Routine Practice Research Articles

Application of Corticosteroids in Dentistry: A Review

ABSTRACT Corticosteroids are crucial in dentistry for their anti-inflammatory and immunosuppressive properties, aiding in managing conditions such as oral lichen planus, recurrent aphthous stomatitis, and post-operative inflammation. By inhibiting pro-inflammatory mediators and immune cell activity, they offer significant symptomatic relief and promote healing. However, potential systemic and local side effects necessitate cautious application. This article explores the use of corticosteroids in routine dental practice.

Degenerative mitral stenosis by echocardiography: presentation and outcome

Abstract Aims Degenerative mitral stenosis (DMS) is due to degenerative mitral annular calcification (MAC) and valvular calcification. However, DMS impacts on the outcome, and therefore, potential treatment needs are poorly known. We aimed at evaluating survival after DMS diagnosis by Doppler echocardiography in routine practice. Methods and results A cohort of 2937 (75 ± 12 years, 67% women) consecutive patients were diagnosed between 2003 and 2014 with DMS (diastolic mean gradient ≥ 5 mmHg), with analysis of short- and long-term survival. All patients had overt mitral annular/valvular degenerative calcification without rheumatic involvement. Mean gradient was 6.5 ± 2.4 mmHg, and DMS was considered mild in 50%, moderate in 44%, and severe in 6%. DMS was associated with left atrial enlargement (52 ± 23 mL/m2) and elevated pulmonary pressure (49 ± 16 mmHg) despite generally normal ejection fraction (61 ± 13%). DMS was associated with frequent comorbid conditions (74% hypertension, 58% coronary disease, and 52% heart failure) and humoural alterations (haemoglobin 11.3 ± 1.8 g/dL and creatinine 1.5 ± 1.4 mg/dL). One-year mortality was 22%, most strongly related to older age, higher comorbidity, and abnormal haemoglobin/creatinine but only weakly to DMS severity (with anaemia 42% irrespective of DMS severity, P = 0.99; without anaemia 18, 23, and 28% with mild, moderate, and severe DMS, respectively, P < 0.0004). Long-term mortality was high (56% at 5 years) also mostly linked to aging and weakly to DMS severity [with anaemia P = 0.90; without anaemia: adjusted-hazard ratio: 1.30 (1.19–1.42), P < 0.0001, for moderate vs. mild DMS and 1.63 (1.34–1.98), P < 0.0001, for severe vs. mild DMS]. Conclusion DMS is a condition of the elderly potentially resulting in severe mitral obstruction and haemodynamic alterations. However, DMS is frequently associated with severe comorbidities imparting considerable mortality following diagnosis, whereas DMS severity is a weak (albeit independent) determinant of mortality. Hence, patients with DMS should be carefully evaluated and interventional/surgical treatment prudently considered in those with limited comorbidity burden, particularly without anaemia. Keywords: Degenerative Mitral Stenosis; Outcome; Natural history; Ecocardiography; Mitral Stenosis.

The role of advanced physiological guidance in contemporary coronary artery disease management.

This review evaluates the emerging role of the pullback pressure gradient (PPG) as a standardized metric for assessing coronary artery disease (CAD) patterns and its implications for clinical decision-making when managing patients undergoing percutaneous coronary interventions (PCIs). By integrating PPG with existing physiological assessments, this review highlights the potential benefits of PPG in predicting treatment outcomes and refining therapeutic strategies for CAD. Recent studies, particularly the PPG Global study have demonstrated a strong correlation between PPG values and post-PCI outcomes, revealing that focal disease is associated with improved fractional flow reserve (FFR) and lower rates of adverse events than vessels with diffuse disease (low PPG). Additionally, PPG has been linked to specific atherosclerotic plaque characteristics, indicating its utility in identifying high-risk plaques. The integration of PPG with advanced imaging techniques further enhances the understanding of CAD patterns and their implications for treatment planning. The PPG represents a significant advancement in the management of CAD, providing a reproducible and objective assessment of coronary artery disease patterns that can inform clinical decision-making. As research continues to explore the relationship among PPG, atherosclerotic characteristics, and patient outcomes, its integration into routine practice is expected to improve the effectiveness of PCI and optimize patient management strategies. Future studies are warranted to establish specific PPG thresholds and further investigate its potential in identifying vulnerable plaques and guiding treatment decisions.

Implementing learning into practice from continuous professional development activities: a scoping review of health professionals’ views and experiences

PurposeContinuing professional development (CPD) is an approach for health professionals to preserve and expand their knowledge, skills, and performance, and can contribute to improving delivery of care. However, evidence indicates that simply delivering CPD activities to health professionals does not lead to a change in practice.This review aimed to collate, summarize, and categorize the literature that reported the views and experiences of health professionals on implementing into practice their learning from CPD activities.MethodsThis review was guided by the Joanna Briggs Institute Reviewers’ Manual methodology for scoping reviews. Three databases, PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL), were systematically searched in February 2023 for articles published since inception. Two independent reviewers screened the articles against the inclusion criteria, and completed the data extraction. Data were summarized quantitatively, and the findings relating to views and experiences were categorized into challenges and facilitators.ResultsThirteen articles were included. Implementation of learning was not the primary focus in the majority of studies. Studies were published between 2008-2022; the majority were conducted in North America and nurses were the most common stakeholder group among Healthcare Professionals (HCPs). Five studies adopted qualitative methods, four quantitative studies, and four mixed-methods studies. The reported barriers of implementation included lack of time and human resource; the facilitators included the nature of the training, course content and opportunity for communal learning.ConclusionThis review highlights a gap in the literature. Available studies indicate some barriers for health professionals to implement their learning from CPD activities into their practice. Further studies, underpinned with appropriate theory and including all relevent stakeholders are required to investigate strategies that may facilitate the integration of learning from CPD into routine practice.

Screening of psoriatic arthritis by dermatologists - a German nationwide survey.

Up to 30% of psoriasis (PsO) is clinically associated with psoriatic arthritis (PsA). A large proportion of new onset of PsA is diagnosed at a later stage, despite the necessity of early effective treatment to prevent structural damage. This study aimed to identify the routine screening practices used for PsA in patients with PsO. This non-interventional, prospective, epidemiological, cross-sectional study conducted in Germany focuses on screening activity and treatment selection of dermatological practices in suspected PsA. Descriptive statistics and patient characteristics were analyzed for different center types. One hundred ninety-five patients from 34 office-based physicians, five non-university hospitals, and nine university hospitals were included. Questionnaires or imaging techniques were not routinely used (<45%). Especially, ultrasounds (≤5%) and MRIs (<6.3%) were rarely performed. Between 30% and 75% of suspected PsA could be confirmed. Referral to rheumatologists and/or appropriate therapy initiation were the most frequent consequences. Results of this study reflect the status of PsA screening activity by dermatologists. Imaging techniques, particularly ultrasound or MRIs to detect early forms of PsA, were inadequately used, which may have contributed to continued underdiagnoses. Collaboration between dermatologists and rheumatologists should be reviewed with a view to improving effective PsA screening.

Baseline eosinophil proportion is a useful predictor of immune-related adverse events following immune checkpoint inhibitor treatment for recurrent metastatic head and neck cancer

Background Immune checkpoint inhibitors (ICIs) occasionally cause immune-related adverse events (irAEs) in various organs. However, predictors of irAEs remain unidentified. Objectives We evaluated the predictors of irAEs and compared the outcomes of ICIs with and without irAEs in patients with recurrent/metastatic head and neck cancers (R/M HNCs). Materials and methods We retrospectively analyzed 157 patients with R/M HNCs who were administered an anti-PD-1 antibody between September 2014 and December 2022. We examined whether various pretreatment factors were associated with irAEs. The overall survival (OS) and progression-free survival (PFS) in patients with and without irAEs were analyzed. Results Overall, 44 patients (28.0%) developed irAEs. The survival curve estimated for patients with and without irAEs showed a significant difference in PFS (p = 0.018), but not in OS (p = 0.208). Multivariate analysis revealed significant differences in relative eosinophil counts (p < 0.001), TP (p = 0.014), and NLR (p = 0.002), which may be independent predictors of irAEs. Conclusion IrAEs may be associated with higher efficacy of ICIs and longer PFS. The relative eosinophil count may be predictors of irAEs and useful in routine medical practice. Using these biomarkers to predict irAEs will help predict ICI effects and manage irAEs.

Research Progress on the Correlation Between Oral Frailty and Dietary Intake in Older Adults

With the increase in age, the oral function of older adults shows an age-related decline, which limits the types, quantity, and quality of their diet. Limited dietary intake can lead to a lack of basic nutrients needed for maintaining oral health, induce a series of oral diseases, and further aggravate the deterioration of oral functions. Oral frailty is the accumulation of mild oral function decline and is an emerging concept in the field of oral health. Currently, research on oral frailty and dietary intake mostly focuses on the impact of single-dimensional oral function decline on the dietary intake, dietary structure, and dietary satisfaction of older adults, as well as the impact of different dietary structures on the status of oral health among older adults. There is still a lack of large-sample, high-quality research on the relationship between comprehensive oral function decline and dietary intake. In addition, existing oral frailty intervention measures often place a narrow emphasis on the exercise and recovery of oral function without considering the impact of dietary intake and nutritional status on the development of oral frailty. Relevant research on taking dietary intake as an entry point or using it as a comprehensive intervention method also needs to be further explored by researchers. In the future, specialized assessment and screening of dietary status may be introduced in the routine health management practices for older adults. Furthermore, targeted intervention programs could also be proposed based on the characteristics of the oral status and the dietary intake habits of older adults, so as to prevent the functional decline related to dietary intake and nutritional supplementation. Herein, we reviewed the correlation between dietary intake and oral frailty to provide new ideas and directions for formulating comprehensive management strategies for oral frailty.

Simple biomarkers to distinguish Parkinson's disease from its mimics in clinical practice: a comprehensive review and future directions.

In the last few years, a plethora of biomarkers have been proposed for the differentiation of Parkinson's disease (PD) from its mimics. Most of them consist of complex measures, often based on expensive technology, not easily employed outside research centers. MRI measures have been widely used to differentiate between PD and other parkinsonism. However, these measurements were often performed manually on small brain areas in small patient cohorts with intra- and inter-rater variability. The aim of the current review is to provide a comprehensive and updated overview of the literature on biomarkers commonly used to differentiate PD from its mimics (including parkinsonism and tremor syndromes), focusing on parameters derived by simple qualitative or quantitative measurements that can be used in routine practice. Several electrophysiological, sonographic and MRI biomarkers have shown promising results, including the blink-reflex recovery cycle, tremor analysis, sonographic or MRI assessment of substantia nigra, and several qualitative MRI signs or simple linear measures to be directly performed on MR images. The most significant issue is that most studies have been conducted on small patient cohorts from a single center, with limited reproducibility of the findings. Future studies should be carried out on larger international cohorts of patients to ensure generalizability. Moreover, research on simple biomarkers should seek measurements to differentiate patients with different diseases but similar clinical phenotypes, distinguish subtypes of the same disease, assess disease progression, and correlate biomarkers with pathological data. An even more important goal would be to predict the disease in the preclinical phase.

The development and evaluation of the Designing for Dissemination and Implementation Learning Hub

Abstract There is a growing emphasis on reducing the gap between research and routine practice. Dissemination and Implementation (D&amp;I) science offers theories, models, and frameworks to enhance the implementation, impact, and sustainment of new programs and interventions. Few training opportunities are available that help leaders, researchers, clinicians, and staff (implementers) translate original research into practice settings in a more timely and effective manner without requiring significant time away from their primary clinical duties. To address these needs, we designed a virtual Designing for Dissemination and Implementation (D4D&amp;I) Learning Hub that offered foundational D&amp;I knowledge and opportunities for skill building. We developed the D4D&amp;I Learning Hub curricula to train novice participants in the multicomponent D4D&amp;I implementation strategy bundle when implementing new programs or innovations. The components of the D4D&amp;I strategy bundle include (i) Pre-implementation assessment for proactive planning and multilevel contextual assessment, (ii) Multilevel partner engagement to learn what is important to end-users and obtain buy-in, (iii) Implementation and adaptations guided by a pre-implementation assessment while retaining program fidelity, and (iv) Program evaluation. We utilized a virtual e-learning platform, expert trainers, mentorship, and a Virtual Learning Collaborative to deliver the six-module curricula to support participants’ growth and success. We used quantitative and qualitative methods informed by the Kirkpatrick Evaluation Model to evaluate the D4D&amp;I Learning Hub. Thirty-one participants completed the D4D&amp;I Learning Hub across four cohorts. Participants found the D4D&amp;I curricula relevant and favorable, indicating they acquired the intended knowledge and skills. In presentations of their key takeaways, participants cited a greater understanding of how to apply various D&amp;I theories, models, and frameworks to their research, engage multilevel partners during all phases of implementation and evaluation, and assess fidelity and adaptations. Participants planned to incorporate the acquired D&amp;I knowledge and skills in future publications, grant applications, and when implementing new programs and projects in clinical settings. The D4D&amp;I Learning Hub provides foundational education for novice participants of D&amp;I science. It promotes designing, disseminating, implementing, and evaluating effective programs in clinical settings. This article discusses the development and implementation of the D4D&amp;I Learning Hub. In addition, we evaluated the first four cohorts using the Kirkpatrick Evaluation Model.

Mn-Catalyzed Aerobic Oxidative α-Cyanation of Tertiary Amines Using Azo/Hydrazide Redox.

Azo compounds such as diethyl azodicarboxylate have been used in oxidative coupling reactions to generate iminium ions from tertiary amines. However, the requirement of stoichiometric amounts of azo compounds limits their large-scale applications. Herein, we present an aerobic oxidative α-cyanation of tertiary amines using catalytic amounts of an azo compound or hydrazine. The developed protocol provides a practical and ecofriendly route for α-cyanated tertiary amines, using molecular oxygen as the terminal oxidant.

Temperature Dependence of the Pre-Chromatographic ‘Lawrence’ Method for Bivalves Contaminated with Paralytic Shellfish Poisoning Toxins

AbstractSaxitoxins are potent neurotoxins originating the acute human neurological syndrome of paralytic shellfish poisoning (PSP) via bivalve vectors. The official testing method in the European Union, commonly known as the ‘Lawrence method’, involves pre-column oxidation steps. The Portuguese monitoring adopted the hydrogen peroxide oxidation screening approach for bivalves contaminated with Gymnodinium catenatum toxins, which can quantify chromatographically at once 6 out of 10 analogues commonly found in bivalves. Seasonal fluctuation in the fluorescence yield of calibration curves was observed across years in a consistent manner. It correlated with fluctuations in average monthly air temperature in Lisbon, highlighting the importance of recording the room temperature during the oxidation steps as a matter of routine practice. Incubation experiments also showed an increase in fluorescence yield with temperature, more pronounced for the 11-hydroxysulphate analogues (dcGTX2 + 3, C1 + 2, GTX2 + 3) than for the 11-H toxins (dcSTX, GTX5[B1], STX). Temperature can be exploited to increase fluorescence yield, assisting in spectral confirmation, but must not exceed 40–50 °C to avoid toxin decomposition or production of extra oxidation products.

The recovery cycle of excitability assessed by a conventional electrodiagnostic machine: A study in healthy volunteers and in Charcot-Marie-Tooth 1A patients

ObjectiveTo validate the ‘paired pulses’ technique with a conventional electrodiagnostic machine (CEM) for studying the axonal excitability recovery cycle (ERC). MethodsPaired pulses, with a variable inter-stimulus interval, were delivered at the wrist along the median nerve. The CEM repeatability was verified in a group of 15 healthy volunteers (test/retest analysis). ERC was then applied in 40 healthy volunteers and 10 patients with Charcot-Marie-Tooth type 1A (CMT1A), using both the threshold tracking (TT) reference method and CEM (basal condition, during and after ischemia). ResultsCEM parameters evaluating absolute refractory and supernormal periods were reproducible (interclass correlation coefficient > 0.75). CEM results were consistent with TT method and literature data. In CMT1A, refractory and superexcitable periods were significantly reduced. According to receiving operator characteristic analysis, the CEM supernormal period area was the most relevant parameter for discriminating CMT1A from healthy volunteers (area under the curve = 0.98). ConclusionsCEM was a valid procedure for studying ERC. CMT1A patients exhibited ERC alterations due to modifications in passive membrane properties and of nodal ion channel distribution resulting from demyelination. SignificanceStudying ERC with CEM could be performed in routine practice in patients with peripheral neuropathies to provide information on motor axonal excitability.

Prenatal diagnostic errors in hemoglobin Bart's hydrops fetalis caused by rare genetic interactions of α-thalassemia.

To describe rare genetic interactions of α-thalassemia alleles causing Hb H disease and Hb Bart's hydrops fetalis which could lead to diagnostic errors in a routine practice. Hematological and molecular characterization were carried out in a Thai family with a risk of having fetus with Hb Bart's hydrops fetalis. Both parents were found to be the thalassemia intermedia patients associated with unusual forms of Hb H disease. DNA analysis of common α-thalassemia mutations in Thailand identified α+-thalassemia (-α3.7 kb del) and unknown α0-thalassemia in the father and α0-thalassemia (--SEA) with unknown α+-thalassemia in the mother. Fetal DNA analysis unlikely identified a homozygosity for α0-thalassemia (--SEA/--SEA). Further analysis identified that the father carried a rare South African α0-thalassemia in combination with α+-thalassemia (--SA/-α), whereas the mother was a patient with Hb H-Queens Park disease (--SEA/ααQP). The fetus was, in fact, a compound heterozygote for (--SA/--SEA). As shown in this study, routine screening for α-thalassemia at prenatal diagnosis in the region should include both common and rare α0-thalassemia alleles found in the population to effectively prevent a fatal condition of Hb Bart's hydrops fetalis syndrome.

Digital methods for diagnosing dental occlusion disorders

Relevance. Occlusal disorders are not only predictors of oral diseases but are also associated with systemic conditions such as endocrine, cardiovascular, and cognitive disorders, highlighting their broader significance in medicine. The digitization of diagnostic processes and the integration of computer technologies into traditional methods offer promising advancements in assessing occlusal status. This makes the analysis of digital methods for diagnosing occlusal relationship disorders particularly relevant.Purpose. To evaluate digital methods and devices used for diagnosing occlusal relationship disorders.Material and methods. A systematic review was conducted, analyzing 40 scientific publications from 2016 to 2024 that focus on digital methods for diagnosing occlusal imbalance. The study assessed electronic devices that measure occlusal force by converting mechanical force into electrical signals using various sensors. These digital methods are employed to evaluate the functional state of the masticatory system, including the detection of temporomandibular joint disorders, mandibular fractures, and occlusal deformities, as well as to monitor occlusal force dynamics during treatment. Recent advancements in portable electronic sensors suggest potential applications for their integration with control chips into dental prostheses or occlusal stabilization splints, allowing real-time monitoring of tooth compression forces, potentially enhanced by artificial intelligence.Results. The development of new diagnostic methods and devices equipped with highly sensitive sensors for measuring masticatory pressure opens new avenues for identifying clinical parameters that were previously difficult to analyze. Recent advances in hardware technology, particularly those utilizing neural network analysis, have the potential to expedite accurate diagnosis and predict the risk of complications.Conclusion. Both in Russia and internationally, significant progress is being made in the development of digital methods for diagnosing occlusal imbalance. These methods are poised to become a priority in the future of dental practice. However, the adoption of digital occlusal methods into routine dental practice is currently hindered by challenges related to the availability of digital equipment in clinics and the insufficient digital skills of many dentists. Addressing these challenges is crucial for improving the quality of dental care for patients with occlusal disorders.

Synthesis of α,α-Difluoromethylene Amines from Thioamides Using Silver Fluoride.

We developed a mild, rapid process employing AgF and thioamides to produce α,α-difluoromethylene amines efficiently. This method exhibited remarkable tolerance toward various functional groups present in N-sulfonylthioamides, thereby broadening the scope of difluoromethylene sulfonamides through a straightforward approach. Additionally, we applied this approach to synthesize various perfluoroalkyl amines, establishing practical synthetic routes for exploring these compounds in pharmaceutical chemistry and materials science.

Hierarchically N-doped porous carbon synthesized from 3D cellulose alcogel decorated by in-situ growth of ZIF-8 for high performance CO2 capture

The physical properties and chemical compositions of porous carbons are crucial factors in determining their effectiveness in adsorbing CO2. Cellulose-based porous carbon has emerged as an outstanding candidate adsorbent for CO2 capture. The research involved the creation of hierarchically nitrogen-doped porous carbon (HNC) using a 3D cellulose alcogel (CA) as substrate, which was prepared through a thermal introduced phase separation (TIPS) method combined with hydrolysis treatment. The plentiful functional groups of CA offered abundant growth sites for the introduction of ZIF-8 crystals. CA/ZIF-8 composite alcogel (CZA) with greater surface area and superior thermal stability compared to CA was successfully fabricated and used as precursor for the production of HNC. The important effects of microporosity and surface chemistry of HNC samples on CO2 capture were discussed in-depth. HNC-350–850 displayed a hierarchically porous structure with a large number of micropores and abundant N/O/Zn-doped functional groups, exhibiting high CO2 uptakes at 1 bar (3.56 mmol/g at 25 °C), good IAST CO2/N2 (15/85, V/V) selectivity of 16.31 at 25 °C, and outstanding regenerability with ∼100 % CO2 adsorption capacity retained after ten cycles. In the two-component CO2/N2 (15/85, V/V) competitive adsorption process, the maximum breakthrough periods for CO2 (433.1 s) is significantly longer than that of N2 (3.8 s). The CO2 breakthrough adsorption capacity reached 1.79 mmol/g at 25 °C and 1 bar with the separation coefficient of 45.8 for CO2 over N2. These results confirmed that HNC, in addition to having excellent CO2/N2 selectivity, demonstrated good feasibility for practical use. The green and practicable synthetic route described in this study is not only expected to offer novel adsorbents for high performance CO2 capture, but also provide a new theoretical foundation for the development of cellulose-based porous materials.

Associations of Racial Equity Training, Policies, and Practices With Routine Supervision Strategies in Community Corrections

Community corrections agencies across the United States are adopting racial equity as a priority in their polices, practices, and staff training, though how racial equity can be translated into the routine practices of probation and parole officers has not been widely discussed. This study examines the associations of perceived racial equity priorities on the supervision strategies reported by probation and parole officers in an online survey ( N = 1054). Approximately one-third of officers reported that their agencies prioritized racial equity. Racial equity scores were stronger in juvenile agencies and in agencies that prioritized evidence-informed practices. Racial equity was associated with reduced accountability-oriented case management practices. Results of this study suggest that racial equity policies and practices may impact client outcomes through changes in general supervision strategies. More research is needed to identify race-conscious strategies that community corrections officers can employ to meet the needs of people involved in the legal system.

Evaluating the Necessity of Routine Histopathology in Sleeve Gastrectomy Specimens: A Five-Year Analysis.

Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric surgery that involves the removal of a portion of the stomach. Routinely, the resected gastric tissue is sent for histopathological examination to screen for malignancies or other significant pathological findings. However, the necessity of this routine practice remains uncertain. This study aims to evaluate the histopathological outcomes of LSG specimens over a five-year period at our institution. We conducted a retrospective analysis of 203 patients who underwent LSG between January 2017 and December 2022 at Heartlands Hospital, University Hospitals Birmingham. Data collected included patient demographics, body mass index (BMI), use of preoperative oesophagogastroduodenoscopy (OGD), and histopathological findings. Patients with incomplete records or those who underwent Roux-en-Y gastric bypass were excluded from the study. Data were extracted for 310 patients, of whom 107 were excluded. The majority of the 203 patients analyzed were female (83%), with a mean age of 45.7 years and a mean BMI of 45.4 ± 7.3. Preoperative OGD was performed in only 0.5% of cases. Histopathological examination revealed that 81.3% (n=165) of patients had normal gastric mucosa, while 14.3% (n=29) had chronic gastritis. Clinically significant findings were rare, with only 1% (n=2) of patients showing gastrointestinal stromal tumors (GISTs) or focal intestinal metaplasia. None of the patients required additional treatment or follow-up based on these histopathological findings. Most LSG specimens in our study showed normal or non-significant histopathological findings, raising questions about the routine use of histopathological examination in LSG procedures. It remains unclear whether histopathology is necessary following sleeve gastrectomy. While no patients in our cohort required further treatment or surveillance, there are reports in the literature where surveillance or further treatment was necessary, though the incidence remains low. Given the low incidence of clinically significant pathology, further studies with larger sample sizes and multi-center data are needed to establish clear guidelines on this issue.

Remarkable Dielectric Breakdown Strength of Printable Polyelectrolyte Photopolymer Complexes.

Polymer-based dielectrics are struggling to keep pace with the increasing demands of modern electronics. This lag in dielectric performance has spurred significant interest in the production of advanced dielectrics via novel chemistries and processing techniques. Polyelectrolyte complexes (PECs) have recently shown great promise as dielectric insulation, but processing challenges presented by these ionically bound networks limit their use to conformal thin films. Recent advances have enabled the additive manufacturing of PECs with vat photopolymerization, allowing the creation of a polyelectrolyte complex of arbitrary shape. Herein, multiple polyelectrolyte resin formulations, comprised of polyethylenimine and methacrylic acid (with varying amounts of 2-hydroxyethyl methacrylate and/or N,N-dimethylacrylamide), are investigated for the production of additively manufactured dielectric insulators. These dielectrics not only possess high dielectric breakdown strengths (>300 kV/mm), but their dielectric behavior can also be readily tailored through resin formulation and post-processing conditions. The presented vat photopolymerization of PECs allows for the creation of bulk dielectrics with arbitrary geometry, while the novel chemistry provides a practical route forward to produce dielectrics with precisely tailored properties for specific applications.

Frailty among stroke patients and its effects on hospital outcomes

BackgroundAlthough assessment of frailty is increasingly being included in routine practice, its effects on hospital outcomes is not well studied. In this study, we used a national database to estimate the effects of frailty on hospital outcomes among stroke patients. MethodsThis study was a retrospective analysis of data from Nationwide Inpatient Sample (NIS) database collected during the years 2016 to 2019. Adult patients 45 years and older with a primary diagnosis of stroke were included for the analysis. Primary outcome was frequency of frailty among stroke patients. Secondary outcomes were in-hospital mortality, prolonged length of stay, mechanical ventilation, and acute renal failure. Frailty levels were assessed by using the Hospital Frailty Risk Score (HFRS). ResultsAmong 2,031,085 stroke hospitalizations, 362,140 (17.8 %) were non-frail, 1,333,000 (65.6 %) were pre-frail, and 335,945 (16.6 %) were frail. Regression analysis showed that the odds of mortality were significantly higher among frail (aOR, 2.82, 95 % CI: 2.63–3.04) and pre-frail (aOR, 1.62, 95 % CI: 1.53–1.73) patients, compared to non-frail patients. Similarly, the odds of mechanical ventilation were significantly higher among frail (aOR, 9.72, 95 % CI: 8.84–10.69) and pre-frail (aOR, 3.41, 95 % CI: 3.12–3.73) patients. The odds of acute renal failure were significantly higher among frail (aOR, 6.96, 95 % CI: 6.62–7.33) and pre-frail (aOR, 2.94, 95 % CI: 2.80–3.08) patients. ConclusionCollaborative efforts by neurologists, neurosurgeons, and physiatrists towards identifying frailty and incorporating it in risk estimation measures could help improve management strategies, resource utilization, and optimization of patient outcomes among frail stroke patients.