Medtronic (Ireland)

This paper examines the optimization of one of the most important metrological characteristics of dosimetric X-ray and gamma-ray installations – the geometric size of the uniform field of the gamma radiation field. The influence of the geometric shape of lead attenuators in verification installations on the size of the uniform region of the gamma radiation field is analyzed. It is shown that the use of classically shaped attenuators leads to a significant reduction in the width beam of uniform, which limits the number of simultaneously verified dosimetric instruments designed for measuring the air kerma rate. Experimental measurements of the air kerma rate were conducted using a setup with various attenuator combinations, and a comparison with published data was made. Based on the results, an optimized attenuator shape is proposed, ensuring both the required attenuation factor and maintaining the size of the uniform region of the gamma radiation field. A design implementation of optimized attenuators is presented, protected by a patent from the Eurasian Patent Office, confirming the novelty of the proposed technical solution.

Keterbatasan sarana dan program pembinaan sosial di panti asuhan sering berdampak pada rendahnya perilaku prososial anak, seperti empati dan kerja sama. Kegiatan Pengabdian kepada Masyarakat ini bertujuan mengelola program literasi sosial sebagai upaya meningkatkan perilaku prososial anak panti asuhan. Metode yang digunakan adalah deskriptif kualitatif dengan pendekatan PKM berbasis program. Subjek kegiatan berjumlah 12 anak asuh berusia 3–18 tahun di Panti Asuhan Mustika Abadi Anak Indonesia, yang dikelompokkan ke dalam tiga kelompok usia. Intervensi dilakukan melalui ceramah interaktif, diskusi kelompok, simulasi permainan, dan refleksi berbasis experiential learning. Hasil kegiatan menunjukkan peningkatan perilaku prososial anak, ditandai dengan munculnya sikap empati, saling membantu, kerja sama, dan komunikasi sosial yang lebih positif pada seluruh kelompok usia. Program literasi sosial berbasis tahap perkembangan terbukti efektif sebagai media pembinaan sosial anak panti asuhan.

This paper presents a novel software platform developed for a $1.5 billion electrical infrastructure project that integrates dynamic pricing, geospatial design data, and circular economy principles. Traditional Bill of Quantities (BoQ)s often becomes outdated due to static pricing and disconnected design updates, leading to inefficiencies and cost overruns. The proposed system automatically generates BoQs from Geographic Information System (GIS) based network designs, synchronizes them with market prices, and incorporates country-specific taxes, duties, and regulatory requirements. Critically, it evaluates material choices based on recyclability, and hazardous content reduction, and reuse potential. Thus, aligning procurement and design decisions with circular economy goals. The platform also supports financial planning by modeling capital investment options, calculating internal rates of return (IRR), and optimizing funding strategies. It factors in carbon offsets, regional incentives, and global energy pricing trends to assess long-term economic and environmental feasibility. This approach offers utilities and large infrastructure stakeholders a smarter scalable and adaptable planning framework.

To evaluate glycemic metrics and insulin delivery during real-world use of the MiniMed 780G (MM780G) system on days when users did not administer boluses. Global CareLink personal data of consenting MM780G users (N = 369,467) uploaded from 2 January 2020 to 31 March 2025 were analyzed. Among these individuals, 54,553 users experienced ≥10 days without any user-initiated boluses. Evaluated key metrics included time in range (TIR; 70-180 mg/dL), time below range (TBR; <70 mg/dL), time above range (>180 mg/dL), the glucose management indicator (GMI), and total insulin delivered. These were analyzed for the overall population who did not initiate boluses and for those who used and did not use recommended optimal settings (ROS; defined as a 100 mg/dL glucose target and a 2-h active insulin time). Subgroup analyses were conducted by age (≤15 or >15 years) and diabetes type (type 1 or 2). On days when boluses were missed, ROS users had a mean sensor glucose (SG) of 149.2 mg/dL, with mean TIR, TBR, and GMI of 76.3%, 0.8%, and 6.9%, respectively, whereas non-ROS users had a mean SG of 159.7 mg/dL with mean TIR, TBR, and GMI of 69.3%, 0.9%, and 7.1%, respectively. ROS use was associated with more individuals achieving consensus TIR, TBR, and GMI goals. These data demonstrate effective glycemic control with the MM780G system on days when some users did not initiate boluses. A greater proportion of real-world users achieved glycemic goals when ROS were used.

Sex‐based disparities in the incidence, prevalence and disease manifestations have been observed across various medical conditions, including type 1 diabetes (T1D). Differences in glycaemic control and quality of life between men and women have been reported, with women experiencing lower rates of glycaemic targets and a higher risk for long‐term complications, particularly cardiovascular disease. Additionally, women face a greater economic and mental health burden related to T1D. This narrative review explores the challenges that complicate glycaemic management in women living with T1D, including hormonal influences during puberty, pregnancy and the (peri‐) menopausal period. We also summarize current available evidence on the safety and efficacy of the MiniMed™ 780G (MM780G) system in addressing these challenges for women living with T1D. Finally, recent real‐world data are reported on the absence of significant sex‐related differences in glycaemic outcomes of over 280 000 real‐world users of the MM780G, across various age groups from childhood and adolescence to the (peri‐) menopausal period.

In Japan, the implantation of implantable cardioverter defibrillators (ICD) for the primary prevention of sudden cardiac death (SCD) is not covered by insurance reimbursement, and the underuse of ICDs has been noted. Therefore, this study analyzed the medical costs incurred due to a lack of primary prevention ICD therapy for SCD. This retrospective cohort study analyzed data from 4 advanced critical care centers between January 2020 and December 2024. From a database of 3,606 cases of cardiac arrest, there were 348 patients with a documented rhythm at the time of arrest that could have been treated with an ICD. Of these patients, 43 (12.4%) had documented evidence of heart failure treatment and were eligible for ICD implantation before experiencing a cardiac arrest. The total mean (±SD) medical cost for these patients was US $11,679±14,666 (¥1,775,150±2,229,272). In this multicenter retrospective analysis, we identified a subset of patients who were eligible for primary prevention ICD therapy but did not receive it prior to experiencing sudden cardiac arrest. These cases were associated with substantial post-arrest medical costs. Our findings highlight the potential clinical and economic impact of the underutilization of ICDs in Japan and suggest that broader implementation of guideline-directed ICD therapy for primary prevention may reduce both mortality and healthcare expenditure.

ABSTRACTBackgroundCardiac implantable electronic device (CIED) infections are a serious complication that occurs in ~1%–3% of device recipients. However, data on total healthcare costs associated with CIED infections in Australia are scant. This study aims to comprehensively estimate the total healthcare costs of CIED infections in Australia.MethodsThis retrospective cohort study included patients 18+ years diagnosed with CIED infections between July 2017 and September 2022 in New South Wales. Using linked administrative data, costs were estimated for in‐hospital care, emergency department visits, outpatient services, Medicare claims, ambulance transport, and dispensed medications in the period from 28 days before to 42 days after CIED infection‐related hospitalizations.ResultsWe identified 726 patients with CIED infections, of whom 233 (32.1%) died during a mean follow‐up of 35.6 months. The average treatment costs of $77 746, predominantly driven by hospital expenses (88.3%). Key hospital cost drivers included device type, mechanical ventilation, intensive care unit (ICU) stays, temporary pacing, lengths of stay, high‐risk patients, and multiple comorbidities. Patients undergoing complete system removal with reimplantation (31.7% of patients) had the highest costs ($120 792), followed by patients with complete system removal only (15.7%; $98 453), and without system removal (52.6%; $45 649). For patients undergoing complete system removal and/or reimplantation procedures, the cost varied by device type ($90 089 for pacemaker patients, $111 677 for cardiac resynchronization therapy (CRT)‐pacemaker, $128 864 for implantable cardiac defibrillators, and $148 888 for CRT‐defibrillator patients).ConclusionsOur findings highlight the substantial health care costs associated with CIED infections, with wide variations across patient factors and clinical care pathways.

Abstract Background Right ventricular placement of the OmniaSecure defibrillation lead has demonstrated high defibrillation success, low occurrence of lead-related major complications and high predicted reliability. With the advent of left bundle branch area pacing (LBBAP) as a more physiologic option for therapeutic delivery of pacing, LBBAP has emerged as a potentially more desirable option for pacing in the ICD population. Purpose To understand the safety and performance of the OmniaSecure defibrillation lead when placed in the LBBA in ICD and CRT indicated patients. Methods The Lead Evaluation for Defibrillation and Reliability in LBBAP (LEADR LBBAP) clinical trial is a global, prospective, non-randomized, multi-center study to evaluate the OmniaSecure defibrillation lead in the LBBAP position. Enrolled patients are indicated for de novo implantation of a primary or secondary prevention ICD (LBBAP-ICD) or left bundle branch area pacing-optimized CRT-D (LOT-CRT-D). LOT-CRT-D patients required a coronary sinus lead for LV pacing. At least 300 patients are required for enrollment with a minimum of 150 LOT-CRT-D implant attempts. Per study protocol, LBBAP includes deep septal pacing. The primary efficacy objective is defibrillation efficacy at implant exceeding a pre-specified threshold of 88% in at least 160 patients. The defibrillation protocol aligned to standard of care testing with a maximum of six inductions and troubleshooting and/or lead repositioning in-between. Defibrillation success was defined as termination of first sustained shockable ventricular arrhythmia (SSVA) episode with 18J or 10J safety margin or termination of additional induced SSVA episodes with a 10J safety margin. The primary safety objective is to demonstrate the lead-related major complication rate at 3 months post-implant. Database snapshot was February 12, 2025. Results As of data snapshot, a total of 191 patients met the criteria for LBBAP implant attempt (age: 66.3±12.0 years; 31.0% female). The physician-reported LBBAP implant success per protocol was 95.8% (n=183; n=104 LBBAP-ICD; n=79 LOT-CRT-D). Defibrillation testing was performed in 162 patients with a protocol success rate of 100%. In 98.1% there was no need for repositioning or troubleshooting as the first induced SSVA was successfully treated. During available follow up (116.7±37.4 days; 62 patients with 3-month follow-up), there was one major lead related complication (high RV threshold) 92 days after implant that resulted in replacement with a non-study lead. There were no lead fractures or deaths related to system and/or procedure. Conclusion The LEADR LBBAP clinical trial is the first large clinical trial to prospectively assess the safety and efficacy of a novel defibrillation lead implanted for LBBAP in a large cohort of ICD and CRT-D indicated patients. These results demonstrate procedural-related safety and efficacy of the OmniaSecure lead when placed for LBBAP. Long-term follow-up is ongoing.

In lung transplantation, there are multiple factors that can contribute to the need for a left atrial cuff reconstruction. While donor and recipient anatomy are inherent considerations during the procedure, other factors like type of surgical devices used may be controlled. This case series describes the safety, ergonomics, and potential left atrial length gain when using a small profile reload during lung transplant recipient pneumonectomies. A single operating surgeon at a single institution performed 35 bilateral lung transplants with a small four-row vascular stapler. 138 firings (136 pulmonary veins and two firings on pulmonary arteries) were analyzed. Twenty-three patients were males (65.7%), mean age was 59.6 ± 12.6 years, and mean BMI was 25.7 ± 4.3 kg/m2. Idiopathic pulmonary fibrosis was the diagnosis in 57% of patients and chronic obstructive lung disease in 29% of the patients. Mean operative time was 7.5 ± 2.04 h. There were no device-related complications. These findings suggest the clinical applicability of a small diameter four-row stapler in recipient pneumonectomies.