Factors associated with treatment limitations in two Swedish intensive care units: Prevalence and patient involvement.

The aim was to study the prevalence, documentation, and patient involvement in treatment limitations (TLs) in two Swedish intensive care units (ICUs). All patients admitted to the ICUs of two Swedish regional hospitals in 2019 were screened for inclusion. Exclusion criteria included postanesthesia care <24 h. Patients were identified using the Swedish Intensive Care Registry (SIR) and data were extracted from SIR and hospital charts. Uni- and multivariable logistic analysis was performed to investigate associations with the presence of TLs. A total of 3090 patients were admitted to the two ICUs in 2019. After exclusion, 1019 patients were included in the study. 45.5% were women and the mean age was 62.9 years. 26.5% of the patients had one or several TLs. Age (OR 1.04 per one year increase 95% confidence interval (CI) 1.02-1.05), SAPS3-score (OR 1.08 per one unit increase 95% CI 1.06-1.09) and ICU length of stay (OR 1.11 per one day increase 95% CI 1.05-1.17) were independently associated with an increased likelihood of receiving a TL. 17% of the patients were involved in the decision-making process and in >30% of cases neither the patient nor next-of-kin were informed. Women were to a larger extent involved in the decision process than men (24.5 vs. 12.5% p < .05). When the intensivist documented why a TL was established, patient autonomy was four times more commonly stated as the motivation for the TL among women compared to men (15.5% vs. 3.8% p < .05). TLs were common in two Swedish ICUs but a substantial number of patients and next-of-kin were not involved in the decision-making process or informed of the decision. Women were more often than men engaged in the decision to establish a TL.

Influence of solidification structure on austenite to martensite transformation in additively manufactured hot-work tool steels.

The microstructure of a hot-work tool steel additively manufactured using laser powder-bed fusion (L-PBF), and its response to post heat treatment, is studied in detail by microstructure characterization and computational thermodynamics and kinetics. The high solidification and cooling rates during the L-PBF process lead to suppression of δ-ferrite and instead solidification of an austenite phase directly containing a cellular substructure where the alloying elements have segregated to the inter-cellular regions and where solidification carbides have formed in the cell junctions. The austenite is then partly decomposed into martensite at lower temperatures. The micro-segregation can be predicted by reducing the complex solidification behavior to a diffusion problem in one dimension enabling detailed comparisons with the measured segregation profiles quantified at a nanometer scale. Martensite start temperature (Ms) calculations along the spatially varying composition show that the Ms temperature decreases in the inter-cellular regions where austenite is observed. The network of austenite in the as-built microstructure can be understood from the combined influence of the composition dependence of the Ms temperature in relation to the build plate temperature and the mechanical stabilization of the small-sized austenite regions. This work demonstrates the power of computational tools based on computational thermodynamics and kinetics for designing tool steels for additive manufacturing by predictions of the steel's response to the L-PBF process and post heat treatments.

Imaging atomic structure in metal nanoparticles using high-resolution cryo-TEM.

It has been shown, by imaging gold (200) planes, that it is possible to achieve better than 0.20-nm structural resolution in cryo-transmission electron microscopy (cryo-TEM). This has been done using commercially available cryo equipment and using a 300-kV field emission gun (FEG) TEM. The images of 15-nm gold particles embedded in amorphous frozen water clearly show the (111) planes (separated by 0.235 nm) in gold. Fourier transform demonstrates the presence of (200) planes in the image, proving a resolution of better than 0.20 nm. The experimental results are supported by image simulations using the multislice method. These simulations suggest that it should be possible to achieve the same resolution even in smaller particles and particles of lighter elements. The crucial experimental problem to overcome is keeping the thickness of the amorphous film low and to work at low electron dose conditions.

Production of milligram quantities of affinity tagged-proteins using automated multistep chromatographic purification.

A new chromatography system, AKTAxpress (GE Healthcare, Amersham Biosciences, Uppsala, Sweden) has been designed to meet the demand for high-throughput purification of proteins in structural genomics and drug discovery. The system offers a number of automated multistep purification protocols for affinity-tagged proteins. All protocols start with affinity chromatography followed by combinations of desalting, ion exchange chromatography and gel filtration. As an option, tag removal can be included in the purification protocols. Up to 16 proteins can be purified per day and the yield can be as high as 50 mg of each protein at > 90% purity. To highlight the versatility of the system, this paper presents several case studies; purifications of hexahistidine- and glutathione S-transferase-tagged proteins using different protocols, automated on-column tag cleavage and optimization studies for a hexahistidine-tagged kinase.