Synergies between Fibrillated Nanocellulose and Hot-Pressing of Papers Obtained from High-Yield Pulp.

To extend the application of cost-effective high-yield pulps in packaging, strength and barrier properties are improved by advanced-strength additives or by hot-pressing. The aim of this study is to assess the synergic effects between the two approaches by using nanocellulose as a bulk additive, and by hot-pressing technology. Due to the synergic effect, dry strength increases by 118% while individual improvements are 31% by nanocellulose and 92% by hot-pressing. This effect is higher for mechanical fibrillated cellulose. After hot-pressing, all papers retain more than 22% of their dry strength. Hot-pressing greatly increases the paper's ability to withstand compressive forces applied in short periods of time by 84%, with a further 30% increase due to the synergic effect of the fibrillated nanocellulose. Hot-pressing and the fibrillated cellulose greatly decrease air permeability (80% and 68%, respectively) for refining pretreated samples, due to the increased fiber flexibility, which increase up to 90% using the combined effect. The tear index increases with the addition of nanocellulose, but this effect is lost after hot-pressing. In general, fibrillation degree has a small effect which means that low- cost nanocellulose could be used in hot-pressed papers, providing products with a good strength and barrier capacity.

Collaboration to improve ICT solutions. / Samarbeid for bedre IKT-løsninger.

In South-Eastern Norway Regional Health Authority, health workers and technologists have collaborated on improving and simplifying medication management in the maternity wards.

On-Site X-ray Fluorescence Spectrometry Measurement Strategy for Assessing the Sulfonation to Improve Chemimechanical Pulping Processes.

Minimizing the fiber property distribution would have the potential to improve the pulp properties and the process efficiency of chemimechanical pulp. To achieve this, it is essential to improve the level of knowledge of how evenly distributed the sulfonate concentration is between the individual chemimechanical pulp fibers. Due to the variation in quality between pulpwood and sawmill chips, as well as the on-chip screening method, it is difficult to develop an impregnation system that ensures the even distribution of sodium sulfite (Na2SO3) impregnation liquid. It is, therefore, crucial to measure the distribution of sulfonate groups within wood chips and fibers on a microscale. Typically, the degree of unevenness, i.e., the amount of fiber sulfonation and softening prior to defibration, is unknown on a microlevel due to excessively robust or complex processing methods. The degree of sulfonation at the fiber level can be determined by measuring the distribution of elemental sulfur and counterions of sulfonate groups, such as sodium or calcium. A miniaturized energy-dispersive X-ray fluorescence (ED-XRF) method has been developed to address this issue, enabling the analysis of sulfur distributions. It is effective enough to be applied to industrial laboratories for further development, i.e., improved image resolution and measurement time.

Lignin Inter-Diffusion Underlying Improved Mechanical Performance of Hot-Pressed Paper Webs.

Broader use of bio-based fibres in packaging becomes possible when the mechanical properties of fibre materials exceed those of conventional paperboard. Hot-pressing provides an efficient method to improve both the wet and dry strength of lignin-containing paper webs. Here we study varied pressing conditions for webs formed with thermomechanical pulp (TMP). The results are compared against similar data for a wide range of other fibre types. In addition to standard strength and structural measurements, we characterise the induced structural changes with X-ray microtomography and scanning electron microscopy. The wet strength generally increases monotonously up to a very high pressing temperature of 270 °C. The stronger bonding of wet fibres can be explained by the inter-diffusion of lignin macromolecules with an activation energy around 26 kJ mol-1 after lignin softening. The associated exponential acceleration of diffusion with temperature dominates over other factors such as process dynamics or final material density in setting wet strength. The optimum pressing temperature for dry strength is generally lower, around 200 °C, beyond which hemicellulose degradation begins. By varying the solids content prior to hot-pressing for the TMP sheets, the highest wet strength is achieved for the completely dry web, while no strong correlation was observed for the dry strength.

Sustainable Design for the Direct Fabrication and Highly Versatile Functionalization of Nanocelluloses.

This study describes a novel sustainable concept for the scalable direct fabrication and functionalization of nanocellulose from wood pulp with reduced energy consumption. A central concept is the use of metal-free small organic molecules as mediators and catalysts for the production and subsequent versatile surface engineering of the cellulosic nanomaterials via organocatalysis and click chemistry. Here, "organoclick" chemistry enables the selective functionalization of nanocelluloses with different organic molecules as well as the binding of palladium ions or nanoparticles. The nanocellulosic material is also shown to function as a sustainable support for heterogeneous catalysis in modern organic synthesis (e.g., Suzuki cross-coupling transformations in water). The reported strategy not only addresses obstacles and challenges for the future utilization of nanocellulose (e.g., low moisture resistance, the need for green chemistry, and energy-intensive production) but also enables new applications for nanocellulosic materials in different areas.

[Termination of mechanical ventilation in amyotrophic lateral sclerosis]. / Avslutning av respiratorbehandling ved amyotrofisk lateral sklerose.

BACKGROUND: Mechanical ventilation may relieve symptoms and prolong life for patients with amyotrophic lateral sclerosis, but may also prolong suffering. More knowledge is needed on ethical, legal and medical aspects upon termination. MATERIAL AND METHODS: Two cases are discussed in light of relevant laws and literature, as well as the authors' own research and clinical experience. RESULTS: A patient who had first declined life-sustaining treatment eventually chose to undergo tracheostomy. He later approached a locked-in state and wanted to terminate the treatment. Another patient reported poor quality of life and wanted to die, but declined to make a statement on refusal of resuscitation in case of an emergency. He was later resuscitated from CO2 narcosis and received non-invasive ventilation. He repeated that he wanted to die, but did not decide to terminate the ventilator until he was offered palliative treatment. Both patients received morphin and anxiolytics, and died shortly after the ventilator was withdrawn. INTERPRETATION: Mechanical ventilation can be terminated in line with good medical and ethical standards, and will then usually be legal. Patients have a legal right to refuse life-sustaining treatment, but not everybody want to make decisions regarding their own death. Fear of conducting euthanasia may prolong the patient's death process and prevent adequate palliative treatment.

[Organisation of palliative care in and outside hospital]. / Organisering av palliasjon i og utenfor sykehus.

Patients with advanced, incurable disease need easy access to qualified care. Basic palliative care should be provided in all clinical hospital departments and in community care. In addition, palliative care units in hospitals and nursing homes, and ambulatory, multidisciplinary, palliative care teams have a supportive role by providing teaching, advice, and care, also in primary care. The regional palliative care centres in university hospitals are important centres for research, skills building, and developmental work, in addition to the management of the most complex patients. Palliative care requires much collaboration, and the general practitioner has an important role. In addition, hospital-based palliative care teams are important bridges between the different levels of the health care system. The Norwegian Standard for Palliative Care gives recommendations for the organisation of palliative care at all levels, and forms the basis for this article.

Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long-term results.

Despite refinements in surgical technique, including bone grafting and sophisticated prosthetic reconstructions, there are limitations to what can be achieved with bone-anchored fixed prostheses in patients with advanced atrophy of the maxillae. A new approach was suggested by a long-term study on onlay bone grafting and simultaneous placement of a fixture based on a new design: the zygoma fixture, and the aim of this study was to assess its potential. Twenty-eight consecutive patients with severely resorbed edentulous maxillae were included, 13 of whom had previously had multiple fixture surgery in the jawbone that had failed. A total of 52 zygoma fixtures and 106 conventional fixtures were installed. Bone grafting was deemed necessary in 17 patients. All patients have been followed for at least five years, and nine for up to 10 years. All patients were followed up with clinical and radiographic examinations, and in some cases rhinoscopy and sinoscopy as well. Three zygoma fixtures failed; two at the time of connection of the abutment and the third after six years. Of the conventional fixtures placed at the time of the zygoma fixture, 29 (27%) were lost. The overall prosthetic rehabilitation rate was 96% after at least five years of function. There were no signs of inflammatory reaction in the surrounding antral mucosa. Four patients with recurrent sinusitis recovered after inferior meatal antrostomy. To conclude, the zygoma fixture seems to be a valuable addition to our repertoire in the management of the compromised maxilla.

Prospective follow-up study of 95 patients with edentulous mandibles treated according to the Brånemark Novum concept.

BACKGROUND: The long-term predictability reported with the traditional two-staged Brånemark method has led to developments aimed at simplifying the technique and reducing healing time. Results from a pilot study using the Brånemark Novum concept are promising, and it has been shown possible to fabricate and deliver an implant-supported fixed prosthesis to the patient on the day of surgery. PURPOSE: The objective of this study is to report clinical and radiographic outcomes in a group of patients treated according to the Brånemark Novum concept. MATERIALS AND METHODS: Ninety-five patients with edentulous mandibles were consecutively included in the study. Three specially designed fixtures were placed in each patient (285 fixtures in total) using drilling templates. The fixtures were immediately splinted with a prefabricated substructure, and fixed prostheses were delivered the same day in 67% of the patients. For the rest, prosthesis delivery ranged from 1 to 40 days (mean 5.6 d). Clinical and radiographic examinations were performed after 3 months, 6 months, 1 year, and then annually. The follow-up time was 1 to 5 years (mean 2.5 yr). RESULTS: The cumulative prosthesis survival rate was 99%. Eighteen fixtures (6.3%) failed in 13 patients. Kaplan-Meier survival estimates demonstrated a probability implant survival at 1 year of 95.0% (94 patients), at 3 years of 93.3% (47 patients), and at 5 years of 93.3% (9 patients). The mean bone loss was 0.73 mm between the examinations at 3 months and 1 year, 0.16 mm during the second year, and 0.13 mm annually during years 3 to 5. CONCLUSIONS: Comparable results, related to continuous prosthesis stability, were shown for the Novum approach compared with the traditional two-staged procedure. Survival of individual fixtures is lower when immediate loading is applied.

Edentulousness and oral rehabilitation: experiences from the patients' perspective.

The psychological effects of tooth loss in the permanent dentition are relatively unknown. Complete edentulousness is a serious life event in terms of readjustment. The aim of the study was to describe the process patients with deteriorating dental status had gone through before treatment with a fixed prosthesis (Brånemark System, Novum), and to describe what living with a fixed prosthesis means to the patients themselves. In-depth interviews were carried out with 18 patients, and the interviews were transcribed verbatim and analysed in open, axial and selective coding processes according to Grounded Theory. In the analysis, four categories were developed and labelled: 'alterations in self-image', 'becoming a deviating person', 'becoming an uncertain person' and 'becoming the person I once was'. 'Alterations in self-image' was identified as the core category and was related to the other three categories. The core category describes the changes in self-image starting with the subjects' increasingly worsened dental status, followed by a period of them having to live and cope with a denture and, finally, their living with a fixed prosthesis. The motive power for the decision to undergo treatment with a fixed prosthesis seems to be a desire to restore dental status and also to recapture attractiveness, self-esteem and a positive self-image.