled Augmented Reality-Based Shared Collaborative Experience
Authors: Chouhan Robin Singh , Rajawat Anand Singh , Goyal S. B. , Bedi Pradeep
Published: September 2022

The unpopular reality of taxpayers we see in the placement of 3D animations in the real world. The objects used can be viewed and communicated by both individual and multiple users. For example, two users, if they are in the same location, can create a shared experience where both can interact with real-world objects. The real-life experience of unpopular taxpayers we see could improve the efficiency of the education sector as well, as students can have practical experience and visual cues that all students can access using their own learning-enhancing devices.
Adaptive Clinical Treatments and Reinforcement Learning for Automatic Disease diagnosis
Authors: Whig Pawan , Gupta Ketan , Jiwani Nasmin , Kouser Shama , Anand Mayank
Published: September 2022

Machine learning models are taught how to make a series of decisions depending on a set of inputs in reinforcement learning. The agent learns how to accomplish a goal in an unexpected, maybe complex environment. Reinforcement learning places artificial intelligence in a game-like environment. It solves the problem by trial and error. Artificial intelligence is rewarded or punished based on its actions. Its purpose is to maximize the amount of money paid out in total. In addition to providing the game's rules, the designer does not give any feedback or recommendations on how to win the model. To maximize reward, the model must determine the optimum way to do a job, beginning with purely random trials and progressing to complex techniques and superhuman abilities. Reinforcement learning, with its power of search and diversity of trials, is likely the most effective strategy for hinting at a system's originality. Unlike humans, AI can learn from thousands of concurrent gameplays if a reinforcement learning algorithm is run on sufficiently efficient computer infrastructure.
Strategies for Presuming Competence in the Inclusive School
Authors: Guijarro Expósito Antonio J.
Published: September 2022

Inclusive education in the school context is a permanent challenge for teaching staff in educational centres. An essential aspect within this inclusive process is to guarantee the adequate training of teaching staff and to attend to all the educational demands and needs of the child and adolescent population with a disability in an individualized manner. The process of adaptation and psychosocial adjustment to a disease considered chronic, or in much more complex situations, as occurs with so-called rare diseases, is a daily challenge for the affected people and their families. One of the most relevant issues within this adaptation process is the role of academic education, as an element that favours or facilitates inclusive processes. Based on a model that aims to offer a global vision of the psychosocial adaptation process, where various factors and variables from different dimensions are integrated and where healthcare, educational and social professionals all intervene.
Development of Digital Materials for Diversity and Social Inclusion Practices
Authors: Cabero Julio , Llorente Carmen
Published: September 2022

When addressing educational and social inclusion, it is fundamental to take into account several aspects, such as the fact that not only people with some difficulty benefit from them, the right of everyone to education, and the incorporation of those individuals excluded from the system based on gender, culture, race, or personal characteristics. Thus, the development of digital materials from and for the practice of diversity and social inclusion is an integrating element that, from formats such as augmented, mixed, or virtual reality, provides different possibilities in those areas where they are least integrated. This chapter addresses, firstly, the concepts of social inclusion and diversity, the influence and impact of information and communication technologies (ICTs), and the digital materials used in the educational scope from different analytical approaches.
Review of Research of Future Teachers' Attitudes Towards Diversity and Social Inclusion
Authors: Pascual María Angeles , Sánchez Susana , Sevillano María Luisa
Published: September 2022

The aim of this chapter is to present the results of a review of specialist publications that address the attitudes of future teachers towards attention to diversity and social inclusion. The bibliometric search enabled the authors to analyze student teachers' interest in, and attitudes towards, inclusion as a way to improve the inclusion process. A descriptive study was carried out to explore and organize the scientific production in educational research on trainee teachers' attitudes to inclusion, and to know the covariance that has occurred in the last 10 years. The data were extracted from the Web of Science (WoS), Scopus, and Dialnet databases. The formula used in the bibliometric search process was (title, abstract, and key words): attitudes* OR beliefs* AND inclusive education AND teaching students, which yielded 68 registers for analysis. The results show that future teachers' attitudes towards inclusion were generally positive. The research suggests a relation between attitude towards inclusion and self-sufficiency on the basis of prior training in inclusive educational proposals.
Enhancing Teacher Leadership for Collaborative Networks
Authors: Berral-Ortiz Blanca , Lucena Francisco Javier Hinojo , Reche Pilar Cáceres , Domingo José Antonio Martínez
Published: September 2022

Currently, among the new challenges of educational organizations in a technological society, there is a drive towards pedagogical or teacher-centered leadership, which brings together collaborative or networked work capable of responding to emerging challenges. Thus, the purpose of this chapter focuses on analyzing the role of this leadership from a theoretical approach, first determining the main roles and competencies within pedagogical leadership, as well as the challenges of organizations in the current digital era, and second, identifying collaborative networks delimiting their main characteristics and highlighting the importance of personal, emotional leadership to promote sustainable organizations, as one of the fundamental axes, delimited in the 2030 Agenda. Finally, it concludes with contributions for teaching improvement and collaborative networks by determining the key points, such as the need to rethink the current management and leadership, as well as the need to enhance the collaborative networking of the centers.
An Online Master of Diversity and Social Inclusion in Italy
Authors: Caforio Alessandro , Sanalitro Cristiana
Published: September 2022

Contextualizing the development of the Master's program on diversity and inclusion at country level and specifically in Italy, this chapter has several objectives: providing an overview of regulations and approaches promoted in Italy for inclusion in education; defining the objective for a Master's program in the country; introducing International Telematic University UNINETTUNO experiences in inclusive research and education activities targeting several vulnerable groups, ranging from migrants and refugees, to ageing people, to students with sensory disabilities; presenting the main references for technological challenges in accessibility; and summarizing the specific dimensions to be addressed for the development of an international Master's program focusing on diversity and inclusion.
Underrepresentation of Women in High Tech
Authors: Whitmore Mark D. , Fisher-Whitmore Eve P.
Published: September 2022

The purpose of this chapter is to explore the issues that relate to the under representation of women in leadership roles in high-tech companies. This is a broad issue that covers the development and education of young woman in the field of technology, the issues that related to difficulties in selection, promotion, and finally, retention issues. To help structure the chapter the authors use Schneider's Attraction-Selection-Attrition Theory introduced in the seminal article “The People Make the Place” to examine the facets of this issue. The authors conclude with recommendations to improve representation of women in STEM technology.
Diversity and Generations in the Workplace Discussion of USA and UAE Approaches and Issues
Authors: Woodard Nina , Agha Kakul
Published: September 2022

This chapter discusses the USA and UAE approaches in looking at generational diversity in today's workplaces. The focus in this chapter is on the realities of the day and a look ahead at what that means for the future of the world of work. Before the pandemic, almost all countries had different situations. The pandemic has enabled a paradigm shift in organizations across the globe. The USA was on the verge of full employment, and there was a significant gap in the numbers of available skilled and talented potential staffers. On the other hand, UAE was able to attract talent from across the world and hence the demand is able to meet the supply. The pandemic propelled all businesses and society headlong into fully accepting technology as an essential component of every workplace. In researching DEI issues in the workplace and the future, with advanced medical and wellness approaches and the American workplace being unique given that the USA prohibits discrimination based on age, the reality of five generations in the workplace presents new DEI challenges.
Algorithms and Diversity
Authors: Upadhyay Ashwani Kumar , Khandelwal Komal
Published: September 2022

Organizations struggle with diversity, equity, and inclusion (DEI) issues despite having DEI management as a KRA for senior management and human resource (HR) professionals. The review of research papers and articles shows that diversity issues result from discrimination based on gender, race, age, sexual orientation, religion, caste, and colour. Artificial intelligence-based platforms can use predictive and descriptive analytics to handle employee data from multiple sources like recruitment, payroll, training, and performance appraisal for conscious and unconscious bias traces. The HR managers can use these insights to handle DEI issues to save organizations from discrimination-based lawsuits and negative press coverage.
The Role and Impact of Federal Learning in Digital Healthcare
Authors: S. Rajasree R. , S. Gopika G. , M. Sree Krishna , Tavera Romero Carlos Andrés
Published: September 2022

During the COVID-19 pandemic, IoT and machine learning played a very important role in assisting doctors by remote patient monitoring. Machine learning and deep learning algorithms are used to process the data that are generated by IoT devices. However, there was major concern about the privacy of the patient data that is generated. The data that has been generated by the devices was sent to central servers which may cause data privacy issues. FL (federated learning), a type of machine learning, was created to address this problem. It provides a solution for data governance and privacy by processing the data rather than transferring the data to another location. The performance of FL models is better when compared to the models that are trained on datasets maintained centrally. In this work, certain insights are given on some of the challenges faced by the healthcare industry while employing digital healthcare techniques and how FL (federated learning) can improve the digital healthcare as well as how patient data can be preserved.
Industry 4.0 Revolution and Its Impact on Society
Authors: Zalte Sheetal , Deshmukh Smita , Patil Prajkta , Patil Minal , Kamat Rajanish K.
Published: September 2022

The term “fourth industrial revolution” is used as a framework for analyzing the influence of coming technologies on the full range of societal impact on the current generation, evolving cultural laws, governmental view, economical growth, and foreign affairs. The fourth industrial revolution idea confirms that technological change is the engine of change in relevant sectors and elements of society. It underscores the theme that many technologies have emerged at some point in history that has been combined in ways that have had an impact on incremental efficiency gains. This chapter introduces how this new revolution has brought great opportunities; the core potential of this industrial revolution is to increase manufacturing output globally to meet social needs and to enhance the capacity across all the different current systems. The chapter focuses on various novel techniques that sustain this ultra-modern era and delineates the influence, prospects, desires, and acclimation of Industry 4.0 from the social viewpoint.
A Visualization Dashboard for COVID-19 Tweets Sentiment Analysis
Authors: Pathak Devang , Kumar Ishita , Raja Maheswari , Hargreaves Carol Anne
Published: September 2022

The COVID-19 pandemic has compelled the world to come to a standstill. Everyone including governments, researchers, organizations were caught off-guard. Social scientists and psychologists all try to understand the sentiment of the public so that they can help social organizations and governments to avert situations that ought to become worse if a negative sentiment persists among the commonality. With government-issued lockdowns in place during the pandemic, the public was mostly confined to their homes. So, the public started to share their status updates, discussions, photos, and videos over social media. Social media became the go-to place to obtain the public's sentiments and insights on the COVID-19 pandemic. This chapter introduces the utilization of the Twitter API to obtain tweets in real-time based on hashtags relating to the COVID-19 pandemic in order to gain insights on the sentiments of people at specific times. Each tweet received will be analyzed for emotional tone and sentiment. All data is stored in a Cloudant database.
Identification of Subtype Blood Cells Using Deep Learning Techniques
Authors: R. Parvathi , V. Pattabiraman
Published: September 2022

The deep learning mechanism has indicated power in numerous applications and is recognized as a superior technique by an ever growing number of people than the conventional models of machine learning. In particular, the use of deep learning algorithms, particularly convolutional neural networks (CNN), brings immense benefits to the clinical sector, where an immense amount of images must be prepared and analyzed. A CNN-based framework is generated to automatically classify the images of blood cells into subtypes of cells. This chapter suggested the deep learning models, which are the convolutional neural network, the deep convolutional neural network, and a CNN-based model built in combination with the recurrent neural network (RNN), which is called RCNN, to identify the monocytes, lymphocytes, and types of WBCs. These are monocytes, eosinophils, lymphocytes, basophils, and neutrophils.
A Close Glimpse on the Security Challenges in the Smart Era
Authors: Goyal Somya , Gupta Ayush , Bansal Shirisha , Chatterjee Jyotir Moy
Published: September 2022

Today the world is facing many cyber-crimes irrespective of the geographical boundaries, and privacy is being compromised all across the globe. According to some assessments, the extent and frequency of data breaches are increasing alarmingly, prompting organizations throughout the world to take action to address what appears to be a worsening situation. In today's world we cannot live without technology and cyber security is vital for keeping our personal information safe. This chapter would improve the awareness about technical, privacy, and security infringements and help in protecting data by prioritizing the most assailed sectors. It will help the key audience to learn about data leaks and other ways our privacy and security gets compromised due various challenges, diverse up-to-date prevention and detection policies, fresh challenges, favourable answers, and exciting opportunities.
Challenges in Adapting to Mobile Banking From the Perspective of the Customers
Authors: Afonso Carolina , Teixeira João Duarte
Published: September 2022

This chapter aims to understand the challenges in transitioning to the digital era of banking from the perspective of customers. This study uses an exploratory and quantitative approach. Quantitative data was collected from 329 bank clients, and then descriptive and correlation analysis was performed. The findings showed that performance expectancy, effort expectancy, and facilitating conditions have a positive relation, whereas social influence was found to have weak relation. Academically, this study presents valuable insights to mobile banking utilization and to the adaptation of the UTAUT model to banking sector. From a managerial perspective, this study provides insights into clients' challenges and suggestions to better integrate online platforms into branch service and to improve customer experience.
Social Media for Teaching Empathy, Civil and Moral Development, and Critical Thinking
Authors: Huston Thomas
Published: September 2022

There is a growing argumentative, hostile element found in many parts of society today; this growth, combined with increasing anonymity in online communications, suggests a dire need for youth to be harnessed with skills for civil deliberation. Numerous educational scholars have highlighted the importance for educational entities to consider utilizing youths' digital interests for teaching and learning. Additionally, recent research conducted during the COVID-19 pandemic found social media used for online education helped engage students in experiential learning and created positive feelings. Thus, a discussion of advantages to using social media is presented for fostering youths' skills in critical thinking, empathy, community, culture, deliberation, discovery, and more, so they might effectively contribute to their society and have a better, fuller understanding of the world around them. Sample curricula for teaching the deliberative arts via social media is included.
Experimental Investigation of Optimization of Machining Parameters in Abrasive Water Jet Machining
Authors: Kumar S. Naga , Sasidhar P. , Rajyalakshmi M. , Vandana K.I. Vishnu
Published: September 2022

Now a days, Non-Conventional Machining process is gaining more attention by the researchers. Abrasive Water jet machining (AWJM) is one of such machining process where material is removed with abrasive slurry as cutting tool. The present work discuss about the development of an optimal solution for minimizing surface roughness using a response surface methodology (RSM) while machining of EN grade steel. The machining parameters considered for the study are Abrasive Grain Size (AGS) and Hydraulic Pressure (HP) and Stand Off Distance (SOD) and the Abrasive Flow Rate (AFR). The response parameter is surface roughness (Ra). The experiments are performed based on the Box-Behnken design. Additionally, the significance of the developed optimization design has been identified using analysis of variance (ANOVA). Finally, the validity and adequacy of the developed model are done through confirmation tests. Key Words: Abrasive Water jet Machining, Response Surface Methodology, Optimization, ANOVA
Semi Active Vibration Control Device for Secondary Suspension of a Railway Wagon to Improve Ride Comfort
Authors: Tadepalli Ravi Kumar , Rao C.S.P. , Rao K. Narayana , Sastry Dva Rama
Published: September 2022

The rail irregularities and wheel-rail interactions in a train running at high speeds may result in large-amplitude vibration in the train's car body and affect passengers by reducing ride comfort. The train suspension systems have a vital role in reducing the vibration and improving ride comfort to an acceptable level. The existing passive viscous dampers have limited scope of achieving this objective. In this paper Magnetorheological (MR) dampers as semi-active control devices for secondary suspension in a railway wagon are used for achieving better ride performance parameters. Compared the ride comfort parameters of the wagon with MR dampers against the conventional passive viscous dampers. The sprung mass acceleration, displacement and suspension travel are assessed for three different control strategies, skyhook, ground hook and hybrid. Matlab/Simulink software is used for simulation of the wagon suspension system.
Optimal Surface Finish of Material Extrusion 3D Printed Products Using Ultimaker Cura Interface
Authors: Vijay Salkapuram , Ganesh G. , Navaneeth Goparaju , Naidu A. Vengala , Kumar G. Achuth
Published: September 2022

Rapid prototyping and additive manufacturing are the emerging trends in due to fast updating technology in all processing areas. An attempt is made in this paper to find the optimum parameters like layer thickness, infill pattern, ironing settings in Cura software interface. Two different filament material Polylactic Acid (PLA) and Acrylonitrile Butadiene Styrene (ABS) materials are selected to make the products. The objective is to get fine surface finished products at the outer surface of the components. Keeping the machine parameters constant, the fabrication parameters of components are varied by Cura software interface. The surface finish of the components made is measured with surf-tester. It is observed that the smooth surface finish of 2.159 μm is obtained for ABS as filament material, line fill pattern, smaller internal layer thickness and larger top and bottom layer thickness.
Analysis of Functionally Graded Cylinders Subjected to Internal Pressure
Authors: Sai Udayagiri Vijay Venkata Siva , Kumar Datti Naga Venkata Ravi Dileep , Rao V. Narasimha , Prasad Bandaru Satya Durga , Kumar P. Ravi
Published: September 2022

In the present study, A functionally graded cylinder subjected to internal pressure has been analyzed using the finite element method based software ANSYS. The variations of properties of the functionally graded material are considered based on a power-law function. The inner and outer surfaces of the cylinder are made of alumina and C45 steel respectively. The continuous composition of the two materials has been considered in the form of varying elastic modulus and Poisson’s ratio along the radial direction as the power-law function. The result of present approach is compared with analytical result of available literature. The comparison represents good coincidence between analytical and numerical results and confirms the accuracy of solutions presented in the present approach for cylinder made up of FGM. Further the stress distribution of FGM made cylindrical shell for given pressure load conditions have analyzed. Stress distributions along the radial direction are studied. The obtained result shows that the property of FGMs has a significant influence to the deformation and stress distribution along the radial direction. Numerical results presented are useful for engineer to design a cylinder made of FGMs
Analysis of benign prostatic obstruction surgery: A long-term evaluation in a real-life context
Authors: Costa Silva Alberto , Abreu-Mendes Pedro , Morgado Afonso , Dinis Paulo , Martins Silva Carlos
Published: September 2022

Objective: Surgery is the treatment for male lower urinary tract symptoms (LUTS) relat-ed to benign prostatic obstruction (BPO) refractory to pharma-cological treatment or with complications. This study aimed to assess factors associated with the need for surgical reinterven-tion and/or continuation of pharmacological treatment. Materials and methods: A retrospective analysis of patients who underwent prostatic surgery for male LUTS associated with BPO between 1 May 2015 and 1 May 2016, with a minimum follow-up of ﬁve years, in an academic tertiary hospital. The type of surgery, preoperative, postoperative and follow-up analysis were collected in a database. Results: A total of 212 patients were included with a mean age of 70 ± 8.66 years at ﬁve years follow-up. At 5 years, a total of 86.9% of patients do not need pharmacological treatment and 12% required surgical reintervention. Of the preoperative parameters, it was found a relationship between prior prostatitis and the need for second surgery with an odds ratio of 4.6.

Conclusions: Patients should be informed of the potential need for pharmacological treatment following surgery, or even of the need for reintervention. History of prostatitis seems to be a risk factor for reintervention.
How long should we follow patients managed for muscle-invasive bladder cancer? Lesson learned from a recent clinical practice
Authors: De Rose Aldo Franco , Vecco Francesco , Ambrosini Francesca , Malinaric Rafaela , Mantica Guglielmo , Terrone Carlo
Published: September 2022

To the Editor,

The exact time to stop bladder cancer patient’s follow-up is not well known and there is not a clear recommendation on if and when stop to follow a patient managed for muscle invasive bladder cancer (MIBC). Major urological guidelines do not provide a precise indication on the timing of follow-up, and there is currently no real consensus on optimal time schedule [...].
Organ harvesting as a mandatory training step of all PGY1 and PGY2 surgical residents
Authors: Malinaric Rafaela , Mantica Guglielmo , Terrone Carlo
Published: September 2022

To the Editor,

Good surgical training is essential for the formation of excellent surgeons, consequently providing the best possible care for our patients in the future. Considering the increase in surgeon shortage over the last two decades (estimated between 14,300 and 23,400 by the year 2032 only in the US), it is important for filling the national health system's needs as well [...].
Spectrum of Clinical and Imaging Characteristics of 48 X-Linked Adrenoleukodystrophy Patients
Authors: Bhat Maya , Natarajan Archana , Chandra SR , Christropher Rita , Netravathi M
Published: September 2022

Background and Objectives:

X-linked adrenoleukodystrophy (X-ALD) occurs due to the mutation in the ABCD1-gene. Our study was to correlate the clinical, radiological, and biochemical features in a cohort of X-ALD patients.

Methods:

We retrospectively analyzed 48 (M: F: 47:1) biochemically confirmed cases of X-ALD, classified them as cerebral ALD (childhood, adolescent, and adult), adrenomyeloneuropathy, Addisonian only. The Magnetic Resonance Imaging (MRI) of the radiological patterns was classified based on Loes classification.

Results:

The various clinical phenotypes were childhood cerebral X-ALD (58.3%), adolescent cerebral X-ALD (14.6%), adult-cerebral X-ALD (20.8%), Addisonian variant (4.2%), and adrenomyeloneuropathy (AMN) (2.1%). The imaging features were posterior white matter (Pattern-1) observed in 33 (68.75%) patients, cerebellar white matter (Pattern-4) noted in 5 subjects, anterior white matter (Pattern-2) observed in 3 patients, combined parieto-occipital and frontal white matter (Pattern-5) observed in 3 patients, isolated projection fiber (Pattern-3) observed in 1 patient. Rare features of the involvement of optic tract, anterior and lateral columns of cervicodorsal cord, bilateral central tegmental tracts, basal ganglia, and tigroid appearance were observed.

Interpretation:

This is a comprehensive clinical, biochemical, and imaging analysis with follow-up information of one of the largest series of X-ALD patients. The knowledge regarding the clinical features, typical and atypical imaging patterns is of vital importance for early diagnosis and treatment.
Impact of Postoperative ABG Analysis and ICU Weaning Protocol in Surgical Outcome of Atlanto-Axial Dislocation
Authors: Marutirao Raghavendra , Singh Suyash , Shamshery Chetna , Sardhara Jayesh , Mishra Prabhakar , Mehrotra Anant , Srivastava Arun Kumar , Jasiwal Awadesh Kumar , Srivastava Shashi , Behari Sanjay
Published: September 2022

Background:

The outcome in patients of atlanto-axial dislocation (AAD) depends on multiple factors like preoperative optimization, intraoperative distractio and cord manipulation. Certain unfocussed factors such as respiratory reserve and compensatory acclimatization to hypoxia warrant consideration.

Aims:

The purpose of this study is to find the association of postoperative arterial blood gas (ABG) analysis and respiratory reserve in patients of AAD with clinical outcome.

Study Design:

We retrospectively analyzed the available records of patients, operated for AAD, at our institute (n = 66), from January 2014 to November 2018.

Materials and Methods:

Preoperative pulmonary function test (PFT) and the postoperative ABG analysis was noted. Timing of extubation, duration of intensive care unit (ICU) stays, and clinical outcomes (Nurick grade) were noted from the inpatient record and the last outpatient follow up. An independent t-test and analysis of variance were used to find significance.

Results:

In total, 41% (n = 27) patients had body mass index of less than 18.5, and 50% (n = 33) had breath holding time of less than 20 minutes. There was improvement in mean Nurick grade from 3.17 ± 0.8 to 2.76 ± 0.7 in follow up. A trend suggesting that patients with poor preoperative PFT has more ICU duration and worse outcome. In patients with mild acid-base disorders, extubation was possible within 24 hours. Out of 26 patients with ICU duration less than 2 days, 23 patients had “good” outcome, whereas ten out of 40 patients with ICU duration of more than or equal to 2 days had “bad” outcome (P = 0.00).

Conclusion:

Patients having moderate to severe primary or mixed acid-base disorder have a probability of re-intubation or delayed extubation. A strong correlation was seen with the novel grading system (grade >6 had worse outcome).
Transcranial Magnetic Stimulation during Gait
Authors: Mate Kedar K. V.
Published: September 2022

Transcranial magnetic stimulation (TMS) is widely used for therapeutic and research purposes such as cognitive studies, treatment of psychiatric disorders, and Parkinson's disease. In research, TMS is perhaps the only technique that can establish a functional connection between brain regions and task performance. In gait research, often TMS is used to identify the extent to which leg motor cortex is involved in different phases on gait cycle. However, using TMS in gait can be challenging for several technical reasons and physiological variations. The objective of this narrative review is to summarize literature in the field of TMS and gait research and present comprehensive challenges. A comprehensive literature search was conducted in PubMed and Google Scholar to identify all relevant literature on TMS and gait. Several critical challenges could potentially impact the findings. For instance, the use of different protocols to obtain motor threshold. This review presents some of the critical challenges in applying TMS during gait. It is important to be aware of these variations and utilize strategies to mitigate some challenges.
Parkinsonism-Plus Syndrome Secondary to Neurosyphilis
Authors: Rissardo Jamir P. , Caprara Ana L. F.
Published: September 2022

Background/Objective:

Neurosyphilis can be associated with a variety of clinical manifestations. There are only a few cases of neurosyphilis associated with parkinsonism-plus syndromes (PPSs) that have been reported in the literature. We describe a case of an elderly woman who presented with abnormal gait and progressive visual disturbance, probably secondary to neurosyphilis.

Methods:

Literature search was performed in Embase, Google Scholar, Medline, Scielo, and ScienceDirect using a set of terms that included parkinsonism, tremor, and syphilis.

Case Report:

A 64-year-old female was admitted because of vision problems, gait disturbances, and cognitive impairment. The neurological examination revealed bradykinesia, rigidity, and rest tremor. The pupils were bilaterally small and reacted in size to a near object but did not constrict when exposed to bright light. The conjugate eye movements showed a defective downward gaze. On neuropsychological examination, the mini-mental state exam showed a moderate cognitive impairment. Reduced phonemic fluency was observed. A positive serum venereal disease research laboratory (VDRL) test was noted. A cerebrospinal fluid analysis showed positive VDRL. Brain and cervical spine magnetic resonance imaging was normal. An electro-encephalogram showed diffused slow waves. Penicillin G was started. Six months after, the patient had a full recovery of her conjugate eye movements and cognitive functions. Upon further questioning, the patient reported no response with a levodopa attempt.

Conclusions:

To the authors' knowledge, two individuals developed progressive supra-nuclear palsy (PSP), and one presented corticobasal degeneration (CBD), probably associated with neurosyphilis. This is the second case to document the occurrence of a progressive supra-nuclear palsy because of syphilis.
The Yin and Yang of Operating on a Posterior Fossa Meningioma
Authors: Ruparelia Jigish , Gosal Jaskaran S. , Kokkula Praneeth , Garg Mayank , Bhaskar Suryanarayanan , Panda Samhita , Tiwari Sarbesh , Jha Deepak K , Kaur Manbir , Bhatia Pradeep K
Published: September 2022

The cerebellum is classically linked with control of motor function, such as coordination, balance, and regulation of movement. There is an increasing awareness, now, of the non-motor functions of the cerebellum, and the occurrence of behavioral anomalies with cerebellar disorders. We present the first report of Schmahmann syndrome (cerebellar cognitive affective syndrome [CCAS]) occurring secondary to posterior fossa meningioma excision. A 35-year-old lady with a posterior fossa meningioma developed an infarct of the right posterosuperior cerebellar hemisphere and ipsilateral superior vermis, following suboccipital craniotomy and tumor resection. Few days after the surgery, she presented with aggressive and emotional behavior, irrelevant talk, and emotional lability. The CCAS scale was administered, and she scored poorly on almost all parameters. A neuropsychological evaluation was also done. The occurrence of CCAS, posterior fossa syndrome (PFS), and behavioral abnormalities like abnormal pathological laughter/crying provides further clinical evidence of the “affective” functions of the cerebellum, modulated mainly by the posterior lobe and vermis of the cerebellum.
Association of HLA DRB1-DQB1 Haplotypes with the Risk for Neuromyelitis Optica among South Indians
Authors: Kanikannan Meena A , Kathgave Rakesh , Yareeda Sireesha , Katkam Shiva K , Kumaraswamy Konda , Kutala Vijay K
Published: September 2022

Background:

Neuromyelitis optica (NMO) is an autoimmune demyelinating disorder, mainly characterized by severe optic neuritis, transverse myelitis and the high levels of antibodies against NMO-immunoglobulin G (IgG) or aquaporin-4 (AQP4). HLA-DR and HLA-DQ alleles within the HLA class II region on chromosome 6p21 are known to play a significant role in several autoimmune diseases including NMO. The rationale of the current case-control study is to explore the association of HLA-DRB1 and HLA-DQB1 alleles with the risk of NMO and its association with the clinical and serological markers.

Methods:

A total of 158 samples (38 NMO cases and 120-age and ethnicity matched controls) were genotyped for the HLA-DRB1 and HLA-DQB1 alleles by using PCR-SSP method.

Results:

Our analysis showed significant association of HLA-DRB1*10 allele (OR 2.63, 95% CI: 1.18-5.83, p=0.02) with NMO whereas DRB1*14 showed protective role against NMO (OR 0.33: 95% CI: 0.11-0.94, p=0.043). HLA-DRB1*10 allele also showed significant association in patients with NMO-IgG positive antibody (OR 3.28: 95% CI: 1.42-7.5, p=0.006). There was no association of HLA DQB1 alleles with NMO and also with NMO-IgG antibody. Among the haplotypes groups, HLA-DRB1*10-DQB1*05 (OR 2.61, 95% CI: 1.11-6.1, p=0.03), HLA-DRB1*15-DQB1*03 (OR 4.5, 95% CI: 1.81-11.5, p=0.001) were strongly associated with the risk of NMO, whereas DRB1*14-DQB1*05 (OR 0.20, 95% CI: 0.060-0.721, p=0.008) showed negative association with NMO.

Conclusion:

From this study, it is concluded that the HLA-DRB1*10 and DRB1*10-DQB1*05 and HLA-DRB1*15-DQB1*03 haplotypes may influence the susceptibility to NMO among the South Indians. Additionally we found DRB1*14 allele and DRB1*14-DQB1*05 haplotype showed protective role for NMO.
A Dysfunctional Descending Pain Modulation System in Chronic Nonspecific Low Back Pain
Authors: Hazra Sandipan , Handa Gita , Nayak Prasunpriya , Sahu Samantak , Sarkar Kaushik , Venkataraman Srikumar
Published: September 2022

Pain, a physiological protective mechanism, turns into a complex dynamic neural response when it becomes chronic. The role of neuroplastic brain changes is more evident than the peripheral factors in the maintenance, modulation and amplification of chronic low back pain (cLBP). In this background, we summarise the brain changes in cLBP in a coordinate-based activation likelihood estimation (ALE) meta-analysis of previous functional magnetic resonance imaging (fMRI) studies. Databases ('PubMed', 'Scopus' and 'Sleuth') were searched till May 2022 and the activity pattern was noted under the 'without stimulation' and 'with stimulation' groups. A total of 312 studies were selected after removing duplicates. Seventeen (553 cLBP patients, 192 activation foci) studies were fulfilled the eligibility criteria and included in the 'without stimulation' group. Twelve statistically significant clusters are localized in the prefrontal cortex, primary somatosensory cortex, primary motor cortex, parietal cortex, anterior cingulate cortex, caudate, putamen, globus pallidus amygdala, occipital lobe, temporal lobe and associated white matter in this group. Ten studies (353 cLBP patients, 125 activation foci) were selected in the' with stimulation' groups. In this group, seven statistically significant clusters were found in the frontal cortex, orbitofrontal cortex, premotor cortex, parietal cortex, claustrum and insula. These statistically significant clusters indicate a probable imbalance in GABAergic modulation of brain circuits and dysfunction in the descending pain modulation system. This disparity in the pain neuro-matrix is the source of spontaneous and persisting pain in cLBP.
Reverse Foster Kennedy Syndrome Caused by an Intra-axial Tumor
Authors: Ramdasi Raghvendra , Thorve Smita , Vekariya Mayank , Karnavat Chandresh
Published: September 2022

We present a case of a 23-year-old male complaining of painless loss of vision in right eye for 1 year and rapidly progressing vision loss in left eye with bilateral lateral rectus palsy. His fundoscopy revealed optic atrophy on the right side and papilledema on the left. Magnetic resonance imaging (MRI) showed intra-axial contrast-enhancing left frontal tumor. We discuss this first case of reverse Foster–Kennedy syndrome in the English literature with emphasis on the clinico-radiological and clinico-histopathological correlation.
Postoperative Salvage Decompressive Craniotomy
Authors: Krishnan Prasad , Ghosh Nabanita
Published: September 2022

Salvage decompressive craniotomies performed following complications after initial planned craniotomies may be inadequate if they are only restricted to removal of the small previously replaced bone flap with some additional nibbling of bone from the surrounding craniotomy margins by retracting the skin. To achieve the aim of adequately decreasing intracranial pressure without affecting wound healing, fresh incisions need to be placed to expand the craniotomy adequately while not compromising vascularity of the scalp. The rationale and safety of the simple posteriorly placed release incision to expand frontotemporal flaps is described.
Epidural Fluid Collections After Cranioplasty
Authors: Raju Dimble , Bhosle Rajesh , Krishnan Prasad
Published: September 2022

Background:

Common complications following cranioplasty (CP) include infections, seizures, bone flap resorption, and intra-cranial hemorrhages. Epidural fluid collections (EFCs), often seen in the immediate post-operative scan as hypo-dense accumulations below the bone flap, have been very infrequently discussed in the literature as in the majority of the cases, they are small, get resorbed spontaneously, and usually do not cause neurological deficits.

Objective:

To document our experience with EFCs that needed re-operation and analyze their clinical and radiological findings.

Materials and Methods:

We describe a series of six cases of symptomatic EFCs following CP that necessitated re-operation in a series of 89 cases over 7 years.

Conclusions:

EFCs following CP have a different pathogenetic mechanism compared to post-operative epidural hemorrhages. Meticulous surgical techniques can reduce their incidence. Symptomatic EFCs can be evacuated by either re-opening the flap or placing burr holes in the replaced bone. EFCs may become symptomatic even a few days after CP.
A Retrospective Cytogenetic Abnormality in Pediatric Acute Lymphoblastic Leukemia
Authors: Ghaffari Kazem , Kouhfar Athena , Ghasemi Ali , Gholami Milad , Arjmand Ali , Falahati Vahid
Published: September 2022

Background:

Acute lymphoid leukemia (ALL) is the largest subset of hematologic malignancies, accounting for approximately 70%–80% of childhood leukemia, and is most common at age 4 years. The aim of this study was to define the frequency of chromosomal abnormalities in pediatric ALL.

Materials and Methods:

In this 11-year retrospective study, we investigated 99 patients which referred to our department due to ALL from 2010 to 2020. The age group of the patients ranged from 6 months to 14 years with a mean of 6.71 ± 4.09 years. Clinical and diagnostic findings were extracted from patients’ medical records.

Results:

We showed cytogenetic abnormalities of 99 pediatric ALL patients, including 78 pre-B-ALL, 9 common B-ALL, and 12 T-ALL cases. The 5-year overall survival rate (OSR) and event-free survival (EFS) of all cytogenetic abnormalities (n = 99) were 48% and 43%, respectively. There was a significant relationship between the two cytogenetic abnormalities, hypodiploidy and t(9;22), with death (P < 0.05). On comparing the subjects with normal cytogenetics to the other cytogenetic abnormalities, EFS was significantly low for hypodiploidy (P = 0.0163, hazard ratio = 0.5308) and t(9;22) (P = 0.0131, hazard ratio = 0.4908), while other cytogenetic abnormalities did not have a statistically significant difference in EFS.

Conclusions:

Our results emphasized the importance of the cytogenetic findings in evaluating the survival outcomes, which allows identifying a variety of OSR and EFS, because some of the cytogenetic abnormalities may interfere with the death and prognosis.
The Value of Vicarious Experiences in Health Professions Education
Authors: Forbes Roma
Published: September 2022

Vicarious experiences are an educational approach that, when used effectively, can harness the benefits of learning with and from others. As a major source of self-efficacy, vicarious experiences can be used in myriad ways to enhance learning. With key design strategies including careful selection of people and tasks to observe, prompting, discourse, and collaboration, this faculty development paper outlines how health professions educators can capture the benefits of vicarious experiences in, and out of, the traditional classroom setting.
Preliminary report on value of Wallis interspinous device for back pain following microdiscectomy
Authors: Hsieh Cheng-Ta , Chen Yu-Hao , Huang Kuo-Chang , Ko Pi-Chan , Sun Jui-Ming
Published: September 2022

Background:

Postoperative back pain is a common complaint following microdiscectomy. The Wallis implant, an interspinous process device, is effective against mechanical low back pain due to spinal instability following discectomy. The present study aims to evaluate the value of the Wallis implant with microdiscectomy compared with microdiscectomy alone.

Materials and Methods:

Twenty patients were enrolled between June 2016 and August 2019. All patients received complete radiography and completed a questionnaire before and 1, 3, 6, and 12 months after surgery. Clinical outcomes were evaluated using the visual analogue scale (VAS) for back pain and Oswestry Disability Index (ODI). Radiologic outcomes were posterior disc height, foraminal height, foraminal area, segmental angle, and range of motion in flexion and extension views.

Results:

The Wallis group contained six male and three female patients (mean age 45.7 ± 13.3 years, range 20–61 years), and the control group comprised three male and eight female patients (mean age 47.6 ± 7.5 years, range 34–58 years). All patients had clinical improvements in VAS score and ODI after microdiscectomy alone or with the placement of the Wallis implant. The Wallis group had more favorable mean VAS score and ODI at the 1-, 3-, 6-, and 12-month follow-ups compared with the control group. However, the mean VAS score of the Wallis group was significantly lower than that of the control group only at postoperative month 6 (P = 0.012), whereas the mean ODI in the Wallis group was significantly better than that of the control group only at postoperative months 1 (P = 0.036) and 12 (P = 0.042). Although greater posterior disc height, foraminal height, and foraminal area were observed in the Wallis group, especially in the extension view, the difference in comparison with the control group was not significant.

Conclusion:

Our limited results indicate that the Wallis implant may reduce postoperative low back pain (VAS score) and improve quality of life (ODI) following microdiscectomy. However, the difference between microdiscectomy alone and microdiscectomy with the Wallis implant was not consistently significant throughout the 12 months of follow-up, regardless of the maintenance of radiologic outcomes.