No abstract

IntroductionStroke is a major contributor to mortality, disability and long-term use of healthcare services. As for all chrono-dependant conditions, clinical results are associated with timely access to appropriate care. Thrombectomy (EVT) is an effective treatment for large vessel occlusions, but can only be provided in highly-specialized centers by experienced personnel. We sought to develop a framework to aid decision-making on the appropriateness of opening new EVT centers in Québec, Canada.MethodsData sources included provincial administrative healthcare databases, population density statistics, field evaluation of Québec's four existing EVT care networks, and literature review concerning structural and performance criteria for EVT centers. We consulted EVT clinical teams, interdisciplinary stroke experts, patients, professional association representatives, healthcare managers and decision-makers.ResultsAccess to EVT is suboptimal in all 17 regions of Québec, with virtually no access in remote areas. Results of key performance indicators indicated favorable treatment delays after arrival at the EVT center. However, door-to-needle and door-in-door-out times were long for patients transferred from non-EVT centers. High use of ambulances indicated the potential to transport patients to the most appropriate center. In light of ‘real world’ results and other sources of information, the need for a new EVT center should consider the following criteria: sub-optimal EVT access within the region; transport time to an existing EVT center >1 hour; expected patient volume within 2 hours of transport; impact on volume of existing programs; availability of long-term financial support; availability of a critical mass of neurointerventionists, vascular neurologists, and neurosurgeons; demonstrated quality of stroke care; and, presence of a stroke unit.ConclusionsThe triangulation of literature, clinician experience and the Québec context enriched the evaluation process. Furthermore, this facilitated the development of a framework that was broadly applicable across regions to the real-world setting of decision-making in a complex system of care.

Impulse oscillometry (IOS) is a variant of forced oscillation technique described by Dubois 50 years ago, which allows us to measure the reactance of the airways and the resistance of the small and large airways during tidal breathing. It requires minimal patient cooperation from subjects who are unable to perform spirometry, like elders, children and patients with neurologic disorders. IOS can outline the diagnosis of obstructive airway disease, differentiate small airway obstruction from large airway obstruction. It is more sensitive than spirometry for peripheral airway disease in determining the severity of the disease, the exacerbations and evaluate the therapeutic response. Other applications include early evaluation of transplant rejection, cystic fibrosis, vocal cord disorder, bronchiectasis, hypersensitivity pneumonitis, obstructive sleep apnea.

As a 21st century trend, sustainability has encompassed the entire world economy, including industry. Today the concept of "Industry 4.0" is known, resulting from advances in ICT (information and communication technologies). In recent years, companies in the metal materials industry have also implemented strategies and technologies belonging to the Industry 4.0 concept. The main purpose of the manuscript is to identify the key issues in the evolution of the development of the metal materials industry. The transition to a higher level of its evolution is based on two vectors, namely: the ecological paradigm, as a vector of in-depth knowledge, and sustainable material, as a vector that ensures sustainability in the areas of convergence of systems in the spheres of life and social consciousness. The systems that have an impact on the sustainable development of the metallic materials industry, through the interactions between them, are: the technological system, the social system and the natural-ecological system. Global knowledge re-quires the use of all inter and multidisciplinary knowledge, which ultimately contributes to the definition and characterization of new intersystem scientific branches: Ecometallurgy, Metallurgical Economics, Metallurgical Ecosociology and Sustainable Materials Engineering. The paper is considered a research study based on elements such as: literary foundations, using databases such as Web of Science (WoS), Scopus, Google Scholar, sustainable universal principles and legislative parameters.