Adequate Distance Research Articles

Prevalence of anemia and its predictors among patients with chronic kidney disease admitted to a teaching hospital in Ethiopia: A hospital-based cross-sectional study.

Anemia is a common complication of chronic kidney disease (CKD) and is associated with adverse patient outcomes. However, data on the prevalence of anemia in CKD patients is sparse, particularly in resource-limited settings. Therefore, this study aimed to assess the prevalence of anemia and its predictors among patients with CKD admitted to the Jimma medical center, southwest Ethiopia. A hospital-based prospective cross-sectional study was conducted from September 1 to November 30, 2020. All adult patients with CKD aged ≥18 years who fulfilled the inclusion criteria were consecutively recruited into the study. Data were entered into the Epi data manager version 4.4.1 and then exported to SPSS version 22 (IBM Corp., Armonk, NY) for analysis. The predictors of anemia were determined using multivariable logistic regression analysis. Statistical significance was set at P < .05. A total of 150 patients were included in this study. Of these, 64.67% were male, 56.67% had stage 5 CKD, 78% had a CKD duration of less than 1 year, and 74% had proteinuria. Hypertension (40.7%) and diabetes (14.7%) were the common causes of CKD. The prevalence of anemia was 85.33%. Of the patients, 28.67%, 40.67%, and 16% had mild, moderate, and severe anemia, respectively. On multivariate logistic regression, stage 4 CKD (adjusted odds ratio [AOR] 3.2, confidence interval [CI]: 1.78-12.91, P = .025), stage 5 CKD (AOR 4.03, CI: 1.17-13.73, P = .016), and CKD duration of less than 1 year (AOR 3, CI: 1.19-9.11, P = .007) were significantly associated with anemia. The prevalence of anemia among stage 3 to 5 CKD patients was very high. Anemia was significantly associated with the severity and duration of CKD. Therefore, serial follow-up of patients with a long duration and advanced stages of CKD may help prevent anemia and its adverse consequences.

Hubungan Kelandaian Jalan dan Panjang Landai Terhadap Kecelakaan Lalu Lintas Jalan Tol

The Semarang – Solo toll road at Km 437+200 – 439+400 is one of the unique segments because many double horizontal and vertical alignments are encountered along approximately 1,600 m. Although this segment geometrically can be considered quite good because it provides adequate stopping distance, the accident data from PT. Trans Marga Jateng showed that this segment is prone to accidents. This studyevaluated this segment's slope and slope length and their relationship to the potential for accidents. This segment was divided into three sections based on the slope and two vehicle types: light vehicles (LV) and heavy vehicles (HV). The results showed that the speed of LV was not significantly affected by slope and slope length variations, but this was not the case for HV. This condition results in a significant speed gap with great potential for accidents, especially at 00.00 – 06.00 and 12.00 – 18.00 when the driver is drowsy or fatigued. Therefore, an in-depth evaluation is recommended on the regulations allowing HVs to operate on toll roads, taking into account the weight-to-power ratio (PWR) and the maximum weight of the HV.

Infection prevention and control in healthcare facilities in Albania

Aim: The objective of this study was to assess the current status regarding Infection Prevention and Control (IPC) in selected healthcare facilities in Albania in light of the ongoing COVID-19 pandemic which continues unabated. Methods: A cross-sectional study was conducted in April 2021 including a nationwide representative sample of 505 health professionals working mostly in primary health care centres in Albania (84 men and 421 women; response rate: 95%). A structured questionnaire developed by the World Health Organization was administered online to all participants inquiring about a wide range of measures and practices employed at health facility level for an effective IPC approach. Fisher’s exact test was used to assess potential urban-rural differences in the distribution of characteristics regarding IPC aspects reported by survey participants. Results: About 47% of health facilities did not have a designated focal point for IPC issues; the lack of one patient per bed standard was evident in more than one-third of health facilities (37%); and the lack of an adequate distance between patient beds was reported in a quarter of health facilities (which was twice as high among health facilities in urban areas compared to rural areas). Furthermore, water services were always available only in about two-thirds of health facilities (63%), whereas an adequate number of toilets (at least two) was evident in slightly more than half of the health facilities surveyed (53%). Also, one out of four of the health facilities did not have functional hand hygiene stations and/or sufficient energy/power supply. A completely adequate ventilation was evidenced in slightly more than half of the health facilities (51%). Four out of five health facilities had always available materials for cleaning and about half (49%) had always available personal protective equipment. Functional waste collection containers were available in nine out of ten health facilities, of which, four out of five were correctly labelled. Conclusion: This study informs about the existing structures, capacities and available resources regarding IPC situation in different health facilities in Albania. Policymakers and decision-makers in Albania and in other countries should prioritize investments regarding IPC aspects in order to meet the basic requirements and adequate standards in health facilities at all levels of care.

Assessing visual symptoms related to dry eye and refractive error in school students before and after online classes during COVID-19 pandemic

Background: During the COVID-19 pandemic, there was a major change in the mode of education from offline to online classes for the school students. Objectives: To determine if school students have developed symptoms related to dry eye. Methodology: Its descriptive cross-sectional study. This study was conducted in a reputed school in the city and 1000 students who had attended online classes during the covid-19 pandemic by the Department of Ophthalmology, Chettinad hospital and research institute, Kelambakkam, Tamil nadu, India Results: About 41% experienced redness of eye, 38% experienced blurring of vision, 36.6% had eye pain, 32% had burning sensation of eyes signs of dryness of eye. 50.2% had adequate distance between your gadget and eyes, 36.1 % had too close to eyes and 13.7 % had too far from eyes. Regarding the eye checkup, 43.7% never checked up their eyes, 11.6% does annual examination and 44.7% does rarely. Comparison between duration of Electronic Gadget usage per day during online class and offline class was significantly reduced after the offline class commencement. P value is 0.000001. Conclusion: There is significant Digital screen exposure time difference is observed during online and in offline classes. And its impact in visual refractive errors and computer vision syndrome

ЭТНИЧЕСКАЯ ИДЕНТИЧНОСТЬ НАСЕЛЕНИЯ ГОРОДА САМАРЫ И САМАРСКОЙ ОБЛАСТИ: ОСНОВНЫЕ ОСОБЕННОСТИ И ЗНАЧЕНИЕ В ВОСПИТАНИИ ЭТНИЧЕСКОЙ ТОЛЕРАНТНОСТИ

The proposed research presents the results of the study of the peculiarities of ethnic identity of the population of Samara and the Samara region, analyzes and highlights its influence on the formation of the ethnic tolerance and self-awareness of the residents of this region. The article contains a general outline of the main provisions of existential social work. Ethnic identity within the framework of the article is interpreted as a socio-psychological category, as a dynamic and multidimensional formation, which characterizes the feeling (implicit component) and awareness (explicit component) of a person as a member of a certain ethnic group/community. In accordance with this interpretation, the purpose of the study was to identify socio-psychological determinants that determine the formation of the ethnic identity of the population of Samara and the Samara region. According to the results of the conducted research with the participation of 300 respondents representing 6 ethnic groups (Russians, Mordva, Chuvash, Tatars, Kazakhs and Armenians) and 2 territories of residence (the city of Samara and other settlements). Samara and other settlements of the Samara region), and the use of 5 diagnostic techniques (“Draw a planet”, “Unfinished sentences”, “Semantic differential”, “Who am I”, “Social distance scale”) it was found that in general among the representatives of the population of Samara and the Samara region the tendencies of ethno-relativism dominate. This is determined by the maintenance of a positive image of representatives of different ethnic groups, efforts to form regional self-awareness (relatively higher importance of the role of a resident of the Samara region in the structure of social roles), as well as educational and pedagogical efforts to increase ethnic tolerance in the region (adequate social distance between ethnic groups). In addition, some differences in the type of the ethnic identity and the expression of socio-psychological formation in representatives of different ethnic groups living on the territory of Samara and the Samara region have been established. Prospects for further psychological, pedagogical and socio-psychological efforts to foster ethnic tolerance in a multi-ethnic region are identified.

Clinical Practice Guidelines for the Use of Transcranial Direct Current Stimulation in Psychiatry.

Clinical Practice Guidelines for the Use of Transcranial Direct Current Stimulation in Psychiatry.

Small hydropower development potential in the Densu River Basin, Ghana

The study investigated potential sites for the development of Small Hydropower Systems (SHP) to augment the existing energy supply in the UDRB. Remote sensing and the Soil and Water Assessment Tool (SWAT) were employed to generate and simulate basin parameters for the hydropower analysis. The energy potential of suitable sites was evaluated using flow duration curves (FDC) and power duration curves (PDC). Results indicate that the upper DRB has potential for small hydropower development with nine sites along the river having an estimated combined firm power of 7.89 MW. The highest hydropower potential sites were located at HP1, HP7, and HP4 with corresponding firm energies of 13.39 GWh, 7.94 GWh, and 6.83 GWh and estimated annual energy production of 28.68 GWh, 14.36 GWh, and 12.68 GWh respectively. Given the adequate spacing distance between sites HP1 and HP4 (11.38 km) and HP4 and HP7 (11.31 km) with a combined annual energy production of 55.72 GWh, a cascade hydropower arrangement of sites HP1, HP4, and HP7 is recommended along the Upper section of the Densu River. However, based on the analysis, these hydropower sites could be developed as a cascade storage hydropower with a 50% or 75% dependability with an installed Francis turbine.

Combining beams in different locations for aerospace defense in a turbulent atmosphere

A fixed high-power laser system used as an aerospace defense weapon has limitations such as the transmitter size, serious thermal blooming during propagation, rapid motion, and the variation of the location of the target. In the present paper, we propose a method by arranging many high-power systems with adequate distance in a defense area. The intensity distribution and the energy irradiated on the target are studied and compared with a fixed laser system. Results show that adequate arrangement of many high-power laser systems can reply to the arbitrary and rapid motion of the target.

Robotic liver resection for hepatocellular carcinoma: analysis of surgical margins and clinical outcomes from a western tertiary hepatobiliary center.

This study was undertaken to determine surgical outcomes of patients undergoing robotic hepatectomy for hepatocellular carcinoma (HCC) and to investigate the correlation between tumor distance to margin and perioperative outcomes, as well as overall survival (OS). To our knowledge, this study represents the largest series of robotic liver resection for HCC in North America. We retrospectively analyzed 58 consecutive patients who underwent robotic liver resection for HCC. Patients were further stratified by tumor distance to margin (≤ 1mm, 1.1-9.9mm, ≥ 10mm) and their clinical outcomes including OS were compared. A majority of patients attained a greater than 1mm tumor distance to margin (81%). There were no differences in tumor size between patient cohorts who attained ≤ 1mm, 1.1-9.9mm, and ≥ 10mm margins. There were no differences in pre-, intra-, and postoperative outcomes among the three cohorts. Cost variables of interest were also similar. OS was highest in the > 10mm margin cohort, and this was statistically significant at 3 and 5years. Robotic HCC resection was associated with adequate tumor distance to margin. Wide margins ≥ 10mm are associated with the best OS.

Investigation of community based hepatitis a outbreak in a district in Northern Kerala

Background: Hepatitis A is the most common form of acute viral hepatitis worldwide. The disease is closely associated with unsafe water or food, inadequate sanitation and poor personal hygiene. Objectives: An epidemiological investigation was carried out to investigate the outbreak, describe epidemiological features and recommend measures for control. An epidemiological case sheet was prepared, case definition formulated. Result: 82 cases of hepatitis A was confirmed. According to investigation, twenty students and one religious teacher staying at nearby mosque were infected and majority was belonging to the age group 15 -25 years. There was clustering of cases in two wards of this panchayath mostly which was around the mosque. Attack rate was found to be more in the age group 15–25 years(13.31%). Males (3.37%) had an attack rate almost 3.5 times higher than that of females (0.96%). One death was reported. The case fatality rate was 1.21. Conclusion: The provision for safe drinking water and proper sanitation needs to be considered high priority by Panchayath. There should be attempts for health awareness of handwashing, proper chlorination and adequate distance between septic tank and water source at households.

Safe Driving Distance and Speed for Collision Avoidance in Connected Vehicles.

Vehicle tailgating or simply tailgating is a hazardous driving habit. Tailgating occurs when a vehicle moves very close behind another one while not leaving adequate separation distance in case the vehicle in front stops unexpectedly; this separation distance is technically called “Assured Clear Distance Ahead” (ACDA) or Safe Driving Distance. Advancements in Intelligent Transportation Systems (ITS) and the Internet of Vehicles (IoV) have made it of tremendous significance to have an intelligent approach for connected vehicles to avoid tailgating; this paper proposes a new Internet of Vehicles (IoV) based technique that enables connected vehicles to determine ACDA or Safe Driving Distance and Safe Driving Speed to avoid a forward collision. The technique assumes two cases: In the first case, the vehicle has Autonomous Emergency Braking (AEB) system, while in the second case, the vehicle has no AEB. Safe Driving Distance and Safe Driving Speed are calculated under several variables. Experimental results show that Safe Driving Distance and Safe Driving Speed depend on several parameters such as weight of the vehicle, tires status, length of the vehicle, speed of the vehicle, type of road (snowy asphalt, wet asphalt, or dry asphalt or icy road) and the weather condition (clear or foggy). The study found that the technique is effective in calculating Safe Driving Distance, thereby resulting in forward collision avoidance by connected vehicles and maximizing road utilization by dynamically enforcing the minimum required safe separating gap as a function of the current values of the affecting parameters, including the speed of the surrounding vehicles, the road condition, and the weather condition.

Cars overtaking cyclists on different urban road types – Expectations about passing safety are not aligned with observed passing distances

Cars overtaking cyclists have been identified as a source of crashes and subjective risk. Several studies investigated the passing distance for different road types. There has been less research concerning cyclists’ expectations concerning the passing distance at different road types. Thus, we aim at contrasting cyclists’ expectations about the passing safety for different speed limits and cycling infrastructures with the passing distances observed at corresponding urban road types. For this purpose, we show participants images of a predefined set of survey zones in a web-based survey, and ask them about the expected passing safety of cars overtaking them when imagining riding their bikes at these locations. We measure the observed passing distances at the same survey zones with a bike-mounted sensor. We find that cars meet the German legal minimum passing distance of 1.5 m in towns in only 30% of all observed events. In 30 km/h speed zones, passing distances at roads featuring dedicated cycling infrastructure (e.g. bike lanes, cycling boulevards) are decreased as compared to those featuring no cycling infrastructure. In contrast, people estimate that the passing safety on roads with dedicated cycling infrastructure is safer than without cycling infrastructure. This effect is even more pronounced on living streets. Situations where oncoming cars (e.g. living streets, ‘opposite’ roads) must be passed in close distance are apparently not perceived as particularly dangerous. Cycling tracks in 50 km/h speed zones increase both the observed passing distance and the corresponding expectations about passing safety. Taken together, the qualitative comparison of the two datasets implies that cyclists’ expectations about cars passing them in a more adequate and safe distance in streets with reduced speed limits and dedicated cycling infrastructure are not justified in light of the actually observed passing distances. Possible explanations for the contradicting patterns could be that cyclists prefer situations where space is explicitly dedicated for bikes, that they account for the anticipated car traffic volume, and that they assume oncoming cars as less dangerous to pass.

Radiative Darcy-Forchheimer Micropler Bödewadt flow of CNTs with viscous dissipation effect

This article aims at the examination of the three-dimensional micropolar nanofluids of single and multi-walled carbon nanotubes (CNTs) dissolved in water and gasoline liquids for the first time reported to the case of so-called classical Bo¨dewadt flow, which occurs when a fluid rotates at an adequate great distance out of a static disk. The static disk is then stretched linearly in the radial direction. The Darcy-Forchheimer porous media are also taken into account. Energy equation is investigated in existence of convection and radiation. The effect of viscous dissipation is also taken into account. The flow field equations are converted from PDEs to ODEs using appropriate transformation. The implementation of the bvp4c technique (Shooting scheme) is used to construct solutions to these ODEs. In addition to Nusselt number, skin friction, axial velocity, radial velocity, tangential velocity, micro-rotational velocities and fluid temperature are all investigated using physical factors. The finding indicates that the volume fraction enhanced, the micro-rotational velocities enhances. The tabulation outcomes indicates that the skin friction declined for escalating values of porosity parameter and volume fraction, while Nusselt number show opposite behavior. It has been also discovered that the effect of multiple-walled CNTs is quite effective than that of single-walled CNTs. When compared to water-based fluids, gasoline oil also displays an overarching trend.

Family-acquired photographs for the evaluation of pediatric head shape via telemedicine: an analysis of photograph quality.

Telemedicine can be an effective tool for the evaluation of the pediatric patient with a cranial deformity, but it increases the reliance of neurosurgical providers on data provided by patients and families. Family-acquired photographs, in particular, can be used to augment the evaluation of pediatric head shape abnormalities via telemedicine, but photographs of sufficient quality are necessary. Here, the authors systematically reviewed the quality and utility of family-acquired photographs for patients referred to their pediatric neurosurgery clinic for telemedicine-based head shape evaluations. All telemedicine encounters that were completed for head shape abnormalities at the authors' institution between May 2020 and December 2021 were retrospectively reviewed. Instructions were sent to families prior to each visit with examples of ideal photographs. Three orthogonal views of the patient's head-frontal, lateral, and vertex-were requested. Data were collected regarding demographics, diagnosis, follow-up, and photograph quality. Quality variables included orthogonality of each requested view, appropriate distance, appropriate lighting, presence of distracting elements, and whether hair obscured the head shape. Overall, 565 patients had 892 visits during the study period. A total of 1846 photograph requests were made, and 3335 photographs were received for 829 visits. Of 2676 requested orthogonal views, 1875 (70%) were received. Of these, 1826 (97%) had adequate lighting, 1801 (96%) had appropriate distance, and 1826 (97%) had no distracting features. Hair did not obscure the head shape on the vertex view in 557 visits with orthogonal vertex views (82%). In-person follow-up was requested for further medical evaluation in 40 visits (5%). The family-acquired photographs in this series demonstrated high rates of adequate lighting and distance, without distracting features. Lack of orthogonality and obscuration of the head shape by hair, however, were more common issues. Family education prior to the visit may improve the quality of family-acquired photographs but requires an investment of time by medical staff. Efforts to further improve photographic quality will facilitate efforts to perform craniometric evaluations through telemedicine visits.

Flapless dental implant placement using a recently developed haptic robotic system

A recent technological breakthrough in implant surgery is the use of robotic guidance (Yomi®, Neocis Inc).1–3 The technique aims to mitigate human-based error and eliminate the use of static surgical guides by algorithmically directing surgeons according to their virtual treatment plan.2 The system’s spatial awareness algorithm fixes the surgeon’s handpiece prior to initiating surgery to ensure that the surgeon is at the correct angulation and depth, and can maintain an adequate safe distance from key anatomical structures.

Prevalence and Associated Factors of Personal Protective Measures Among the Southeastern Iranian Population During the COVID-19 Pandemic

Introduction: The main focus of our study was on prevalence and potential explanatory factors related to personal protective measures (e.g., face mask wearing and physical distancing) in the southeastern Iranian population during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A total of 351 participants in southeastern Iran were examined in this cross-sectional study using self-report scales of personality traits, COVID-19 risk perception, face mask wearing, physical distancing, and public trust. The data were analyzed by SPSS v25 software at the significance level of p<0.05. Results: Descriptive statistics showed that the prevalence rates of COVID-19 risk perception and face mask wearing among participants were 76.4% and 77.8%, respectively. In addition, 59.6% of participants reported that they maintained an adequate distance when communicating with others; 41.9% acknowledged that they did not allow relatives and friends to visit them at home; 46.8% said they preferred to stay at home and not go outside unless necessary. Furthermore, multiple regression analysis revealed that older age, being female, lower levels of neuroticism and higher levels of extraversion, agreeableness, conscientiousness, COVID-19 risk perception, and public trust were associated with higher adherence to personal protective measures. Conclusions: These results emphasized the importance of individual differences in reacting to the COVID-19 pandemic and provided essential information about related factors of personal protective measures. However, further investigations should be carried out due to inconsistent findings concerning the roles of age, gender, education, income, and neuroticism in adopting personal protective measures.

NATURALLY VENTILATED CLASSROOMS: CO2 AND COVID PROTECTION

ABSTRACT: Natural ventilation has become one of the most effective and sustainable strategies to address COVID-19 in confined spaces. Air intake through windows and other openings improves the Indoor Air Quality (IAQ) of a classroom, decreases the likelihood of respiratory disease transmission with an adequate social distance of about 1.5 m and is affordable in terms of energy consumption. In this study, a comparison of CO2 concentration, wind speed, number of people, type of ventilation and window surfaces of a school in a Mediterranean climate is carried out for 4 different cases of opening. For this purpose, CO2 levels were measured in different classrooms with different window openings (33%, 67%, 81%, 81%). (33%, 67%, 81% and 100% respectively). In addition, three types of ventilation (cross ventilation, partial cross ventilation and multidirectional ventilation) were analyzed in a time period between February and March 2021. The results show an interaction between CO2 levels and the type of ventilation. Thus, the fact that the window surface is a critical factor in reducing CO2 concentrations was determined, considering that the distance between students was approximately 1.5 m. Therefore, the orientation of buildings towards the predominant wind direction and the Window to Floor Ratio (WFR) should be reconsidered in new constructions. Keywords: natural ventilation, indoor air quality, carbon dioxide (CO2) concentration, school, WFR.

3D progressive damage analysis of a unidirectional multi-layered composite for mechanical joints

ABSTRACT Due to the presence of holes in composite mechanical joints, stresses around the holes are increased, and they may cause failure in the composites. Analysis of the composite behaviour after damage initiation around the holes is important, complex, and mostly three-dimensional. In order to achieve accurate results about the composite failure modes, damage analysis using a modern criterion is needed. In this research, to investigate the damage behaviour of a unidirectional multi-layered composite plate of a mechanical joint under pure tension, three codes are prepared in the USDFLD, VUSDFLD and VUMAT subroutines based on the Hashin criterion and implemented in ABAQUS software. These codes, using the methods of suddenly and gradually degradation in composite properties, progressively simulate the three-dimensional damage behaviour of the composite plate after damage initiation. The results show that, when a mechanical joint is under pure tension, the adequate distance from the edge of a hole to the edge of a composite plate is about two times the hole diameter. Furthermore, it is found that to rapidly investigate and analyse a mechanical joint in the composite structures, the USDFLD subroutine, which uses suddenly decreased material properties after damage initiation, is reasonable and more efficient.

Layout optimization for safety evaluation on LNG-fueled ship under an accidental fuel release using mixed-integer nonlinear programming

The Liquefied Natural Gas (LNG)-fueled ship is an alternative solution to deal with the Emission Control Area (ECA) issued by the International Maritime Organization (IMO). LNG fuel has eco-green characteristics since sulfur oxide and particulate matter are eliminated. The equipment sitting on the Fuel Gas Supply System (FGSS) layout needs a good arrangement to prevent the domino effect. This study’s scopes are to establish the feasible FGSS layout based on the equipment position and conduct an accidental LNG release that adopts the Computational Fluid Dynamics (CFD). Mixed-Integer Nonlinear Programming (MINLP) is provided as an optimization tool. The MINLP framework is written in the Python programming language. The minimum separation distance, deck size, and non-overlapping functions of equipment are included as the MINLP constraint. The separation distances are provided based on the Center of Chemical Process Safety (CCPS) recommendation. Also, several options of the separation distance are added that consist of 5.0, 6.0, and 7.0 m to observe the congestion effect. The total pipe length is considered as the MINLP objective that can be used to estimate the pipe cost. The proposed MINLP framework is designated to generate a feasible layout that has an adequate separation distance and minimum cost of the pipe. CFD results show that the increase of separation distance can reduce the gas accumulation effectively which eventually reduces the severity of other consequences. Finally, the feasible layout is proposed based on a series of several consequences under an accidental LNG release, such as gas dispersion, fire, and vapor cloud explosion.

Improving Voice Outcomes After Thyroid Surgery - Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve.

Technological advances in thyroid surgery have rapidly increased in recent decades. Specifically, recently developed energy-based devices (EBDs) enable simultaneous dissection and sealing tissue. EBDs have many advantages in thyroid surgery, such as reduced blood loss, lower rate of post-operative hypocalcemia, and shorter operation time. However, the rate of recurrent laryngeal nerve (RLN) injury during EBD use has shown statistically inconsistent. EBDs generate high temperature that can cause iatrogenic thermal injury to the RLN by direct or indirect thermal spread. This article reviews relevant medical literatures of conventional electrocauteries and different mechanisms of current EBDs, and compares two safety parameters: safe distance and cooling time. In general, conventional electrocautery generates higher temperature and wider thermal spread range, but when applying EBDs near the RLN adequate activation distance and cooling time are still required to avoid inadvertent thermal injury. To improve voice outcomes in the quality-of-life era, surgeons should observe safety parameters and follow the standard procedures when using EBDs near the RLN in thyroid surgery