Exploring the Limits of High-Tg Epoxy Vitrimers Produced through Resin-Transfer Molding.

Over the past few years, scientists have developed new ways to overcome the recycling issues of conventional thermosets with the introduction of associative covalent adaptable networks (i.e., vitrimers) in polymer materials. Even though various end-use vitrimers have already been reported, just a few of them have targeted high-performance industrial applications. Herein, we develop a promising high-performance epoxy vitrimer based on a commercially available resin widely used in aeronautics with the highest glass transition temperature (Tg) of 233 °C ever reported for a vitrimer. A complete study of its physicochemical properties and cure kinetics was conducted, enabling the construction of the first time-temperature-transformation (TTT) diagram reported in the literature. This diagram allows a full determination of the processing and curing parameters leading to the manufacturing of vitrimer samples by the resin-transfer molding (RTM) process. The reshapability and limits therefrom of this high-Tg vitrimer were evaluated by three successful thermoforming cycles without degradation.

Be careful with triage in emergency departments: interobserver agreement on 1,578 patients in France.

BACKGROUND: For several decades, emergency departments (EDs) utilization has increased, inducing ED overcrowding in many countries. This phenomenon is related partly to an excessive number of nonurgent patients. To resolve ED overcrowding and to decrease nonurgent visits, the most common solution has been to triage the ED patients to identify potentially nonurgent patients, i.e. which could have been dealt with by general practitioner. The objective of this study was to measure agreement among ED health professionals on the urgency of an ED visit, and to determine if the level of agreement is consistent among different sub-groups based on following explicit criteria: age, medical status, type of referral to the ED, investigations performed in the ED, and the discharge from the ED. METHODS: We conducted a multicentric cross-sectional study to compare agreement between nurses and physicians on categorization of ED visits into urgent or nonurgent. Subgroups stratified by criteria characterizing the ED visit were analyzed in relation to the outcome of the visit. RESULTS: Of 1,928 ED patients, 350 were excluded because data were lacking. The overall nurse-physician agreement on categorization was moderate (kappa = 0.43). The levels of agreement within all subgroups were variable and low. The highest agreement concerned three subgroups of complaints: cranial injury (kappa = 0.61), gynaecological (kappa = 0.66) and toxicology complaints (kappa = 1.00). The lowest agreement concerned two subgroups: urinary-nephrology (kappa = 0.09) and hospitalization (kappa = 0.20). When categorization of ED visits into urgent or nonurgent cases was compared to hospitalization, ED physicians had higher sensitivity and specificity than nurses (respectively 94.9% versus 89.5%, and 43.1% versus 30.9%). CONCLUSIONS: The lack of physician-nurse agreement and the inability to predict hospitalization have important implications for patient safety. When urgency screening is used to determine treatment priority, disagreement might not matter because all patients in the ED are seen and treated. But using assessments as the basis for refusal of care to potential nonurgent patients raises legal, ethical, and safety issues. Managed care organizations should be cautious when applying such criteria to restrict access to EDs.

Management and prognosis of status epilepticus according to hospital setting: a prospective study.

BACKGROUND: The treatment of status epilepticus (SE) is based on relatively little evidence although several guidelines have been published. A recent study reported a worse SE prognosis in a large urban setting as compared to a peripheral hospital, postulating better management in the latter. The aim of this study was to analyse SE episodes occurring in different settings and address possible explanatory variables regarding outcome, including treatment quality. METHODS: Over six months we prospectively recorded consecutive adults with SE (fit lasting five or more minutes) at the Centre Hospitalier Universitaire Vaudois (CHUV) and in six peripheral hospitals (PH) in the same region. Demographical, historical and clinical variables were collected, including SE severity estimation (STESS score) and adherence to Swiss SE treatment guidelines. Outcome at discharge was categorised as "good" (return to baseline), or "poor" (persistent neurological sequelae or death). RESULTS: Of 54 patients (CHUV: 36; PH 18), 33% had a poor outcome. Whilst age, SE severity, percentage of SE episodes lasting less than 30 minutes and total SE duration were similar, fewer patients had a good outcome at the CHUV (61% vs 83%; OR 3.57; 95% CI 0.8-22.1). Mortality was 14% at the CHUV and 5% at the PH. Most treatments were in agreement with national guidelines, although less often in PH (78% vs 97%, P = 0.04). CONCLUSION: Although not statistically significant, we observed a slightly worse SE prognosis in a large academic centre as compared to smaller hospitals. Since SE severity was similar in the two settings but adherence to national treatment guidelines was higher in the academic centre, further investigation on the prognostic role of SE treatment and outcome determinants is required.

Measurement of left mainstem bronchus using multiplane CT reconstructions and relationship between patient characteristics or tracheal diameters and left bronchial diameters.

STUDY OBJECTIVES: To measure the tracheal diameters (TDs) [transverse (Tr) TD, and anteroposterior (AP) TD] and left main bronchus diameters (LBDs) [Tr and AP] using multiplane CT scan reconstructions with a tridimensional correction of the declination. To evaluate the relationship between clinical variables and CT scan diameters of the tracheobronchial tree. To aid in the selection of a double-lumen tube of appropriate size. DESIGN: Prospective observational study. SETTING: Private and university hospitals. PATIENTS: A total of 206 patients (105 women and 101 men) undergoing a CT scan for medical investigations or preoperative evaluation. INTERVENTION: No intervention. MEASUREMENTS AND RESULTS: TDs and LBDs are greater in men (p < 0.001). The Tr-TD is smaller than AP-TD for men (p < 0.001). The Tr-LBD is greater than AP-LBD in both sexes (p < 0.001). In men, height, Tr-TD, and AP-TD are predictive factors for Tr-LBD, while Tr-TD and AP-TD are the only predictive factors for AP-LBD. In women, Tr-TD and AP-TD are the only predictive factors for Tr-LBD and AP-LBD. The smallest LBD (ie, the lesser of the Tr-LBD or the AP-LBD [called the smallest LBD]) is the Tr-LBD in 25.2% of the cases. The mean (+/- SD) ratio of the smallest LBD/Tr-TD is 0.70 +/- 0.14 for men and 0.65 +/- 0.12 for women. The estimated (Est) LBD is calculated using this ratio. The mean value for Est-LBD minus the smallest LBD is 1.6 +/- 1.3 mm, and this difference is < 1 mm in 40% of male patients and 39% of female patients. CONCLUSIONS: In conclusion, the left main bronchus is most often elliptic, and the smallest LBD cannot be accurately evaluated using patient characteristics or a ratio from TD.