3D printing in COVID-19: Productivity estimation of the most promising open source solutions in emergency situations

Copyright © 2020 by the authors. The COVID-19 pandemic has caused a surge of demand for medical supplies and spare parts, which has put pressure on the manufacturing sector. As a result, 3D printing communities and companies are currently operating to ease the breakdown in the medical supply chain. If no parts are available, 3D printing can potentially be used to produce time-critical parts on demand such as nasal swabs, face shields, respirators, and spares for ventilators. A structured search using online sources and feedback from key experts in the 3D printing area was applied to highlight critical issues and to suggest potential solutions. The prescribed outcomes were estimated in terms of cost and productivity at a small and large scale. This study analyzes the number and costs of parts that can be manufactured with a single machine within 24 h. It extrapolates this potential with the number of identical 3D printers in the world to estimate the global potential that can help practitioners, frontline workers, and those most vulnerable during the pandemic. It also proposes alternative 3D printing processes and materials that can be applicable. This new unregulated supply chain has also opened new questions concerning medical certification and Intellectual property rights (IPR). There is also a pressing need to develop new standards for 3D printing of medical parts for the current pandemic, and to ensure better national resilience.Academy of Finland, grant number 325509, in the frame of project Directdigital manufacturing in health care production and operations (DiDiMinH)

A comparative study of four intensive care outcome prediction models in cardiac surgery patients

<p>Abstract</p> <p>Background</p> <p>Outcome prediction scoring systems are increasingly used in intensive care medicine, but most were not developed for use in cardiac surgery patients. We compared the performance of four intensive care outcome prediction scoring systems (Acute Physiology and Chronic Health Evaluation II [APACHE II], Simplified Acute Physiology Score II [SAPS II], Sequential Organ Failure Assessment [SOFA], and Cardiac Surgery Score [CASUS]) in patients after open heart surgery.</p> <p>Methods</p> <p>We prospectively included all consecutive adult patients who underwent open heart surgery and were admitted to the intensive care unit (ICU) between January 1^st2007 and December 31^st2008. Scores were calculated daily from ICU admission until discharge. The outcome measure was ICU mortality. The performance of the four scores was assessed by calibration and discrimination statistics. Derived variables (Mean- and Max- scores) were also evaluated.</p> <p>Results</p> <p>During the study period, 2801 patients (29.6% female) were included. Mean age was 66.9 ± 10.7 years and the ICU mortality rate was 5.2%. Calibration tests for SOFA and CASUS were reliable throughout (p-value not < 0.05), but there were significant differences between predicted and observed outcome for SAPS II (days 1, 2, 3 and 5) and APACHE II (days 2 and 3). CASUS, and its mean- and maximum-derivatives, discriminated better between survivors and non-survivors than the other scores throughout the study (area under curve ≥ 0.90). In order of best discrimination, CASUS was followed by SOFA, then SAPS II, and finally APACHE II. SAPS II and APACHE II derivatives had discrimination results that were superior to those of the SOFA derivatives.</p> <p>Conclusions</p> <p>CASUS and SOFA are reliable ICU mortality risk stratification models for cardiac surgery patients. SAPS II and APACHE II did not perform well in terms of calibration and discrimination statistics.</p

Evidence for quark-matter cores in massive neutron stars

The theory governing the strong nuclear force-quantum chromodynamics-predicts that at sufficiently high energy densities, hadronic nuclear matter undergoes a deconfinement transition to a new phase of quarks and gluons(1). Although this has been observed in ultrarelativistic heavy-ion collisions(2,3), it is currently an open question whether quark matter exists inside neutron stars(4). By combining astrophysical observations and theoretical ab initio calculations in a model-independent way, we find that the inferred properties of matter in the cores of neutron stars with mass corresponding to 1.4 solar masses (M-circle dot) are compatible with nuclear model calculations. However, the matter in the interior of maximally massive stable neutron stars exhibits characteristics of the deconfined phase, which we interpret as evidence for the presence of quark-matter cores. For the heaviest reliably observed neutron stars(5,6) with mass M approximate to 2M(circle dot), the presence of quark matter is found to be linked to the behaviour of the speed of sound c(s) in strongly interacting matter. If the conformal bound cs2Peer reviewe

Community Willingness to Participate in a Dengue Study in Aceh Province, Indonesia

Background: Dengue virus infection is the most rapidly spreading vector-borne disease in the world. Essential research on dengue virus transmission and its prevention requires community participation. Therefore, it is crucial to understand the factors that are associated with the willingness of communities in high prevalence areas to participate in dengue research. The aim of this study was to explore factors associated with the willingness of healthy community members in Aceh province, Indonesia, to participate in dengue research that would require phlebotomy. Methodology/Principal Findings: A community-based cross-sectional study was carried out in nine regencies and municipalities of Aceh from November 2014 to March 2015. Interviews using a set of validated questionnaires were conducted to collect data on demography, history of dengue infection, socioeconomic status, and knowledge, attitude and practice regarding dengue fever. Two-step logistic regression and Spearman's rank correlation (rs) analysis were used to assess the influence of independent variables on dependent variables. Among 535 participants, less than 20% had a good willingness to participate in the dengue study. The factors associated with good willingness to participate were being female, working as a civil servant, private employee or entrepreneur, having a high socioeconomic status and good knowledge, attitude and practice regarding dengue. Good knowledge and attitude regarding dengue were positive independent predictors of willingness to participate (OR: 2.30 [95% CI: 1.36-3.90] and 3.73 [95% CI: 2.24-6.21], respectively). Conclusion/Significance: The willingness to participate in dengue research is very low among community members in Aceh, and the two most important associated factors are knowledge and attitude regarding dengue. To increase participation rate, efforts to improve the knowledge and attitude of community members regarding dengue fever and dengue-related research is required before such studies are launched