Parámetros de calidad comercial de exportación de la palta (persea americana) hass y fuerte procedente de los valles de chincheros y andahuaylas de la región apurímac

La palta es fruto con alto contenido nutricional, y es consumida a nivel mundial, y el Perú se ha convertido en un potencial exportador de este producto, el éxito en la comercialización de la palta, está en función de la calidad comercial, para ello, se debe evaluar las características físicas y químicas del fruto antes de la cosecha. El objetivo del presente trabajo de investigación, fue evaluar los parámetros de calidad de la palta comercial de exportación de variedad Hass y Fuerte procedente de los valles de Chincheros y Andahuaylas de la región Apurímac, para lo cual se identificó las zonas de exportación de este fruto. Los datos fueron recolectados por triplicado, y analizados a través del test de Tukey al 5% de significancia, bajo un diseño completamente al azar. Los resultados obtenidos de los parámetros físicos y químicos de la variedad Hass y Fuerte, mostraron valores de densidad aparente entre 1016.88 - 1037.27, 1023.04 - 1033.46 kg/m3, índice de madurez de 17.42 - 25.69, 17.80 - 22.61 % índice de color de -13.18 - -25.73, -12.26 - -25.73, color, L* de 21.10 - 30.38, 21.98 - 33.86, a* de -14.78 - -19.08, -15.34 - -12.38, b* de 29.52 - 53.92, 27.60 - 57.00 y textura de 168.02 - 194.82, 143.83 - 155.60 N respectivamente. La materia seca de las variedades Hass y Fuerte fueron de 19.00 - 23.03, 18.83 - 22.77 %; acidez titulable de 0.18 - 0.24, 0.19 - 0.24 %; solidos solubles de 4.23 - 4.73, 4.20 - 4.87 °Brix y pH de 6.43 - 6.70, 6.40 - 6.77 respectivamente. Concluyéndose que los parámetros de calidad comercial de los frutos de palta de la variedad Hass y Fuerte, se encuentran dentro de los valores establecidos en la Norma Técnica Peruana y por el CODEX STAN, y en las normas definidas por los países importadores de este fruto

Ultrasound-guided percutaneous laser ablation for papillary thyroid microcarcinoma: a literature review

The incidence of papillary thyroid microcarcinoma has been increasing worldwide. However, the optimal management strategy remains a topic of discussion and varies from an active follow-up to a thyroidectomy. New thermoablation techniques for selected cases seem to be sufficiently effective but minimally invasive. One of the newest thermoablation methods is ultrasound-guided percutaneous laser ablation. There are already some data showing promising results of this method in the management of papillary thyroid microcarcinomas. In this article, we review recent papers and conclude on the current status of the ultrasound-guided percutaneous laser ablation technique for the management of papillary thyroid microcarcinomas

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

“I only want to make quality, skillfully executed and sustainable products.” : discursive analysis of the meanings that craft teacher students associate with craft expression

Käsityön tekeminen ei perustu enää vain tarpeeseen. Käsityön merkitys itseilmaisua koros-tavana oppiaineena on kasvanut, ja käsityöopettajilla on merkittävä rooli, miten käsityötä tu-levaisuudessa arvotetaan. Tutkimuksen teoreettinen viitekehys tarkasteli käsityön tekemi-sen sosiokulttuurista kontekstia ja sitä, mitkä tekijät vaikuttavat käsityön ilmaisullisiin merki-tyksiin. Tutkimuksessa jäsennetään käsityöopettajaopiskelijoiden käsityöilmaisuun liittämiä merkityksiä ja aineistosta rakentuvia diskursseja. Kielenkäyttö tutkimuskohteena heijasti käsityöilmaisun merkitysten kontekstisidonnaisuutta ja kulttuurisuutta. Diskurssi tarkoitti tutkimuksessa tietyn asian melko vakiintunutta puhetapaa, joka rakentaa sosiaalista todellisuutta. Tutkimuksen aineistona oli Helsingin yliopiston käsi-työopettajaopiskelijoiden vuonna 2014 ja 2017 Opintojen suunnittelu- kurssilla tuottamat 38 kirjoitelmaa, joissa tehtävänannon osana oli pohtia omaa käsityöilmaisua. Laadullisen tutki-muksen tutkimusmetodina oli tulkitseva diskurssianalyysi. Aluksi sisällönanalyysin kautta hahmotin, millaisia merkityksiä käsityöopettajaopiskelijat liittivät käsityöilmaisuun kuvates-saan omaa käsityöilmaisua. Diskursiivisen analyysin vaiheessa tulkitsin, millaisia diskursseja aineistosta rakentui. Aineistosta korostui käsityön tuote- ja tarvelähtöinen ymmärtäminen, jossa käytännöllisyyden koettiin poissulkevan käsityön ilmaisevuutta. Analyysin perusteella aineistosta rakentui neljä käsityöilmaisun diskurssia: kestävän käsityön, virheettömän tekemisen, kauneuden ja ei-ilmaisun diskurssi. Kuten käsityöilmaisuun liitetyt merkitykset, diskurssien sisällöt limittyivät keskenään ja aiheet saivat useita näkökulmia eri diskursseissa. Käsityöilmaisuun liitetyt merkitykset ja puhetavat avaavat käsityön kulttuurisuuden vaikutuksia sekä auttavat ym-märtämään käsityön merkitystä osana elämän monimuotoisuutta.Making crafts is no longer based on need alone. The importance of craft as a subject emphasizing self-expression has grown, and craft teachers have a significant role in how craft is valued in the future. The theoretical framework of the study examines the sociocultural context of craft and which elements affect the expressive meanings of craft. The study outlines the meanings associated with craft expression by craft teacher students and discourses based on the research data. The use of language as a research subject reflected the contextual nature and culture of the meanings related to craft expression. In the study, discourse referred to a fairly established discussion about issues that construct social reality. The research data consisted of 38 essays written by the craft teacher students in the University of Helsinki during the Study planning course in 2014 and 2017. Part of the essay assignment was to reflect on one’s own craft expression. The qualitative research method was interpretive discourse analysis. Initially, through content analysis, I outlined what meanings craft teacher students attached to craft expression when describing their own craft expression. In the discursive analysis phase, I interpreted what kind of discourses were constructed from the data. The data emphasized product- and need-based understanding of craft, in which practicality was found to exclude expressiveness of craft. Based on the data analysis, four discourses of craft expression were constructed: sustainable craft, flawless craft making, beauty and non-expression. Like the meanings associated with craft expression, discourses overlapped, and the topics got various aspects in different discourses. The meanings and discourses associated with craft expression open up the effects of craft culture and help to understand the significance of craft as part of the diversity of life

Prospective Analysis of Risk for Hypothyroidism after Hemithyroidectomy

Objectives. To evaluate risk factors and to develop a simple scoring system to grade the risk of postoperative hypothyroidism (PH). Methods. In a controlled prospective study, 109 patients, who underwent hemithyroidectomy for a benign thyroid disease, were followed up for 12 months. The relation between clinical data and PH was analyzed for significance. A risk scoring system based on significant risk factors and clinical implications was developed. Results. The significant risk factors of PH were higher TSH (thyroid-stimulating hormone) level and lower ratio of the remaining thyroid weight to the patient’s weight (derived weight index). Based on the log of risk factor, preoperative TSH level greater than 1.4 mU/L was assigned 2 points; 1 point was for 0.8–1.4 mU/L. The derived weight index lower than 0.8 g/kg was assigned 1 point. A risk scoring system was calculated by summing the scores. The incidences of PH were 7.3%, 30.4%, and 69.2% according to the risk scores of 0-1, 2, and 3. Conclusion. Risk factors for PH are higher preoperative TSH level and lower derived weight index. Our developed risk scoring system is a valid and reliable tool to identify patients who are at risk for PH before surgery