Search

This Article describes the design, synthesis, and analysis of a new class of polymer that is capable of depolymerizing continuously, completely, and cleanly from head to tail when a detection unit on the head of the polymer is exposed to a specific applied signal. The backbone of this polymer consists of 1,3-disubstituted pyrroles and carboxy linkages similar to polyurethanes. Diverse side chains or reactive end-groups can be introduced readily, which provides modular design of polymer structure. The designed depolymerization mechanism proceeds through spontaneous release of carbon dioxide and azafulvene in response to a single triggering reaction with the detection unit. These poly(carboxypyrrole)s depolymerize readily in nonpolar environments, and even in the bulk as solid-state plastics.

X-ray interferometry provides a dark-field image, essentially a small-angle X-ray scattering image, of the voids and print defects in an additively manufactured polymer object. The interferometers used were tuned to scattering length 2–5 μm and configured to measure scattering along both vertical and horizontal directions. The samples studied included Stanford Bunnies, fabricated from acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA), and a quadratic test object fabricated from PLA. The dark-field projection images show orientation-dependent X-ray scattering which is due to anisotropic voids and gaps at the filament-to-filament interface in these fused deposition modeling additive manufacturing objects. SEM corroborates the existence of gaps between filaments.

Tensile stress in selective laser melted (SLM) stainless steel 316 (SS316) bars was studied with neutron imaging methods for measurement of attenuation, scattering, and diffraction. The hypotheses for stress failure includes modifications to both the grain structure and residual porosity. Neutron Bragg edge imaging showed a change in crystallographic structure and/or texture at a pre-existing fracture, but did not provide evidence for presumptive crack formation. A Talbot-Lau grating-based neutron interferometer yielded better than 100 μm spatial resolution for the attenuation images and was tuned to an autocorrelation scattering length of 1.97 μm for the dark-field (scattering) images. The interferometry imaging was performed with samples parallel and perpendicular to the linear grating, allowing assessment of scattering along and perpendicular to the additive manufacturing build direction. In the 3D tomography dark-field volume of a tensile stressed bar, features were observed that suggested possible sites of crack formation. The features were quantified with line probes and found to be reproducible over three tomography experiments. After imaging, the half-stressed bar was pulled to failure; the fracture point is correlated with a feature in the line probe having enhanced neutron scattering. Neutron interferometry, particularly the dark-field imaging modality, emerges as a powerful non-destructive method for detecting early crack formation in additive manufactured components.

A high-resolution neutron tomography system and a grating-based interferometer are used to explore electron beam-melted titanium test objects. The high-resolution neutron tomography system (attenuation-based imaging) has a pixel size of 6.4 µm, appropriate for detecting voids near 25 µm over a (1.5 cm)3volume. The neutron interferometer provides dark-field (small-angle scattering) images with a pixel size of 30 µm. Moreover, the interferometer can be tuned to a scattering length, in this case, 1.97 µm, with a field-of-view of (6 cm)3. The combination of high-resolution imaging with grating-based interferometry provides a way for nondestructive testing of defective titanium samples. A chimney-like pore structure was discovered in the attenuation and dark-field images along one face of an electron beam-melted (EBM) Ti-6Al-4V cube. Tomographic reconstructions of the titanium samples are utilized as a source for a binary volume and for skeletonization of the pores. The dark-field volume shows features with dimensions near and smaller than the interferometer auto-correlation scattering length.

Context: Mixed martial arts (MMA) is rapidly growing in popularity in the United States and abroad. This combat sport joins athletes from a wide variety of martial art disciplines, each with characteristic and distinguishing injury profiles, together in competition. Because of increasing participation by professionals and amateurs alike, injuries sustained by MMA athletes have been on the rise.Evidence Acquisition: A review of relevant publications using the search term mixed martial artsand each of its component combat sports (eg, Muay Thai, Brazilian jiu-jitsu) from 1980 through 2015 was completed using PubMed and Google Scholar.Study Design: Clinical review.Level of Evidence: Level 5.Results: The majority of studies on MMA injuries evaluate those sustained during competition, which range in incidence from 22.9 to 28.6 per 100 fight-participations. Striking-predominant disciplines such as boxing, karate, and Muay Thai have high rates of head and facial injuries, whereas submission-predominant disciplines such as Brazilian jiu-jitsu, judo, and wrestling have high rates of joint injuries.Conclusion: Numerous studies have evaluated injuries in athletes who participate in MMA and its component disciplines during competition but much remains to be discovered about injuries sustained during training and in specific patient populations such as adolescents and women.

Brief interventions such as Screening, a single session of Brief Intervention, and Referral to Treatment (SBIRT) have shown mixed effectiveness in primary care. However, there are indications that multi-session brief interventions may demonstrate more consistently positive outcomes, and perhaps a more intensive approach would be of benefit in addressing substance use in primary care. This study compared the effectiveness of SBIRT with a single BI session (BI/RT) to a multi-session brief-treatment intervention (BI/RT+) in primary care. We also developed easy-to-use, evidence-based materials to assist clinicians in delivering these interventions. This study was conducted in three Federally Qualified Healthcare Centers (FQHCs). A total of 10,935 patients were screened, and 600 individuals were recruited. The sample was primarily Black/African American (82 %) with a mean age of 40. Patients who attended a healthcare appointment were screened for substance use via the AUDIT and DAST. Patients were eligible for the study if they scored 8 or higher on the AUDIT, were using only marijuana and scored 2 or higher on the DAST, or were using other illicit drugs and scored 1 or higher on the DAST. Participants were randomly assigned to receive one-session BI/RT, or two to six sessions of brief intervention that incorporated elements of motivational enhancement therapy and cognitive-behavioral therapy (BI/RT+). Both interventions were delivered by behavioral health consultants at the FQHCs. Participants completed follow-up assessments every 3 months for 1 year. Primary outcome variables included substance use treatment sessions attended and days of substance use. Secondary outcomes included measures of health, employment, legal, and psychiatric functioning and HIV risk behaviors. Additionally, we will conduct an economic evaluation examining cost-effectiveness and will analyze outcomes from a process evaluation examining patient and provider experiences. The ability of brief interventions to impact substance use has great potential, but research findings have been mixed. By conducting a large-scale randomized controlled trial in real-world health centers, this study will answer important questions about the effectiveness of expanded BIs for patients who screen positive for risky substance use in primary care. Trial registrationNCT01751672

To develop and conduct a pilot study of a curriculum of 4 surrogate bone training modules to assess and track progress in basic orthopedic manual skills outside the operating room.

Rapid point-of-need assays are used to detect abundant biomarkers. The development of in situsignal amplification reactions could extend these assays to screening and triaging of patients for trace levels of biomarkers, even in resource-limited settings. We, and others, have developed small molecule-based in situsignal amplification reactions that eventually may be useful in this context. Herein we describe a design strategy for minimizing background signal that may occur in the absence of the target analyte, thus moving this in situsignal amplification approach one step closer to practical applications. Specifically, we describe allylic ethers as privileged connectors for linking detection and propagating functionality in a small molecule signal amplification reagent. Allylic ethers minimize background reactions while still enabling controlled release of a propagating signal in order to continue the signal amplification reaction. This paper characterizes the ability of allylic ethers to provide an amplified response, and offers insight into additional design considerations that are needed before in situsmall molecule-based signal amplification becomes a viable strategy for point-of-need diagnostics.

Problem-to-services matching is critical to patient-centered care. Further, the extent to which substance abuse treatment is individualized to meet specific client needs is a key predictor of success and represents “best practice” in substance abuse treatment. The CASPAR Resource Guide, an electronic database of local free and low-cost services, is an evidence-based tool designed to help counselors easily and quickly provide off-site referrals to services not available in most community treatment programs to increase problem-to-service matching. This paper examines system-level barriers to using the CASPAR Resource Guide among 30 counselors and 21 site directors across 16 sites in two different studies. Results from qualitative implementation analyses found that key program components needed to support the implementation of this evidence-based practice (e.g., individualized treatment planning, individual treatment sessions, and individual counselor supervision) were lacking, which jeopardized successful adoption of the CASPAR research interventions and prompted a redesign of the studies in order to enhance each program's ability to support individualized care.

ABSTRACTCommunity substance abuse treatment programs face many barriers to adopting “evidence-based” therapies. Training budgets are inadequate to permit acquisition of complex skills, there is little clinical supervision available, and almost all counseling is done in group sessions. The authors adopted an approach widely used in the teaching field—developing a resource “toolkit” for a specific topic, in this case, a Decisional Balance exercise often used in the evidence-based treatment approach of Motivational Interviewing. This trial toolkit was comprised of a DVD (televised during group to illustrate the clinical concept), a laminated counselor guide (to provide guidance and talking points for the counselor during group), and some worksheets and wallet cards for patients to retain key points (see Table 1). A feasibility trial assessed the acceptability, and sustainability of the “Decisional Balance” concept toolkit among 26 counselors and 210 of their patients, from 6 community-based substance abuse treatment programs. The great majority of patients (97%) and all counselors (100%) reported they were satisfied with the toolkit session; 84% of patients said they would like more groups like the toolkit session. Almost all counselors (96%) were still using at least one component of the toolkit 3 months after their initial exposure with no prompting. The toolkit curriculum–based approach may be a viable and attractive way of translating core concepts from sophisticated evidence-based therapies into use by counselors within contemporary, community-based treatment programs with minimal training.

Community substance abuse treatment programs face many barriers to adopting “evidence-based” therapies. Training budgets are inadequate to permit acquisition of complex skills, there is little clinical supervision available, and almost all counseling is done in group sessions. The authors adopted an approach widely used in the teaching field—developing a resource “toolkit” for a specific topic, in this case, a Decisional Balance exercise often used in the evidence-based treatment approach of Motivational Interviewing. This trial toolkit was comprised of a DVD (televised during group to illustrate the clinical concept), a laminated counselor guide (to provide guidance and talking points for the counselor during group), and some worksheets and wallet cards for patients to retain key points (see Table 1). A feasibility trial assessed the acceptability, and sustainability of the “Decisional Balance” concept toolkit among 26 counselors and 210 of their patients, from 6 community-based substance abuse treatment programs. The great majority of patients (97%) and all counselors (100%) reported they were satisfied with the toolkit session; 84% of patients said they would like more groups like the toolkit session. Almost all counselors (96%) were still using at least one component of the toolkit 3 months after their initial exposure with no prompting. The toolkit curriculum–based approach may be a viable and attractive way of translating core concepts from sophisticated evidence-based therapies into use by counselors within contemporary, community-based treatment programs with minimal training.

Telomere attrition, DNA damage and constitutive mitogenic signaling can all trigger cellular senescence in normal cells and serve as a defense against tumor progression. Cancer cells may circumvent this cellular defense by acquiring genetic mutations in checkpoint proteins responsible for regulating permanent cell cycle arrest. A small family of tumor suppressor genes encoding the retinoblastoma susceptibility protein family (Rb, p107, p130) exerts a partially redundant control of entry into S phase of DNA replication and cellular proliferation. Here we report that activation of the p53-dependent DNA damage response has been found to accelerate senescence in human prostate cancer cells lacking a functional Rb protein. This novel form of irradiation-induced premature cellular senescence reinforces the notion that other Rb family members may compensate for loss of Rb protein in the DNA damage response pathway. Consistent with this hypothesis, depletion of p107 potently inhibits the irradiation-induced senescence observed in DU145 cells. In contrast, p130 depletion triggers a robust and unexpected form of premature senescence in unirradiated cells. The dominant effect of depleting both p107 and p130, in the absence of Rb, was a complete blockade of irradiation-induced cellular senescence. Onset of the p107-dependent senescence was temporally associated with p53-mediated stabilization of the cyclin-dependent kinase inhibitor p27 and decreases in c-myc and cks1 expression. These results indicate that p107 is required for initiation of accelerated cellular senescence in the absence of Rb and introduces the concept that p130 may be required to prevent the onset of terminal growth arrest in unstimulated prostate cancer cells lacking a functional Rb allele.

The safest and most effective method of early cervical spine clearance in unconscious patients is the subject of intense debate. We hypothesize that helical computed tomography (CT) is a sufficiently sensitive investigation to render dynamic screening redundant.

The dissociation onset for halogen atom loss was investigated for 2-iodo and 2-chloropropane ions using a newly developed threshold photoelectron photoion coincidence (TPEPICO) technique that suppresses the effects of hot electrons. This study was undertaken in order to resolve current discrepancies concerning these onsets in the literature. The 0 K dissociation thresholds were determined to be 9.818 ± 0.010 and 11.036 ± 0.010 eV for 2-C3H7I and 2-C3H7Cl, respectively. These numbers agree quite well with photoionization and a mass analyzed threshold ionization (MATI) study, but are significantly lower than onsets measured by the much higher resolution pulsed field ionization PEPICO method. The derived C3H7+heat of formation at 298 K is 803.9 ± 1.5 kJ mol−1, and a more precise value for the 298 K 2-iodopropane heat of formation is −40.8 ± 1.3 kJ mol−1. The derived proton affinity of propene is 746.1 kJ mol−1. We have also performed a high-level ab initiocalculation on the 0 K dissociation limit, E0, for C3H7+from C3H7Cl at the CCSD(T)/CBS level of theory with high-level corrections. The theoretical prediction of 11.048–11.061 eV for E0(C3H7+) from C3H7Cl is found to be consistent with the current experimental value.

Humeroradial synostosis may occur sporadically or as an extremely rare inheritable disorder. The current classification divides cases into class I (fixed in extension with ulnar ray hypoplasia) or class II (fixed in flexion without hypoplasia). Familial cases of class II synostosis segregate into autosomal recessive and autosomal dominant groups. Autosomal recessive pedigrees are heterogeneous. However, when inherited as an autosomal dominant some cases of humeroradial synostosis demonstrate striking similarities limited to the musculoskeletal system class II humeroradial synostosis, proximal symphalangism, short first metacarpal and metatarsal bones, carpal and tarsal coalitions and a prominent nasal bridge. We believe that when class II humeroradial synostosis is associated with these features, the primary diagnosis is the multiple synostosis syndrome. Furthermore, a prominent nasal bridge is present in the neonate and may aid diagnosis at this stage. We illustrate these findings with the case of a mother and only child, both demonstrating class II humeroradial synostosis and features characteristic of the multiple synostosis syndrome.

To describe predominantly persistent intraretinal fluid (PP-IRF) and its association with visual acuity (VA) and retinal anatomic findings at long-term follow-up in eyes treated with pro re nata (PRN) ranibizumab or bevacizumab for neovascular age-related macular degeneration.

The management of blunt abdominal injury (BAI) has undergone quite significant changes over recent years. The emphasis is now on the recognition and limitation of the underlying metabolic insult associated with severe abdominal injury. The concepts of damage control and non-operative management while seeming diametrically opposed have both found favour in selected patient groups. The interventional radiologist has opened a new dimension in the control of inaccessible bleeding and is able to contribute to non-operative approaches. The complimentary use of the methods of investigation available for BAI will also improve the accuracy and specificity of diagnosis allowing more appropriate management. Embracing these new concepts of management by all institutions dealing with trauma victims will hopefully reduce the morbidity and mortality of BAI.

The article discusses key issues concerning the Wicker Park/Bucktown Self-Description Project, an outdoor installation of signs throughout the Bucktown and Wicker Park neighborhoods of Chicago, Illinois. It includes background information on the project, as well as its role as a descriptive mapping of the neighborhoods and its inhabitants.