Specific Instruments Research Articles

Development and validation of the caregiver Burden from infant home NGT care instrument

ObjectiveTo design and validate an age and condition-specific health status instrument to best reflect the parental experience caring for these children with complex needs and home Nasogastric Tube (NGT) placement. Study designCombined Qualitative and Quantitative design, testing and implementation for item production and reduction, followed by formal validation by evaluating validity, reliability, and establishing a clinically meaningful change score. SettingsTertiary care, multi-disciplinary aerodigestive center. ParticipantsAll caregivers whose infant met criteria for eligibility for discharge home from the NICU or Special Care Nursery (SCN) with NGT in place were offered inclusion in this group.Intervention/Exposure: Structured qualitative interviews of these caregivers to explore and define these concepts and domains, to item generate and then reduce, and then psychometric analyses. MethodsStructured, moderated qualitative interviews with parents/caregivers of children who have undergone home NGT care of their children for item creation, design, and then reduction. Reliability was assessed by Cronbach alpha analysis. Construct validity and clinically meaningful change score was assessed using various query methods. Main outcome measuresCronbach's alpha to assess reliability, a priori hypotheses validity analyses, and minimally important clinical difference calculation. ResultsScaled scores of this condition specific instrument ranged from 14 to 74 where higher scores indicate better QOL related to managing the NGT. Cronbach's alpha with all 14 items was 0.93. Validity was assessed by a self-assessment question to discriminate between change (95% CI: 8.5–14.1; p < 0.0001) as well as by other comparators to identify the instrument's ability to discriminate among populations where parents felt a difference in experience. The minimally important difference was calculated at 18 points. ConclusionThis represents the initial validation of the first condition and age-specific health status instrument to assess parent experience of caring for infants requiring a home NGT for dysphagia.

Ergonomic considerations for unique surgeon populations.

Surgeons are rapidly diversifying as a population, introducing new ergonomic challenges. This review describes the challenges that are experienced by special populations of surgeons including small-handed surgeons, pregnant surgeons, and trainees, and evidence-based solutions to overcome them. Small-handed and female surgeons report more musculoskeletal complaints compared with their male counterparts. Pregnant surgeons frequently report development or worsening of musculoskeletal disorders such as carpal tunnel syndrome and low back pain. Trainees also report high rates of musculoskeletal complaints with minimal autonomy to alter their environment. Limited objective data exists regarding the ideal instruments currently available for special populations. Several small, randomized studies have proposed exercise regimens targeting the upper extremities and pregnancy-related pain syndromes with improvements in symptoms. Various methods of ergonomic education have been studied in trainees with improvements in operating room posture and performance. Limited objective data is available to recommend specific surgical instruments for high-risk surgeon populations. Beneficial exercise regimens have been described for musculoskeletal disorders commonly plaguing surgeons but have yet to be studied explicitly in small-handed or pregnant surgeons and trainees.

Patient-reported outcomes in HSCT for autoimmune diseases: Considerations on behalf of the EBMT ADWP, PAC, and Nurses Group

BackgroundOver the last three decades, hematopoietic stem cell transplantation (HSCT) has been successfully used to treat severe and refractory autoimmune diseases (AIDs). A multidisciplinary appraisal of potential benefits and risks by disease and transplant specialists is essential to determine individual suitability for HSCT. ObjectivesPatient-reported outcomes (PROs) and Health-related Quality of Life (HRQoL) instruments can capture the unique patient perspective on disease burden and impact of treatment. MethodsHerein, we describe the basis and complexity of endpoints measuring patient-reported perceptions of efficacy and tolerability used in clinical practice and trials for patients with ADs undergoing autologous HSCT. ResultsPatient-reported outcome measures (PROMs) and patient-reported experience measures (PREM) are key tools to evaluate the impact and extent of disease burden for patients affected by ADs. For formal scientific assessment, it is essential that validated general instruments are used, while adaptations have resulted in disease specific instruments that may help guiding tailored interventions. An additional approach relates to qualitative evaluations, from carefully structured qualitative research to informal narratives, as patient stories. The patients’ subjectively reported responses to HSCT may be influenced by their pre-procedure expectations and investment in HSCT journey. ConclusionsThe complexity of AIDs advocates for individualized and multidisciplinary approach to impact positively the patient journey. PROs and HRQoL need to be collected using validated instruments in clinical practice and trials to enable robustness of data, ensure the impact of the intervention is comprehensively assessed, addressing the main questions and needs of the involved stakeholders.

English Language Teaching Digital Module for Android-Based Food and Beverage Services

The Covid-19 pandemic forced the schools to conduct e-learning. The challenges are even greater for vocational schools since the students do practices using specific instruments. Thus, this study aimed to develop an Android-based digital module for teaching English for food and beverage services to help students learn English effectively through online learning. This study followed the 4D model of research and development study. The data of the study were collected through observation, documentation, expert judgment, and questionnaire. The data were analysed both qualitatively and quantitatively. This study successfully developed the final format of the module in the form of an electronic book consisting of eight units. In addition, the quality of the module can be categorized as very good material based on the questionnaire results, which were given to the related students, lecturers, and expert judges. The exercises provided in the module provide many opportunities for students to practice and learn. The implication of this finding has a potential to revolutionize the way that English is taught and learned. By providing students with access to high quality digital modules can help students to achieve the student’s English language learning in Food and Beverage Services. This research merely evaluates the module in the formative process.

Behavioral Intention of Women to Use E-Learning

Behavioral intention research suggests that it can effectively predicts intention to adopt information technology and emphasizes the importance of examining antecedents of such use. However, the literature also highlights that individual behavioral intentions can be affected by external factors and social influences. Current study examines the impacts of different factors (quality, social, behavioral, and innovative) on behavioral intention to use e-learning system. We designed special instruments to examine female students' behavioral intention to adopt e-learning system by extending the TPB as foundational framework. An extension of TPB is used with McLean &amp; Delone and Innovative Theory to enhance the overall theoretical framework. Survey data collected from 699 female e-learning participants to test the study hypotheses. Findings suggested that subjective norms, self-efficacy, environment quality, and perceived innovativeness presented significant associations to behavioral intention of e-learning. Research implications and limitations are also examined and discussed.

"Cloth-to-Clothes-Like" Fabrication of Soft Actuators.

Inspired by adaptive natural organisms and living matter, soft actuators appeal to a variety of innovative applications such as soft grippers, artificial muscles, wearable electronics, and biomedical devices. However, their fabrication is typically limited in laboratories or a few enterprises since specific instruments, strong stimuli, or specialized operation skills are inevitably involved. Here a straightforward "cloth-to-clothes-like" method to prepare soft actuators with a low threshold by combining the hysteretic behavior of liquid crystal elastomers (LCEs) with the exchange reaction of dynamic covalent bonds, is proposed. Due to the hysteretic behavior, the LCEs (resemble "cloth") effectively retain predefined shapes after stretching and releasing for extended periods. Subsequently, the samples naturally become soft actuators (resemble "clothes") via the exchange reaction at ambient temperatures. As a post-synthesis method, this strategy effectively separates the production of LCEs and soft actuators. LCEs can be mass-produced in bulk by factories or producers and stored as prepared, much like rolls of cloth. When required, these LCEs can be customized into soft actuators as needed. This strategy provides a robust, flexible, and scalable solution to engineer soft actuators, holding great promise for mass production and universal applications.

Left-handedness in otolaryngology, who is right?

This study aimed to ascertain the prevalence of left-handedness (LH) among otolaryngology-head and neck surgery (ORLHN) practitioners, investigate dexterity's impact on LH trainees, and identify common patterns in their training to improve the training experience. A web-based survey was distributed anonymously via email to members of the Saudi Otorhinolaryngology Society. The survey targeted ORLHN attending consultants, board-certified registrars, and current residents. It consisted of three sections: the first focused on the experience of attending consultants in training LH individuals, the second investigated common maneuvers employed by rhinologists, and the third explored the experiences and impacts reported by LH trainees. The study included 174 participants, and found a 13.2% LH prevalence among them. Rhinologists showed disparities, with 50% advising trainees to stand on the left side of the bed and use their left hand for the scope, whereas the other half asked otherwise. Additionally, 94.4% of the participants had not encountered any courses specifically tailored for LH trainees. Among LH trainees, 57% and 41% reported difficulties in learning and performing side-specific procedures such as functional endoscopic sinus surgery and endoscopic septoplasty, respectively, often attempting to switch to their nondominant hand, and feeling disadvantaged due to their laterality. Left-handedness presents challenges for both LH trainees and their trainers in surgical specialties, particularly in ORLHN, in which specific positioning and instruments are crucial to gain access to the desired surgical field. Despite these challenges, there is insufficient support for LH individuals. We recommend encouraging LH trainees to openly disclose and discuss their left-handedness, provide them with mentors, establish standardized operating room setups and techniques, supply appropriate instruments, and demonstrate flexibility in accommodating their needs. Level 5.

Effect of Procurement Planning on Organizational Performance Within the Public Sector: A Case of Ruhengeri Referral Hospital in Musanze District, Rwanda

Public entities in Rwanda spend a significant amount of money on procurement. This is the process of acquiring goods, works, or services from a vendor. The general objective of this study was to assess the effect of procurement planning on organizational performance within the public sector. Specifically, the study assessed the effect of needs assessments in procurement planning on performance of Ruhengeri referral hospital, analyze the effect of quality specification in procurement planning on performance of Ruhengeri referral hospital, examine the effect of cost estimation in procurement planning on performance of Ruhengeri referral hospital and assess the effect of terms of payment in procurement planning on performance of Ruhengeri referral hospital. Research was guided by Resource Based viewpoint theory and Transaction Cost Economics theory. Descriptive research design was adopted in this research. This study has taken 106 populations who have direct works related to procurement planning functions from Ruhengeri referral hospital and reporting health centers (42 working at Ruhengeri referral hospital main location and 64 from 12 health centers under management of Ruhengeri referral hospital). The researcher has determined that due to the small population size, a census inquiry method employed instead of sampling. This study used both primary and secondary data, and each has its specific instruments for collection including questionnaire, documentary and interview. Here the researcher tends to interpret frequency, percentages, mean, and standard deviation, as results of Statistical Package for Social Scientists (SPSS) version 20 while content analysis used to analyze qualitative data. The Model Summary provides valuable observations into the effect of independent variables Terms of payment in procurement planning, Needs identification in procurement planning, Quality specification in procurement planning, Cost estimation in procurement planning on the dependent variable, organization performance. The findings revealed the coefficient of determination (R Square), which is 0.652, demonstrates that 65.2% of the variance in organizational performance of Ruhengeri Referral Hospital explained Terms of payment in procurement planning, Needs identification in procurement planning, Quality specification in procurement planning, Cost estimation in procurement planning. The results indicate the coefficient of needs identification in procurement planning (β: 0.399, p: 0.000), it shows the significant effect of needs assessments in procurement planning on organizational performance of Ruhengeri referral hospital. The results indicate the coefficient of quality specification in procurement planning (β: 0.387, p: 0.001), it shows the significant effect of quality specification in procurement planning on organizational performance of Ruhengeri referral hospital. The results indicate the coefficient of cost estimation in procurement planning (β: 0.152, p: 0.022), it shows the significant effect of cost estimation in procurement planning on organizational performance of Ruhengeri referral hospital. The results indicate the coefficient of terms of payment in procurement planning (β: 0.237, p: 0.021), it shows the significant effect of terms of payment in procurement planning on organizational performance of Ruhengeri referral hospital. It is recommended that Ruhengeri Referral Hospital continues to strengthen its needs assessment process by involving a wider range of stakeholders.

Effect of Lifestyle Counselling via a Mobile Application on Disease Activity Control in Inflammatory Arthritis: A Single-Blinded, Randomized Controlled Study.

Mobile applications (apps) are a resource for information on lifestyle and nutrition which are associated to improved outcomes in inflammatory arthritis. The aim of this study was to explore whether targeted lifestyle counselling via an app improves disease activity in arthritis patients. Patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA) were randomized to 12 weeks of lifestyle counselling via an app (Mida, Midaia GmbH, Germany) pertaining to a healthy Mediterranean Diet, physical activity, and mental health. Disease activity was measured with specific instruments by a blinded physician and categorized (remission, low, moderate, high). Dietary adherence was assessed by the Mediterranean Diet Adherence Screener (MEDAS). Mixed effects logistic regression adjusted to baseline disease activity, age, and sex were calculated. Of 158 patients included (73% female, 53.3 ± 11.7 years), 74 were in the active counselling group (ACG). All showed improvement in low disease activity or remission. ACG patients had an odds ratio (OR) of 2.8 (95%-CI 1.1-7.2, p = 0.035), while OR in the control group was not significant OR = 2.1 (0.9-5.0, p = 0.097). The control group was less likely to reach a MEDAS >= 4 (OR = 0.16 (0.03-0.77), p = 0.02), while this was not seen in the ACG (OR = 0.54 (0.06-4.63), p = 0.6). Patients in the ACG showed a tendency towards improved adhesion to a Mediterranean Diet (MEDAS) (β = 0.35 (-0.05-0.74), p = 0.086). This tendency was not observed in the control group (β = 0.09 (-0.29-0.46), p = 0.64). Individualized lifestyle and dietary counselling via app may help to improve disease control in inflammatory arthritis patients.

Exploratory and confirmatory factor analysis of digital entrepreneur skills

Research in the field of entrepreneurship has become an intriguing area for further investigation. In an era where digital advancements are ubiquitous, previous researchers have identified a gap: the lack of a specific instrument to identify digital entrepreneur skills. Therefore, this study aims to determine the constructs of students’ digital entrepreneur skills. The analysis techniques include confirmatory factor analysis (CFA), exploratory factor analysis (EFA), Pearson correlation, Kendall’s, Spearman’s, and Cronbach’s alpha. The study was conducted over five phases with 235 participants from university students in Indonesia who run or own a business. The results revealed strong instrument validity with robustness ranging from significant Pearson, Kendall’s, and Spearman’s analyses (&amp;amp;lt;0.05) and Cronbach’s alpha (&amp;amp;gt;0.60). The exploratory factor analysis indicated a Kaiser-Meyer-Olkin value of 0.954 (&amp;amp;gt;0.05) and Bartlett’s test (0.000 &amp;amp;lt; 0.05), with all items having values of anti-image (&amp;amp;gt;0.50), communalities (&amp;amp;gt; 0.50), and factor loadings (&amp;amp;gt; 0.40), uncovering three components. Lastly, the CFA demonstrated an overall good fit model, with high first-order factor loadings (&amp;amp;gt;0.60) and a second-order construct digital entrepreneur skills comprising three components: interpersonal digital skills with a factor loading of 0.890, idea and technology management skills (0.920), and adaptation and innovation skills (1.020). The study highlights the critical need for students to develop digital entrepreneurial skills encompassing interpersonal digital skills, ideation, and technology management, as well as adaptation and innovation abilities to thrive in the digital economy and enhance their personal and professional growth. AcknowledgmentI want to thank all those who have helped make this research a success, especially for Sebelas Maret University as a place of affiliation and all respondents willing to participate in my study.

Conformal growth of B/N modified graphene on metal strings by chemical vapor deposition for robust protection

For string-plucked instruments, the metal strings are always subjected to sweating corrosion and ambient oxidation during the daily use. A specifically thin protection coating, which will not alter its timbre and tone, is highly desirable. In this study, a two-dimensional (2D) coating of B/N-modified graphene (BNG) films is proposed to deposit on the surface of Cu alloy strings via chemical vapor deposition (CVD) as a corrosion barrier. Through providing appropriate amount of B/N dopant, conformal growth of BNG films on Cu alloy string substrate with sharp step-terraces topography can be optimized, and largely improving its robust anti-corrosion performance in both short-term electrochemical and long-term ambient corrosion tests for evaluation. On one hand, the conformal coupling between in-situ grown BNG and Cu alloy string can form a strong interaction which limits the interfacial diffusion of corrosive species. On the other hand, once the defects oxidation is initialized, B/N modified graphene can reduce its conductivity, then suppressing the electrochemical corrosion in the long-term protection. With the insights and understanding of in-situ coating method and the enhanced anti-corrosion mechanisms, this work will extend the potential applications of 2D materials as an atomic-thick protectioncoating for some special devices and instruments.

Aftermath Türkiye’s double earthquake: detailed analysis of fracture characteristics and acute management from a level I trauma center

BackgroundThis research investigated surgical interventions for the treatment of extremity and pelvic fractures and aimed to provide an analysis of management challenges under crisis conditions in a Level I Trauma Center after Türkiye’s February 6, 2023, earthquakes.MethodsThe study was a retrospective examination of the medical records of 243 fracture cases associated with the earthquakes. The age, gender, time of admission, types of extremity and pelvic fractures, anatomical localizations, and surgical treatment methods for fractures were recorded. The results of these parameters were evaluated in detail, together with the results of other surgical treatments performed in the hospital in the first week after the disaster, such as fasciotomy, amputation, and wound debridement.ResultsMost of the 243 (119 males and 124 females) patients with extremity fractures and pelvic fractures receiving surgical treatment were adults (n = 182, 74.9%). The most common lower extremity fractures among all fracture cases were tibial shaft (30.8%) and femoral shaft (20.6%) fractures. A total of 33 patients had surgical procedures for the treatment of two or more significant bone fractures involving either the extremity or the pelvic ring. The analysis showed that the median age of patients who underwent surgery due to extremity and pelvic fractures was 36 years, with a range of 1 to 91 years, which was statistically increased compared to patients who received surgery for other musculoskeletal injuries such as fasciotomy, amputation and debridement (p < 0.001).ConclusionFractures were one of the most common musculoskeletal injuries in the first days after earthquakes, and the management of fractures differs significantly from soft tissue injuries and amputation surgeries as they require implants, special instruments, and imaging devices. The delivery of healthcare is often critically impaired after a severe earthquake. Shortages of consumables such as orthopedic implants, power drills, fluoroscopy equipment, and the need for additional staff should be addressed immediately after the earthquake, ideally by the end of the first day.

Unilateral biportal endoscopy via two different approaches for upper lumbar disc herniation: a technical note

BackgroundThe traditional surgical procedures for upper lumbar disc herniation (ULDH) usually lead to frequent complications. We aim to investigate the clinical efficacy of the unilateral biportal endoscopy (UBE) technique in treating upper lumbar disc herniation (ULDH).MethodsFrom January 2020 to December 2021, the clinical data of 28 patients with ULDH treated with the UBE technique were collected and analyzed for surgery time under UBE, postsurgical drainage, postsurgical hospital stay, and complications. The clinical efficacy was evaluated according to the modified MacNab score, Oswestry disability index (ODI), and visual analogue scale (VAS) of low back pain and lower limb pain before the surgery; one week, one month, and three months after the surgery; and at the last follow-up.ResultsAll patients underwent the UBE surgery successfully. The surgery time under UBE for non-fusion cases was 47.50 ± 11.84 min (monosegment) and 75.00 ± 20.66 min (two segments), while that for fusion cases was 77.50 ± 21.02 min. The postsurgical drainage for non-fusion cases was 25.00 ± 13.94 mL (monosegment) and 38.00 ± 11.83 mL (two segments), while that for fusion cases was 71.25 ± 31.72 mL. The postsurgical hospital stay was 8.28 ± 4.22 days. The follow-up time was 15.82 ± 4.54 months. The VAS score for each time period after the surgery was significantly lower (P < 0.05), while the ODI was significantly higher than that before the surgery (P < 0.05). According to the modified MacNab scoring standard, the ratio of excellent to good was 96.43% at the last follow-up. Two patients experienced transient numbness and pain in their lower limbs and no activity disorder after the surgery, and they recovered after conservative treatment.ConclusionsThe clinical effect of UBE technique in treating ULDH was reliable. According to the needs of the disease, the interlaminar approach or paraspinal approach of the UBE technique was selected. This technique took into account the effect of treatment, achieved the purpose of minimal invasiveness, and did not require special instruments. Therefore, it has the potential for clinical application.

Validation of an organ mapping antibody panel for cyclical immunofluorescence microscopy on normal human kidneys.

The lack of standardization in antibody validation remains a major contributor to irreproducibility of human research. To address this, we have applied a standardized approach to validate a panel of antibodies to identify 18 major cell types and 5 extracellular matrix compartments in the human kidney by immunofluorescence (IF) microscopy. We have used these to generate an organ mapping antibody panel for two-dimensional (2-D) and three-dimensional (3-D) cyclical IF (CyCIF) to provide a more detailed method for evaluating tissue segmentation and volumes using a larger panel of markers than would normally be possible using standard fluorescence microscopy. CyCIF also makes it possible to perform multiplexed IF microscopy of whole slide images, which is a distinct advantage over other multiplexed imaging technologies that are applicable to limited fields of view. This enables a broader view of cell distributions across larger anatomical regions, allowing a better chance to capture localized regions of dysfunction in diseased tissues. These methods are broadly accessible to any laboratory with a fluorescence microscope, enabling spatial cellular phenotyping in normal and disease states. We also provide a detailed solution for image alignment between CyCIF cycles that can be used by investigators to perform these studies without programming experience using open-sourced software. This ability to perform multiplexed imaging without specialized instrumentation or computational skills opens the door to integration with more highly dimensional molecular imaging modalities such as spatial transcriptomics and imaging mass spectrometry, enabling the discovery of molecular markers of specific cell types, and how these are altered in disease.NEW & NOTEWORTHY We describe here validation criteria used to define on organ mapping panel of antibodies that can be used to define 18 cell types and five extracellular matrix compartments using cyclical immunofluorescence (CyCIF) microscopy. As CyCIF does not require specialized instrumentation, and image registration required to assemble CyCIF images can be performed by any laboratory without specialized computational skills, this technology is accessible to any laboratory with access to a fluorescence microscope and digital scanner.

Can Green Bonds Boost the Development of Energy Projects in Colombia? An Opportunity for Responsible and Sustainable Investment

The excessive exploitation of natural resources brings with it a growing environmental problem, which is largely due to industrial development. Different international treaties, conventions, and protocols try to mitigate the impacts of global warming. However, new tools are constantly needed to achieve the sustainability of economies and the preservation of renewable resources. In response to this, green bonds arise providing a coherent solution that integrates both the industry and the environment. These bonds constitute a financial instrument allowing the collection of resources, with the only requirement of being invested in sustainable projects generating environmental and social well-being. This paper highlights Colombia's potential as an emerging market attractive for investments classified as green. This Colombian green market is expected to grow, due to the low amounts of GHG emissions compared to the industrialized countries and the richness in natural resources of the nation. However, to develop sustainable energy projects in Colombia, special instruments are required to enhance the promotion and financing of energy projects. For this reason, various financing alternatives to the traditional systems for the development of clean energy must be evaluated. This paper emphasizes the potential of green bonds to improve energy projects in Colombia and obtain additional benefits to reduce climate change through the use of sustainable renewable energies. Through a document review exercise in specialized literature and the application of a case study, the advantage of green bonds over other traditional mechanisms for financing initiatives for small and medium enterprises is demonstrated.

Dapagliflozin and quality of life measured using the EuroQol 5-dimension questionnaire in patients with heart failure with reduced and mildly reduced/preserved ejection fraction.

Although much is known about the usefulness of heart failure (HF)-specific instruments for assessing patient well-being, less is known about the value of generic instruments for the measurement of health-related quality of life (HRQL) in HF. The aim of this study was to assess the relationship between the EuroQol 5-dimension 5-level (EQ-5D-5L) visual analogue scale (VAS) and index scores, clinical characteristics, and outcomes in patients with HF and the effect of dapagliflozin on these scores. We performed a patient-level pooled analysis of the DAPA-HF and DELIVER trials, which investigated the effectiveness and safety of dapagliflozin in patients with HF and reduced ejection fraction (HFrEF) and mildly reduced/preserved ejection fraction (HFmrEF/HFpEF), respectively. Patients reporting higher (better) EQ-5D-5L VAS and index scores had a lower prevalence of comorbidities, including atrial fibrillation and hypertension, than patients with a worse score. They were also more likely to have better investigator-reported (New York Heart Association class) and patient-self-reported (Kansas City Cardiomyopathy Questionnaire) health status and lower median N-terminal pro-B-type natriuretic peptide levels. Compared to patients with the lowest scores (Q1), those with higher EQ-5D-5L VAS scores had better outcomes: the hazard ratio for the composite of cardiovascular death or worsening HF was 0.81 (95% confidence interval 0.72-0.91) in Q2, 0.74 (0.65-0.84) in Q3, and 0.62 (0.54-0.72) in Q4. The risk of each component of the composite outcome, and all-cause death, was also lower in patients with better scores. Similar findings were observed for the index score. Treatment with dapagliflozin improved both EQ-5D-5L VAS and index scores across the range of ejection fraction. Both higher (better) EQ-5D-5L VAS and index scores were associated with better outcomes. Dapagliflozin treatment improved EQ-5D-5L VAS and index scores, irrespective of ejection fraction.

Anterior soft tissue retraction during arthroscopy of the ankle

Ankle arthroscopy has been increasingly employed in recent times due to a wide variety of ankle pathologies and advances in indications and technology. We have described a technique of retraction of the anterior soft tissue structures that can be used during ankle arthroscopy that is easy, does not require special instruments, is quick to apply, and gains valuable tourniquet time by reducing interruptions caused by tissue interference and increasing the visual field.

Financing for pandemic preparedness and response measures: a systematic scoping review.

To obtain insights into reducing the shortfall in financing for pandemic preparedness and response measures, and reducing the risk of another pandemic with social and economic costs comparable to those of the coronavirus disease. We conducted a systematic scoping review using the databases ScienceDirect, Scopus, JSTOR, PubMed® and EconLit. We included articles published in any language until 1 August 2023, and excluded grey literature and publications on epidemics. We categorized eligible studies according to the elements of a framework proposed by the World Health Organization Council on the Economy of Health for All: (i)root/structural causes; (ii)social position/foundations; (iii)infrastructure and systems; and (iv)communities, households and individuals. Of the 188 initially identified articles, we included 60 in our review. Most (53/60) were published after 2020, when academic interest had shifted towards global financing mechanisms. Most (37/60) addressed two or more of the council framework elements. The most frequently addressed element was infrastructure and systems (54/60), discussing topics such as health systems, financial markets and innovation ecosystems. The roots/structural causes were discussed in 25 articles; communities, households and individuals in 22 articles; and social positions/foundations in 11. Our review identified three important gaps: a formal definition of pandemic preparedness and response, impeding the accurate quantification of the financing shortfall; research on the extent to which financing for pandemic preparedness and response has been targeted at the most vulnerable households; and an analysis of specific financial instruments and an evaluation of the feasibility of their implementation.

Comparison of 3D computer-assisted planning with and without patient-specific instrumentation for severe bone defects in reverse total shoulder arthroplasty

BackgroundPreoperative planning is an integral aspect of managing complex deformity in reverse shoulder arthroplasty (RSA). The purpose of this study was to compare the success of patient specific instrumentation (PSI) and 3D computer-assisted planning with standard instrumentation (Non-PSI) in achieving planned corrections of the glenoid among patients undergoing RSA with severe bony deformity requiring glenoid bone grafts. MethodsA retrospective case-control study was performed, including all patients that underwent RSA with combined bone grafting procedures (BIO-RSA or structural bone grafting) for severe glenoid deformity by a single between June 2016 and July 2023. Patients were required to have preoperative and postoperative CT scans as well as preoperative 3D planning performed for inclusion. Patients were divided into two groups based on the use of 3D computer-assisted planning with or without PSI (PSI vs. Non-PSI). The corrected inclination and version were measured by two separate reviewers on preoperative and postoperative 2D CT scans and compared to their corresponding preoperative planning goals utilizing bivariate analyses. ResultsWe identified 45 patients that met our inclusion criteria (22 PSI and 23 Non-PSI). Preoperative inclination (mean ± SD) (PSI 10.12° ± 15.86°, Non-PSI 9.43° ± 10.64°; P = 0.864) and version (PSI -18.78° ± 18.3°, Non-PSI -17.82° ± 11.49°; P = 0.835) measurements were similar between groups. No significant differences in the mean deviation (error) between the postoperative and planned inclination (PSI 5.49° ± 3.72; Non-PSI 6.91° ± 5.05; P = 0.437) and version (PSI 8.37° ± 5.7; Non-PSI 5.37° ± 4.43; P = 0.054) were found between groups. No difference in the rate of outliers (>10° error) was noted in inclination (P = 0.135) or version (P = 0.445) between groups. Greater planned version correction was correlated with greater error when PSI was utilized (PSI r = 0.519, P = 0.013; Non-PSI r = 0.362, P = 0.089). ConclusionBoth PSI and 3D computer-assisted planning without PSI (Non-PSI) appear to be useful techniques to achieve version and inclination correction among patients undergoing RSA with severe glenoid deformity required glenoid bone grafting with no clear superiority of one method over the other. Surgeons should be aware that when utilizing PSI, slightly greater error in achieving version goals may occur as version correction is increased.

SUSTAINABILITY TRANSPARENCY IN SOVEREIGN WEALTH FUNDS: BENCHMARK AND CASE STUDY APPROACH

The COVID-19 pandemic and the current food, energy, and safety crisis caused by the war in Ukraine strongly affected the existing gap in Sustainable Development Goals funding. Restoring global sustainability progress and the 2030 Agenda requires reshaping responsible investment architecture and rethinking the role of sovereign wealth funds as the largest investors in this process.The current study explores the ways in which the most transparent sovereign wealth funds act towards sustainability values and incorporate environmental, social, governance, and ethical criteria (ESGE) into their investment strategy, portfolio, and reporting. Also, 16 high-ranked funds by the Sustainability Transparency Index (Cavagnetto et al., 2022) were investigated by using the case study and benchmark analysis. Study results demonstrate the similarity of all funds disclosure within some questionnaire criteria like sustainability policy, scoring (voting) rules for decision-making, ESGE criteria, stakeholder engagements, and assurance of the financial information disclosed. Nevertheless, qualitative differences were identified between the sustainability transparency criteria of A and B-ranked funds. There is also huge variation in the implementation of funds’ ethical criteria, sustainability coherence, relevance of sustainability goals, disclosure of specific climate-related goals, and foundation membership criteria.Policy implications derived from the differences in sovereign funds' benchmarks are aimed at enhancing the sustainability context in funds’ operating frameworks, developing impact measurement metrics, prioritizing the most material stakeholder requests, sustainability verification procedures, and standardizing funds’ sustainability reporting. Specific channels, instruments, and regulatory measures towards greater funds’ sustainability transparency and their involvement in bridging the sustainable development funding gap may be the subject of further investigation.