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The Prostate Cancer Center at Capio S:t Göran hospital is located in Stockholm and offers testing for prostate cancer. The pathway applies task shifting from doctors to nurses and new and innovative test methods, and leverages digitalization opportunities to enable a cost-efficient pathway with high specificity and sensitivity. In this article, we describe our experiences of the Capio S:t Göran Model.
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Procedimentos Clínicos , Neoplasias da Próstata , Humanos , Masculino , Biópsia , Procedimentos Clínicos/economia , Períneo , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/economia , Neoplasias da Próstata/patologia , Sensibilidade e EspecificidadeRESUMO
Atom probe tomography (APT) was utilized to supplement scanning electron microscopy (SEM) characterization of a precipitation strengthening nickel-based superalloy, Alloy 247LC, processed by laser powder bed fusion (L-PBF). It was observed that the material in the as-built condition had a relatively high strength. Using both SEM and APT, it was concluded that the high strength was not attributed to the typical precipitation strengthening effect of γ'. In the absence of γ' it could be reasonably inferred that the numerous black dots observed in the cells/grains with SEM were dislocations and as such should be contributing significantly to the strengthening. Thus, the current investigation demonstrated that relatively high strengthening can be attained in L-PBF even in the absence of precipitated γ'. Even though γ' was not precipitated, the APT analysis displayed a nanometer scale partitioning of Cr that could be contributing to the strengthening. After heat-treatment, γ' was precipitated and it demonstrated the expected high strengthening behavior. Al, Ta and Ti partitioned to γ'. The strong partitioning of Ta in γ' is indicative that the element, together with Al and Ti, was contributing to the strain-age cracking occurring during heat-treatment. Cr, Mo and Co partitioned to the matrix γ phase. Hf, Ta, Ti and W were found in the carbides corroborating previous reports that they are MC.
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Owing to its excellent properties, Metal Matrix Composites (MMC) has gained popularity and finds application in aerospace, aircraft, shipbuilding, biomedical, biodegradable implant materials and many more. To serve the industrial needs, the manufactured MMC should have homogenous distribution along with minimum agglomeration of reinforcement particles, defect-free microstructure, superior mechanical, tribological and corrosive properties. The techniques implemented to manufacture MMC highly dominate the aforementioned characteristics. According to the physical state of the matrix, the techniques implemented for manufacturing MMC can be classified under two categories i.e. solid state processing and liquid state process. The present article attempts to review the current status of different manufacturing techniques covered under these two categories. The article elaborates on the working principles of state-of-the-art manufacturing techniques, the effect of dominating process parameters and the resulting characteristic of composites. Apart from this, the article does provide data regarding the range of dominating process parameters and resulting mechanical properties of different grades of manufactured MMC. Using this data along with the comparative study, various industries and academicians will be able to select the appropriate techniques for manufacturing MMC.
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Background: Pathological digital rectal examination (DRE) is suggestive of prostate cancer but has low sensitivity and specificity. DRE is incorporated in many clinical risk calculators, but there is less evidence on how DRE performs in the setting of blood biomarkers and polygenic risk prediction models other than prostate-specific antigen (PSA) associated with prostate cancer. The Stockholm3 test combines a blood test and clinical variables including DRE. Objective: To assess the predictive performance of DRE for finding clinically significant prostate cancer in systematic biopsy and evaluate its added value to the multivariable diagnostic test Stockholm3. Design setting and participants: This population-based study in the screening by invitation setting included 5543 men aged 50-69 yr with PSA ≥3 ng/ml who were referred for systematic prostate biopsy between 2012 and 2015. The STHLM3 study is registered with ISRCTN.com as ISRCTN84445406. Outcome measurements and statistical analysis: Predictive performance was assessed via estimates of sensitivity and specificity and in logistic regression. Clinically significant cancer was defined as International Society of Urological Pathology grade group ≥2 (GG ≥2) cancer on systematic biopsy. Results and limitations: We found that 11% of men with PSA ≥3 ng/ml had a suspicious DRE. A suspicious DRE was associated with a 3.16-fold higher risk (95% confidence interval [CI] 2.83-3.52) of GG ≥2 cancer and greater length of cancer on biopsy. The risk of nonsignificant cancer was similar regardless of the DRE finding. The risk of GG ≥2 cancer was 46.2% (95% CI 42.2-50.3%) for men with a suspicious DRE versus 14.6% (95% CI 13.7-15.7%) for men with a negative DRE. The elevated risk of GG ≥2 cancer persisted after adjusting for the other Stockholm3 test parameters (odds ratio 2.88, 95% CI 2.32-3.57). For detection of GG ≥2 cancer among men with PSA ≥3 ng/ml, DRE had sensitivity of 27.8% (95% CI 25.1-30.7%) and specificity of 92.8% (95% CI 92.1-93.6%). Conclusions: In this screening-by-invitation setting we found that for men with PSA ≥3 ng/ml, a suspicious DRE indicates more than threefold higher risk of harboring significant prostate cancer. DRE as a variable adds significant precision to the Stockholm3 prediction model. Men with a suspicious DRE should be referred for further diagnostic workup, including biopsy. Patient summary: We investigated the ability of digital rectal examination to predict if a patient has clinically significant prostate cancer. We found that digital rectal examination provides valuable information and can help doctors in making an informed decision on whether to recommend prostate biopsy.
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The prospect of using metal-cored wires instead of solid wires during gas metal arc welding (GMAW) of 2.25 Cr-1.0 Mo steels embraces several challenges. The in-service requirements for the equipment made up of these steels are stringent. The major challenge faced by the manufacturers is temper embrittlement. In the current study, the temper embrittlement susceptibility of the welded joint was ascertained by subjecting it to step cooling heat treatment. A 25 mm thick 2.25 Cr-1.0 Mo weld joint was prepared using a combination of the regulated metal deposition (RMD) and GMAW processes incorporating metal-cored wires. After welding the plates were exposed to post-weld heat treatment followed by a rigorous step cooling heat treatment prescribed by API standards. The temper embrittlement susceptibility of the weld joint was ascertained by Bruscato X-factor as well as by formulating ductile-to-brittle transition temperature (DBTT) curves by carrying out the impact toughness testing at various temperatures. Detailed microscopy and hardness studies were also carried out. It was established from the study that the X-factor value for the welded joint was 15.4. The DBTT for the weld joint was found to occur at -37 °C which was well below 10 °C. Optical microscopy and scanning electron microscopy indicated the presence of carbides and the energy dispersive X-ray spectrometry studies indicated the presence of chromium and manganese-rich carbides along with the presence of sulfur near the grain boundaries. This study establishes a base for the usage of metal-cored wires particularly in high temperature and pressure application of Cr-Mo steels.
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In this paper the design of the free-electron laser (FEL) in the SXL (Soft X-ray Laser) project at the MAX IV Laboratory is presented. The target performance parameters originate in a science case put forward by Swedish users and the SXL FEL is foreseen to be driven by the existing MAX IV 3â GeV linac. The SXL project is planned to be realized in different stages and in this paper the focus is on Phase 1, where the basic operation mode for the FEL will be SASE (self-amplified spontaneous emission), with an emphasis on short pulses. Simulation results for two linac bunches (high and low charge) with different pulse duration are illustrated, as well as the performance for two-color/two-pulses mode and power enhancement through tapering. Besides standard SASE and optical klystron configurations, the FEL setup is also tailored to allow for advanced seeding schemes operations. Finally possible upgrades that will be implemented in a second phase of the project are discussed.
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The manufacturing of parts from nickel-based superalloy Alloy 247LC by laser powder bed fusion (L-PBF) is challenging, primarily owing to the alloy's susceptibility to cracks. Apart from the cracks, voids created during the L-PBF process should also be minimized to produce dense parts. In this study, samples of Alloy 247LC were manufactured by L-PBF, several of which could be produced with voids and crack density close to zero. A statistical design of experiments was used to evaluate the influence of the process parameters, namely laser power, scanning speed, and hatch distance (inherent to the volumetric energy density) on void formation, crack density, and microhardness of the samples. The window of process parameters, in which minimum voids and/or cracks were present, was predicted. It was shown that the void content increased steeply at a volumetric energy density threshold below 81 J/mm3. The crack density, on the other hand, increased steeply at a volumetric energy density threshold above 163 J/mm3. The microhardness displayed a relatively low value in three samples which displayed the lowest volumetric energy density and highest void content. It was also observed that two samples, which displayed the highest volumetric energy density and crack density, demonstrated a relatively high microhardness; which could be a vital evidence in future investigations to determine the fundamental mechanism of cracking. The laser power was concluded to be the strongest and statistically most significant process parameter that influenced void formation and microhardness. The interaction of laser power and hatch distance was the strongest and most significant factor that influenced the crack density.
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The aim of this work was to characterize the microstructure of the as-cast Haynes® 282® alloy. Observations and analyses were carried out using techniques such as X-ray diffraction (XRD), light microscopy (LM), scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray spectroscopy (EDS), wave length dispersive X-ray spectroscopy (WDS), auger electron spectroscopy (AES) and electron energy-loss spectrometry (EELS). The phases identified in the as-cast alloy include: γ (gamma matrix), γ' (matrix strengthening phase), (TiMoCr)C (primary carbide), TiN (primary nitride), σ (sigma-TCP phase), (TiMo)2SC (carbosulphide) and a lamellar constituent consisting of molybdenum and chromium rich secondary carbide phase together with γ phase. Within the dendrites the γ' appears mostly in the form of spherical, nanometric precipitates (74 nm), while coarser (113 nm) cubic γ' precipitates are present in the interdendritic areas. Volume fraction content of the γ' precipitates in the dendrites and interdendritic areas are 9.6% and 8.5%, respectively. Primary nitrides metallic nitrides (MN), are homogeneously dispersed in the as-cast microstructure, while primary carbides metallic carbides (MC), preferentially precipitate in interdendritic areas. Such preference is also observed in the case of globular σ phase. Lamellar constituents characterized as secondary carbides/γ phases were together with (TiMo)2SC phase always observed adjacent to σ phase precipitates. Crystallographic relations were established in-between the MC, σ, secondary carbides and γ/γ' matrix.
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A model for tribofilm growth is developed. The model is used in combination with numerical contact mechanics tools to enable evaluation of the combined effects of chemistry and contact mechanics. The model is tuned with experimental data and is thereafter applied to rough surfaces. The growth of the tribofilm is evaluated for 3 different contact cases and short-term tribofilm growth behaviour is analyzed. The results show how tribofilms grow in patches. The model is expected to be used as a tool for analysis of the interaction between rough surfaces.