Experiência no uso das ferramentas de abordagem familiar por uma equipe da Estratégia Saúde da Família / Experiencia en el uso de herramientas de abordaje familiar por un equipo de Estrategia de Salud de la Familia / Family Health Strategy team's experience in the use of family approach tools

Problema: Experiência da intervenção de uma equipe multiprofissional da Estratégia Saúde da Família (ESF) em uma família por meio das ferramentas de abordagem familiar. Entre os problemas identificados no caso estão a sobrecarga de trabalho da paciente índice, diagnóstico de Transtorno do Espectro Autista (TEA) nos filhos dela, etilismo crônico do esposo e relacionamento hostil no ciclo familiar. Método: Estudo descritivo, qualitativo, de relato de experiência, desenvolvido em uma família da área de abrangência da equipe da ESF no segundo semestre de 2019, escolhida em razão da hiperutilização do serviço pela paciente índice. As ferramentas aplicadas foram o genograma, ecomapa, Fundamental Interpersonal Relations Outcome (FIRO), problem, roles, affect, communication, time in life, illness, coping with stress, environment/ecology (PRACTICE) e ciclo de vida familiar. Resultados: Com a aplicação das ferramentas foram identificadas as estruturas e modos de compartilhamento das relações familiares, os problemas de saúde presentes, os possíveis vínculos identificados e o estágio no ciclo de vida. Como modos de intervenção, a equipe propôs consultas de cuidado em saúde, assistência psicológica e escutas qualificadas. Além disso, por meio de reuniões intersetoriais, foi solucionado o problema escolar que afetava a condição de saúde da paciente. Conclusão: A aplicação das ferramentas foi um excelente método para realizar o estudo, pois permitiu uma visão global da família, além de identificar fragilidades a serem corrigidas ou minimizadas com recurso a intervenções pela equipe de saúde.

Problem: Intervention experience of a multidisciplinary team of the Family Health Strategy (ESF) through family approach tools. Among the problems identified in the case are the work overload of the index patient, diagnosis of autism spectrum disorder (ASD) in her children, husband's chronic alcoholism and hostile relationship within the family circle. Method: Descriptive and qualitative experience report. Developed by an ESF team in a family in the coverage area. Experience conducted in the second half of 2019. The tools applied were the genogram, ecomap, FIRO, PRACTICE and the family life cycle. The tools were chosen because of the index patient's frequent use of the ESF's services. Results: Through the application of the tools, the structures and ways of sharing family relationships, the health problems, the possible bonds identified and the stage in the life cycle were identified. As modes of intervention, the team proposed health care consultations, psychological assistance and qualified listening. In addition, through intersectional meetings, a school problem that affected the patient's health condition was solved. Conclusion: The application of the tools was an excellent method to carry out the study. It allowed a global view of the family, in addition to identifying weaknesses to be corrected or minimized, through interventions by the health team.

Problema: Experiencia de la intervención de un equipo multidisciplinario de la Estrategia Salud de la Familia (ESF) en una familia a través de herramientas de abordaje familiar. Entre los problemas identificados en el caso están la sobrecarga de trabajo de la paciente índice, diagnóstico de Trastorno del Espectro Autista (TEA) en sus hijos, alcoholismo crónico del marido y relación hostil dentro del ciclo familiar. Método: Estudio descriptivo, cualitativo de relato de experiencia desarrollado en una familia de la zona de cobertura del equipo de la ESF en el segundo semestre de 2019. Las herramientas aplicadas fueron el genograma, ecomapa, F.I.R.O., P.R.A.C.T.I.C.E. y el ciclo de vida familiar, elegido por la sobreutilización del paciente índice de los servicios de la ESF. Resultados: Mediante la aplicación de las herramientas se identificaron las estructuras y formas de compartir las relaciones familiares, los problemas de salud presentes, los posibles vínculos identificados y la etapa del ciclo de vida. Como modos de intervención, el equipo propuso la consulta de salud, la asistencia psicológica y la escucha cualificada. Además, a través de reuniones intersectoriales se solucionó un problema escolar que afectaba el estado de salud del paciente. Conclusión: La aplicación de las herramientas fue un método excelente para la realización del estudio, ya que permitió una visión global de la familia, además de identificar debilidades a ser corregidas o minimizadas, a través de intervenciones del equipo de salud.

Immediate implant placement in damaged extraction sockets: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: The aim of this study was to observe whether immediate implant placement (IIP) into damaged extraction sockets is a successful modality for treating hopeless teeth that require extraction. DATA SOURCE: An electronic search was carried out through four databases (PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect) to identify randomized controlled trials (2013-2023) to understand whether IIP in damaged sockets is a successful treatment. The focus question was, 'In a patient with a hopeless tooth that needs extraction with the indication for dental implant treatment, is IIP in damaged extraction sockets, compared to undamaged sockets or healed sites, an effective method for the replacement of hopeless teeth and achieving a favorable clinical result?' The risk of bias was appraised and a meta-analysis using random effect was applied. Five studies with 135 patients and 138 implants were included. The implant survival rate was 100% for all studies and period evaluated; the pink esthetic score (PES) scores had no statistically significant result for all articles that evaluated this parameter; the soft tissue changes was reported by two studies: one found no significant differences and the other showed that the test group experienced reduced soft tissue loss at the 1-year evaluation (measured with digital intraoral scanners); other two studies assessed the marginal bone loss, presenting no differences between groups. The meta-analysis showed homogeneity between the studies. There was an equilibrium among the groups in the various studies included, and age tended to be lower in the test group. The buccal bone tissue and pink esthetic score showed favoritism for the test group but without statistical significance. CONCLUSION: This study suggests that IIP in the presence of buccal bone defects can achieve comparable clinical and radiological outcomes to traditional methods in the short term of the limited studies available. The buccal aspect is not possible to be evaluated through radiographs. Bone regeneration was essential to reach optimal results. It is important to emphasize that IIP requires adherence to rigorous criteria to ensure functionally acceptable results.

Ergonomic differences in mesh placement and mesh fixation between laparoscopic and robotic inguinal hernia repair with mesh.

PURPOSE: General differences in surgeon ergonomics between laparoscopic and robotic-assisted inguinal hernia repairs (LIHR vs. RIHR) have been previously studied. However, specific differences in the ergonomics of mesh placement (MP) and mesh fixation (MF) are undetermined. Our aim was to determine if there are differences in the ergonomics of MP and MF between the surgical approaches. We hypothesize that we will identify differences, with the potential for worse ergonomics during LIHR. METHODS: Data was collected from fifteen LIHR and fifteen RIHR. All cases were elective, primary inguinal hernias completed by a fellowship-trained minimally invasive surgeon. Surface electromyography (EMG) of four upper extremity muscle groups, including the upper trapezius (UT), anterior deltoid (AD), flexor carpi radialis (FCR) and extensor digitorum (ED), was recorded bilaterally during MP and MF. Muscle activation as a percent of maximum voluntary contraction (%MVCRMS) and muscle fatigue denoted as the median frequency of muscle activations (Fmed) were calculated for each muscle. RESULTS: EMG analysis showed increased %MVCRMS in LIHR compared to RIHR cases, with significant findings in the left UT, right UT, ED, and FCR for MP and MF and the left FCR during MP. Muscle fatigue was decreased in LIHR compared to RIHR cases, with significant differences in left FCR and right ED and AD. CONCLUSION: Despite greater muscle activations during LIHR, RIHR had greater muscle fatigue. It is possible that short periods of high muscle activation are ergonomically protective during minimally invasive inguinal hernia repair. Identifying these differences may aid in development of procedure-specific interventions to improve ergonomics.

Nursing student voices: A qualitative thematic synthesis of education elements supporting nursing students' clinical learning during placement.

AIM: to report a thematic synthesis of students' narratives in free text comments from a national quality survey of Australian nursing degree students' clinical placements. BACKGROUND: Nursing student evaluation surveys are submitted to the Australian National Placement Evaluation Centre. Students in 36 Australian nursing programs are included. DESIGN: Thematic synthesis of nursing students' narrative comments. METHODS: Data were sourced from 10,226 surveys submitted between July and December 2023. From these, the 3640 free text comments were extracted and tabulated to form the sample for synthesis. Three authors conducted a thematic synthesis and all five authors agreed on the findings. FINDINGS: Student's comments generally portrayed a positive learning culture in clinical placement environments. One dominant theme 'Support' was interpreted as giving deeper meaning to students' perceptions of the help and encouragement of placement facility staff. Three subthemes 'Welcoming environment', 'Providing learning opportunities' and 'Teaching strategies' described students' ideas of what elements contribute to learning. Ten ways of teaching were revealed in students' narratives as education activities. Students commonly referred to staff supporters, illustrating that various staff worked to ensure students were supervised during clinical skills practice and that students' learning objectives were addressed. CONCLUSIONS: Staff-student relationships are paramount for students' learning and students' narratives revealed perceptions of a generally positive learning environment. The notion of support is implied as vital to nursing students' positive experience of clinical learning during placements. Curriculum designers, university course convenors and placement partners may use the findings identified in this study to ensure academic and placement facility staff are aware of how best to support students. In this way, institutions may narrow the gap between successful and less successful nursing student clinical placements.

A Case of Simultaneous Sinus Augmentation and Oroantral Fistula Closure for Implant Preparation.

An oroantral communication (OAC) may form in the upper molar region after tooth extraction. The patient is a 59-year-old female, who is a non-smoker. At the initial visit, teeth #14, #15, and #17 were missing. After tooth #16 was extracted due to apical periodontitis, a bone defect with a diameter of approximately 4 mm was observed, leading to the formation of an oroantral fistula (OAF). Another window was created in the lateral wall adjacent to the superior part of the bone defect at the fistula site to achieve closure of the OAF through bone formation and simultaneously perform sinus floor elevation (lateral approach) for implant placement. Through this lateral window, instruments were inserted into the maxillary sinus towards the bone defect at the fistula site. During this process, the remaining bone between the lateral window and the bone defect at the fistula site was carefully removed with instruments, connecting the two bone defects to facilitate the manipulation of the instruments. The Schneiderian membrane was elevated without enlarging the tear. Six months after these surgeries, a CBCT scan confirmed the closure of the fistula with hard tissue and the elevation of the sinus floor. Subsequently, three implants were placed, and prosthetic treatment was completed. Follow-up data is provided, including periapical X-ray and CBCT images taken two years and three months after surgery (one year and three months after the placement of the final prosthetic structure). The progress so far has been favorable.

Magnetic navigation-assisted colonoscopic enteral tube placement in swine (with video): a preliminary study.

BACKGROUND: Colonoscopic enteral tube placement using current methods has some shortcomings, such as the complexity of the procedure and tube dislodgement. The magnetic navigation technique (MNT) has been proven effective for nasoenteral feeding tube placement, and is associated with reduced cost and time to initiation of nutrition. This study attempted to develop a novel method for enteral tube placement using MNT. METHODS: The MNT device consisted of an external magnet and a 12 Fr tube with a magnet at the end. Ten swine were used, and bowel cleansing was routinely performed before colonoscopy. Intravenous anesthesia with propofol and ketamine was administered. A colonoscopic enteral tube was placed using the MNT. The position of the end of the enteral tube was determined by radiography, and angiography was performed to check for colonic perforations. Colonoscopy was used to detect intestinal mucosal damage after tube removal. RESULTS: MNT-assisted colonoscopic enteral tube placement was successfully completed in all pigs. The median operating time was 30 (26-47) min. No colon perforation was detected on colonography after enteral tube placement, and no colonic mucosal bleeding or injury was detected after the removal of the enteral tube. CONCLUSIONS: MNT-assisted colonoscopic enteral tube placement is feasible and safe in swine and may represent a valuable method for microbial therapy, colonic drainage, and host-microbiota interaction research in the future.

Walking the Talk: "Reflexivity" to Advance Integration of Patient Reported Outcomes for Cancer Care Screening.

In this commentary, we propose the use of video-reflexive ethnography (VRE) as a means to support integration of patient-reported outcomes (PROs) in cancer care screening. As for any policy or intervention, the optimization of PROs depends on moving beyond their mere formal introduction, and depends on the integration of PROs in the everyday practice contexts of health care professionals (HPEs). The use of VRE allows for video-playback sessions among oncology professionals to support team-based learning and practice-change grounded in "reflexivity." Through a review of previous methods used to support organizational change in healthcare settings (e.g., policies, quality improvement initiatives, simulation sessions), we present some unsung advantages of VRE that can be applied to a complex integrated setting, such as cancer care. As opposed to other methods to create change, VRE does not dictate new measures, but rather supports "bottom-up" provider-initiated changes to health care practices and contexts, grounded in collaborative day-to-day practice. We argue that VRE optimizes PROs in cancer care by facilitating their effective and sustainable integration, to promote improved patient care.

Analysis of electrode locations on limb condition effect for myoelectric pattern recognition.

BACKGROUND: Gesture recognition using surface electromyography (sEMG) has garnered significant attention due to its potential for intuitive and natural control in wearable human-machine interfaces. However, ensuring robustness remains essential and is currently the primary challenge for practical applications. METHODS: This study investigates the impact of limb conditions and analyzes the influence of electrode placement. Both static and dynamic limb conditions were examined using electrodes positioned on the wrist, elbow, and the midpoint between them. Initially, we compared classification performance across various training conditions at these three electrode locations. Subsequently, a feature space analysis was conducted to quantify the effects of limb conditions. Finally, strategies for group training and feature selection were explored to mitigate these effects. RESULTS: The results indicate that with the state-of-the-art method, classification performance at the wrist was comparable to that at the middle position, both of which outperformed the elbow, consistent with the findings from the feature space analysis. In inter-condition classification, training under dynamic limb conditions yielded better results than training under static conditions, especially at the positions covered by dynamic training. Additionally, fast and slow movement speeds produced similar performance outcomes. To mitigate the effects of limb conditions, adding more training conditions reduced classification errors; however, this reduction plateaued after four conditions, resulting in classification errors of 22.72%, 22.65%, and 26.58% for the wrist, middle, and elbow, respectively. Feature selection further improved classification performance, reducing errors to 19.98%, 19.75%, and 27.14% at the respective electrode locations, using three optimal features derived from single-condition training. CONCLUSIONS: The study demonstrated that the impact of limb conditions was mitigated when electrodes were placed near the wrist. Dynamic limb condition training, combined with feature optimization, proved to be an effective strategy for reducing this effect. This work contributes to enhancing the robustness of myoelectric-controlled interfaces, thereby advancing the development of wearable intelligent devices.

EMVision: An electromagnetic tracking guidance system for accurate placement of interstitial brachytherapy applicators.

PURPOSE: To design, construct, and evaluate a system for image-guided placement of brachytherapy applicators using electromagnetic tracking (EMT) technology for improved procedure quality and efficiency. The system, named EMVision, provides a three-dimensional display of planned needle sites, visibility of the anatomy and needle position during placement, and reference tracking to account for generator or target anatomy shifts. METHODS: The EMVision EMT guidance system registers CT and EMT reference frames using an automated point-based algorithm according to tandem/ovoid locations. Subsequent needle placement and digitization is guided with an intraluminal EMT sensor and user interface that displays the needle's location in axial, coronal, sagittal, and 3D-volumetric CT views. The interface can overlay contours, preplanned needles, and provide 6DOF compensation for tandem movement during needle placement/manipulation. EMVision accuracy was evaluated in phantom and human cadaver by comparing EMVision's DICOM needle positions with a ground-truth, postimplant CT. RESULTS: Proof of concept was demonstrated for EMT-assisted placement of brachytherapy needles. EMVision accuracy in phantom (mean ± standard deviation) on a brachysuite CT table was 0.76 ± 0.13 mm for needle tips placed up to 75 mm from the tandem/ovoids and 0.52 ± 0.27 mm for needle shafts at distances up to 100 mm from the tandem/ovoids. Performance in human cadaver was similar, with tip and shaft accuracies of 0.77 ± 0.14 mm and 0.40 ± 0.21 mm, respectively. CONCLUSION: EMVision provides sub-millimeter accuracy for the placement of brachytherapy needles without repeated or continuous imaging. The technology can be used to reduce brachytherapy procedure times, improve the correspondence between intended and actual needle positions, or decrease the trainee learning curve.

Chlorocilliumsinense sp. nov. (Clavicipitaceae) and Calcarisporiumguizhouense sp. nov. (Calcarisporiaceae) in Hypocreales from China.

Two new species, Chlorocilliumsinense and Calcarisporiumguizhouense, isolated from a spider and fruiting body of Cordyceps sp., are introduced. Morphological comparisons and phylogenetic analyses based on multigene datasets (ITS+LSU+RPB2+tef-1alpha) support the establishment of the new species. A combined dataset of ITS, LSU, RPB2, and tef-1alpha showed the taxonomic placement of Chlorocillium in Clavicipitaceae for the first time. Pseudometarhizium is regarded as a synonym of Chlorocillium and two Pseudometarhizium species are transferred into the latter based on the phylogenetic analysis and morphological characteristics.

Individual placement and support (IPS): duration of employment support and equity of access and outcome in routine clinical practice.

AIMS AND METHOD: To explore the duration of support, reach, effectiveness and equity in access to and outcome of individual placement and support (IPS) in routine clinical practice. A retrospective analysis of routine cross-sectional administrative data was performed for people using the IPS service (N = 539). RESULTS: A total of 46.2% gained or retained employment, or were supported in education. The median time to gaining employment was 132 days (4.3 months). Further, 84.7% did not require time-unlimited in-work support, and received in-work support for a median of 146 days (4.8 months). There was a significant overrepresentation of people from Black and minority ethnic communities accessing IPS, but no significant differences in outcomes by diagnosis, ethnicity, age or gender. CLINICAL IMPLICATIONS: Most people using IPS services do not appear to need time-unlimited in-work support. Community teams with integrated IPS employment specialists can be optimistic when addressing people's recovery goals of gaining and retaining employment.

Soft and hard tissue evaluation for vestibular socket therapy of immediately placed implants in infected and non-infected sockets: a 1-year prospective cohort study.

BACKGROUND: Immediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets. METHODS: We included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann-Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P < 0.05. RESULTS: All implants survived; no significant difference was found between groups N and I regarding apical, mid, and crestal bone thickness and soft tissue level, except at the mesial papilla, where the recession was significantly more in group N than in group I. Changes over time were statistically significant in the apical, mid, and crestal bone thickness in both groups. The mean bone thickness gain ranged from 0.85 to 2.4 mm and 0.26-1.63 mm in groups I and N, respectively. Additionally, the mean mucosal recession ranged from 0.29 to 0.51 mm and 0.39-1.47 mm in groups I and N, respectively. CONCLUSION: Within the limitations of this study immediate implant placement in type II infected sockets using the 6-day protocol and VST achieved 100% implant survival, while maintaining the regenerated facial bone thickness with minimal mucosal recession. TRIAL REGISTRATION: The protocol for this study was registered on clinicaltrials.gov at 3/10/2021 (registration number NCT04787224).

Student radiographers' confidence of adapting practice for autistic patients: A qualitative survey on the role of placement experiences.

INTRODUCTION: Healthcare services can be inaccessible to autistic people without adaptions to clinical practice and the care provided. Therefore, understanding how radiographer education develops students' confidence in adapting care for autistic patients is crucial. This study aimed to explore how placement experience impacts student radiographer confidence in adapting care for autistic patients. METHODS: UK final-year student diagnostic and therapeutic radiographers were invited to complete a qualitative online survey. The survey asked for a description of placement experiences; of observing and/or performing the care of autistic patients and how this impacted confidence in caring for autistic patients. The data was thematically analysed. RESULTS: 43 responses (of 44 received) were included, from which 5 themes emerged. Those who felt placement experiences developed confidence described opportunities to apply theory learnt at university (theme 1) or drew attention to the benefit of prior (external) experience with autistic people (theme 3). However, the balance of power with the supervising radiographer (theme 2), witnessing autistic patients in distress (theme 4), and the heterogeneous nature of autism (theme 5) disrupted students' development of confidence. CONCLUSION: Several participants in this study found clinical placement developed confidence with autistic patients through applying knowledge and providing an opportunity for reflexive learning. However, various obstacles hindered this development, such as witnessing distressed patients, limited experiences with autistic patients and difficulty navigating relationships with radiographers. IMPLICATIONS FOR PRACTICE: To improve student radiographers' confidence of providing care for autistic patients, educators should consider methods, e.g., co-produced simulation, to fill potential gaps in their experience. There is also a pressing need for all radiographers to understand their responsibility in educating students and their impact on student wellbeing.

Levonorgestrel 52mg Intrauterine Device placement without uterine sounding: A Feasibility study.

OBJECTIVE: To evaluate feasibility of levonorgestrel 52mg intrauterine device (IUD) placement without uterine sounding. STUDY DESIGN: We performed a three-phase feasibility study from February 2023-May 2024. In phase one, participants had levonorgestrel 52mg IUD placement with sounding. In the experimental phases, placement occurred without sounding and with (phase two) or without (phase three) concurrent transabdominal sonography and participants had 3-month follow-up. We defined feasibility as successful IUD placement without uterine sounding based on ultrasound confirmation immediately following placement. We measured total instrumentation time from the sound or inserter touching the cervix to inserter removal. Participants reported maximal pain experienced using a 100-mm Visual Analogue Scale when the inserter was removed. Physicians rated procedures as easy, moderate, or difficult. We calculated a sample size of 30 per phase so that if there was one failed placement, the lower 95% confidence interval of the successful placement rate would be no less than 90.0%. RESULTS: Successful placement without sounding occurred in 30(100%) participants in phase two and 28(93.3%) in phase three. Median instrumentation was longest in phase one (49.5 [IQR 42.3-55.0] seconds) compared to phases two (16.0 [IQR12.0-28.0] seconds, p<0.0001) and three (25.0 [IQR 18.5-32.2] seconds, p<0.0001). Participants' median placement pain was 21.0 (IQR 10.3-32.8) mm in phase one with no difference in phase two (25.5 [IQR 14.3-47.0] mm, p=0.35), but was higher in phase three (36.0 [IQR 22.8, 61.0] mm, p=0.01).Physicians rated IUD placement "easy" most often in phase two (n=29[96.7%]) compared to phases one (n=22[73.3%], p=0.03) or three (n=22[73.3%], p=0.03). Participants experienced one perforation and one expulsion, both in phase three. CONCLUSION: Levonorgestrel 52mg IUD placement without sounding is feasible with concurrent sonography. Placement without sounding results in shorter instrumentation time but does not decrease maximum placement pain.

How Were Palliative Care Assessments Performed by Students During a Clinical Nursing Experience? A Study in Interpretive Phenomenology Analysis.

Objectives: There has been limited investigation into nursing students' experiences of carrying out comprehensive assessments. Consequently, there is a need to explore the most effective and efficient assessment approach for students conducting palliative assessments for patients. This study aimed to investigate nursing students' experiences of performing palliative assessments while on clinical placement in a hospital. Materials and Methods: This research was conducted in West Kalimantan, Indonesia. Eight nursing students participated in semi-structured interviews utilising open-ended questions, generating 10 audio recordings. This qualitative study applied interpretative phenomenology analysis, with data analysed thematically. Results: The study identified eight substantial themes that illustrate the experiences of nursing students in palliative care assessment: Upgrading assessment skills, Contributing influences in the assessment process, The way the patient responds to the assessment, Replenishment of data, The importance of family involvement, Emerging issues in the assessment process, Approaches to assessment and Refining the assessment process. The study enhances comprehension of how students surmount assessment challenges. Conclusion: The findings present a potential guide for future research on assessing the effectiveness of palliative care instruments employed by nurses to enhance comprehensive holistic assessments for patients.

Designing an optimal task scheduling and VM placement in the cloud environment with multi-objective constraints using Hybrid Lemurs and Gannet Optimization Algorithm.

An efficient resource utilization method can greatly reduce expenses and unwanted resources. Typical cloud resource planning approaches lack support for the emerging paradigm regarding asset management speed and optimization. The use of cloud computing relies heavily on task planning and allocation of resources. The task scheduling issue is more crucial in arranging and allotting application jobs supplied by customers on Virtual Machines (VM) in a specific manner. The task planning issue needs to be specifically stated to increase scheduling efficiency. The task scheduling in the cloud environment model is developed using optimization techniques. This model intends to optimize both the task scheduling and VM placement over the cloud environment. In this model, a new hybrid-meta-heuristic optimization algorithm is developed named the Hybrid Lemurs-based Gannet Optimization Algorithm (HL-GOA). The multi-objective function is considered with constraints like cost, time, resource utilization, makespan, and throughput. The proposed model is further validated and compared against existing methodologies. The total time required for scheduling and VM placement is 30.23%, 6.25%, 11.76%, and 10.44% reduced than ESO, RSO, LO, and GOA with 2 VMs. The simulation outcomes revealed that the developed model effectively resolved the scheduling and VL placement issues.

Evaluation of Postoperative Effects of Using Ozonated Water as an Irrigant on Soft and Hard Tissues Surrounding Dental Implants: A Randomized Controlled Clinical Trial.

Aim To evaluate the short-term and long-term postoperative effects of ozonated water when used as an irrigant in terms of postoperative pain, healing, and implant stability when compared to normal saline irrigation during implant surgery, both carried out using conventional drilling protocol. Methods A total of 34 implants were placed in 17 patients, two implants in each patient, one implant using normal saline as an irrigant and another one using ozonated water as an irrigant during the surgical procedure of implant site osteotomy. Postoperative pain was assessed after 48 hours of the surgical procedure using the visual analog scale (VAS). Soft tissue healing was assessed after eight days using the tissue healing index. Osseointegration was checked by measuring the primary stability at the moment of implant placement and comparing it to the secondary stability measured three months after the implant placement. These stability values (ISQ) were obtained using resonance frequency analysis (RFA). Results The VAS scores for the control group (Group A) after 48 hours were 71.76±5.57 and for the experimental group (Group B) after 48 hours were 47.64±5.33 so mean values in the experimental group were significantly lower as compared to that in the control group (p<0.001). The mean healing index score for the control group (Group A) was 3.35±0.49 and the mean healing index score for the experimental group (Group B) was 4.64±0.49 so the mean values of tissue healing index in the experimental group were significantly higher as compared to that in the control group (p<0.001). The increase in stability value over the period of three months is 5.83 ISQ in the control group while the increase in stability value over the period of three months is 7.06 ISQ in the experimental group. The difference although not statistically significant shows a slight increase in stability in the experimental group as compared to that of the control group. Conclusion Ozone water irrigation at implant site osteotomy reduced postoperative pain and accelerated the tissue wound healing but the significant effect on osseointegration could not be determined.

Preventing Proximal Radio-Ulnar Joint Screw Penetration during Coronoid Fracture Fixation: A 3D-Digital Modeling and Cadaver Study.

Objective: Intra-articular screw penetration is a probable complication of coronoid fracture fixation. The present study aimed to determine the best radiography technique for visualizing the proximal radioulnar joint (PRUJ) space. Moreover, it aimed to determine the safe angle and length of the screw to avoid PRUJ penetration during coronoid fracture fixation. Methods: The Mimics software was used to construct a three-dimensional model of a healthy man's forearm from a computer tomography scan. It was analyzed using the Solidworks software to determine the X-ray angle that clearly showed the PRUJ space to detect penetration of screws from the coronoid process into the PRUJ and determine the maximum screw angle and length that could be used without intra-articular penetration. To verify these findings, a cadaveric study combined with radiographs was conducted. Results: To visualize PRUJ space, the optimal X-ray angle was 13º lateral to the perpendicular line when the forearm was positioned at full supination. If the coronoid process was segmented into zones 1 (closest to the radioulnar joint) to 4 (farthest from the joint), the screw could only be inserted at a right angle in zone 1. In zones 2, 3, and 4, inclination angles less than 15, 35, and 60 would prevent intra-articular penetration, respectively. Conclusions: The X-rays could visualize the PRUJ space with an anteroposterior radiograph at an angle of 13º ulnar deviation from the perpendicular plane. During coronoid process fracture fixation, shorter screws with less lateral inclination were safer when inserting screws in the zones of the coronoid process adjacent to the PRUJ.

Management of gastroschisis in an extremely low birth weight infant: report of a case.

BACKGROUND: Gastroschisis is a rare congenital anomaly in which abdominal organs herniate through a defect in the abdominal wall. Managing gastroschisis in extremely low birth weight (ELBW) infants presents significant challenges because of their immature physiologies and increased risk of complications. CASE PRESENTATION: This report discusses the case of a female ELBW infant born via an emergency cesarean section at 29 weeks of gestation, weighing 768 g, who had a prenatal diagnosis of gastroschisis. Postnatal management included immediate surgical intervention using a hand-made silo manufactured from expanded polytetrafluoroethylene (ePTFE) sheets that were sutured to the patient's abdominal wall to accommodate her small abdominal cavity and preserve mesenteric blood flow. Necrotizing enterocolitis with bowel perforation emerged as a complication, which led to the excision of a 10 cm segment of the ileum and the creation of an ileostomy. The infant experienced insufficient weight gain and liver dysfunction. However, she was eventually discharged on day 142 of life, weighing 2774 g, on oral feeding, without significant complications. CONCLUSIONS: This case emphasizes how prematurity significantly affected the patient's clinical outcomes, and highlights the importance of individualized management strategies. Our experience demonstrates that custom silo placement allows for the size to be adapted to the abdominal defect, and highlights the critical need to prioritize postnatal bowel perfusion in ELBW infants with gastroschisis.

A Safe Methodology for Suction Drain Placement in in Head & Neck Reconstruction after Free Tissue Transfer.

Introduction: Free tissue transfer is now done routinely for Head & neck reconstruction. A suction drain is needed for efficient drainage of the neck post-dissection & with it arises a new dilemma, challenge or obsession amidst the practicing surgeons about the safe and efficient placement of suction drain in an anatomical location so that it does not injure or impair the anastomosis but will still be able to carry out its role efficiently. No prior studies are available regarding the safe practice. Hence the aim of our study was to explore & establish a reliable manoeuvre where the drain could be introduced in a safe and efficient way. From April of 2017-February of 2024 a prospective study was carried out in which cases of 517 patients were taken into account who underwent head and neck reconstruction using a free tissue transfer procedure where the suction drain tube was placed in the dependent part of the neck (i.e. the posterior triangle region) & the margin of sternocleidomastoid muscle was fixed with the pre-vertebral layer of the cervical fascia. The drain was secured externally with a percutaneous non- absorbable suture. Study Design: A prospective Study. Study Period: April 2017- February 2024. Observation: A thorough observation was carried out & no evidence of drain induced anastomotic complications were reported. Conclusion: Hence it can be assumed that this particular method of drain placement is both safe & efficient and it can act as a beacon among the surgeons who suffer a from a dilemma & challenge about where to place the drain safely & efficiently.