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The timely communication of clinically significant image appearances to Emergency Department (ED) referrers is necessary for optimum patient care. Australian reliance on verbal communication only is time-limited, open to misinterpretation and lacks transparency. A combined radiographer alert and comment model was designed to reliably communicate image abnormalities to ED referrers in real-time. A multidisciplinary steering group designed the model for all ED general imaging. Protocols were developed to document radiographer comments (critical, urgent and clinically significant) in patients' medical records. Critical findings were communicated directly to ED. Five NSW hospitals varying in size, complexity and population demographics piloted the model between three to twelve months during 2021–2022. Site auditors compared comments with the radiology report and designated each as True Positive (TP), False Positive (FP), indeterminate and clinically significant. Indeterminate cases were analysed by an external radiologist. Inter-observer consensus was obtained for all classifications via two independent auditors. The Positive Predictive Value (PPV), or precision of the comment, was calculated for each site. Radiographers (n = 69) provided comments for 1102 cases. The pooled average PPV for TP was 0.96; (0.947–0.971; 95% CI). The weighted mean error (FP comments) was 3.9%; (2.9% - 5.3%.; 95% CI). The Radiographer Comment model provided consistent levels of commenting precision and reproducibility across a range of sites with a pooled average PPV (0.96). The False Positive rate or weighted mean error (FP) of 3.9% (2.9% - 5.3%.; 95% CI) was low. A strategic, interprofessional approach in the implementation of an image alert combined with a Radiographer Comment can be adapted across a variety of hospital settings for ED and other departments. [ABSTRACT FROM AUTHOR]

• Lymphedema is an important consideration following severe morel-Lavallee lesions. • Lymphovenous anastomoses can prevent fluid accumulation and restore lymphatic drainage by reconstructing lymphatic outflow. • Plastic surgeons are well equipped to treat these patients using modern diagnostic and microsurgical lymphatic techniques. Morel-Lavallee Lesions lead to disruption of lymphatic anatomy that require early identification and may necessitate lymphatic reconstruction. We present the case of a 59-year-old male with lower extremity lymphedema resulting after a severe Morel-Lavallee lesion and treated using lymphovenous anastomoses. He was initially managed with multiple aspirations followed by repeat incision and drainage. At 10 months following his injury, he continued to have swelling of his upper thigh and developed a large festoon medially, with lower leg pitting edema. He was diagnosed with lymphedema via lymphoscintigraphy. His superficial lymphatic anatomy was visualized using indocyanine green (ICG) lymphography and showed diffuse dermal backflow across his thigh, with signs of altered lymphatic anatomy distally. We preformed two lymphovenous anastomoses at the level of his mid-thigh to bypass the lymphatic disruption and restore drainage to his lower leg. After rerouting lymphatic flow from the lower extremity, the patient had overall improvement of his symptoms and reduced swelling with continued therapy. At 5 months postoperatively, his volumetric lower extremity measurements showed a decrease by 314 mL and he began walking again in 20-minute intervals. Lymphedema may be an important consideration following severe Morel-Lavallee lesions. Using modern diagnostic and supermicrosurgical techniques, plastic surgeons can help treat this long-term morbidity. [ABSTRACT FROM AUTHOR]

This article investigates the dynamic instability of a stiffened sandwich plate with an auxetic honeycomb core and three-phase hybrid composite (PMMA/GPL/Carbon fiber) layers. To achieve this objective, the governing equations related to the plate and stiffener are expanded using the first-order shear deformation theory (FSDT). The isogeometric analysis (IGA) method is employed to solve these governing equations. The results are compared with data from previously published articles to validate their accuracy and demonstrate the high precision of the isogeometric analysis method for analyzing stiffened sandwich plates. In this study, the dynamic instability of a stiffened sandwich plate is studied by creating a non-conformed interface between the stiffener and the plate surface. Furthermore, this study investigates how stiffeners, geometric and mechanical characteristics of the auxetic honeycomb core, and three-phase hybrid composite layers simultaneously affect the dynamic instability of a sandwich plate. • Dynamic instability of sandwich plates with auxetic honeycomb core and three-phase hybrid composite layers is studied. • The effects of the simultaneous combination of different honeycomb cores and stiffeners are considered. • The effective properties of the nanocomposite-reinforced face sheets were estimated using the Halpin-Tsai law. • Effect of negative Poisson's ratio of auxetic honeycomb core on the dynamic instability of sandwich plate is considered. • The impact of curvilinear stiffener on the dynamic instability of the sandwich plate is studied under various conditions. [ABSTRACT FROM AUTHOR]

• Static, stability and free vibration analysis of FG plate are carried out. • Free vibration of plates with inner point, line and area supports is studied. • The finite strip method with longitudinal RKPM functions based on FSDT is used. • A decent way is used to impose boundary conditions considering meshfree functions. • Elimination of shear-locking, as an undesirable phenomenon, is elaborated. This paper is focused on the application of a novel reproducing kernel particle finite strip method (RKP-FSM) for the static, mechanical and thermal buckling, and free vibration analyses of rectangular functionally graded (FG) plates with different boundary conditions and internal supports. Conventional reproducing kernel particle method (RKPM) is incorporated into the finite strip method (FSM), and the governing equations are derived based on the first-order shear deformation theory (FSDT). As a convenient approach, boundary conditions are imposed using a simple method based on the RKPM correction function and the essence of the FSDT displacement field. Several examples are studied using this method, and the results are compared to those obtained from other numerical methods. The proposed method is also extended to consider different support geometries and complex inner conditions, and the results are validated using COMSOL finite element software. The shear-locking error, which occurs when considering C0 plate theories, is noticeably reduced by considering the RKPM parameters in the finite strip formulation. [ABSTRACT FROM AUTHOR]

Currently only two alloplastic temporomandibular joint (TMJ) total joint replacement (TJR) systems are available in the United States. The aim of this study was to define variables that determine whether a Biomet stock prosthesis could have been used to reconstruct a TMJ previously reconstructed with a TMJ Concepts patient-fitted prosthesis. All of the TMJ Concepts prostheses placed between 2010 and 2018 at the University of Texas – Health at San Antonio were analyzed retrospectively. There were 128 cases (241 joints) with intact stereolithographic models analyzed for successful adaptation of the Biomet stock TMJ prosthesis. Anatomical, demographic, etiological, and perioperative data were gathered for each joint to investigate possible causes of failure of stock adaptation. The majority of joints, 74% (178/241), could have had a stock prosthesis adapt. All joints with ≥40 mm gap arthroplasty failed stock prosthesis adaptation. Only 50% (32/64) of the joints with at least one previous open TMJ surgery and 60% (58/96) of the joints with concomitant orthognathic surgery could have had a stock TMJ prosthesis. The stock prosthesis could not be adapted for any of the patients requiring TMJ replacement for congenital disorders or those requiring TMJ salvage. Overall, the majority of cases treated with a patient-specific TMJ TJR could have been treated with a stock prosthesis. [ABSTRACT FROM AUTHOR]

Treatment of intracranial aneurysms with flow-diverting stents is a safe and minimally invasive technique. The goal is stable embolisation that facilitates stent endothelialisation, and elimination of the aneurysm. However, it is not fully understood why some aneurysms fail to develop a stable clot even with sufficient levels of flow reduction. Computational prediction of thrombus formation dynamics can help predict the post-operative response in such challenging cases. In this work, we propose a new model of thrombus formation and platelet dynamics inside intracranial aneurysms. Our novel contribution combines platelet activation and transport with fibrin generation, which is key to characterising stable and unstable thrombus. The model is based on two types of thrombus inside aneurysms: red thrombus (fibrin- and erythrocyte-rich) can be found in unstable clots, while white thrombus (fibrin- and platelet-rich) can be found in stable clots. The thrombus generation model is coupled to a CFD model and the flow-induced platelet index (FiPi) is defined as a quantitative measure of clot stability. Our model is validated against an in vitro phantom study of two flow-diverting stents with different sizing. We demonstrate that our model accurately predicts the lower thrombus stability in the oversized stent scenario. This opens possibilities for using computational simulations to improve endovascular treatment planning and reduce adverse events, such as delayed haemorrhage of flow-diverted aneurysms. [ABSTRACT FROM AUTHOR]

Highlights • Static analysis of corrugated-core sandwich plate is investigated. • Free and forced vibration analyses of corrugated-core sandwich plate are studied. • The finite strip method based on the first order shear deformation theory is used. • Effect of geometric parameters and different boundary conditions are studied. Abstract Free and forced vibration and static analysis of corrugated-core sandwich plates are investigated in this study by employing the classic finite strip method. The 3D corrugated-core plate is converted to a 2D orthotropic continuum model by considering some equivalent elastic constants. Various boundary conditions and different features of these plates are explored and the geometric and mechanical factors influencing their responses, such as displacements, rotations, moments and shear forces, are evaluated. Because of the significant effect of the shear stiffness on the behavior of corrugated-core sandwich plates, the first order shear deformation theory (FSDT) is used to analyze the plate. Due to the comparatively low shear to flexural stiffness ratio of these plates compared to ordinary plates, the convergence of the results is relatively slow. Therefore, a fast numerical technique such as finite strip method which yields effective reduction of calculation cost is employed. A MATLAB program is developed to obtain the results and the validity of the proposed method is evaluated by comparing the results with those presented by previous researches. [ABSTRACT FROM AUTHOR]

Background: Trauma centres and systems have been associated with improved morbidity and mortality after injury. However, variability in outcomes across centres within a given system have been demonstrated. Performance improvement initiatives, that utilize external benchmarking as the backbone, have demonstrated system-wide improvements in outcomes. This data driven approach has been lacking in Australia to date. Recent improvement in local data quality may provide the opportunity to engage in data driven performance improvement. Our objective was to generate risk-adjusted outcomes for the purpose of external benchmarking of trauma services in New South Wales (NSW) based on existing data standards.Methods: Retrospective cohort study of the NSW Trauma Registry. We included adults (>16 years), with an Injury Severity Score >12, that received definitive care at either Major Trauma Services (MTS) or Regional Trauma Services (RTS) between 2012-2016. Hierarchical logistic regression models were then used to generate risk-adjusted outcomes. Our outcome measure was in-hospital death. Demographics, vital signs, transfer status, survival risk ratios, and injury characteristics were included as fixed-effects. Median odds ratios (MOR) and centre-specific odds ratios with 95% confidence intervals were generated. Centre-level variables were explored as sources of variability in outcomes.Results: 14,452 patients received definitive care at one of seven MTS (n = 12,547) or ten RTS (n = 1905). Unadjusted mortality was lower at MTS (9.4%) compared to RTS (11.2%). After adjusting for case-mix, the MOR was 1.33, suggesting that the odds of death was 1.33-fold greater if a patient was admitted to a randomly selected centre with worse as opposed to better risk-adjusted mortality. Definitive care at an MTS was associated with a 41% lower likelihood of death compared to definitive care at an RTS (OR 0.59 95%CI 0.35-0.97). Similar findings were present in the elderly and isolated severe brain injury subgroups.Conclusions: The NSW trauma system exhibited variability in risk-adjusted outcomes that did not appear to be explained by case-mix. A better understanding of the drivers of the described variation in outcomes is crucial to design targeted locally-relevant quality improvement interventions. [ABSTRACT FROM AUTHOR]

μ-Opioid receptor (MOR) agonists are often used to treat severe pain but can result in adverse side effects. To circumvent systemic side effects, targeting peripheral opioid receptors is an attractive alternative treatment for severe pain. Activation of the δ-opioid receptor (DOR) produces similar analgesia with reduced side effects. However, until primed by inflammation, peripheral DOR is analgesically incompetent, raising interest in the mechanism. We recently identified a novel role for G-protein-coupled receptor kinase 2 (GRK2) that renders DOR analgesically incompetent at the plasma membrane. However, the mechanism that maintains constitutive GRK2 association with DOR is unknown. Protein kinase A (PKA) phosphorylation of GRK2 at Ser-685 targets it to the plasma membrane. Protein kinase A-anchoring protein 79/150 (AKAP), residing at the plasma membrane in neurons, scaffolds PKA to target proteins to mediate downstream signal. Therefore, we sought to determine whether GRK2-mediated DOR desensitization is directed by PKA via AKAP scaffolding. Membrane fractions from cultured rat sensory neurons following AKAP siRNA transfection and from AKAP-knock-out mice had less PKA activity, GRK2 Ser-685 phosphorylation, and GRK2 plasma membrane targeting than controls. Site-directed mutagenesis revealed that GRK2 Ser-685 phosphorylation drives the association of GRK2 with plasma membrane-associated DOR. Moreover, overexpression studies with AKAP mutants indicated that impaired AKAP-mediated PKA scaffolding significantly reduces DORGRK2 association at the plasma membrane and consequently increases DOR activity in sensory neurons without a priming event. These findings suggest that AKAP scaffolds PKA to increase plasma membrane targeting and phosphorylation of GRK2 to maintain DOR analgesic incompetence in peripheral sensory neurons. [ABSTRACT FROM AUTHOR]

We examine the reaction of ethanol with glyoxal to form hemiacetal by means of the high-level G4(MP2) procedure. In this reaction, an intermolecular proton transfer is coupled with the formation of a covalent C O bond between the two molecules. We find a novel catalytic reaction mechanism in which an H 2 SO 4 catalyst reduces the barrier height from ∆ H ‡ 298 = 140.2 to 16.3 kJ mol −1 . It is well established that H 2 SO 4 can effectively catalyse intramolecular proton transfers. This letter shows that H 2 SO 4 can catalyse an intermolecular proton transfer that is coupled with a covalent bond formation. [ABSTRACT FROM AUTHOR]

Adverse wall shear stress (WSS) patterns are known to play a key role in the localisation, formation, and progression of intracranial aneurysms (IAs). Complex region-specific and time-varying aneurysmal WSS patterns depend both on vascular morphology as well as on variable systemic flow conditions. Computational fluid dynamics (CFD) has been proposed for characterising WSS patterns in IAs; however, CFD simulations often rely on deterministic boundary conditions that are not representative of the actual variations in blood flow. We develop a data-driven statistical model of internal carotid artery (ICA) flow, which is used to generate a virtual population of waveforms used as inlet boundary conditions in CFD simulations. This allows the statistics of the resulting aneurysmal WSS distributions to be computed. It is observed that ICA waveform variations have limited influence on the time-averaged WSS (TAWSS) on the IA surface. In contrast, in regions where the flow is locally highly multidirectional, WSS directionality and harmonic content are strongly affected by the ICA flow waveform. As a consequence, we argue that the effect of blood flow variability should be explicitly considered in CFD-based IA rupture assessment to prevent confounding the conclusions. [ABSTRACT FROM AUTHOR]

Abstract: In the present work, the buckling and vibration of rectangular single-layered graphene sheets is analyzed based on the nonlocal theory of elasticity which takes the small scale effects into account. The graphene sheet is assumed as a thin plate, and the classical plate theory is applied to obtain the differential equation of the sheet. For the first time, the complex finite strip method is employed to study the vibration and buckling behavior of graphene sheets. The weighted residual method is employed to obtain the stiffness, stability and the mass matrices of the graphene sheet which is assumed to be an isotropic nanoplate. A sinusoidal displacement function is used for the longitudinal direction, which satisfies the simply supported boundary condition, while piecewise interpolation polynomials including the Hermitian and bubble functions are assumed for the other direction. A matrix eigenvalue problem is solved to find the vibration frequency and buckling load of graphene sheets subjected to different types of in-plane loadings including the uniform and non-uniform uniaxial and biaxial compressions as well as shear loading. The accuracy of the proposed model is validated by comparing the results with those reported by the available references. Furthermore, a number of examples are presented to investigate the effects of various parameters (e.g., boundary conditions, nonlocal parameter, aspect ratio, and type of loading) on the results. [Copyright &y& Elsevier]

Introduction: Fall from ladders is increasingly identified as a significant cause of injury and mortality, yet large-scale research into ladder fall outcomes and trends is limited.Objectives: To explore the nature and severity of injuries resulting from ladder falls and to determine predictors of Injury Severity Score (ISS) and 6-month mortality.Methods: Data were obtained from the New South Wales (NSW) Trauma Registry, Admitted Patient Data Collection and Registry of Births, Deaths, and Marriages on patients aged 15 and over who had major trauma from a ladder fall and were admitted to hospital between January 1st, 2012, and July 31st, 2019. Data linkage and descriptive statistics were carried out alongside bivariate and multivariable regression analysis.Results: 963 patients injured after ladder falls were identified. The mean age was 61.9 years (SD 14.2), 91.0% were male, and 489 (50.8%) were born in Australia. The height of fall was between one and five meters in 827 (86.2%) patients, and the place of fall was home and residential places in 27.5%. The most common body areas injured were the head (26.5%), spine (21.2%) and thorax (20.6%), and the median injury severity score was 17. The median length of stay of patients' in-hospital and intensive care unit was six days and two days, respectively. Six months post-discharge mortality was 6.4%. The unadjusted association between the presence of comorbidities or socio-economic class and ISS or mortality was not statistically significant. Increasing ISS was found to be associated with increasing age (Estimate (Est), 15.2; 95% Confidence Interval (CI), 12.3-18.1) and a fall height greater than five metres (Est, 5.8; CI, 3.2-8.4). Mortality was found to be associated with increasing age (Odds ratio (OR), 1.06; CI, 1.03-1.08) and increasing ISS (OR, 1.19; CI, 1.15-1.24).Conclusion: People presenting to the hospital after falling from a ladder were predominately male, aged over 60 and had fallen in a residential setting. Increasing age and fall height are associated with more severe injuries. [ABSTRACT FROM AUTHOR]

This paper presents the buckling analysis of rectangular sandwich plates with pure polymeric tapered cores and functionally graded carbon nanotube (FG-CNT) reinforced composite face sheets under static and harmonic dynamic loads. One uniform and four linearly-varying patterns are considered for the applied in-plane loads. The effective material properties of face sheets, in which the polymeric matrix is reinforced with aligned single-walled carbon nanotubes (SWCNT), are estimated using the extended rule of mixture. A higher-order zigzag shear deformation theory, which has the same number of dependent unknowns as the first-order theory, is employed to express the plate's displacement field. The governing equations are derived using Hamilton's principle and discretized by the spline finite strip method. The dynamic instability regions of plates with uniform and variable thickness are obtained by employing Bolotin's method. The accuracy of the present method is demonstrated by considering the problems for which solutions are available. A detailed numerical study is conducted to examine and compare the effects of different parameters, including the taper angle, type of the applied in-plane load, static and dynamic load factors, length-to-width ratios, the volume fraction of CNT, distribution pattern of CNTs along the thickness direction, temperature, and boundary conditions on the behavior of sandwich plate. [ABSTRACT FROM AUTHOR]

COVID-19 is the shocking viral pandemics of this year which affected the health, economy, communications, and all aspects of social activities all over the world. Early diagnosis of this viral disease is very important since it can prevent lots of mortalities and care consumption. The functional similarities between COVID-19 and COVID-2 in inducing acute respiratory syndrome lightened our mind to find a diagnostic mechanism based on early traces of mitochondrial ROS overproduction as lung cells' dysfunctions induced by the virus. We designed a simple electrochemical sensor to selectively detect the intensity of ROS in the sputum sample (with a volume of less than 500 μl). Comparing the results of the sensor with clinical diagnostics of more than 140 normal and involved cases resulted in a response calibration with accuracy and sensitivity both 97%. Testing the sensor in more than 4 hospitals shed promising lights in ROS based real-time tracing of COVID-19 from the sputum sample. • A novel electrotechnical diagnosis system for fast screening of COVID-19 was developed. • It has been based on early tracing of reactive oxygen species (ROS) overproduction. • MWCNTs have a crucial role in selective detection of released ROS induced by the virus. • These impressive results were achieved while the sensor declared diagnosis in less than 30 s. [ABSTRACT FROM AUTHOR]

With the development of nanotechnology, research activities on carbon nanostructures have increased rapidly. In recent years, due to the extraordinary mechanical properties of graphene sheets, there has been a growing interest in investigating the mechanical response of these carbon nanostructures. In this article, the modified couple-stress theory (MCST) is first employed to study the free vibration and mechanical buckling of single-layered graphene sheets (SLGSs). To this end, SLGS is modeled as a nanoplate and the two-variable refined plate theory (TVRPT) is adopted to extend the finite strip method (FSM) formulation. The natural free vibration frequency and mechanical buckling loads of the sheet are then obtained by solving the proper eigenvalue problems. Mechanical buckling and free vibration of multi-layered graphene sheets (MLGSs) are also investigated considering the effects of van der Waals (vdW) bonds between the layers. Modified couple-stress theory is applied to consider the small-scale effects of the graphene sheets. The results obtained by the proposed method are validated against those available in the literature. Finally, a comprehensive parametric study is performed to investigate the effects of different parameters such as loading schemes, nanoplate dimensions and boundary conditions. [ABSTRACT FROM AUTHOR]

Introduction: Trauma registries are used to analyse and report activity and benchmark quality of care at designated facilities within a trauma system. These capabilities may be enhanced with the incorporation of administrative and electronic medical record datasets, but are currently limited by the use of different injury coding systems between trauma and administrative datasets.Objectives: Use an Abbreviated Injury Scale to International Classification of Disease (AIS-ICD) mapping tool to correlate estimated injury severity scores and major trauma volume based on administrative data collections with trauma registry data.Methods: Adult trauma cases were identified from the New South Wales Trauma Registry between 2012 and 2016 and linked probabilistically using age, facility and date of facility arrival to the Admitted Patient Data Collection (APDC). Estimated Injury Severity Scores (ISS) were derived using the AIS-ICD mapping tool applied to diagnoses contained in the APDC.Results: A total of eligible 13,439 cases were analysed. The overall correlation between trauma registry ISS and ISS estimated from APDC using the AIS-ICD mapping tool was low to moderate (Spearman Rho 0.41 95%CI 0.40, 0.43). Based on an estimated ISS cut-off value of 8, there was high correlation between estimated trauma volume and the number of major trauma cases at each facility (Spearman Rho 0.98, 95%CI 0.95, 0.99). Trauma Revised Injury Severity Score (TRISS) was associated with only slightly higher mortality prediction performance compared to estimated ISS (AUROC 0.76 95%CI 0.75, 0.78 versus AUROC 0.74 95%CI 0.73, 0.76).Conclusion: A low to moderate correlation exists between individual patient ISS scores based on AIS to ICD mapping of in-patient data collection, but a high correlation for overall major trauma volume using the AIS-ICD mapping at facility level with comparable TRISS mortality prediction. [ABSTRACT FROM AUTHOR]

Spinel BaAl 2 O 4 nanopowders were synthesized via an aqueous combustion using stoichiometric amount of cations, Ba 2+ and Al 3+ , in rational fraction of a fuel (maltose). In order to achieve pure crystals, single fuel led to the formation of combustion reaction. The structural analysis indicates that the concentration of the starting materials and annealing temperature directly affect the purity of the product. The Scherrer and Hall-Williamson equation were performed to measure the average crystallite sizes of the BaAl 2 O 4 nanopowders in the range of 26.5 and 40.8 nm, respectively. The microscopic analysis, SEM and TEM, were indicated the morphology and the nanoscale formation of BaAl 2 O 4 ranging from 30 to 40 nm. The Band gap energy was calculated using Tauc method obtained at 3.34 eV. The maximum discharge capacity of BaAl 2 O 4 obtained at 1000 mAh/g after 15 cycles. This result was also confirmed by theoretical calculation. [ABSTRACT FROM AUTHOR]

Background: While comorbidities and types of road users are known to influence survival in people hospitalised with injury, few studies have examined the association between comorbidities and survival in people injured in road traffic crashes. Further, few studies have examined outcomes across different types of road users with different types of pre-existing comorbidities. This study aims to examine differences in survival within 30 days of admission among different road user types with and without different pre-existing comorbidities.Method: Retrospective cohort study using data for all major road trauma cases were extracted from the NSW Trauma Registry Minimum Dataset (1 January 2013 - 31 July 2019) and linked to the NSW Admitted Patient Data Collection, and the NSW Registry of Births, Deaths and Marriages - death dataset. Pre-existing comorbidities and road user types were identified by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes and Charlson Comorbidity Index in the Trauma Registry, hospital admission, and death datasets. Logistic regression was used to assess the associations between six types of road users (pedestrian, pedal cycle, two- and three-wheel motorcycle, car and pick-up truck, heavy vehicle and bus, and other types of vehicle) and death within 30 days of hospital admission while controlling for comorbidities. All models used 'car and pick-up truck driver/passenger' as the road user reference group and adjusted for demographic variables, injury severity, and level of impaired consciousness.Results: Within 6253 traffic injury person-records (all aged ≥15 years old, ISS>12), and in final models, injured road users with major trauma who had a history of cardiovascular diseases (including stroke), diabetes mellitus, and higher Charlson Comorbidity Index score, were more likely to die, than those without pre-existing comorbidities. Furthermore, in final models, pedestrians were more likely to die than car occupants (OR: 1.68 - 1.77, 95CI%: 1.26 - 2.29 depending on comorbidity type).Conclusions: This study highlights the need to prioritize enhanced management of trauma patients with comorbidities, given the increasing prevalence of chronic medical conditions globally, together with actions to prevent pedestrian crashes in strategies to reach Vision Zero. [ABSTRACT FROM AUTHOR]

• Severely injured patients have significant morbidity and mortality. Patients with blunt chest injury are a risk of further complications, particularly the elderly population who traditionally have comorbidities. This paper is one of a series of studies investigating the impact of comorbidities in severely injured patients. • Severely injured patients with blunt chest injury and comorbidities are at risk of prolonged length of stay. Blunt chest injuries result in up to 10 % of major trauma admissions. Comorbidities can complicate recovery and increase the mortality rate in this patient cohort. A better understanding of the association between comorbidities and patient outcomes will facilitate enhanced models of care for particularly vulnerable groups of patients, such as older adults. i) compare the characteristics of severely injured patients with blunt chest injury with and without comorbidities and ii) examine the relationship between comorbidities and key patient outcomes: prolonged length of stay, re-admission within 28 days, and mortality within 30 days in a cohort of patients with blunt chest injury admitted after severe trauma. A retrospective cohort study using linked data from the NSW Trauma Registry and NSW mortality and hospitalisation records between 1st of January 2012 and 31st of December 2019. After adjusting for potential confounding factors, patients with severe injuries, chest injuries, and comorbidities were found to have a 34 % increased likelihood of having a prolonged length of stay (OR = 1.34, 95 % I = 1.17–1.53) compared to patients with no comorbidities. There was no difference in 30-day mortality for patients with a severe chest injury who did or did not have comorbidities (OR = 1.05, 95 %CI = 0.80–1.39). No significant association was found between comorbidities and re-admission within 28 days. Severely injured patients with blunt chest injury and comorbidities are at risk of prolonged length of stay. [ABSTRACT FROM AUTHOR]

[Display omitted] • A multiscale reference model is developed by combining CBCT and μCT scans. • Geodesic wave propagation is proposed for prescribing cortical bone orthotropy. • Variations in the mandible material properties are represented by 16 zones. • Muscles are realistically modeled using uniformly distributed muscle fiber bundles. • The range of dental problems can be studied by editing the reference intact model. Computer modeling of lower mandible physiology remains challenging because prescribing realistic material characteristics and boundary conditions from medical scans requires advanced equipment and skill sets. The objective of this study is to provide a framework that could reduce simplifications made and inconsistency (in terms of geometry, materials, and boundary conditions) among further studies on the topic. The OpenMandible framework offers: 1) the first publicly available multiscale model of the mandible developed by combining cone beam computerized tomography (CBCT) and μCT imaging modalities, and 2) a C++ software tool for the generation of simulation-ready models (tet4 and hex8 elements). In addition to the application of conventional (Neumann and Dirichlet) boundary conditions, OpenMandible introduces a novel geodesic wave propagation - based approach for incorporating orthotropic micromechanical characteristics of cortical bone, and a unique algorithm for modeling muscles as uniformly directed vectors. The base intact model includes the mandible (spongy and compact bone), 14 teeth (comprising dentin, enamel, periodontal ligament, and pulp), simplified temporomandibular joints, and masticatory muscles (masseter, temporalis, medial, and lateral pterygoid). The complete source code, executables, showcases, and sample data are freely available on the public repository: https://github.com/ArsoVukicevic/OpenMandible. It has been demonstrated that by slightly editing the baseline model, one can study different "virtual" treatments or diseases, including tooth restoration, placement of implants, mandible bone degradation, and others. OpenMandible eases the community to undertake a broad range of studies on the topic, while increasing their consistency and reproducibility. At the same time, the needs for dedicated equipment and skills for developing realistic simulation models are significantly reduced. [ABSTRACT FROM AUTHOR]

• Prehospital trauma systems are designed to ensure survival from critical injuries by triaging and transporting patients to the most appropriate hospital in a timely manner. • Median prehospital transport times are longer in non-metropolitan road transports compared to metropolitan transports. • In an inclusive trauma system increasing prehospital transport times and scene location were not associated with increasing mortality. Prehospital trauma systems are designed to ensure optimal survival from critical injuries by triaging and transporting such patients to the most appropriate hospital in a timely manner. We sought to evaluate whether prehospital time and location (metropolitan versus non-metropolitan) were associated with 30-day mortality in a cohort of patients transported by road ambulance using a trauma transport protocol. Data linkage analysis of routinely collected ambulance and hospital data across all public hospitals in New South Wales (NSW). The data linkage cohort included adult patients (age ≥ 16years) transported by NSW Ambulance, where a T1 Major Trauma Transport Protocol was documented by paramedic crews and transported by road to a public hospital emergency department in NSW for two years between January 2019 and December 2020. The outcomes of interest were prehospital times (response time, scene time and transport time) and 30-day mortality due to injury. 9012 cases were identified who were transported to an emergency department with T1 protocol indication. Median prehospital transport times were longer in non-metropolitan road transports [ n = 3,071, 98 min (71–126)] compared to metropolitan transports [ n = 5,941, 65 min (53–80), p < 0.001]. There was no significant difference in 30-day mortality between the two groups (1.24% vs 1.65%, p = 0.13). In the subgroup of patients with abnormal vital signs, the only predictors of mortality were increasing age, presence of severe injury (OR 24.87, 95%CI 11.02, 56.15, p < 0.001), and arrival at a non-trauma facility (OR 3.01, 95%CI 1.26, 7.20, p < 0.05). Increasing transport times were not found to increase the odds of 30-day mortality. In the context of an inclusive trauma system and an established prehospital major trauma protocol, increasing prehospital transport times and scene location were not associated with increased mortality. [ABSTRACT FROM AUTHOR]

• Ambulance triage and transport protocols are critical components of the trauma system response to major injury. • The sensitivity of the New South Wales ambulance service was found to be 14% with a specificity of 90%. Undertriage and overtriage rates were 3% and 63% respectively. • The T1 protocol could be improved using a combination of clinical factors and other trauma treatment protocols. Prehospital triage and transport protocols are critical components of the trauma systems. Still, there have been limited studies evaluating the performance of trauma protocols in New South Wales, such as the NSW ambulance major Trauma transport protocol (T1). Determine the performance of a major trauma transport protocol in a cohort of ambulance road transports A data-linkage study using routine ambulance and hospital datasets across New South Wales Australia. Adult patients (age > 16 years) where any trauma protocol was indicated by paramedic crews and transported to any emergency department in the state were included. Major injury outcome was defined as an Injury Severity Score >8 based on coded in-patient diagnoses, or admission to intensive care unit or death within 30 days due to injury. Multivariable logistic regression was used to determine ambulance predictors of major injury outcome. There were 168,452 linked ambulance transports analysed. Of the 9,012 T1 protocol activations, 2,443 cases had major injury [positive predictive value (PPV) = 27.1%]. There were 16,823 major injuries in total giving a sensitivity of the T1 protocol of 2,443/16,823 (14.5%), specificity of 145,060/151,629 (95.7%) and a negative predictive value (NPV) of 145,060/159,440 (91%). Overtriage rate associated with T1 protocol was 5,697/9,012 (63.2%) and undertriage rate was 5,509/159,440 (3.5%). The most important predictor of major injury was the activation of more than one trauma protocol by ambulance paramedics. Overall, the T1 was associated with low undertriage and high specificity. The protocol may be improved by considering age and the number of trauma protocols activated by paramedics for any given patient. [ABSTRACT FROM AUTHOR]

Abstract Objective Develop a hydrophobic, degradation-resistant dental restorative based on an O xirane- A crylate IPN Sys tem (OASys) with low shrinkage-stress to substantially extend clinical lifetime. Methods Unfilled OASys blends were prepared using dipenta-erythritol-hexaacrylate (DPHA) and p -cycloaliphatic-diepoxide (EP5000). Varying proportions of camphorquinone/iodonium photoinitiator, with a co-reactant oligomeric-diol, served as the experimental curing system. The effects of oxirane-acrylate ratio on the degree-of-cure (Durometer-D hardness), hydrophobicity (contact angle), mechanical properties (3-point bending), near-infrared FTIR degree-of-conversion (DoC), polymerization shrinkage, and shrinkage stress were determined. 70:30 BisGMA:TEGDMA resin served as control. Results Oxirane tended to decrease hardness and increase hydrophobicity. 0:100, 25:75, 50:50 EP5000:DPHA are harder after 24 h than control. 75:25 and 100:0 EP5000:DPHA increased in hardness over 24 h, but were softer than control. All groups increased in contact angle over 24 h. After 24 h, 50:50, 75:25 and 0:100 EP5000:DPHA were more hydrophobic (∼75–84°) than the control (∼65°). Acrylate DoC was ∼60% across all experimental groups. Initial oxirane conversion varied from ∼42% in 100:0 EP5000:DPHA to ∼82% 75:25 EP5000:DPHA. However, oxirane DoC increased for 100:0 EP5000:DPHA to ∼73° over 24 h, demonstrating dark cure. Moduli and ultimate transverse strengths of OASys groups were higher than for 0:100 EP5000:DPHA, with 50:50 EP5000:DPHA having higher modulus than other experimental groups. However, the control had higher modulus and UTS than all experimental groups. Volumetric shrinkage averaged 7% for experimental groups, but stress decreased dramatically with increasing oxirane content. Significance Hydrophobic, low shrinkage-stress OASys resins are promising for development of composites that improve longevity and reduce the cost of dental care. [ABSTRACT FROM AUTHOR]

Without any doubt, vaccination was the best choice for Coronavirus disease 2019 (COVID-19) pandemic control. According to the American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO), people with cancer or a history of cancer have a higher risk of dying from Covid-19 than ordinary people; hence, they should be considered a high-priority group for vaccination. On the other hand, the effect of the Covid-19 vaccination on cancer is not transparent enough. This study is one of the first in vivo studies that try to show the impact of Sinopharm (S) and AstraZeneca (A) vaccines on breast cancer, the most common cancer among women worldwide. Vaccination was performed with one and two doses of Sinopharm (S1/S2) or AstraZeneca (A1/A2) on the 4T1 triple-negative breast cancer (TNBC) mice model. The tumor size and body weight of mice were monitored every two days. After one month, mice were euthanized, and the existence of Tumor-infiltrating lymphocytes (TILs) and expression of the important markers in the tumor site was assessed. Metastasis in the vital organs was also investigated. Strikingly, all of the vaccinated mice showed a decrease in tumor size and this decrease was highest after two vaccinations. Moreover, we observed more TILs in the tumor after vaccination. Vaccinated mice demonstrated a decrease in the expression of tumor markers (VEGF, Ki-67, MMP-2/9), CD4/CD8 ratio, and metastasis to the vital organs. Our results strongly suggest that COVID-19 vaccinations decrease tumor growth and metastasis. [Display omitted] [ABSTRACT FROM AUTHOR]

Nonlinear shell modeling is always accompanied by simplifying assumptions on some computational parameters. In the latest nonlinear model based on eight parameters, that considers the displacement field as third-order polynomials in all three directions of curvilinear system, rotational inertia and shear deformations are also included; however, nonlinear terms are eliminated from some dependent variables, in addition, curvature and torsion variations of the shell are also assumed linear. In this study, not only all the dependent variables were considered as nonlinear in a different approach, but curvatures and torsion nonlinearities also retained, and a complete and accurate model for thick shells of any shape was presented. The equations of motion of the system have been derived on the basis of Lagrange equations, and cylindrical shells under static and dynamic loads have been studied. In the case of static loading, it was seen, with increasing the shell thickness, the effects of nonlinear curvature and torsion were limited, but have a significant impact on post-buckling behavior of the shell, where noticeable large deformations have occurred. However, their effects in static loading were less than the dynamic case, especially the aftermath of the buckling. It was also observed in dynamic loading, while the nonlinearities of curvature and torsion raised the system frequency content, it also intensifies the vibration amplitude and changes the response style to the dynamic excitation. • Dependent variables are reduced through an analytic solution of nonlinear B.C. equations. • An improved nonlinear model is derived applying two variables asymptotic approximation. • The nonlinearity in the curvature and torsion changes parameters are retained. • Static & dynamic bifurcation analyses are performed by the local parameterization method. • In the dynamic case, a solver code is developed in the MATHEMATICA program. [ABSTRACT FROM AUTHOR]