To evaluate the surface and positional trueness of removable dies fabricated using fused filament fabrication (FFF), compared to dies produced with digital light processing (DLP), addressing the limited evidence on the deviations of FFF-based removable dies. A typodont with a prepared right mandibular first molar was digitized to design a removable die and corresponding hollow partial arch cast. Forty dies (n = 10) and four casts (n = 1) were fabricated using FFF (Filadent Aligner [FF-AL], Filadent Gypsum [FF-GP], Filadent Tray [FF-TR]) or DLP (DentaModel [DM]). Dies and their positions in the casts were digitized to assess surface (crown, root, root base, overall) and positional (crown region and point-based) deviations. Data were analyzed either with one-way analysis of variance (surface deviations) or Kruskal-Wallis tests (positional deviations, α = 0.05). DM exhibited the lowest crown region and overall deviations, followed by FF-TR (P < 0.001). Root deviations increased in the order of DM, FF-TR, FF-AL, and FF-GP, whereas FF-TR had the lowest base of the root deviations (P < 0.001). Seated FF-GP dies had lower crown region deviations than the other FFF-based dies, while DM led to lower deviations than FF-TR (P ≤ 0.041). FF-AL showed lower point-based deviations than FF-GP (P = 0.001). FFF-fabricated dies showed lower surface trueness than DM dies, with FF-TR achieving the highest trueness among FFF dies. Positional deviations remained within clinically acceptable limits, though FF-TR dies tended to be positioned coronally and the others apically. FFF may be used to produce clinically acceptable dies, but DLP offers superior surface trueness. Removable dies produced with the tested polylactic acid filaments and FFF printer may serve as alternatives to those fabricated with the tested resin and vat polymerization printer, given the small and potentially clinically irrelevant differences in surface deviations and clinically acceptable mean positional deviations.
Recent advances in dental additive manufacturing have introduced plant-based resins for casts and alcohol-free cleaning solutions; however, their suitability for producing dimensionally accurate and stable removable dies remains unclear. The purpose of this in vitro study was to assess the dimensional and positional deviations and 4-week stability of additively manufactured removable dies made from 2 plant-based and 1 dental cast resins, cleaned with methyl ether solvent (MES), isopropyl alcohol (IPA), or a water-based solution (WBS). A typodont with a prepared right first mandibular molar was digitized to design removable dies and hollow partial arch casts. Fifty-four dies (N=18) and 9 casts (N=3) were fabricated from 3 resins: Soy-Based Resin (EX), FotoDent biobased model (FD), and KeyModel Ultra Ivory (KM). Specimens were divided into 3 subgroups by cleaning solution; MES, IPA, and a WBS (n=6 dies, n=1 cast). Dies and their corresponding seated casts were digitized at 1 day (T0) and at 1-week intervals up to 4 weeks (T1-T4) after fabrication. Trueness was assessed from the surface deviations of die regions (crown, root, and root base) and positional deviations within casts at T0, while T0-T4 deviations evaluated stability. T0 deviations were assessed with a generalized linear model, while those over time were evaluated with linear mixed-effects models (α=.05). Resin type-cleaning solution interaction influenced the dimensional and positional deviations at T0 (P≤.049). In addition, crown region deviations were influenced by resin type-cleaning solution and resin type-time point interactions, whereas other surface and positional deviations were affected by interactions among all main factors (P≤.005). FD dies and MES-cleaned dies mostly had lower surface deviations, while IPA-cleaned FD dies had the lowest positional deviations (P≤.040). FD resin dies generally showed higher dimensional trueness and stability, while MES-cleaning also increased the dimensional trueness and stability of tested dies. IPA-cleaned FD dies exhibited the highest positional trueness and stability. The effect of the time point on deviations was minimal and likely clinically negligible.
Moderate coronal destruction cases have recently been repaired using minimally invasive adhesive overlays with varying cavity depths and occlusal preparations. The optimal cavity preparation (criteria and dimensions) varies according to clinical crown length, patient age and inter occlusal space. Consequently, design and thickness of restoration will affect esthetics, function and fracture resistance necessitates the employment of new materials capable of meeting their full potential. However, there are numerous available materials and different preparation designs. However, there is insufficient data on the selection of appropriate material, preparation thickness and their effect on fracture resistance. To evaluate the fracture resistance of chairside (CAD/CAM) lithium disilicate using two diverse overlay restoration designs for premolars. Specimens were prepared using a CNC milling machine, according to two different overlay designs: (A) overlay with 2 mm cavity depth & 1.5 mm occlusal thickness, (B) overlay with 1.5 mm cavity depth & 2 mm occlusal thickness. 42 restorations were designed and fabricated with a chairside CAD/CAM system (Mc XL, Dentsply Sirona) using 3 CAD/CAM lithium disilicate blocks (IPS e.max CAD, Amber Mill, CEREC Tessers) (14 specimens/group). Restorations were luted to 3D printed resin dies using standard resin luting cement (Breeze, Pentron) and then loaded with a steel indenter until fracture. The group findings were analyzed using one-way analysis of variance, and the medians were assessed independently using Kruskal-Wallis. The null hypothesis states that there will be no significant difference in the fracture resistance between the three CAD/CAM lithium disilicate materials and the two preparation designs. The fracture force of CAD/CAM lithium disilicate restorations varied significantly based on the restoration design. Among the two overlays, the restorations with design A showed significantly higher fracture force than the restorations with design B (p < 0.001). Within design A: there was no significant difference between the materials. Within design B: there was a significant difference in fracture resistance between materials. Design A, including more cavity depth (2 mm) related to less occlusal reduction(1.5 mm) provides more fracture resistance values than design B using lithium disilicate overlay preparation design. Preparation design has a great effect on fracture resistance values of overlay restorations, while material type has negligible effect. Despite the presence of additional virgilite crystals in CT, it did not produce any increase in fracture resistance.
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In high-income countries, humans are continuously exposed to indoor and outdoor air pollution. Chronic exposure to these airborne solids and gases from natural or artificial sources is related to higher mortality. The objective of this work is to critically assess whether the association between indoor air pollution and death can support robust causal inference from a strict medico-legal perspective. We conducted a narrative review of existing literature on reported health consequences, autopsy and histopathological findings potentially linked to indoor air pollution exposure, and dose-response relationships and examined their role in criminal liability in Western countries. Despite prevention measures and regulations, establishing criminal liability for indoor air pollution remains arduous beyond a reasonable doubt given associative epidemiological evidence, translational biases, and non-specific autopsy findings. Further research on non-linear models and targeted forensic investigations is warranted.
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The integration of complementary metal-oxide-semiconductor (CMOS) and micro-electromechanical systems (MEMSs) technologies for miniaturized biosensor fabrication enables unprecedented spatiotemporal resolution in monitoring the bioelectrical activity of the nervous system. Wafer-level CMOS technology incurs high costs, but multi-project wafer (MPW) runs mitigate this by allowing multiple users to share a single wafer. Still, monolithic CMOS biosensors require specialized surface materials or device geometries incompatible with standard CMOS processes. Performing MEMS post-processing on the few square millimeters available in MPW dies remains a significant challenge. In this paper, we present a MEMS post-processing workflow tailored for CMOS dies that supports both surface material modification and layout shaping for intracortical biosensing applications. To address lithographic limitations on small substrates, we optimized spray-coating photolithography methods that suppress edge effects and enable reliable patterning and lift-off of diverse materials. We fabricated a needle-like, 512-channel simultaneous neural recording active pixel sensor (SiNAPS) technology based neural probe designed for integration with optical fibers for optogenetic studies. To mitigate photoelectric effects induced by light stimulation, we incorporated a photoelectric shield through simple modifications to the photolithography mask. Optical bench testing demonstrated >96% light-shielding effectiveness at 3 mW of light power applied directly to the probe electrodes. In vivo experiments confirmed the probe's capability for high-resolution electrophysiological measurements.
The decision to pursue physician-assisted dying can place a significant emotional burden on relatives. Despite the considerable psychosocial stress they often face, these individuals have received limited attention in research, clinical practice and ethical or societal debates surrounding this topic. This article provides an overview of the role of relatives in the context of physician-assisted dying.Previous studies indicate that relatives are frequently confronted with moral dilemmas, ambivalent emotions and anticipatory grief. In addition, they often take on organisational responsibilities in support of the person wishing to die and may experience stigma and subsequent social isolation. Research also suggests that relatives and close friends are at increased risk for mental health challenges.At the same time, certain aspects of the process, such as the opportunity to say goodbye, open communication and the active involvement of relatives, can have a positive effect and support a more adaptive grieving process. These findings highlight the importance of psychosocial support for relatives as well as the necessity of involving them at an early stage throughout the entire process. Die Entscheidung für einen assistierten Suizid kann für Angehörige mit erheblichen emotionalen Belastungen einhergehen. Trotz der vielfältigen psychosozialen Herausforderungen finden Angehörige in Forschung, Versorgung sowie in ethischen und gesellschaftlichen Diskursen zu diesem Thema bislang nur unzureichende Beachtung. Der vorliegende Artikel bietet einen Überblick über die Rolle der Angehörigen im Kontext des assistierten Suizids.Bisherige Studien zeigen, dass Angehörige häufig mit moralischen Dilemmata, ambivalenten Emotionen sowie antizipatorischer Trauer konfrontiert sind. Darüber hinaus übernehmen sie oftmals organisatorische Aufgaben zur Unterstützung der sterbewilligen Person und erleben nicht selten Stigmatisierung sowie daraus resultierende soziale Isolation. Zudem deuten bisherige Studienergebnisse darauf hin, dass Angehörige ein erhöhtes Risiko für die Entwicklung psychischer Erkrankungen aufweisen können.Gleichzeitig können bestimmte Merkmale des assistierten Suizids entlastend auf Angehörige wirken und die Verarbeitung des Verlusts positiv beeinflussen. Hierzu zählen unter anderem die Möglichkeit zur Abschiednahme, offene Kommunikation sowie die Einbindung in den Prozess des assistierten Suizids. Diese Befunde unterstreichen die Notwendigkeit spezifischer psychosozialer Unterstützungsangebote für Angehörige sowie deren frühzeitige Einbindung in relevante Prozesse.
Every 2 minutes, a woman dies from cervical cancer, resulting in over 300 000 preventable deaths globally. Nearly all cervical cancers are caused by human papillomavirus (HPV) and are preventable with HPV vaccination and screening through Papanicolaou (Pap) and HPV tests. In Canada, cervical cancer mortality rates have declined in recent decades with more accessible cervical cancer screening programmes. However, screening rates remain low, particularly among Black women and people with a cervix (WPC).Cervical cancer screening studies of Black WPC in Ontario-Canada's most populous province-are limited. These studies indicate Black WPCs are at elevated risk for under-screening, with many overdue for screening.An innovative approach to begin addressing delays is HPV self-sampling (HPVSS). Self-sampling is a cost-effective and more accurate test for detecting high-risk HPV infections associated with precancerous changes versus the Pap test. Self-sampling supports Canada's action plan-a response to WHO's global strategy-to eliminate cervical cancer by 2040.Despite Canada's plan, research on the state of Black WPCs' HPV knowledge and self-sampling interventions tailored to them is scant. These scarcities are concerning as Ontario plans to implement HPV primary screening and offer HPVSS soon.The study objective is to codevelop an HPVSS intervention tailored for and made by Black WPC in Peel region, Ontario. This protocol focuses on phase one of a two-phased study. In phase one, a qualitative, community-informed approach, co-led by community research assistants, will be used to purposively recruit 10 service providers (eg, clinicians, social workers, community care workers) and 40 Black WPC who will undergo one-on-one semistructured interviews and sociodemographic surveys to explore the state of: (1) Black WPC's level of HPV, cervical cancer and cervical cancer screening knowledge; (2) Black WPC's motivators, beliefs, attitudes and misconceptions towards HPVSS; (3) Black WPC's perceived barriers and facilitators to HPVSS and (4) service providers' perspectives on Black WPC's barriers and facilitators to HPVSS. Charmaz's grounded theory approach and intersectionality will guide data collection and analysis. Ethical approval has been obtained from the Trillium Health Partners Research Ethics Board (ID#1207). Study findings will be disseminated through community healthcare events, conference presentations, peer-reviewed publications and virtual and physical pamphlets. Additionally, summaries of the findings will be shared and tailored to collaborators, healthcare leadership and researchers and community health centres. Wide dissemination will help enhance understanding of the state of cervical cancer screening, HPV and HPVSS among Black WPC. Given Canada's commitment to eliminating cervical cancer, study findings will be used to begin developing an HPVSS intervention for Black communities.
Advanced lithium disilicate glass ceramics offer excellent esthetics, but conservative crown preparations are not always the preferred choice. Various margin designs are available; however, more conservative vertical preparations (vertipreps) have less scientific evidence supporting their esthetic outcomes compared to shoulder or chamfer designs. To assess the marginal adaptation and internal fit of crowns fabricated from advanced lithium disilicate (CEREC Tessera) using computer-aided design and manufacturing (CAD/CAM) with three distinct margin designs. Three mandibular molar typodont teeth were prepared with three finish line designs: chamfer 0.5 mm (C), rounded shoulder 1 mm (RS), and vertiprep 0.2 mm (V) using a modified dental surveyor for standardization. Silicone replicas were used to create epoxy resin dies. Twenty-four crowns were produced on the replicated resin dies, with eight crowns for each finish line design (n = 8). Preparations were scanned using an intraoral scanner (Carestream Dental LLC, 3625 Cumberland Blvd., Ste. 700, Atlanta, GA 30339), and advanced lithium disilicate (Tessera) crowns were milled via CAD/CAM. Crowns were cemented onto their respective dies, and marginal adaptation was measured using a stereomicroscope; then, crowns were sectioned using a microtome to evaluate internal fit. One-way ANOVA showed a significant difference in the marginal adaptation among groups (p  < 0.001). Group RS had the largest gap (125.45 ± 12.11 µm), followed by Group C (107.31 ± 9.25 µm) and Group V (101.79 ± 9.01 µm). Internal fit also differed significantly (p  < 0.001), with Group V having the smallest gap (70.09 ± 8.45 µm), followed by Group RS (87.85 ± 6.82 µm) and Group C (94.45 ± 9.21 µm). The vertiprep showed the least marginal adaptation and best internal fit compared to shoulder and chamfer designs, with no significant difference in marginal gap between vertiprep and chamfer.
This paper investigates an integrated blank separation process combining cutting and plastic deformation (longitudinal upsetting) to ensure high volumetric and geometric accuracy. The relevance of the study stems from the need to produce high-quality blanks for cold forging and extrusion, where simple blanks made from long rolled products often exhibit unacceptable dimensional deviations. Based on 3D finite element modeling in DEFORM software and experimental studies, an optimal two-support cutting scheme was determined. Unlike cantilever (single-support) cutting, this scheme creates oppositely directed inclination angles at the ends of the blank, minimizing their axial displacement and preventing loss of stability during subsequent upsetting. A key feature of the proposed method is the use of elastic press unloading energy, which is typically considered «detrimental» due to the vibrations and impact loads it imposes on the equipment. The authors demonstrated that this energy can be redirected to perform useful work during plastic forming. Calculations and experiments showed that the work required for double-sided cutting is approximately 53% of that required for longitudinal upsetting. This energy is sufficient to correct the shape of the workpiece; however, achieving high accuracy requires the use of additional energy sources in modernized presses with combined dies. As a result of the research, a die design was developed and proposed that implements an integrated cutting and longitudinal upsetting process. This design ensures high geometric accuracy of workpieces, increased process productivity, and improved operational reliability of the pressing equipment.
Older people who die with a serious chronic disease are at risk of experiencing extended periods (ie, months or years) of fluctuations and deterioration in their health and well-being. Traditional categorisations of these end-of-life trajectories focus on physical functioning and often consider three types (ie, cancer, organ failure, frailty/dementia), but data supporting these categories are limited, often neglect psychological, social and existential domains of health and well-being and provide little information on the extent and determinants of variation in end-of-life trajectories. This study aims to identify distinct temporal patterns in the trajectories of older people with serious chronic illness and determine to which extent personal, clinical and social characteristics predict them. We have developed and piloted a novel, feasible and acceptable study protocol for a longitudinal survey study with older people nearing the end of life. We will conduct a longitudinal survey study with 280 older people, aged 70 years or over, who have one or more chronic illnesses and who are in deteriorating health. Assessments will be done at baseline and every 2 months, over 12 months or shorter if the participant dies before. Deteriorating health is determined based on disease-specific criteria which we developed in collaboration with clinical specialists. People without cognitive capacity to consent to research participation, those in the terminal phase of life (ie, last days) and those who cannot participate in data collection in Dutch or French will be excluded. Participants will be recruited from hospitals in Belgium. The survey covers health and well-being in the physical, social, psychological and existential domains and determinants related to sociodemographic, clinical and social environment characteristics. When a participant dies, we will invite an adult proxy respondent (a family member or another close person) to complete a mortality follow-back study covering the deceased participants' health and care in the last 3 months of life. We will analyse trajectories with latent class growth models and mixed-effects models. The TRAJECT project has received approval from the Commissions for Medical Ethics from Universitair Ziekenhuis Brussel (Brussels University Hospital) and Ghent University Hospital. The findings of the study will be disseminated through scientific publications in international peer-reviewed journals and scientific conferences. For non-expert audiences, updates and findings will be shared through the project website, press releases and events for the general public.
The ionization energies (IEs) and double ionization energies (DIEs) of the amino acids alanine and glycine have been studied in the gas phase and a polarizable continuum model (PCM) to account for solvent effects. Amino acids undergo structural modifications, particularly in their functional groups, in response to changes in their chemical environment, such as pH. Four possible different structural forms, neutral (NH2-R-COOH), zwitterionic (NH3+-R-COO-), deprotonated (NH2-R-COO-), and protonated (NH3+-R-COOH), were generated for each amino acid. In this study, we use these four forms to explore the effects of protonation and deprotonation (pH effect) on the IEs of inner-valence states. In amino acids, IEs and DIEs are essential for evaluating the energetic viability of inner-valence-initiated non-radiative decay processes, such as interatomic Coulombic decay (ICD). All IE and DIE values were calculated using the complete active space perturbation theory (CASPT2) method. A comparison is made across gas-phase and PCM environments to assess the impact of solvation. The observed variations in IE and DIE values indicate a lot about alanine and glycine's electronic structure and chemical reactivity under different physiological and environmental conditions (pH effect and solvation), hence improving our understanding of their functional roles in biochemical systems.
To evaluate and compare the effect of simulated aging on conventional lithium disilicate (LDS) and advanced lithium disilicate (ALD) computer-aided design-computer-aided manufacturing (CAD-CAM) glass ceramics on color stability and fracture resistance utilizing different veneer preparation designs. Two prepared typodont maxillary right central incisors were replicated into forty epoxy resin dies, which were divided into 2 groups based on preparation design (n = 20): Group butt joint (BJ), and Group incisal overlap (IO). Each group was further subdivided into two equal sub-groups based on ceramic material (n = 10): e.max (IPS e.max CAD, Ivoclar Vivadent, Schaan, Liechtenstein), and Tessera (Cerec Tessera, Dentsply Sirona, Hanau, Germany). After cementation of laminate veneers on the epoxy resin dies, color change and fracture resistance were evaluated before and after 10,000 cycles of thermal cycling. Two-way ANOVA was used to compare the materials and design on the mean color change. For fracture resistance, a three-way ANOVA was used to compare the materials, designs, and aging. Pairwise comparison was tested using independent t-test (α = 0.05). For color change, Two-way ANOVA revealed that different materials, preparation designs and their interaction showed a non-significant effect on the ΔE00 (p = 0.352, 0.158 and 0.678, respectively). For fracture resistance, different materials, preparation designs, and aging, had a significant effect on fracture resistance at p < 0.05. The interaction between all the groups showed a non-significant effect (p = 0.918). Before aging, IO showed significantly lower fracture resistance compared to BJ for both e.max and Tessera. A non-significant difference was shown between the tested materials within the same preparation design. After aging, a non-significant difference between all tested groups was shown. Within the limitations of this in vitro study, it was concluded that thermal cycling affected both color stability and fracture resistance of both tested materials. The color change for BJ for both materials was within the clinically accepted range. Both tested materials showed comparable mean fracture resistance before and after thermal cycling within the same preparation design. BJ showed significantly higher fracture resistance than IO before thermal cycling; however, the difference between the two tested preparation designs after thermal cycling was not significant. Both materials (LDS and ALD) are clinically viable; however, preparation design has a greater impact on mechanical performance than on color stability. BJ performed better than IO for veneer preparation design.
To introduce and validate optimized multifrequency cardiac time-harmonic elastography (THE) with portable drivers and multiple-heartbeat acquisitions for detecting abnormal diastolic stiffness using in silico testing and investigating participants with confirmed cardiac wild-type transthyretin amyloidosis (ATTRwt), a model disease for myocardial stiffness, compared to healthy controls. Cardiac THE was performed using continuous vibrations of 60, 70, and 80 Hz induced by a portable driver. Shear wave speed (SWS) maps, as a proxy for myocardial stiffness, were acquired over 4 seconds in a parasternal long axis view. Cardiac ultrasound simulations with CT-data-based anatomies were used for in silico validation and parameter optimization. Diagnostic performance was assessed using the area under the ROC curve (AUC) with 95% confidence interval (95%-CI). Healthy controls (N=10; median age: 32 years [range: 27-56]; five men) and participants with ATTRwt (N=11; median age: 83 years [range: 64-86]; ten men) were investigated, resulting in accurate amyloidosis detection (AUC: 1.00; 95%-CI: 0.94-1.00). In-silico-estimated SWS agreed with ground-truth values (r²=0.94; median error: 5.6% [range: -26.2-19.7]) across various stiffnesses [range: 1.3-4.0 m s-1] and thicknesses [range: 10-20 mm]. A trend towards underestimation was only observed in the unlikely scenario of thin and very stiff septa. For the first time, the accuracy of cardiac THE was quantified both in silico and in vivo, specifically in a cohort including patients with ATTRwt. Multifrequency shear waves induced by portable drivers and encoded in standard ultrasound provide a rapid, low-cost echocardiographic contrast that aids the detection of cardiomyopathies such as amyloidosis. Ziel: Vorstellung und Validierung einer optimierten multifrequenten kardialen zeit-harmonischen Elastographie (THE) mit tragbaren Schwingungstreibern und Mehrfach-Herzschlag-Akquisitionen zur Detektion abnormer diastolischer Steifigkeit. Dies erfolgte durch in-silico-Tests sowie durch Untersuchungen an Probanden mit bestätigter kardialer Wildtyp-Transthyretin-Amyloidose (ATTRwt) -einer Modellerkrankung für myokardiale Steifigkeit- im Vergleich zu gesunden Kontrollpersonen. Kardiale THE wurde unter Verwendung kontinuierlicher Vibrationen von 60, 70 und 80 Hz durchgeführt, die durch einen tragbaren Schwingungstreiber erzeugt wurden. Scherwellengeschwindigkeits-(SWS)-Karten als Stellvertretermaß für die myokardiale Steifigkeit wurden über 4 Sekunden in einer parasternalen Längsachsendarstellung akquiriert. Ultraschallsimulationen des Herzens basierend auf CT-Daten anatomischer Modelle wurden für die in-silico-Validierung und Parameteroptimierung eingesetzt. Die diagnostische Leistungsfähigkeit wurde anhand der Fläche unter der ROC-Kurve (AUC) mit 95%-Konfidenzintervall (95%-CI) bewertet. Ergebnisse: Gesunde Kontrollpersonen (N=10; Medianalter: 32 Jahre [Bereich: 27-56]; fünf Männer) und Teilnehmende mit ATTRwt (N=11; Medianalter: 83 Jahre [Bereich: 64-86]; zehn Männer) wurden untersucht. Dies führte zu einer präzisen Detektion der Amyloidose (AUC: 0.99; 95%-CI: 0.93-1.00). Die in-silico geschätzten SWS-Werte stimmten gut mit den Referenzwerten überein (r²=0,94; Medianfehler: 5,6% [Bereich: -26.2-19.7]) über verschiedene Steifigkeiten [Bereich: 1.3-4.0 m s-1] und Wanddicken [Bereich: 10-20 mm]. Eine Tendenz zur Unterschätzung zeigte sich nur im unwahrscheinlichen Fall dünner und sehr steifer Septen. Schlussfolgerungen: Zum ersten Mal wurde die Genauigkeit der kardialen THE sowohl in silico als auch in vivo quantifiziert -insbesondere in einer Kohorte, die Patientinnen und Patienten mit ATTRwt einschließt. Multifrequente Scherwellen, die durch tragbare Schwingungstreiber induziert und in Standard-Ultraschall codiert werden, ermöglichen einen schnellen, kostengünstigen echokardiographischen Kontrast, der die Detektion von Kardiomyopathien wie Amyloidose unterstütz.
Globally, stroke is the second leading cause of death. About 20% of patients with acute stroke die within 30 days of onset, yet fewer than 10% receive palliative care, and only a small fraction of these receive it in specialized palliative units. Rather, they are treated in stroke units, where both knowledge of palliative care and support for bereaved family members may be inconsistent and limited. To describe the occurrence and design of bereavement support in the form of conversations offered to family members of patients who die from acute stroke in a stroke unit, as well as the registration in the Swedish Register of Palliative Care. This study employed a quantitative descriptive design with a cross-sectional approach. A study-specific survey consisting of three main questions and several follow-up questions was used. All 72 stroke units in Sweden were contacted in person, by phone, or by email; 71 units ultimately participated. Bereavement support in the form of conversations was provided to the family members of patients who had died from an acute stroke in 34 (48%) of the 71 stroke units. Among these, 21 units offered bereavement support to family members in all deaths, while 13 provided it when the need for support was identified. In total, 60 of the 71 stroke units (84%) register in the Swedish Register of Palliative Care, and of these, 25 units systematically use the registered data. Neither bereavement support in the form of conversations nor the systematic use of the palliative care registry are fully established part of care at stroke units. To ensure good and equitable end-of-life care, support for bereaved family members needs to be strengthened. Palliative registry data from stroke units represent an underutilized resource with the potential to improve both palliative care and bereavement support. Exploring bereavement support and use of the Palliative Care Registry in Swedish stroke units: A nationwide survey Why was the study done? Stroke is one of the leading causes of death worldwide. Many people who suffer a severe stroke die within a month, but only a few receive palliative care, specialized support for patients and their families at the end of life. Most are cared for in stroke units, where support for grieving family members can vary and may be limited. What did the researchers do? This study looked at how stroke units in Sweden support families after a patient dies. Researchers contacted all 72 stroke units in the country, and 71 responded. Three main questions and follow-up questions were posed. What did the researchers find? Less than half (48%) of the stroke units regularly offered conversations to support grieving families. Some units did this for every death, while others only offered support when they felt it was needed. Most stroke units (84%) also report data to the Swedish Register of Palliative Care, but only a few use this data to improve care. What do the findings mean? This study shows that support for grieving families and the use of palliative care data are not yet standard practice in stroke units. Strengthening these areas could help ensure better and fairer care for patients and their families.
Two preventable trauma deaths during my medical training in Lagos, an eight-year-old boy, with a splenic injury and a mother struck by a truck, revealed a devastating truth: in many settings, treatable injuries become fatal because trauma systems fail to respond fast enough. These losses, compounded by witnessing the stark contrast in trauma care during my elective at a US level II trauma center, crystallized my commitment to acute care surgery as both a career and a mission. I envision impacting the field through three pillars: first, conducting research focused on golden hour care, prehospital interventions, and rapid response protocols adaptable to resource-limited settings. Second, becoming an educator who trains the entire trauma care chain, from paramedics to surgeons, recognizing that trauma systems are only as strong as their weakest link. Third, contributing to the development of scalable trauma systems through policy work, artificial intelligence integration, and trauma registry development. Acute care surgery represents medicine at its most urgent and human. My goal is to translate witnessed losses into system-level change, ensuring that no patient dies from a treatable injury simply because organized, timely care was unavailable, whether in Nigeria or anywhere else in the world.
In the automotive industry, the push for lightweighting, sustainability, and performance underpins the need for continuous improvement of materials and processes; thus, this research explores the introduction of different approaches for processing optimization. The Finite Element Method (FEM) excels at enhancing structural efficiency and reducing material use in composite tooling like stamping dies, while Life Cycle Assessment (LCA) quantifies environmental impacts over the product life cycle. Coupling these approaches is promising but challenging due to difficult integration into well-established industrial practices. In this framework, the study presents the combination of FEM-LCA analyses on a tool for a composite car bonnet, considering an industrial case. The reduction in weight (-85%) obtained through FEM topology optimization, along with novel materials (thermoplastic polymers) and processes (3D printing, internal recycling), results in an environmental impact reduction over the tooling process (-43% in climate change). The two analyses enable a holistic tool design that balances mechanical performance with reduced carbon footprint, aligning with the European regulatory framework and emission targets. The results demonstrate the feasibility of a coupled FEM-LCA approach to optimize composite tooling in the automotive context, with a positive prospect of full-scale integration into the industrial value chain.
Disease outbreaks often begin within a small group of the population and spread through contact. While all population may be biologically susceptible, only those interacting with infectious individuals form the true target population and responsible for the disease transmission. To capture this reality, we develop a compartmental model incorporating dynamic contacts and an evolving target susceptible population. Applied to COVID-19 data in Nepal, the model accurately produces the timing, magnitude, and shape of three major epidemic waves, aligns closely with reported seroprevalence (8-11% post-first wave, 63-69% post-second wave), and reveals significant under-reporting of cases. Sensitivity analyses highlight the critical role of the target population expansion rate in driving epidemic severity, with higher values escalating peak infections and cumulative cases. The basic reproduction number (R0) is primarily influenced by the size of the target population, underscoring the need to limit high-risk exposure. Sensitivity and threshold analyses further identify the target population expansion rate as a critical parameter, beyond which the epidemic rapidly increases in magnitude. Our findings demonstrate that strategic interventions reducing transmission rates, controlling target population expansion, and managing contact network transitions can significantly mitigate epidemic burden and enhance the likelihood of disease extinction. In addition to numerical simulations, we rigorously study the analytical properties of the proposed model and identify an extinction threshold index that governs whether the disease dies out or persists. This evolving network model offers a robust framework for real-time epidemic assessment, adaptive policy making, and improved pandemic preparedness.