bluuebunny/crossref_metadata_2025 huggingface dataset:
Modification of Unsaturated Polyester Resin Using Elastomers
Authors: Lubi C. Mary , Ravi K. , Ahammed Abdeen , Thachil Eby Thomas
Published: July 2017

Unsaturated polyester resin is widely used in the fiber reinforced plastic industry It suffers from lack of toughness, which makes it susceptible to breakage in the absence of reinforcement. This problem can be solved, at least partly, by the incorporation of elastomers. In this study a simple technique of dissolving various masticated elastomers in styrene and subsequent solution blending with unsaturated polyester resin has been done. The results point to the suitability of nitrile rubber for this purpose compared to other elastomers. An increase in toughness has been achieved without sacrificing any other property substantially.
New Sources Of Carbon Black
Authors: Gotshall William W. , Fernandes Dudley P.
Published: July 2017

The search for new or substitute rubber reinforcing materials for the rubber industry has greatly accelerated in the last few years due to two major problems facing the traditional carbon black industry — shortage of feedstocks and disproportionate increases in the price of these feedstocks. This paper discusses two promising substitute materials that potentially can replace 35—40% of the existing carbon black market.

The first process produces a substitute black using fluid petroleum coke as raw material. Fluid coke is first pulverized to sub-micron particles in a non-oxidizing atmosphere, then these particles are coated to protect the highly active surfaces from oxidation until they are incorporated into the rubber. Advantages offered by this process are high profitability, low capital costs, high yields, no polluting wastes, low energy requirements (80% less than for conventional processes).

The second process produces a reinforcing black from scrap automobile tires. Chopped scrap tires are pyrolyzed under conditions that maximize carbon production. This rubber char is then pulverized as described above to produce a reinforcing black. In addition to the advantages offered by the fluid coke process described above, the rubber char process further reduces new energy consumption to virtually zero since the feedstock provides all the energy required to operate the process.
Studies on Mastication Stage Binding of Antioxidants
Authors: Avirah Shanti A. , Joseph Rani
Published: July 2017

Paraphenylenediamine and diphenylamine were chemically attached to natural rubber during mastication. The rubber bound antioxidants were characterized by TLC, 'H-NMR, IR and TGA. The efficiency and permenance of these bound antioxidants were compared with a conventional amine type antioxidant in filled natural rubber vulcanizates. The rubber bound antioxidants were found to be less volatile and less extractable as compared to conventional antioxidants. The vulcanizates showed improved ageing resistance as compared to vulcanizates containing conventional antioxidants. This semisolid rubber bound antioxidant can reduce the amount of plasticizer required for compounding.
Effect of High Crystalline Trans-Polyoctenylene (TOR) on Different Cure System of SBR Compounds
Authors: Chattaraj P. P. , Kalidaha A. K. , Mukhopadhyay R. , Tripathy D. K.
Published: July 2017

To improve performance properties in conventional system (CV) of Styrene butadiene rubber (SBR) without sacrificing processing advantages, a systematic study was carried out using a co-crosslinkable processing aid, Trans-polyoctenylene (TOR) in SBR. Different curing systems, i.e., CV, Semi-Efficient (SEV), Efficient (EV) vulcanizing system are included in the study under anaerobic aging conditions. Optimum cure time increases and reversion resistance improves with compounds containing TOR. Retention of network properties improves on anaerobic aging with compounds containing TOR in CV and SEV systems. Correlation of modulus shows that 10 parts TOR in CV system can retain modulus well above that of compounds without TOR in EV system on anaerobic aging. Improved retention is due to co-crosslinking of the TOR phase which has been explained through differential scanning calorimetry (DSC) study.
Laboratory Performance of ASR Modified Asphalt Binders
Authors: Dutta Utpal , Ibadat Imran , Klempner Daniel , Keshawarz Mohammad S.
Published: July 2017

Automobiles, when they are no longer useful, are flattened and shipped to an automotive shredder facility. At the shredder facility, while they are shredded to recover the ferrous and non-ferrous metals for recycling, a huge quantity of non-metallic residue commonly called Automotive Shredder Residue (ASR) is generated. Since ASR mostly contains plastic and rubber related materials, and addition of plastic and scrap rubber from waste tires as a road material has been proven to be effective in solving existing pavement related problems, attempts were made to examine the feasibility of ASR as a road material additive. As a part of this effort, compatibility and mechanical properties of ASR modified asphalt were studied. The asphalt was mixed with a requisite amount of ASR for one hour at 375°F. Glass transition temperature (Tg) and microstructure of ASR, asphalt and ASR modified as-phalt were examined to determine compatibility. Mechanical properties of ASR modified asphalt were studied by performing dynamic mechanical analysis. The photomicrographs and Tg of ASR modified asphalt demonstrated some compatibility between ASR and asphalt. Dynamic mechanical analysis indicated that rutting and aging properties of asphalt should improve with the addition of ASR.
Studies on the Influence of Cure System on the Shrinkability of Polyolefin-Bromobutyl Blends
Authors: Patra P. K. , Das C. K.
Published: July 2017

Influence of cure systems on the extent of shrinkage of polyolefm bromobutyl blends have been studied as a function of cure time and the polyolefin/elastomer ratio. During measurement of shrinkage, one of the parameters is kept constant while the other is varied. With the increase in cure time the shrinkability of the blends increases when elastomer content is fixed. Similarly, at constant cure time the shrinkability of the blend increases with high elastomer content. Blends elongated under high temperature (H-T) have higher shrinkage than those elongated under room temperature (R-T). DCP is more effective than sulfur for a particular set of blends so far as the shrinkability of the blend system is concerned. The morphological pattern of DCP cured relaxed samples and sulfur cured relaxed samples is corroborated by the SEM studies where the pattern appears to be more globular in nature for the former. The crystallinity of the blend depends on the curing agent, and the dose and type of polyolefin used.
Dynamic Shear Rheological Properties of Polymer-Modified Asphalt Binders
Authors: Newman J. Kent
Published: July 2017

Rheological characteristics were measured using DSR (Dynamic Shear Rheometry) for two asphalts (A and B, conventional AC-20 viscosity grades) from different crude sources modified with 5% SBR, 5.5% LDPE, 5% SB, and a crumb rubber (5%)/SBS (2%) mixture. Mastercurves were constructed from DSR frequency sweeps at temperatures ranging from -20 to 80°C. The mastercurves were constructed using the method of reduced variables, similar to the WLF equation, and described all binders well except for the A-LDPE binder. Polymer network formation is suggested in the B-SB binders based on the tendency of the tan δ mastercurve to exhibit a local minimum and the lack of observable phase separated polymer domains within the resolution of the fluorescence microscope. The morphology of the SBR polymer in the asphalt was observed to be dependent on the specific asphalt source. Initiation of polymer network formation is postulated for B-SBR based on the behavior of tan δ and the asphalt swollen phase separated polymer domains as observed by fluorescence reflection microscopy. For B-LDPE, A-CR + SBS, and B-CR + SBS the response of tan δ suggests networking but is postulated to be a contribution of the clearly observable phase separated polymer domains. The overall response of B-LDPE and the CR + SBS binders are a sum of the contributions of each phase with the polymer acting more as a filler, dominating the rheological response at intermediate frequencies.
Palm Oil Fatty Acid Additives (POFA's): Preparation and Application
Authors: Ismail Hanafi , Ng C. T.
Published: July 2017

A synthesis procedure for preparing palm oil fatty acid additives (POFA's) is described. The performance of these acids in carbon black (CB) filled natural rubber (NR) compounds was examined. The incorporation of POFA's is found to improve mechanical properties of CB filled NR compounds, especially below a concentration of 2 phr. Scanning electron microscopy (SEM) indicates that POFA's improved filler dispersion while swelling measurement tests show that POFA's have some effect on crosslink density.
Studies on Rheological Behaviour of Self-Vulcanizable Rubber Blends Based on Chlorosulphonated Polyethylene and Carboxylated Nitrile Rubber
Authors: Mukhopadhyay Sujata , Gupta B. R.
Published: July 2017

The rheological behaviour of self-vulcanizable rubber blends based on chlorosulphonated polyethylene (hypalon) and carboxylated nitrile rubber (XNBR) has been investigated in terms of effect of blend ratio, carboxyl content of carboxylated nitrile rubber, carbon black filler loading, rate of shear and temperature on viscosity, die swell and power law constants ( n and K). The blend system follows the power law model in the experimental range of rate of shear and shows pseudoplastic flow behaviour. XNBR shows higher viscosity than hypalon and in blends an increasing proportion of XNBR increases the blend viscosity at a constant shear stress or rate of shear. XNBR shows maximum die swell and hypalon shows the least. Blends show lower die swell as compared to the single rubbers. Addition of filler reduces die swell and surface roughness of the extrudates.
Comparison of Dynamically Loaded PP/EPDM- and PP/mPE-Blends Using the Hysteresis Measurement Method
Authors: Raue Frank , Ehrenstein Gottfried W.
Published: July 2017

New metallocene polymerized polyethylenes (mPE) with low densities possess elastomeric properties and show good dispersibility in poly-propylene (PP). Therefore substituting mPE for EPDM in PP/EPDM-blends has the potential to improve blend properties. However, their technical application requires knowledge of critical load values.

This work shows the deformation behavior of PP/EPDM- and PP/mPE-blends under static and dynamic loading. Dynamic load limits are obtained using the hysteresis measurement method. The influence of the type and the amount of soft phase on different mechanical properties is examined.
An Innovative Study to Evaluate Fillers, Part 1: Carbon Black and Silica
Authors: Patel Arvind C.
Published: July 2017

The main components of a rubber compound, polymer and fillers, are evaluated jointly to characterize the reinforcing characteristic of carbon black and silica. A new concept has been developed around three filler parameters: (1) surface area, N2SA; (2) volume of the aggregate, VF; and (3) volume fraction of the filler in a compound, (c. These parameters are associated with a decrease in the randomly oriented polymer chains from unity. This decrease is attributed to the interaction between surface chemistry and morphology of the filler. Two parameters are derived from the colloidal properties of the filler: total volume (0t) and total surface area (E,). The experimental data discuss dynamic and technological properties as a function of Es and Qt. The fillers involved in the study are carbon black and silica. Compound properties were obtained, at variable loading, in filled and unfilled S-SBR, E-SBR, EPDM and NR. The second part discusses rubber properties, at constant loading, of carbon black and silica. The concept was applied to create precise blends of carbon black and silica to reduce hysteresis and duplicate silica compound properties.

The results demonstrate a very sensitive relationship between filler parameters Es and qt with compound properties.
John's Account of Jesus' Demonstration in the Temple: Violent or Nonviolent?
Authors: Bredin Mark R.
Published: July 2017

In this article I attempt to deal only with John's account of the temple incident in chapter 2. The initial concern of this article is to what extent John's version of the temple incident harmonizes with the Jesus who teaches love for neighbors and enemies alike. I will argue that John's telling of the incident is controlled by his reflections on certain First Testament traditions and traditions regarding Isaac and the temple. The distinctive aspects of the account can be accounted for by First Testament allusions and later Judean developments. In conclusion, it is possible to establish Jesus' demonstration as motivated by his perception that the temple is the center of violence.
A Modified Three-Phase Model for Determining the Elastic Constants of a Short Fiber Composite
Authors: Whitney James M.
Published: July 2017

A micromechanics model is presented for determining the elastic constants of unidirectional composites reinforced with short fibers. The model is based on the modification of a 3-phase embedded concentric cylinder model. In this modification the cylindrical fibers are replaced by composite fibers which reflects the distance between fiber ends in the aligned short fiber composite, i.e., the fiber cylinder is assumed to be constructed of a fiber length and a matrix length. A strength-of-materials approach is then utilized for determining the elastic properties of the compostie fiber. All elastic constants are determined by this procedure.
Non-Linear Behavior of Polymeric Resin Matrix Composites: Modeling of Laminates
Authors: Jouannigot S. , Leroy M. , Mallard H.
Published: July 2017

This paper presents an analytical method to model the non-linear behavior of polymeric resin matrix composites. Complementary energy density is used to derive a stress-strain relation which is non-linear in uniaxial loadings in the longitudinal, transverse directions and in shear. The laminae behaviors are modeled by an n-order terms equation, with n going from two to five according to the non-linearity behavior. This paper presents results for [mat/0 well-balanced woven/mat] E-glass/polyester laminates with high matrix ratio and shows good agreement with experimental data.
On the Evaluation of Critical Thrust for Delamination-Free Drilling of Composite Laminates
Authors: Upadhyay P. C. , Lyons Jed S.
Published: July 2017

The existing analytical models in the literature for estimating the critical thrust force of the drill to avoid delamination of composite laminates during drilling assume the drill force as a point load on the laminate. Also, they are based on small deflection assumptions even while considering the pushing out of the last one or two plies at drill exit. In this paper, the effects of these two assumptions on the critical thrust value have been examined by taking an alternate assumption of a distributed thrust over the drill diameter, and large deformation of un-cut plies during drill exit. The effects of both these assumptions are calculated and analyzed separately.
On the Characterisation of Syntactic Foam Core Sandwich Composites for Compressive Properties
Authors: Gupta Nikhil , Kishore  , Sankaran S.
Published: July 2017

Sandwich structures, especially those with honeycomb and grid structures as the core material, are very commonly employed in aircraft structures. There is an increasing use of closed-pore rigid syntactic foams as core materials in sandwich constructions because they possess a number of favourable properties. The syntactic foams, owing to their structure and formation, behave differently under compression compared to other traditionally used core materials. In the present study, therefore, syntactic foam core sandwich constructions are evaluated for their behaviour under compression in both edgewise and flatwise orientations. Further, the work characterises the relative performance of two sets of sandwich materials, one containing glass-epoxy and the other, glass/carbon hybrid-epoxy skins. As non-standard geometry test specimens were involved, only a comparative evaluation was contemplated in this approach. The experiments indicate that the nature of the reinforcement fabric in the skin has a bearing on the test results in edgewise orientation. Thus, the tendency towards initiation of vertical crack in the central plane of the core material, which is a typical fracture event in this kind of material, was found to occur after a delay for the specimens containing the glass fabric in the skin. Attempts are made to establish the correlation between observations made on the test specimen visually during the course of testing and the post-compression microscopic examinations of the fracture features.
Damage Mechanics Analysis of Transverse Cracking Evolution in Delaminated CFRP Laminates
Authors: Kobayashi S. , Takeda N. , Ogihara S. , Kobayashi A.
Published: July 2017

A damage mechanics analysis was applied to predict transverse crack evolution in a laminated composite. The analysis was originally developed to predict thermoelastic properties of a laminate containing transverse cracks. Two criteria based on both critical average ply stress and critical energy release rate were used to discuss the transverse cracking behavior. The effect of delamination was also considered in the present study. The predictions of transverse crack density based on both criteria were successfully compared with experimental results. This analysis can be applied to laminate with arbitrary lay-up configuration.
Mode II Interlaminar Fracture Behavior of Fiber Reinforced Polyamide Composites under Static and Dynamic Loading Conditions
Authors: Todo Mitsugu , Nakamura Takashige , Takahashi Kiyoshi
Published: July 2017

Mode II interlaminar fracture tests of continuous fiber reinforced polyamide-6 composites were carried out at a quasi-static and a dynamic loading rate. Loadingrate dependence on the mode II interlaminar fracture toughness was investigated, and two different kinds of the composites, carbon fiber cloth reinforced polyamide-6 and glass fiber cloth reinforced polyamide-6, exhibited different loading-rate dependencies on the frao. ture toughness. Micromechanisms of the mode II interlaminar fracture were also studied using a scanning electron microscope. Loading-rate effects on the mode II interlaminar fracture behavior of the composites are discussed on the basis of the experimental results.
The Right of Minors to Confidentiality and Informed Consent
Authors: Weisleder Pedro
Published: July 2017

Doctor-patient confidentiality is a precept of adolescent medicine. In general, physicians honor the privacy of adolescents unless there is evidence that the youngster is engaging in dangerous activities. An otherwise healthy 16 year old was referred for headache evaluation. During the portion of the interview conducted outside the presence of his mother, the patient revealed using marijuana and cocaine regularly and LSD (lysergic acid diethylamide), hallucinogenic mushrooms, and “Ecstasy” (3,4-methylenedioxymethamphetamine) occasionally. Given this information, and as allowed by North Carolina's General Statutes, the patient was offered confidential treatment for illegal substance abuse; he declined the offer. He also turned down the request to forgo his right to privacy so that his parents could be made aware of his addiction. As a result of the patient's drug use and disregard of its consequences, it was determined that notification of a parent was essential to his life or health; thus, confidentiality was breached. Although substance abuse is a behavior that threatens the abuser's health and life, state and federal laws vary regarding the rights of minors to confidential evaluation and treatment. For this article, laws that govern minors' rights to consent to confidential treatment for illegal substance abuse were reviewed. The aforementioned case is used as a catalyst for discussion. ( J Child Neurol 2004;19:145—148).
Actin-Related Myopathy Without Any Missense Mutation in the ACTA1 Gene
Authors: Goebel Hans H. , Brockmann Knut , Bönnemann Carsten G. , Warlo Irene A. P. , Hanefeld Folker , Labeit Siegfried , Durling Hayley J. , Laing Nigel G.
Published: July 2017

Actinopathies are defined by missense mutations in the ACTA1 gene coding for sarcomeric actin, of which some 70 families have, so far, been identified. Often, but not always, muscle fibers carry large patches of actin filaments. Many such patients also have nemaline myopathy, qualifying actinopathies as a subgroup of nemaline myopathies. This article concerns a then newborn, now 21/2-year-old boy, the first and single child of nonconsanguineous parents, who was born floppy, requiring immediate postnatal assisted ventilation. A quadriceps muscle biopsy revealed large patches of thin myofilaments reacting at light and electron microscopic levels with antibodies against actin but only a few sarcoplasmic rods and no intranuclear rods. DNA analysis of the patient's and both parents' blood did not reveal any missense mutation in the ACTA1 gene. Thus, this congenital myopathy can be caused by a new type of ACTA1 gene mutation, a new non- ACTA1 gene mutation, or no mutation at all, designating it as an actin-related myopathy, perhaps a new type of congenital myopathy and a new member of protein aggregate myopathies marked by aggregation of proteins within muscle fibers, among them desminopathies, α-β crystallinopathies, other desmin-related myopathies (also termed myofibrillar myopathies), actinopathies and, now, actin-related myopathies. ( J Child Neurol 2004;19:149—153).
Intracranial Tumors in Infants
Authors: Young Helen K. , Johnston Heather
Published: July 2017

The prognosis in infants with brain tumors has historically been very poor. This study reviews 16 infants under the age of 12 months with brain tumors who presented to our institution between 1988 and 1999. The aim was to describe the clinical presentation, diagnosis, and management of these patients and to establish if newer diagnostic and treatment modalities have improved prognosis in terms of survival and neurocognitive outcome. Charts were reviewed retrospectively for age at diagnosis, time to diagnosis, presenting features, location, histology, surgical and adjuvant treatment, survival, and neurocognitive outcome. Survival has improved. Three quarters of the patients remain alive. The 5-year survival rate was 81%. The 5-year progression-free survival rate was 51%, with a median follow-up time of 70 months. The 5-year survival rate for benign tumors was 100%. None of the children with malignant tumors survived. Morbidity remains high: 8 of 13 survivors had focal neurologic deficits, 7 of 13 had epilepsy, and 7 of 12 had significant cognitive disability. Future treatment protocols should include formal analysis of neurocognitive morbidity, functional outcome, and quality of life measures to provide accurate prognostic information and to prepare families for early intervention programs. ( J Child Neurol 2004; 19:424-430).
Agenesis of the Corpus Callosum Is Associated With Feeding Difficulties
Authors: Ng Yu-tze , McCarthy Colleen M. , Tarby Theodore J. , Bodensteiner John B.
Published: July 2017

Our objective was to characterize the common occurrence of feeding and swallowing disorders noticed by our speech therapy department among patients with agenesis of the corpus callosum. All patients with suspected or presumed agenesis of the corpus callosum undergoing therapy for feeding and/or swallowing disorders, including oral and/or pharyngeal dysphagia and oral-sensory disorder, were identified. Their brain magnetic resonance imaging (MRI) studies and charts were reviewed in detail. Seven patients with striking oral-motor and oral-sensory disorder met the criteria for agenesis of the corpus callosum. Particular difficulties noted include oral-sensory defensiveness in five of these seven patients, oral dysphagia/weakness in all seven patients, and pharyngeal dysphagia with risk of aspiration in three of these seven patients. The oral-motor weakness observed in all of the patients affected the strength and coordination necessary for functional oral-phase swallowing. We conclude that feeding and swallowing disorders are significant in children with agenesis of the corpus callosum. Although the pathophysiologic mechanism is not known, recognition of this phenomenon is important because early detection and intervention can facilitate functional feeding and swallowing patterns earlier in these patients, therefore avoiding the adverse and more severe disorders that can arise when dysphagias and/or oral-sensory disorder persist over extended periods of time. ( J Child Neurol 2004;19:443-446).
Syringomyelia in Twin Brothers Discordant for Chiari I Malformation: Case Report
Authors: Tubbs R. Shane , Wellons John C. , Blount Jeffrey P. , Oakes W. Jerry
Published: July 2017

Familial syringomyelia outside of trauma, tumor, or infection has been reported. Cases are presented that highlight the possible connection between familial syringomyelia and the Chiari 0 malformation. We report on 11-year-old twin brothers both with syringomyelia. Magnetic resonance imaging further revealed that one brother had Chiari I malformation and the other had Chiari 0 malformation. Both underwent posterior fossa decompression with radiologic improvement of their syringes. These case reports lend credence to earlier reports of improvement in syringomyelia following posterior fossa decompression in the absence of Chiari I malformation, the so-called Chiari 0 malformation. In addition, these case reports should influence the manner in which familial syringomyelia without tonsillar ectopia is defined and addressed, that is, posterior fossa decompression versus shunting of the syrinx, thereby addressing the potential cause of the syringomyelia and not only the enlarged cavity itself. ( J Child Neurol 2004; 19:459-462).
Meningismus is a Commonly Overlooked Finding in Tension-Type Headache in Children and Adolescents
Authors: Almazov Irina , Brand Natan
Published: July 2017

At present, both migraine and tension-type headaches in children are believed to be chronic primary headaches. Meningeal signs in both cases are ignored or not examined, and the neurologic status is considered normal. This is the first study that focuses on meningeal signs in children with chronic headaches. The study population comprised 1738 patients aged 5 to 17 years who were examined in an outpatient neurologic clinic over a 6-year period. Particular attention was paid to examination of meningeal signs, including nuchal rigidity, Kernig's sign, Brudzinski's three signs (upper, middle, and lower), the “tripod” sign, and Guillain's and facial signs; the presence of these signs was regarded as meningismus syndrome. Some meningeal signs were found in 12% of 1007 children suffering from migraine, whereas 97% of 731 children with tension-type headaches had the whole set of meningeal signs. This suggested that meningismus is the major clinical syndrome in chronic tension-type headaches in children and adolescents. Chronic mild sterile (possibly autoimmune) inflammation of meninges (dura mater) can be caused by a preceding infection, as well as minor trauma of the head and/or back. Prolonged rest in a recumbent position usually resulted in relief or complete disappearance of both headache and meningeal signs. Monitoring of the meningeal signs is helpful for evaluation of the patient's condition in the course of treatment. ( J Child Neurol2006;21:423—425; DOI 10.2310/7010.2006.00095).
Corpus Callosum Size and Neuropsychologic Impairment in Adolescents who Were Born Preterm
Authors: Caldú Xavier , Narberhaus Ana , Junqué Carme , Giménez Mónica , Vendrell Pere , Bargalló Núria , Segarra Dolors , Botet Francesc
Published: July 2017

Prematurity is associated with cerebral abnormalities that might account for poorer cognitive performance. The aim of our study was to investigate the correlations between corpus callosum reductions and neuropsychologic performance in adolescents who were born preterm. Twenty-five subjects born before 33 weeks' gestation were compared with 25 subjects born at term and of similar age, gender, and sociocultural status. All subjects underwent magnetic resonance imaging and neuropsychologic examinations. Premature subjects performed worse than controls in global cognitive functioning, verbal memory, and verbal fluency. Corpus callosum measurements showed a global reduction owing mainly to thinning in the splenium, posterior midbody, and genu. Corpus callosum size significantly correlated with gestational age, Wechsler Performance IQ, and memory performance. These results suggest that cerebral growth during infancy does not compensate for corpus callosum reduction and that this reduction reflects neuropsychologic deficit. The cognitive impairment can arise from the paucity of the complex interneuronal connections owing to fiber damage, particularly myelinated fibers. ( J Child Neurol 2006;21:406—410; DOI 10.2310/7010.2006.00106).
Reconciling Diabetes Management and the Ketogenic Diet in a Child with Pyruvate Dehydrogenase Deficiency
Authors: Henwood Maria J. , Thornton Paul S. , Preis Christina M. , Chee Claire , Grimberg Adda
Published: July 2017

A 4-year-old girl with pyruvate dehydrogenase deficiency, static encephalopathy, and seizure disorder treated with the ketogenic diet presented in severe diabetic ketoacidosis. Pyruvate dehydrogenase deficiency is a rare genetic defect of mitochondrial energy metabolism that leads to inefficient glucose use and lactic acidosis. The ketogenic diet provides the brain with an alternate fuel source, but its implementation opposes traditional diabetes management. Faced with this therapeutic dilemma, we aimed to maintain ketosis without compromising safety to optimize neurologic function and quality of life. This is the first report, to our knowledge, of a child simultaneously treated with the ketogenic diet and exogenous insulin. A 28-month follow-up revealed excellent glycemic control, improved activity level, significant developmental achievements, and, perhaps most striking, catch-up linear growth from < 5th percentile to the 50th percentile. Her progress to date indicates that diabetes does not preclude use of the ketogenic diet. ( J Child Neurol 2006;21:436—439; DOI 10.2310/7010.2006.00109).
Adjunctive Lamotrigine for Refractory Epilepsy in Adolescents with Mental Retardation
Authors: McKee Jerry R. , Sunder Theodore R. , Vuong Alain , Hammer Ann E.
Published: July 2017

Epilepsy is a major comorbid condition in adolescents with mental retardation and is often characterized by multiple seizure types that are refractory to treatment. This study ( n = 22) describes a subanalysis of data from a larger multi-center study of adjunctive lamotrigine therapy in patients with mental retardation and refractory epilepsy and focuses on the outcome measures of seizure reduction, safety and tolerability, and impact on behaviors in adolescents with mental retardation and refractory epilepsy. The study kept baseline antiepileptic drugs constant and titrated lamotrigine over 8 weeks to the target dose, followed by an 8-week maintenance phase and then a 12-week optimization phase during which all antiepileptic drugs and lamotrigine could be altered as clinically indicated. Sixty percent of subjects had a 50% decrease in seizures by the end of the maintenance phase and a mean 39% reduction in seizure frequency by the end of the maintenance phase (25% by end of study) compared with baseline. Global improvements were observed in most patients, with statistically significant improvements in the Aberrant Behavior Checklist and the Habilitative Improvement Scale, which is predictive of less need for supportive care in activities of daily living and thus enhanced potential for greater independence. Lamotrigine-associated improvements in behavior can be attributed to improved control of seizures, a reduction in concomitant antiepileptic drugs, and/or direct mood-stabilizing and behavior-enhancing properties independent of the antiseizure effects of the drug. The results of this study suggest that lamotrigine is an important treatment option in adolescents with mental retardation and comorbid epilepsy. ( J Child Neurol2006;21:372—379; DOI 10.2310/7010.2006.00123).
Coincidence of Semilobar Holoprosencephaly and Chiari II Malformation: Correlation of Prenatal Diagnostics and Neuropathologic Findings
Authors: Mittelbronn Michel , Beschorner Rudi , Capper David , Haist Markus , Meyermann Richard , Meyer-Wittkopf Matthias
Published: July 2017

As holoprosencephaly and Chiari II malformation differ considerably, both in pathogenesis and in phenotypic localization, the coincidence of both entities is extremely rare. The case presented is, to our knowledge, the first published report comprising a combination of a semilobar holoprosencephaly associated with a Chiari II malformation and a myelomeningocele diagnosed prenatally and confirmed by postmortem neuropathologic evaluation. These findings indicate that in the case of pre- and postnatal detection of a myelomeningocele and/or Chiari II malformation, possible additional intracranial malformation, such as a semilobar holoprosencephaly, should also be taken into account and vice versa. ( J Child Neurol 2006;21:426—429; DOI 10.2310/7010.2006.00125).
Validation of the Willingness to Invest in Marriage Scales
Authors: Katz Jennifer , Long Patricia J. , Beach Steven R. H.
Published: July 2017

The Willingness to Invest in Marriage Scales (WIMS) were designed to assess an individual's motivation to improve his or her marital relationship. Convergent validity is examined in a community sample ( N = 172) of married individuals (Study 1) and predictive validity for marital problem-solving behavior is examined in a separate sample of couples ( N = 66) (Study 2). As predicted, the WIMS demonstrated acceptable convergent validity. Further, in interaction with couple satisfaction, the WIMS accounted for approximately .30 of the variance in husbands' and wives' interactive behavior beyond that accounted for by satisfaction alone. Implications for clinical treatment and future research with clinical populations are discussed.
Changes in Perceptions and Practices of Farmers and Pesticide Retailers on Safer Pesticide Use and Alternatives: Impacts of a Community Intervention in Chitwan, Nepal
Authors: Vaidya Abhinav , Gyenwali Deepak , Tiwari Sundar , Pande Badri Raj , Jørs Erik
Published: July 2017

Unsafe use of hazardous pesticides is a neglected public health problem in developing countries. This survey evaluates the effects of a training program to increase awareness on harmful effects of pesticides and to enhance capacity for safe handling involving 57 trained farmers, 98 neighboring farmers, 94 control farmers, and 23 pesticide retailers from villages in Chitwan, Nepal. Knowledge and attitude–related variables improved in all 3 farmer groups, with a significant trend of better knowledge and attitude from trained to neighboring to control farmers (in 14/16 [87.5%] variables). In practice, there were significant differences among the groups with a trend from trained to neighboring to control farmers (in 10/26 [38.5%] variables).The pesticide retailers also improved on knowledge and practice. In conclusion, training farmers and pesticide retailers improved their knowledge and practice, with possible positive effect on neighboring farmers and control villages as well. An improved extension service to farmers is recommended.
Sex Differences in the Anatomical Distribution of Melanocytic Nevi in Canadian Hutterite Children
Authors: Kwan Tammi Y. , Belke Terry W. , Enta Tom
Published: July 2017

Background:

Studies of the distribution of melanocytic nevi (MN) and/or cutaneous malignant melanoma (CMM) in white populations have commonly observed greater numbers of MN and CMM on the torsos of males and on the limbs of females. The most commonly cited explanation for this sex difference is differential sunlight exposure of body subsites due to gender differences in clothing styles and recreational activities. Less common, but more speculative, explanations suggest hormonal differences or regional differences in melanocytes across body subsites.

Objective:

The purpose of the present study was to evaluate these explanations in light of sex differences in the anatomical distribution of nevi in Canadian Hutterite children whose traditional religious costume protects them from sun exposure.

Methods:

Nevi counts from 178 male and 154 female children, aged 5 to 15 years, from 23 Central Alberta Hutterite colonies were broken down by age and body subsite.

Results:

At age levels from 6 to 15 years, males had greater nevus counts on the torso, whereas females had greater counts on the upper and lower limbs.

Conclusion:

The appearance of this distribution of nevi in sun-protected children as early as age 6 is problematic for explanations based on differential sunlight exposure and hormonal changes at puberty.
Review of Teleconsultations for Dermatologic Diseases
Authors: Phillips Charles M. , Burke William A. , Bergamo Bethany , Mofrad Susan
Published: July 2017

Background:

Telemedicine has been increasingly used in some areas to provide consultation for isolated populations that might otherwise have difficulty accessing specialty care. Little information exists on what types of patients or diseases are being seen in dermatology telemedicine consultation services.

Objective:

To review our consultations done over a regional telemedicine network with an emphasis on looking at what type of patient, cutaneous diseases, and diagnostic or therapeutic recommendations were made.

Results:

Between August 1992 and December 1997, 796 teleconsultations were done. The most common diagnoses made were eczemas, follicular based diseases, skin infections, and skin tumours. Steroids were the most commonly recommended therapy, along with antibiotics, antihistamines, and antifungal therapy. Diagnostic recommendations commonly made were a skin biopsy and potassium hydroxide preparation.

Conclusion:

Common skin problems were seen by our dermatology teleconsultation service. A significant number of diagnostic biopsies and potassium hydroxide preparations were recommended. The efficacy of telemedicine in the delivery of dermatologic care is reviewed.
Pyoderma Gangrenosum in a Patient with Essential Thrombocythemia
Authors: King Kim W. , Murray Alexander
Published: July 2017

Background:

Pyoderma gangrenosum is an uncommon ulcerative condition associated with inflammatory bowel disease, arthritis, and hematologic disease. We report a patient with essential thrombocythemia and pyoderma gangrenosum.

Objective:

This article is a review of the associations between pyoderma gangrenosum and other diseases. Results: There have been two previous reports of patients with pyoderma gangrenosum and essential thrombocythemia.

Conclusion:

There may be a possible association between pyoderma gangrenosum and essential thrombocythemia. The diagnosis of pyoderma gangrenosum should be considered in patients with essential thrombocythemia and cutaneous ulcers.
Rapid Aggressive Soft-Tissue Necrosis after Beetle Bite Can Be Treated by Radical Necrectomy and Vacuum Suction-Assisted Closure
Authors: von Goßler Celia M. E. , Horch Raymond E.
Published: July 2017

Background:

The substance cantharidin, which is produced by a type of beetle, rapidly penetrates the epidermis and can cause severe toxicities such as skin necrosis. Optimal treatment for necrotic beetle bites has not been well defined. Conservative management has been advocated but the hospital stays are long and long-term morbidity may result, especially in multimorbid patients.

Objective:

The value of aggressive surgical management of such necrotizing diseases using newly developed surgical tools is compared to the traditional more conservative approach.

Results:

We present the case of a multimorbid 60-year-old man with a rapidly progressive necrosis of the medial thigh (measuring 30 × 15 cm), acquired during a stay in Western Africa after being bitten by a beetle of the species Cantharide. The patient was treated with radical surgical debridement and continuous elimination of the wound fluid by permanent computer-controlled negative pressure with a vacuum-assisted wound-closure device. This led to the sudden relief of both local and systemic symptoms and allowed extremely early wound closure.

Conclusions:

Comparing literature data with the course of this combined treatment, we strongly suggest an early aggressive management with complete radical excision of necrotic tissue, conditioning of the wound bed by temporary suction-assisted vacuum closure and subsequent skin grafting with continued vacuum application. This treatment leads to immediate relief of pain and enhanced healing of this lesion even in the condition of immunosuppression in the elderly.
Effects of a Sun Protection Program Targeting Elementary School Children and Their Parents
Authors: Barankin Benjamin , Liu Kimberly , Howard John , Guenther Lyn
Published: July 2017

Background:

Excessive sun exposure in childhood is considered a risk factor for later development of skin cancer, so sun awareness programs targeting children have been developed.

Objective:

To assess the benefits of involving parents at home in the sun protection program received by their children at school.

Method:

The existing “Sun and the Skin” program was enhanced in two ways. Parents were educated both about their child's program and with supplemental information. Also, sunscreen was distributed to each child.

Results:

Certain methods of sun protection, particularly the use of sunscreen, are being practiced by the majority of children, while others, such as protective clothing, have not been readily adopted. The enhanced group of students showed improvement over control and standard groups in their attitude toward tanning. There is a need for teachers to remind their students to practice protective measures.

Conclusions:

While a sun-awareness curriculum has been shown to be beneficial for elementary school children, the adjunct of parental and school involvement in this process can improve the results and ultimately decrease the risk of skin cancer in the children.
Changes in Patient Perception and Behavior following Mohs Micrographic Surgery
Authors: Maser Elana , Berg Daniel , Solish Nowell
Published: July 2017

Background:

Mohs micrographic surgery (MMS) is used for the removal of difficult or recurrent skin cancer. Little is known about the behavioral changes of patients who have undergone this procedure.

Objective:

This study was conducted to document patients' long-term psychological and behavioral changes following AIMS.

Methods:

A survey was mailed to a sample of 260 persons who underwent the Mohs procedure in 1997. It included questions on sunscreen use, level of anxiety about cancer, patient confidence in MMS, and changes in high-risk habits.

Results:

The study included 214 patients who responded to our mailed questionnaire. Trends showed an increase in some but not all preventative measures taken to avoid skin cancer recurrence post-MMS. Other healthy lifestyle changes, such as decreased cigarette smoking, were not noted.

Conclusion:

Mohs micrographic surgery has an impact on some aspects of patients' health-related behavior, especially skin cancer prevention. Other aspects which are not affected may be targets for extra patient education.
Olanzapine May Be an Effective Adjunctive Therapy in the Management of Acne Excoriée: A Case Report
Authors: Gupta Madhulika A. , Gupta Aditya K.
Published: July 2017

Background:

The self-inflicted dermatoses such as acne excoriée and neurotic excoriations are often chronic, recurring, and resistant to standard dermatologic therapies.

Objective:

We present a 28-year-old woman with longstanding acne excoriée, whose acne started at age 14 years and was followed by acne excoriée at age 16 years. The patient reported that her acne and self-excoriative behavior were exacerbated by psychological stress. The previously treatment-resistant acne excoriée responded favorably to treatment with the atypical antipsychotic agent olanzapine.

Methods:

The patient was started on olanzapine 2.5 mg at bedtime.

Results:

After 4 weeks of therapy with olanzapine she reported a significant decline in her self-excoriative behavior which was associated with an improvement in her acne excoriée. The patient used the olanzapine 2.5 mg for 6 months, during which time she also entered psychotherapy in order to deal with some psychosocial stressors that were exacerbating her self-excoriative behavior. The patient has not experienced a recurrence in her self-excoriative behavior or acne excoriée for 4 months after discontinuing the olanzapine.

Conclusion:

Olanzapine may prove to be a useful adjunctive therapy in some self-induced dermatoses including acne excoriée.
One-Year Followup on the Impact of a Sun Awareness Curriculum on Medical Students' Knowledge, Attitudes, and Behavior
Authors: Liu Kimberly E. , Barankin Benjamin , Howard John , Guenther Lyn C.
Published: July 2017

Background:

A one-week sun awareness curriculum was developed at the University of Western Ontario to educate first-year medical students on skin cancer risks and prevention.

Objective:

To assess the retention of knowledge, attitudes, and behavioral practices one year after receiving education in sun awareness.

Method:

Three surveys were administered: before, immediately after the sun awareness teaching, and one year later. Actual practiced behavior in the past year was compared with the intended behavior.

Results:

Half as many sunburns were reported in the year following the sun awareness curriculum compared with the previous year. Medical students demonstrated a good retention of the knowledge learned a year earlier. However, many students still believed that a tanned appearance looks healthy. While there was intent to adopt more healthy behavior after the curriculum, the actual behavior practiced varied.

Conclusions:

An undergraduate medical curriculum on sun awareness can be effective in improving the knowledge, attitudes, and behaviors of future physicians.