The as-prepared carbon materials possessed a porous structure with a large BET surface area of 2933 m2 g−1, while being simultaneously naturally doped by three heteroatoms . More importantly, the resultant N, P, S-tri-doped porous carbon exhibited outstanding electrochemical activity towards triiodide reduction with good stability. Moreover, the DSC with the optimized TPC electrode showed a power conversion efficiency of 7.83%, which is comparable to the device with a costly Pt-based CE (8.34%), measured under one sun illumination (AM 1.5G). This work demonstrates that carbonization of fish waste offers a cost-effective approach to prepare multifunctional carbon materials for advanced energy applications.Strategies for environmentally friendly reutilization of waste biomass are highly desirable nowadays. Meanwhile, seeking Pt-free electrocatalysts for triiodide reduction with both high catalytic activity and low cost is critical for the development of dye-sensitized solar cells (DSCs). In the study, heteroatom tri-doped porous carbons (TPCs) were prepared  Tri-doped porous carbon derived from waste-biomass was developed for a highly efficient counter electrode in dye-sensitized solar cell with an efficiency of 7.83%. Consequently, the ideal catalyst for the CE should possess high conductivity, good electrocatalytic activity of the redox couple, excellent stability in the corrosive electrolyte and low production costs.4,6 In most cases, platinum metal is commonly utilized as a CE in DSCs due to its high conductivity and outstanding catalytic activity for triiodide reduction. However, its high-cost, scarcity and poor stability in corrosive I3−-based electrolyte limit its application in large-scale manufacture.10–16 Thus, alternatives to the Pt CE have been extensively explored, such as transition metal compounds,14,17,18 conducting polymers19,20 and carbon-based materials.21–28 Among these materials, the carbon-based materials, including mesoporous carbon,22,27 hollow carbon nanospheres,23 graphene24–26 and activated carbon,28 are the most popular electrode materials owing to their intrinsic chemical inertness against corrosive electrolyte as well as high surface areas. Further investigations reveal that the edges and defect sites within the graphitic carbon framework provide active sites for efficient triiodide reduction.21–23,25,26 Moreover, the implantation of heteroatoms, such as nitrogen, sulfur and phosphorus, into the graphitic carbon lattice could induce charge redistribution, create more active sites, and thus boost the reduction of the redox couple.21–23,26,29 For example, the lone pair electrons in both pyridinic and quaternary nitrogen states account for promoting the catalytic activity of disulfide/thiolate redox shuttle and cobalt trisbipyridine redox mediator.29–31 With phosphorus-doping treatment on the reduced graphene oxide (rGO) CE, the power conversion efficiency of the device increased from 4.18 to 6.04%.21 The enhanced catalytic performance is ascribed to the existence of P–C bonds distributed in the carbon matrix.21 Meanwhile, dual-doped carbonaceous materials have also been widely investigated as counter electrode materials in DSCs.30 Compared with the N-doped (3.85%) or S-doped (4.23%) rGO CE-based device, the device containing N, S dual-doped rGO CE showed an increased power conversion efficiency (4.73%).30 The increased performance is attributed to the presence of a highly localized state of carbon within the carbon frameworks. This enormous progress indicates that carbon-based materials are promising alternative materials for Pt CE in DSCs.Considering the growing demand of energy and worsening of environmental pollution, there is a must to develop sustainable energy systems.32–34 Consequently, much effort has been devoted to the preparation of functional carbon materials from renewable biomass for energy applications. For instance, pine cone flower and sea tangle were utilized to synthesize porous carbons,11,35 and soybean powder was used to prepare carbon quantum dots in photovoltaic applications.33 As reported, a large amount of fish waste is generated in the food industry daily. Fish waste is abundant in nitrogen, sulfur and phosphorous elements, besides having a high content of carbon.36 Thus, fish waste is an ideal precursor for synthesis of heteroatom-doped carbon materials. Nevertheless, to the best of our knowledge, the heteroatom doped porous carbon derived from biomass as a counter electrode in DSCs has never been investigated.Generally, the above-mentioned porous carbon materials were prepared using soft or hard template approaches with chemicals containing nitrogen and sulfur as the heteroatom sources. Additionally, the synthesis strategy involves rigorous preparation conditions and high production cost. Therefore, simply and cost-effective approaches are desirable for synthesis of porous carbon catalysts for high-efficient counter electrode. Biomass is a low-cost raw material for preparing carbon materials because of its rich organic functional groups, abundant supply and environmental friendliness.via simple carbonization of fish waste. As-prepared TPC possessed a large surface area. Moreover, the TPC electrode presented both outstanding catalytic activity and high electrochemical stability on triiodide reduction. Besides, the synthesis process is simple and easy to control, and thus suitable for industrial application. These interesting results demonstrated that porous carbon derived from fish waste exhibited advantages for application as a high-performance counter electrode in DSCs.Herein, in the present study, we demonstrated the synthesis of tri-heteroatom-doped porous carbon (TPC) for DSC application 22.12PtCl6, tert-butylpyridine and acetonitrile were purchased from Sigma-Aldrich Chemical Inc. These chemicals and solvents were in analytical grade and used as received.Potassium hydroxide, lithium perchlorate, hydrochloric acid, ethyl cellulose, terpineol and titanium isopropoxide in analytical grade were from Sinopharm Chemical Reagent Co. Ltd. Lithium iodide, iodine, dimethylpropyl imidazolium iodide, H2.236 The fish scales were washed with de-ionized water, and then dried in an oven. The raw material was firstly pre-carbonized at 300 °C for one hour under nitrogen atmosphere. Subsequently, the pre-carbonized sample was activated with KOH in a quartz boat at 700 °C for 1.5 hours under nitrogen atmosphere. The as-obtained solid sample was washed with diluted HCl aqueous solution and de-ionized water, respectively. Finally, the product was dried at 80 °C for 24 h and kept in desiccator before use.The porous carbon was prepared from fish waste according to reported processes.10 Briefly, a certain amount of carbon powder  was grinded with 1.0 mL of binder solution under atmosphere and stirred for 24 h to get a homogeneous dispersion. The binder solution was the mixture of 0.2 g of ethyl cellulose and 8.0 mL of terpineol as well as 0.5 mL titanium isopropoxide. Then, the carbon pastes were coated on the FTO-glass  using doctor-blading method and dried at 120 °C for 15 min. The electrodes were subsequently sintered under Ar atmosphere at 500 °C for 30 min. The thickness of the porous carbon layer on the resultant electrode was estimated using SEM. For comparison, the Pt/FTO CE electrode was prepared by thermal decomposition of H2PtCl6 (5 mM in isopropanol) on the FTO substrate using spin-coating method and sintered at 390 °C for 15 min.To fabricate carbon counter electrode, the as-obtained material was firstly made to paste.2.32 film consisted of a transparent TiO2 layer ) and a scattering layer ).19 The DSC device had a sandwich-type configuration with a N3-sensitized TiO2 electrode, a counter electrode and liquid electrolyte. The electrolyte was 0.1 M lithium iodide, 0.05 M iodine, 0.6 M dimethylpropyl imidazolium iodide and 0.5 M tert-butylpyridine in acetonitrile. The N3 photoanodes were prepared by immersing TiO2 electrode into 0.5 mM N3 dye solution for 24 hours.The TiO2.42 sorption analysis, the sample was degassed at 300 °C for 12 hours.The morphologies and EDX mapping of the as-prepared carbon samples were observed with a field emission scanning electron microscopy  and transmission electron microscopy . X-ray photoelectron spectroscopy (XPS) measurement was carried out with an ESCA Lab 250xi spectrometer using Al Kα (1486.6 eV) irradiation as X-ray source. All the spectra were calibrated to the binding energy of the adventitious C 1s peak at 284.8 eV. Raman spectrum was recorded using a Renishaw inVia spectrometer. The porosity and BET surface area were obtained from nitrogen adsorption isotherms at 77 K using a Micromeritics 3Flex analyzer (USA). Prior to N4, 10 mM LiI, and 1 mM I2 in acetonitrile. The carbon electrode or Pt electrode was used as the working electrode, a saturated calomel electrode (SCE) served as the reference electrode, and platinum wire as the counter electrode. The photocurrent density–voltage (J–V) of device was performed using a digital source meter . A 300 W Xe arc lamp (Oriel) equipped with optical filters was used as a light source for simulating the solar spectrum at AM 1.5 (100 mW cm−2). The intensity of light was calibrated with a Si solar cell. Electrochemical impedance spectroscopy (EIS) of dummy cells was measured using a Solartron SI 1287 electrochemical interface and a Solartron 1255B frequency response analyzer in the frequency range from 0.05 to 105 Hz. EIS spectrum for DSCs with different electrodes were obtained using the same frequency response analyzer and potentiostat at amplitude of 10 mV and the open-circuit voltage under light irradiation of 100 mW cm−2 in the frequency range from 0.05 to 105 Hz. The obtained data was fitted with a Z-View software.Cyclic voltammogram (CV) measurement was performed in a three-electrode cell with liquid electrolyte containing 0.1 M LiClO3The morphologies of the as-obtained sample (denoted as TPC) prepared at 700 °C and the pre-carbonized fish sample were characterized with scanning electron microscopy (SEM) and transmission electron microscope (TEM). The corresponding SEM and TEM images are shown in 2 physisorption measurements to provide insight into the micro- and meso-pore structures. The N2 adsorption/desorption isotherms and its corresponding pore size distribution curve of the sample are shown in 2 adsorption/desorption isotherms of the sample showed a steep increase at a low relative pressure  as a result of filling of the micropores, and a hysteresis loop was observed at a high relative pressure range  ascribed to the capillary condensation of N2 inside the mesopores. Its corresponding specific BET surface area and total pore volume are 2933 m2 g−1 and 0.81 cm3 g−1, respectively. The pore size distribution of TPC sample calculated using DFT method from N2 adsorption isotherm is about 2.7 nm  is about 1.0, implying good graphitic degree of as-prepared sample.29 Results from XRD and Raman indicate that the fish waste was successfully converted into graphitized carbon without other impurities via a simple pyrolysis process.The sample was investigated using Nt 2.7 nm . These r2 C and C 1s state in C–N/C–O, respectively.29,37 The low subpeak at 289.2 eV is attributed to formation of C PBM data was replaced with SVG by xgml2pxml:<glyph-data id="z.dbd" format="PBM" resolution="300" x-size="8" y-size="10" xml:space="preserve">00000000000000000000000000000000111111110000000011111111000000000000000000000000</glyph-data><svg xmlns="http://www.w3.org/2000/svg" version="1.0" width="13.200000pt" height="16.000000pt" viewBox="0 0 13.200000 16.000000" preserveAspectRatio="xMidYMid meet"><metadata>Created by potrace 1.16, written by Peter Selinger 2001-2019</metadata><g transform="translate scale" fill="currentColor" stroke="none"><path d="M0 440 l0 -40 320 0 320 0 0 40 0 40 -320 0 -320 0 0 -40z M0 280 l0 -40 320 0 320 0 0 40 0 40 -320 0 -320 0 0 -40z"/></g></svg>O bond. Meanwhile, the core level spectrum of N 1s can be deconvoluted into three subpeaks at 398.6, 399.9 and 400.9 eV, as shown in 37 The presence of pyridine-like and graphitic N are thought to promote the catalytic activity.26 Furthermore, weak signals from P and S elements were also detected. Core level spectrum of P 2p and S 2p are shown in Fig. S2b and c,21,22 The formation of C–S–C and P–C bonds will also promote the catalytic performance.21,22 Combining the results of XPS and those from XRD and EDS characterizations, it can be confidently concluded that the N, P and S elements were successfully doped into porous carbon matrix. The estimated atomic content of N, P and S is about 7.9, 1.2 and 1.2%, respectively. Doping carbon materials with ternary heteroatoms will benefit the catalytic activity on triiodide reduction process.29–31The chemical composition of the TPC material was investigated with energy-dispersive spectroscopy (EDS). The typical EDS mapping images are shown in 4 as the supporting electrolyte, with LiI and I2 as the redox couple. Two pairs of oxidation/reduction peaks were observed for Pt electrode, whereas, one typical pair of I3− ion oxidation/reduction peaks was present in the case of TPC carbon electrode within scanning range. During the operation of dye-sensitized solar cells, the produced I3− ions must be efficiently reduced to I− ions at the CE interface.1–6 Thus, the reduction peak of triiodide reduction is the research focus of CV analysis.18,20 The cathodic peak potential for TPC electrode is very close to that for Pt electrode. As expected, the cathodic peak current density of TPC electrode is much larger than that in Pt electrode. This is due to large surface area of TPC electrode, compared with Pt CE. These results imply that the as-prepared TPC electrode can effectively catalyze I3−/I− redox couple, similar to the case of Pt electrode. The CV curves for two electrodes were recorded with 100 cycles to check the electrochemical stability. The changes in cathodic and anodic current density for two electrodes are summarized in Fig. S3.3−-based electrolyte, surpassing that of Pt electrode.The catalytic activity of the as-obtained TPC carbon towards triiodide reduction was evaluated with cyclic voltammetry (CV) analysis, in comparison with that of Pt electrode. 24,25,39 The Nyquist plots for TPC and Pt electrodes are displayed in 19,24,25 The equivalent circuit for fitting experimental results is listed in Scheme S1.Rct) for Pt and TPC electrode are 0.42 and 0.54 Ω cm2, respectively. Obviously, the two electrodes exhibited nearly identical Rct, which is largely below than 10 Ω cm2 needed for highly-efficient dye-sensitized solar cells.19 These results indicate that TPC could be used as efficient counter electrodes for dye-sensitized solar cells.The electrochemical characteristics of CE was also investigated with electrochemical impedance spectra conducting on a symmetric sandwich device configuration with two identical electrodes.2 photoanodes were used to assemble solar cells. For comparison, the DSC containing conventional Pt CE was also fabricated as reference. The corresponding photocurrent density-voltage curves of devices are shown in Voc) of 0.750 V, a short-circuit photocurrent density (Jsc) of 15.64 mA cm−2, and fill factor (FF) of 0.668. The as-optimized photovoltaic performance for TPC-based device cloud be comparable to that for conventional Pt-based device .Consequently, the TPC electrodes of different thicknesses and N3-sensitized TiO19,39–42 EIS of DSCs with TPC-2 and Pt CEs was measured under the light illumination . The corresponding Nyquist plots are presented in RCT1), and the arc at middle frequency is attributed to the charge transfer resistance at the interface of N3-sensitized TiO2/electrolyte (RCT2). Meanwhile, the low frequency semicircle is ascribed to the diffusion resistance of redox couple within the electrolyte (ZN). In most cases, the RCT2 are commonly overlapped with ZN due to the application of liquid state electrolyte in the study.19,38 The fitted curves with the equivalent circuit are also shown in the RCT1 for TPC-2 and Pt-based devices are 1.58 and 1.52 Ω, respectively. The almost equal values of RCT1 for both devices confirm that the as-prepared CE (TPC-2) could catalyze I3−/I− redox couple as efficiently as Pt CE. The corresponding values of RCT2 are 18.21 Ω for TPC-2 CE and 16.81 Ω for Pt CE. The DSC with a TPC-2 CE showed a slightly larger RCT2 than that for Pt-based solar cell. The power conversion efficiency of device is dependent on the total resistance of the device.19,38 Therefore, RCT1 and RCT2 in the case of TPC-2 electrode can lead to a slightly low FF for TPC-2 based devices, compared to device with a Pt CE. The high performance for device containing TPC CE could be ascribed to high surface area and well-defined porosity for promoting electrolyte diffusion within electrode, as well as heteroatom doping-induced electrocatalytic activity on I3− reduction.The photovoltaic properties of devices with different CEs were investigated using the electrochemical impedance spectra (EIS).4via pyrolysis approach using fish waste as raw material in an inert atmosphere. The N, P and S elements contained in the fish waste were doped simultaneously into porous carbon matrix during the pyrolysis process. The resultant porous carbons possessed both large surface area and highly graphitized nanostructures, and thus presented perfect catalytic activity on triiodide reduction. The optimized DSC with a TPC-2 CE exhibited a power conversion efficiency of 7.83%, which is comparable to that for the device with a Pt CE (8.34%). The results indicate that porous carbon derived from fish waste could catalyze as efficiently as noble metal Pt on the triiodide reduction in DSC. The idea of “making waste profitable” reported here could be suitable for exploring low-cost non-noble metal catalysts in a wide variety of applications.Ternary heteroatom-doped porous carbons were successfully prepared There are no conflicts to declare.RA-008-C8RA02575D-s001


P < 0.05); comprehensive examination showed that 39 patients had obstruction between ureter and bladder anastomosis, 13 cases had rejection, 10 cases had perirenal hematoma, 5 cases had renal infarction, and 22 cases had no complications; the diagnostic sensitivity, specificity, accuracy, and consistency of the observation group were higher than those of the control group (P < 0.05). In the control group, the sensitivity, specificity, and accuracy in the diagnosis of complications after renal transplantation were 66.5%, 84.1%, and 78.32%, respectively; in the observation group, the sensitivity, specificity, and accuracy in the diagnosis were 67.8%, 86.7%, and 80.6%, respectively. DRSA-U-Net denoising algorithm can clearly display the information of MRI images on the kidney, ureter, and surrounding tissues, improve its diagnostic accuracy in complications after renal transplantation, and has good clinical application value.This study was to explore the diagnostic value of magnetic resonance imaging (MRI) optimized by residual segmentation attention dual channel network (DRSA-U-Net) in the diagnosis of complications after renal transplantation and to provide a more effective examination method for clinic. 89 patients with renal transplantation were selected retrospectively, and all underwent MRI. The patients were divided into control group  and observation group (MRI image diagnosis based on DRSA-U-Net). The accuracy of MRI images in the two groups was evaluated according to the comprehensive diagnostic results. The root mean square error (RMSE) and peak signal-to-noise ratio (PSNR) of DRSA-U-Net on T1WI and T2WI sequences were better than those of U-Net and dense U-Net ( The development of renal transplantation has gone through a long process and has now become the first in the field of peripheral organ transplantation . TransplAt present, the process of renal transplantation has been standardized, the new triple suppression regimen exerts the greatest immunosuppressive function with the least drug toxicity, the first-year survival rates of patients and grafts are more than 96% and 91%, respectively, and the quality of life of patients is significantly improved . The repU-Net was proposed by Marticorena Garcia et al.  and nameThis study was aimed to explore the diagnostic value of optimized MRI based on DRSA-U-Net in the diagnosis of complications after renal transplantation and to provide a more effective examination method for clinic.In this study, 89 patients who underwent renal transplantation in hospital from March 2020 to March 2021 were included and examined by MRI. The patients received MRI at 2 weeks after operation. The patients were randomly divided into the control group  and the observation group (MRI image diagnosis based on DRSA-U-Net). There were 59 males and 30 females, aged 27–46 years, with the mean age of 42 years. 76 transplanted kidneys were located in the right iliac fossa and 13 transplanted kidneys in the left iliac fossa; 45 developed tenderness 30 days after surgery; 37 had anuria 9 days after surgery; and 7 had postoperative fever and abdominal pain. This study approved by the ethics committee of the hospital, and the patients' families signed the consent form.Inclusion criteria: all patients received renal transplantation; those who follow doctor's advice and actively cooperate with the treatment.Exclusion criteria: history of contrast medium allergy; those who are allergic to the drugs used; patients with other types of serious diseases; heart, liver, spleen, and other important organ dysfunction.T superconducting MRI scanner was used, gradient was 32 mT/m, switching rate was 132 Tm−1 s−1, and flexible phased array circular polarization coil was used. Examination order and parameters: referring to the clinical symptoms of patients, laboratory tests, and ultrasound results, with different sequences, all patients underwent routine renal MRI and magnetic resonance urography (MRU) examination. Sequence and main parameters: axial, spin echo (SE) sequence T1WI, TR/TE was 112 ∼ 124 ms/4.85 ms; fast spin echo (FSE) sequence fat suppression T2WI, TR/TE was 2,121 ∼ 2,406 ms/132 ms; coronal TRUFI sequence, TR/TE was 5.1 ms/2.56 ms; layer thickness was 7 mm; spacing was 2.1 mm; average signal number was 2–4; and acquisition matrix was 258 × 258. T1WI without fat suppression and T2WI underwent fat suppression and nonfat suppression scanning 3 times, and field of vision (FOV) was 34 cm × 38 cm.1.6Renal MRU examination: single-shot fast spin-echo sequence (SSFSE), thick T2WI, TR/TE was infinite, layer thickness was 82 mm, interval was 0, FOV was 4,002 mm × 402 mm, and acquisition matrix was 314 × 258; thin T2WI, TR/TE was 1,123 ms/567 ms, flip angle was 152, layer thickness was 5 mm, interval was 0, FOV was 352 mm × 352 mm, and acquisition matrix was 258 × 158.r-Softmax of attention mechanism is used to extract features, and the extracted features and the output of each branch are multiplied and added to obtain the feature layer with the same dimension as the input. In the parallel space channel compression and excitation module, DRSA-U-Net adds Scse module after each jump connection in U-Net to compress and excite the MRI images of T1WI and T2 downsampling weighted image. It can extract the effective information in each channel and space and enhance the learning efficiency of the network. The biggest feature of these algorithms is that the learning rate remains unchanged. Parameter update can only be achieved by gradient, and in equation . The parameters are expressed in equation w=b·wμ equivalently achieves adaptive learning rate. The global learning rate is denoted as Ψ. The algorithm is defined by equations . . μ equivDRSA-U-Net is based on the traditional U-Net structure. The left side is composed of three encoders. There is a 65 × 4 × 4 convolution layer before the first encoder, which extracts the input of two channels into 65 channels. The first encoder is composed of three independent note residual modules and average titer sampling. The second encoder is composed of four independent residual modules and average sampling, and its output is 65 channels. Then, the output image is sampled. The third encoder is composed of five independent note residual modules and average sampling, and there are 256 output channels. The encoder is composed of three decoders. Each decoder is composed of an interpolation module. The decoder corresponding to each encoder jumps to connect with a convolution layer. The compression module is also added to the clock excitation attention of the second and third decoding units. The interpolation module samples the image through the nearest neighbor of interpolation and extracts the compression excitation attention module of channel and spatial information. The convolution layer fuses the feature channel. The output channels behind each decoder are 129, 65, and 17. At the end of the network, the output of the network is merged into a channel through the convolution layer. The examination results of all patients were analyzed by two independent reviewers, and a consensus was reached on the controversial results after discussion. Observation: whether there was abnormal signal in the transplanted kidney, whether the boundary of renal corticomedullary was clear, whether the ureter was unobstructed, whether there was abnormal signal around the kidney, whether the transplanted renal vessels were unobstructed, and whether the cortical enhancement density was uniform.P < 0.05 was considered statistically significant.Statistics was completed using SPSS16 software. Measurement data were expressed by The image quantification indexes of synthetic T2WI under different inputs of U-Net, Dense-U-Net, and DRSA-U-Net networks were displayed. The data were the mean value ± standard deviation of the synthetic images of all layers in the test set. When 1/4 downsampling T2WI was added to synthesize T2WI after input, the mean peak signal-to-noise ratio (PSNR) of DRSA-U-Net synthesized T2WI was enhanced by about 0.5 dB and 0.9 dB, respectively, compared with U-Net and Dense-U-Net, and the mean root mean square error (RMSE) was reduced by about 0.03 and 0.02, compared with U-Net and Dense-U-Net; when 1/8 downsampling T2WI was added to synthesize T2WI after input, the PSNR of DRSA-U-Net synthesized T2WI was enhanced by about 1.6 dB and 1.9 dB, compared with U-Net and Dense-U-Net, and the RMSE index was the same as Dense-U-Net, reduced by about 0.02 and 0.02, compared with U-Net; therefore, no matter how much downsampling rate T2WI was added to the input, the fidelity of T2WI synthesized by DRSA-U-Net was good.P < 0.05) . The PSNR and RMSE of the T2WI synthesized by DRSA-U-Net were the best. In terms of visual effect, the T2WI synthesized by U-Net and Dense-U-Net, DRSA-U-Net network was very similar to the real T2WI, but the degree of ambiguity was different. In order to observe the details, the selected part of the composite image (blue box) was amplified, and the difference in detail and texture of the composite image was found. The T2WI synthesized by DRSA-U-Net network was closer to the real image, and the ambiguity was the smallest. The results of comprehensive examination of 89 patients were as follows: 39 cases of hydronephrosis of the transplanted kidney, hydronephrosis of the renal pelvis of the transplanted kidney, ureteral dilatation, and obstruction at the bladder; 13 cases of blurred corticomedullary demarcation of the transplanted kidney, slightly increased signal intensity of the transplanted kidney parenchyma on T2WI, significantly increased fat suppression signal on the T2 sequence, blurred renal corticomedullary structure, and abdominal effusion, which were diagnosed as rejection; 10 cases of perirenal hematoma formation, hematoma formation around the transplanted kidney, ureteral compression, and hydronephrosis; 5 cases of vascular occlusion of the transplanted kidney, vascular occlusion, and local renal infarction 2 days after the operation. There were no complications in 22 patients .The sensitivity, specificity, and accuracy of conventional MRI images (control group) in the diagnosis of complications after renal transplantation were 66.5%, 84.1%, and 78.32%, respectively. The sensitivity, specificity, and accuracy of MRI images based on DRSA-U-Net (observation group) were 67.8%, 86.7%, and 80.6%, respectively .Rejection of the transplanted kidney is a series of cellular and fluid immune reactions of the recipient kidney to graft antigens and can occur in 91% of patients . With thThere are few reports of vascular occlusion and regional renal infarction in the transplanted kidney. In the experiment, 5 patients were diagnosed with vascular occlusion and regional renal infarction by MSCTA after renal transplantation, which was confirmed by surgery.Perirenal bleeding after renal transplantation to form a periureteral hematoma and compression of the ureter to form hydronephrosis is a rare complication that requires definitive diagnosis and urgent surgical treatment , 21. TheIn conclusion, the DRSA-U-Net denoising algorithm can clearly show the information of MRI images on the kidney, ureter, and surrounding tissues and improve the diagnostic accuracy of complications after renal transplantation, which has a good clinical application value. However, there is a small sample size, and clinical trials should be conducted in multicenter hospitals with large sample size, rather than in a single area or small area. For the application of spatial information of three-dimensional data, new multimodality images with strict interlayer registration can be acquired to further verify the relationship between multilayer input and interlayer registration. Network performance needs to be validated and optimized on multiple different data sets to improve the generalization capability of the network.


However, these batteries following Li2CO3-product route usually deliver low output voltage (<2.5 V) and energy efficiency. Besides, Li2CO3-related parasitic reactions can further degrade battery performance. Herein, we introduce a soluble binuclear copper(I) complex as the liquid catalyst to achieve Li2C2O4 products in Li–CO2 batteries. The Li–CO2 battery using the copper(I) complex exhibits a high electromotive voltage up to 3.38 V, an increased output voltage of 3.04 V, and an enlarged discharge capacity of 5846 mAh g−1. And it shows robust cyclability over 400 cycles with additional help of Ru catalyst. We reveal that the copper(I) complex can easily capture CO2 to form a bridged Cu(II)-oxalate adduct. Subsequently reduction of the adduct occurs during discharge. This work innovatively increases the output voltage of Li–CO2 batteries to higher than 3.0 V, paving a promising avenue for the design and regulation of CO2 conversion reactions.Li–CO 2 batteries following Li2CO3-product route suffer from low output voltage and severe parasitic reactions. Herein, a soluble binuclear copper(I) complex is introduced as the liquid catalyst to achieve Li2C2O4 products in Li–CO2 batteries, which increases their output voltage to higher than 3.0 V.Li–CO Varieties of CCU technologies that can convert CO2 into value-added chemicals, such as methane dry reforming8, hydrogenation10, electrochemical reduction12, and photocatalytic reduction14, have been developed. In the past decade, a kind of energy storage device of Li–CO2 battery was proposed, offering an attractive tactic to utilize CO2 and produce electrical energy17. A typical Li–CO2 battery is composed of a lithium metal anode separated by an aprotic electrolyte from a porous CO2 cathode. The typical reversible reaction at the cathode involves the reduction of CO2 to form Li2CO3 and carbon on discharge, and the process is reversed on charge  is gaining increasing attention in the field of CO2 batteries usually present discharge voltages of around 2.5 V, sometimes even lower than 2.0 V in previous reports23. Generally, the quality of electrical energy is determined by the voltage supplied. An output voltage lower than 3.0 V leads to a low-quality electrical energy24. Obviously, the actual output voltage of Li–CO2 batteries is far lower than the theoretical value which is not high enough. Apart from the thermodynamic information of the reaction, the voltage that the battery can provide depends on the catalytic activity of catalysts and the transport properties of charge and mass in bulk and between phase boundaries.However, practical Li–CO26, noble metals28, and transition metal oxides30. Although they can remarkably reduce the charging overpotential, they have minimal effect in increasing the discharge voltage. It should be explained here that the catalytic characteristics of solid catalysts bring the difficulty of raising battery discharge voltage. As illustrated in Fig. 2. Specifically, three solid phases contain solid catalysts, Li2CO3, and carbon on the cathode surface. The liquid phase includes Li ions and dissolved CO2 in electrolyte. CO2 reduction during discharge occurs at the catalyst/electrolyte interface. The effect of catalytic reaction partially depends on the catalytic surface area of the solid catalyst particles on which CO2 is reduced. The sluggish kinetics of charge-transfer and mass-transport across multiphase interfaces aggravate the large voltage hysteresis. What’s more, active sites of solid catalysts are occupied by insulating and insoluble Li2CO3 products, leading to their invalidation32.On this basis, much efforts on solid catalysts have been exerted in raising the discharge voltage and reducing the charge voltage. The reported catalysts include carbon allotropes2CO3 itself usually occurs irreversibly during the charging process of Li–CO2 batteries 34 cause severe parasitic reactions. The gradual accumulation of irreversible byproducts threatens the stability of batteries. Thus, a catalyst designed with the strategy of Li2CO3-free pathway might be a good choice.It is worth mentioning that discharge products also affect the charging performance of the next cycle. In accordance with previous reports, electrochemical decomposition of Li2 reduction process, which is effective to reduce the discharge overpotential. The reported liquid catalysts, including 2,5-ditert-butyl-1,4-benzoquinone35, 2-ethoxyethylamine36, and tris-dichloro-ruthenium(II)37, can promote the discharge potential to a certain extent. However, batteries involving these catalysts still follow the Li2CO3 pathway. It might be better for the battery to discharge without taking the Li2CO3 path by liquid catalysts. As depicted in Fig. 2, and catalytic RMs are mixing at the molecular level in the liquid phase of electrolyte. Typical discharge process contains two steps. RM molecules capture CO2 to form RM–CO2 species first. The newly formed molecules then gain electrons at the cathode and are reduced to original RM and corresponding products (such as Li2C2O4). The liquid catalyst has more full contact with CO2 at the molecular level in the liquid phase, which effectively improves the reaction kinetics. The electrochemical redox process of the RM–CO2 at the electrode replaces the directly electrochemical reduction of CO2. This process allows to adjust the battery’s output voltage up to above 3.0 V by selecting and designing RM molecules  rather than solid one can reduce the number of phases involved in the COles Fig. .2 to oxalate chemicals38. This condition inspires us to introduce the catalytic effect of metal complexes into the design of Li–CO2 batteries. Moreover, Li2C2O4 as an electrochemical product can take the battery out of the troublesome Li2CO3 pathway. Herein, we introduce a binuclear copper(I) complex (denoted as Cu(I) RM) as the liquid catalyst in Li–CO2 batteries and study the battery performance, including the discharge potential, capacity, and cycle performance, in detail. In addition, we use a variety of spectroscopic analysis techniques, such as Raman and differential electrochemical mass spectrometry (DEMS), to explore the Li2CO3-free path experienced by the discharge process of the cathode. Furthermore, we employ an additional catalyst containing Ru nanoparticles to reduce the charge overpotential synergistically. This study increases the output voltage of Li–CO2 batteries to more than 3.0 V, which strongly promotes the practical application of this electric energy storage system.Apart from the abovementioned conventional liquid catalysts, some soluble metal complexes can also catalyze the electrochemical reduction of CO3CN)4]BF4 in dry acetonitrile (MeCN)39 (details of the preparation procedure are provided in the Methods section). 1H nuclear magnetic resonance spectroscopy (1H NMR) and electrospray ionization mass spectrometry (ESI-MS) were performed first to verify the molecular structure of the prepared ligand. As shown in Supplementary Fig. m/z) ratio of 545.25 matches well with that calculated for [C30H37N6S2]+ of the ligand 4]BF4 in MeCN. A prominent signal at the m/z ratio of 335.05 in Supplementary Fig. 2C30H36N6S2]2+, confirming the successful synthesis of the target complex.The binuclear Cu(I) RM was synthesized by the reaction of disulfide ligand with two equivalents of BF4  was added to the MeCN solution containing ligand  in an Ar glove box to acquire the Cu(I) RM.The binuclear Cu(I) RM was synthesized as described in previous literature28: RuCl3•xH2O (50 mg) was dissolved in ethylene glycol of 100 mL. Then Super P carbon (80 mg) was added in the solution, where the suspension was stirred for 3 h at 170 °C via an oil bath. The mixtures were filtered by deionized water and ethanol for several times after cooling to room temperature. The final products were dried at 120 °C under vacuum for 12 h.Ru@Super P was prepared in accordance with our previous study1H NMR (Bruker DRX500) was applied to analyze the molecular structures of the ligand. ESI-MS (Agilent 6460) was performed to collect information of the ligand and Cu(I) RM.All samples were transferred to different characterization equipment by using an air-tight sample module. Φ 3 mm) that was polished elaborately prior to use. The counter electrode was obtained by rolling the mixture of LiFePO4, Super P carbon, and polytetrafluoroethylene (PTFE) binder (W: W: W = 80: 10: 10) into a film (1.0 × 1.2 cm) and pressing on a stainless steel (SS) current collector. The pre-charged  LixFePO4 (x = 0.9) electrode was applied as the reference electrode, which had a stable potential of 3.45 V versus Li/Li+. The galvanostatic discharge-charge measurements were conducted in Swagelok batteries, including a Super P carbon (or Ru@Super P) cathode , a pre-charged LixFePO4 anode (Φ 12 mm), a glassy fiber separator , and a gas chamber. The cathode was prepared by rolling the mixture of Super P carbon (or Ru@Super P) and PTFE binder (W: W = 85: 15) into a film and pressing on a SS mesh. The mass loading of the electrode was 0.5 ± 0.2 mg cm−2. The thickness of a glassy fiber separator was 675 μm. All the electrodes were dried at 120 °C under vacuum for at least 12 h before assemblage. LiClO4 (0.1 M) in MeCN with or without Cu(I) RM (0.5 mM) was employed as electrolytes and the amount of electrolyte in each battery was about 300 μL.A three-electrode glass cell was first used to conduct CV tests. The working electrode was commercial glassy carbon . Galvanostatic tests were performed on LAND 2001A Battery Testing Systems  at 25 °C under Ar or CO2 atmosphere. The batteries were discharged and charged at a specific current of 100 mA g−1 and potential cut-offs of 2 V and 4.8 V. Galvanostatic discharge/charge cycling tests were conducted at a constant current density of 100 mA g−1 or 200 mA g−1 and a fixed capacity of 1000 mAh g−1. All current densities and capacities were normalized by the mass of active materials on the cathode. The specific energy based on active substance on the cathode was the product of specific capacity and output voltage.CV measurements were carried out on an electrochemical workstation  at 25 °C inside an Ar or CO−1. FTIR measurement was conducted on a FTIR spectroscope  with a wavenumber range of 4000–450 cm−1 and a resolution of 1.0 cm−1. The states of surface elements on the cathodes were characterized through XPS (Thermo Fisher Scientific Model K-Alpha spectrometer) equipped with Al Ka radiation (1486.6 eV) at a working voltage of 12 kV and a current of 10 mA. The morphology of cathodes was observed by SEM (Hitachi SU8010). The microstructure was further characterized by TEM (FEI TF20), and the SAED pattern was collected from a Gatan charge-coupled device camera. To evaluate the interaction between Cu(I) RM and CO2 in the electrolyte, ESI-MS and UV–vis absorption spectra data were collected. The UV–vis spectra were evaluated on a UV–vis spectrophotometer . XRD analysis was performed to analyze the crystalline structure of the catalyst by employing a Bruker D8 advanced diffractometer with Cu–Kα radiation (λ = 1.5406 Å) at a scan rate of 0.064° s−1. TG was carried out on an SDT Q600 TA instrument with a temperature range of 25–800 °C in O2 gas and the heating rate was 5 °C min−1.The discharged and recharged electrodes were washed with MeCN and dried sufficiently before characterization. The components of electrodes and electrolytes during different reaction stages were recorded by Raman spectroscopy  with the excitation light of an air-cooled He–Ne laser at 633 nm through a 50× long working distance lens (Leica Microsystems Inc.). To obtain apparent signals on the spectra and avoid the degradation of carbon cathode, the acquisition time was set as 120 s with 10% laser power. The resolution of Raman spectroscopy was around 1.0 cm2/Ar (V: V = 9: 1) was purged continuously to eliminate residual air first, after which 0.5 mM Cu(I) RM in MeCN (1 mL) was injected to the sealed vessel, and the remaining gas was purged to the mass spectrometer chamber (PrismaPro QMG 250 M2). The sealed vessel was connected by using two PEEK valves to the purge gas system. The electrochemical reaction was conducted by a home-made Li–CO2 battery mold with two PEEK valves connected to a quadrupole mass spectrometer with a turbomolecular pump (Pfeiffer Vacuum). During the charge process, ultrapure Ar was employed as carrier with a flux of 0.5 mL min−1. The DEMS battery was also performed on LAND 2001A Battery Testing Systems.In situ DEMS measurements were performed by chemical/electrochemical reactions. With regard to the chemical reaction, a mixture of COSupplementary Information


The mutual influences of social epidemiology and ideas of justice, each on the other, have been seminal in the development of public health ethics and law over the past two decades, and to the prominence that these fields give to health inequalities and the social—including commercial, political, and legal—determinants of health. General and political recognition of injustices in systematised health inequalities have further increased given the crushingly unequal impacts of the COVID-19 pandemic; including impacts of the legal and policy responses to it. However, despite apparent attention from successive UK governments to injustices concerning avoidable inequalities in health opportunities and outcomes, significant challenges impede the creation of health laws and policy that are both effective and ethically rigorous. This article critically explores these points. It addresses deficiencies in a UK health law landscape where health care contexts and medico-ethical assumptions predominate, to the great exclusion of broader social and governmental influences on health. The article explains how a public health framing better serves analysis, and engages with a framework of justice-oriented questions that must be asked if we are to understand the proper place and roles of law and regulation for the public’s health. The links between social justice and health inequalities are empirical as well as critical philosophical matters.A forceful representation of the challenges of structural causes of (ill) health, and the problems of relative powerlessness to respond to them simply through enjoining individual responsibility or personal choice, is found in the following table produced by David Gordon and colleagues in the University of Bristol’s Townsend Centre for International Poverty Research.In this article, our aim is to contribute to critical discourses on the place of law in the context of such debates in the UK, and in particular England. As already indicated,the practical impacts (for better and worse) of legal forms of regulation;the broader concept of law itself as an overall social phenomenon and source of normative ideas and ideals; andthe contributions of legal scholarship to practical agendas concerning health inequalities.The article adds to the growing academic field of public health law,In what follows, we therefore look to the question of securing the critical underpinnings to claims about how laws, law, and legal scholarship do, can, and should address health inequalities in the UK (in particular with a focus on England). More negatively, this involves a challenge to narrow, medico-ethical and medico-legal framings, and the predominance of paradigms that pretend to ethical neutrality and/or perpetuate impossible demands on individual responsibility through a fixation on civil and political rights to non-interference by the state. More positively, our analysis involves a practical representation of how philosophically-driven approaches from public health may be combined with practical questions in critical legal theory and philosophy to assist engagement and, with the right political will, the achievement of a fairer society. Section II of the article explains why health inequalities are wrongly addressed as a question for medical law and indicates how insights from public health literatures lend perspectives that otherwise could not be drawn. Section III expands on this, identifying in greater and critical detail what it means to take a public health approach. Section IV, with reference to practical questions of justice that have been seen in the context of the COVID-19 pandemic and government responses to it, then introduces a framework that is designed to promote a better marrying of the empirical and critical questions that must be engaged if we are to understand and respond to health inequalities as a problem of law and social justice.English medical law, by design, presents conceptual and analytical frameworks that are blind to inequalities. Given the tightness—even the ‘symbiotic’ naturehave regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service’.her values, beliefs, wishes, and feelings, however eccentric or irrational these may be.With that said, it is right to acknowledge that the National Health Service Act 2006 provides an  obligation on the Secretary of State for Health and Social Care to ‘Against that framing, ‘the system’ more widely, and trends regarding different groups or communities within it—including patterns related to health inequalities—are simply irrelevant. ‘Treating patients right’ within English medical law means drawing from a library of contextually-contained rights that would apply at the point of receiving health care.It would, therefore, be odd to imagine that one could or should generalise from principles governing clinical interactions to all other areas of interpersonal and political morality. Nevertheless, the idea of the libertarian person found in the rights-holding medical patient carries a great deal of weight more widely in bioethical thought in the UK, both within and beyond the biomedical sphere.general rejection of paternalism, or a general assumption of empowerment being assured through the securing of negative rights. Yet an historical imperative to give greater recognition to patients’ rights to non-interference need not imply a writ-large endorsement of narrowly libertarian systems of rights, duties, and state powers more generally. Nevertheless, arguments are advanced on the basis, essentially, of medico-ethical norms driving public policy more widely, rather than things working the other way around: norms of and for medicine are given as the starting point for questions regarding health, where the starting point should cover the whole of contexts embraced by politics and political decision-making.What is remarkable in this is not the focus that has been given to patients’ negative rights. Rather, it is the unnecessary and unargued affirmation it gives to wholesale political theories and, for instance, a Population [health] interventions … that focus on providing advice, guidance, and encouragement rely heavily on individuals being able and motivated to engage with this advice, guidance and encouragement. These types of interventions have been described as highly “agentic”: recipients must use their personal resources, or “agency,” to benefit.However, just as a great deal of bioethical scholarship may draw too quickly—or without adequate analytical scrutiny—from works in liberal political philosophy, so it is the case that public health agendas, and critical analyses of public health responsibilities in England, are advanced in the shadow of such works.Policy measures—including the UK Government’s public health plans for England following the onset of the COVID-19 pandemicA challenge for health law scholarship that aims to look beyond  clinical encounters is therefore to revisit the foundational questions of social theory and political philosophy that secure assumptions about what is impermissible, permissible, to be encouraged, or outright mandated. To take seriously concerns about health inequalities, and to be able to frame these as questions of health (in)justice, we should not start from medico-ethical norms. Equally, we need to be prepared to engage with and potentially challenge the libertarian norms more generally that support such policy approaches; including empirical evidence that undermines the concepts  on which their normative conclusions are based.If social factors are identified as determining such significant aspects of human well-being as mortality and morbidity, the moral responsibility for ill health and health inequalities expands beyond the individual to include social institutions and processes.One of the leading scholars on health justice in the UK and globally, Sridhar Venkatapuram, has made significant contributions given epidemiological research on the socially-determined influences on health that we highlighted in the introduction to this article. Venkatapuram’s position may be seen to raise arguments that run in two directions in such an exercise.practical responsibility for health  does not therefore move wholesale from asking whether, why, and how individuals can and should be responsible for their own health. But it also calls into the framing—and morally implicates—other actors and institutions. What this means for ultimate moral, political, and legal responsibility is a separate question. There is a difference between identifying regrettable consequences of our social and political systems and in identifying moral failures in political and social responsibility. But crucially, we should not accept philosophical arguments that hold that individual responsibility is sufficient to address responsibility for health  where they do so on the basis that individuals alone can determine their health outcomes: to quote again from Gordon and colleagues’ ‘Top Ten Tips for Health’, a person cannot simply choose, for example, not to be poor.Venkatapuram’s arguments rest on the matter of demonstrable, empirical fact that individuals alone are not empowered to account for or respond to all of the impacts and influences on their health. The question of To conclude this section, we therefore observe that UK medical ethics and law have developed with predominant assumptions and framings that are ill-suited to addressing health inequalities and associated questions of justice. In the next section of the article, we explain and show how public health approaches are, by contrast, well equipped to problematize questions of health inequalities, and to help identify solutions better to address them through justice-oriented law and policy. As we have argued here, medical law’s contained focus does not allow the development and application of assumptions that may straightforwardly carry into questions of  policy writ large. They may even, problematically, be taken without due analysis to affirm and endorse the general soundness and applicability of normative assumptions, for instance, concerning the meaning and scope of individual responsibility for health. In its more doctrinal senses, medical law does not ask, and thus cannot answer, the greater questions concerning health inequalities. And in its more critical and philosophical aspects, it also fails in this regard. Biomedical ethics may include regard to questions of justice; it is, for example, one of the canonical four principles of biomedical ethics.As we will explain, a public health perspective presents various (broadly) unifying conceptual and normative themes. However, to begin to understand how a public health framing may better serve health law analyses, it is important to appreciate that the term ‘public health’ covers multiple, quite distinct ideas, professional identities, areas of policy, scientific approaches, and indeed ideological perspectives.Similarly, in practice and policy, there are core identifiable functions and related government powers that are centrally public health in nature; for example, functions in monitoring and responding to outbreaks of infectious diseases under powers provided in the Public Health (Control of Disease Act) 1984. In relation to infectious disease, the potential reach of these powers  are well represented too by the Coronavirus Act 2020. But public health concerns are far more extensive still, and span across government departments and sectors; for instance, education, employment, environment, housing, town-planning, transport—to name just some that we could list—all draw in salient responsibilities regarding the public’s health. Equally, health features as an important consideration when evaluating the rationales for, and proportionality of, public policy; notably as an express consideration given in qualifications to legally protected human rights such as the right to respect for private and family life.A single, preclusive characterisation of public health cannot, therefore, be given. It is, though, possible to discern particular features of ideas of public health that sit at the intersection of different understandings of what it means. These in turn circumscribe particular scientific (broadly conceived) approaches and matters of practical concern. Robert Beaglehole and colleagues capture this very effectively with the pithy definition of public health as ‘[c]ollective action for sustained population-wide health improvement’.As explained in Geoffrey Rose’s seminal paper ‘Sick Individuals and Sick Populations’, public health sciences look to what we learn when we make observations about health by studying populations.And just as observations and understanding may differ when we look at a population level, so may our interventions when ‘treatment’ is of the ‘population as a patient’.The Lancet, ‘public health is the science of social justice’.whether values are at play, but which moral values should inform the core of public health and from there come to direct policy and practice? Section II of this article has shown how and why medico-legal framings are ill equipped for this task. Exploring the question from a cross-societal, cross-sector, population perspective allows us to see how studies in public health ethics and law may much better engage with questions of inequality and injustice.In its core senses, public health is therefore unavoidably political, intertwining concerns for scientific rigour with ideas about ethical values and social equity. This has direct implications for the roles and remits of public institutions and the communities that they serve. In the phrase of Richard Horton, editor of As Kathryn MacKay argues, it is sometimes the case that public health ethics is represented as espousing a blunt and monistic, maximising moral system (often presented as utilitarianism).In line with MacKay’s observation and its underlying concerns, the ethics paper that supports the Public Health Skills and Knowledge Framework for the UK’s public health workforce explains how public health research and practice are widely recognised as resting on a mission to address two particular sources of moral concern.equity or fairness—of distributive justice—are foundational within the ethics ‘of’ public health.Fair Society, Healthy Lives:To reduce the steepness of the social gradient in health [i.e. to provide greater health equality across distinct points of social position], actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism. Greater intensity of action is likely to be needed for those with greater social and economic disadvantage, but focusing solely on the most disadvantaged will not reduce the health gradient, and will only tackle a small part of the problem.However, that maximising ethic is complemented—and sometimes constrained—by a distinct, egalitarian ethic to prioritise addressing avoidable, systematised health inequalities.These ideas capture the ‘moral mandates’ of public health.First, health opportunities and outcomes are to be maximised both through proportionate preventive measures to defend against disease, illness, and injury, and through proportionate health-promotion interventions to sustain and enhance general levels of health (and on many counts well-being); andSecondly, systematised, avoidable, and unfair inequalities in health (opportunities) must be addressed: social architecture that supports or creates differential enjoyment of health rests on poor foundations, and priority should thus be given to protecting and promoting the health of groups and communities who face greater disadvantage.In relation to both of these moral mandates, and recognising that they may, at times, stand in tension with one another, insights from a public health perspective take us through considerations of what instances of poor health should be of concern, and where responsibility for addressing them should lie.Improving the Health of the Public by 2040,In terms of health, prevention involves a range of interventions aimed at reducing risks or threats to health. Primary prevention aims to prevent disease or injury before it occurs, for example by immunisation, health education and preventing exposure to hazards. Secondary prevention aims to reduce the impact of a disease or injury which has already occurred, for example by detecting, diagnosing and treating as soon as possible as well as taking steps to prevent reoccurrence. Regular screening programs, such as mammograms for detecting breast cancer, are an example. Tertiary prevention aims to reduce the impact of a disease or illness which is ongoing and has long-term effects, by helping people to manage often complex health problems and injuries to maximise their quality of life and life expectancy. Rehabilitation and support programs are forms of tertiary prevention.Effectively assuring conditions in which people can enjoy good health, and addressing avoidable inequalities in health, in public health parlance, includes a great concern for looking to (often complex networks of) ‘upstream causes’Given the practical understandings that public health research gives us of causes of avoidable ill health and health inequalities, why do they persist so forcefully? Why do we not have better systems of primary prevention? The ideas of assuring better and fairer health opportunities and outcomes are constructed around scientific evidence bases that explain both how and why we find incidences of poorer health, and what practical measures would address these.As explained in Section III of this article, advocacy to respond to health inequalities is a longstanding concern in public health and public health ethics. But within public discourses consequent to the onset and impact of the COVID-19 pandemic, there has been a renewed recognition of health inequalities as a problem of social justice. While everyone has been affected by COVID-19 and measures put in place against it , the harms and burdens have not been equally spread out within societies or dissociated from pre-existing structural determinants of unequal enjoyment of health . Rather, they have fallen along racialised,Because health inequalities are avoidable through changes to social norms, structures, and institutions, their very existence makes them a question of social justice.If we engage these literatures, rather than consider questions of health inequalities with blunt and  exclusive reference, for instance, to liberal conceptions of autonomy and the need for defences against state regulations and professional hegemonies, we see causation within a ‘matrix of domination’,It is at such points that insufficient explanations and framings for the existence of health inequalities become more stark, and the substantiation about claims that they are unfair may crystalise. Through that process, we also may identify what it means to address them head on if law (and policy) are to respond to questions of health injustice, rather than be complicit in their causal structures. Some explanations for inequalities during the COVID-19 pandemic have been marked by wilful ignorance of systemic factors. For example, the UK Government, through a report published by its Commission on Race and Ethnic Disparities on 21 March 2021, dismissed state-sanctioned racism as a contributor to health inequalities.In conclusion, while COVID-19 has brought health and other inequalities into sharp relief, it would be mistaken to assume that if there had not been a pandemic then the inequalities would not have existed, and/or that health inequalities would disappear after the pandemic ‘ends’. The circumstances pre-existing the COVID-19 pandemic, such as harsh austerity measures for a decade and deep welfare cuts, directly created the context for the inequities and many of the avoidable harms, that have resulted from the coronavirus and responses to it. For example, the use of food banks, including by people in full time employment,In the final section of this article before the conclusion, we take the practical points regarding inequalities as exemplified against narratives that have come to the fore during the COVID-19 pandemic, and indicate how approaching these through a public health perspective and as a matter of social justice can work. This is not with a view to being comprehensive in representation of ideas of justice, or to advancing or defending a single or preclusive idea of justice; rather, it is to show the sorts of prior questions that must be asked, and to indicate the critical scope that any response to them must have.To begin a critical re-evaluation of law’s place in relation to health inequalities, we would promote research agendas that take an adapted version of a framework of four questions concerning social injustices, health inequalities, and COVID-19, which was developed by one of this paper's authors as part of the UK Pandemic Ethics Accelerator project.whose care (broadly conceived) is constructed as the type of care that can consistently be left waiting? This question does not prompt us to challenge the idea of prioritisation questions per se. In any resource-limited system, there will always be the need to prioritise due to finite resources . The question instead prompts us to consider systemic neglect and care-lessness aimed at communities. Scholarship on health justice needs to pay attention to the serial disregard for particular groups and communities.First, who does not get to breathe? The summer of 2020 was filled with chants of ‘I can’t breathe’ in protests that erupted after the killing of George Floyd through police brutality.Secondly, whose voices are not being heard? This is a basic as well as a central question in any policy evaluation. At the heart of justice is listening to voices; particularly those that are more likely to be erased.Thirdly, what outcomes are truly (not) inevitable? This question helps us to scrutinise explanations as to why things are the way they are. Sometimes health inequalities are seen as inevitable because, for example, their causes are framed as a manifestation of a culture of a particular population.status quo bias, or a hearkening to the priority of what has been ‘normal’, requires as strong a defence in terms of justice as any challenges to it.Fourthly, Health inequalities indicate problems of social injustice. Specifically , they are problematic insofar as they are unfair and avoidable through means that themselves are morally-mandated. That point bears emphasis because, as we have spelled out, these properties of unfairness and avoidability require us to bite political bullets. Wherever we sit in political philosophical terms—whether in a more libertarian or more collectivist or communitarian campLancet-O’Neill report on the legal determinants of health.with justice have divided people in the UK. The pandemic has seen the implementation of sweeping and draconian statutory measures, both under the Coronavirus Act 2020 and through secondary legislation made under the Public Health (Control of Disease) Act 1984, with consequent (and ongoing) reviews by Parliament,The public health ethics literatures provide excellent examples of works that take on this task. And recognising the growing legal scholarship that engages and contributes to these,First, we may look at law as a key structural aspect within the social determinants of health: laws practically contribute to the materialisation of better or worse, and more or less just, health outcomes. This applies to laws that, for example, empower government to implement health protection measures, or to apply taxes to products such as sugary drinks or tobacco to discourage their consumption. It applies to laws that govern interactions of and between private individuals, organisations, corporations, and so on, from public health rationales within torts such as negligence, to areas such as employment law duties. And it applies to criminal law measures around particular forms of harmful behaviours and practices. Secondly, there is law as a constraint to guard against undue interference with individual and commercial freedoms: for example, human rights and equality protections, or wider protections of basic constitutional and common law rights. Notably, within this function too we see the importance of philosophical commitments that are embedded within the idea of law writ large: for example, the rule of law. Thirdly, we have law as a normative system whose study provides its own important measures of critical evaluation in value-based standards of justice. These may come from standards that are internal to (ideas of) law, such as human rights norms or the rule of law. And they also come from critical moral and political theories that help us, as legal scholars, to evaluate, critique, and make practical proposals in relation to law.inter alia) the health sciences and political sciences to give empirical accounts of laws’ practical effects and influences; and of their potential, through litigation, legislation, and distinct methods of implementation. The necessary multi- and transdisciplinarity of studies in law and public health need equally to extend in the directions of philosophy and critical social theory. Works such as the Lancet-O’Neill report explicitly note the relevance of the normative questions that would be clustered under our third point in the above list. But much greater attention to and incorporation of such questions within legal scholarship is necessary if we are adequately to frame and respond practically to legal determinants of health injustice.Leading scholarship in public health law and legal epidemiology has been particularly attentive to the first and second of these.Many libertarian, and more ‘narrowly liberal’, theories, ideas, and norms, feature in and underpin normative assumptions, both in UK medical law and political morality. This at once perpetuates notions of self-reliance, atomised individualism, and so on, and gives rise to a wariness of the state  advancing positions on the ethical values that matter (most), or that act with a paternalistic goal of defining and serving people’s interests. These problems manifest for  laws, in critiques of the idea of law, and as routine assumptions with UK health law scholarship. Nevertheless, we also see sustained, and perhaps growing, concerns about the stark realities of health inequalities, and the structures that contribute to their (worsening) existence. Laws are a fundamental part of the social and institutional architecture within which health inequalities are created and sustained. They may thus also be part of the response to them. Individual laws, law writ large, and the work of legal scholars, have a key part to play in identifying what is meant by health injustice, and how it may be addressed. In this article, we have sought to explain why medical law provides the wrong starting point, what bringing a public health perspective brings to health law scholarship, and outlined four critical, framing questions that must be addressed within such scholarship. The combination of the continued impacts of austerity, the COVID-19 pandemic, the predominance of libertarian ethico-political norms in health policy, and the development and implementation of a new policy agenda underscore the urgency of the project of addressing the legal determinants of health (in)justice.


Wearable Internet of Things (IoT) devices can be used efficiently for gesture recognition applications. The nature of these applications requires high recognition accuracy with low energy consumption, which is not easy to solve at the same time. In this paper, we design a finger gesture recognition system using a wearable IoT device. The proposed recognition system uses a light-weight multi-layer perceptron (MLP) classifier which can be implemented even on a low-end micro controller unit (MCU), with a 2-axes flex sensor. To achieve high recognition accuracy with low energy consumption, we first design a framework for the finger gesture recognition system including its components, followed by system-level performance and energy models. Then, we analyze system-level accuracy and energy optimization issues, and explore the numerous design choices to finally achieve energy–accuracy aware finger gesture recognition, targeting four commonly used low-end MCUs. Our extensive simulation and measurements using prototypes demonstrate that the proposed design achieves up to 95.5% recognition accuracy with energy consumption under 2.74 mJ per gesture on a low-end embedded wearable IoT device. We also provide the Pareto-optimal designs among a total of 159 design choices to achieve energy–accuracy aware design points under given energy or accuracy constraints. Gesture recognition is among the popular issues for human–machine interface applications. In particular, hands are the parts that can move most accurately with relatively little energy, compared to other body parts. Thus, hand gesture recognition is used as an efficient interface for human–computer interaction (HCI) ,5,6,7,8.An alternative method of implementing gesture recognition is to use wearable sensors such as inertial measurement units (IMU), electromyography (EMG) sensors, flex sensors, and pressure sensors ,11,12,13Among various wearable sensors such as IMUs, EMG, and flex sensors, we focus on using a state-of-the-art flex sensor  which ca-Provide the full design for a finger gesture recognition system using a single flex sensor. -Explore the design choices of a finger gesture recognition system in terms of performance, accuracy, and energy consumption using the conducted performance and energy consumption models.-Demonstrate the functionality and feasibility of the proposed designs by implementing the prototypes using four commonly used low-end embedded MCUs.-Show the energy–accuracy aware design which achieves up to 95.5% accuracy with an energy consumption of 2.74 mJ per gesture.-Provide the energy–accuracy aware Pareto-optimal designs among a total of 159 design choices to find energy–accuracy aware design points under given energy or accuracy constraints.In this paper, we design a light-weight finger gesture recognition system that can be implemented in low-end embedded devices using a single flex sensor. To this end, we first design a framework for a finger gesture recognition system that recognizes 17 finger gestures. The framework consists of data collection, preprocessing filters, and a light-weight multi-layer perceptron (MLP)-based classifier. Then, we construct performance and energy models to find optimal design choices efficiently. We analyze and discuss the energy–accuracy aware system-level design issues, and explore the design choices of finger gesture recognition by considering computation requirements/memory resource targeting for four types of low-end micro controller units (MCUs). Finally, the functionality and feasibility of the proposed work are verified by implementing prototypes. The contributions of this paper are summarized as follows:The rest of this paper is organized as follows. The backgrounds are described in This section describes the backgrounds of this work which consists of the existing work related to gesture recognition and the basics of the flex sensor used in this work.An IMU sensor which embeds micro electro mechanical systems (MEMS) accelerometers, gyroscopes, and magnetometers was popularly used because it can capture the wide range of body movements. An IMU sensor can even be attached to a cane to detect falls in the elderly . HoweverEMG sensors are used for body movement recognition as well. Instead of directly measuring the physical movements of the body, the sensor alternatively measures the biomedical signals using specially made probes attached to the skin surface. EMG sensors can detect the very fine movements of the body that cannot be detected by physical movement measuring sensors alone ,16,17. HConventional flex sensors based on conductive ink, fiber-optic, or conductive fabric technologies are used for various wearable IoT applications such as embedded device-based health care , sign laIn general, data collected from the wearable flex sensor for body movement recognition requires time-domain data analysis using machine learning (ML) techniques such as dynamic time warping (DTW) , hidden Flex sensors measure the amount of bending or deflection. There are three types of commonly used flex sensors, as shown in Sensors made with an optical fiber support high accuracy and high durability. However, a pair of a light source and a detector is required, and only unidirectional sensing is possible . Conduct2C) standard communication interface. This means that power-hungry analog-to-digital converters (ADCs) are not necessary, which is good for wearable IoT devices.The advanced flex sensor introduced in the previous subsection is made with a silicone elastomer layered with a conductive and non-conductive material. This sensor not only measures the bending degree of two axes stably with a single sensor, but also has the advantage of being flexible and stretchable with silicon material. As mentioned, this sensor is not a simple variable resistor type but a sensor module that embeds a low-power integrated analog front, resulting much less noise over time compared with the other sensors. In addition, it generates digital data through an inter-integrated circuit  activation function. For each explored MLP model, we perform an independent training and testing process. The exploration in detail will be described with system-level optimization in Output Layer: The number of nodes in the output layer is generally determined by the number of recognized gestures. In this work, the number of gestures is set to 17. Thus, we design the output layer to have 17 nodes. Each node in the output layer uses a Softmax activation function to generate a probability value for each gesture so that the gesture with the highest probability is selected as the final result.Based on the design described in In terms of the design components, the proposed system consists of data collection, preprocessing filters, and an MLP-based classifier. At the same time, in terms of hardware components, the system mainly consists of a flex sensor and an MCU board. Thus, management of these hardware components is a practical issue of the implementation. For example, activation/deactivation scheduling of the MCU and the sensor module is tightly coupled with the performance and energy consumption of the system. The MCU can be in a standby state synchronized with the operating frequency of the sensor. When the preprocessing and MLP classification tasks are executed in the MCU, the sensor can be entered into a standby state to minimize the power consumption of the sensor. To address these issues, we first build timing models of gesture recognition, as shown in The time taken per single gesture recognition, 2C configuration when running at 400 KHz. Note that the sensor is always in the active state during Looking at the data collection process which accounts for most of the time spent on gesture recognition, the MCU repeats the sensor data read with the sampling frequency When estimating Since our design considers The energy consumption per single gesture recognition, In the data collection task, the MCU operates periodically with the frequency of The energy consumption for executing the preprocessing, As mentioned, the sensor is in the active state only during data collection for time Based on Equations (3)–(7), Similar to Equation (2), only AT and There are numerous design choices where the energy and accuracy are trade-off relations in general. This means that maximizing recognition accuracy while simultaneously minimizing energy consumption is not easy to solve. Thus, we first define accuracy- or energy-constrained objective functions as below:As modeled in previous sections, the sampling frequency, Using Equation (8), we can easily analyze and explore the design choices of In designing preprocessing filters, a simple design choice is whether each filter is adopted. We use a segmentation filter and a reshape filter for all design choices because they are indispensable while noise and normalization filters are optional. In designing a segmentation filter, determining , the higher the accuracy but the larger the energy consumption. Similar to , the maximum achievable accuracy is also limited even when In designing a MLP classifier, finding the optimal number of parameters used in the MLP is important to find an energy–accuracy aware design. The higher the This section introduces experimental setups including the prototypes we implement to verify the energy–accuracy aware design points. Then, the results of design choice exploration and the Pareto-optimal energy–accuracy aware design points are presented with some findings and discussions.2C to the MCU board. We consider four commonly used low-end MCUs for targeting low-end embedded devices. To demonstrate the feasibility of the proposed designs, we implemented an in-house prototype tiny enough to wear on the body, as shown in The prototypes are used for two purposes—data collection and design verification—through real-time gesture recognition. In data collection, the raw data collected are directly sent to the PC so that the data are used for training and for testing the MLP classifier. The prototypes are also used to provide the timing information to the energy models defined in In total, 17 types of gestures are defined as continuous motions, as shown in MLP training is performed in the Pytorch environment. The hyper-parameters used for trainings are 0.0075 and 500 for the learning rate and epoch, respectively. No significant performance change is observed after the epoch of 500, so the maximum epoch is fixed at 500. For comparison purposes, we build one gated recurrent unit (GRU) and two tiny ML models generated using TensorFlow and Neuton’s AutoML, which is commercially available from Google AI.k-th hidden layer, and n is the number of hidden layers. Note that As expected, recognition accuracy is highly correlated with The accuracy for the single hidden layer and double hidden layer of MLPs shows different behaviors depending on whether the preprocessing filter is applied. When preprocessing filters are not applied, the double-hidden-layer MLP shows better performance at most ranges of problems . We obseBased on comparisons of the four configurations, we conclude that the single-hidden-layer MLP with preprocessing is more suitable for devices that have limited resources.We explored the design choices of the proposed finger gesture recognition system in terms of accuracy as well as the energy consumption by analyzing a total of 159 designs with varying design choices. Atmega2560 has the worst energy–accuracy efficiency. We found that Atmega2560 is based on an 8-bit RISC architecture, and computation requirements during the preprocessing and forward propagation operations in the MLP needs more active time of the MCU, which increases energy consumption when A confusion matrix is useful for analyzing the patterns of mispredictions. In this paper, we implemented a finger gesture recognition system based on a light-weight MLP-based classifier using a low-end MCU and a 2-axes flex sensor. In order to find energy–accuracy aware design points, we first designed a full process of finger gesture recognition and its system-level performance and energy models. Then, we analyzed system-level design issues including sensor operating frequency and the size of the MLP classifier. Finally, we explored the numerous design choices based on accuracy and energy constraints. Considering four commonly used MCUs, a total of 159 design points were determined according to the configuration of the sensor operating frequency, the presence of preprocessing filters, and the size of the MLP classifier. As a result of Pareto Fronts, the proposed design achieved up to 95.5% accuracy with an energy consumption of 2.74 mJ, which shows up to 10% higher accuracy than previous studies  with simIn this work, we do not address the effect of using AI accelerators such as digital signal processors (DSPs), FPGAs or application-specific integrated chips (ASICs). Since these accelerators will greatly affect performance as well as energy efficiency, considering these components will be our future work to find energy–accuracy aware design choices for wearable IoT devices.


This article forms part of a series looking at management of patients with tooth wear. Articulated study casts can be essential in assisting the clinician to plan and communicate proposed treatment to the dental technician and patient. Their production is often seen as straightforward, but a lack of attention to detail can quickly lead to articulated casts that do not replicate the patient clinical presentation. This in turn will lead to inaccurate planning and potentially a suboptimal treatment outcome. This article discusses a collection of the clinical records needed to produce accurate articulated study casts, which can be utilised for tooth wear planning. It also aims to present the evidence base for the recommendations outlined. Articulated study casts can form an integral part of the treatment planning process for patients with complex tooth wear. The stages to produce accurately mounted study casts include recording impressions to achieve high-quality study casts, recording a facebow, recording a centric relation record and lab mounting. Each stage needs to be carried out with the greatest of care to ensure consistent results.After the records have been collected and processed by the laboratory, it is essential that the mounted study casts are verified for accuracy. Accuracy is by no means a guarantee and errors can occur at any point. This can result in mounted study casts that do not replicate the tooth contacts found clinically. The use of analogue techniques to produce articulated study casts is well documented.Articulated study casts serve as a medico-legal record of the patients' pre-treatment presentation. They can be used to examine the static and dynamic occlusal contacts without muscular guarding or the visual limitation of the soft tissues. Duplicated study casts can be modified with mock equilibrations, tooth removal, or additive waxing, to simulate proposed treatment plans. They are also useful in the production of guides and stents. The production of articulated study casts comes at significant expense and must provide added value. They are not always necessary but are invaluable when executing complex tooth wear cases.Recording impressions to achieve high-quality study castsRecording a facebowRecording a centric relation record (CRR)Lab mounting and verification.The stages to produce accurately mounted study casts include:This article will aim to outline a simple and evidence-based summary of how to execute the stages above to a high standard.Alginate impression material in a universal stock tray will provide sufficient accuracy to produce high-quality study casts. Alginate provides a cheap and well-tolerated impression material. However, an understanding of the material's limitations is essential if it is to be used consistently.Alginate is most commonly bought in bulk. After opening, the loose alginate is stored in an airtight container . It is e8 Setting time of alginates can vary considerably between manufacturers. Most setting times are based on 22 °C tap water and average 2-3 minutes. By increasing or decreasing the temperature of the water, the setting time can be manipulated. There is some evidence to suggest that higher temperature water results in less dimensionally accurate impressions. For the best results, cold water is recommended.9,10By altering the powder-to-water ratio when mixing alginate, it is possible to manipulate the consistency. For the best results, it is best to maintain the volume of powder and vary the amount of water. Altering the powder-water ratio by up to 25% does not affect the accuracy of the impression.11 When using alginate, universal plastic stock trays provide adequate rigidity.The tray is the foundation of an accurate impression. Classically, metal rim lock trays were recognised to be the gold standard. This was born out of concerns about the rigidity of newer plastic stock trays, which were thought to flex and then rebound on impression removal. In reality, the studies that have investigated this have been concerned with high viscosity silicone putty, not alginate.Sizing the tray appropriately is essential. There should be good material support around the full arch and 3-5 mm clearance from the teeth around all aspects of the tray to allow adequate alginate thickness. Tray perforations through the alginate can lead to inaccurate impressions and ideally should be avoided, particularly in key areas . Stock t12Special attention needs to be paid to large edentulous saddles or high-vaulted palates. Alginates do not self-support well and can sag before the gelation phase is complete. The tray is best augmented with compound or putty in these areas to prevent this .12Fig. 4In vitro studies have demonstrated that it can improve the dimensional accuracy of alginate impressions.13,14 It is essential that pooled adhesive is not left in the tray as this can act as a lubricant  and absorption (imbibition) of water. Special attention has to be paid to impression disinfection, storage, transportation and the time delay until pouring, to prevent suboptimal performance.16,17The disinfection of an alginate impression can be completed by either immersion in a disinfectant bath or soaking with a disinfectant spray. Both have been shown as effective and achieve cross-infection control. The effect of disinfection on dimensional accuracy has been extensively researched. A recent critical review of the literature demonstrates that there are negligible effects on dimensional accuracy of the impression as long as the manufacturer's instructions are followed.18 This has led to the belief that an alginate impression needs to be cast as soon as possible after capture. This has been disputed in other publications and largely depends on the alginate being used.19,20 There have been huge advances in alginate in recent years, with some manufacturers claiming their alginate can maintain dimensional stability for as many as seven days. The evidence would support the dimensional stability of these newer extended pour alginates.21 That said, we cannot expect standard alginates to perform in this way. It is essential that these are poured as soon as possible.22 If there is likely to be periods of over 24 hours between recording and pouring of your impression, an extended pour alginate or addition cure silicone should be considered.23It is commonly quoted that distortion of an alginate impression can start to develop in as little as 12 minutes after removal.The importance of the facebow transfer can be conceptionally difficult to grasp. A facebow allows us to record the spatial orientation of the maxilla to the terminal hinge axis clinically and then transfer this information via the mounting process to an articulator .Fig. 8 AAesthetically, it allows any incisal and occlusal cants, relative to the horizontal reference plane being utilised, to be recorded. Although this can be achieved in other ways, a facebow is quick and predictable . If thisThere are many different articulator manufacturers on the market, each with their own specific facebow. It is essential that the correct facebow to the articulators used in your chosen laboratory is selected. Facebows rely on two posterior reference points and one anterior reference point when positioning their upper member. Confusingly, these reference points change depending on the brand of facebow utilised. It is therefore essential that the manufacturer's instructions are followed.24Most facebows utilise the external auditory meatus (EAM) as a convenient, but arbitrary, posterior reference point to represent the terminal hinge axis (THA). The THA is an imaginary line drawn between the patient's condyles around which the mandible rotates in early opening and late closing. Because of this, they are more appropriately named 'earbows' . The EAM25 This discrepancy is unlikely to significantly impact most cases and is a small price to pay for the incredible ease with which the 'earbow' can be used clinically. Greater accuracy can be achieved but involves advanced equipment, such as pantographs and fully adjustable articulators.Manufacturers have gone to great lengths to construct the upper member of their facebow in order to account for the average discrepancy between the anatomical position of the THA and the EAM. But there is no doubt that this 'one size fits all' approach will lead to inaccuracy. The impact of this has been studied by researchers and it has been concluded that even a 5 mm discrepancy between the EAM and the THA will result in only a 0.2 mm discrepancy in mandibular position on closure when a 3 mm thick CCR inter-occlusal record is used.When recording the facebow, a non-flexible material, such as silicone bite registration material or beauty wax, should be used to record the tooth positions on the bite fork. It should be possible to stabilise the study cast on the bite fork with three well-distributed points of contact. If this is not possible due to the distribution of the teeth, then a wax record block will be necessary. Ideally, this should be constructed on the model to be mounted to improve accuracy of fit.Centric Relation (CR) is a maxillomandibular relationship, independent of tooth position. In CR, the mandible is restricted to a purely rotation movement. Diagnostic casts are mounted on the articulator in CR using a CRR.26 But as clinicians, we recognise CR as the familiar feel of 'passive rotation' of the mandible. An accurate CRR can be time-consuming to achieve depending on the degree of muscle guarding the patient has. It is best to test the degree of muscle guarding by gently manipulating the mandible up and down  bite registration material . It can 32It is important that a rigid PVS material is used, ideally one with a Vickers hardness of D or above. Pink or silver wax are not suitable to record a CRR as they are not rigid at room temperature.It is essential that the CRR has a minimum of tripod contacts on the remaining teeth. If the patient has multiple missing posterior teeth, there may be a need to include wax registration rims as part of the CRR . Wax rimSilicone bite registration material records more surface detail than alginate. The high degree of accuracy with which the silicone captures the fissure pattern of the teeth prevents the occlusal record from fully seating on the study casts produced from the alginate impressions . It is tAfter the records above have been collected and processed by the laboratory, it is essential that the mounted study casts are verified for accuracy. Accuracy is by no means a guarantee and errors can occur at any point. This can result in mounted study casts that do not replicate the tooth contacts found clinically.33,34,35,36 Verification can be completed in different ways. The recording of multiple CRRs allows the use of a Centri-Check.37 More practically, the initial tooth contact in CR can be marked with articulating paper clinically. Occlusal indicator wax can also be used to record and retain this tooth contact. An occlusal sketch could be used for the same purpose (The occlusion should already have been examined in detail clinically. purpose .Fig. 23 When the models are returned from the laboratory, the initial tooth contact on the study casts should replicate those found clinically. This can be marked with articulating foil and confirmed with the occlusal indicator wax or occlusal sketch . If the The production of accurate articulated study casts is a time-consuming process. Each stage in the process must be executed to the highest standard if we are to be successful.Alginate provides a cheap and accurate impressions material but must be handled with care to achieve the best results. The use of a facebow is not always necessary, particularly if not increasing the occlusal vertical dimension. But when needed, the ear bow can provide adequate accuracy for most tooth wear cases, even accepting its limitations relative to a pantograph with fully adjustable articulator. The recording of a CRR can be challenging, particularly in patients with extensive muscle guarding. But by using a staged approach to deprogram the patient's muscles, and selection of the correct inter-occlusal material, an accurate record can be achieved . Even with excellent clinical techniques and care, it cannot be assumed that the lab mounting process will progress without fault. The verification of mounting accuracy in comparison to the patient's clinical tooth contacts is essential for success.