ABSTRACT Purpose: To determine the clinical outcomes in patients after type 1 Boston keratoprosthesis surgery and the significance of ultrasound biomicroscopy imaging for postoperative follow-up. Methods: This retrospective analysis included 20 eyes of 19 patients who underwent corneal transplantation with type 1 Boston keratoprosthesis between April 2014 and December 2021. Data on patient demographics, preoperative diagnosis, visual acuity, and postoperative clinical findings were analyzed. Results: Type 1 Boston keratoprosthesis implantation resulted in intermediate- and long-term positive outcomes. However, blindness and other serious complications such as glaucoma, retroprosthetic membrane formation, endophthalmitis, or retinal detachment also occurred. The use of ultrasound biomicroscopy imaging allowed for better evaluation of the back of the titanium plate, anterior segment structures, and the relationship of the prosthesis with surrounding tissues, which provided valuable postoperative information. Conclusion: Regular lifetime monitoring and treatment are necessary in patients who undergo Boston type 1 keratoprosthesis implantation for high-risk corneal transplantation. ultrasound biomicroscopy imaging can be a valuable imaging technique for the evaluation of patients with Boston type 1 keratoprosthesis, providing important information on anterior segment anatomy and potential complications. Further studies and consensus on postoperative follow-up protocols are required to optimize the management of patients with Boston type 1 keratoprosthesis. Purpose followup. followup follow up. up Methods 2 201 2021 demographics diagnosis acuity analyzed Results intermediate longterm long term However glaucoma formation endophthalmitis occurred plate structures tissues Conclusion highrisk high risk 202

Abstract Introduction: Almost 800 female deaths occur daily due to preventable causes associated with complications during or after pregnancy or childbirth, equivalent to two maternal deaths per minute. Objective: To develop a nursing care process for a pregnant woman who suffered from hyperthyroidism using diagnostic taxonomies, results and nursing interventions with a focus on Orem's theory. Methodology: Case study of a pregnant woman treated in a second level care hospital, the Orem assessment guide was used, developing the stages: assessment, diagnosis, planning, execution and evaluation, individualized care plans were designed and executed. Privacy was protected by omitting identity, respecting the rights and well-being of the participant. Results: The risk conditioning factor that compromised the health of the mother-child binomial gave way to care planning aimed at the process of ineffective motherhood and ineffective self-management of health, establishing interventions such as high-risk pregnancy care and teaching the process of illness and prescribed medications, an improvement was obtained in the patient's health status, which allowed her discharge and adequate management of the high-risk pregnancy. Conclusion: The nursing care process exposed the context in which the pregnant woman with known uncontrolled pathology is admitted, which compromised maternal-fetal well-being. Nursing education is required to promote preconception maternal health for future pregnancies.

Abstrato Introdução: Quase 800 mortes femininas ocorrem diariamente por causas evitáveis associadas a complicações durante ou após a gravidez ou o parto, o equivalente a duas mortes maternas por minuto. Objetivo: Desenvolver um processo de cuidado de enfermagem a uma gestante portadora de hipertireoidismo utilizando taxonomias diagnósticas, resultados e intervenções de enfermagem com enfoque na teoria de Orem. Metodologia: Estudo de caso de uma gestante atendida em um hospital de atenção secundária, utilizou-se o guia de avaliação de Orem, desenvolvendo as etapas: avaliação, diagnóstico, planejamento, execução e avaliação, foram desenhados e executados planos de cuidados individualizados. A privacidade foi protegida pela omissão da identidade, respeitando os direitos e o bem-estar do participante. Resultados: O fator condicionante de risco que comprometia a saúde do binômio mãe-filho deu lugar ao planejamento do cuidado voltado ao processo de maternidade ineficaz e à autogestão ineficaz da saúde, estabelecendo intervenções como o cuidado à gravidez de alto risco e ensinando o processo e medicamentos prescritos, houve uma melhora no estado de saúde da paciente, o que permitiu sua alta e o gerenciamento adequado da gravidez de alto risco. Conclusão: O processo de cuidado de enfermagem expôs o contexto em que a gestante com patologia conhecida não controlada é internada, o que compromete o bem-estar materno-fetal. A educação em enfermagem é necessária para promover a saúde materna pré-concepcional em futuras gestações.

Resumen Introducción: Casi 800 muertes de mujeres en forma diaria ocurren por causas prevenibles asociadas a complicaciones durante o después del embarazo o el parto, equivaliendo dos muertes maternas por minuto. Objetivo: Desarrollar un proceso de atención de enfermería a gestante que cursó con hipertiroidismo empleando las taxonomías diagnósticas, resultados e intervenciones de enfermería con enfoque de la teoría de Orem. Metodología: Estudio de caso a mujer gestante atendida en hospital de segundo nivel de atención, se empleó la guía de valoración de Orem desarrollando las etapas: valoración, diagnóstico, planeación, ejecución y evaluación, se diseñaron y ejecutaron planes de cuidados individualizados. Se protegió la privacidad omitiendo identidad, respetando los derechos y bienestar de la participante. Resultados: El factor condicionante de riesgo que comprometía la salud del binomio madre-hijo, dio paso a la planificación del cuidado encaminado al proceso de maternidad ineficaz y autogestión ineficaz de la salud, estableciendo intervenciones como cuidados del embarazo de alto riesgo y enseñanza del proceso de enfermedad y medicamentos prescritos, se obtuvo mejora en el estado de salud de la paciente, lo que permitió su alta y un adecuado manejo del embarazo de alto riesgo. Conclusión: El proceso de atención de enfermería expuso el contexto en el que ingresa la mujer gestante con patología conocida no controlada, lo que comprometía el bienestar materno-fetal. Se requiere educación por parte de enfermería para fomentar la salud materna preconcepcional para futuros embarazos.

Resumen Objetivo: desarrollar un método para la cobertura delta de portafolios de opciones europeas listadas con base en la teoría del cálculo conformable que mejora la precisión de las predicciones usando la aproximación de primer orden. Metodología: permitimos que la primera derivada en el modelo clásico de Black-Scholes-Merton tenga un orden fraccional 0 ≤ α ≤ 1 y calculamos la delta correspondiente de un portafolio como función de este parámetro conformable. Resultados: aplicando este método a un portafolio conformado de ocho opciones europeas listadas sobre el índice SPX, encontramos que la cobertura conformable genera predicciones más precisas, en promedio, que la cobertura tradicional. Limitaciones: este método es aplicable solamente a la cobertura delta (hedging) de opciones europeas. Originalidad: esta es la primera aplicación exitosa del cálculo conformable a la cobertura delta en opciones europeas. Conclusiones: la aplicación del cálculo conformable permite mayor flexibilidad en la aproximación local implícita en la cobertura delta de portafolios de acciones europeas y se ofrece como una metodología novel y de mayor precisión que la tradicional.

Abstract Objective: we aim to develop a method for delta hedging portfolios of European options based on the theory of conformable calculus which improves accuracy of risk management of listed options in a first-order approximation. Methodology: we allow the time derivative in the classic Black-Scholes-Merton model to have a fractional order 0 ≤ α ≤ 1 and calculate the corresponding delta of a portfolio of listed options as a function of this conformable parameter. Results: applying this method to a portfolio consisting of eight European options on the SPX index, we find that conformable delta hedging offers more accurate average predictions than classical delta hedging. Limitations: this method is applicable for delta hedging in European options only. Originality: this is the first successful application of conformable calculus to delta hedging in European options. Conclusions: application of Conformable Calculus allows for a greater flexibility in the local approximation to price in delta-hedging European options and offers a new and more precise methodology to this objective.

RESUMEN En la actualidad las organizaciones deben hacer frente a numerosos riesgos, dada la multitud de actividades que se desarrollan diariamente en un entorno dinámico e incierto, por lo que se hace necesario perfeccionar los modelos de gestión en función de lograr mejoras en su desempeño organizacional. El objetivo de la propuesta que se presenta es una metodología para la gestión de riesgo basado en las normas ISO 31000 en una entidad de ciencia, tecnología e innovación. Se emplearon varios métodos y técnicas que permitieron transitar desde el análisis de los fundamentos teóricos y conceptuales que permitieron presentar la metodológica, emergiendo como un instrumento para coordinar y realizar las acciones necesarias para reducir vulnerabilidades para prevenir, mitigar, atender y recuperar efectos negativos.

ABSTRACT Currently, organizations must face numerous risks, given the multitude of activities that are carried out daily in a dynamic and uncertain environment, which makes it necessary to improve management models in order to achieve improvements in their organizational performance. The objective of the proposal presented is a risk management methodology based on ISO 31000 standards in a science, technology and innovation entity. Several methods and techniques were used that allowed to move from the analysis of the theoretical and conceptual foundations that allowed to present the methodology, emerging as an instrument to coordinate and carry out the necessary actions to reduce vulnerabilities to prevent, mitigate, attend and recover negative effects.

Resumo: Introdução: A hipertensão arterial (HA) é a principal causa de morte por doenças cardiovasculares. Apesar dos avanços, o percentual de hipertensos não diagnosticados e não tratados é de 58,4%. A avaliação do dano cognitivo na hipertensão concentra-se na prevenção do acidente vascular cerebral, enquanto o dano funcional é ignorado. Esse manejo inadequado pode ser multifatorial. É objetivo fue analisar a opinião dos médicos sobre a relação entre hipertensão arterial e danos cognitivos. Metodologia: Estudo observacional, descritivo, transversal desenvolvido no período entre agosto de 2020 e agosto de 2023. Análise de dados obtidos a partir de questionário autoaplicável, anônimo e voluntário. Revelar informações sobre o perfil profissional, conhecimento sobre a HA, sua ligação com o comprometimento cognitivo (DC), diagnóstico e tratamento. Resultados: Foram incluídos 222 profissionais, 215 (96,8%) concordam com a existência de ligação entre hipertensão e outros fatores de risco cardiovascular na DC e 218 (98,1%) reconhecem ajudar pacientes com risco de sofrer de D.C. A avaliação da DC é realizada em casos selecionados por 132 (59,4%) participantes e 59 (26,7%) a fazem sempre. Dos que realizam avaliação, 103 (54%) utilizam o Mini Exame do Estado Mental (MEEM), 10 (5,2%) utilizam a Avaliação Cognitiva de Montreal (MoCA) e 9 (4,7%) utilizam o Clock Drawing Test. Em relação à diminuição da pressão arterial em pacientes idosos e a ligação com o risco de DC: 54 (24,3%) não reconhecem risco e 65 (29,2%) reconhecem risco moderado-alto. Em referência à implicação do tratamento de doenças cardiovasculares e DC: 217 (97,7%) reconheceram o efeito benéfico. Discussão: Dado o reconhecimento da ligação entre hipertensão e DC, seria de esperar que a DC fosse investigada na grande maioria, no entanto apenas 26,7% sempre a avaliam. Não há consenso sobre o método, sendo o MEEM o mais utilizado, com baixa aplicação do teste MoCA e/ou Clock Drawing Test, sendo estes últimos os que avaliam a função executiva, majoritariamente alterada nos DC vinculados à HA. Embora o tratamento das doenças cardiovasculares seja reconhecido como benéfico em relação à DC, o controle da HA em idosos é considerado arriscado. É feito um diagnóstico de uma situação em que é evidente uma disparidade entre o que se reconhece como saber e o que se afirma fazer. Conclusões: O papel da doença vascular no dano cerebral funcional é reconhecido, considerando-se necessário conhecer o estado cognitivo dos pacientes, porém há baixa aplicação de testes de triagem que avaliam a função executiva. Nesse contexto, evidencia-se uma lacuna entre o conhecimento e a prática médica.

Abstract: Introduction: High blood pressure (HBP) is the leading cause of death from cardiovascular disease. Despite the advances, the percentage of undiagnosed and untreated hypertensive patients is 58.4%. The evaluation of cognitive damage in HBP focuses on preventing stroke, while functional damage is ignored. This inadequate management may be multifactorial. The objective was to analyze the opinions that doctors have about the relationship between high blood pressure and cognitive damage. Methodology: Observational, descriptive, cross-sectional study developed in the period between August 2020 and August 2023. Analysis of data obtained from a self-administered, anonymous and voluntary questionnaire. Revealing information on the professional profile, knowledge of HBP, its link with cognitive impairment (CD), diagnosis and treatment. Results: 222 professionals were included, 215 (96.8%) agree with the existence of a link between HBP and other cardiovascular risk factors in CD, and 218 (98.1%) acknowledge assisting patients at risk of suffering from CD. The CD evaluation is carried out in selected cases by 132 (59.4%) participants and 59 (26.7%) always do it. Of those who perform evaluation, 103 (54%) use the Mini Mental State Examination (MMSE), 10 (5.2%) use the Montreal Cognitive Assessment (MoCA) and 9 (4.7%) use the Clock Drawing Test. Regarding the decrease in blood pressure in elderly patients and the link with risk of CD: 54 (24.3%) do not recognize risk and 65 (29.2%) recognize a moderate-high risk. In reference to the implication of the treatment of cardiovascular disease and CD: 217 (97.7%) recognized a beneficial effect. Discussion: Given the recognition of the link between HBP and CD, it would be expected that CD would be investigated in the vast majority, however only 26.7% always evaluate it. There is no consensus on the method, the MMSE being the most used, with a low application of the MoCA test and/or Clock Drawing Test, the latter being the ones that evaluate executive function, mostly altered in CD linked to HBP. Although the treatment of cardiovascular disease is recognized as beneficial with respect to CD, the control of HBP in older adults is considered risky. A diagnosis is made of a situation where a disparity is evident between what one recognizes as knowing and what one claims to do. Conclusions: The role of vascular disease in functional brain damage is recognized, considering it necessary to know the cognitive status of patients, however there is a low application of screening tests that evaluate executive function. In this context, a gap between medical knowledge and practice is shown.

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Abstract Introduction. Livestock farming with Creole cattle is practiced in rural areas with challenging characteristics for species management. Objective. To describe the production system and the socio-cultural and technical-economic factors affecting the production of Nunkiní Creole cattle (Bos taurus). Materials and methods. The study was conducted from November 2020 to October 2021 in nine livestock production units of Nunkiní, Calkiní municipality, Campeche, Mexico. Information was obtained from an interview form with social, cultural, technical, and economic study variables, applied to selected producers. Data were analyzed using descriptive statistics and ANOVA. Results. Livestock farming was carried out by men (100 %), with an average age of 58.44 years. The average years of experience were 34.61. Younger producers had higher levels of education and less experience, and were responsible for the production units of higher technological levels. The size of the livestock production unit ranged from five to twenty-two cattle (average of 14). Feeding management followed a transhumance scheme, with cattle being free-ranging on ejido lands and from May to December and semi-stabled from January to April, grazing on cultivated pastures and supplemented with agricultural residues. With the zootechnical management implemented by the producers, an average pregnancy rate of 83 % was achieved. The main product marketed was fresh meat in cuts and direct sale to consumers, with an average price of 2.675 USD$/kg. Conclusion. It is traditional extensive system that takes advantage of the common use of grasslands. It involves experienced but older producers, with small investments, and serves to strengthen their family economy. This activity is threatened by the lack of revaluation of Creole cattle and the introduction of exotic breeds in the area to maximize production.

Resumen Introducción. La ganadería con bovinos criollos se práctica en espacios rurales con características difíciles para el manejo de las especies. Objetivo. Describir el sistema productivo y los factores socioculturales y técnico-económicos que afectan la producción del bovino criollo de Nunkiní (Bos taurus). Materiales y métodos. El estudio se realizó entre noviembre del 2020 a octubre del 2021, en nueve unidades de producción pecuarias de Nunkiní en el municipio de Calkiní, Campeche, México. La información se obtuvo de una cédula de entrevista con variables de estudio sociales, culturales, técnicas y económicas, aplicada a productores seleccionados. Los datos se analizaron mediante estadística descriptiva y ANDEVA. Resultados. La crianza del ganado la realizaron hombres (100 %), con edad promedio de 58,44 años. Los años de experiencia promedio fueron de 34, 61. Los productores jóvenes tuvieron mayor escolaridad y menor experiencia, y se encargaron de las unidades de producción de mayor nivel tecnológico. El tamaño de la unidad de producción pecuaria varió de cinco a veintidós bovinos (media de 14). El manejo alimenticio tuvo un esquema de trashumancia, donde de mayo a diciembre estuvieron libres en tierras ejidales y de enero a abril se manejaron semiestabulados, con pastoreo en potreros cultivados y suplementados con residuos agrícolas. Con el manejo zootécnico implementado por los productores, se obtuvo un promedio de 83 % de preñez. El producto principal comercializado fue carne fresca en cortes y venta directa al consumidor, con un precio promedio de 2,675 USD$/kg. Conclusión. Es un sistema tradicional extensivo que aprovecha el uso común de los agostaderos. Con productores de experiencia, pero de edad avanzada, de pequeña inversión y le sirve para fortalecer su economía familiar. Dicha actividad se ve amenazada por la falta de revalorización del bovino criollo y la introducción de razas exóticas en la zona para maximizar la producción.

Abstract Introduction. Pesticides are used to control pests and diseases in agricultural activities. Improper management of these products poses a potential risk to human health and the environment. Objective. To evaluate the (eco)toxicological pressure exerted by synthetic pesticides on tobacco crops (Nicotiana tabacum) in the province of Sancti Spíritus, Cuba. Materials and methods. A database from the Provincial Directorate of Plant Health for the period 2016-2019 was used, where the pesticides assigned to the province for this crop were compared with those reported by interviewed farmers. The dual indicator POCER was used to obtain the results, determining the pressure exerted by different pesticides and their harmful reference on humans and the environment. Results. The trend in pesticide consumption (summarized in tables and graphs) showed 50 % decrease, corresponding to the country’s crop protection policy. Farmers mentioned the use of authorized and unauthorized active ingredients in the conducted surveys, and sixteen high-risk active ingredients were detected in the analyzed samples. Evaluating the POCER results and analyzed samples, a significant (eco)toxicological pressure was observed on both the environment and human health, exerted by a group of high-toxicity active ingredients used in tobacco cultivation in the province. Conclusion. Using the dual indicator POCER provides an evaluation of the (eco)toxicological pressure exerted by synthetic pesticides used in the tobacco cultivation (Nicotiana tabacum) in the province of Sancti Spíritus, Cuba, for the study period.

Resumen Introducción. Los plaguicidas son utilizados para controlar las plagas y enfermedades en las actividades agrícolas. El manejo inadecuado de estos productos constituye un riesgo potencial para la salud humana y el medio ambiente. Objetivo. Evaluar la presión toxicológica (eco) ejercida por los plaguicidas sintéticos en los cultivos de tabaco (Nicotiana tabacum) en la provincia de Sancti Spíritus, Cuba. Materiales y métodos. Se utilizó una base de datos de la Dirección Provincial de Sanidad Vegetal para el período 2016-2019, donde se tomaron los plaguicidas asignados a la provincia para este cultivo y se compararon con los declarados por los agricultores entrevistados. Para la obtención de los resultados se utilizó el indicador dual POCER, que determinó la presión ejercida por los diferentes plaguicidas y su referencia nociva sobre el ser humano y el medio ambiente. Resultados. La tendencia del consumo de plaguicidas (resumida en tablas y gráficos) mostró una disminución del 50 %, que corresponde a la política de protección de los cultivos del país. Los agricultores mencionaron el uso de ingredientes activos autorizados y no autorizados en las encuestas realizadas, y en las muestras analizadas se detectaron dieciséis ingredientes activos de alto riesgo. Al evaluar los resultados de POCER y muestras analizadas se observó que existe una gran presión (eco)toxicológica tanto para el medio ambiente como para la salud humana ejercida por un grupo de ingredientes activos de alta toxicidad utilizados en el cultivo de tabaco de la provincia. Conclusión. Con la utilización del indicador dual POCER, se obtiene una evaluación de la presión (eco)toxicológica ejercida por los plaguicidas sintéticos utilizados en el cultivo del tabaco (Nicotiana tabacum) en la provincia de Sancti Spíritus, Cuba para el período de estudio.

Abstract The research analyzes the variables that influence the strengthening of business and tax culture through knowledge management. Methodologically, it is a study with a qualitative and analytical approach. The study highlights the importance of knowledge management as a catalyst for improving organizational culture and tax compliance in companies. Variables such as effective communication allow the organization to improve tax and administrative management through the individual knowledge of each employee. The acquisition of skills and knowledge through training and education strengthens the resilience of individuals to regulatory changes. Technology, used as a management and process optimization tool, reduces error variability while increasing efficiency and performance. Teamwork in the execution of tasks facilitates more efficient planning and optimal allocation of individual responsibilities. Finally, by implementing a risk management approach, it is possible to exercise greater diligence in the early detection of errors and minimize their impact on the ongoing business development context.

Resumen La investigación analiza las variables que influyen en el fortalecimiento de la cultura empresarial y tributaria a través de la gestión del conocimiento. A nivel metodológico es un estudio con enfoque cualitativo y analítico. El estudio destaca la importancia de la gestión del conocimiento como un catalizador para mejorar la cultura organizacional y el cumplimiento tributario en las empresas. Variables como la comunicación efectiva, permite en la organización el mejoramiento en la gestión tributaria y administrativa por medio del conocimiento individual de cada trabajador; la adquisición de habilidades y conocimientos a través de la formación y capacitación fortalece la resiliencia de los individuos ante las modificaciones regulatorias; la tecnología, utilizada como un instrumento para la gestión y optimización de los procesos, reduce la variabilidad de errores, al tiempo que aumenta la eficiencia y el rendimiento; el trabajo en equipo en la ejecución de tareas facilita una planificación más eficiente y una asignación óptima de las responsabilidades individuales; y finalmente, mediante la implementación de un enfoque de gestión de riesgos, es posible ejercer una mayor diligencia en la detección temprana de fallos y en la minimización de su impacto en el contexto del desarrollo del negocio en marcha.

Resumo Historicamente, são necessários, em média, 17 anos para que novos tratamentos passem da evidência clínica para a prática diária. Considerando os tratamentos altamente eficazes disponíveis atualmente para prevenir ou retardar o início e a progressão da doença renal, esse período é demasiadamente longo. Agora é o momento de reduzir a lacuna entre o que sabemos e aquilo que fazemos. Existem diretrizes claras para a prevenção e o manejo dos fatores de risco comuns para doenças renais, como hipertensão e diabetes, mas apenas uma fração das pessoas com essas condições é diagnosticada mundialmente, e um número ainda menor recebe tratamento adequado. Da mesma forma, a grande maioria das pessoas que sofrem de doença renal não têm conhecimento de sua condição, pois ela costuma ser silenciosa nos estágios iniciais. Mesmo entre pacientes que foram diagnosticados, muitos não recebem tratamento adequado para a doença renal. Levando em consideração as graves consequências da progressão da doença renal, insuficiência renal ou óbito, é imperativo que os tratamentos sejam iniciados precocemente e de maneira adequada. As oportunidades para diagnosticar e tratar precocemente a doença renal devem ser maximizadas, começando no nível da atenção primária. Existem muitas barreiras sistemáticas, que vão desde o paciente até o médico, passando pelos sistemas de saúde e por fatores sociais. Para preservar e melhorar a saúde renal para todos em qualquer lugar, cada uma dessas barreiras deve ser reconhecida para que soluções sustentáveis sejam desenvolvidas e implementadas sem mais demora. Historicamente necessários média 1 diária longo fazemos renais diabetes mundialmente forma condição iniciais diagnosticados óbito adequada maximizadas primária sistemáticas médico sociais lugar demora

Abstract Historically, it takes an average of 17 years for new treatments to move from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. Now is the time to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions are diagnosed worldwide, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because it is often silent in the early stages. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from the patient to the clinician to the health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay. Historically 1 practice progression long diabetes worldwide target Similarly condition stages failure death appropriately level everywhere

Abstract Introduction Teachers are a high-risk group for the development of vocal dysfunction, as they use voice extensively in their profession. Objective To know the prevalence and risk factors associated with voice strain in teachers. Methods A cross-sectional study was conducted among schoolteachers in Chitwan, Nepal. The Voice Handicap Index questionnaire was used as a survey tool. Result A total of 315 teachers were enrolled in the study. The mean age of the participants was of 36.7 years. Teachers from public schools, primary grade classes, > 50 pupils in the classroom, > 24 hours of classes per week, dust in class, and recurrent tonsil problems were associated with various degrees of vocal handicap. Conclusion There is a high prevalence of voice disorder among teachers. A holistic approach, which includes teacher education regarding voice care during their work and management of their voice handicap by taking into consideration different risk factors, must be adopted. highrisk dysfunction profession crosssectional cross sectional Chitwan Nepal tool 31 367 36 7 36. years schools 5 classroom 2 week class approach adopted 3

Abstract: The Intensity-Duration-Frequency (IDF) curves are a way to visualize and represent extreme hydrometeorological rainfall events. In this article, an analysis of convective rainfall events recorded at the La Piedra Meteorological Station, Villa Clara, Cuba, was conducted. To develop IDF curves, the 2006-2019 time series was analyzed. A partial duration series was generated, including intervals from 20 minutes to 4320 minutes, subjected to an outlier detection process. The series was divided into two categories: one for durations ≤ 720 minutes and another for durations > 720 minutes. The resulting series underwent non-parametric tests to assess their independence, randomness, homogeneity, and seasonality. Subsequently, they were fitted to the Generalized Pareto probability distribution and to a parametric equation of the Montana model, and then the curves were plotted for return periods of 10, 50 and 100. The Montana model led to obtaining correlation coefficients greater than 0.90 compared to the other methods used, significantly improving the quality of the fit in both categories. This research provides information to understand and plan the management of intense climatic phenomena and adequate risk management in an area where such studies are lacking, facilitating access to crucial data essential in the design and execution of hydraulic engineering projects in the region.

Resumen: Las curvas de Intensidad-Duración-Frecuencia (IDF) son una manera de visualizar y representar los eventos hidrometeorológicos extremos de lluvia. En este artículo se llevó a cabo un análisis de eventos de lluvias convectivas registrados en la Estación Meteorológica La Piedra, Villa Clara, Cuba. Para desarrollar curvas IDF se analizó la serie temporal 2006-2019. Se generó una serie de duración parcial que incluyó intervalos de 20 minutos hasta 4320 minutos, sometiéndola a un proceso de detección de datos anómalos. La serie se dividió en dos categorías: una para duraciones ≤ 720 minutos y otra para duraciones > 720 minutos. Las series resultantes se sometieron a pruebas no paramétricas para evaluar su independencia, aleatoriedad, homogeneidad y estacionalidad. Posteriormente, se procedió a ajustarlas a la distribución probabilística Generalizada de Pareto y a una ecuación paramétrica del modelo de Montana. Luego se grafica la representación de las curvas para períodos de retorno de 10, 50 y 100 años. El modelo de Montana condujo a la obtención de coeficientes de correlación superiores a 0.90 y a los demás métodos utilizados, mejorando significativamente la calidad del ajuste en ambas categorías. Esta investigación aporta información para comprender y planificar la gestión de fenómenos climáticos intensos, así como para una adecuada gestión de riesgos en una zona donde no se cuenta con este tipo de estudios. Asimismo, facilita el acceso a datos cruciales que resultan fundamentales en el diseño y ejecución de proyectos de ingeniería hidráulica en la zona.

ABSTRACT Background and Objective Salvage robot assisted radical prostatectomy (sRARP) is performed for patients with biochemical or biopsy proven, localized prostate cancer recurrences after radiation or ablative therapies. Traditionally, sRARP has been avoided by lower volume surgeons due to technical demand and high complication rates. Post-radiation sRARP outcomes studies exist but remain few in number. With increasing use of whole gland and focal ablative therapies, updates on sRARP in this setting are needed. The aim of this narrative review is to provide an overview of recently reviewed studies on the oncologic outcomes, functional outcomes, and complications after post-radiation and post-ablative sRARP. Tips and tricks are provided to guide surgeons who may perform sRARP. Materials and Methods We performed a non-systematic literature search of PubMed and MEDLINE for the most relevant articles pertaining to the outlined topics from 2010-2022 without limitation on study design. Only case reports, editorial comments, letters, and manuscripts in non-English languages were excluded. Key Content and Findings Salvage robotic radical prostatectomy is performed in cases of biochemical recurrence after radiation or ablative therapies. Oncologic outcomes after sRARP are worse compared to primary surgery (pRARP) though improvements have been made with the robotic approach when compared to open salvage prostatectomy. Higher pre-sRARP PSA levels and more advanced pathologic stage portend worse oncologic outcomes. Patients meeting low-risk, EAU-biochemical recurrence criteria have improved oncologic outcomes compared to those with high-risk BCR. While complication rates in sRARP are higher compared to pRARP, Retzius sparing approaches may reduce complication rates, particularly rectal injuries. In comparison to the traditional open approach, sRARP is associated with a lower rate of bladder neck contracture. In terms of functional outcomes, potency rates after sRARP are poor and continence rates are low, though Retzius sparing approaches demonstrate acceptable recovery of urinary continence by 1 year, post-operatively. Conclusions Advances in the robotic platform and improvement in robotic experience have resulted in acceptable complication rates after sRARP. However, oncologic and functional outcomes after sRARP in both the post-radiation and post-ablation settings are worse compared to pRARP. Thus, when engaging in shared decision making with patients regarding the initial management of localized prostate cancer, patients should be educated regarding oncologic and functional outcomes and complications in the case of biochemically recurrent prostate cancer that may require sRARP. (sRARP proven therapies Traditionally Postradiation Post number needed postradiation post postablative nonsystematic non systematic 20102022 2010 2022 2010-202 design reports comments letters nonEnglish English excluded pRARP (pRARP presRARP pre lowrisk, lowrisk low risk, risk low-risk EAUbiochemical EAU highrisk BCR injuries contracture year postoperatively. postoperatively operatively. operatively post-operatively However postablation ablation Thus 2010202 201 202 2010-20 201020 20 2010-2 20102 2 2010-

ABSTRACT Toxic cyanobacteria blooms are an increasingly common global problem due to eutrophication, the effects of climate change and increased surveillance efforts in aquatic ecosystems. In Cuba, several ecosystems have been analyzed in the eastern region, demonstrating that this risk occurs to surface and inland waters, due to climatic conditions, mainly in small ecosystems with great human pressures. However, other areas are still unexplored. The objective of this work was to implement a risk management protocol in the San Blas Lagoon, Camaguey, due to the presence of toxic cyanobacteria in the ecosystem, following a community report, with the death of domestic and wild animals; unpleasant odors and dermatological symptoms in humans. A management protocol and community actions were implemented to minimize the impact of toxic cyanobacteria. In this small eutrophic reservoir, the presence of a mixed bloom of toxigenic cyanobacteria was confirmed, being Spherospermopsis torques-reginae the majority, as well as other nine species associated with the production of microcystins, anatoxins and/or cylindrospermopsins were identified. Strategic actions were implemented to contain the risk situation, with the participation of the community and experts, led by the Camagüey Criminalistics Laboratory.

RESUMEN Las floraciones de cianobacterias tóxicas constituyen un problema global cada vez más frecuente, debido a la eutrofización, los efectos del cambio climático y a un mayor esfuerzo de vigilancia en los ecosistemas acuáticos. En Cuba se han muestreado varios ecosistemas en la región oriental, demostrando que este riesgo existe en aguas superficiales e interiores, debido a las condiciones climáticas, principalmente en pequeños ecosistemas con grandes presiones humanas. Sin embargo, otras zonas están aún inexploradas. El objetivo de este trabajo fue implementar un protocolo de gestión de riesgos en la Laguna San Blas, debido a la presencia de cianobacterias tóxicas en el ecosistema, a raíz de un reporte comunitario, con muerte de animales domésticos y silvestres; olor desagradable y síntomas dermatológicos en humanos. Se implementó un protocolo de gestión y acciones comunitarias para minimizar el impacto de las cianobacterias tóxicas. En este pequeño reservorio eutrófico se confirmó la presencia de una floración mixta de cianobacterias toxigénicas, siendo mayoritaria Spherospermopsis torques-reginae, identificándose otras nueve especies asociadas a la producción de microcistinas, anatoxinas y/o cilindrospermopsinas. Se implementaron acciones estratégicas para contener la situación de riesgo, con la participación de la comunidad y expertos, liderados por el Laboratorio de Criminalística de Camagüey.

BACKGROUND: Maintaining or promoting employment in the presence of disability or reducing the impact of disability on employability should be the adopted focus to decrease the negative impact that disability has on the economy and just as important on the livelihood and well-being of exposed insured individuals. Group risk disability insurance protects an employee's income when illness or injury result in work disability. To achieve this, factors that promote the success of rehabilitation and support for return-to-work of employees following illness and injury need to be understood from an insurance perspective. OBJECTIVES: To explore principles of disability claims management during the rehabilitation and work reintegration stage using a multi-stakeholder approach for the purpose of successful return to work. METHODS: An exploratory qualitative design was used to collect data via semi-structured interviews with 26 purposively selected participants. Interviews were audio-recorded, data were transcribed and analysed thematically. Qualitative research was used to understand the necessary role players in the work reintegration process, factors that hinder and promote work reintegration and best practice principles for Disability Claims Management (DCM). RESULTS: Three themes emerged from the study; (i) role players and their functions with collaboration is integral to disability claims management, (ii) various factors promote and restrict return-to-work planning, and (iii) best practice principles in the DCM pathway that promote return-to-work. These principles include behavioural economics as the central principle, with resource identification and competency, governance, role engagement and education and awareness as supporting principles. CONCLUSION: Collaborative and integrated approaches by role players within a workers' family unit, health system, employer structure and insurance compensation are required for positive return-to-work outcomes. The various role players are responsible for creating policies, structures, intervention strategies, and environments that foster return-to-work. IMPLICATIONS FOR PRACTICE • An integrated approach is required for optimal RTW outcomes as employers' policies restrict work integration. • A collaborative approach by all role players involved in DCM, focusing on positive RTW outcomes is required in the RTW process • Occupational therapists can influence employer incapacity and disability policies in order to keep people employed and productive in the presence of medical conditions with the application of reasonable accommodations where necessary. • Occupational therapists are suitably positioned to outline workplace environment and other supports required to guide and support employees through rehabilitation and RTW and in ensuring that employees who can remain at work while on a partial or fully insured benefit, can engage optimally in aspects of work function.

Climate change adaptation (CCA) and disaster risk reduction (DRR) agendas converge in their priorities to reduce social vulnerability and enhance resilience in the face of climate change. However, they are often treated separately in practice and in local government plans. In South Africa, while municipalities are legally mandated to develop Integrated Development Plans (IDPs) and Disaster Management Plans (DMPs), this is not the case for CCA. In this study, we assessed the engagement with, and linkages between, CCA and DRR in 20 local municipalities from contrasting socio-economic contexts in the Eastern Cape Province of South Africa by conducting an analysis of their IDPs, DMPs and any plans or strategies pertaining to CCA. Our results show that none of the municipalities had separate CCA strategies, with only two municipalities complying with the mandate to have DMPs. While municipalities mostly included CCA- and DRR-related activities in their IDPs, there were no explicit linkages made between the two approaches. Apparent was the prioritisation of bolstering infrastructure with little attention towards addressing social vulnerability and building resilience. Overall, little has been done to prioritise or link CCA and DRR at the local government level, especially in the context of addressing social vulnerability and building resilience. These findings suggest the need for South Africa to implement and promulgate legal instruments, policies and resources to capacitate local municipalities in mainstreaming and integrating CCA and DRR. SIGNIFICANCE: • This study highlights that, while CCA and DRR converge in theoretical frameworks and international and national policies, little has been done to link the two at the local government level in South Africa. • Overall, findings indicate that social vulnerability reduction and resilience building are still not recognised as important aspects of CCA and DRR. • Local municipalities prioritise technical solutions and infrastructure maintenance, with little attention to development and structural causes of vulnerability. • Support, in terms of resources, is needed to capacitate local municipalities in (1) linking CCA and DRR and (2) reducing social vulnerability and building resilience.