Dynamic mechanical thermal analysis of maxillofacial prosthetic elastomers: the effect of different disinfecting aging procedures.

In this study, dynamic mechanical thermal analysis was used to evaluate the changes that occurred in maxillofacial elastomers subjected to different disinfecting regimens. A commercial polydimethyl siloxane (PDMS) and an experimental chlorinated polyethylene (CPE) were treated with different disinfection procedures for a period that simulates 1 year of clinical service: microwave exposure (D1), hypochlorite solution (D2), neutral soap (D3), and a commercial disinfecting solution (D4). A fifth group was kept in dark storage as control. Dynamic mechanical thermal analysis tests operated in a fixed frequency (1 Hz) over a range of temperatures (-130°C to 20°C for PDMS, -60°C to 120°C for CPE). Loss modulus (G″), storage modulus (G'), and loss factor (tanδ) were recorded as a function of temperature. The obtained glass transition temperature (Tg) values were subjected to statistical analysis. Dynamic mechanical thermal analysis revealed changes in Tg values for both materials, which reflect the possible changes in their chemical and physical structure, after different disinfection procedures. The PDMS and CPE samples seem to have less dense structure maybe because of chain scission reaction that probably occurred during the disinfection procedures. According to statistical analysis, Tg values presented significant changes from the control samples among the different materials and disinfecting procedures. Microwave exposure and hypochlorite solution affect CPE significantly, whereas PDMS exhibited significant changes after being treated with a commercial antimicrobial agent, concerning changes that occurred in Tg. In all cases, Tg values were decreased compared with the untreated samples, which were stiffer, presenting higher Tg and G' values.

Βarriers and Gaps to Medical Care for Transgender Individuals: A TRANSCARE Scoping Review with a Focus on Greece.

Trans people face substantial barriers to care worldwide. In Greece, limited evidence regarding trans health and actions to improve accessibility in healthcare services is available. This study aims to identify barriers to care for transgender populations in order to discuss the potential gaps in healthcare providers' training in this direction. A scoping review was conducted in PubMed. Study eligibility criteria included: (a) reporting on at least one barrier to care for trans individuals or at least one educational need for healthcare providers; (b) free full text availability; and (c) publishing from 2015 and afterwards. Discrepancies in study inclusion were discussed between the research team until consensus was reached. Out of 560 identified references, 69 were included in this study, with only three reporting empirical research from Greece. Several individual-, interpersonal-, and institutional-level barriers to healthcare for trans individuals were identified. These included discriminatory treatment by healthcare providers, a lack of knowledgeable providers trained on trans-specific healthcare issues, lack of trusted and safe healthcare environments, health coverage-related issues, and healthcare systems that do not take into account particular transgender health issues during care provision. Improving access to care for transgender people is a multidimensional issue that should be addressed at the societal, healthcare, and research levels. Actions for future professional education initiatives should focus on respecting transgender identity, protecting confidentiality, creating trusted provider-patient relationships, and providing sufficient competency on trans-specific healthcare issues.

Effects of storage in simulated skin secretions on mechanical behavior and color of polydimethylsiloxanes elastomers.

BACKGROUND: Among the deteriorations that occur in maxillofacial prosthesis due to exposure in various environmental factors, sebaceous oils (sebum) and perspiration are also responsible for several alterations. PURPOSE: Mechanical properties and color changes of 3 different medical-grade polydimethylsiloxanes were investigated in this study (Elastomer 42, Techsil 25, and M511), after immersion for 6 months in simulated sebum and perspiration at 37 °C. The purpose of this study was to determine the effects of storage in their physical properties. The null hypothesis investigated was that immersion time did not affect the measured properties. METHODS: Polydimethylsiloxane specimens were immersed in simulated perspiration and in sebum. Compression tests were conducted on a Zwick testing machine. Shore A hardness measurements were carried out in a CV digital Shore A durometer. Weight changes were measured, and color changes were determined in the CIELAB system, using a MiniScan XE spectrophotometer. Simple mathematical models were developed to correlate the measured properties with the immersion time. The data were analyzed by analysis of variance and Tukey multiple range test at a level of α = 0.05. RESULTS: Specimens immersed in simulated skin secretions became harder because of facilitation of the propagation of cross-linking reaction that probably occurred during aging of the polydimethylsiloxane samples, except for Elastomer 42, which seems to become more soft and ductile after immersed in sebum. Some weight increase was observed for the specimens immersed into the aqueous solutions, whereas for those immersed in sebum, weight loss was recorded, probably because of extraction of some compounds. The color change was higher for the specimens immersed in sebum than that corresponding to simulated perspiration. According to statistical analysis, all measured properties changed significantly after immersion in simulated perspiration and in sebum. Moreover, mathematical models reveal major alterations as well, which were introduced through their constants. Thus, the hypothesis investigated was rejected. CONCLUSIONS: Significant changes were observed in all the examined elastomers. The elastomers were aged for a period, which simulates 1.5 years of clinical service. Within the limitation of this study, concerning the mechanical behavior and mostly the color changes, sebum and perspiration greatly affect the examined elastomers.

Optical properties of pigmented polydimethylsiloxane prosthetic elastomers: effect of "outdoor" and "indoor" accelerating aging.

OBJECTIVES: Optical properties of facial prosthetic elastomers undergo significant changes mainly due to aging. The resulting changes in their appearance are the main reasons of facial prosthesis' replacement. PURPOSE: The purpose of this study was to evaluate changes in the translucency parameter (TP) and color (ΔE*) of polydimethylsiloxane (PDMS) maxillofacial elastomers after exposure to 3 different aging conditions (time passage, accelerated "outdoor" aging, and accelerated "indoor" aging). MATERIALS AND METHODS: The PDMS prosthetic elastomers tested in this study were low- (LTV) and high-temperature vulcanized (Episil and Mollomed, respectively) in various shades. Color changes (ΔE*) and translucency parameter (TP) were determined in the CIE L*a*b* system using a tristimulus colorimeter. Data were subjected to 2-way analysis of variance followed by Tukey post hoc test. In addition, TP values were analyzed by paired t tests. The significance level of α = 0.05 was set for all tests. RESULTS: Translucency parameter values for most samples were significantly changed after aging, and ΔE* values were characterized as unacceptable. Both aging procedure and material type affected the changes that occurred. Moreover, dark-shaded samples of both silicone materials revealed significant changes in TP values before and after aging. ΔE* was not significantly different among the same material samples but had significant differences between the 2 materials (Episil and Mollomed). Time passage did not significantly affect TP values contrary to the other 2 accelerated aging procedures. Between outdoor and indoor aging, no significant differences were detected. CONCLUSIONS: Accelerated outdoor and indoor aging caused significant changes in ΔE* and TP values. Significant changes were also detected between material types.

Effect of time passage on some physical properties of silicone maxillofacial elastomers.

OBJECTIVES: Changes in color and other physical properties of silicone facial prosthesis are the main reasons for its replacement. The purpose of this study was to investigate the effect of time passage on some physical properties such as tensile strength, modulus of elasticity, elongation at break, tear strength, hardness, color stability, and contrast ratio (CR) of 2 silicone facial elastomers after being sealed in glass containers and kept in the dark for 1 year. MATERIALS AND METHODS: Specimens from 2 silicone elastomers (Silasto 30 and Premium 2) were made and stored in the dark. Tensile and tear strength tests were conducted according to International Organization for Standardization specification nos. 37 and 39, respectively, in a universal testing machine. Shore A hardness was measured according to the American Society for Testing Materials specification D 2240. Color changes (ΔΕ*) were determined in the CIE L*a*b* system using a tristimulus colorimeter, and CR also was calculated. Data were analyzed by paired and unpaired t-tests at a significance level of α = 0.05. RESULTS: Elongation at break, modulus of elasticity, and hardness were significantly changed, whereas changes in CR were observed only in 1 of the 2 elastomers. Tensile and tear strengths were not significantly changed for both of them. Within the limitations of this study, color changes (ΔΕ) were unacceptable. CONCLUSIONS: Most of the physical properties studied were significantly affected because of time passage. Mechanical and physical properties of silicone maxillofacial elastomers can be changed with time passage (natural aging in the dark). The average time of replacing a facial prostheses is 6 to 18 months; thus, it is important that the findings of this study covered a period of 12 months. Time passage seems to be a critical factor contributing to the overall deterioration of a silicone maxillofacial elastomer.

Effects of outdoor weathering on facial prosthetic elastomers.

Physical weathering is usually responsible for the degradation of maxillofacial prosthetic elastomers and the replacement of prostheses. The purpose of this study was to investigate the effects of outdoor weathering on the physical properties of four nonpigmented facial prosthetics after 1 year of exposure. In addition, simple mathematical models were developed to correlate the measured properties with irradiation time, including parameters with physical meaning. Three different medical-grade polydimethyl siloxanes (PDMSs) and an experimental chlorinated polyethylene (CPE) were examined in this study. The samples were exposed to solar radiation for 1 year in Athens, Greece. Mechanical tests (compression and tensile) were performed using universal-type testing machine, and hardness measurements were performed with a durometer (Shore A). Thermal tests were also performed with a differential scanning calorimeter. Simple mathematical models were developed to describe the examined properties. Changes observed in the properties of examined materials, before and after the exposure, reflected the effect of weathering. More specifically, two of the silicone prosthetics (Elastomer 42, TechSIL 25) seemed to become harder and more brittle, different from the other silicone (M511) sample and the CPE sample, which became softer and more ductile. Moreover mathematical models correlate the measured properties with irradiation time, and their constants indicate that duration of exposure seems to increase the degradation. Significant changes in the mechanical and thermal properties of the examined materials were observed as a result of outdoor weathering. The effect of weathering on samples' properties was introduced through its effect on the mathematical models' parameters.

Evaluation of the Bioactive Compounds Found in Tomato Seed Oil and Tomato Peels Influenced by Industrial Heat Treatments.

The circular economy action plan involves principles related to food waste reduction and integration of recovered nutrients to the market. In this context, the present study aims to highlight the valuable bioactive components found in tomato processing by-products (carotenoids, phenolic compounds and fatty acids) influenced by industrial pre-treatments, particularly cold break (CB) process at 65-75 °C and hot break (HB) process at 85-95 °C. The fatty acid profile of the tomato seed oil was examined by gas chromatography coupled to mass spectrometry (GC-MS), individual carotenoid and phenolic compositions were determined by high performance liquid chromatography (HPLC) and the viscoelastic properties were evaluated by rheological measurements. The physicochemical properties revealed appropriate characteristics of the tomato seed oil to fit the standards of generally accepted edible oils, for both CB and HB derived samples, however, significant qualitative and quantitative differences were detected in their phenolic composition and carotenoids content. Lycopene (37.43 ± 1.01 mg/100 mL) was a major carotenoid in the examined samples, linoleic acid was the main fatty acid (61.73%) detected in the tomato seed oil and syringic acid appeared to be one of two major phenolic acids detected in the samples of CB process. Our findings extend the boundaries of tomato processing industry by validating that tomato seed oil is a bioactive rich edible oil with additional health benefits, which can be integrated in functional food products.

Appraisal of a Contact Tracing Training Program for COVID-19 in Greece Focusing on Vulnerable Populations.

BACKGROUND: Contact tracing as an epidemiological strategy has repeatedly contributed to the containment of various past epidemics and succeeded in controlling the spread of disease in the community. Systematic training of contact tracers is crucial in ensuring the effectiveness of epidemic containment. METHODS: An intensive training course was offered to 216 health and other professionals who work with vulnerable population groups, such as Roma, refugees, and migrants in Greece, by the scientific team of the postgraduate programme "Global Health-Disaster Medicine" of the Medical School, National and Kapodistrian University of Athens, with the support of the Swiss embassy in Greece. The course was delivered online due to the pandemic restriction measures and was comprised of 16 h over 2 days. The course curriculum was adapted in Greek using, upon agreement, a similar training course to what was developed by the Johns Hopkins University Bloomberg School of Public Health. Evaluation of the course was conducted in order to determine the short term satisfaction from participating in this training course. RESULTS: A total of 70% of the course participants completed the evaluation questionnaires and all trainers gave feedback on the course. The training modules were ranked as extremely useful by the majority of the participants and over 50% of the participants specifically stated that the course content was directly related to their work with vulnerable groups. Content about the ethics of contact tracing and the effective communication skills presented were deemed most useful. CONCLUSION: The course was well organised and provided the required skills for effective contact tracing. Many course participants intend to use some components in their work with vulnerable populations groups. Contact tracing efforts work best in a systematic and coordinated way and the provision of systematic and organised training can greatly increase its effectiveness.

Dynamic mechanical analysis of novel cosmeceutical facial creams containing nano-encapsulated natural plant and fruit extracts.

BACKGROUND: Cosmetic industry following the recent trends in the relative market has turned its interest in the formation of cosmeceutical products containing natural bioactive ingredients. Natural extracts may reveal undesirable sensory characteristics due to their composition. Encapsulation and nanotechnology are the most promising methods to overcome these drawbacks, opening up new perspectives for the future of cosmeceutical industry. AIMS: The purpose of this study was the use of nano-encapsulated plant and fruit extracts to formulate cosmeceutical facial creams with acceptable rheological characteristics. METHODS: Electrohydrodynamic process was used to encapsulate pomegranate and tea tree oil extracts and incorporate them in facial cosmetic creams. All the formulations including those without additives, were stored at three different temperatures. Subsequently, rheological oscillatory tests (frequency sweep tests) were performed using the dynamic mechanical analysis method in order to evaluate alterations in storage modulus (G'), loss modulus (G''), and complex viscosity (η*). RESULTS: Dynamic mechanical analysis, showed that all formulations are suitable for application in cosmetic industry, while changes due to storage period or the storage temperature were negligible. CONCLUSION: The addition of the selected extracts' nanofibers to formulate cosmeceutical facial creams, developed products with acceptable rheological characteristics that could be decisive for the cosmetics industry.

Effect of different disinfecting procedures on the hardness and color stability of two maxillofacial elastomers over time.

OBJECTIVE: Disinfection procedures often cause deterioration in a maxillofacial prosthesis. Color and hardness alterations could lead to a replacement of the prosthesis. MATERIAL AND METHODS: An experimental chlorinated polyethylene (CPE) and a commercial polydimethyl siloxane (PDMS) sample were treated with four different disinfection procedures for a period which simulates 1 year of clinical service. The applied disinfection procedures included microwave exposure and immersion in three solutions, sodium hypochlorite, neutral soap and a commercial disinfecting soap. Shore A hardness (∆H) and color differences (∆E) were determined before and after each procedure. All data were analyzed by Two Way Analysis of Variance (ANOVA) and Tukey's post hoc tests at a level of α=0.05. RESULTS: The samples presented significant alterations in color and hardness after the different disinfection treatments. The color differences (∆E) were at least eye detectable in all cases and clinically unacceptable in most of the cases, with values ranging from 1.51 to 4.15 and from 1.54 to 5.92 for the PDMS and CPE material, respectively. Hardness was decreased after all the disinfection procedures in the PDMS, while for the CPE, a decrement was observed after disinfection with sodium hypochlorite and neutral soap and an increment after microwave exposure and the disinfection with a commercial antimicrobial agent. The PDMS samples presented greater alterations in color and hardness after disinfection with sodium hypochlorite solution, while the microwave exposure caused negligible effects. The CPE samples were affected most after disinfection when treated with neutral soap, and more slightly when disinfected with sodium hypochlorite solution. CONCLUSIONS: The disinfection procedures caused alterations in color and hardness of the examined materials. The most suitable disinfection procedure for the PDMS material is microwave exposure, while disinfection with sodium hypochlorite solution is not recommended. The CPE material is suggested to be disinfected with sodium hypochlorite solution and the use of neutral soap is not recommended. Comparing the two materials, the PDMS material is most color stable, while the CPE material presented fewer changes in hardness.

Tensile and microindentation properties of maxillofacial elastomers after different disinfecting procedures.

STATEMENT OF PROBLEM: Daily disinfection of maxillofacial prosthesis may reduce their service-life and lead to replacement. PURPOSE: The purpose of this study was to evaluate possible alterations in the mechanical behavior of two maxillofacial elastomers after application of four different disinfection procedures. MATERIAL AND METHODS: The materials tested were two maxillofacial elastomers, a commercially available polydimethylsiloxane (PDMS) and an experimental chlorinated polyethylene (CPE). Different disinfection procedures such as microwave exposure, hypochlorite solution, neutral soap and a commercially antimicrobial solution, were applied for a period which simulates one year of a real service life. Mechanical behavior was investigated through tensile and microindentation tests in various depths. Mathematical models were fitted to tensile curves. Alterations in tensile parameters (maximum stress, maximum strain, elasticity and viscoelasticity parameter) were subjected to two way ANOVA and Tukey's post hoc tests (α=.05). RESULTS: Most of the tensile parameters presented significant alterations among different disinfection procedures and maxillofacial materials which became also harder. Microwave exposure caused greater changes in PDMS and CPE elastomer whereas commercial antimicrobial solution and neutral soap did not significantly affect them. Microindentation and tensile tests revealed similar changes in materials' elastic modulus and hardness whereas the observed changes were greater into smaller depths. CONCLUSIONS: Tensile and microindentation properties of PDMS and CPE elastomers presented changes after disinfected with four different procedures. Changes in the surface of both materials were more intense than in the bulk of the materials. Microwave exposure affected most the two elastomers, so concerning the findings of this study is not recommended for the disinfection of the examined PDMS and CPE elastomers. Moreover, microwave exposure and hypochlorite solution caused greater changes in the surface (3µm) of CPE samples as indicated by microindentation results. PDMS affected less from the commercial antimicrobial agent and CPE from neutral soap, which seems to be the most suitable disinfection techniques.

Material properties of a maxillofacial chlorinated polyethylene elastomer stored in simulated skin secretions.

STATEMENT OF PROBLEM: Facial prostheses deteriorate in a service environment primary due to exposition to various environmental factors, including sebaceous oils (sebum) and perspiration. PURPOSE: This study investigated the physical properties of an experimental, facial prosthetic after immersion for 6 months in simulated sebum, and perspiration at 37 degrees C. MATERIAL AND METHODS: Chlorinated polyethylene (CPE) specimens were immersed in simulated perspiration as well as in sebum. Compression tests were conducted on a Zwick testing machine. Shore A hardness measurements were carried out in a CV digital Shore A durometer. Melting and glass transition temperatures were evaluated with a differential scanning calorimeter. Weight changes were measured and color changes were determined in the CIE LAB system using a MiniScan XE spectrophotometer. Simple mathematical models were developed to correlate the measured properties with immersion time. The data were also subjected to analyses of variance (ANOVA) and the Tukey multiple range tests at a level of alpha = 0.05. RESULTS: Specimens immersed in perspiration became harder due to facilitation of the propagation of cross-linking reaction that probably occurred during aging of the CPE samples. Some weight increase was observed for the specimens immersed into the aqueous solutions, whereas for those immersed in sebum, weight loss was recorded, probably because of extraction of some compounds. The color change was higher for the specimens immersed in sebum than that corresponding to simulated perspiration. CONCLUSIONS: The chlorinated polyethylene specimens aged for a period, which simulates 1.5 years of clinical service1, showed significant deformations in their physical properties.

Effect of different disinfecting procedures on the hardness and color stability of two maxillofacial elastomers over time

Objective Disinfection procedures often cause deterioration in a maxillofacial prosthesis. Color and hardness alterations could lead to a replacement of the prosthesis. Material and Methods An experimental chlorinated polyethylene (CPE) and a commercial polydimethyl siloxane (PDMS) sample were treated with four different disinfection procedures for a period which simulates 1 year of clinical service. The applied disinfection procedures included microwave exposure and immersion in three solutions, sodium hypochlorite, neutral soap and a commercial disinfecting soap. Shore A hardness (∆H) and color differences (∆E) were determined before and after each procedure. All data were analyzed by Two Way Analysis of Variance (ANOVA) and Tukey's post hoc tests at a level of α=0.05. Results The samples presented significant alterations in color and hardness after the different disinfection treatments. The color differences (∆E) were at least eye detectable in all cases and clinically unacceptable in most of the cases, with values ranging from 1.51 to 4.15 and from 1.54 to 5.92 for the PDMS and CPE material, respectively. Hardness was decreased after all the disinfection procedures in the PDMS, while for the CPE, a decrement was observed after disinfection with sodium hypochlorite and neutral soap and an increment after microwave exposure and the disinfection with a commercial antimicrobial agent. The PDMS samples presented greater alterations in color and hardness after disinfection with sodium hypochlorite solution, while the microwave exposure caused negligible effects. The CPE samples were affected most after disinfection when treated with neutral soap, and more slightly when disinfected with sodium hypochlorite solution. Conclusions The disinfection procedures caused alterations in color and hardness of the examined materials. The most suitable disinfection procedure for ...