Analysis of Mechanical Properties Related to Fiber Length of Closed-Loop-Recycled Offcuts of a Thermoplastic Fiber Composites (Organo Sheets)

Increasing demand for energy-efficient means of transport has steadily intensified the trend towards lightweight components. Thermoplastic glass fiber composites (organo sheets) play a major role in the production of functional automotive components. Organo sheets are cut, shaped and functionalized by injection molding to produce hybrid components, such as those used in car door modules. The cutting process produces a considerable amount of production waste, which has thus far been thermally recycled. This study develops a closed mechanical recycling process and analyzes the different steps of the process. The offcuts were shredded using two shredding methods and implemented directly in the injection-molding process. Using tensile tests and impact bending tests, the material properties of the recycled materials were compared with the virgin material. In addition, fiber length degradation via the injection-molding process and the influence of the waterjet-cutting process on the mechanical properties are investigated. Recycled offcuts are both comparable to new material in terms of mechanical properties and usability, and are also economically and ecologically advantageous. Recycling polypropylene waste with glass fiber reinforcement in a closed loop is an effective way to reduce industrial waste in a sustainable and economical production process.     

Intensity of care in cancer patients in the last year of life: a retrospective data linkage study

Background Delivering high-quality palliative and end-of-life care for cancer patients poses major challenges for health services. We examine the intensity of cancer care in England in the last year of life.Methods We included cancer decedents aged 65+ who died between January 1, 2010 and December 31, 2017. We analysed healthcare utilisation and costs in the last 12 months of life including hospital-based activities and primary care.Results Healthcare utilisation and costs increased sharply in the last month of life. Hospital costs were the largest cost elements and decreased with age (0.78, 95% CI: 0.73–0.72, p < 0.005 for age group 90+ compared to age 65–69 and increased substantially with comorbidity burden (2.2, 95% CI: 2.09–2.26, p < 0.005 for those with 7+ comorbidities compared to those with 1–3 comorbidities). The costs were highest for haematological cancers (1.45, 95% CI: 1.38–1.52, p < 0.005) and those living in the London region (1.10, 95% CI: 1.02–1.19, p < 0.005).Conclusions Healthcare in the last year of life for advanced cancer patients is costly and offers unclear value to patients and the healthcare system. Further research is needed to understand distinct cancer populations’ pathways and experiences before recommendations can be made about the most appropriate models of care.Subject terms: Cancer, Cancer     

Chronic venous leg ulcers benefit from surgery: long-term results from 173 legs

OBJECTIVE: The purpose of this retrospective study was to present 7 years of data from operations of currently active, chronic venous leg ulcers (CEAP: C6), focusing on the short- and long-term effects of healing and recurrence and considering concomitant risk factors. METHODS: Between January 1997 and March 2004, 173 patients (239 legs) with a currently active, chronic venous leg ulcer were surgically treated. The surgical procedures included two main steps: (1) the surgical interruption of reflux in the superficial and perforating veins to reduce venous hypertension in the entire leg and/or the affected area and (2) the surgical procedure involving the ulcer. A total of 123 patients (173 legs) who came to the follow-up were examined. The follow-up period ranged from 3 months to 7 years. The data collection integrated a preoperative examination that included medical history and clinical diagnoses and incorporated measurements such as body mass index, ankle-brachial pressure index, and the neutral position method at the follow-up. The function of the veins was measured with duplex ultrasonography. Finally, the data were analyzed by using various statistical methods, including Kaplan-Meier analysis, Cox regression analysis, and paired t tests. RESULTS: Initially, ulcer healing occurred in 87% of the cases (151 legs). A total of 13% (22 legs) of the venous ulcers never healed, and recurrent venous ulcers occurred in 5% (9 legs). The Kaplan-Meier analyses of ulcer healing showed a healing rate of 85% in 6 months for all legs. The mean time of healing was 1.5 months. Furthermore, the Kaplan-Meier analyses of ulcer recurrence showed a 1.7% rate of recurrence in 6 months for all legs. The 5-year ulcer recurrence rate was 4.6%. The mean time of recurrence was 70.4 months. CONCLUSIONS: On the basis of the results from the 7 years of data from functional surgery of venous leg ulcers and as a result of the outcomes of our study, we recommend surgical treatment of venous leg ulcers at any stage. We therefore conclude that surgery is indicated before an ulcer is intractable to treatment. In general, our findings are based on the understanding and identification of the causes and symptoms of venous ulceration and illustrate that standard surgical methods can be applied for the therapy of venous leg ulcers at any stage.     

Contrast-enhanced T1-weighted fluid-attenuated inversion-recovery BLADE magnetic resonance imaging of the brain: an alternative to spin-echo technique for detection of brain lesions in the unsedated pediatric patient?

RATIONALE AND OBJECTIVES: We compared contrast-enhanced T1-weighted magnetic resonance (MR) imaging of the brain using different types of data acquisition techniques: periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER, BLADE) imaging versus standard k-space sampling (conventional spin-echo pulse sequence) in the unsedated pediatric patient with focus on artifact reduction, overall image quality, and lesion detectability. MATERIALS AND METHODS: Forty-eight pediatric patients (aged 3 months to 18 years) were scanned with a clinical 1.5-T whole body MR scanner. Cross-sectional contrast-enhanced T1-weighted spin-echo sequence was compared to a T1-weighted dark-fluid fluid-attenuated inversion-recovery (FLAIR) BLADE sequence for qualitative and quantitative criteria (image artifacts, image quality, lesion detectability) by two experienced radiologists. Imaging protocols were matched for imaging parameters. Reader agreement was assessed using the exact Bowker test. RESULTS: BLADE images showed significantly less pulsation and motion artifacts than the standard T1-weighted spin-echo sequence scan. BLADE images showed statistically significant lower signal-to-noise ratio but higher contrast-to-noise ratios with superior gray-white matter contrast. All lesions were demonstrated on FLAIR BLADE imaging, and one false-positive lesion was visible in spin-echo sequence images. CONCLUSION: BLADE MR imaging at 1.5 T is applicable for central nervous system imaging of the unsedated pediatric patient, reduces motion and pulsation artifacts, and minimizes the need for sedation or general anesthesia without loss of relevant diagnostic information.     

Loss to follow‐up among children and adolescents growing up with HIV infection: age really matters

Introduction : Globally, increasing numbers of HIV‐infected children are reaching adolescence due to antiretroviral therapy (ART). We investigated rates of loss‐to‐follow‐up (LTFU) from HIV care services among children as they transition from childhood through adolescence. Methods : Individuals aged 5–19 years initiated on ART in a public‐sector HIV clinic in Bulawayo, Zimbabwe, between 2005 and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age‐bands namely: 5–9 (children), 10–14 (young adolescents) and 15–19 (older adolescents). The effect of age at ART initiation, current age (using a time‐updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson regression. Results : Of 2273 participants, 1013, 875 and 385 initiated ART aged 5–9, 10–14 and 15–19 years, respectively. Unlike those starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older adolescent age‐band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94–2.55) and similarly, older adolescents had higher LTFU rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05–3.07). In older adolescents, the LTFU rate among those who started ART in that age‐band was higher compared to the rate among those starting ART at a younger age (ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age‐groups. Conclusions : Adolescents had higher rates of LTFU compared to other age‐groups, with older adolescents at particularly high risk in all analyses. Age‐updated analyses that examine movement across narrow age‐bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes.     

Patients with autosomal dominant polycystic kidney disease have elevated fibroblast growth factor 23 levels and a renal leak of phosphate

Fibroblast growth factor 23 (FGF23) and parathyroid hormone blood levels rise following progressive loss of renal function. Here we measured parameters of phosphate metabolism in 100 patients with autosomal dominant polycystic kidney disease (ADPKD) in stage 1 or 2 of chronic kidney disease, 20 patients with non-diabetic chronic kidney disease, and 26 with type 2 diabetes. Twenty healthy volunteers served as controls. The mean levels of FGF23 were significantly (4-fold) higher in ADPKD compared to non-diabetic and diabetic patients, and healthy volunteers. Mean serum phosphate levels were significantly lower in ADPKD patients compared to non-diabetic and diabetic patients, and the healthy volunteers. The prevalence of hypophosphatemia was 38, 25, 27, and 5% in ADPKD, non-diabetic and diabetic patients, and healthy volunteers, respectively. The tubular maximum of phosphate reabsorption per glomerular filtration rate was lowest in ADPKD patients with a significantly high positive correlation with serum phosphate levels. Estimated glomerular filtration rates were approximately 100 ml/min per 1.73 m2 in all groups and parathyroid hormone and vitamin D metabolite levels were in the normal range. Thus, FGF23 was substantially elevated in ADPKD patients compared to other CKD patients matched for glomerular filtration rate, and was associated with increased renal phosphate excretion. The mechanism for this anomaly will require further study.