bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of composition ratios and mixing steps on properties of BR/NR/NBR blends and blends foam
Authors: Thongpin C , Jumpathong K , Jaroenjai R , Bunwanna W , Jareanta J
Published: March 2020

This research is aimed to prepare foam from BR/NR/NBR blends which should integrate key property of these three rubbers. BR possesses high abrasion resistance but low tensile strength while NR possesses high tensile strength [1]. The addition of NBR was advantage for non-polar solvent resistance [2]. The effect of the mixing steps of rubber with vulcanizing additives on vulcanization of rubber and on mechanical properties and foaming of BR/NR/NBR were reported. The ratios of BR/NR/NBR were various as 60/20/20, 40/40/20 and 20/60/20. The vulcanizing additives used for rubber compounding were 5 phr ZnO, 2 phr stearic acid, 1.5 phr MBTS and 2 phr sulfur. The first part of the work was to study the effect of mixing step on rubber blends. Compounding system I was carried out by masticated BR, NR and NBR on a two-roll mill after that vulcanizing agent was added consecutively obtaining BR/NR/NBR rubber compounds with various rubber compositions. Rubber compounds were then characterized and vulcanized in order to investigate vulcanizate properties. In System II, three rubbers were mixed separately with required vulcanizing additives on the two-roll mill, obtaining BR, NR and NBR compound containing the same content of vulcanizing agent. Then the compounds were blended to obtain compound blended for the same blend ratios in System I. The blended rubber compounds were then characterized and vulcanized for their properties. In term of rubber blend foaming these two mixing systems were also used to compound the rubbers by addition foaming agent into the compound during mastication or blending of rubber on the two-roll mill. The results showed that mixing step affected the properties of rubber compound and vulcanizate in rubber blend. As various rubbers were mixed in different step resulting in different viscosity and hence affect foaming of rubber and subsequently properties of rubber foam.
Study of rubber composites between natural rubber and Mahogany Shell Powder (MHSP) and potential for pavement block
Authors: Jaroenta J , Siangsawad R , Onkate R , Jearjiratikul V , Thongpin C
Published: March 2020

This research was aimed to study the feasibility of using mahogany fruit shell powder as filler in rubber and investigated in properties of obtained vulcanized rubber. As mahogany fruit shell contains 75.61% holocellulose, 13.54% lignin and 11.02% extractives [1]. Hence the fruit shell should be able to act as reinforcement in rubber materials [2]. In this study, mahogany fruit shell was milled into small particles with the particle size of approximately 60 micrometres follow by ASTM D 422 - Standard Test Method for Particle-Size Analysis of Soils. The particle was characterized for their thermal stability. The morphology of mahogany fruit shell powder, MHSP, was flake like particle and can be used as reinforcement fillers in natural rubber. As NR is generally sensitive to O2 thus ethylene propylene diene monomer, EPDM, would be laminated on the top of NR/MHSP composites. The rubbers were formulated with efficient vulcanization system and contain 10, 20, 30, 40 and 50 phr of MHSP. The rubber compounds were characterized for cure characteristic parameter such as scorch time, cure time, minimum and maximum torque. Rubber vulcanizates were prepared using compression molding and characterized for their morphology, mechanical properties, thermal degradation, hardness and weathering resistance. In order to improve environment stability and abrasion resistance of the NR/MHSP composites, EPDM/MHSP were prepared and laminated on NR/MHSP and vulcanized. The laminated vulcanizated composites possessed the properties follow Thai Industrial Standard for rubber paving blocks could be obtained. The results also showed that NR filled with 50 phr of MHSP in NR and in EPDM gave the properties follow the standard and has high potential for outdoor rubber paving block.
Electrical and Mechanical Properties of PEDOT:PSS Strain Sensor based Microwave Plasma modified Pre-vulcanized Rubber Surface
Authors: Thana K , Petchsang N , Jaisutti R
Published: March 2020

Poly(3, 4- ethylenedioxythiophene) doped with poly(styrenesulfonate) (PEDOT:PSS) conductive polymer has been extensively used in various applications including flexible electrode and stretchable sensor. This study reports the electrical and mechanical strain behaviours of PEDOT:PSS deposited on pre-vulcanized rubber substrate, which is modified surface by microwave plasma. The effect of plasma treatment cycles on adhesion of PEDOT:PSS coated pre-vulcanized rubber and conductivity have been investigated. The results show a uniform PEDOT:PSS film on rubber surface after treating with microwave plasma. The electrical conductivity slightly increases by increasing treatment cycles. In addition, an electrical strain and mechanical strain increase up to 60 and 50%, respectively under 4 treatment cycles.
Study on processability and mechanical properties of parawood-powder filled PLA for 3D printing material
Authors: Chansoda K , Suwanjamrat C , Chookaew W
Published: March 2020

Recently, there has been an increasing interest in the development of 3-Dimensional (3D) printing technologies. Among those, material development play an important role in helping the growth of 3D printing technique, which led to more supporting of wide range of applications and user requirements. In that regards, advanced materials are continually developed, i.e. filament filled reinforcing fiber and plastic containing metal granulate or wood powder. Special material supporting 3D printer normally showed an expensive cost. On the other hand, it is well known that the processes involving natural rubber from Para rubber trees produced a large amount of wood a year, which resulted in releasing of an abundant waste from wood processing. Therefore, this work focused on the utilization of parawood powder derived from the furniture industry. The processability of polylactic acid (PLA) filament containing wood powder was investigated. Twin and single-screw extrusion machines were used to produce the composite filaments. Coupling agent and treated method were also studied. The results of this work showed that the maleic anhydride (MAH) and sodium hydroxide (NaOH) did not have significantly effects in improving the compatibility and processability. In addition, wood contents were found to influence the quality of filament and mechanical properties. Moreover, it was also found that parawood powder can be filled into PLA with approximately 10 wt%.
A 3D-RISM study of water and potassium ion adsorption in Montmorillonite nanoclay
Authors: Ruankaew N , Kristinawati A , Yoshida N , Phongphanphanee S
Published: March 2020

In this study, we investigated the intercalation of water and K+ to interlayer of Montmorillonite (MMT) nanoclay by using the statistical mechanics theory of molecular liquids or three-dimensional reference interaction site model (3D-RISM). The results from 3D-RISM show that the distribution of water and K+ bound to the MMT’s surfaces with different sites. Moreover, the results from 3D-RISM show the amount of water corresponds to the d-basal spacing of the clay, which are in good agreements with other simulation methods as well as experimental.
Injection-molded polyethylene/natural rubber blends
Authors: Yoksan R
Published: March 2020

The present research aims to develop polyethylene/natural rubber (PE/NR) blends, with a weight proportion of PE:NR of 60:40, for injection-molded articles. Two types of PE, i.e. high density polyethylene (HDPE) and linear low density polyethylene (LLDPE) were used. The blends were fabricated by melt processes and then converted into dumbbell-shaped specimens using an injection molding machine. The effect of NR on properties of PE was investigated. The blends showed lower melt flow ability than the corresponding PE. Although PE/NR blends exhibited lower tensile strength and Young’s modulus than PE, their elongation at break and impact strength tended to be higher. In addition, hardness and heat distortion temperature of PE decreased by blending with NR. The obtained PE/NR blends are thermoplastics, which can be further converted into product prototypes using injection molding process.
Enhancement of the tyre rolling resistance testing machine
Authors: Lakkam S , Tempiem A
Published: March 2020

Rubber tree is an outstanding product in commercial area of Thailand. Tyre is one of the prominent and downstream products as components in the automotive industry with a high production capacity. While tyres are used widely, a regulation for the rolling resistance of tyres has been set up by the European Commission. Therefore, the operators must test their products. By the high costs for the testing before certification, the researchers realize the limitation of the test equipment suffering with the small and medium enterprises that do not have access to check their tyres. This is the weakness of the tyre industry in Thailand. Therefore, the low-cost of tyre rolling resistance testing machine has been built in accordance with the UNECE Regulation No. 117 which is accepted worldwide. As a result, the in-house tyre rolling resistance testing machine is compared with the imported one in terms of production cost. The budget can be reduced up to 50% since the test equipment can be produced with currently technology in the country. Moreover, this is the self-reliance of technological machinery industry. For the working result, it was found that the vibration level of tyre rolling resistance testing machine consented to the standard ISO 10816. Besides, the experimental results of tyre rolling resistance coefficient is compliance with the requirements UNECE Regulation No. 117 Annex 6 and also verified by the international authority (TUV Rheinland Thailand Ltd). It can reduce the limitation in terms of the testing and also support the economic expansion of the production of quality tyres in the country to be accepted in international level.
Development and influence of tribomechanical properties on magnesium based hybrid metal matrix composites-a review
Authors: Anand N , S Senthil Kumaran
Published: March 2020

Composite materials are being widely studied for the last few decades, and it has optimized the day to day applications in the engineering field. In this advancement, the use and development of metal matrices was a significant outcome that concentrated on the addition of many particulate materials in a metal matrix at nano and micro levels. Among these Magnesium, metal matrices are having a high potential, especially in transport, defense, and aircraft industries. Many research works are being carried out to use the capabilities of Magnesium and has provided excellent results. This paper is an overview of the development, processing, and improvement of properties in Magnesium alloys. Various manufacturing processes such as self-propagating high-temperature method, stir casting, laser cladding, and powder metallurgy has been used to develop the magnesium composites for increasing the properties by using various wt% of reinforcements added in the matrix. The improvement in mechanical properties such as tensile strength, yield strength, hardness and tribological properties such as wear rate is reviewed. The different properties and capabilities of Magnesium alloys such as AZ31, AZ91, and ZE41 is also discussed from the various research works.
Real-space light-reflection mapping of atomically thin WSe2 flakes revealing the gradient local strain
Authors: Guo Yang , Huang Yuan , Du Shuo , Sun Chi , Tian Shibing , Luo Hailan , Liu Baoli , Zhou Xingjiang , Li Junjie , Gu Changzhi
Published: March 2020

The spatially continuous control of the physical properties in semiconductor materials is an important strategy in increasing electron-capturing or light-harvesting efficiencies, which is highly desirable for the application of optoelectronic devices including photodetectors, solar cells and biosensors. Unlike the multi-layer growth of chemical composition modulation, local strain offers a convenient way to continuously tune the physical properties of a single semiconductor layer, and open up new possibility for band engineering within the 2D plane. Here, we demonstrate that the gradient refractive index and bandgap can be generated in atomically thin transition metal dichalcogenide flakes due to the effect of thermal strain difference. A highly resolved confocal scanning optical microscopy is used to perform a real-space light-reflection mapping of suspended atomically thin WSe2 flakes at the low temperature of 4.2 K, in which the parabolic light-reflection profiles have been observed on suspended monolayer and bilayer WSe2 flakes. This finding is corroborated by our theoretical model which includes the effect of strain on both the refractive index and bandgap of nanostructures. The inhomogeneous local strain observed here will allow new device functionalities to be integrated within 2D layered materials, such as in-plane photodetectors and photovoltaic devices.
Study on corrosion behavior of TWIP steel and properties of surface electroless Ni-P coatings
Authors: Yang Minghui , Yue Lijie , Xie Kun , Zhang Shuxin , Sun Yipin , Tan Yunliang
Published: March 2020

In this study, the corrosion behavior and corrosion resistance of TWIP (Twinning Induced Plasticity) steels in the industrial atmospheric environment were studied by dry-wet cycle immersion test and electrochemical experiments. The results showed that the corrosion rates of TWIP steel gradually decreased with the increase of corrosion time. A layer of corrosion products was formed on the surface of TWIP steel during alternating immersion accelerated corrosion process, whose main components were Fe3O4 and α-FeOOH. With the prolongation of corrosion time, the rust layer on the surface of TWIP steel had a certain protective effect on the steel matrix. The adherent and defect-free electroless nickel–phosphorus (Ni-P) coatings were prepared on TWIP steels. Electrochemical test results showed the corrosion current density of the coating was about six times lower than that of TWIP steel substrate, indicating that the coating effectively improved corrosion resistance of TWIP steel and protected the steel substrate from erosion of corrosive ions. Additionally, the surface microhardness of TWIP steel was significantly increased after electroless Ni-P plating treatment.
The Potential Impact of Plastic Surgery Expertise on Body Contouring Procedure Outcomes
Authors: Bezzini Dylan R , Washington George N , Abiodun Olumayowa , Olufajo Olubode A , Jones India , Butts DeMario Montez , Ortega Gezzer , Paul Henry
Published: March 2020

Background

With the increasing demand for body contouring procedures in the United States over the past 2 decades, more surgeons with diverse specialty training are performing these procedures. However, little is known regarding the comparative outcomes of these patients.

Objectives

The purpose of this study was to compare outcomes of body contouring procedures based on the specialty training of the surgeon.

Methods

Data from the American College of Surgeons National Surgical Quality Improvement Program (2005-2015) were reviewed for all body contouring procedures. Patients were stratified by surgeon training (plastic surgery [PS] vs general surgery [GS]). Descriptive statistics and regression analyses were used to evaluate differences in outcomes.

Results

A total of 11,658 patients were included; 9502 PS cases and 2156 GS cases. Most were women (90.4%), aged 40 to 59 (52.7%) and white (79.5%). Compared with PS patients, GS patients were more likely to be obese (61.4% vs 40.6%), smokers (13.6% vs 9.8%), and with ASA classification ≥3 (35.3% vs 18.6%) (all P < 0.001). Abdominal contouring procedures were the most common (76%) cases. Multivariate regression revealed that compared with PS cases, those performed by GS practitioners were associated with increased wound and infectious complications (adjusted odds ratio [aOR], 1.81; 95% confidence interval [CI], 1.44-2.27), reoperation (aOR, 1.85; 95% CI, 1.31-2.62), and predicted mean length of stay (1.12 days; 95% CI, 0.64-1.60 days).

Conclusions

The variable outcomes in body contouring procedures performed by PS compared with GS practitioners may imply procedural-algorithmic differences between the subspecialties, leading to the noted outcome differential.

Level of Evidence: 2
Increased glutamate transporter-associated anion currents cause glial apoptosis in episodic ataxia 6
Authors: Kovermann Peter , Untiet Verena , Kolobkova Yulia , Engels Miriam , Baader Stephan , Schilling Karl , Fahlke Christoph
Published: March 2020

Episodic ataxia type 6 is an inherited neurological condition characterized by combined ataxia and epilepsy. A severe form of this disease with episodes combining ataxia, epilepsy and hemiplegia was recently associated with a proline to arginine substitution at position 290 of the excitatory amino acid transporter 1 in a heterozygous patient. The excitatory amino acid transporter 1 is the predominant glial glutamate transporter in the cerebellum. However, this glutamate transporter also functions as an anion channel and earlier work in heterologous expression systems demonstrated that the mutation impairs the glutamate transport rate, while increasing channel activity. To understand how these changes cause ataxia, we developed a constitutive transgenic mouse model. Transgenic mice display epilepsy, ataxia and cerebellar atrophy and, thus, closely resemble the human disease. We observed increased glutamate-activated chloride efflux in Bergmann glia that triggers the apoptosis of these cells during infancy. The loss of Bergmann glia results in reduced glutamate uptake and impaired neural network formation in the cerebellar cortex. This study shows how gain-of-function of glutamate transporter-associated anion channels causes ataxia through modifying cerebellar development.
Canada's New Feminist International Assistance Policy: Business as Usual?
Authors: Parisi Laura
Published: March 2020

This paper asks to what extent does Canada's new Feminist International Assistance Policy (FIAP) represent a more transformational and intersectional approach to gender equality and neoliberal international development? In other words, what is “new” about Canada's international development policy when it comes to gender equality and women's empowerment? Through a critical examination of the discourses of economic development in the FIAP on poverty, trade, market citizenship, and the private sector, I argue that the FIAP embodies both neoliberal feminism as well as feminist neoliberalism, which limit the transformational potential and impact of the FIAP on gender and international development strategies.
Dose–Response Association Between Accelerometer-Assessed Physical Activity and Incidence of Functional Disability in Older Japanese Adults: A 6-Year Prospective Study
Authors: Chen Tao , Honda Takanori , Chen Sanmei , Narazaki Kenji , Kumagai Shuzo
Published: March 2020

Background

It is unknown whether moderate-to-vigorous physical activity (MVPA) in bouts of <10 minutes protects against disability risks or if only 10 minutes bouts of MVPA is critical. Additionally, it is unclear whether light physical activity (LPA) or its accumulation patterns is associated with functional disability.

Methods

A total of 1,687 adults aged ≥65 years and without functional disability at baseline were followed up for 6 years. Functional disability was identified using the database of Japan’s Long-term Care Insurance System. Physical activity was measured using a tri-axial accelerometer secured to the waist.

Results

Functional disability was identified in 274 participants (16.2%). When examined as quartiles, higher levels of all MVPA measures were dose-dependently associated with lower risk of functional disability. Associations of MVPA in ≥10 and <10 minutes bouts remained significant in a mutually adjusted model. Neither total LPA nor LPA in bout of ≥10 minutes, but LPA in bouts of <10 minutes was associated with functional disability. Analyses using restricted cubic spline functions showed that associations of all MVPA measures and LPA in bouts of <10 minutes with functional disability were linear (p for nonlinear >.05). The hazard ratios (HRs; 95% confidence interval [CI]) for functional disability per 10 minutes increment of total MVPA and LPA in bout of <10 minutes were 0.86 (0.81–0.92) and 0.96 (0.93–0.99), respectively.

Conclusions

Higher MVPA, regardless accumulation patterns, or LPA in bouts of <10 minutes was associated with lower risk of functional disability in a linear dose–response manner in older adults.
Naming Plantations: Toponyms and the Construction of the Plantation System in the English Atlantic
Authors: Musselwhite Paul
Published: March 2020

This essay pioneers a critical approach to place naming in early America, which offers new insight into the evolving definition of plantation. In early seventeenth-century England, planting was understood as a public effort to establish new commonwealths. Only gradually around the Atlantic world did plantations become predominantly associated with private places producing staple crops with enslaved labor. This essay uses the radically underutilized evidence of place-names to explore how this slippage occurred on the ground, and the way it shaped, and was shaped by, the individuals who embraced the status of “planter.” The names that individuals gave to the places they called plantations reveal how they perceived the plantation and the political, economic, and social relations it structured. By analyzing data from nearly 5,000 named tracts of land patented in four Maryland counties between 1634 and 1750, this essay charts the changing popularity of distinct elements within plantation names, including geographic descriptors, affects of the landowner, and European place-names. It reveals there was no straightforward rush to carve up the land into privatized commercial units. Instead, individuals initially structured plantations around communal frameworks defined variously by manorialism, urban civic traditions, and shared geographic lexicons. As the tobacco economy consolidated into the hands of a slave-owning class, plantation names reframed places as subjective manifestations of planter identities. These conclusions adjust our understanding of the transition to capitalism and slavery in Maryland and they also offer a blueprint for a broader toponymy of the plantation in the Atlantic world.
Unauthorized Storytelling: Reevaluating Racial Politics in Julia Alvarez’s In the Time of the Butterflies
Authors: Zimmerman Tegan
Published: March 2020

This article revisits Julia Alvarez’s critically acclaimed historical novel In the Time of the Butterflies (1994). While much scholarship has paid attention to the novel as historiographic metafiction, its depiction of Rafael Leónidas Trujillo’s regime (1930-61), and its feminist perspective on the Dominican Republic, its racial politics are under-studied. In particular, scholars have overlooked Fela, the Afra-Dominican servant, spirit medium, and storyteller. I argue that studying Fela’s presence in the text as an unauthorized and unauthored voice not only adds complexity to the production of historiography and storytelling but also provides new insight into postcolonial feminist critiques of voice/lessness, narrative, and marginalized identities in the novel and criticism on it. Closely analyzing Fela’s voice—as it intersects with storytelling, historical slave narratives, Vodou, the maternal, and Haiti’s contribution to the Dominican Republic’s history—makes visible the unacknowledged yet essential role of the Afra-Dominican not only in this novel specifically but also to the Dominican Republic more generally.
Mutation effect estimation on protein–protein interactions using deep contextualized representation learning
Authors: Zhou Guangyu , Chen Muhao , Ju Chelsea J T , Wang Zheng , Jiang Jyun-Yu , Wang Wei
Published: March 2020

The functional impact of protein mutations is reflected on the alteration of conformation and thermodynamics of protein–protein interactions (PPIs). Quantifying the changes of two interacting proteins upon mutations is commonly carried out by computational approaches. Hence, extensive research efforts have been put to the extraction of energetic or structural features on proteins, followed by statistical learning methods to estimate the effects of mutations on PPI properties. Nonetheless, such features require extensive human labors and expert knowledge to obtain, and have limited abilities to reflect point mutations. We present an end-to-end deep learning framework, MuPIPR (Mutation Effects in Protein–protein Interaction PRediction Using Contextualized Representations), to estimate the effects of mutations on PPIs. MuPIPR incorporates a contextualized representation mechanism of amino acids to propagate the effects of a point mutation to surrounding amino acid representations, therefore amplifying the subtle change in a long protein sequence. On top of that, MuPIPR leverages a Siamese residual recurrent convolutional neural encoder to encode a wild-type protein pair and its mutation pair. Multi-layer perceptron regressors are applied to the protein pair representations to predict the quantifiable changes of PPI properties upon mutations. Experimental evaluations show that, with only sequence information, MuPIPR outperforms various state-of-the-art systems on estimating the changes of binding affinity for SKEMPI v1, and offers comparable performance on SKEMPI v2. Meanwhile, MuPIPR also demonstrates state-of-the-art performance on estimating the changes of buried surface areas. The software implementation is available at https://github.com/guangyu-zhou/MuPIPR.
Syntactic Argumentation
Authors: Aarts Bas
Published: March 2020

The aim of this chapter is to discuss the role of syntactic argumentation in the description of English grammar. The chapter first discusses some of the general principles that are used in syntactic argumentation, namely economy and elegance, which are regarded as two dimensions of simplicity. These principles are then exemplified in a number of case studies. The final section discusses how argumentation can be used to establish constituency in clauses.
Grammar and Discourse
Authors: Bowie Jill , Popova Gergana
Published: March 2020

This chapter reviews the relationship between grammar and discourse in English from three different perspectives. First, it focuses on the challenges for grammatical analysis of looking beyond the sentence to the level of discourse. These include difficulties in delimiting grammatical units, in analysing ellipsis, and in accounting for the clause fragments found frequently in spoken interaction. The second perspective, that of the discourse analysis tradition, concerns how particular grammatical choices help to shape discourse so that different ideologies are suggested or different attitudes expressed. The discussion here focuses on choices in the areas of transitivity, nominalization, modality, and stance. From the third perspective, language use in discourse can be seen as shaping grammar: frequent patterns of use can result in grammatical changes and in the development of new functional resources through grammaticalization processes. This is illustrated with examples from both spoken and written discourse.
The Effects of Chronic Preoperative Opioid Use on Single-level Lumbar Fusion Outcomes
Authors: Bhattacharjee Sarah , Pirkle Sean , Shi Lewis L. , Lee Michael J.
Published: March 2020

Study Design:

A retrospective study using a national insurance claims database.

Objective:

The objective of this study was to assess the relationship between chronic preoperative opioids and the outcomes of revision surgery and nonunion after single-level lumbar fusion.

Summary of Background Data:

Opioids are widely utilized for pain management before spine procedures. Studies have associated opioids with unfavorable postoperative outcomes, and animal models have also linked opioid administration with unstable bone healing.

Methods:

Single-level lumbar fusion patients were identified. Patients with any fracture history within 1 year before surgery were excluded. A chronic preoperative opioid cohort was defined by opioids prescriptions within 3 months prior and within 4–6 months before surgery. The rates of revision surgery within 6 months and nonunion within 6–24 months after surgery were assessed. Univariate analyses of chronic preoperative opioid prescriptions and various comorbidities for revision and nonunion were conducted followed by multivariate analyses controlling for these factors. Individual analyses were run for each of the 3 single-level lumbar fusion procedures.

Results:

A total of 8494 single-level lumbar fusion patients were identified. Of the 3929 (46.3%) patients filled criteria for the chronic preoperative opioid cohort, while 3250 (38.3%) patients had no opioid prescriptions within 6 months before surgery. The opioid cohort experienced significantly higher rates of both revisions (3.92% vs. 2.71%, P=0.005) and nonunion (3.84% vs. 2.89%, P=0.027) relative to the opioid-naive cohort. In the multivariate analyses, chronic preoperative opioids were identified as an independent risk factor for revision (odds ratio: 1.453, P=0.006).

Conclusions:

We report that chronic opioid prescriptions before lumbar fusion may increase the risk of revision. Although these prescriptions were also associated with increased nonunion, the comparisons did not achieve statistical significance in the multivariate model. Chronic preoperative opioid use may be considered a potential risk factor in arthrodesis populations.
A Faculty Development Model that Promotes Success of Early Career Faculty in Academic Medicine
Authors: Sandi Giselle , Chubinskaya Susan
Published: March 2020

Introduction:

Medical school offices of faculty development aim to facilitate the academic growth of junior faculty by fostering independent research, enhancing teaching skills, and bolstering career opportunities. The Rush Research Mentoring Program aims to achieve this goal at Rush University medical center by offering a broad resource armamentarium and creating an environment that fosters productive relationships between mentees and mentors. This article describes the program's structure, evaluation, outcomes, and the university vision for its future.

Methods:

The program's contributions to the overall success of the University were measured by scholarly productivity, intramural and extramural funding, junior faculty retention, and mentee satisfaction with the program from its inception in 2006 until 2018.

Results:

Over 12 years, mentees have collectively received 639 grants. Of the 130 mentees who have completed the 5-year program and transitioned to program alumni, 65% have been retained as faculty members, with 40% receiving promotions to associate professor and 5% to full professor. Mentees report frequent use of the available resources and high satisfaction with the program.

Discussion:

We anticipate that structured mentoring programs with institutionally supported professional development activities and strategic mentor–mentee partnerships can be successfully adopted at similar academic medical centers.
Acute Spontaneous Rupture of the Superior Ophthalmic Vein
Authors: Vahdani Kaveh , Rose Geoffrey E.
Published: March 2020

Purpose:

To describe patients presenting with sudden onset of localized hemorrhage from a presumed acute spontaneous rupture of the superior ophthalmic vein.

Methods:

A retrospective review of the pattern of presentation, clinical implications and outcomes, and the characteristic imaging and histologic features.

Results:

Six patients (5 men; 84%) presented at a mean age of 45 years (range 15–72), with the commonest symptoms and signs being acute onset of Valsalva-negative proptosis (mean 3.3 mm; range 0–7 mm), orbital pain, and diplopia; none had a known precipitating factor (such as severe Valsalva maneuver or coagulopathy). Two patients developed a mild optic neuropathy. Imaging revealed a well-defined, ovoid, homogenous soft-tissue mass above (2 cases), superomedially to (3 cases), or below the superior ophthalmic vein; the masses were typically echogenic on B-mode ultrasonography, and there was no detectable internal blood-flow. Resolution of signs and symptoms was noted in 5 patients over an average of 4.6 months (range 3–7 months), while 1 patient—the youngest—required excision of a persistent mass with increasing exophthalmos and early optic neuropathy.

Conclusions:

Well-localized hemorrhage from the mid-part of the superior ophthalmic vein is very rare and appears to occur spontaneously in the absence of a detectable venous-lymphatic anomaly. This event might imply a spontaneous “blowout” from an area of mural susceptibility in this part of the superior ophthalmic vein, thus forming a pseudoaneurysm. In most cases, the clinical signs slowly improve over several months, surgical intervention is not required, and recurrence appears very infrequent.
Are Patients With Schizophrenia Better Off With Lifetime Antipsychotic Medication?
Authors: Glick Ira D. , Zamora Daisy , Davis John M. , Suryadevara Uma , Goldenson Andrea , Kamis Danielle
Published: March 2020

Purpose/Background

The question of whether people with schizophrenia should be treated with antipsychotics for life has been debated for decades. We recently reported results of 2 retrospective long-term naturalistic studies examining the association of medication adherence and global outcomes in different demographic samples. In both, we found that patients with a history of better adherence to antipsychotic medication had better quality of life outcomes. Using similar methodology, here we present such associations for a very different sample—patients with chronic schizophrenia with a long past history of antipsychotic treatment that had been treated for 19 to 53 years in a Veterans Affairs clinic.

Methods

This is a retrospective, naturalistic, longitudinal 19- to 53-year (mean average, 33.5 years) lifetime follow-up of a consecutive series of patients with schizophrenia, who had at least 8 years of antipsychotic treatment. Lifetime data were collected on (1) their medication adherence, (2) long-term global outcome, and (3) life satisfaction. Outcomes were rated by 2 different clinicians, one with information on medication adherence (nonblind rater) and one without (blind rater). Linear regression models, adjusted for age, family support, substance use disorder, race, marital status, and number of years in treatment were used to estimate the association between adherence and each outcome.

Results

A total of 20 patients were assessed. Medication adherence was positively associated with the blind clinician's rating of global outcome (P = 0.049) and the Global Assessment of Functioning (P = 0.021). In the nonblinded clinician's rating, medication adherence was positively related to global outcome (P = 0.001) and to the patient's report of life satisfaction (P = 0.028).

Implications/Conclusions

This replication study, together with our previous 2 studies, is consistent with the recommendation for continuous, long-term treatment for chronic schizophrenia over many years of a patient's lifetime unless medically contraindicated.
Problem Gambling Associated With Aripiprazole in First-Episode Psychosis Patients
Authors: Corbeil Olivier , Corbeil Stéphanie , Giroux Isabelle , Jacques Christian , Dorval Michel , Demers Marie-France , Roy Marc-André
Published: March 2020

Background

Aripiprazole (ARI), an antipsychotic drug used to treat various mental health disorders, has recently been associated with the emergence of problem gambling (PBG). However, few cases have been reported in the schizophrenia-related psychotic disorders population, and even fewer provided sufficient details to systematically assess the causality of the association.

Methods

This article describes 6 cases with first-episode psychosis in whom PBG emerged while on ARI. Detailed information was gathered from clinical staff and patients' families to systematically assess the causal link between ARI and the emergence of PBG using the Naranjo and Liverpool Adverse Drug Reaction scales.

Findings

Five of these cases were previously diagnosed with a substance use disorder and/or cluster B personality traits. Five had received a more potent dopaminergic antagonist treatment before being switched to ARI. Two of them had presented PBG before being diagnosed with a psychotic disorder. The level of certainty about the causal role of ARI varied from possible to certain, and in 4 cases, the 2 scales yielded different ratings.

Implications

Although these cases suggest that ARI may be associated with the emergence of PBG in the early course of schizophrenia-related psychotic disorders, they cannot prove the causality or the strength of this association. They provide the impetus to perform adequately powered and well-controlled prospective studies to draw more definite conclusion about the causality of this association and, in the meantime, further emphasize the need to carefully assess PBG in this population.
How Successful Are Residents and Fellows at Quality Improvement?
Authors: Eden Elizabeth L. , Harrington Terence , Chen Ling-Wan , Chelluri Lakshmipathi , Higgins Linda W. , Freel Jennifer A. , DeKosky Allison , Bump Gregory M.
Published: March 2020

Background:

Nationally, there is an expectation that residents and fellows participate in quality improvement (QI), preferably interprofessionally. Hospitals and educators invest time and resources in projects, but little is known about success rates or what fosters success.

Purpose:

To understand what proportion of trainee QI projects were successful and whether there were predictors of success.

Methods:

We examined resident and fellow QI projects in an integrated healthcare system that supports diverse training programs in multiple hospitals over 2 years. All projects were reviewed to determine whether they represented actual QI. Projects determined as QI were considered completed or successful based on QI project sponsor self-report. Multiple characteristics were compared between successful and unsuccessful projects.

Results:

Trainees submitted 258 proposals, of which 106 (41.1%) represented actual QI. Non-QI projects predominantly represented needs assessments or retrospective data analyses. Seventy-six percent (81/106) of study sponsors completed surveys about their projects. Less than 25% of projects (59/258) represented actual QI and were successful. Project category was predictive of success, specifically those aimed at preventive care or education.

Conclusion:

Less than a quarter of trainee QI projects represent successful QI.

Implications:

Hospitals and training programs should identify interventions to improve trainee QI experience.
Association of Disability Benefits and/or Litigation With Time to Return to Work After Tibia Shaft Fracture Fixation
Authors: Rehman Yasir , Jones Aaron , Madden Kim , Heels-Ansdell Diane , Busse Jason W.
Published: March 2020

Objectives:

We explored the association of compensation status with return to work (RTW) after tibial fracture.

Methods:

Eligible patients were adults with tibial shaft fractures enrolled in the Trial to Re-evaluate Ultrasound in the Treatment of Tibial Fractures. We explored the association between disability benefits and/or litigation and RTW using multivariable discrete interval hazard analysis, adjusting for sex, age, country of residence, smoking status, body mass index, polytrauma, fracture severity, fracture gap, pain severity, and physical functioning.

Results:

Of 330 eligible patients, 111 (34%) had not returned to full-time work 1-year after surgery. In our adjusted model, receipt of disability benefits and/or involvement in litigation was associated with delayed RTW (HR = 0.71, 95% CI 0.52-0.96).

Discussion:

Tibial shaft fracture patients receiving disability benefits and/or involved in litigation are less likely to RTW.
Safety and Health Innovation in Preschools
Authors: Farewell Charlotte V. , Powers Jamie , Puma Jini
Published: March 2020

Objective:

The primary objective of this study was to evaluate quality of work life in early childhood education (ECE) centers and implement a total worker health (TWH) pilot project with a small sample of ECE teachers.

Methods:

An evidence-based strategic planning process to make policy, system, and environmental (PSE) changes related to TWH was implemented with six ECE centers. A pre-post design with mixed-methods was used to evaluate the impact.

Results:

Baseline findings suggest that there are significant disparities related to quality of work life among ECE teachers compared with the national population. After implementation of the pilot project, ECE centers averaged 4.7 PSE changes. Qualitative data informed facilitators and barriers to implementation of TWH-related changes.

Conclusions:

This pilot project reflects an evidence-based participatory approach to assessing and improving the well-being of ECE teachers.
Leveraging Advanced Practice Nursing in Complex Health Care Systems
Authors: Younger Samuel J.
Published: March 2020

The US health care system has seen unprecedented growth in health care cost with only a mediocre return on investment. Achieving sustained quality improvement will require innovation that is effectively integrated into complex systems of care. Complexity leadership has the ability to place value on traditional quality improvement processes, with less focus on rigid structure and more attention on the potential for flexibility and creativity at the point of care. Clinical team leaders, such as nurse practitioners, must nurture adaptability to the constantly changing clinical environment while balancing structured thinking of team members. Nurse practitioners operating in interdisciplinary teams are well positioned to foster adaptive change through rapid cycle improvements at the point of care. As a learning approach to quality improvement, the PDSA (plan-do-study-act) method should be seen as a useful tool for organizations to create an emergent quality improvement process. This article discusses the significance of nurse practitioner leadership using the PDSA method informed by complexity leadership theory and the impact for clinical practice.
Applying Complexity Science as a DNP Quantum Leader
Authors: Root Lynda , Denke Nancy , Johnson Ingrid , McFadden Mary , Wermers Rita
Published: March 2020

As Doctor of Nursing Practice (DNP) students and graduates begin to apply new knowledge in real-life situations, they are transforming their organizations. The impact of DNP projects is noted by measurable outcomes in diverse settings. This article presents 4 unique clinical/organizational examples of DNP projects. The authors have identified an application of complexity science and leadership theory in their practice changes. In addition, they share their thoughts and feelings as emerging leaders.
Education Resource Nurse
Authors: Derrick Lisa M. , Mangold Kara
Published: March 2020

It is challenging to implement a hospital discharge process that effectively prepares patients for success at home, especially when self-care needs are immense. This article describes a disruptive model that leverages nurse autonomy on an acute care medical-surgical hospital unit. The integration of an education resource nurse within existing resources is showing positive gains in 30-day readmission rates and specific patient experience metrics. The continued success of this newly created role is dependent on an adaptive capacity to leverage principles of complexity leadership and to grow the role within the ever-changing health care environment.
Prehospital Life-Saving Interventions Performed on Pediatric Patients in a Combat Zone: A Multicenter Prospective Study
Authors: Reeves Lauren K. , Savell Shelia C. , Maddry Joseph K. , Samsey Kathleen M. , Mora Alejandra G. , Lairet Julio R.
Published: March 2020

Objectives:

We aimed to describe and evaluate prehospital life-saving interventions performed in a pediatric population in the Afghanistan theater of operations.

Design:

Our study was a post hoc, subanalysis of a larger multicenter, prospective, observational study.

Setting:

We evaluated casualties enrolled upon admission to one of the nine military medical facilities in Afghanistan between January 2009 and March 2014.

Patients:

Adult and pediatric (<17 yr old) patients.

Measurements:

We conducted initial descriptive analyses followed by comparative tests. For comparative analysis, we stratified the study population (adult vs pediatric), and subsequently, we compared injury descriptions and the interventions performed. Following tests for normality, we used the t test or Wilcoxon rank-sum test (nonparametric) for continuous variables and chi-square or Fisher exact for categorical variables. We reported percentages and 95% CIs.

Main Results:

We enrolled 2,106 patients, of which 5.6% (n = 118) were pediatric. Eighty-two percent of the pediatric patients were male, and 435 had blast related injuries. A total of 295 prehospital life-saving interventions were performed on 118 pediatric patients, for an average of 2.5 life-saving interventions per patient. Vascular access (IV 96%, intraosseous 91%) and hypothermia prevention–related interventions (69%) were the most common. Incorrectly performed life-saving interventions in pediatric patients were rare (98% of life-saving interventions performed correctly) and n equals to 24 life-saving interventions over the 6-year period were missed. The most common incorrectly performed and missed life-saving interventions were related to vascular access. When compared with adult life-saving interventions received in the prehospital environment, pediatric patients were more likely to receive intraosseous access (p < 0.0001), whereas adult patients were more likely to have a tourniquet placed (p = 0.0019), receive wound packing with a hemostatic agent (p = 0.0091), and receive chest interventions (p = 0.0003).

Conclusions:

In our study, the most common intervention was vascular access followed by hypothermia prevention and hemorrhage control. The occurrence of missed or incorrectly performed life-saving interventions were rare.