Specific Instruments Research Articles

Evaluation of Acute Leukaemias by Flow Cytometry and Its Correlation With Diagnosis Using Morphological and Special Staining Techniques.

Leukaemia can be reliably diagnosed and classified by the simultaneous application of multiple techniques. Cytochemical stains that are cheap and do not require any special instruments are very important in developing countries for the diagnosis of acute leukaemia (AL). To diagnose AL in all suspected cases by flow cytometry and to correlate the diagnosis with morphological and special staininglike myeloperoxidase (MPO) and periodic acid-Sciff (PAS)techniques. Methods and materials: The study participants' peripheral blood smear details and bone marrow aspirate smear morphologic findings, as well as socio-demographic information, were taken from the patients' medical files. In total, 57 newly diagnosed instances of acute leukaemia confirmed by flow cytometry were incorporated into the study, which underwentcytochemical labeling and morphological diagnosis. All patients who gave previous consent had their bone marrow aspirated, and a Wright-stained smear was produced for microscopic inspection, cytochemical staining, and immunophenotyping. In an ethylenediaminetetraacetic acid (EDTA) container, peripheral blood was also drawn for the same purpose. During the entire bone marrow smear examination, we used both MPO and PAS staining techniques. The study was carried out between July 2019 and June 2020. Out of 57 cases in the study, 29 (50.9%) cases on cytochemical analysis of leukaemia using PAS and MPO were diagnosed with acute myeloid leukaemia (AML) and 28 (49.1%) were diagnosed as acute lymphoid leukaemia (ALL).Cytochemical analysis of leukaemia using PAS and MPO rendered the diagnosis in 92.9% of acute leukaemia cases in our study. A total of 25 out of 25 AML cases and28 out of 32 cases of ALLwere correctly diagnosed based on morphology and cytochemical staining. Morphology and cytochemical analysis alone were unable to correctly diagnose a total of four ALL cases. All AML cases that were wrongly diagnosed as ALL were mostly M0 and M1-AML. Morphological staining diagnosis by itself is capable of correctly identifying a large proportion of cases of AL, which comprised 92.98% of total cases. There was also a favorable relationship between findings of diagnosis by flow cytometry and findings of diagnosis by morphology assessment in determining acute leukaemias.

Clinical analysis of a new multifunctional instrument set for gasless endoscopic thyroidectomy with two different approaches

BackgroundFollowing the rapid development of endoscopic thyroidectomy techniques, various surgical procedures have been developed (e.g., transoral, submandibular, areolar, axillary, retroauricular, and combined procedures), and each of these procedures has its own advantages. In recent years, gasless endoscopic thyroidectomy has emerged as a feasible procedure, and it has replaced traditional CO2 insufflation approaches because of advantages such as stable cavity construction, pollution reduction, resource saving, and risk reduction. However, each gasless procedure requires special instruments for cavity construction, and this results in enormous wastage of medical resources. In the present study, we introduced a set of instruments developed by our team. This set of instruments is designed to be compatible with the current gasless endoscopic thyroidectomy approaches, including transoral, submandibular, transareolar, transaxillary, retroauricular, combined, and lateral cervical lymph node dissection. Here, we introduced this set of instruments for two gasless endoscopic thyroidectomy procedures (transaxillary and transareolar). Following the incorporation of this set of instruments in regular clinical practice, it could be used for more gasless endoscopic thyroidectomy procedures in the future.ObjectiveTo investigate the feasibility, safety, and efficacy of the self-developed instruments for gasless endoscopic thyroidectomy in two different approaches.MethodsA total of 180 patients diagnosed to have papillary thyroid carcinoma (PTC) between January 2020 and April 2022 were retrospectively investigated. The patients were assigned to a gasless transaxillary group (group A) and a gasless transareolar group (group B). The same gasless endoscopic-assisted instruments were used for both groups. The clinical characteristics, treatment results, and complications were compared between the two groups.ResultsAll 180 patients were successfully operated. The extent of surgical resection in all patients was the same: “unilateral glandular lobectomy + isthmus combined with ipsilateral central zone lymph node dissection.” There were 130 and 50 patients in group A and group B, respectively; one patient in the former group was converted to open surgery due to intraoperative bleeding. No significant difference was observed between the two groups in terms of gender, age, body mass index (BMI), education level, and proportion of concomitant Hashimoto’s thyroiditis (P > 0.05). The establishment of cavity time was significantly longer in group A than in group B (35.62 ± 5.07 min vs. 17.46 ± 2.55 min, P < 0.01). The number of lymph nodes cleared was slightly less in group A than in group B (4.06 ± 2.93 vs. 4.52 ± 2.38, P = 0.07). Moreover, the two groups showed no significant differences (P > 0.05) in the total operative time (145.54 ± 45.11 min vs. 143.06 ± 46.70 min), tumor size (0.68 ± 0.46 cm vs. 0.71 ± 0.49 cm), postoperative hospital stay (4.08 ± 1.48 days vs. 3.72 ± 1.07 days), vocal cord paralysis [4 (3.1%) vs. 2 (4%)], postoperative swallowing discomfort [24 (18.5%) vs. 5 (10%)], and postoperative recurrence and satisfaction scores (3.27 ± 1.52 vs. 3.28 ± 1.53).ConclusionAlthough the two approaches of gasless endoscopic surgery have different operative paths and different time periods for cavity construction, both approaches are similar in terms of the principle of cavity construction, safe and reliable postoperative efficacy, and good cosmetic effect. Therefore, the same set of instruments can be used to complete the surgery in both approaches, thus saving medical resources and facilitating the popularization of this technology.

Transfer Learning Using Musical Instrument Audio for Improving Automatic Singing Label Calibration

AbstractAutomatic Singing Label Calibration (ASLC) aims to enhance the labeling accuracy of coarse singing labels through the analysis of raw audio. However, the ASLC model faces limitations due to the challenges and costs associated with generating or augmenting real‐world songs. To address this problem, we propose a novel approach to strengthen limited singing audio using easily available musical instrument audio. Directly using the musical instrument audio as a data augmentation for the singing audio is unreliable due to the distinct differences between vocal and instrumental sounds. Therefore, we employ transfer learning, which allows relevant knowledge to be transferred from one domain to another. In the pre‐training stage, the ASLC model learns to predict the accurate labels from the musical instrument audio. We then consider the vocal as a special musical instrument and fine‐tune the pretrained ASLC model using a singing annotation data set. Experimental results demonstrate that our transfer learning‐based approach outperforms the original ASLC model. By leveraging the readily available musical instrument audio, our method achieves improved performance in enhancing the labeling accuracy of singing audio. © 2024 Institute of Electrical Engineer of Japan and Wiley Periodicals LLC.

A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-h discharge for breast cancer patients.

Due to the short operation time and no need for special instruments, reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with direct-to-implant breast reconstruction (DIBR) has been rapidly becoming popular in the last three years. However, there has yet to be an evaluation of its oncologic safety or the feasibility of discharging patients within 24 h. In this single-centre retrospective cohort study, individuals diagnosed with stage 0-III breast cancer between May 2020 and April 2022 who underwent traditional open mastectomy or R-E-NSM with DIBR were included. Follow-up started on the date of surgery and ended in December 2023. Data, including demographics, tumour characteristics, medium-term oncological outcomes, and postoperative complications, were collected and analyzed. Propensity score matching (PSM) was performed to minimize selection bias. This study included 1679 patients [median (IQR) age, 50 [44-57) years]. Of these, 344 patients underwent R-E-NSM with DIBR (RE-R group), and 1335 patients underwent traditional open mastectomy (TOM group). The median [IQR] follow-up time was 30 [24-36] months [29 (23-33) months in the RE-R group and 30([24-36) months in the TOM group]. Regarding before or after PSM, the P value of local recurrence-free survival (LRFS, 0.910 and 0.450), regional recurrence-free survival (RRFS, 0.780 and 0.620), distant metastasis-free survival (DMFS, 0.061 and 0.130), overall survival (OS, 0.260 and 0.620), disease-free survival (DFS, 0.120 and 0.330) were not significantly different between the RE-R group and the TOM group. The 3y-LRFS and 3y-DFS rates were 99.0% and 97.1% for the RE-R group and 99.5% and 95.3% for the TOM group, respectively. The rates of any complications and major complications were not significantly different between the RE-R patients who were discharged within 24 h and the RE-R patients who were not discharged within 24 h ( P =0.290, P =0.665, respectively) or the TOM patients who were discharged within 24 h ( P =0.133, P =0.136, respectively). R-E-NSM with DIBR is an innovative oncologic surgical procedure that not only improves cosmetic outcomes but also ensures reliable oncologic safety and fewer complications, enabling patients to be safely discharged within 24 h. A long-term prospective multicenter assessment will be supporting.

C. P. E. Bach, Haydn and the Evolving Keyboard Idioms of the Later Eighteenth Century

AbstractThe long careers of Carl Philipp Emanuel Bach and Joseph Haydn coincided with fundamental transformations in how keyboard instruments were built and played and how composers wrote for them. Haydn's keyboard music probably saw the more profound changes in compositional style, yet C. P. E. Bach and others preceded him in discovering ways to incorporate new keyboard idioms into pieces written for new types of instruments. Bach gradually shifted from writing generic keyboard music to composing in idioms most appropriate to two-manual harpsichords, unfretted clavichords or fortepianos. Haydn likewise began writing in a generic idiom; many works that have been posited as having been meant for the clavichord cannot in fact be assigned clearly to that or any other specific instrument. Although Haydn did eventually turn to writing specifically for the fortepiano, he too made a gradual, and relatively late, transition from a generic approach to one that centred on the grand fortepianos of the late eighteenth century. Bach's influence on Haydn is inseparable from the matter of the keyboard instruments. Although the precise nature and extent of Bach's influence cannot be determined, compositional elements derived by Haydn from Bach's music range from superficial thematic and notational parallelisms to fundamental conceptions of what keyboard music could be or could express.

Instrumentos para avaliação da função e da satisfação sexual das mulheres grávidas no contexto dos cuidados de saúde pré-natais: protocolo de revisão scoping

Introduction Despite the fears and beliefs related to sexual function and satisfaction during pregnancy, the healthy experience of sexuality (which is not reduced to these aspects but encompasses them) is relevant to women. Although quality of life is associated with sexual function and satisfaction, the effect of pregnancy in those dimensions, needs to be further explored in order to prevent problems and respond appropriately to women needs. Objective This scoping review aims to map, in the scientific literature, the assessment instruments to evaluate the sexual function and sexual satisfaction of pregnant women in prenatal health care context. Methods The Joanna Briggs Institute guidelines are used to conduct this protocol. The key information sources to be searched include several databases, such as MEDLINE, CINAHL, MedicLatina, Pubmed, Web of Science, Google Scholar and Open Access Scientific Repository of Portugal. Quantitative, qualitative, or mixed studies and secondary studies published in Portuguese, English, Spanish, French, and between 2018 and 2023 will be included. For inclusion criteria will be considered studies referring to instruments to evaluate sexual function and satisfaction of pregnant woman 18 years or over, in prenatal health care context [Population Concept Context framework]. Titles and abstracts of identified citations will be screened independently and assessed for eligibility by two reviewers. Potentially relevant full-text studies and data will be extracted using a data extraction form. The extraction table will show the data mapped in a descriptive way responding to research questions. Selected documents by each reviewer will be uploaded to the Covidence web tool, to optimize the systematic review process and facilitate collaboration between reviewers. For the management of references, the Mendeley software will be used. Discussion Mapping the instruments will enable to summarize the valid, reliable, and specific assessment instruments, their possibilities, and limitations. This results, will contribute to improve the access to information about sexual function and satisfaction during pregnancy, to identify women needs, and plan specific health care interventions. The outcomes relevance will help to guide health professionals and researchers to use the most appropriate assessment tools in prenatal health care context. Systematic review registration Open Science Framework - registration number: osf.io/csg8t

Secrets Beneath Your Feet—The Fascinating World of Scientific Drilling

Why do scientists drill into the Earth? Drilling is a valuable tool to unravel secrets of the planet’s history because lots of information is safely stored deep below our feet within the Earth. By taking samples from deep in the Earth and performing laboratory tests on them, scientists find rock materials, water, bacteria, and fossils that can help to unravel mysteries of life and the environment over millions of years. Drilling is also important for finding sustainable new resources, such as geothermal heat, which can be used to produce energy for our homes. Drilling can also help us understand and protect our planet. Another important reason for drilling is to install specific instruments deep in the Earth, to monitor Earth’s movements. These instruments help us to better understand natural disasters like earthquakes or volcanic eruptions and can enhance the safety of billions of people worldwide.

“Some Sort of Machine without a Body”

AbstractFrom the mid-1950s, Basel harpsichordist Antoinette Vischer (1909–1973) promoted the harpsichord as a modern instrument, commissioning numerous composers to contribute to a new repertoire. To this end, she turned to György Ligeti, who completed Continuum for her in 1968. The composer had already used the harpsichord in ensembles several times, but now he had to think about it in a soloistic function for the first time, starting from a specific performer with her specific instrument. In this paper, I focus on this relationship between composer, performer-commissioner, and instrument, drawing primarily on the correspondence between Ligeti and Vischer preserved at the Paul Sacher Foundation in Basel. These unpublished letters document their collaboration and how both negotiated their artistic positions and aesthetic concepts of the harpsichord as “some sort of machine.” An in-depth analysis of Ligeti and Vischer's exchange about the instrument's peculiarities and performance issues allows us to better understand their self-conception as artists and their ideas of “modernity.” Furthermore, this case study sheds light on a specific period in the history of an instrument that through the efforts of performers like Vischer was transformed from an artifact of the past to an emblem of the present.

Prehydrated collagenated cortico-cancellous heterologous bone gel and papillae tunneling for isolated intrabony defects: 12-month noninferiority trial.

This study assessed the effectiveness of prehydrated collagenated xenogenic bone gel and a collagenated cortico-cancellous heterologous bone mixture in conjunction with papillae tunneling techniques (PTT) for treating isolated periodontal intraosseous defects. Twenty patients with periodontitis stage III/IV and at least one deep isolated interdental 2/3-wall intraosseous defect were included in the study. Surgical incisions were made vertically at the adjacent tooth or horizontally at the mucogingival junction. A full-thickness flap was then carefully lifted under the papillae using special tunneling instruments. The root surfaces were completely cleaned, and the defects were randomly filled with either prehydrated collagenated bone gel (test group; n = 10) or collagenated cortico-cancellous heterologous bone mixture (control group; n = 10). Wounds were closed with microsurgical sutures. We predicted that the lower 95% confidence interval for the difference between the two procedures would exceed a prespecified noninferiority threshold. All wounds closed sufficiently to prevent biomaterial exposure. The test and control groups showed similar mean pocket depth reduction (3.5 ± 1.0vs. 3.9 ± 1.7 mm; p = 0.52), similar gingival recession (-0.10 ± 0.99vs. 0.2 ± 0.8 mm; p = 0.46), and similar clinical attachment gain (3.6 ± 1.51vs. 3.7 ± 1.8 mm; p = 0.89) at the 12-month follow-up. All results were below the noninferiority margin of the sample. At 12 months, prehydrated collagenous bone gel performed similarly to collagenous heterologous bone granules in the treatment of intraosseous lesions with PTT. In addition, both biomaterials preserved soft tissue with minimal further recession at 1 year. When combined with PTT, collagenous xenogeneic bone granules and prehydrated collagenous bone gel achieve comparable clinical outcomes in intrabony defects.The study was registered under the NCT04782921 on ClinicalTrails.

Managing health through environmental policies. Analysis for European Union countries

PurposeEnvironmental degradation resulting from human activities may adversely affect human health in multiple ways. Until now, policies aimed at mitigating environmental problems such as climate change, environmental pollution and damage to biodiversity have failed to clearly identify and drive the potential benefits of these policies on health. The conducted study assesses and demonstrates how specific environmental policies and instruments influence perceived human health in order to ensure input for a data-driven decision process.Design/methodology/approachThe study was conducted for the 2004–2020 period in European Union (EU) countries with the use of dynamic panel data modeling. Verification of specific policies' impact on dependent variables allows to indicate this their effectiveness and importance. As a result of the computed dynamic panel data models, it has been confirmed that a number of significant and meaningful relationships between the self-perceived health index and environmental variables can be identified.FindingsThere is a strong positive impact of environmental taxation on the health index, and the strength of this relationship causes effects to be observed in the very short term, even the following year. In addition, the development of renewable energy sources (RES) and the elimination of fossil fuels from the energy mix exert positive, although milder, effects on health. The reduction of ammonia emissions from agriculture and reducing noise pollution are other health-supporting factors that have been shown to be statistically valid. Results allow to identify the most efficient policies in the analyzed area in order to introduce those with the best results or a mix of such measures.Originality/valueThe results of the authors' research clearly indicate the health benefits of measures primarily aimed at improving environmental factors, such as environmental taxes in general. The authors have also discovered an unexpected negative impact of an increase in the share of energy taxes in total taxes on the health index. The presented study opens several possibilities for further investigation, especially in the context of the rapidly changing geopolitical environment and global efforts to respond to environmental and health challenges. The authors believe that the outcome of the authors' study may provide new arguments to policymakers pursuing solutions that are not always easily acceptable by the public.

Cross-cultural validation of the Portuguese version of the Dialysis Symptom Index for haemodialysis patients.

Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) are associated with low quality of life (QoL) and high disease-related symptoms. The patient self-report instruments can assess the burden of physical and psychological symptoms. The Dialysis Symptom Index (DSI) is a specific instrument to evaluate the multidimensional reported symptoms by patients undergoing HD. To translate, validate and assess the psychometric properties of the Portuguese version of the DSI. A cross-cultural adaptation process from English to Portuguese and a validation study (n = 156) were conducted. Reliability, validity and responsiveness were assessed. The patients' most reported symptoms were, nausea (n = 86, 55%), muscle cramps (n = 92, 59%), feeling tired or lack of energy (n = 92, 59%), bone or joint pain (n = 88, 56%) and trouble staying asleep (n = 95, 60%). Cronbach's alpha of the DSI was 0.87, and intraclass correlation coefficient was 0.868 (95%CI 0.836-0.896). The smallest detectable change was 28.32. The Portuguese DSI demonstrates excellent psychometric properties for assessing HD patients' reported symptoms. It highlights symptom severity and impact, providing valuable insights for healthcare practitioners. Nurses can use the DSI to tailor interventions and enhance patient-centred care.

Dupilumab treatment improves signs, symptoms, quality of life, and work productivity in patients with atopic hand and foot dermatitis: Results from a phase 3, randomized, double-blind, placebo-controlled trial

Despite high disease burden, systemic treatment options for patients with atopic hand and/or foot dermatitis (H/F AD) are limited. To evaluate efficacy and safety of dupilumab in H/F AD using specific instruments for assessing disease severity on hands and feet. In this multicenter phase 3 trial, adults and adolescents with moderate-to-severe H/F AD were randomized to dupilumab monotherapy (regimen approved for generalized AD), or matched placebo. The primary endpoint was proportion of patients achieving Hand and Foot Investigator's Global Assessment score 0 or 1 at week 16. Secondary prespecified endpoints assessed the severity and extent of signs, symptom intensity (itch, pain), quality of life, and sleep. A total of 133 patients (adults=106, adolescents=27) were randomized to dupilumab (n=67) or placebo (n=66). At week 16, significantly more patients receiving dupilumab (n=27) than placebo (n=11) achieved Hand and Foot Investigator's Global Assessment score 0 or 1 (40.3% vs 16.7%; P=.003). All other prespecified endpoints were met. Safety was consistent with the known AD dupilumab profile. Short-term, 16-week treatment period. Dupilumab monotherapy resulted in significant improvements across different domains of H/F AD with acceptable safety, supporting dupilumab as a systemic treatment approach for this often difficult to treat condition.

The Non-Speech Oral Movement Assessment for Children

Introduction: Examination of oral movements is often part of an assessment undertaken by a speech and language therapist (SLT). Until now, there have been no specific instruments or tests with reference values for typically developing children in Dutch that exclusively evaluate non-speech oral movements in young children. Therefore, a non-speech oral motor observation list was designed to attempt to bridge this gap: the Non-Speech Oral Movement Assessment for Children (NOMAC). The aim of this study was to evaluate the psychometric properties of the NOMAC in terms of inter-rater reliability and its’ construct validity. In addition, we aimed to collect reference values for non-speech oral movements in children. Methods: Data from typically developing Dutch children aged 2–8 years were collected. Inter-rater reliability was studied by estimating the intra-class correlation coefficient (ICC). Construct validity was investigated by assessing the effect of age group and gender on the mean execution score per item (general linear model). To present normative data, the percentage of the children performing a normal oral motor execution was calculated. Results: The study includes a total of 318 children, divided into 9 age groups. The inter-rater reliability shows a moderate to excellent ICC for most items. A significant effect of the factor age group on almost all items was seen, confirming robust construct validity. Normative data are presented with the percentage of the children performing a normal oral movement execution. Conclusion: Non-speech oral movements can be assessed with the NOMAC in children between 2 and 8 years old and can be compared with values obtained from a normative group. It should be used as part of a clinical feeding and speech assessment. Despite the fact that current insights indicate that oral motor training has no value for improving mastication, swallowing, and speech, it is important to know the status of non-speech oral motor capabilities. With this assessment, a complete profile of the child’s oral motor abilities can be achieved, supportive of clinical decision making in SLT.

Secondary Ion Mass Spectral Imaging of Metals and Alloys.

Secondary Ion Mass Spectrometry (SIMS) is an outstanding technique for Mass Spectral Imaging (MSI) due to its notable advantages, including high sensitivity, selectivity, and high dynamic range. As a result, SIMS has been employed across many domains of science. In this review, we provide an in-depth overview of the fundamental principles underlying SIMS, followed by an account of the recent development of SIMS instruments. The review encompasses various applications of specific SIMS instruments, notably static SIMS with time-of-flight SIMS (ToF-SIMS) as a widely used platform and dynamic SIMS with Nano SIMS and large geometry SIMS as successful instruments. We particularly focus on SIMS utility in microanalysis and imaging of metals and alloys as materials of interest. Additionally, we discuss the challenges in big SIMS data analysis and give examples of machine leaning (ML) and Artificial Intelligence (AI) for effective MSI data analysis. Finally, we recommend the outlook of SIMS development. It is anticipated that in situ and operando SIMS has the potential to significantly enhance the investigation of metals and alloys by enabling real-time examinations of material surfaces and interfaces during dynamic transformations.

Validation of China Health-Related Outcomes Measures-Cardiovascular Disease

ObjectivesChina Health-Related Outcomes Measures (CHROME) was an initiative aimed at developing a system of preference-based health-related quality of life instruments for China. CHROME-cardiovascular disease (CVD) is a CVD-specific instrument with 14 items developed under this initiative. This study aimed to test the psychometric properties of CHROME-CVD. MethodsThis validation study was conducted using cross-sectional questionnaire survey in China. Eligible patients with CVD were recruited and asked to complete the CHROME-CVD, the EQ-5D-5L, and a CVD-specific nonpreference-based health-related quality of life instrument selected according to the confirmed diagnosis of the patients. Item evaluation, internal consistency, measurement invariance, test-retest reliability, structural validity, and construct validity were tested using classic test theory. Item response theory was used to evaluate item-level performance. ResultsA total of 444 patients with CVD (coronary artery disease, n = 276, heart failure, n = 104, angina, n = 33, and atrial fibrillation, n = 16) from 6 provinces in China were enrolled for the validation. Exploratory factor analysis identified 4 factors: chest pain, other symptoms, physical health, and mental and social health. Cronbach’s alpha and intraclass correlation coefficient were >0.8. A total of 20 of 26 (76.9%), and 90 of 95 (94.7%) predefined hypotheses were met for convergent and discriminant validities, respectively. No important difference was identified between subgroups of gender and residency. Response options of 10 items were found overlapped based on categorical response curves, which led to modification to 4-level response options. Wording of 3 items were modified by referring wordings of reference instruments. ConclusionThe validation of the CHROME-CVD demonstrated generally good psychometric properties. Further validation on the modified CHROME-CVD is needed.

Knowledge, practices and barriers to access sexual health of women in the menopausal stages: a cross-sectional study with Brazilian gynecologists

BackgroundSexual health access and care for women in the menopausal stages face significant barriers, presenting deficits in relation to diagnosis and treatment. Although epidemiological data indicate high prevalence of problems related to sexual health in this population, traditionally, the theme is not discussed in health care settings. This study aimed to analyze knowledge, practices and barriers to access sexual health of women in the menopausal stages in the context of women’s health care in Brazil.MethodsWith a cross-sectional design, a questionnaire was distributed electronically, encompassing variables related to knowledge; practices; and barriers to access sexual health of women in the menopausal stages. The data obtained were subjected to analysis using both descriptive and inferential statistics. Specifically, we employed multivariate analysis, employing multiple linear regression models, to discern potential factors associated with outcomes concerning the level of knowledge and the frequency of addressing the topic in professional practice.ResultsThe sample included 70 physicians with specialization in obstetrician/gynecologists who work in health care with women in the menopausal transition or postmenopausal women. A high level of self-reported knowledge about sexual health was identified. Regarding the practices, most of them reported directly proposing the subject and not using instruments. Although they reported frequently addressing the topic in general, topics related to vaginal lubrication, dyspareunia, and sexual dysfunction have been more present in the clinic compared to sexual orientation and women’s relationship with themselves. The main barriers were time limitation and patient discomfort with the topic. The multivariate models indicated that female gynecologists and professionals with higher levels of knowledge on the subject had a higher frequency of addressing sexual health in clinical practice with women in menopausal stages.ConclusionsSexual health access and care for brazilian women in the menopausal stages presents discrepancies in the frequency of approach between the various topics, in addition to the predictive character of technical knowledge in the practices of professionals. To ensure universal access to sexual health services for this population, an active approach through specific instruments is important, as well as the reinforcement of strategies to improve the level of knowledge of professionals.

Transosseous wiring method for simple transverse shaft fracture of the upper extremity

Purpose: A diaphyseal simple transverse fracture (DSTF) of the upper extremity (UE) requires direct anatomical reduction and absolute stability. No standard efficient method exists for reducing and maintaining a DSTF, despite its importance. Here, we introduce our transosseous wiring (TOW) method for UE-DSTFs.Methods: To maintain reduction, the UE-DSTF was first fixed with TOW before definitive fixation with a locking plate across the fracture. We retrospectively reviewed 15 patients with at least 1 year of postoperative follow-up treatment from 2019 to 2021.Results: All patients had achieved anatomical reduction and bone union at the final follow-up. Three patients had hardware removed because of irritation caused by the plate and screws. However, none of those three patients complained of irritation from the wire. One patient experienced refracture at the same site after hardware removal after a fall. The same technique was used in this case, and the bone union was observed 6 months after surgery.Conclusion: TOW is a simple straightforward method that can be applied without special instruments. It could be an efficient method for interfragmentary compression and attachment of a locking plate without the burden of maintaining the reduction of UE-DSTFs.

Upper partial sternal split for pediatric cardiac surgery

ObjectivesWe introduced the use of an upper partial sternal split for pediatric cardiac surgical procedures in our unit in 2016. We report the outcomes of our experience in 51 patients using this approach.MethodsFrom February 2016 to September 2022, 51 patients underwent congenital cardiac surgical procedures using an upper partial sternal split including vascular ring repair (n = 20), subaortic membrane (n = 12), ventricular septal defect closure with aortic valve resuspension (n = 9), aortic arch repair (n = 4), pulmonary artery band (n = 2), pulmonary artery sling (n = 1), supravalvular aortic stenosis (n = 1), aortic valve replacement (n = 1), and pulmonary artery plasty (n = 1). The surgical approach involved a midline skin incision, based on the manubrium, followed by an upper manubriotomy. No special surgical instrumentation was required. Median patient age was 2.9 years (IQR 1.3, 6.0); median body weight was 15 kg (IQR 9.8, 20).ResultsThere was no mortality and no patient required intraoperative conversion to full sternotomy. One patient required re-exploration for bleeding when the incision was converted to a full sternotomy. There were no wound complications in any patient. Twenty-one patients (41%) were extubated on the table and of the remaining 30 patients, 23 patients (76%) were extubated within 24 h of surgery. Eleven patients did not require intensive care unit (ICU) admission. Median ICU and hospital stay was 1 day (IQR 1, 1.25) and 5 days (IQR 4, 8) ,respectively.ConclusionAn upper partial sternal split approach is straightforward and can be performed safely with a preferable cosmetic result in selected pediatric cardiac operations.

The 2030 Agenda in Uruguay: critical aspects of its implementation during the period 2015-2020

We are facing a time of multidimensional crisis that demands new policy responses that place sustainable development at the centre. The 2030 Agenda was born in 2015 as a framework for collective action in response to the challenge of the multidimensional crisis, with the aim of serving as a guide for all countries to move towards sustainable development. This article addresses this challenge by studying the implementation of the 2030 Agenda in Uruguay between 2015 and 2020. It analyses the deployment of this agenda with reference to six critical areas for the success of the 2030 Agenda: the visions and narratives of the agenda, the institutional framework, the strategic vision, coordination and coherence between actors, the role of civil society and the specific instruments for its implementation. The article focuses on the strengths and weaknesses of this process, highlighting the excessive focus on the dynamics of technocratisation and accountability that can undermine efforts for achieving sustainable development.

Biomechanical phenotyping pipeline for stalk lodging resistance in maize

Stalk lodging (structural failure crops prior to harvest) significantly reduces annual yields of vital grain crops. The lack of standardized, high throughput phenotyping methods capable of quantifying biomechanical plant traits prevents comprehensive understanding of the genetic architecture of stalk lodging resistance. A phenotyping pipeline developed to enable higher throughput biomechanical measurements of plant traits related to stalk lodging is presented. The methods were developed using principles from the fields of engineering mechanics and metrology and they enable retention of plant-specific data instead of averaging data across plots as is typical in most phenotyping studies. This pipeline was specifically designed to be implemented in large experimental studies and has been used to phenotype over 40,000 maize stalks. The pipeline includes both lab- and field-based phenotyping methodologies and enables the collection of metadata. Best practices learned by implementing this pipeline over the past three years are presented. The specific instruments (including model numbers and manufacturers) that work well for these methods are presented, however comparable instruments may be used in conjunction with these methods as seen fit.•Efficient methods to measure biomechanical traits and record metadata related to stalk lodging.•Can be used in studies with large sample sizes (i.e., > 1,000).