Bem-estar no trabalho: influência das condições para criatividade entre psicólogos dos Creas-MG / Well-being at work: influence of creativity conditions among CREAS-MG psychologists / Bienestar en el trabajo: influencia de las condiciones para la creatividad entre psicólogos de los centros de referencia especializados en asistencia social en Minas Gerais (CREAS-MG)

Trata-se de estudo quantitativo correlacional com objetivo de testar um modelo em que Bem-Estar no Trabalho (BET) é explicado pelas Condições Favoráveis e Desfavoráveis para a Criatividade no Ambiente de Trabalho de psicólogos que trabalham nos Centros de Referência Especializado de Assistência Social de Minas Gerais. Após a aprovação do Comitê de Ética, contatos dos centros foram localizados via arquivo público digital. O convite foi enviado por e-mail com o link de acesso ao Termo de Consentimento Livre e Esclarecido; Questionário com Dados Demográficos e Funcionais; Escala de Bem-estar no Trabalho; e Indicadores de Condições para Criar no Ambiente de Trabalho. A medida de BET contempla Afeto Positivo, Afeto Negativo e Realização Pessoal e Profissional; enquanto há seis Condições Favoráveis e três Desfavoráveis à Criatividade no Trabalho. As escalas multidimensionais apresentam evidências de validade e resposta Likert de cinco pontos. Os dados foram analisados a partir de estatísticas descritivas e inferenciais, regressão múltipla padrão para teste do modelo e Alfa de Cronbach para verificação da fidedignidade das escalas. A amostra de conveniência contou com 145 psicólogos, majoritariamente mulheres (n=125), com pós-graduação lato senso (n=102) e vínculo estatutário (n=74). As maiores médias encontradas foram Realização Pessoal e Profissional (M=3.47; DP=0.65), Atividades Desafiantes (M=3.50; DP=0.68), e Excesso de Serviços e Escassez de Tempo (M=3.51; DP=0.85). Os resultados apontam que as Condições para a Criatividade no Trabalho contribuem significativamente para as três dimensões de BET, demonstrando a importância de promover um contexto propício à criatividade e ao bem-estar dos trabalhadores.(AU)

This is a quantitative correlational study aiming to test a model in which Well-Being at Work (WBW) is explained by the Favorable and Unfavorable Conditions for Creativity in the Work Environment of psychologists who work in the Specialized Reference Centers for Social Assistance in Minas Gerais (CREAS-MG). After approval by the Ethics Committee, contacts of the centers were located via public digital file. The invitation was sent by e-mail with the link to access the Informed Consent Form; Questionnaire with Demographic and Functional Data; Workplace Well-Being Scale; and Indicators of Conditions for Creating in the Workplace. The WBW measures Positive Affection, Negative Affection, and Personal and Professional Fulfillment; alongside six Favorable Conditions and three Unfavorable Conditions for Creativity at Work. Multidimensional scales provide evidence of validity and a five-point Likert response. Data were analyzed based on descriptive and inferential statistics, standard multiple regression to test the model and Cronbach's Alpha to verify the reliability of the scales. The convenience sample consisted of 145 psychologists, mostly women (n=125), with lato sensu post-graduation (n=102), and statutory employment (n=74). The highest means are Personal and Professional Fullfilment (M=3.47; SD=0.65), Challenging Activities (M=3.50; SD=0.68), and Excessive Services and Shortage of Time (M=3.51; SD=0.85). The results indicate that the Conditions for Creativity at Work significantly contribute to the three dimensions of WBW and demonstrate the importance of promoting a context conducive to creativity and well-being of workers.(AU)

Este estudio cuantitativo correlacional tuvo el objetivo de probar un modelo en el que el bienestar en el trabajo (BET) se explica por las condiciones favorables y desfavorables para la creatividad en el ambiente laboral de los psicólogos que laboran en los Centros de Referencia Especializados en Asistencia Social en Minas Gerais. Tras la aprobación del Comité de Ética, se buscaron los contactos de estos centros en un archivo digital público. La invitación enviada por correo electrónico contenía el enlace para acceder al Formulario de Consentimiento Informado, al Cuestionario con Datos Demográficos y Funcionales, a la Escala de Bienestar Laboral y a los Indicadores de Condiciones para la Creación en el Lugar de Trabajo. La medida BET incluye afecto positivo, afecto negativo y realización personal y profesional; mientras que la otra medida cubre seis condiciones favorables y tres condiciones desfavorables para la creatividad en el trabajo. Las escalas multidimensionales proporcionan evidencia de validez y una respuesta Likert de cinco puntos. Para el análisis de datos se utilizó estadística descriptiva e inferencial, regresión múltiple estándar para probar el modelo y Alfa de Cronbach para verificar la confiabilidad de las escalas. La muestra de conveniencia consistió en 145 trabajadores, en su mayoría mujeres (n=125), con posgrado lato sensu (n=102) y empleo estatutario (n=74). Los promedios más altos son el logro personal y profesional (M=3,47; DE=0,65), las actividades desafiantes (M=3,50; DE=0,68), el exceso de servicios y la escasez de tiempo (M=3,51; DE=0,85). Los resultados indican que las condiciones para la creatividad en el trabajo contribuyen significativamente a las tres dimensiones de BET y demuestran la importancia de promover un contexto propicio para la creatividad y el bienestar de los trabajadores.(AU)

Wearable Electronics Based on the Gel Thermogalvanic Electrolyte for Self-Powered Human Health Monitoring.

There is always a temperature difference of more than 10 degrees between the human body, as a sustainable heat source, and the ambient temperature. Converting body heat into electricity that in turn is used to drive personal medical electronics is of significance in smart wearable medicine. To avoid the frangibility and complex preparation of traditional thermoelectric materials, we fabricated a gel electrolyte-based thermogalvanic generator with Fe3+/Fe2+ as a redox pair, which presents not only moderate thermoelectric performance but also excellent flexibility. With a micropore-widespread polyvinylidene fluoride diaphragm implanted in the gel, a thermal barrier was created between the two halves, effectively improving the Seebeck coefficient by reducing its thermal conductivity. Considering the superior temperature response of the gel, a self-powered body temperature monitoring system was established by conformally affixing it to the forehead. Meanwhile, the gel patch with a high specific heat capacity can effectively cool down fever patients. This work may offer a new train of thought for exploiting self-powered wearable medical electronics by scavenging low-grade body heat.

Textile Electrocardiogram (ECG) Electrodes for Wearable Health Monitoring.

Wearable health-monitoring systems should be comfortable, non-stigmatizing, and able to achieve high data quality. Smart textiles with electronic elements integrated directly into fabrics offer a way to embed sensors into clothing seamlessly to serve these purposes. In this work, we demonstrate the feasibility of electrocardiogram (ECG) monitoring with sewn textile electrodes instead of traditional gel electrodes in a 3-lead, chest-mounted configuration. The textile electrodes are sewn with silver-coated thread in an overlapping zig zag pattern into an inextensible fabric. Sensor validation included ECG monitoring and comfort surveys with human subjects, stretch testing, and wash cycling. The electrodes were tested with the BIOPAC MP160 ECG data acquisition module. Sensors were placed on 8 subjects (5 males and 3 females) with double-sided tape. To detect differences in R peak detectability between traditional and sewn sensors, effect size was set at 10% of a sample mean for heart rate (HR) and R-R interval. Paired student's t-tests were run between adhesive and sewn electrode data for R-R interval and average HR, and a Wilcoxon signed-rank test was run for comfort. No statistically significant difference was found between the traditional and textile electrodes (R-R interval: t = 1.43, p > 0.1; HR: t = - 0.70, p > 0.5; comfort: V = 15,p > 0.5).

Validity of flexicurve for the assessment of spinal flexibility in asymptomatic individuals / Validade do flexicurva na avaliação da flexibilidade da coluna vertebral em indivíduos assintomáticos / Validez del flexicurve en la evaluación de la flexibilidad de la columna vertebral en individuos asimomáticos

Abstract Introduction: Spine problems are common, and assessment of spine flexibility provides relevant information; however, alternative evaluation methods need to be validated. Objective: To evaluate the concurrent validity of the Flexicurve using 3D videogrammetry as a reference value to assess spinal flexion and extension in the lumbar and thoracic regions. Method: The consecutive sample consisted of 39 individuals aged between 18 and 50 years. Two consecutive evaluations were performed by the same rater on the same day and at the same location: (1) Flexicurve and (2) 3D videogrammetry. The assessments were performed with the spine in the neutral position, followed by maximum flexion and extension. The range of motion (ROM) in the maximum flexion and extension positions was calculated in MATLAB® and defined as the difference between the maximum flexion or extension angle and that of the neutral position. Statistical analyses used were the Pearson Product-Moment Correlation coefficient, RMS error and Bland-Altman plot (α < 0.05). Results: The ROM between instruments was similar, with high correlations for thoracic flexion (r = 0.751), extension (r = 0.814) and lumbar flexion (r = 0.853), and RMS errors under 8°. The correlation for lumbar extension was moderate (r = 0.613) and the RMS error was more than 10°. The limits of agreement varied between ± 10º and ± 21º. Conclusion: The Flexicurve is valid for assessing maximum flexion and extension of the thoracic spine, and maximum flexion of the lumbar spine. We suggest caution in evaluating the maximum extension of the lumbar spine.

Resumo Introdução: Problemas na coluna vertebral são frequentes, sendo a avaliação da flexibilidade uma informação relevante a ser considerada pelo profissional. Métodos alternativos para realizar avaliação da flexibilidade da coluna carecem de validação. Objetivo: Avaliar a validade concorrente do Flexicurva utilizando a videogrametria 3D como medida de referência, para a avaliação da flexibilidade em flexão e extensão da coluna vertebral torácica e lombar. Método: A amostra consecutiva contou com 39 indivíduos com idades entre 18 e 50 anos. Duas avaliações consecutivas foram realizadas pelo mesmo avaliador no mesmo dia e local: (1) Flexicurva e (2) videogrametria 3D. As avaliações foram realizadas com a coluna na posição neutra, seguida das posições de flexão e extensão máximas. A ADM nas posições de flexão e extensão máximas foram calculadas no MATLAB®, sendo definida como a diferença entre os ângulos máximos de flexão ou extensão e a angulação da posição neutra. Na análise estatística utilizou-se: Teste de Correlação Produto-Momento de Pearson, Erro RMS e Análise de Bland-Altman. (α < 0,05). Resultados: Os valores de ADM entre os instrumentos foram similares, com correlações altas para a flexão torácica (r = 0,751), extensão torácica (r = 0,814) e para flexão lombar (r = 0,853), com erros RMS inferiores a 8°. Para a extensão lombar a correlação foi moderada (r = 0,613), com erro RMS superior a 10°. Limites de concordância variaram entre ± 10º e ± 21º. Conclusão: O Flexicurva mostrou-se válido para avaliar o movimento flexão máxima e extensão máxima da coluna torácica, e flexão máxima da coluna lombar. Sugerimos cautela na avaliação da extensão máxima da coluna lombar.

Resumen Introducción: Los problemas en la columna vertebral son frecuentes, siendo la evaluación de la flexibilidad de la columna vertebral una información relevante a ser considerada por el profesional. Los métodos alternativos para realizar la evaluación de la flexibilidad de la columna necesitan validación. Objetivo: Evaluar la validez concurrente del Flexicurva utilizando la videogrametría 3D como medida de referencia para evaluar la flexión y extensión de la columna en las regiones lumbar y torácica. Método: La muestra consecutiva consistió en 39 individuos de edades comprendidas entre 18 y 50 años. El mismo evaluador realizó dos evaluaciones consecutivas en el mismo día y local: (1) Flexicurve (2) Videogrametría 3D. Las evaluaciones se realizaron con la columna en posición neutral seguida de la máxima flexión y extensión. El RDM en la posición máxima de flexión y extensión se calculó en MATLAB®, la flexión máxima y la extensión se definieron como la diferencia entre el ángulo de la posición con respecto al punto neutro. Los análisis estadísticos consistieron en la prueba de correlación de producto-momento de Pearson, error de RMS y los análisis de Bland-Altman (α < 0,05). Resultados: Los valores de RDM entre instrumentos fueron similares, con altas correlaciones para flexión torácica (r = 0.751), extensión torácica (r = 0.814) y flexión lumbar (r = 0.853), y errores RMS por debajo de 8°. Para la extensión lumbar, se moderó la correlación (r = 0,613) y el error RMS fue superior a 10°. Los límites de concordancia variaron entre ± 10º y ± 21º. Conclusión: El Flexicurva se mostró válido para evaluar la flexión máxima y la extensión máxima de la columna torácica, y la flexión máxima de la columna lumbar. Sugerimos precaución al evaluar la extensión máxima de la columna lumbar.

In-vitro pliability assessment of embolization coils for intracranial aneurysm treatment.

BACKGROUND: Embolization coils have routinely been used to treat intracranial aneurysms via an endovascular approach. Soft coils are typically viewed as the best design for filling and finishing the aneurysms to achieve a higher packing density and are hypothesized to exert a lower force against the aneurysm wall during deployment. We report here an in vitro pliability test method to assess clinically relevant coil softness and compare these metrics for two commercially available framing and finishing coil products. METHODS: A force measurement sensor was affixed onto a side-wall synthetic aneurysm model to continuously measure forces on the aneurysm wall during coil deployment at a fixed delivery rate. A quantitative overall energy metric (average work number or AWN) was calculated from the force-displacement graph representing coil delivery into the aneurysm. Two groups of coils were evaluated: (a) finish coil group (N = 20 ea.): Axium™ Prime Extra Soft coil (ES) and Target™ 360 Nano coil (Nano), and (b) frame coil group (N = 20 ea.): Axium™ Prime FC coil (FC) and Target™ 360 Standard coil (Standard). RESULTS: (a) In the finish coil group, AWN was measured as: ES (0.53 ±â€¯0.09 gf-cm) and Nano (0.99 ±â€¯0.21 gf-cm). (b) In the frame coil group, AWN was measured as FC (2.54 ±â€¯0.53 gf-cm) and Standard (4.48 ±â€¯0.52 gf-cm). In both groups, Axium Prime coils had statistically lower measures of AWN and therefore higher pliability compared to Target coils (p < .001). CONCLUSIONS: The in-vitro pliability test method offers quantitative metrics to assess coil softness during deployment in a clinically relevant aneurysm model.

Ultralow-Cost, Highly Sensitive, and Flexible Pressure Sensors Based on Carbon Black and Airlaid Paper for Wearable Electronics.

Flexible pressure sensors have attracted considerable attention because of their potential applications in healthcare monitoring and human-machine interactions. However, the complicated fabrication process and the cos of sensing materials limit their widespread applications in practice. Herein, a flexible pressure sensor with outstanding performances is presented through an extremely simple and cost-efficient fabrication process. The sensing materials of the sensor are based on low-cost carbon black (CB)@airlaid paper (AP) composites, which are just prepared by drop-casting CB solutions onto APs. Through simply stacking multiple CB@APs with an irregular surface and a fiber-network structure, the obtained pressure sensor demonstrates an ultrahigh sensitivity of 51.23 kPa-1 and an ultralow detection limit of 1 Pa. Additionally, the sensor exhibits fast response time, wide working range, good stability, as well as excellent flexibility and biocompatibility. All the comprehensive and superior performances endow the sensor with abilities to precisely detect weak air flow, wrist pulse, phonation, and wrist bending in real time. In addition, an array electronic skin integrated with multiple CB@AP sensors has been designed to identify spatial pressure distribution and pressure magnitude. Through a biomimetic structure inspired by blooming flowers, a sensor with the open-petal structure has been designed to recognize the wind direction. Therefore, our study, which demonstrates a flexible pressure sensor with low cost, simple preparation, and superior performances, will open up for the exploration of cost-efficient pressure sensors in wearable devices.

Screening flexible sigmoidoscopy versus colonoscopy for reduction of colorectal cancer mortality.

PURPOSE: Colonoscopy and flexible sigmoidoscopy are both recommended colorectal cancer (CRC) screening strategies, but their relative effectiveness is unclear. We sought to evaluate the ability of each of these two modalities to reduce CRC mortality. METHODS: We conducted a case-control study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Cases were persons aged 70-85 years who died of CRC and were matched to up to three non-CRC controls. Receipt of endoscopy was ascertained from Medicare claims and endoscopy indication assigned using a validated algorithm. Conditional logistic regression models were developed to estimate the association between screening colonoscopy or sigmoidoscopy and CRC mortality. We conducted secondary analyses by race, sex, and endoscopist characteristics, and with varying duration of the look-back period. RESULTS: In the initial analysis using all available look-back years, screening flexible sigmoidoscopy was associated with a 35% reduction in CRC mortality (OR 0.65, 95% CI 0.48, 0.89), while screening colonoscopy was associated with a 74% reduction (OR 0.26, 95% CI 0.23, 0.30). Sigmoidoscopy was not associated with any reduction in proximal CRC mortality. The association between colonoscopy and reduced CRC mortality was stronger in the distal than the proximal colon. Results were similar in analyses using a 5-year look-back period. CONCLUSIONS: Screening colonoscopy was associated with greater reductions in CRC mortality than screening sigmoidoscopy, and with a greater reduction in the distal than the proximal colon. These results provide additional information on the relative benefits of screening for CRC with sigmoidoscopy and colonoscopy.

Filament flexibility enhances power transduction of F-actin bundles.

The dynamic behavior of bundles of actin filaments growing against a loaded obstacle is investigated through a generalized version of the standard multifilament Brownian Ratchet model in which the (de)polymerizing filaments are treated not as rigid rods but as semiflexible discrete wormlike chains with a realistic value of the persistence length. By stochastic dynamic simulations, we study the relaxation of a bundle of Nf filaments with a staggered seed arrangement against a harmonic trap load in supercritical conditions. Thanks to the time scale separation between the wall motion and the filament size relaxation, mimicking realistic conditions, this setup allows us to extract a full load-velocity curve from a single experiment over the trap force/size range explored. We observe a systematic evolution of steady nonequilibrium states over three regimes of bundle lengths L. A first threshold length Λ marks the transition between the rigid dynamic regime (L < Λ), characterized by the usual rigid filament load-velocity relationship V(F), and the flexible dynamic regime (L > Λ), where the velocity V(F, L) is an increasing function of the bundle length L at a fixed load F, the enhancement being the result of an improved level of work sharing among the filaments induced by flexibility. A second critical length corresponds to the beginning of an unstable regime characterized by a high probability to develop escaping filaments which start growing laterally and thus do not participate anymore in the generation of the polymerization force. This phenomenon prevents the bundle from reaching at this critical length the limit behavior corresponding to perfect load sharing.

Training and assessment in flexible sigmoidoscopy: using a novel direct observation of procedural skills (DOPS) assessment tool.

BACKGROUND AND AIMS: Data supporting milestone development during flexible sigmoidoscopy (FS) training are lacking. We aimed to present validity evidence for our formative direct observation of procedural skills (DOPS) assessment in FS, and use DOPS to establish competency benchmarks and define learning curves for a national training cohort. METHODS: This prospective UK-wide (211 centres) study included all FS formative DOPS assessments submitted to the national e-portfolio. Reliability was estimated from generalisability theory analysis. Item and global DOPS scores were correlated with lifetime procedure count to study learning curves, with competency benchmarks defined using contrasting groups analysis. Multivariable binary logistic regression was performed to identify independent predictors of DOPS competence. RESULTS: This analysis included 3,616 DOPS submitted for 468 trainees. From generalisability analysis, sources of overall competency score variance included: trainee ability (27%), assessor stringency (15%), assessor subjectivity attributable to the trainee (18%) and case-to-case variation (40%), which enabled the modelling of reliability estimates. The competency benchmark (mean DOPS score: 3.84) was achieved after 150-174 procedures. Across the cohort, competency development occurred in the order of: pre-procedural (50-74), non-technical (75-149), technical (125-174) and post-procedural (175-199) skills. Lifetime procedural count (p<0.001), case difficulty (p<0.001), and lifetime formative DOPS count (p=0.001) were independently associated with DOPS competence, but not trainee or assessor specialty. CONCLUSION: Sigmoidoscopy DOPS can provide valid and reliable assessments of competency during training and can be used to chart competency development. Contrary to earlier studies, based on destination-orientated endpoints, overall competency in sigmoidoscopy was attained after 150 lifetime procedures.

Avaliação da regulação exteroceptiva e interoceptiva do equilíbrio corporal de idosas ativas / Evaluation of exteroceptive and interoceptive regulation of body balance of active seniors

O processo do envelhecimento humano traz consigo um conjunto de alterações para o organismo, dentre elas há a diminuição da eficácia das estratégias motoras do equilíbrio corporal e o aumento do tempo de reação muscular, o que torna o indivíduo mais suscetível à queda. O objetivo deste estudo foi avaliar o desempenho do equilíbrio de um grupo de idosas fisicamente ativas, com ênfase na regulação do sistema visual, vestibular e somatossensorial do equilíbrio estático e dinâmico, bem como sua performance em testes de marcha e flexibilidade. Trata-se de um estudo transversal analítico, realizado com 32 mulheres (67,48±4,88 anos), praticantes regulares de Pilates e hidroginástica. Os instrumentos utilizados foram: Escala do Equilíbrio de Berg (EEB), Timed Up and Go Test (TUG), Teste de Alcance Funcional (TAF) e o Teste de Equilíbrio Corporal (TEC). As idosas foram estratificadas em grupos: G1 (60-64 anos), G2 (65-69 anos), G3 (70-74 anos) e G4 (75-79 anos). A EEB atestou para um equilíbrio conservado [F(3,29)=1,766, p≥0,50], o TUG para independência funcional preservada [F(3,29)=0,418; p≥0,50] e o TAF sem risco para quedas [F(3,20)=2,228; p≥0,50]. O TEC identificou déficit da regulação interoceptiva do equilíbrio para todas as idades e comprometimento regulação interoceptiva do equilíbrio dinâmico para septuagenárias [F(3,29)= 0,301; p≥0,50]. Observou-se correlação moderada entre EEB-TEC (r=0,416; p=0,018), TEC-TUG (r=-345; p=0,013) e negativa entre EEB-TUG (r=-0,427; p=0,013). Sendo que, o TAF não se mostrou equivalente aos demais instrumentos. Conclui-se que mulheres sexagenárias e septuagenárias, praticantes regulares de exercícios físicos, apesar de indicarem bom desempenho nos testes de equilíbrio, marcha e flexibilidade, apresentaram comprometimento dos sistemas de regulação sensorial do equilíbrio estático e dinâmico...(AU)

The process of human aging brings with it a number of alterations to the organism, among them there is a decrease in the effectiveness of the motor strategies of the body balance and the increase of the time of muscular reaction, which makes the individual more susceptible to fall. The aim of this study was to evaluate the balance performance of a group of physically active elderly women, with emphasis on the regulation of the visual, vestibular and somatosensory systems of the static and dynamic balance, as well as their performance in gait tests and flexibility. This is a cross-sectional, analytical study of 32 women (67.48 ± 4.88 years), regular Pilates practitioners, and water aerobics. The instruments used were: Berg Balance Scale (BBS), Timed Up and Go Test (TUG), Functional Reach Test (TAF) and Body Balance Test (TEC). The elderly were stratified into groups: G1 (60-64 years), G2 (65-69 years), G3 (70- 74 years) and G4 (75-79 years). BBS attained a conserved equilibrium [F(3.29)=1.766, p≥0.50], the TUG for preserved functional independence [F(3.29)=0.418; p≥0.50] and TAF without risk of falls [F(3,20)=2,228; p≥0.50]. The TEC identified deficit of interoceptive regulation of balance for all ages and compromise interoceptive regulation of dynamic balance for septuagenarians [F(3,29)=0.301; p≥0.50]. It was observed a moderate correlation between BBS-TEC (r=0.416, p=0.018), TEC-TUG (r=-345, p=0.013) and negative between BBS-TUG (r=-0.427, p=0.013). The TAF did not prove to be equivalent to the other instruments. It was concluded that sexagenarian and septuagenarian women, regular physical exercise practitioners, despite indicating good performance in tests of balance, gait and flexibility, presented impairment of the systems of sensorial regulation of the static and dynamic balance...(AU)

Fiberoptic versus Digital: A Comparison of Durability and Cost Effectiveness of the Two Flexible Ureteroscopes.

AIMS: We aimed to evaluate the durability and cost effectiveness of the latest digital flexible ureterescope by comparing it with the conventional fiberoptic one. MATERIALS AND METHODS: Data of patients who underwent retrograde intrarenal surgery between January 2013 and December 2014 were collected. Fiberoptic Flex-X2 or digital Cobra vision flexible ureteroscopes were used for the procedures. The comparison of both ureteroscopes was performed in terms of patient and stone characteristics, operative outcomes, durability, and cost effectiveness. RESULTS: A total of 105 patients were evaluated for the study. The patient and stone characteristics and operative outcomes were similar between the groups. Overall, 54 and 51 procedures were performed using Flex-X2 and Cobra vision, respectively, before they were sent for renovation. The purchase prices were USD 29,500 for Flex-X2 and USD 58,000 for Cobra vision. Costs of per case were determined as USD 549.29 for Flex-X2 and as USD 1,137.25 for Cobra vision. Per minute working time costs were USD 772.04 and 1,471.33 for Flex-X2 and Cobra vision respectively. CONCLUSIONS: The digital Cobra vision has high costs without any difference in durability as compared to Flex-X2. Moreover, it has no benefit over Flex-X2 in terms of surgical outcomes.

DRU: uma estimativa da capacidade de flexibilização baseada no orçamento da seguridade social

Esta nota técnica estima a capacidade de flexibilização da DRU, baseando-se no orçamento da seguridade social (OSS). Demonstra que a desvinculação pode liberar recursos, mas em valor muito aquém da "desvinculação original". A situação orçamentária, qual seja, elevado deficit, impõe limites ao almejado remanejamento de receitas. Nessas circunstâncias, a comentada rigidez não estaria associada à excessiva vinculação de receitas, mas à abundância de despesas obrigatórias, isto é, àquelas que não se sujeitam à limitação de empenho.

Childhood socioeconomic position and physical capability in late-middle age in two birth cohorts from the Copenhagen aging and midlife biobank.

This study examines the association between childhood socioeconomic position and objective physical capability including new functional measures of potential relevance to a population in late-middle age. The study population covers two Danish birth cohorts followed-up in the Copenhagen Aging and Midlife Biobank (age 48-58 years, 2009-2011, N = 4,204). Results from linear regression models revealed that being born in higher socioeconomic position was associated with higher jump height: Paternal occupational class four = 0.19 cm (95% confidence interval (CI): -0.44, 0.82), three = 0.59 cm (95% CI: -0.02, 1.19), two = 1.29 cm (95% CI: 0.64, 1.94), and one = 1.29 cm (95% CI: 0.45, 2.13) (reference = five); medium parental social class = 0.88 cm (95% CI: 0.03, 1.72) and high = 1.79 cm (95% CI: 0.94, 2.63) (reference = low). Higher childhood socioeconomic position was also associated with better chair rise performance and hand grip strength, while among women it was related to reduced flexibility: Medium parental social class = -1.31 cm (95% CI: -3.05, 0.42) and high = -2.20 cm (95% CI: -3.94, -0.47) (reference = low); unwed mother = 1.75 cm (95% CI: 0.36, 3.14) (reference = married). Overall, the findings suggest that higher childhood socioeconomic position is primarily related to moderately better scores in the most strenuous physical capability measures and hand grip strength among healthy adults in late-middle age.

Assessment of Pliability and Elasticity of the External Nasal Skin in Patients With Unilateral Nasal Valve Collapse: A Static Biomechanical Evaluation.

IMPORTANCE: Understanding the skin biomechanics, specifically pliability and elasticity, in patients with nasal valve collapse may allow for new methods to assess which patients require more advanced nasal valve surgery. OBJECTIVE: To test the hypothesis that in patients with unilateral nasal valve collapse, the side of the nose with the collapse will have lower elasticity and increased pliability compared with the normal side, as assessed by a blinded observer using the Cutometer MPA 580. DESIGN, SETTING, AND PARTICIPANTS: Prospective, investigator-blinded, case-control cohort study of patients with unilateral nasal valve collapse and subjective nasal obstruction conducted in an academic otolaryngology-head and neck surgery clinic. INTERVENTIONS: Patients were assessed using the Cutometer MPA 580 by a blinded assessor. Three measurements were performed bilaterally on the exterior skin of the nose corresponding to the level of the inferior edge of the upper lateral cartilage. Measurements taken at the skin inferior to the zygoma were used as a control. MAIN OUTCOMES AND MEASURES: Primary outcome measures of the nasal skin were pliability (Uf, defined as the lengthening of the skin after 3 seconds of constant load) and elasticity (Ua/Uf, defined as the percentage of the skin that returned to its normal position 3 seconds after the release from the 3-second constant load). RESULTS: Of the 27 patients included in the study, 15 (56%) were male, and 12 (44%) were female; mean (SD) age, 44 (21) years (range, 16-90 years). There was no difference between the measurements of the skin overlying the area of nasal valve collapse in elasticity: side without collapse (0.960% [0.031%]) vs side with collapse (0.967% [0.036%]) (mean difference, 0.007%; 95% CI, -0.018% to 0.021%) (P = .90). However, there was a significant difference in pliability: side of the nose without collapse (0.520 [0.139] mm) vs side with collapse (0.610 [0.200]) (mean difference, 0.090 mm; 95% CI, 0.014-0.156 mm) (P = .02). CONCLUSIONS AND RELEVANCE: Although the skin in patients with nasal valve collapse appears to maintain its elasticity, it demonstrates an increased ability to stretch and lengthen compared with nasal skin of those without valve collapse. Future studies are required to determine whether the biomechanical changes are related to the length and severity of nasal obstruction, or whether these changes in the skin may help predict who will benefit from nasal valve surgery and whether these patients are at an increased risk of surgical failure. LEVEL OF EVIDENCE: 2.

Direct Observation vs. Video-Based Assessment in Flexible Cystoscopy.

OBJECTIVE: Direct observation in assessment of clinical skills is prone to bias, demands the observer to be present at a certain location at a specific time, and is time-consuming. Video-based assessment could remove the risk of bias, increase flexibility, and reduce the time spent on assessment. This study investigated if video-based assessment was a reliable tool for cystoscopy and if direct observers were prone to bias compared with video-raters. DESIGN: This study was a blinded observational trial. Twenty medical students and 9 urologists were recorded during 2 cystoscopies and rated by a direct observer and subsequently by 2 blinded video-raters on a global rating scale (GRS) for cystoscopy. Both intrarater and interrater reliability were explored. Furthermore, direct observer bias was explored by a paired samples t-test. RESULTS: Intrarater reliability calculated by Pearson's r was 0.86. Interrater reliability was 0.74 for single measure and 0.85 for average measures. A hawk-dove effect was seen between the 2 raters. Direct observer bias was detected when comparing direct observer scores to the assessment by an independent video-rater (p < 0.001). CONCLUSION: This study found that video-based assessment was a reliable tool for cystoscopy with 2 video-raters. There was a significant bias when comparing direct observation with blinded video-based assessment.

A Preliminary Quantitative Comparison of Vibratory Amplitude Using Rigid and Flexible Stroboscopic Assessment.

STUDY OBJECTIVE: The purpose of this study was to establish preliminary, quantitative data on amplitude of vibration during stroboscopic assessment in healthy speakers with normal voice characteristics. Amplitude of vocal fold vibration is a core physiological parameter used in diagnosing voice disorders, yet quantitative data are lacking to guide the determination of what constitutes normal vibratory amplitude. METHODS/STUDY DESIGN: Eleven participants were assessed during sustained vowel production using rigid and flexible endoscopy with stroboscopy. Still images were extracted from digital recordings of a sustained /i/ produced at a comfortable pitch and loudness, with F0 controlled so that levels were within ±15% of each participant's comfortable mean level as determined from connected speech. Glottal width (GW), true vocal fold (TVF) length, and TVF width were measured from still frames representing the maximum open phase of the vibratory cycle. To control for anatomic and magnification differences across participants, GW was normalized to TVF length. GW as a ratio of TVF width was also computed for comparison with prior studies. RESULTS: Mean values and standard deviations were computed for the normalized measures. Paired t tests showed no significant differences between rigid and flexible endoscopy methods. Interrater and intrarater reliability values for raw measurements were found to be high (0.89-0.99). CONCLUSIONS: These preliminary quantitative data may be helpful in determining normality or abnormality of vocal fold vibration. Results indicate that quantified amplitude of vibration is similar between endoscopic methods, a clinically relevant finding for individuals performing and interpreting stroboscopic assessments.