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Capability of Additive Manufacturing (AM) technology in the production of complex parts with high flexibility has led to the growing interest in their application as an alternative for conventional manufacturing processes. Despite the outstanding benefits of the AM process, due to their poor surface quality, the precision parts produced by this method generally need to be machined, ground, or polished. This paper addresses the machinability of AM Ti6Al4V titanium alloy parts in the micro-milling process with a specific focus on cutting forces, specific cutting energy, burr formation, and surface quality. Additive parts were produced by Electron Beam Melting (EBM) technique and were compared with the extruded Ti6Al4V parts in the micro-milling process. No significant difference could be observed in the cutting forces of both materials at chip thicknesses between 7.4 and 37.3 μm, despite the higher hardness of the EBM Ti6Al4V compared to the extruded Ti6Al4V. However, micro-milling of the EBM parts produced finer surfaces. Cutting forces and specific cutting energies of EBM parts were less than those of extruded parts at minimal chip thicknesses (lower than 7.4 μm). Continuous wavy-type burrs were formed in micro-milling of the EBM Ti6Al4V and were larger than those of extruded Ti6Al4V. • No remarkable difference with respect to the cutting force between additively manufactured and extruded parts at higher h cu • Specific cutting energy of extruded parts is higher than that in additive parts at lower chip thicknesses. • Surface roughness of additive parts is finer compared to extruded parts. • Burr formation of additive parts is wavy type and without irregularities on the surface is more than extruded parts. [ABSTRACT FROM AUTHOR]

Objectives The Japan Academy of Midwifery published "2016 Evidence-based Guidelines for Midwifery Care" (hereinafter, this is called "2016 Guidelines"). The objective of this study was to search and clarify about maternity care policies based on 2016 Guidelines among Obstetric Institutions in Japan. Methods The participants of this survey were 3164 institutions; hospitals, clinics, and midwifery birth centers in Japan. This study was self-administered anonymously questionnaire survey and was conducted with mail or web surveys. The questionnaire included 11 maternity care policies that based on "2016 Guidelines". Data was collected through November to December 2016. The ethics committee of St. Luke's International University, Tokyo, Japan (No.16-A062) provided ethical approval. Results 362 institutions participated in the study (the response rate, 80.4%). Few institutions recommended or provided "Folic acid supplementation" (8.3%), "Screening for domestic violence" (6.9%) and "Antenatal perineal massage" (10.6%). Supplementation in pregnancy; Many institutions did not recommend "Vitamin supplementation" (60.1%) for pregnant women. Conversely, "Iron supplementation" was common (66.1%). The health guidance for discomforts in pregnancy; "Foot bath for leg edema" (74.9%), "Massage for leg edema" (78.4%), "Exercise for low back and pelvic pain" (92.5%) and "Taking dietary fibers for constipation" (96.1%) ware very common at each institutions. The health guidance of taking luxury grocery items; About half of the institutions provided "Health guidance for taking alcohols" (52.6%), but "Health guidance for taking caffeins" were provided still 29.0%. There was significant difference about "Antenatal perineal massage" (χ2: 8.870, OR: 1.385, 95%CI: 1.129-1.699, p=0.003) whether institutions provided midwifery care in ambulatory or not. Conclusion Our results demonstrated that there were some gaps between evidence and clinical practice about maternity care in Japan. This study suggested that necessity of diffusion about "2016 Guidelines" and evidence of maternity care. [ABSTRACT FROM AUTHOR]

In this work, the feasibility of laser surface finishing of parts obtained by additive manufacturing (AM) was investigated. To this end, a 450 W fiber laser (operating in continuous wave, CW) was adopted to treat the surface of Ti-6Al-4V samples obtained via electron beam melting (EBM). During the tests, different laser energy densities and scanning speeds were used. In order to assess the quality of the treatment, either the as-built or the treated samples were analyzed by means of a three-dimensional (3D) profilometer, digital microscopy, and scanning electron microscopy. Analysis of variance (ANOVA) was performed to check which and how process parameters affected the finishing. The results show that, in the best conditions, the laser treatment reduced surface roughness by about 80%. [ABSTRACT FROM AUTHOR]

For more than 40 years, marine zoning has played a key role while evolving as part of the adaptive management of the Great Barrier Reef (GBR) Marine Park. The statutory zoning plan provides the primary integrating component that prohibits many threatening activities and manages the impacts of allowed human activities and competing uses by means of various zones, special management areas and other spatial management tools.How zoning is applied, however, has changed considerably since the first zoning plan was finalized in 1981. Today, zoning is applied in combination with other layers of marine spatial planning; the effective combination of these management tools provides the integrated approach, considered one of the best for managing a large marine protected area.The zoning plan provides the foundation for management of the GBR and is the fundamental component of the integrated marine spatial planning approach ensuring high levels of protection for significant areas of the GBR, while also allowing ecologically sustainable use.The paper outlines the legal and managerial contexts of zoning, providing 38 lessons that may be useful for marine zoning and ecosystem‐based management elsewhere. It outlines aspects of zoning that have worked well in the GBR Marine Park and what has changed in the light of experience and changing contexts, and seeks to clarify various misconceptions about zoning and marine spatial planning.The integrated management approach in the GBR utilizes a variety of spatial planning tools, which complement the underlying zoning; some of these comprise statutory management layers (e.g. designated shipping areas, special management areas, plans of management, fishery management arrangements, Traditional Owner agreements, defence training areas); other layers are non‐statutory (e.g. site plans).This paper is written for planners, managers and decision‐makers considering the use of zoning to achieve effective marine conservation, protection and ecologically sustainable use. [ABSTRACT FROM AUTHOR]

It is increasingly evident that climate change is having significant impacts on marine ecosystems and dependent fisheries. Yet, translating climate science into management actions and policies is an ongoing challenge. In particular, four aspects have confounded implementation of climate-resilient management: (i) regional management tools may not be well-suited for managing the same systems under climate change, (ii) individual management policies and climate research studies are often implicitly focussed on spatio-temporal scales that are rarely aligned, (iii) management approaches seldom integrate across spatio-temporal scales and are, therefore, maladapted to unidirectional change and extreme events, and (iv) challenges to modelling socio-economic implications of climate change impede projections of cumulative costs to society, disguise adaptive limits, and ultimately impact climate risk and management trade-off assessments. We suggest that addressing environmental change favours adaptive and dynamic management approaches, while addressing shifting socio-economic and political conditions favours fixed long-term measures; considering both jointly requires a combination of dynamic-adaptive-fixed approaches. We outline a framework to integrate climate-responsive tools into a unified climate-resilient management approach using nested dynamic-adaptive-fixed management portfolios that improve management effectiveness and efficiency. This approach may help reduce future conflict between marine resource extractive and conservation goals through more explicit characterization of management trade-offs and identification of social and ecological tipping points. [ABSTRACT FROM AUTHOR]

Purpose: To provide information regarding the accuracy of additive manufacturing in comparison to conventional casting, specifically for fabrication of complete palatal coverage metal frameworks. Materials and Methods: Three additive manufacturing techniques were tested: selective laser melting (SLM), electron beam melting (EBM), and computer‐aided design/cast (CADcast), with conventional casting as the control. Both the SLM and EBM groups were tested pre‐ and post‐finishing, for a total of six test groups (n = 10/group). A digital master design was used as the standard to which all frameworks were digitally compared by best‐fit analysis, which generated root mean square values using proprietary software. A one‐way ANOVA was conducted to test for statistical differences among materials, followed by a post‐hoc multiple comparison test (Tukey's test HSD). Surface roughness for one framework arbitrarily selected from each group was analyzed using a profilometer. Results: There was a significant difference in accuracy among the materials (F = 99.79, p < 0.0001). A post‐hoc Tukey test indicated that CADcast differed significantly from the other five materials (i.e., most accurate, p < 0.01). EBM prefinished and EBM finished were both significantly different from the other materials (i.e., least accurate). Color mapping images help visualize the differences between each framework compared to the master design. The surface roughness values ranged from 22 to 63.5 µm, with CADcast being the smoothest, and EBM prefinished the roughest. Conclusions: CADcast and SLM techniques were as or more accurate than the conventional technique for producing an uncomplicated framework design. Further investigation is recommended regarding the surface roughness of additive manufacturing products and potential biological complications. [ABSTRACT FROM AUTHOR]

The author presents a 2019 update of the acupuncture evidences, focusing only on evidences of the efficacy and/or specificity of acupuncture. This research is mainly based on the Σ Chinese Medical Sciences Database developed by CFA-MTC, Faformec and GERA. A critical analysis of some recommendations taking into account acupuncture is proposed. [ABSTRACT FROM AUTHOR]

Ecological efficiency is an important basis for evaluating the level of regional ecological civilization. It is also a common index and variable for the comprehensive study of resources and environment in geography and economics. The lack of research on the measure of ecological efficiency at the county level has restricted the above-mentioned problems to be researched at the county level. Constructing a scientific path for measuring ecological efficiency at the county level is conducive to accurately identifying the regional economic and social ecological development pattern and providing a possibility for county-level government green performance assessment. Under the national strategy of ecological priority and green development of the Yangtze River economic belt, taking the middle reaches of the Yangtze River as the research area and relying on the multi-source remote sensing data to construct the index system for estimating the ecological efficiency of the county scale, the ecological efficiency of the county area from 2000 to 2015 was calculated by using the non- consensual output EBM super efficiency model, and the GIS spatial analysis tool was used to reveal spatial differences and spatial correlation characteristics. A robust test scheme is designed to test the scientificity and robustness of the county- scale ecoefficiency measurement path. The results show that: (1) The ecological efficiency of the counties under the jurisdiction of Changsha- Zhuzhou-Xiangtan urban agglomeration and Poyang Lake urban agglomeration is better than that of the counties under the jurisdiction of Wuhan urban agglomeration. (2) During the study period, the ecological efficiency of 12 counties and cities such as Wuhan maintained a high level, while that of 7 counties and cities such as Ruichang maintained a low level. (3) The H-H concentration area of ecological efficiency in the early stage is mainly in Hengyang, Zhuzhou and its surrounding areas. By 2015, these areas had disappeared. The L-L agglomeration area of ecological efficiency follows the clockwise trend and gradually forms a closed circular area around the city of Wuhan. (4) The robustness test based on the comparison of city ecological efficiency rankings shows that the measurement path and results of county ecological efficiency constructed in this paper have high reliability. [ABSTRACT FROM AUTHOR]

• This paper has been meticulously analyzed the relationship between the water pollution and marketization. • The paper used many new methods to analyze the relationship between the water pollution and marketization. • The paper joined the complex network analysis into the spatial econometrics. The paper used the Epsilon-Based Measure (EBM) models, the data envelopment analysis (DEA) models, to measure the water resource utilization efficiency based on provincial panel data from 2008 to 2013 in China. The results show that overall of water resource utilization efficiency has a clear rising trend. Moreover, the results show distinct differences in the water resource utilization efficiency from different provinces in China. The water resource utilization efficiency from the eastern regions is higher than that in other regions. Then this paper used the Ordinary Least Square (OLS) models, the econometric models, to estimate the effect of marketization on the water resource utilization efficiency in China. The regression results show that the marketization has a positive effect on the water resource utilization efficiency in China. Lastly, this paper used the Spatial Error Model (SEM), the spatial econometric models, to estimate the spatial spillover effect of marketization on the water resource utilization efficiency in China. The regression results show that the marketization has a positive spatial spillover effect on the water resource utilization efficiency in China. The economic adjacency matrix was selected to be the spatial weight matrix. In particular, this paper used Quadratic Assignment Procedure (QAP), the complex network models, to analyze the rationality of spatial weight matrix selection. The results show that selecting the spatial weighting matrix based on economy-spatial distance is reasonable. Therefore, the research finding is that marketization can improve the water resource utilization efficiency. [ABSTRACT FROM AUTHOR]

We raise a problem of applicability of RCTs to validate nuclear diagnostic imaging tests. In spite of the wide application of PET and other similar techniques that use radiopharmaceuticals for diagnostic purposes, RCT-based evidence on their validity is sparse. We claim that this is due to a general conceptual problem that we call Prevalence of Treatment, which arises in connection with designing RCTs for testing any diagnostic procedure in the present context of medical research, and is particularly apparent in this case. We also identify three practical reasons why RCTs do not qualify as the best option for PET validation, which have to do with specific characteristics of nuclear diagnostic imaging, and of radiopharmaceuticals. The paper is meant to contribute both to the philosophical discussion on the EBM hierarchy of evidence, and on the specific debate on radiopharmaceuticals in nuclear medicine. [ABSTRACT FROM AUTHOR]

Additive manufacturing, a rapidly expanding technology, enables the production of intricate parts through the successive layering of materials. However, there remains a dearth of research on the viability of incorporating recycled powder into this process, with the potential to decrease expenses and enhance sustainability. This study's objective is to investigate the ramifications of employing recycled Titanium Ti-6Al-4 V alloy powder, for up to ten cycles, without the addition of virgin powder, in the context of additive manufacturing. The findings reveal that the mechanical properties of the material experience an approximate 40 % degradation in comparison to virgin powder. In ultrasonic very high-cycle fatigue tests (VHCF), the failure stress in the Z direction for additive manufacturing EB-PBF equals or surpasses 245 MPa. This research makes a significant contribution to the sustainable advancement of additive manufacturing, as it demonstrates the potential for recycling Titanium Ti-6Al-4 V grade 5 powder for the production of new items. This not only reduces costs but also serves the environment by circumventing unnecessary material disposal. Consequently, the outcomes of this investigation underscore the promising prospects of additive manufacturing with recycled powder, ushering in fresh opportunities for the industry, especially with regards to sustainability and environmental responsibility. [ABSTRACT FROM AUTHOR]

Background . Hypertension is a civilization disease which currently affects about 10.5 m people in Poland. The number of patients with diagnosed, untreated hypertension amounts to 18%, and as many as 45% of patients are treated ineffectively whereas only 26% are treated effectively. Impedance cardiography (IC) is an important tool both in diagnostics and the treatment of hypertensive patients, particularly in the case of antihypertensive treatment resistance. This method allows for the individualized treatment of each patient on the basis of hemodynamic parameters, monitoring of hypertensive patients in the outpatient care setting, and the assessment of cardiovascular risk factors. Objectives . The aim of the study was to evaluate the efficacy of hypotensive medications in patients with hypertension using impedance cardiography. Material and methods. The study involved 60 hypertensive patients, treated with antihypertensives, who failed to achieve the required blood pressure values. The modification of hypertension therapy was based on EBM (evidence-based medicine) and on hemodynamic parameters obtained using impedance cardiography. Results . It was found that high blood pressure therapy based on impedance cardiography parameters has a significant influence on blood pressure reduction compared to EM B-based therapy: below 140/90: 66.8 vs. 55.1% and below 130/80: 23.5 vs. 18.9%. Conclusions . On the basis of this study it was confirmed that impedance cardiography allows for a significant reduction of hypertension and the selection of the most effective therapeutic strategy, providing for the optimization and efficacy of hypertension treatment.

Machined devices made of titanium or titanium alloys are widely used in biomedical applications. Recently, additive manufacturing technologies (AM) were proposed to reduce the cost of parts and customise their shape. While several researchers have studied the characterisation of the machined surfaces of AM products, less attention has been focused on the study of the surfaces of as-produced parts. The aim of this study was to compare the surface and bulk properties of Ti-6Al-4V alloy products obtained using two types of AM—i.e., electron beam melting and direct metal laser sintering—in comparison to the wrought material and analyse their metallographic, crystallographic, topographic, and electrochemical properties. The metallographic and crystallographic, as well as topographic, analysis showed different microstructures and surface area extensions between the tested specimens. Potentiodynamic polarisation tests highlighted the complex electrochemical behaviour of additively manufactured parts if compared to that of the traditionally fabricated ones. The tests performed on mechanically polished parts underlined similar electrochemical performance between them, even if the additive manufactured ones exhibited a certain instability. Although the as-produced additive manufactured parts present exciting surface shapes, useful in the biomedical field, significant drawbacks remain. A more in-depth study of the device surface modifications, to improve their electrochemical behaviour, is needed.

In this work a mechanical characterization of Ti6Al4V processed by electron beam powder bed fusion additive manufacturing was carried out to investigate the viability of this technology for the manufacturing of flyable parts for general aviation aircraft. Tests were performed on different manufacturing conditions in order to investigate the effect of post processing as machining on the mechanical behavior. The study provides useful information to airframe designers and manufacturing specialists that work with this technology. The investigation confirms the low process variability and provides data to be used in the design loop of general aviation primary structural elements. The test results show a high level of repeatability indicating that the process is well controlled and reliable enough to match the airworthiness requirements. In addition, the so-called “as-built specimens”, i.e., specimens produced by the electron beam melting machine without any major post-processing, have lower mechanical performances than specimens subjected to a machining phase after the electron beam melting process. Specific primary structural elements will be designed and flight cleared, resulting from the findings presented herein.

Highlights • Lower mechanical properties of as-built EBM parts than those post-processed. • Different notch strengthening behaviour compared to wrought titanium. • The more severe the notch is, the higher the strength is. • Lower defect sensitivity on more severely notched components. Abstract Additive manufacturing (AM) offers the potential to economically produce customized components with complex geometries. However, the introduction of complex geometry goes hand in hand with the presence of notches. Thus, the basic understanding of the tensile behaviour of AM fabricated notched components must be substantially improved so that the unique features of this rapidly developing technology can be utilized in critical load bearing applications. This work aims to assess the tensile behaviour of different notched specimens manufactured by means of the Electron Beam Melting (EBM) technology and tested in their as-built conditions in order to reveal the interplay between notch geometry and AM specific processing. Scanning Electron Microscopy (SEM) was used to investigate the fracture surface of the broken samples, revealing the presence of process-induced defects, harmfully affecting tensile strength with a reduction of 10% and elongation to failure with 40% with respect to values reported in literature for heat treated AM parts, respectively. Interestingly, the authors have discovered an increase in the tensile strength with the severity of the stress concentrators, quite contrary to what is commonly observed for wrought Ti-6Al-4V. This notch strengthening behaviour particular to AM specimens is related to the influence of defects on the failure driving force. The authors provide a qualitative explanation for this phenomenon using 3D FE analyses together with a theoretical description via the ellipse criterion. [ABSTRACT FROM AUTHOR]

Highlights • Fatigue strength and surface roughness of as-built DMSL Ti64 and EBM Ti64 are determined and compared. • As-built DMSL Ti64 shows higher fatigue strength than as-built EBM Ti64. • A new test method using mini specimens conveniently provides knowledge on PBF metals fatigue. • The present fatigue data are coherent with data obtained with standard specimens and test methods. Abstract The powder bed fusion PBF is used in the fabrication layer-by-layer of metallic parts directly from a CAD file. Localized powder melting is obtained by a concentrated energy source. Fatigue tests of PBF Ti6Al4V were performed on smooth specimens produced with different orientations with respect to build direction using either a laser beam system (DMLS) or an electron beam system (EBM). As-built specimen were subjected the fatigue loading to understand and quantify the influence of the surface roughness and morphology. The original results are discussed on the basis of previous studies on the same material and processes taken from the literature. [ABSTRACT FROM AUTHOR]

Aim: To assess knowledge, attitude, and practice of graduate physicians toward evidence‐based medicine (EBM) and the barriers to the implementation of EBM worldwide. Methods: Relevant databases were searched systematically with appropriate search terms up to September 2017. References of the articles detected by the search were screened for any new articles. Risk of bias was assessed by two independent reviewers. Data were extracted from the full‐text articles based on the study summary measures and were collected in a data table. Results: Fifty‐seven articles were finally included in this systematic review. The studies were of variable and moderate quality. Based on our results, physicians have a generally positive attitude toward EBM and most of them believe that its implementation improves patient care. However, their self‐reported awareness and knowledge regarding EBM concepts and the main databases are generally poor. The major barriers to the practice of EBM were related to patient overload and lack of personal time, knowledge, and skills rather than a lack of facilities and resources. However, this pattern varied among the studies. Most of the physicians in the included studies referred to their colleagues and textbooks to answer most of their clinical questions. Conclusion: Although many physicians have poor EBM knowledge and skills, the majority of them have a positive attitude toward the implication of EBM. To overcome the barriers against the evidence‐based practice, it is recommended that appropriate policies be adopted to decrease physicians' workload and to provide them with preappraised evidence. [ABSTRACT FROM AUTHOR]

The water resources system is closely related to the regional economy. It is more intuitive to use economic value to reflect the losses caused by water system risks such as water resource imbalance and mismatch. In order to evaluate the risk of water resources system through quantitative economic value, this paper firstly constructed the water loss risk economic loss model, and used the EBM model to calculate the water use efficiency, and combined the water price and per capita wage in Heilongjiang Province to determine the water resource risk value. Then, based on the EBM, a two-stage Tobit model was added to analyze the causes of the risk economic loss of the water resources system. The results show that the least economic loss caused by insufficient water resources investment in Heilongjiang Province from 2000 to 2020 is 7.52 billion yuan (2008), the highest is 42.51 billion yuan (2013); the economic loss of minimum output of water resources is 111.9 billion yuan (2000), the highest is 1 106.8 million yuan (2012). From 2000 to 2015, the economic loss of water resources in Heilongjiang Province increased year by year, and the economic loss of water resources output accounted for more than 90% of the economic loss of water resources system. It is estimated that the economic loss of water resources risk in 2020 is 813.87 billion yuan. Jixi, Suihua, Qiqihar, Harbin, Daqing, Jiamusi, Shuangyashan, Qitaihe and Hegang have lower economic losses caused by input and better water resources allocation. The cities with large economic losses caused by output are Yichun, Mudanjiang and Suihua, which require the government to pay more attention to the utilization of water resources in the region. It is necessary to rationally allocate water resources, improve water use efficiency, and reduce the risk economic loss of water resources systems. Hegang, Qitaihe, Jiamusi and other major grain producing areas have greater risk of water resources, greater economic losses and lower water use efficiency. In general, the agricultural water use efficiency in Heilongjiang Province is low, and the phenomenon of flood irrigation is still serious. It is necessary for the government and farmers to cooperate with each other to improve water use efficiency. During the research period, the risk economic loss of water resources system in Heilongjiang Province was large, and the water use efficiency was low. The water use efficiency in most areas was only in the medium range. From the perspective of spatial distribution, water use efficiency is high in the north-south direction and low in the east-west direction. The water use efficiency in the eastern region is lower than that in the other regions. The water resources system of Heilongjiang Province is affected by industrial structure, per capita GDP, per capita water resources and water resources investment. Water price is correlated with water use efficiency in only a few cities, indicating that the government's purpose of regulating water resources through water prices has not been met, and the government needs to introduce relevant policies to change in the future. This article will support the development of risk aversion measures for subsequent water resources systems. [ABSTRACT FROM AUTHOR]

A high alloy CrMnNi TRIP steel has been processed by electron beam melting, a powder-bed based additive manufacturing (AM) technology, to investigate its fatigue properties. The material was characterized by average grain sizes of 32 μm in the as-built and 106 μm in the solution annealed state. Total strain controlled fatigue tests with strain amplitudes in the range of 0.25% ≤ Δε t /2 ≤ 1.2% were performed revealing a similar cyclic deformation behavior and α′-martensite evolution compared to a hot pressed reference material. Moreover, the fatigue lives of the EBM states were surprisingly high in consideration of severe process-induced lack of fusion defects of more than 500 μm revealed by investigations of the fracture surfaces. Thus, the impact of these inhomogeneities was substantially alleviated by the outstanding damage tolerance of the present TRIP steel induced by its high ductility and remarkable hardening capacity. [ABSTRACT FROM AUTHOR]

Conventional tactile and optical testing methods are not capable to detect complex inner geometries or complex surface shapes. Detecting porosities in parts is also not possible with those nondestructive methods. Among other material parameters, geometrical accuracy is essential to determine part's quality. Additive manufacturing processes also have to be optimized regarding geometry deviations caused by distortion or unfavorable orientation in the build chamber. For additive manufactured parts that incorporate previously mentioned features, high-performance computer tomography is the more suitable nondestructive testing method. Components of different materials such as plastics, ceramics, composites, or metals can be completely characterized. This nondestructive testing method was used for porosity analysis regarding the shape and local distribution of pores in an additive manufactured part to find correlations concerning the most suitable process conditions. The measured part data were also compared to original CAD files to determine zones of deviation and apply specific process strategies to avoid distortion. This paper discusses the results of integrating high-performance computer tomography (power: 500 W, max. part size: Ø 300 mm, 300 × 430 mm2) in a productionlike environment of additively manufactured parts for a wide range of technologies (i.e., electron beam melting and selective laser melting). [ABSTRACT FROM AUTHOR]

In response to the increasing emphasis on ‘evidence‐based teaching’, this article examines the privileging of randomised controlled trials and their statistical synthesis (meta‐analysis). It also pays particular attention to two third‐level statistical syntheses: John Hattie's Visible learning project and the EEF's Teaching and learning toolkit. The article examines some of the technical shortcomings, philosophical implications and ideological effects of this approach to ‘evidence’, at all these three levels. At various points in the article, aspects of critical realism are referenced in order to highlight ontological and epistemological shortcomings of ‘evidence‐based teaching’ and its implicit empiricism. Given the invocation of the medical field in this debate, it points to critiques within that field, including the need to pay attention to professional experience and clinical diagnosis in specific situations. Finally, it briefly locates the appeal to ‘evidence’ within a neoliberal policy framework. [ABSTRACT FROM AUTHOR]

This paper examines alternative hypotheses of beta convergence for different measures of energy efficiency. We collect a novel set of prefecture-level data that substantially extend the breadth of the datasets ever used in this literature. GMM estimators are then used to empirically test the national and club convergence of energy efficiency among these prefectures. We find strong evidence for prefecture-level national and club convergence in energy efficiency. In particular, the listed key environmental protection (KEP) prefectures, prefectures in central and western regions and prefectures not listed as resource-based (RB) converge faster than the non-KEP prefectures, prefectures in eastern region and RB prefectures. Sensitivity analyses suggest that these results are robust to alternative measures of energy efficiency and GMM specifications. [ABSTRACT FROM AUTHOR]

This study outlines a model calibration approach for an accelerated creep test called the dynamic negative stepped test (DNST) to enable the rapid screening of creep-resistant materials. In DNST, stress is stepped decreased based on the attainment of a sufficient minimum-creep-strain-rate (MCSR) at each stress level. Steps are repeated, torturing the material, until rupture occurs. The DNST is advantageous as a screening test for new alloys. Alloys and heats with superior creep resistance will be able to survive longer and with greater ductility than those with poor creep resistance. The calibration of a constitutive model to DNST data furnishes predictions of the conventional creep response being between 65 h and 6685 h from the relatively short (<130 h) DNST Data. In this study, DNSTs are performed on electron beam melted (EBM) Ti-6Al-4V at 650 °C with stepping through 150, 75, 60, and 50 MPa. Six build orientations are tested including 0 deg, 30 deg, 45 deg, 60 deg, 90 deg, and V (vertical) direction. The Wilshire-Cano-Stewart (WCS) model is employed to calibrate the experimental data. A systematic calibration approach is adopted. Each step is calibrated numerically. A unique set of minimum-creep-strain-rate (MCSR) and stress-rupture (SR) related material constants, i.e., the Wilshire and Sinh constants are obtained for each build direction. A nonhomogenous objective function is used to numerically optimize the strain trajectory and damage trajectory constants. To find the best-fit curve, the strain trajectory constants, and damage trajectory constants are numerically refined for each step. The WCS model shows a near-perfect prediction of the DNST data. Based on the calibrated constants, conventional creep curves are generated in order to determine which build orientations are likely to exhibit poor, moderate, and superior creep resistance. Predictions of MCSR and SR curves over a wide stress range are estimated outside the experimental range to investigate the extrapolation pedigree of the approach. This will allow the material designers to have more confidence in DNST-generated test data for predicting long-term creep response and structural lifetime. [ABSTRACT FROM AUTHOR]

Goede toepassing van Evidence Based Medicine (EBM) bestaat uit het wegen van de best beschikbare evidence, de wensen en voorkeuren van de patiënt en de klinische expertise van de arts. In de praktijk worden ouderen echter vaak uitgesloten van deelname aan wetenschappelijke studies en is er vaak sprake van multimorbiditeit, hetgeen het toepassen van EBM bemoeilijkt. Gezamenlijke besluitvorming (SDM), een proces waarbij hulpverlener en patiënt samen tot een passende behandeling komen kan helpen om EBM voor deze groep patiënten vorm te geven. In dit artikel geven we handvatten voor het vinden van de relevante literatuur voor de geriatrische patiëntenpopulatie en voor het vormgeven van het SDM proces om te komen tot echt op het individu afgestemde zorg.

Biomedical metal materials with good corrosion resistance and mechanical properties are widely used in orthopedic surgery and dental implant materials, but they can easily cause stress shielding due to the significant difference in elastic modulus between the implant and human bones. The elastic modulus of porous metals is lower than that of dense metals. Therefore, it is possible to adjust the pore parameters to make the elastic modulus of porous metals match or be comparable with that of the bone tissue. At the same time, the open porous metals with pores connected to each other could provide the structural condition for bone ingrowth, which is helpful in strengthening the biological combination of bone tissue with the implants. Therefore, the preparation technologies of porous metal implants and related research have been drawing more and more attention due to the excellent features of porous metals. Selective laser melting (SLM) and electron beam melting technology (EBM) are important research fields of additive manufacturing. They have the advantages of directly forming arbitrarily complex shaped metal parts which are suitable for the preparation of porous metal implants with complex shape and fine structure. As new manufacturing technologies, the applications of SLM and EBM for porous metal implants have just begun. This paper aims to understand the technology status of SLM and EBM, the research progress of porous metal implants preparation by using SLM and EBM, and the biological compatibility of the materials, individual design and manufacturing requirements. The existing problems and future research directions for porous metal implants prepared by SLM and EBM methods are discussed in the last paragraph.

In this work, the feasibility of laser surface finishing of parts obtained by additive manufacturing (AM) was investigated. To this end, a 450 W fiber laser (operating in continuous wave, CW) was adopted to treat the surface of Ti-6Al-4V samples obtained via electron beam melting (EBM). During the tests, different laser energy densities and scanning speeds were used. In order to assess the quality of the treatment, either the as-built or the treated samples were analyzed by means of a three-dimensional (3D) profilometer, digital microscopy, and scanning electron microscopy. Analysis of variance (ANOVA) was performed to check which and how process parameters affected the finishing. The results show that, in the best conditions, the laser treatment reduced surface roughness by about 80%.

The performance of two selective electron beam melting operation modes, namely the manual mode and the automatic ‘build theme mode’, have been investigated for the case of a Ti-6Al-4V alloy (45−105 μm average particle size of the powder) in terms of porosity, microstructure, and mechanical properties. The two operation modes produced notable differences in terms of build quality (porosity), microstructure, and properties over the sample thickness. The number and the average size of the pores were measured using a light microscope over the entire build height. A density measurement provided a quantitative index of the global porosity throughout the builds. The selective-electron-beam-melted microstructure was mainly composed of a columnar prior β-grain structure, delineated by α-phase boundaries, oriented along the build direction. A nearly equilibrium α + β mixture structure, formed from the original β-phase, arranged inside the prior β-grains as an α-colony or α-basket weave pattern, whereas the β-phase enveloped α-lamellae. The microstructure was finer with increasing distance from the build plate regardless of the selected build mode. Optical measurements of the α-plate width showed that it varied as the distance from the build plate varied. This microstructure parameter was correlated at the sample core with the mechanical properties measured by means of a macro-instrumented indentation test, thereby confirming Hall-Petch law behavior for strength at a local scale for the various process conditions. The tensile properties, while attesting to the mechanical performance of the builds over a macro scale, also validated the indentation property measurement at the core of the samples. Thus, a direct correlation between the process parameters, microstructure, porosity, and mechanical properties was established at the micro and macro scales. The macro-instrumented indentation test has emerged as a reliable, easy, quick, and yet non-destructive alternate means to the tensile test to measure tensile-like properties of selective-electron-beam-melted specimens. Furthermore, the macro-instrumented indentation test can be used effectively in additive manufacturing for a rapid setting up of the process, that is, by controlling the microscopic scale properties of the samples, or to quantitatively determine a product quality index of the final builds, by taking advantage of its intrinsic relationship with the tensile properties.

Owing to the inherent nature of the process, typically material produced via electron beam melting (EBM) has a columnar microstructure. As a result of that, the material will have anisotropic mechanical properties. In this work, anisotropic elastic properties of EBM built Alloy 718 samples at room temperature were investigated by using experiments and modelling work. Electron backscatter diffraction data from the sample microstructure was used to predict the Young’s modulus. The results showed that the model developed in the finite element software OOF2 was able to capture the anisotropy in the Young’s modulus. The samples showed transversely isotropic elastic properties having lowest Young’s modulus along build direction. In addition to that, complete transversely isotropic stiffness tensor of the sample was also calculated. This paper is part of a thematic issue on Nuclear Materials. [ABSTRACT FROM AUTHOR]

As evidence-based medicine has increasingly become the standard for assessing the efficacy of health care, the Czech Republic finds itself in a dilemma, with centuries of sanatorium-style spa treatments resisting easy categorization. Despite some critics' contentions that spas are "pointless holidays" and reductions in government funding of health spas, in 2014 Czech courts affirmed every Czech citizen's right to spa treatments if their health status merits it. Drawing on research in two children's respiratory spas, this article considers the experiences of patients aged 2-15 and their accompanying parents or guardians (mainly mothers) to suggest that in addition to the range of therapeutic procedures highlighted within spa cures, more amorphous aspects-such as pleasure and discipline-may be just as central to spas' successes. Indeed, as some spa physicians contend, spas may be considered a "package deal," to which EBM criteria is not easily applied. [ABSTRACT FROM AUTHOR]

The relationship between fisheries and marine spatial planning (MSP) is still widely unsettled. While several scientific studies highlight the strong relation between fisheries and MSP, as well as ways in which fisheries could be included in MSP, the actual integration of fisheries into MSP often fails. In this article, we review the state of the art and latest progress in research on various challenges in the integration of fisheries into MSP. The reviewed studies address a wide range of integration challenges, starting with techniques to analyse where fishermen actually fish, assessing the drivers for fishermen's behaviour, seasonal dynamics and long-term spatial changes of commercial fish species under various anthropogenic pressures along their successive life stages, the effects of spatial competition on fisheries and projections on those spaces that might become important fishing areas in the future, and finally, examining how fisheries could benefit from MSP. This paper gives an overview of the latest developments on concepts, tools, and methods. It becomes apparent that the spatial and temporal dynamics of fish and fisheries, as well as the definition of spatial preferences, remain major challenges, but that an integration of fisheries is already possible today. [ABSTRACT FROM AUTHOR]

Selective Laser Melting (SLM) and Electron Beam Melting (EBM) are powder bed fusion processing which allows to build-up parts by successive addition of layers using 3D-CAD models. Among the advantages, are the high degree of freedom for part design and the small loss of material, which explain the increase of Ti-6Al-4V parts obtained by these processes. However, Ti-6Al-4V parts produced by SLM and EBM contain defects (surface roughness, porosity, tensile residual stresses) which decrease significantly the High Cycle Fatigue (HCF) life. In order to minimize the porosity and tensile residual stresses, post-processing treatments like Hot Isostatic Pressing (HIP) and Stress Relieving are often conducted. But the modification of the surface roughness by machining is very costly and not always possible, especially for parts with complex design. The aim of this work is to evaluate the effect of the surface roughness and microstructure of Ti-6Al-4V parts produced by SLM and EBM on the HCF life. Five sets of specimens were tested in tension-compression (R=-1; f=120Hz): Hot-Rolled (reference); SLM HIP machined; SLM HIP As-Built; EBM HIP machined; EBM HIP As-Built. For each condition, microstructure characterization, observation of the fracture surface of broken specimens and surface analysis were carried out respectively by Optical Microscope (OM), Scanning Electron Microscope (SEM) and 3D optical profilometer. Results of fatigue testing show a significant decrease of the HCF life mainly due to the surface roughness. Along with experimental testing, numerical simulations using FEM were conducted using the surface scans obtained by profilometry. Based on extreme values statistics of the crossland equivalent stress averaged on a critical distance, a methodology is proposed to take into account the effect of the surface roughness on the HCF life. [ABSTRACT FROM AUTHOR]

While Traditional Chinese medicine (TCM) does not lack well-conceived, empirically- and timetested diagnostic and therapeutic treatment methodologies, these may be insufficient to support its fuller integration with the dominant Western health system. Western medicine continues to discount, ignore, or even dismiss, many of the fundamental theories of TCM. Moreover, there continues to be widespread criticism of the methods, and therefore the findings, of TCM-related research. Although questions increasingly arise as to the appropriateness of randomized controlled trials (RCTs) for studying certain types of medical research questions, including many pertaining to TCM, RCTs remain the gold standard for scientific research and strongly influence evidence-based medicine (EBM). Aspects of EBM have been an informal component of TCM dating back to the time of Zhang Zhong-Jing, and the Shang Han Lun certainly reflects key elements of formal EBM. A deeper understanding and greater use of EBM among TCM professionals would improve the overall perception and credibility of TCM and contribute to its fuller integration with the conventional Western healthcare system, including among those who provide, pay for, and utilize TCM services. [ABSTRACT FROM AUTHOR]

Drugs that have shown their efficacy in diabetes mellitus are ACE inhibitors and statins. However, guidelines focus on intensive glycemic control although there is no proof of its clinical efficacy. Howdoes it influenceGP'sprescriptions? When they are confronted with a diabetic patient who is treated with metforminwho has aHbA1c of 8.1%, 84.4% of GPs prescribe a second drug of which 92% are an oral antidiabetic agent. 85.4% want to improve the HbA1c. Medical prescriptions are based mainly on a biological objective which does not correspond to Evidence BasedMedicine. [ABSTRACT FROM AUTHOR]