Programa de gimnasia laboral para los moldeadores manuales metalúrgicos

Los trastornos músculo-esqueléticos relacionados con el trabajo constituyen motivo de preocupación para la comunidad científica, avalado por su efecto negativo en la vida de los trabajadores y la productividad de las empresas. En el proceso de fundición de metales, los moldeadores manuales con pisón neumático exteriorizan manifestaciones de estas afecciones. Ello indujo a realizar una investigación que tuvo como objetivo elaborar un programa de Gimnasia Laboral para contribuir a la atención de los trastornos músculo-esqueléticos en los moldeadores manuales metalúrgicos. Para recopilar, analizar y procesar los datos se emplearon métodos teóricos, empíricos y matemático-estadísticos, entre ellos el histórico-lógico, analítico-sintético, inductivo-deductivo, sistémico-estructural-funcional, la observación participante, encuesta, entrevista, revisión documental, el experimento, criterio de usuarios y la estadística descriptiva e inferencial. La población objeto de estudio estuvo conformada por 19 moldeadores manuales metalúrgicos, seleccionados de forma intencional. El diagnóstico y la sistematización teórica alcanzada posibilitaron elaborar un programa de Gimnasia Laboral, en correspondencia con los requerimientos del proceso de moldeo, cuya efectividad fue constatada.

As lesões músculo-esqueléticas relacionadas com o trabalho são motivo de preocupação para a comunidade científica, sustentadas pelos seus efeitos negativos na vida dos trabalhadores e na produtividade das empresas. No processo de fundição do metal, os moldadores manuais com compactador pneumático externalizam as manifestações dessas condições. Isso originou uma pesquisa que teve como objetivo desenvolver um programa de Ginástica Laboral para contribuir no cuidado de lesões osteomusculares em moldadores manuais metalúrgicos. Para coletar, analisar e tratar os dados foram utilizados métodos teóricos, empíricos e matemático-estatísticos, incluindo histórico-lógico, analítico-sintético, indutivo-dedutivo, sistêmico-estrutural-funcional, observação participante, levantamento, entrevista, revisão documental, o experimento, critérios de usuário e estatísticas descritivas e inferenciais. A população em estudo foi composta por 19 modeladores manuais metalúrgicos, selecionados intencionalmente. O diagnóstico e a sistematização teórica conseguidos permitiram desenvolver um programa de Ginástica Laboral, em correspondência com as exigências do processo de moldagem, cuja eficácia foi verificada.

Work-related musculoskeletal disorders are a cause of concern for the scientific community, supported by their negative effect on the lives of workers and the productivity of companies. In the metal casting process, manual molders with pneumatic tamper externalize manifestations of these conditions. This led to carrying out a research that aimed to develop a Labor Gymnastics program to contribute to the care of musculoskeletal disorders in metallurgical manual shapers. To collect, analyze and process the data, theoretical, empirical and mathematical-statistical methods were used, including historical-logical, analytical-synthetic, inductive-deductive, systemic-structural-functional, participant observation, survey, interview, documentary review, the experiment, user criteria and descriptive and inferential statistics. The population under study was made up of 19 metallurgical manual shapers, intentionally selected. The diagnosis and theoretical systematization achieved made it possible to develop a Labor Gymnastics program, in correspondence with the requirements of the molding process, whose effectiveness was verified.

Physical Therapy Management for a Patient with Hallux Rigidus in a Baseball Player.

Hallux rigidus is a common condition affecting the foot. There is a paucity of evidence describing the management of patients with hallux rigidus with manual physical therapy consisting of hands-on manual therapy techniques and movement reinforcing exercise. This case highlights the management of a patient with hallux rigidus by a physical therapist. The patient was a 60-year-old male baseball player with pain, loss of metatarsophalangeal joint motion, and radiographically visible degenerative changes suggesting a diagnosis of hallux rigidus. Treatment involved non-thrust joint manual distraction mobilization to the 1st metatarsophalangeal joint. Improvements were noted immediately in the patient's ability to run with decreased symptoms. I carefully instructed the patient to perform the manual distraction techniques at home. After 4 clinical visits, the patient returned to baseball the following spring. Outcomes were maintained 8 years after initial evaluation.

Two cases of sigmoid colon cancer with intussusception prolapsing through the anus in adults: consideration of preoperative reduction and surgical approaches: case reports.

Background: Adult intussusception is a rare condition that is often associated with a high incidence of malignancy. The optimal management strategy remains controversial, particularly regarding the necessity for bowel reduction before resection. To date, there is a paucity of data on adult intussusception in the English literature. We present two cases of sigmoid colon cancer with intussusception prolapsing through the anus and highlight the different surgical approaches. Case Description: Case 1: an 84-year-old woman presented with sigmoid colon prolapse and biopsy-confirmed adenocarcinoma. Urgent surgery revealed intussusception. Despite unsuccessful manual reduction, the Hutchinson technique successfully resolved the intussusception. Resection with a temporary colostomy was performed. Histopathological examination revealed mucinous adenocarcinoma without metastasis; the patient recovered well. Case 2: a 76-year-old woman with sigmoid colon prolapse presented with abdominal pain and blood-streaked stools. Emergency surgery was performed because of failed reduction attempts and persistent symptoms. Intussusception resolution was achieved through transanal insertion of a circular sizer. Resection with temporary colostomy was performed, after which tubular adenocarcinoma was identified. The patient remains symptom-free 3 years post-surgery. Conclusions: Choice of the surgical approach depends on the ease of intussusception reduction. In cases wherein reduction is straightforward, routine preoperative examinations are preferred given the low risk of injury or cancer cell dissemination. Conversely, in situations such as ours, gentle reduction under general anesthesia might be crucial. In addition, laparoscopic surgery could be beneficial. Importantly, accumulation of reports on adult intussusception could contribute to the standardization of this approach.

Case Report: The effect of automated manual lymphatic drainage therapy on lymphatic contractility in 4 distinct cases.

Introduction: Automated manual lymphatic drainage therapy (AMLDT) is available for home use in the form of a pneumatic mat of 16 pressurized air channels that inflate and deflate to mimic the stretch and release action of manual lymphatic drainage therapy. Four cases (a patient with complex regional pain syndrome and lymphedema, a healthy patient, a breast cancer survivor with chronic pain, and a patient with a history of abdominal surgery) underwent near-infrared fluorescence lymphatic imaging (NIRFLI) with AMLDT to evaluate the effect of AMLDT on lymphatic pumping and pain. Methods: Each patient received 32-36 injections of 25 µg indocyanine green (ICG) on the anterior and posterior sides of their body and underwent 1 h of NIRFLI to assess the drainage of ICG laden lymph toward regional nodal basins at baseline. Each patient lay supine on the mat for 1 h of AMLDT with NIRFLI to assess lymphatic flow during treatment. A final NIFRFLI assessment was done 30-60 min posttreatment with the patient in the supine and prone position. Patients reported baseline and posttreatment pain using the Visual Analogue Scale. An imager analyzed NIRFLI images using ImageJ (US National Institutes of Health). Using time stamps of the first and last images to determine time lapsed and the number of pulses observed in a timeframe, pulsing frequency (pulses/min) was obtained to assess lymphatic function. Results: All 4 cases completed the NIRFLI and AMLDT without complications; all 3 patients with baseline pain reported reduced pain posttreatment. AMLDT appeared to alter lymphatic contractility, with both increased and decreased pulsing frequencies observed, including in nonaffected limbs. Pulsing frequencies were very heterogeneous among patients and varied within anatomic regions of the same patient. Discussion: This proof-of-concept study suggests that AMLDT may impact lymphatic contractility. Further research on its effect on lymphatic function is warranted.

Evaluating the accuracy of lung-RADS score extraction from radiology reports: Manual entry versus natural language processing.

INTRODUCTION: Radiology scoring systems are critical to the success of lung cancer screening (LCS) programs, impacting patient care, adherence to follow-up, data management and reporting, and program evaluation. LungCT ScreeningReporting and Data System (Lung-RADS) is a structured radiology scoring system that provides recommendations for LCS follow-up that are utilized (a) in clinical care and (b) by LCS programs monitoring rates of adherence to follow-up. Thus, accurate reporting and reliable collection of Lung-RADS scores are fundamental components of LCS program evaluation and improvement. Unfortunately, due to variability in radiology reports, extraction of Lung-RADS scores is non-trivial, and best practices do not exist. The purpose of this project is to compare mechanisms to extract Lung-RADS scores from free-text radiology reports. METHODS: We retrospectively analyzed reports of LCS low-dose computed tomography (LDCT) examinations performed at a multihospital integrated healthcare network in New York State between January 2016 and July 2023. We compared three methods of Lung-RADS score extraction: manual physician entry at time of report creation, manual LCS specialist entry after report creation, and an internally developed, rule-based natural language processing (NLP) algorithm. Accuracy, recall, precision, and completeness (i.e., the proportion of LCS exams to which a Lung-RADS score has been assigned) were compared between the three methods. RESULTS: The dataset includes 24,060 LCS examinations on 14,243 unique patients. The mean patient age was 65 years, and most patients were male (54 %) and white (75 %). Completeness rate was 65 %, 68 %, and 99 % for radiologists' manual entry, LCS specialists' entry, and NLP algorithm, respectively. Accuracy, recall, and precision were high across all extraction methods (>94 %), though the NLP-based approach was consistently higher than both manual entries in all metrics. DISCUSSION: An NLP-based method of LCS score determination is an efficient and more accurate means of extracting Lung-RADS scores than manual review and data entry. NLP-based methods should be considered best practice for extracting structured Lung-RADS scores from free-text radiology reports.

Prolonged exposure to mixed reality alters task performance in the unmediated environment.

The popularity of mixed reality (MR) technologies, including virtual (VR) and augmented (AR) reality, have advanced many training and skill development applications. If successful, these technologies could be valuable for high-impact professional training, like medical operations or sports, where the physical resources could be limited or inaccessible. Despite MR's potential, it is still unclear whether repeatedly performing a task in MR would affect performance in the same or related tasks in the physical environment. To investigate this issue, participants executed a series of visually-guided manual pointing movements in the physical world before and after spending one hour in VR or AR performing similar movements. Results showed that, due to the MR headsets' intrinsic perceptual geometry, movements executed in VR were shorter and movements executed in AR were longer than the veridical Euclidean distance. Crucially, the sensorimotor bias in MR conditions also manifested in the subsequent post-test pointing task; participants transferring from VR initially undershoot whereas those from AR overshoot the target in the physical environment. These findings call for careful consideration of MR-based training because the exposure to MR may perturb the sensorimotor processes in the physical environment and negatively impact performance accuracy and transfer of training from MR to UR.

Exploring the role of therapeutic alliance and biobehavioural synchrony in musculoskeletal care: Insights from a qualitative study.

BACKGROUND: Person-centred care underscores the therapeutic alliance (TA) as fundamental, fostering positive treatment outcomes through collaborative patient-clinician interactions. Biobehavioural synchrony within the TA, essential for effective care, reflects an adaptive process where organisms align responses during interactions. Enactivism and active inference provide profound insights into human perception, reshaping musculoskeletal care understanding. Touch and verbal communication, integral to the TA, foster synchrony and alignment of personal beliefs. AIM: This study aimed to identify the tools used by manual therapists in musculoskeletal care to establish a TA with patients. Furthermore, it endeavours to evaluate the alignment of these strategies with current literature and their correlation with biobehavioural synchrony, enactivism, and the role of touch in active inference. METHODS: The methodology followed rigorous qualitative research principles, particularly Grounded Theory and interpretative-constructivist principles, conducting eleven semi-structured interviews with open-ended questions. RESULTS: The core category identified in the study is elucidated as follows: "Interwoven Connection: The Fabric of Therapeutic Synchrony." The interviews unveiled three main categories, each comprising sub-categories: (1) Creating a meaningful dialogue; (2) Promoting active patient participation; (3) Synchronisation. CONCLUSION: Fostering meaningful dialogue, patient involvement, and therapeutic synchrony is crucial for a robust therapeutic alliance in musculoskeletal care. This underscores the importance of establishing a deep connection between clinicians and patients, central to effective person-centred care. Clinicians must prioritise two-way communication, empathy, and patient collaboration in defining personalised goals. Emphasizing touch and seeking patient feedback are also pivotal. Further research is needed to explore these elements and their impact.

Effects of spinal mobilisation in adolescent idiopathic scoliosis: A randomised controlled trial.

AIM: The aim of this study was to evaluate the effects of spinal mobilisation on curvature magnitude, angle of trunk rotation (ATR) and pulmonary function in adolescents with idiopathic scoliosis (AIS). METHODS: Conducted as a double-blind randomised controlled trial, the study included 40 patients with AIS (Cobb angles 10°-25°) randomised to experimental (n = 20; female = 12, male = 8; age = 12.9 ± 1.8 mean ± SD) and control (n = 20; female = 13, male = 7; age = 12.85 ± 1.81 mean ± SD) groups. The experimental group received spinal mobilisation for 30 min per session followed by 60 min of core stabilisation exercises (CSE), twice a week for 10 weeks. The control group received CSE only at the same frequency and duration. Evaluation of Cobb angle, ATR and pulmonary function tests (PEF: Peak Expiratory Flow, FEV1: Forced Expiratory Volume in 1 s, FVC: Forced Vital Capacity, and FEV1/FVC: Tiffeneau index) were performed at baseline and after the intervention. RESULTS: Both groups showed significant improvements in Cobb angle, ATR, PEF and FVC, with the experimental group showing significantly greater improvements in Cobb angle (-7.65 ± 3.17) and ATR (-2.5 ± 1.43) compared to the control group (P < 0.05). In addition, while the control group showed no change in FEV1, the experimental group showed improvement. There was no change in FEV1/FVC ratio in either group. CONCLUSION: These results indicate that adding spinal mobilisation to treatment sessions can effectively reduce the magnitude of curvature and improve scoliosis-related problems in the short term.

Analysis of Different Lymphedema Assessment Tools in Women with Breast Cancer After Mastectomy.

Background: Lymphedema is a common complication after mastectomy in women with breast cancer. Several methods have been described to assess and diagnose lymphedema, one of the most studied being the perimeter and ultrasonography. However, the reliability of these methods and the correlation between them are still controversial. The aim of this study was to analyze the reliability of cytometry and ultrasound imaging in the assessment of lymphedema after mastectomy in women with breast cancer and to study the correlation between them. Methods and Results: A cross-sectional study was conducted in 29 women with mastectomy after breast cancer. Lymphedema in the arm was measured both with cytometry and ultrasonography. Reliability was calculated with intraclass correlation coefficient. The correlation between the two methods was carried out with the Pearson correlation coefficient. Both cytometry (M1: α = 0.999, ICC = 0.996; M2: = α = 0.998, ICC = 0.994) and ultrasonography (M1: α = 0.992, ICC = 0.976; M2: = α = 0.991, ICC = 0.973) are reliable methods to assess lymphedema in the arm. No significant correlation was found between them (p > 0.05). Conclusions: Cytometry and ultrasonography appear to be adequate for the measurement of edema in women with breast cancer after mastectomy. However, for an accurate measurement of lymphedema, these measurements should not be used interchangeably.

Laparoscopic Management of a Trapped Placenta Following Normal Delivery in a Woman With a Mullerian Anomaly.

Entrapped placenta following vaginal delivery is an uncommon complication. In resistant cases, it needs to be removed by laparotomy, although this is exceptionally rare. Here, we report a 28-year-old woman, 33 weeks pregnant through in vitro fertilization, who delivered a premature male baby weighing 2400 grams with an Apgar score of 7. After delivery, the placenta remained in the unicornuate uterus. Ultrasound ruled out placenta accreta spectrum, and manual removal attempts under anesthesia failed due to lower uterine segment contraction despite using nitroglycerine. Conservative management with misoprostol and broad-spectrum antibiotics was initiated. However, increasing C-reactive protein levels and abdominal pain necessitated a computerized tomography scan, revealing the placenta trapped in the unicornuate uterus. Thirty-six hours after the delivery, the decision was made to remove the placenta laparoscopically instead of laparotomy. A unicornuate uterus containing a placenta on the right and the left rudimentary horn connected to the right uterus with bilateral adnexa, including theca cysts, were revealed during laparoscopic observation. No pelvic organ injury was noted. The placenta was removed via a fundal incision with a monopolar hook and using claw traumatic forceps. The uterus was closed with V-lock sutures; additional Z-sutures were applied. A 270-gram entire placenta was extracted using an endo bag successfully. The patient was discharged several days after the procedure without any complications. Laparoscopic extraction of a third-trimester placenta can successfully be used in resistant cases while avoiding laparotomy, even in the early postpartum period.

Feasibility, safety, and efficacy of a novel external compression vascular closure device: The LockeT® study.

INTRODUCTION: Hemostasis following large-bore femoral vein access remains a challenge. Manual compression has been the standard of care but requires bedside staff, prolonged bed rest, and longer length of stay. The LockeT is an external compression device that attempts to address these issues while achieving venous hemostasis. OBJECTIVES: We evaluate postprocedural hemostasis and vascular closure outcomes after using LockeT following cardiac electrophysiologic procedures. METHODS: We performed a single-center, observational study of patients who underwent vascular closure for electrophysiology procedures using LockeT. Postprocedural outcomes were subsequently analyzed. RESULTS: We studied 102 patients (N) for whom LockeT was used to close 182 separate vascular access sites (n). Common procedures were atrial fibrillation ablation (56.9%, N = 58) and left atrial appendage occlusion (28.4%, N = 29). Most often, 8-Fr [48.3% (n = 126)], 11-Fr [27.2% (n = 71)], and 8.5-Fr [16.9% (n = 44)] sheaths were used, with an average procedure time of 82.1 ± 29.4 min. Hemostasis was achieved in 97.8% (n = 187) of all LockeT cases. Time to ambulation and discharge were 3.93 ± 1.10 h and 8.1 ± 4.4 h, respectively. No major complications were noted. Postprocedurally, 52% (N = 53) of patients were discharged on the same day. There were no differences in hemostasis (p = .859) or ambulation times (p = .202) between procedure types. CONCLUSION: The LockeT can effectively close venous access sites with no major complications.

Awake Early Manual Reduction Is Highly Effective for Subaxial Cervical Spine Dislocation.

Introduction: Guidelines published in 2013 recommend early closed reduction for cervical spine dislocation. There are two types of closed reduction: manual reduction and traction. Manual reduction can be performed early. In addition, it can correct rotation and requires a short time for complete reduction. We perform manual reduction for cervical spine dislocation. This study aimed to evaluate early manual reduction's success rate and safety for cervical dislocation. We also examined the relationship between time to reduction and improvement in paralysis. Methods: This retrospective cohort study included 361 patients with cervical spine injuries treated at our hospital between July 2010 and December 2021. We assigned patients to the early group if the time from injury to reduction was ≤6 hours and to the late group if >6 hours. We performed awake manual reduction on the patients. Furthermore, we compared reduction's success rate and safety, including neurological outcomes. Results: Overall, 46 patients were included in the study: 31 and 15 in the early and late groups, respectively. The success rate of reduction was 93%, and no neurological complications from reduction were observed. The neurological outcomes and reduction success rates were significantly superior in the early group than in the late group. Conclusions: Neurological outcomes were significantly superior when reduction was performed within 6 hours than after 6 hours. Manual reduction can be performed early, safely, and easily. It is effective for cervical spine dislocation requiring early reduction for an excellent neurologic prognosis.

Evaluation of apically extruded debris following glide-path preparation with different file systems.

The amount of apically extruded debris following glide-path preparation of mesial root of 120 freshly extracted human mandibular molar teeth using Senseus ProFinder files, PathFile, G-Files, Scout-RaCe files, HyFlex glidepath files and V glide-path two file system is of interest. The Eppendorf tubes were used as test equipment for collecting debris and the average weight of the debris was measured using an electronic micro-balancing system. It was observed that regardless of the file system utilized, debris was expelled from the apex. The G files resulted in a lower quantity of debris being extruded (0.070 ± 0.002 mg). In contrast, the V glide-path two file system exhibited the highest amount of debris extrusion (0.110 ± 0.004 mg) compared to all other file systems.

SCAI Manual of Standard Operating Procedures for Performing Scientific Surveys.

The Society for Cardiovascular Angiography & Interventions (SCAI) endeavors to serve the interventional cardiology community, including both clinicians and patients. The SCAI Scientific Oversight Committee is charged with annually reviewing the scientific needs of the membership at large, including survey-based research of the practice patterns and perspectives of SCAI members and stakeholders. This document is intended as a reference by the survey proponents, document writing groups, external collaborators, SCAI representatives, peer reviewers, and anyone seeking information about the SCAI surveys program. The aims of this SCAI document are to: (1) provide a framework for members to develop survey requests that are relevant, feasible, and align with the Society's missions and goals; (2) promote transparency and clarity for the process of performing a survey through SCAI; (3) establish the criteria for evaluating survey requests and provide input on reliable and meaningful design, data collection, and best practices; and (4) facilitate collaboration and communication between the survey committee and members of SCAI to maximize the impact of the findings to the interventional community at large.

Study of safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery for hard-grade cataracts.

PURPOSE: The purpose was to study the safety and efficacy of sub-Tenon and subconjunctival anesthesia in manual small-incision cataract surgery (MSICS) in patients with hard-grade cataracts. STUDY DESIGN: The design of the study was a prospective, observational, and randomized control study. MATERIALS AND METHODS: A total of 196 eyes, including 98 eyes in the subconjunctival anesthesia group (group A) and 98 eyes in the sub-Tenon anesthesia group (Group B), undergoing MSICS were enrolled in the study. A single surgeon performed all the surgeries. Intraoperative and postoperative pain scores, patient comfort, surgeon's satisfaction, and intraoperative complications were examined. RESULTS: The mean age of patients in Group A was 66.64 ± 9.95 years and that of patients in Group B was 64.52 ± 9.46. No statistically significant difference was noted in the intraoperative (P = 0.54) and postoperative pain (P = 0.66) scores between the two groups. There was no pain (0 score) in 30% of patients in Group A and 35% of patients in Group B intraoperatively. The average surgical time (P = 0.66) and surgeon's comfort (P = 0.34) were not statistically significant. The mean corneal haze was 0.054 ± 0.12 in group A and 0.065 ± 0.22 in group B (P = 0.45). Two patients in group A required supplemental anesthesia. There were no surgical complications that could compromise visual outcomes. No patients in either group showed alterations in vital parameters or required intravenous sedation. CONCLUSION: Both techniques of anesthesia are safe and effective for performing MSICS in hard-grade cataracts. However, it is prudent to choose a technique according to the surgeon's requirements.

Pelvic Palpatory Tests in Manual Therapy and Osteopathy: A Critical Review of the Literature and Suggestions for New Research.

Manual therapists apply physical interventions to the entire structure of the body to promote healing, prevent pathologies, and improve patient health. In osteopathic practice, palpatory evaluation is considered a fundamental clinical practice requirement for identifying somatic dysfunction. Most of the articles published in this area have failed to demonstrate a level of reproducibility that supports palpation in evidence-based clinical practice. When considering the poor reliability of the palpatory tests highlighted in the literature, a discrepancy is noted with what is known about the tactile sensitivity of human hands. For static touch, the minimum size that can be detected, in the absence of applied movement or vibration, is approximately 0.2 mm. Yet, it seems that this high level of precision is insufficient to ensure reliability in the tests used to evaluate osteopathic somatic dysfunction. The purpose that underscores this article is to determine how these two contradictory elements, high sensitivity and low reliability, can be present in palpatory tests. The article reports the literature findings regarding palpatory tests of pelvic, which is an important structure for clinical purposes. Additionally, a critical review of how these studies were conducted is provided to identify any elements that may justify the obtained results. Following recent accredited guidelines present in the literature, we propose suggestions on vision training methods, manual perception refinement training, the search for anatomical markers, and the position of the examiner in relation to the examinee that may be useful for future studies on the topic covered by the article.

A two-stream decision fusion network for cervical pap-smear image classification tasks.

Deep learning, especially Convolution Neural Networks (CNNs), has demonstrated superior performance in image recognition and classification tasks. They make complex pattern recognition possible by extracting image features through layers of abstraction. However, despite the excellent performance of deep learning in general image classification, its limitations are becoming apparent in specific domains such as cervical cell medical image classification. This is because although the morphology of cervical cells varies between normal, diseased and cancerous, these differences are sometimes very small and difficult to capture. To solve this problem, we propose a two-stream feature fusion model comprising a manual feature branch, a deep feature branch, and a decision fusion module. Specifically, We process cervical cells through a modified DarkNet backbone network to extract deep features. In order to enhance the learning of deep features, we have devised scale convolution blocks to substitute the original convolution, termed Basic convolution blocks. The manual feature branch comprises a range of traditional features and is linked to a multilayer perceptron. Additionally, we design three decision feature channels trained from both manual and deep features to enhance the model performance in cervical cell classification. Our proposed model demonstrates superior performance when compared to state-of-the-art cervical cell classification models. We establish a 15-category 148762 cervical cytopathology image dataset (CCID). In addition, we additionally conducted experiments on the SIPaKMeD dataset. Numerous experiments show that our proposed model performs excellently compared to state-of-the-art classification models. The outcomes illustrate that our approach can significantly aid pathologists in accurately evaluating cervical smears.

An implementation manual for an interprofessional enhanced recovery after surgery protocol in cardiac surgery following international established frameworks.

Introduction: Enhanced Recovery After Surgery (ERAS) protocols represent a paradigm shift in perioperative care, aim to optimize patient outcomes and accelerate recovery. This manual presents findings from implementing the INCREASE study, a bicentric prospective randomized controlled trial focusing on ERAS in minimally invasive heart valve surgery. Methods: Utilizing the Consolidated Framework for Implementation Research (CFIR) and the Template for Intervention Description and Replication (TIDieR), the study examined contextual factors, intervention components, and implementation strategies. Results: Key findings from the CFIR analysis revealed critical domains influencing implementation success. These included innovation characteristics, external and internal settings, and individual dynamics. The study showcased ERAS's adaptability to diverse healthcare systems, emphasizing its potential for successful integration across varying contexts. Furthermore, the importance of interprofessional collaboration emerged as a foundation of practical implementation, fostering teamwork, communication, and patient-centered care. Utilizing the TIDieR framework, this manual comprehensively describes ERAS intervention components, detailing preoperative counseling, intraoperative management, and postoperative care strategies. The manual underscored the importance of tailored, patient-centered approaches, highlighting the role of an academic ERAS nurse, early mobilization, and psychosomatic interventions in promoting optimal recovery outcomes. Discussion: In conclusion, the INCREASE study provided valuable insights for creating an implementation manual for ERAS in cardiac surgery, emphasizing adaptability, collaboration, and ongoing evaluation as key drivers of successful implementation. These findings have broad implications for improving patient care outcomes and advancing perioperative practices in cardiac surgery settings.

Impact of blue-collar vs. white-collar occupations on disease burden in psoriatic arthritis patients: A Swiss clinical quality management in rheumatic diseases cohort study.

Biomechanical stress may exacerbate inflammation in psoriatic arthritis (PsA). This study aimed to investigate disease activity, work disability, and drug response/retention rates in PsA patients among two different occupation's types: blue-collar workers (BCol) with manual labor versus white-collar workers (WCol) with sedentary occupations. PsA patients registered in the Swiss cohort (SCQM) were classified as BCol or WCol workers and assessed at the initiation of a biologic or targeted synthetic disease-modifying anti-rheumatic drug (b-/tsDMARD). We compared the baseline characteristics at treatment start and the DAS28-CRP for the 1-year remission. Treatment retention was investigated using Kaplan-Meier curves and Cox regression analysis. Multivariable models were adjusted for potential confounders. Of 564 patients, 29% were BCol, and 71% were WCol workers. Baseline disease activity was comparable between both groups. BCol workers were predominantly male (79.8%) and more work disabled at baseline (84.0% vs. 27.9%; p < 0.01). One hundred seventy-four treatment courses (TCs) of 165 PsA patients were included for longitudinal analysis. Occupation did not significantly influence the achievement of DAS28-CRP remission at 1 year. Kaplan-Meier analysis (n = 671) indicated longer retention for BCol workers (mean retention duration: 3.15 years vs. 2.15 years, (p = 0.006). However, adjusted Cox regression analysis did not corroborate these findings. This study indicates that physically demanding occupations correlate with increased rates of work disability among PsA patients, while treatment response seems to be unaffected by the patients' occupation type. Additional research is required to thoroughly comprehend the relationship between physical workload, disease activity, and treatment outcomes. Key Points • This study indicates that physically demanding occupations correlate with increased rates of work disability among PsA patients. • The treatment response among of PsA patients seems unaffected by the patients' occupation type.

Upright versus inverted catching and crating end-of-lay hens: a trade-off between animal welfare, ergonomic and financial concerns.

This study explores upright versus inverted catching and crating of spent laying hens. Both catching methods were compared using a cost-benefit analysis that focused on animal welfare, ergonomic, and financial considerations. Data were collected on seven commercial farms (one floor system and six aviary systems) during depopulation of approximately 3,000 hens per method per flock. Parameters such as wing flapping frequency, catcher bird interaction, incidence of catching damage and hens dead on arrival (DOA) were measured and compared between catching methods. Ergonomic evaluations were performed via catcher surveys and expert assessment of video recordings. The wing flapping frequency was lower (3.1 ± 0.6 vs. 4.0 ± 0.5, P < 0.001) and handling was gentler (1.9 ± 0.5 vs. 4.4 ± 0.5, P < 0.001), both on a 7-point Likert scale, for upright versus inverted catching. However, more person-hours per 1000 hens were required for upright than inverted catching (8.2 ± 3.2 h vs. 4.8 ± 2.0 h, P = 0.011), with only wing bruises being significantly less common for upright than inverted catching (1.1 ± 0.6 % vs. 1.7 ± 0.7%, P = 0.04). Upright catching was 1.8 times more expensive than inverted catching; compensation for this cost would require a premium price of approximately €0.0005 extra per egg. Ergonomically, both catching methods were considered demanding, although catchers (n = 29) preferred inverted catching. In conclusion, this study showed animal welfare benefits of upright vs. inverted catching. Industry adoption of upright catching will depend on compensation of the additional labor costs, adjustments to labor conditions and shorter loading times.