Classifications of mental disorders change regularly. This fact requires analysis, taking into account changes in the epidemiological situation and changes in the organizational structure of mental health service, and development of its technical and human resources. The preliminary analysis of these changes presented in the article using the example of ICD-11 gives us reason to believe that they are almost unrelated to the diagnostic process improvement. On the contrary, each new classification is characterized by an increasing formalization and simplification of the criteria for separate clinical forms. The inevitable losses of clinical accuracy in psychopathological assessment of disorder are compensated for increasing opportunities to deliver care to a significantly greater number of patients.
Классификации психических расстройств меняются регулярно. Этот факт требует анализа с учетом изменений эпидемиологической ситуации и изменений организационной структуры психиатрической помощи, развития ее технических и кадровых ресурсов. Представленный в статье предварительный анализ этих изменений на примере ICD-11 дает основания считать, что они почти не связаны с совершенствованием диагностического процесса. Напротив, каждая новая классификация характеризуется все большей формализацией и упрощением критериев отдельных клинических форм. Неизбежные потери точности психопатологической оценки болезненного состояния компенсируются расширяющимися возможностями оказания помощи значительно большему числу больных.

The aim of this case series report is to provide a new topical view of styletubation (video intubating stylet technique) in obese patients undergoing bariatric surgeries. In contrast to various conventional direct laryngoscopes (DLs), videolaryngoscopes (VLs) have been applied in such obese populations with potentially difficult airway complications. The safety and effectiveness of VLs have been repeatedly studied, and the superiority of VLs has then been observed in and advocated for routine use. In this article, among our vast use experiences with styletubation (more than 54,998 patients since 2016) for first-line routine tracheal intubation, we present the unique experience to apply the styletubation technique in obese patients undergoing bariatric surgery. Consistent with the experiences applied in other patient populations, we found the styletubation technique itself to be swift (the time to intubate from 5 s to 24 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satisfaction). The learning curve is steep, but competency can be enhanced if technical pitfalls can be avoided. We, therefore, propose that the styletubation technique can be feasibly and routinely applied as a first-line airway modality in obese patients undergoing bariatric surgery.

暂无摘要。

The current changes to the treatment recommendations and the diagnostic categorization of trans* identities in the ICD-11 require a new consideration of past therapeutic methods and approaches. The depathologization of trans* lives in the ICD-11 finally enables trans* people to access psychotherapeutic services more freely, as the compulsory therapy that has thus far been required for access to transition-related treatments, as well as the so-called \"diagnosis\" and \"treatment\" of \"transsexuality\", have been removed. Trans* people will nevertheless be interested in qualified psychotherapeutic treatment options. Due to the decades-long discrimination and treatment in the health system that has disregarded the human rights of trans* people, a trans*-affirmative approach is necessary, one that takes into account the context of the treatment and critically reflects upon one\'s own position as a health professional. This affirmative and self-reflective approach provides the basis upon which therapeutic concerns and topics related to a life lived in accordance with a self-determined (gender) identity, related needs, and the fulfillment of those needs, can be discussed. The consequences of experiences of discrimination, violence and exclusion are, moreover, important elements of therapy that require a structural and social contextualization in order to address internalized trans*-negativity and to empower trans* people in their self-assertion.

This is an era of uncertainty, during which adaptability is a key capability to survival and future success. What has Singapore done to develop an education system that facilitates its young to learn in such an era? Firstly, Singapore enhances the adaptive capacity of its education system by increasing its diversity. In particular, it is developing more educational pathways, areas of learning and types of schools. Secondly, Singapore emphasizes lifelong learning. In particular, Singapore will be focusing on providing more learning opportunities for working adults and enhancing support for mid-career reskilling. In these educational changes, Singapore has been addressing both hardware (changing policies) and software (addressing culture), in order to develop an education system that can facilitate learners to learn in an era of uncertainty. What will help Singapore in further developing such a system? This paper suggests two software \"upgrades\", namely \"inspiration by design\" and \"readiness for paradigm shift\". Firstly, instead of a paradigm of competence, Singapore adopts a paradigm of inspiration. In this paradigm, the aim is for students to find their inspiration to learn, and such inspiration is provided through a systemic approach. This is \"inspiration by design\". Secondly, Singapore nurtures the spirit of readiness for paradigm shifts in education. An example of a paradigm shift is to be ready for the advent of artificial intelligence in education. Such readiness is about reflecting on fundamentals so that the use of artificial intelligence enhances the development of real human intelligence.

In June 2023, the UK began official hearings for its independent investigation into pandemic preparedness. Thus far, the inquiry has been told that planning has been wholly inadequate and that a future outbreak is inevitable. We present here four key problems that contributed to significant morbidity and mortality during the Coronavirus 2019 (COVID-19) pandemic over the past 3 years in the UK - and which will contribute to excess morbidity and mortality in the next outbreak. First, there was misunderstanding about what procedures were deemed as aerosol generating. Aerosol transmission has always been a component of respiratory viruses; however, no specific aerosol-generating procedures are required to transmit any respiratory pathogens over long distances. Second, policy-makers were too binary in their answers to the public in terms of questions about severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). This meant that, as evidence evolved and different conclusions were drawn, the public lost faith in both the UK Government and science. Third, public health guidance did not take into account that certain groups would be impacted differentially by public health guidelines and instead used a one-size-fits-all approach to non-pharmaceutical interventions. Finally, there was worsening of existing inequalities, especially in ethnic minority groups, that resulted in excessive numbers within certain cohorts becoming infected.

UNASSIGNED: Urogenital fistula is a physically, socially and psychologically devastating condition for the patient. In developed countries, these fistulae are typically related to gynecological surgery, pelvic pathology like malignancy or post radiation therapy. In contrast, classical teaching is that urogenital fistulae in the developing countries like India are usually associated with prolonged labor and obstetric complications. This retrospective study conducted at a tertiary care health Institute shows a paradigm shift in epidemiology, etiology and management of genitourinary fistulae in India in recent times.
UNASSIGNED: This retrospective study included patients undergoing surgical repair for various genitourinary fistulae at our institute from 2016 to 2022. Epidemiology, etiology, site, size and number of fistulae, clinical presentation, and management records of these patients were recorded and reviewed retrospectively.
UNASSIGNED: In our study, the mean age of the patients was 38.4 ± 10.2 years. Vesicovaginal Fistula (VVF) was found to be most common fistula in the study population (87.5%) followed by vesicouterine (7.1%) and urethrovaginal fistula (5.4%). The causes of genitourinary fistula were iatrogenic (73.2%), carcinoma of cervix (16.1%), obstructed prolonged labor (7.1%), and genitourinary tuberculosis (3.57%). Among the 48 vesicovaginal fistulas that underwent surgery, 45.8% were treated using a transvaginal approach, 29.2% were managed through a laparoscopic transabdominal repair, and 25% were addressed using a robotic approach. Recurrence occurred in 7.1% of the operated patients.
UNASSIGNED: Enhanced healthcare services in the country have contributed to a decrease in the incidence of obstructed labor, subsequently reducing related injuries. Iatrogenic injuries resulting from gynecological surgeries and carcinoma cervix have given rise to more complex fistulas, necessitating the implementation of advanced treatment strategies.

Bioelectronics, which converges biology and electronics, has attracted great attention due to their vital applications in human-machine interfaces. While traditional bioelectronic devices utilize nonliving organic and/or inorganic materials to achieve flexibility and stretchability, a biological mismatch is often encountered because human tissues are characterized not only by softness and stretchability but also by biodynamic and adaptive properties. Recently, a notable paradigm shift has emerged in bioelectronics, where living cells, and even viruses, modified via gene editing within synthetic biology, are used as core components in a new hybrid electronics paradigm. These devices are defined as \"living synthelectronics,\" and they offer enhanced potential for interfacing with human tissues at informational and substance exchange levels. In this Perspective, the recent advances in living synthelectronics are summarized. First, opportunities brought to electronics by synthetic biology are briefly introduced. Then, strategic approaches to designing and making electronic devices using living cells/viruses as the building blocks, sensing components, or power sources are reviewed. Finally, the challenges faced by living synthelectronics are raised. It is believed that this paradigm shift will significantly contribute to the real integration of bioelectronics with human tissues.

Groundwater Charge was introduced in 2005 as one of the sustainable resource management measures in South Korea. The implementation rate, however, stagnated around 37 %, indicating that most local governments chose not to adopt this \'optional\' regulation. While previous Stakeholder Analysis studies mainly blamed exclusion - or limited involvement - of stakeholders in the designing and structuring stage of policy-making process for policy failures, this study focused on the interest conflicts and dynamics hindered implementation process. This is because the issue with the subject policy, i.e., Groundwater Charge in South Korea, is low \'implementation rate\' not the \'collection rate\' or \'tax deficit.\' If it was simply design or structural issue, the Charge should suffer from tax deficit problem due to lower tax income than operational costs. Thus, in order to investigate the reasons of low Charge adoption rate at the local government level, the Stakeholder Analysis Theory was applied to examine each stakeholder of the Charge to distinguish the interaction among supportive and opposing groups. The analysis revealed that there are only strong opponents of the policy without clearly identifiable supporters. Having agricultural & fishery industry and small independent businesses in spas, hotels, and swimming pool as strong Players, the Context setters (local governments) are not motivated to enforce Groundwater charge. Furthermore, today\'s social norm governed by economic efficiency is preventing the environmentalists and other Subjects to counteract Players. Under these circumstances, this study recommends the Subject to transform the Crowds (general public) into policy supporters through education. Environmental education is the only viable means to encourage necessary paradigm shift to enable effective implementation of environmental policies like Groundwater charge.

Ketosis is currently regarded as a major metabolic disorder of dairy cows, reflective of the animal\'s efforts to adapt to energy deficit while transitioning into lactation. Currently viewed as a pathology by some, ketosis is associatively implicated in milk production losses and peripartal health complications that increase the risk of early removal of cows from the herd, thus carrying economic losses for dairy farmers and jeopardizing the sustainability of the dairy industry. Despite decades of intense research in the mitigation of ketosis and its sequelae, our ability to lessen its purported effects remains limited. Moreover, the association of ketosis to reduced milk production and peripartal disease is often erratic and likely mired by concurrent potential confounders. In this review, we discuss the potential reasons for these apparent paradoxes in the light of currently available evidence, with a focus on the limitations of observational research and the necessary steps to unambiguously identify the effects of ketosis on cow health and performance via controlled randomized experimentation. A nuanced perspective is proposed that considers the dissociation of ketosis-as a disease-from healthy hyperketonemia. Furthermore, in consideration of a growing body of evidence that highlights positive roles of ketones in the mitigation of metabolic dysfunction and chronic diseases, we consider the hypothetical functions of ketones as health-promoting metabolites and ponder on their potential usefulness to enhance dairy cow health and productivity.