Desarrollo, fabricación y caracterización de nuevas estructuras de materiales compuestos tipo sándwich con núcleos derivados de ácido poliláctico, PLA

[ES] El presente trabajo muestra la elaboración de una estructura de material tipo sándwich con núcleos derivados de ácido poliláctico PLA, en el que la geometría óptima para los núcleos a utilizar en las estructuras es de tipo hexagonal, por lo que se hablará de núcleos en forma de panal de abeja. Para llevar a cabo el proceso de desarrollo, fabricación y caracterización se hace un estudio del arte en el cual se toman en cuenta los antecedentes, propuestas, patentes y demás ideas que contribuyen a la ejecución del proyecto. A la vez, se muestra todo un proceso constructivo de un molde de aluminio para la fabricación de los núcleos hexagonales, mediante un proceso de termo-compresión, el cual es una propuesta innovadora para la construcción de materiales con formas determinadas mediante el uso de fibras naturales y materiales termoplásticos. La propuesta de la construcción de núcleos en forma de panal de abeja con material PLA abre muchas líneas de investigación. El objetivo es elaborar materiales alternativos que permitan nuevos desarrollos, y sustituyan ó permitan la reducción de materiales tradicionales que actualmente están generando controversia en el tema de la contaminación. Una vez se cuente con el molde, se procederá a la construcción de las piezas a utilizar en las estructuras, en las que se emplean materiales biodegradables y de procedencia ECO como el PLA, fibras de lino con PLA, no tejidos de PLA y adhesivos elaborados a partir de elementos naturales. En su caracterización se procede a la evaluación de la estructura tipo sándwich, identificando las propiedades mecánicas que presentan los núcleos elaborados a diferentes espesores. También se efectúa un análisis de la propiedad 4D, la cual hace un estudio de memoria de forma de la geometría utilizada en los núcleos de PLA.[EN] The present work shows the elaboration of a structure of sandwich material with nuclei derived from polylactic acid PLA, in which the optimal geometry for the nuclei to be used in the structures is of hexagonal type, for which reason we will speak of nuclei in the form of honeycomb. To carry out the process of development, manufacture and characterization, a study of art is made in which the background, proposals, patents and other ideas that contribute to the execution of the project are taken into account. At the same time, a whole constructive process of an aluminum mold for the manufacture of hexagonal cores is shown, through a process of thermo-compression, which is an innovative proposal for the construction of materials with shapes determined by the use of fibers natural and thermoplastic materials. The proposal for the construction of honeycombed nuclei with PLA material opens many lines of research. The objective is to develop alternative materials that allow new developments, and replace or allow the reduction of traditional materials that are currently generating controversy in the issue of pollution. Once the mold is available, we will proceed to the construction of the pieces to be used in the structures, in which biodegradable materials of ECO origin are used, such as PLA, flax fibers with PLA, non-woven PLA and elaborated adhesives from natural elements. In its characterization we proceed to the evaluation of the sandwich structure, identifying the mechanical properties of the cores produced at different thicknesses. An analysis of the 4D property is also carried out, which makes a shape memory study of the geometry used in the PLA cores.[CA] En el present treball es pot visualitzar l'elaboració d'una estructura de material tipus sandvitx amb nuclis derivats d'àcid polilàctic PLA, en què la geometria òptima per als nuclis a utilitzar en les estructures és de tipus hexagonal, de manera que es parlés de nuclis en forma de bresca d'abella. Per dur a terme el procés de desenvolupament, fabricació i caracterització es fa un estudi de l'art en el qual es té en compte els antecedents, propostes, patents i altres idees que contribueixen a l'execució del projecte. Alhora, es mostra tot un procés constructiu d'un motlle d'alumini per a la fabricació dels nuclis hexagonals, mitjançant un procés de termo-compressió, el qual és una proposta innovadora per a la construcció de materials amb formes determinades mitjançant l'ús de fibres naturals i materials termoplàstics. La proposta de la construcció de nuclis en forma de bresca d'abella amb material PLA obre moltes línies d'investigació. L'objectiu és elaborar materials alternatius que permetin nous desenvolupament, i substitueixin, o permetin la reducció, de materials tradicionals que actualment estan generant controvèrsia en el tema de la contaminació. Un cop es compti amb el motlle, es procedirà a la construcció de les peces a utilitzar en les estructures, en el qual es fan servir materials biodegradables i de procedència ECO, com el PLA, fibres de lli amb PLA, no teixits de PLA i adhesius elaborats a partir elements naturals. En la seva caracterització es procedeix a l'avaluació de l'estructura tipus sandvitx, identificant les propietats mecàniques que presenten els nuclis elaborats a diferents gruixos. També es fa una anàlisi de la propietat 4D, la qual fa un estudi de memòria de forma de la geometria utilitzada en els nuclis de PLA.Guillén Pineda, RM. (2018). Desarrollo, fabricación y caracterización de nuevas estructuras de materiales compuestos tipo sándwich con núcleos derivados de ácido poliláctico, PLA. Universitat Politècnica de València. http://hdl.handle.net/10251/164454TFG

From freeze-dried precursors to microwave sintered Al2O3-ZrO2 composites

[EN] Homogeneous Al2O3-Zr0.91Y0.09O1.955 (65-35 mol%) nanopowders have been prepared in a wide temperature range (from 1073 to 1573 K) by thermal decomposition of amorphous precursors, made previously by freeze-drying of appropriate solutions in air Electron microscopy images show that, whereas at low temperatures (973 K) pseudo-spherical particles constituted of Al2O3 and Zr0.91Y0.09O1.955 grains are observed (similar to 38nm), at high temperatures (1573 K) a homogeneous dispersion of nanocrystalline ZrO2-based grains (similar to 186 nm) is dispersed in the sintered Al2O3 matrix. The comparison between phase and microstructure evolution in these samples clearly indicates that the disorder at the atomic scale in the precursor makes the attainment of higher temperatures necessary for nucleation and growth of both phases. Finally, a selected material was sintered in a mono-mode microwave device at 2.45 GHz in air at 1573 and 1673 K. This fast-microwave technology allows fabrication of composites with high densities (similar to 99% TD) and excellent mechanical properties, such as hardness and Young's modulus reaching 25.6 GPa and 358 GPa, respectively.The authors would like to thank to the Generalitat Valenciana for financial support received for the project PROMETEO/2016/040 and Santiago Grisolia program scholarship (GRISOLIAP/2018/168). A. Borrell acknowledges the Spanish Ministry of Economy and Competitiveness for her RyC contract (RYC-2016-20915).Borrell Tomás, MA.; Gil-Flores, L.; Guillén-Pineda, RM.; Salvador Moya, MD. (2019). From freeze-dried precursors to microwave sintered Al2O3-ZrO2 composites. Processing and Application of Ceramics. 13(2):157-163. https://doi.org/10.2298/PAC1902157BS15716313

Manufacturing and Characterization of Highly Environmentally Friendly Sandwich Composites from Polylactide Cores and Flax-Polylactide Faces

[EN] This work focuses on the manufacturing and characterization of highly environmentally friendly lightweight sandwich structures based on polylactide (PLA) honeycomb cores and PLA-flax fabric laminate skins or facings. PLA honeycombs were manufactured using PLA sheets with different thicknesses ranging from 50 to 500 mu m. The PLA sheets were shaped into semi-hexagonal profiles by hot-compression molding. After this stage, the different semi-hexagonal sheets were bonded together to give hexagonal panels. The skins were manufactured by hot-compression molding by stacking two Biotex flax/PLA fabrics with 40 wt% PLA fibers. The combined use of temperature (200 degrees C), pressure, and time (2 min) allowed PLA fibers to melt, flow, and fully embed the flax fabrics, thus leading to thin composite laminates to be used as skins. Sandwich structures were finally obtained by bonding the PLA honeycomb core with the PLA-flax skins using an epoxy adhesive. A thin PLA nonwoven was previously attached to the external hexagonal PLA core, to promote mechanical interlock between the core and the skins. The influence of the honeycomb core thickness on the final flexural and compression properties was analyzed. The obtained results indicate that the core thickness has a great influence on the flexural properties, which increases with core thickness; nevertheless, as expected, the bonding between the PLA honeycomb core and the skins is critical. Excellent results have been obtained with 10 and 20 mm thickness honeycombs with a core shear of about 0.60 and facing bending stresses of 31-33 MPa, which can be considered as candidates for technical applications. The ultimate load to the sample weight ratio reached values of 141.5 N center dot g(-1) for composites with 20 mm thick PLA honeycombs, which is comparable to other technical composite sandwich structures. The bonding between the core and the skins is critical as poor adhesion does not allow load transfer and, while the procedure showed in this research gives interesting results, new developments are necessary to obtain standard properties on sandwich structures.This research work was funded by the Spanish Ministry of Science and Innovation (MICI) project number MAT2017-84909-C2-2-R.Lascano-Aimacaña, DS.; Guillén-Pineda, RM.; Quiles-Carrillo, L.; Ivorra-Martínez, J.; Balart, R.; Montanes, N.; Boronat, T. (2021). Manufacturing and Characterization of Highly Environmentally Friendly Sandwich Composites from Polylactide Cores and Flax-Polylactide Faces. Polymers. 13(3):1-13. https://doi.org/10.3390/polym13030342S11313

Comparison in mechanical properties of zirconium titanate (ZrTiO4) synthetized by alternative routes and sintered by microwave (MW)

[EN] At present, ZrTiO4 nanopowders are used as a dielectric in the electroceramic field, applications of catalysis, microwave telecommunications devices, pigments, composites, etc. One of the most interesting applications is the potential as structural material and similar applications that require a high thermal resistance. However, all the properties of zirconium titanate are still a subject of interest for the industrial field.12 There are several routes of synthesis of ZrTiO4; among them is the sol-gel method and lyophilization. These methods have been used to make powders or small pieces of zirconium titanate. However, structural applications require materials in large quantities, so it is necessary to identify the differences between the methods of synthesizing and allowing the preparation of powders suitable for the generation of green materials for subsequent sintering.3 To develop a new generation of nanomaterials with microstructural differences it is necessary to innovate in the sintering process. Years ago, the use of conventional oven for sintering material was the usual procedure. Nowadays, non-conventional methods as Microwave sintering (MW) are a bright way to produce high dense materials, using heating rates in reduce dwell times and lower consumption using 70%-80% less energy. 4 This reactive sintering technique achieves excellent mechanical properties, homogeneous microstructure employing lower sintering temperatures. All these energy and economic advantages generate a new vision for the future on ceramic materials and their industrial production. The main objective of this study is to make a comparison of the mechanical properties of the materials synthesized by sol-gel method and lyophilization and sintered by microwaves.The authors would like to thank to the Generalitat Valenciana for financial support received for Santiago Grisolía program scholarship (GRISOLIAP/2018/168). A. Borrell acknowledges the Spanish Ministry of Economy and Competitiveness for her RyC contract (RYC-2016-20915).Guillén Pineda, RM.; Borrell Tomás, MA.; Salvador Moya, MD.; Peñaranda Foix, FL.; Moreno, R. (2019). Comparison in mechanical properties of zirconium titanate (ZrTiO4) synthetized by alternative routes and sintered by microwave (MW). En AMPERE 2019. 17th International Conference on Microwave and High Frequency Heating. Editorial Universitat Politècnica de València. 433-438. https://doi.org/10.4995/AMPERE2019.2019.9892OCS43343

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Desarrollo de materiales cerámicos base circona sinterizados mediante técnicas rápidas no convencionales

[ES] Los avances tecnológicos se encuentran, en algunas ocasiones, limitados debido a la imposibilidad de combinar las excelentes prestaciones de los materiales conocidos con algunas funcionalidades críticas necesarias para desarrollar nuevas aplicaciones tecnológicas. Estos nuevos materiales con un diseño a la carta resultan extremadamente interesantes ya que permiten combinar propiedades y funcionalidades actualmente inalcanzables. La circona, u oxido de zirconio (ZrO2), es un sólido cristalino blanco con enlaces iónicos altamente estables que es principalmente obtenido en forma de polvo para aplicaciones tecnológicas. Debido a sus propiedades física y químicas, la circona es un material cerámico que posee una serie de características excepcionales, que incluyen una dureza, tenacidad y fractura relativamente altas en comparación con otros materiales cerámicos, bajo coeficiente de fricción y alto punto de fusión. Además, es un material relativamente no reactivo cuando se expone a ambientes húmedos y corrosivos en comparación con otros materiales como metales y polímeros, con buena resistencia a altas temperaturas y abrasión. Todas estas propiedades posicionan a la circona como un material muy versátil con un amplio espectro de aplicaciones que abarca intercambiadores de calor, celdas de combustible, componentes de turbinas para sistemas aeronáuticos y generación de electricidad, así como para medicina, odontología y otras aplicaciones. El propósito de esta tesis doctoral es la obtención de materiales base circona que puedan ser empleados en la fabricación de nuevos composites con funcionalidades a la carta en sectores tecnológicos como el transporte, energía, medicina, etc. Para ello se utilizarán técnicas de sinterización no-convencionales: Microondas (MW) y Spark Plasma Sintering (SPS). Para este trabajo se plantea el estudio de distintos composites base circona: circona reforzada con óxido de niobio (Nb2O5), Titania (TiO2) y composites de circona reforzados con manganita de lantano dopada con estroncio (LSM). El resultado final de esta investigación permitirá determinar si las técnicas rápidas de sinterización no-convencional, permiten mejoran las propiedades mecánicas, eléctricas y magnéticas de los materiales obtenidos en comparación con la sinterización por métodos convencionales.[CA] Els avenços tecnològics són, en algunes ocasions, limitats per la impossibilitat de combinar l'excel·lent comportament dels materials coneguts amb algunes funcionalitats crítiques necessàries per desenvolupar noves aplicacions tecnològiques. Aquests nous materials amb disseny a la carta resulten summament interessants ja que permeten combinar propietats i funcionalitats actualment inabastables. La circonia, o òxid de zirconi (ZrO2), és un sòlid cristal·lí blanc amb enllaços iònics altament estables que s'obté principalment en forma de pols per a aplicacions tecnològiques. A causa de les seves propietats físiques i químiques, la zircònia és un material ceràmic que posseeix una sèrie de característiques excepcionals, que inclouen duresa, tenacitat i fractura relativament altes en comparació amb altres materials ceràmics, baix coeficient de fricció i alt punt de fusió. A més, és un material relativament no reactiu quan s'exposa a ambients humits i corrosius en comparació amb altres materials com metalls i polímers, amb bona resistència a altes temperatures i abrasió. Totes aquestes propietats posicionen a la zircònia com un material molt versàtil amb un ampli espectre d'aplicacions que inclou intercanviadors de calor, piles de combustible, components de turbines per a sistemes aeronàutics i generació d'electricitat, així com per a medicina, odontologia i altres aplicacions. L'objectiu d'aquesta tesi doctoral és l'obtenció de materials base de zircònia que puguin ser utilitzats en la fabricació de nous compòsits amb funcionalitats sota demanda en sectors tecnològics com transport, energia, medicina, etc. Per a això, s'utilitzaran tècniques de sinterització no convencionals utilitzat: microones (MW) i sinterització per plasma d'espurna (SPS) Per a aquest treball es proposa l'estudi de diferents composites a força de zircònia: zircònia reforçada amb òxid de niobi (Nb2O5), titanat (TiO2) i composites de zircònia reforçats amb manganita de lantani dopat amb estronci (LSM). El resultat final d'aquesta investigació permetrà determinar si les tècniques de sinterització ràpida no convencional permeten millorar les propietats mecàniques, elèctriques i magnètiques dels materials obtinguts en comparació amb la sinterització per mètodes convencionals.[EN] Technological advances are, on some occasions, limited due to the impossibility of combining the excellent performance of known materials with some critical functionalities necessary to develop new technological applications. These new materials of great design are extremely interesting since they allow combining properties and functionalities currently unattainable. Zirconia, or zirconium oxide (ZrO2), is a white crystalline solid with highly stable ionic bonds that is mainly obtained in powder form for technological applications. Due to its physical and chemical properties, zirconia is a ceramic material that possesses several exceptional characteristics, including relatively high hardness, toughness and fracture compared to other ceramic materials, low coefficient of friction, and high melting point. Furthermore, it is a relatively non-reactive material when exposed to humid and corrosive environments compared to other materials such as metals and polymers, with good resistance to high temperatures and abrasion. All these properties position zirconia as a very versatile material with a wide spectrum of applications that includes heat exchangers, fuel cells, turbine components for aeronautical systems and electricity generation, as well as for medicine, dentistry, and other applications. The purpose of this doctoral thesis is to obtain zirconia base materials that can be used in the manufacture of new composites with on-demand functionalities in technological sectors such as transport, energy, medicine, etc. For this, non-conventional sintering techniques will be used: Microwaves (MW) and Spark Plasma Sintering (SPS) For this work, the study of different zirconia-based composites is proposed: zirconia reinforced with niobium oxide (Nb2O5), titania (TiO2) and zirconia composites reinforced with strontium-doped lanthanum manganite (LSM). The result of this research will make it possible to determine whether rapid non-conventional sintering techniques allow the mechanical, electrical, and magnetic properties of the materials obtained to be improved compared to sintering by conventional methods.El autor agradece a la Generalitat Valenciana por la ayuda económica recibida para la beca del programa Santiago Grisolía (GRISOLIAP/2018/168)Guillén Pineda, RM. (2021). Desarrollo de materiales cerámicos base circona sinterizados mediante técnicas rápidas no convencionales [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/180231TESI

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat