Designing sustainable medical devices

Stakeholders in the medical device manufacturing industry are becoming more concerned about the environmental impact of their products and processes. The consumers are also becoming more aware of the negative impact that manufacturers can have on the environment. Government initiatives continue to increase environmental awareness through the development of new policy and legislation, encouraging industry to become more accountable for the environmental impact of their products and operations. The ISO 14001 standard, Environmental Management Systems-Requirements with Guidance for Use, sets guidelines to enable businesses to recognize the environmental effects of their products and processes. Departments can use the tool to set targets to lower the environmental impact and identify areas of high environmental concern when designing, purchasing, and marketing products. Research in these areas will be used to develop the environmental scoring tool to aid in the design of future sustainable medical devices

Local anesthetic infiltration vs. nervous blocks in face’s skin lesions: what’s new

Skin tumors are the most common type of cancer. They are localized throughout the body, more frequently in those regions chronically exposed to sun, like face, scalp and neck, compromising aesthetic appearance. The optimization of day hospital surgical procedures is mandatory, to avoid erroneous indications, insufficient intra operative comfort and prolonged recovery. New guidelines should be discussed and shared. Patients were divided in two groups: i. Group A of 50 patients, 21 male and 29 female, age 65 ±9, ASA I – III (10/19/21), weight 68±11 kg, height 160±8, with anesthetic Local Infiltration (LI); ii. Group B of 50 patients, 16 male, 34 female, age 68 ±10, ASA I – III (9/22/19), weight 64 ± 9 kg, height 158 ±11, with nerve block (NB). The purpose of our study is to evaluate the analgesia level, compliance and complication rate after LI or selective NB with alkalinised mepivacaine cloridrate 2%, Guardant®. Demographic data, ASA physical stauts, size of lesions, surgery, anesthesia durations and volume of LA injected were analyzed. Fisher’s exact test and Student’s t test were used; P ≤ 0.05 was considered statistically significant. No differences in age (65 ± 9 vs 68 ± 10 years), weight (68 ± 11 vs 64 ± 9), height (160 ± 8 vs 158 ± 11 cm), size of lesion (23 ± 11 vs 25 ± 14 mm), duration of surgery (47 ± 18 vs 51 ± 23 minutes) were detected in two groups (p > 0.05). Both anesthetic techniques ensured good analgesia, but only nerve’s blocks were be able to determine satisfactory intra operative patient’s comfort, a bloodless wound and weak risk for nervous lesions and toxic reaction to local anesthetic

Alternative acceptor materials for organic photovoltaic cells

Synthesis and spectroscopic characterization of perylene derivatives (perylene monoimides and diimides) are reported. The aim of the present work is to investigate the synthesis of these compounds in detail in order to highlight the crucial factors for obtaining a specific class of molecules. The final compounds of the synthetic pathway would be able to mimic the peculiar properties of fullerene derivatives, up to now the best candidates as accepting materials

Contraceptive use and sexual function: a comparison of Italian female medical students and women attending family planning services

Objectives: The aims of the study were to understand how education relates to contraceptive choice and how sexual function can vary in relation to the use of a contraceptive method. Methods: We surveyed female medical students and women attending a family planning service (FPS) in Italy. Participants completed an online questionnaire which asked for information on sociodemographics, lifestyle, sexuality and contraceptive use and also included items of the Female Sexual Function Index (FSFI). Results: The questionnaire was completed by 413 women (362 students and 51 women attending the FPS) between the ages of 18 and 30 years. FSFI scores revealed a lower risk of sexual dysfunction among women in the control group who did not use oral hormonal contraception. The differences in FSFI total scores between the two study groups, when subdivided by the primary contraceptive method used, was statistically significant (p < 0.005). Women using the vaginal ring had the lowest risk of sexual dysfunction, compared with all other women, and had a positive sexual function profile. In particular, the highest FSFI domain scores were lubrication, orgasm and satisfaction, also among the control group. Expensive contraception, such as long-acting reversible contraception, was not preferred by this young population, even though such methods are more contemporary and manageable. Compared with controls, students had lower compliance with contraception and a negative attitude towards voluntary termination of pregnancy. Conclusion: Despite their scientific knowledge, Italian female medical students were found to need sexual and contraceptive assistance. A woman's sexual function responds to her awareness of her body and varies in relation to how she is guided in her contraceptive choice. Contraceptive counselling is an excellent means to improve female sexuality

Pilot study and evaluation of a SMMR-derived sea ice data base

Data derived from the Nimbus 7 scanning multichannel microwave radiometer (SMMR) are discussed and the types of problems users have with satellite data are documented. The development of software for assessing the SMMR data is mentioned. Two case studies were conducted to verify the SMMR-derived sea ice concentrations and multi-year ice fractions. The results of a survey of potential users of SMMR data are presented, along with SMMR-derived sea ice concentration and multiyear ice fraction maps. The interaction of the Arctic atmosphere with the ice was studied using the Nimbus 7 SMMR. In addition, the characteristics of ice in the Arctic ocean were determined from SMMR data

The role of ephemeris and GPSs distribution in high resolution satellite images modeling.

The geometric resolution of the images coming from the new generation satellites is almost competitive with that found in the traditional aerial photograms. The aim of this work is to define the role of satellite ephemerides and to optimise the number andvdistribution of Ground Control Points (GCPs) for the image registration. A zone of the Campania region in Italy has been used as a test area: it is characterized by a mountainous area without constructions and by flat land areas densely inhabited. The images that have been used relate to different epochs and different satellites such as Spot5, Ikonos2 and QuickBird. Spot5 images have also been used to generate automatic Digital Elevation Models (DEMs). The assessment of DEM precision has been carried out by comparison with raster DEMs from cartography. The GCPs coordinates have been obtained from a GPS network made up of almost hundred and some of them are used as Check Points (CPs). Different tests have been performed, either varying the number of GCPs or hypothesizing the presence or absence of satellite ephemeris. Some numerical evaluations confirm that the use of the satellite ephemeris greatly reduces the amount of residuals on the CPs; in the case of Spot5 images this improvement becomes even more evident

Systemic approach to the management of infrastructure safety: Organizational items

This study deals with the organizational items within a systemic approach finalized to make the safety management of road infrastructures more sustainable at a scale of territory. In fact, the infrastructure safety is a very relevant topic in many states with structural systems built some decades ago. Beyond the inherent structural problems, other items are worthy to be investigated, such as, social, economic and organizational aspects. With this aim, the study describes a systemic approach finalized to make all the public and private stakeholders active actors in the management process by improving the organizational items: interaction and mode of governance. In detail, regarding a case study in an Italian region, the authors propose to take on the satellite-based information to investigate the structural safety problems of the infrastructures at a scale of territory. Along this issue, risk or alert maps are properly defined. Successively, useful suggestions are discussed with the focus to increase the interactions between the different actors for a better management of the safety. The recommendations are able to improve the governance mode and decision process with a more all-inclusive level of organization

Transepithelial Corneal Cross-Linking With Vitamin E-Enhanced Riboflavin Solution and Abbreviated, Low-Dose UV-A: 24-Month Clinical Outcomes

Purpose: To report the clinical outcomes with 24-month follow-up of transepithelial cross-linking using a combination of a D-alpha-tocopheryl polyethylene-glycol 1000 succinate (vitamin E-TPGS)-enhanced riboflavin solution and abbreviated low fluence UV-A treatment. Methods: In a nonrandomized clinical trial, 25 corneas of 19 patients with topographically proven, progressive, mild to moderate keratoconus over the previous 6 months were cross-linked, and all patients were examined at 1, 3, 6, 12, and 24 months. The treatments were performed using a patented solution of riboflavin and vitamin E-TPGS, topically applied for 15 minutes, followed by two 5-minute UV-A treatments with separate doses both at fluence below 3 mW/cm2 that were based on preoperative central pachymetry. Results: During the 6-month pretreatment observation, the average Kmax increased by +1.99 +/- 0.29 D (diopter). Postoperatively, the average Kmax decreased, changing by -0.55 +/- 0.94 D, by -0.88 +/- 1.02 D and by -1.01 +/- 1.22 D at 6, 12, and 24 months. Postoperatively, Kmax decreased in 19, 20, and 20 of the 25 eyes at 6 months, 12 months, and 24 months, respectively. Refractive cylinder was decreased by 3 months postoperatively and afterward, changing by -1.35 +/- 0.69 D at 24 months. Best spectacle-corrected visual acuity (BSCVA) improved at 6, 12, and 24 months, including an improvement of -0.19 +/- 0.13 logarithm of the minimum angle of resolution units at 24 months. There was no reduction in endothelial cell count. No corneal abrasions occurred, and no bandage contact lenses or prescription analgesics were used during postoperative recovery. Conclusions: Transepithelial cross-linking using the riboflavin-vitamin E solution and brief, low-dose, pachymetry-dependent UV-A treatment safely stopped keratoconus progression

Customized Corneal Cross-Linking-A Mathematical Model

Purpose: To improve the safety, reproducibility, and depth of effect of corneal cross-linking with the ultraviolet A (UV-A) exposure time and fluence customized according to the corneal thickness. Methods: Twelve human corneas were used for the experimental protocol. They were soaked using a transepithelial (EPI-ON) technique using riboflavin with the permeation enhancer vitamin E-tocopheryl polyethylene glycol succinate. The corneas were then placed on microscope slides and irradiated at 3 mW/cm2 for 30 minutes. The UV-A output parameters were measured to build a new equation describing the time-dependent loss of endothelial protection induced by riboflavin during cross-linking, as well as a pachymetry-dependent and exposure time-dependent prescription for input UV-A fluence. The proposed equation was used to establish graphs prescribing the maximum UV-A fluence input versus exposure time that always maintains corneal endothelium exposure below toxicity limits. Results: Analysis modifying the Lambert-Beer law for riboflavin oxidation leads to graphs of the maximum safe level of UV-A radiation fluence versus the time applied and thickness of the treated cornea. These graphs prescribe UV-A fluence levels below 1.8 mW/cm2 for corneas of thickness 540 [mu]m down to 1.2 mW/cm2 for corneas of thickness 350 [mu]m. Irradiation times are typically below 15 minutes. Conclusions: The experimental and mathematical analyses establish the basis for graphs that prescribe maximum safe fluence and UV-A exposure time for corneas of different thicknesses. Because this clinically tested protocol specifies a corneal surface clear of shielding riboflavin on the corneal surface during UV-A irradiation, it allows for shorter UV-A irradiation time and lower fluence than in the Dresden protocol

Secondary Sex Ratio among Women Exposed to Diethylstilbestrol in Utero

BACKGROUND. Diethylstilbestrol (DES), a synthetic estrogen widely prescribed to pregnant women during the mid-1900s, is a potent endocrine disruptor. Previous studies have suggested an association between endocrine-disrupting compounds and secondary sex ratio. METHODS. Data were provided by women participating in the National Cancer Institute (NCI) DES Combined Cohort Study. We used generalized estimating equations to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the relation of in utero DES exposure to sex ratio (proportion of male births). Models were adjusted for maternal age, child's birth year, parity, and cohort, and accounted for clustering among women with multiple pregnancies. RESULTS. The OR for having a male birth comparing DES-exposed to unexposed women was 1.05 (95% CI, 0.95-1.17). For exposed women with complete data on cumulative DES dose and timing (33%), those first exposed to DES earlier in gestation and to higher doses had the highest odds of having a male birth. The ORs were 0.91 (95% C, 0.65-1.27) for first exposure at ≥ 13 weeks gestation to < 5 g DES; 0.95 (95% CI, 0.71-1.27) for first exposure at ≥ 13 weeks to ≥ 5 g; 1.16 (95% CI, 0.96-1.41) for first exposure at < 13 weeks to < 5 g; and 1.24 (95% CI, 1.04-1.48) for first exposure at < 13 weeks to ≥ 5 g compared with no exposure. Results did not vary appreciably by maternal age, parity, cohort, or infertility history. CONCLUSIONS. Overall, no association was observed between in utero DES exposure and secondary sex ratio, but a significant increase in the proportion of male births was found among women first exposed to DES earlier in gestation and to a higher cumulative dose.National Cancer Institute (N01-CP-21168, N01-CP-51017, N01-CP-01289