Search

Recent trends in car body manufacturing indicate that the use of a consistent mix of lightweight materials in conjunction with adhesive bonding, not only allows substantial weight reduction, but can also drive down costs and potentially enables more intelligent designs. Yet, presently, it is highly desirable that the introduction of structural adhesives is made with minimum impact on the automotive body framing systems. Adhesives commonly deployed in car body production (i.e. body-in-white) are applied without any prior surface preparation and final curing is carried out during the baking process that follows the electrophoretic coating. Several structural adhesives have been tailored to the conditions dictated by the automotive production process. The aim of this work is to assess the mechanical properties of adhesive joints bonded with automotive grade hot setting epoxy adhesives employed for the assembly of frame and panels. Single-lap and T-joints were fabricated and adhesive hardening was carried out following the typical curing cycle employed in the process chain of automobile production. The resulting mechanical properties were assessed before and after exposure to a standard accelerated thermal cycling under controlled humidity. The evaluation of the mechanical behavior was done through a combination of testing and analysis, which included the assessment of fracture surfaces using optical microscopy to resolve the locus of failure. [ABSTRACT FROM AUTHOR]

A purposive sampling strategy was used to recruit 113 adult children to determine what factors mediate the effects of providing care to a parent with Alzheimer's disease. The sample was composed of 51 non-Hispanic and 62 Hispanic adult children. Although similar in age, the Hispanic caregivers reported greater appraisal of satisfaction, mastery, self acceptance, and purpose in life (p

The number of individuals with Alzheimer's disease or a related dementia is growing at a staggering rate. Thus, it is essential that social workers in geriatric settings are knowledgeable about this disorder and the appropriate interventions to use at all stages of the disease. The purpose of this article is to examine the types of non-pharmacological, psychosocial treatments that are used to manage the behavioral manifestations and changes in the mood of individuals with Alzheimer's disease or a related dementia. While great strides have been made in pharmacological treatments of Alzheimer's disease, less attention has been given to the types of psychosocial interventions that are readily employed in community-based and long-term care settings to assist in the care of these individuals. This article provides an overview of psychosocial interventions, as well as identifies the direction for future evidence-based treatment studies, for individuals with Alzheimer's disease and related dementia. [ABSTRACT FROM AUTHOR]

While research on caregivers of individuals with Alzheimer's disease dominated gerontological research for the last 25 years, little attention has been given to the grief reactions of caregivers, particularly male caregivers. This study examined the expression of grief and loss among 71 male caregivers who were currently caring for a loved one with Alzheimer's disease. Qualitative research methodology found that while not all caregivers perceived themselves to be grieving, expressions of loss were present in all statements. Implications for geriatric social work practice were examined. [ABSTRACT FROM AUTHOR]

The CA.ME.LI.A (CArdiovascular risks, MEtabolic syndrome, LIver and Autoimmune disease) epidemiological study was conducted in Abbiategrasso (Milan, Italy) to identify risk factors for metabolic and cardiovascular disease in an apparently healthy population of northern Italy. The population ( n = 2,545, 1,251 men, 1,254 women) was stratified according to body mass index [normal body weight (NBW): <25 kg/m 2 ; overweight-obese (OWO): ≥25 kg/m 2 ] and according to fasting blood glucose [normal fasting glucose: <100 mg/dL; impaired fasting glucose (IFG): 100-125 mg/dL; diabetes mellitus (DM): ≥126 mg/dL]. The incidence of cardiovascular (CV) events and overall mortality were studied by the Kaplan-Meier method using the log rank test. Univariate analysis was conducted with time-dependent Cox models. During the 7-yr follow-up period, 80 deaths and 149 CV events occurred. IFG [hazard ratio (HR): 2.81; confidence interval (CI): 1.37-5.77; P = 0.005], DM (HR: 4.88; CI: 1.47-16; P = 0.010), or OWO (HR: 2.78; CI:1.68-4.59; P < 0.001) all produced significant increases in CV events and deaths. In the combination IFG/OWO (HR: 5.51; CI: 3.34-9.08; P < 0.001), there was an apparent additive effect of the two conditions, whereas in the combination DM/OWO (HR: 12.71; CI: 7.48-22; P < 0.001), there was an apparent multiplicative effect on the risk for CV events and deaths. In males, the DM/NBW group had a higher incidence of cardiovascular events and deaths than the IFG/OWO group. In contrast, in females, the IFG/OWO group had a higher incidence of cardiovascular events and deaths than the DM/NBW group. In women, there was a greater incidence of CV events in the IFG/OWO group (HR: 6.23; CI: 2.88-13; P < 0.001) than in men in the same group (HR: 4.27; CI: 2.15-8.47; P < 0.001). Consistent with these data, also all-cause mortality was progressively increased by IFG/DM and OWO, with an apparently exponential effect in the combination DM/OWO (HR: 11.78; CI: 6.11-23; P < 0.001). IFG/DM and OWO, alone or in combination, had major effects in increasing mortality for all causes and CV events. The relative contributions of hyperglycemia and overweight/obesity on cardiovascular events and deaths were apparently, to a certain extent, sex dependent. Females were more affected by overweight/obesity either alone or combined with IFG, as compared with males. NEW & NOTEWORTHY For the first time, the combined effects of glucose tolerance and BMI have been investigated in an apparently healthy large population sample of a city in the north of Italy. We found that there are synergistic effects of glucose levels with BMI to increase not only cardiovascular events and deaths but also cancer-related deaths and all-cause mortality.

This column shares lessons learned from a 1-year pilot implementation of a crisis response program deploying crisis professionals to rural parts of Albany County, New York. The data (325 crisis interventions for 191 unique individuals, 57% of cases resolved on the scene) suggest that the program helps fill the crisis services gap in these communities. Police were present on 80% of cases. Educating police to build confidence in the program and providing clearer guidelines on the triage process for dispatchers may be important strategies to continue shifting crisis response duties from traditional first responders to crisis professionals., Competing Interests: The authors report no financial relationships with commercial interests.

Cannabis as a therapeutic agent is increasing in popularity all around the globe, particularly in Western countries, and its potential is now well assessed. On the other hand, each country has its own regulation for the preparation of cannabis macerated oils; in Italy, there are only a few preparation methods allowed. With this work, we aim to perform a stability study of cannabis oils produced with a novel method for the extraction of cannabinoids from cannabis inflorescence. Three different varieties of cannabis were used, with and without the adding of tocopherol acetate as an antioxidant. Cannabinoids were extracted using ethanol at room temperature; then, the solvent was evaporated under reduced pressure and the preparations reconstituted with olive oil. In this work, we assessed the stability of both cannabinoids and terpenes in these formulas over 8 months. Cannabinoid stability was assessed by monitoring the concentrations of THC and CBD, while terpene stability was assessed by monitoring β -Caryophyllene and α -Humulene concentrations. Stability of the extracts was not influenced by the presence of tocopherol acetate, though refrigeration seems to be detrimental for a long storage of products, especially regarding THC concentrations. The improvements offered by this method reside in the flexibility in controlling the concentration of the extract and the ability to produce highly concentrated oils, alongside the possibility to produce standardized oils despite the variability of the starting plant material., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

For different manufacturing processes, porosity occurs in parts made using selective laser sintering (SLS) technology, representing one of the weakest points of materials produced with these processes. Even though there are different studies involving many polymeric materials employed via SLS, and different manuscripts in the literature that discuss the porosity occurrence in pure or blended polymers, to date, no researcher has reported a systematic and exhaustive comparison of the porosity percentage. A direct comparison of the available data may prove pivotal in advancing our understanding within the field of additively manufactured polymers. This work aims to collect and compare the results obtained by researchers who have studied SLS's applicability to different amorphous or semi-crystalline polymers and pure or blended materials. In particular, the porosity values obtained by different researchers are compared, and tables are provided that show, for each material, the process parameters and the measured porosity values.

The recently reported efficient conversion of cyclic ketones to lactones by Oxone in neutral buffered water is extended to heterocyclic ketones, namely, cyclic N -Boc azaketones and oxoethers with the aim of obtaining N -protected azalactones and their analogues with oxygen in place of nitrogen. N -Boc-4-piperidinone and all the cyclic oxoethers were successfully oxidized to lactones, while the azacyclic ketones with nitrogen α-positioned to carbonyl were univocally transformed into N -Boc-ω-amino acids and N -Boc- N -formyl-ω-amino acids operating in alkaline water and DMF, respectively.

We investigate the mechanics of crack propagation in architected adhesive joints whose adherends are inspired to the base plate of the barnacle Amphibalanus ( =Balanus ) amphitrite , and feature an array of buried hollow cylindrical channels located perpendicularly to the direction of crack growth. Selective laser sintering is used to obtain the adherends that are subsequently bonded in the double cantilever beam configuration to ascertain the mechanics of crack growth. Finite element (FE) simulations are deployed to determine the strain energy release rate (ERR) and to elucidate the salient features of the fracture process. It is shown that the channels induce a modulation of the ERR and enable a crack tip shielding mechanism. Besides, FE simulations based on a cohesive zone approach indicate the occurrence of crack pinning/depinning cycles that are validated via experiments. A highlight of the present study is the use of a mechanoluminescent (ML) coating to unravel the evolution of the transient stress field in the crack tip region. The coating comprises an optical epoxy resin loaded with doped strontium aluminate phosphors (SrAl 2 O 4 /Eu 2+ ) and converts mechanical energy into light emission with intensity proportional to the magnitude of mechanical stress. By combining the ML emission patterns with the stress distribution obtained from FEA, we unveil interesting details of snap-through cracking in architected bio-inspired adhesive joints.

The use of polymers in the transportation industry represents a great opportunity to meet the growing demand for lightweight structures and to reduce polluting emissions. In this context, additive manufacturing represents a very effective fabrication route for mechanical components with sophisticated geometry that cannot be pursued by conventional methods. However, understanding the mechanical properties of 3D-printed polymers plays a crucial role in the performance and durability of polymer-based products. Polyamide is a commonly used material in 3D printing because of its excellent mechanical properties. However, the layer-by-layer deposition process and ensuing auxiliary steps (e.g., post-processing heating) may affect the microstructure and mechanical properties of 3D-printed nylon with respect to the bulk counterpart. In this work, we explore the effect of displacement rate and heat exposure on the mechanical properties of 3D-printed polyamide (PA12) specimens obtained by selective laser sintering (SLS). Moreover, the thermal characteristics of the powders and sintered material were evaluated using differential scanning calorimetry (DSC). Our results highlight the expected rate dependency of mechanical properties and show that a post-processing heat treatment partly affects mechanical behavior.

The management of food and food-related wastes represents a growing global issue, as they are hard to recycle and dispose of. Foremost, waste can serve as an important source of biomasses. Particularly, fat-enriched biomasses are receiving more and more attention for their role in the manufacturing of biofuels. Nonetheless, many biomasses have been set aside over the years. Wool wax, also known as lanolin, has a huge potential for becoming a source of typical and atypical fatty acids. The main aim of this work was to evaluate and assess a protocol for the fractioning of fatty acids from lanolin, a natural by-product of the shearing of sheep, alongside the design of a new and rapid quantitative GC-MS method for the derivatization of free fatty acids in fat mixtures, using MethElute™. As the acid portion of lanolin is characterized by the presence of both aliphatic and hydroxylated fatty acids, we also evaluated a procedure for the parting of these two species, by using NMR spectroscopy, benefitting of the different solubilities of the components in organic solvents. At last, we evaluated and quantified the fatty acids and the α-hydroxy fatty acids present in each attained portion, employing both analytical and synthetic standards. The performed analyses, both qualitative and quantitative, showed a good performance in the parting of the different acid components, and GC-MS allowed to speculate that the majority of α-hydroxylated fatty acids is formed of linear saturated carbon chains, while the totality of properly said fatty acids has a much more complex profile.

Caring for people with chronic kidney disease, let alone during a pandemic, can place nurses at risk for burnout. This study explored the effects of the Mindful Self-Compassion (MSC) 8-week training on nephrology nurses' levels of self-compassion, burnout, and resilience. Twelve nurses participated. Surveys were completed before, immediately after, and three months after training. A focus group was also conducted. Results demonstrated in creased levels of self-compassion, mindfulness, and resilience while levels of burnout decreased. The central qualitative theme was enhanced resilience. Subthemes were creating a community of support, awareness and discovery, and the mastery of the techniques. The MSC training was an effective intervention to build essential skills for maintaining a healthy workforce. Implementation of such training programs within the health care environment are highly encouraged., Competing Interests: The authors reported no actual or potential conflict of interest in relation to this nursing continuing professional development (NCPD) activity., (Copyright© by the American Nephrology Nurses Association.)

The role of diabetes nurse educators during the COVID-19 lockdown to telematically provide routine reviews of glycaemic control in children with type 1 diabetes (T1D) using continuous glucose monitoring systems is evaluated. Implementing these routines in the day-to-day clinical practice could reduce in-person clinic visits and improve glucose control., (Copyright © 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

The main concerns in targeted " sphingolipidomics " are the extraction and proper handling of biological samples to avoid interferences and achieve a quantitative yield well representing all the sphingolipids in the matrix. Our work aimed to compare different pre-analytical procedures and to evaluate a derivatization step for sphingoid bases quantification, to avoid interferences and improve sensitivity. We tested four protocols for the extraction of sphingolipids from human plasma, at different temperatures and durations, and two derivatization procedures for the conversion of sphingoid bases into phenylthiourea derivatives. Different columns and LC-MS/MS chromatographic conditions were also tested. The protocol that worked better for sphingolipids analysis involved a single-phase extraction in methanol/chloroform mixture (2:1, v / v ) for 1 h at 38 °C, followed by a 2 h alkaline methanolysis at 38 °C, for the suppression of phospholipids signals. The derivatization of sphingoid bases promotes the sensibility of non-phosphorylated species but we proved that it is not superior to a careful choice of the appropriate column and a full-length elution gradient. Our procedure was eventually validated by analyzing plasma and erythrocyte samples of 20 volunteers. While both extraction and methanolysis are pivotal steps, our final consideration is to analyze sphingolipids and sphingoid bases under different chromatographic conditions, minding the interferences.

Although the human body may dynamically adapt to mild and brief oxygen shortages, there is a growing interest in understanding how the metabolic pathways are modified during sustained exposure to chronic hypoxia. Located at an equivalent altitude of approximately 3,800 m asl, the Concordia Station in Antarctica represents an opportunity to study the course of human adaption to mild hypoxia with reduced impact of potentially disturbing variables else than oxygen deprivation. We recruited seven healthy subjects who spent 10 months in the Concordia Station, and collected plasma samples at sea level before departure, and 90 days, 6 months, and 10 months during hypoxia. Samples were analyzed by untargeted liquid chromatography high resolution mass spectrometry to unravel how the non-polar and polar metabolomes are affected. Statistical analyses were performed by clustering the subjects into four groups according to the duration of hypoxia exposure. The non-polar metabolome revealed a modest decrease in the concentration of all the major lipid classes. By contrast, the polar metabolome showed marked alterations in several metabolic pathways, especially those related to amino acids metabolism, with a particular concern of arginine, glutamine, phenylalanine, tryptophan, and tyrosine. Remarkably, all the changes were evident since the first time point and remained unaffected by hypoxia duration (with the exception of a slight return of the non-polar metabolome after 6 months), highlighting a relative inability of the body to compensate them. Finally, we identified a few metabolic pathways that emerged as the main targets of chronic hypoxia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Dei Cas, Morano, Ottolenghi, Dicasillati, Roda, Samaja and Paroni.)

We evaluated the performance of three different single-phase extraction methods to be used before untargeted lipidomics analysis by Liquid Chromatography High-Resolution Mass Spectrometry. Lipids were extracted from a pool of healthy human donors' plasma in triplicates and run in both positive and negative ESI. The most satisfactory results were attained using methanol/chloroform (2:1, v/v) mixture. Eventually, we evaluated whether a filtration of the samples could be beneficial to yield cleaner and more mass-friendly extracts. Instead of using syringes, we set up a method we called tip-tip filtration, which requires the usage of a filtrating pipette tip. This way of purification led to superior results than the solvent extraction method alone. This additional procedure not only increased reproducibility but also allowed the same lipid coverage. In addition, it permitted to spare time and money, as tip-tip filtration is not particularly expensive nor time-consuming and hopefully it may be useful to increase analytical column lifetime., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Although the serum lipidome is markedly affected by COVID-19, two unresolved issues remain: how the severity of the disease affects the level and the composition of serum lipids and whether serum lipidome analysis may identify specific lipids impairment linked to the patients' outcome. Sera from 49 COVID-19 patients were analyzed by untargeted lipidomics. Patients were clustered according to: inflammation (C-reactive protein), hypoxia (Horowitz Index), coagulation state (D-dimer), kidney function (creatinine) and age. COVID-19 patients exhibited remarkable and distinctive dyslipidemia for each prognostic factor associated with reduced defense against oxidative stress. When patients were clustered by outcome (7 days), a peculiar lipidome signature was detected with an overall increase of 29 lipid species, including-among others-four ceramide and three sulfatide species, univocally related to this analysis. Considering the lipids that were affected by all the prognostic factors, we found one sphingomyelin related to inflammation and viral infection of the respiratory tract and two sphingomyelins, that are independently related to patients' age, and they appear as candidate biomarkers to monitor disease progression and severity. Although preliminary and needing validation, this report pioneers the translation of lipidome signatures to link the effects of five critical clinical prognostic factors with the patients' outcomes., (© 2021. The Author(s).)

A headspace method called full evaporation technique (FET) coupled to capillary gas chromatography with a mass detector operating in time-of-flight mode (HS-GC/MS-TOF) was developed to characterize the volatile components, especially the terpene fraction, in Cannabis sativa L. inflorescences. This analytical approach allows to reach a high equilibration temperature, that was able to obtain a complete quantification of the volatile components, providing simple sample preparation, specific qualitative detection, high sensitivity, a precise and accurate quantitative determination. The method was applied to 20 cannabis THC-dominant (I) and 13 CBD-dominant (III) chemotypes. The obtained results were then compared with a series of standard solutions consisting of 35 terpenoids and the mass spectra present in a computer library (NIST). The method has an accuracy of more than 90 % and a limit of detection of 5 ppm for all analytes. The main terpenoids in cannabis are namely (% Chemotypes III vs. I of the total terpene content): β-Caryophyllene (25 vs. 19.3), β-Mircene (18.2 vs. 20.0), Terpinolene (12.1 vs. 7.0), α-Humulene (6.5 vs. 8.5), D-Limonene (6.2 vs. 7.2), α-Pinene (5.8 vs. 4.9), β-Pinene (5.0 vs. 5.8) and cis-β-Ocimene (4.3 vs. 5.2), whose presence is confirmed in both plant chemotypes and account for more than 80 % of the total terpenoids amount. The terpenoids which can clearly distinguish the chemotype are α-Terpineol, Linalool, DL-Menthol, α-Cedrene, and Borneol. This application provides important data on the secondary volatile components of the plant, which may be useful for a better understanding of the therapeutic properties of the cannabis phyto-complex. It gives the possibility of establishing the aroma profile of different Cannabis batches, allowing possible similarities between samples and identifying any artificial adulteration such as hexyl butyrate ester and it provides the opportunity to highlight some target compounds characteristic of the different chemotypes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Drain Amylase level are routinely determined to diagnose pancreatic fistula after Pancreatocoduodenectomy. Consensus is lacking regarding the cut-off value of amylase to diagnosis clinically relevant postoperative pancreatic fistulae (POPF). The present study proposes a model based on Amylase Value in the Drain (AVD) measured in the first three postoperative days to predict a POPF. Amylase cut-offs were selected from a previous published systematic review and the accuracy were validated in a multicentre database from 12 centres in 2 countries. The present study defined POPF the 2016 ISGPS criteria (3 times the upper limit of normal serum amylase). A learning machine method was used to correlate AVD with the diagnosis of POPF. Overall, 454 (27%) of 1638 patients developed POPF. Machine learning excluded a clinically relevant postoperative pancreatic fistulae with an AUC of 0.962 (95% CI 0.940-0.984) in the first five postoperative days. An AVD at a cut-off of 270 U/L in 2 days in the first three postoperative days excluded a POPF with an AUC of 0.869 (CI 0.81-0.90, p < 0.0001). A single AVD in the first three postoperative days may not exclude POPF after pancreatoduodenectomy. The levels should be monitored until day 3 and have two negative values before removing the drain. In the group with a positive level, the drain should be kept in and AVD monitored until postoperative day five., (© 2021. Italian Society of Surgery (SIC).)

The metabolism of nitric oxide plays an increasingly interesting role in the physiological response of the human body to extreme environmental conditions, such as underwater, in an extremely cold climate, and at low oxygen concentrations. Field studies need the development of analytical methods to measure nitrite and nitrate in plasma and red blood cells with high requirements of accuracy, precision, and sensitivity. An optimized spectrophotometric Griess method for nitrite-nitrate affords sensitivity in the low millimolar range and precision within ±2 μM for both nitrite and nitrate, requiring 100 μL of scarcely available plasma sample or less than 50 μL of red blood cells. A scheduled time-efficient procedure affords measurement of as many as 80 blood samples, with combined nitrite and nitrate measurement in plasma and red blood cells. Performance and usefulness were tested in pilot studies that use blood fractions deriving from subjects who dwelt in an Antarctica scientific station and on breath-holding and scuba divers who performed training at sea and in a land-based deep pool facility. The method demonstrated adequate to measure low basal concentrations of nitrite and high production of nitrate as a consequence of water column pressure-triggered vasodilatation in deep-water divers.

Nephrology nurses are not immune to the effects of a stressful work environment. As a result, their emotional and psychological health can be at risk. In addition, there has been unprecedented stress and uncertainty working as nephrology nurses during the pandemic. These stressors can have negative effects on nurses' health, resulting in burnout and/or compassion fatigue, which can lead to nurses leaving nephrology or the nursing profession. Mindfulness has been suggested as a strategy to mitigate work-related stressors and build a more resilient workforce. Our experience suggests that combining self-compassion practices with mindfulness is also effective. Mindfulness may be beneficial for nephrology nurses, but its use does not negate the need for organizations to address the structural system issues that also contribute to burnout., Competing Interests: The authors reported no actual or potential conflict of interest in relation to this nursing continuing professional development (NCPD) activity., (Copyright© by the American Nephrology Nurses Association.)

Adhesive bonding of carbon-fiber-reinforced polymers (CFRPs) is a key enabling technology for the assembly of lightweight structures. Surface pretreatment is necessary to remove contaminants related to material manufacturing and ensure bond reliability. The present experimental study focuses on the effect of mechanical abrasion on the damage mechanisms and fracture toughness of CFRP/epoxy joints. The analyzed CFRP plates were provided with a thin layer of surface epoxy matrix and featured enhanced sensitivity to surface preparation. Various degrees of morphological modification and fairly controllable carbon fiber exposure were obtained using sanding with emery paper and grit-blasting with glass particles. In the sanding process, different grit sizes of SiC paper were used, while the grit blasting treatment was carried by varying the sample-to-gun distance and the number of passes. Detailed surveys of surface topography and wettability were carried out using various methods, including scanning electron microscopy (SEM), contact profilometry, and wettability measurements. Mechanical tests were performed using double cantilever beam (DCB) adhesive joints. Two surface conditions were selected for the experiments: sanded interfaces mostly made of a polymer matrix and grit-blasted interfaces featuring a significant degree of exposed carbon fibers. Despite the different topographies, the selected surfaces displayed similar wettability. Besides, the adhesive joints with sanded interfaces had a smooth fracture response (steady-state crack growth). In contrast, the exposed fibers at grit-blasted interfaces enabled large-scale bridging and a significant R-curve behavior. While it is often predicated that quality composite joints require surfaces with a high percentage of the polymer matrix, our mechanical tests show that the exposure of carbon fibers can facilitate a remarkable toughening effect. These results open up for additional interesting prospects for future works concerning toughening of composite joints in automotive and aerospace applications.

Carcinomas of the thyroid with Ewing family tumor elements (CEFTEs) are small cell thyroid tumors characterized by epithelial differentiation and EWSR1-FLI1 rearrangements. In contrast to primary thyroid Ewing sarcomas, these rare tumors have a favorable prognosis. CEFTEs may co-exist with papillary thyroid carcinoma (PTC) foci and are thought to arise from either PTCs or main cells of solid cell nests (SCN). Due to their rare occurrence, characteristic clinical presentations, preoperatory sonographic (US) findings, and fine-needle aspiration (FNA) cytologic features were ill-defined until now. We report a case of a 40-year-old male who was referred to the thyroid clinic for a progressively enlarging, hard, painless, cervical mass. US examination revealed a hypoechoic nodule with lobulated margins and scant intranodular vascular signals of the right thyroid lobe. Evidence of extracapsular spread was not identified. FNA provided a Bethesda V cytology classification on conventional smears. Repeat FNA sampling with the use of a CytoFoam Core allowed a preoperative diagnosis consistent with undifferentiated thyroid carcinoma. Total thyroidectomy without lymph node dissection was performed. Histologic examination with subsequent molecular studies provided the diagnosis of papillary carcinoma of the thyroid with Ewing family tumour elements (CEFTEs). No additional treatment was rendered and the patient showed no evidence of local or distant disease by clinical examination, US, and 18 FDG-TAC/PET after 6 months of follow-up. This is the first reported case of CEFTE with complete clinical, US, cytologic, and immunohistochemical preoperatory assessment.

Improvement of chronic disease management demands effective collaborative relationships between health and social-care which is achieved through teamwork. Interprofessional Education (IPE) and Interprofessional Collaboration (IPC) are recognized as essential for the delivery of effective and efficient healthcare. Although IPC and IPE are key components of primary care, evidence of studies evaluating how an IPE intervention prior to IPC improved chronic patient outcomes remains scarce. The aim of this study was to assess the impact of IPC interventions on the management of chronic patients compared to usual care. A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) on IPC interventions on chronicity management and their impact on clinical and process outcomes was conducted. Of the 11,128 papers initially retrieved, 23 met the inclusion criteria. Meta-analyses results showed the reduction of systolic blood pressure (Mean Difference (MD) -3.70; 95 % CI -7.39, -0.01), glycosylated hemoglobin (MD -0.20; 95 % CI -0.47, -0.07), LDL cholesterol (MD -5.74; 95 % CI -9.34, -2.14), diastolic blood pressure (MD -1.95; 95 % CI -3.18, -0.72), days of hospitalization (MD -2.22; 95 % CI -4.30, -0.140). A number of positive findings for outcomes related to IPC were found reflecting an improvement of quality of care and an enhancement in the delivery of patient-centered and coordinated care. Moreover, the need for a purposeful systemic approach linking interprofessional education with interprofessional collaboration and patient health and wellbeing is necessary., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This study aims to explore the association of depressive symptoms with the informal social support network reported by dementia caregivers participating in a community-based caregiver support program. Caregivers in a community-based dementia caregiver program completed an intake assessment, including the social support network instrument. Measures were completed for caregivers' social support network, using the social support network instrument (SSNI). Measures also included depression, caregiver strain, basic activities of daily living, instrumental activities of daily living, and demographics. Findings suggest the effects of social supports and social network on caregivers' depressive symptoms. Caregivers who had financial supports were less likely to have depressive symptoms. Also, the frequency of contact among social network variables predicted the decrease of depressive symptoms.

The rapid growth of the aging population in the United States has produced concern over whether the social work profession will be able to meet the needs of elders and their caregivers. Currently, a shortage of gerontological social workers trained specifically to work with this population exists, and based on projections, this shortage will only become more critical over the next few decades. In order to address this shortage, one approach has been adopted that seeks to increase the number of gerontological social work faculty, who can then encourage Bachelor and Master of Social Work students to consider working with older adults, and prepare them with the knowledge and skills necessary for doing so. In this commentary, we describe a program that adopts this approach and the measures used to determine its success, and conclude with a brief description of three articles included in this issue of the JGSW that analyze and report the results of these measures.

Unmet need for long-term services and supports has been linked to a variety of harmful health outcomes. One suggested strategy for ameliorating unmet need is to give participants control of a budget and let them construct individualized plans. The evaluation of the Cash and Counseling controlled experiment (CCDE) documented a marked reduction in unmet need when compared to traditional agency-based solutions, but it also showed significant unmet needs remained. This paper reanalyzes 76 case studies from the CCDE to, for the first time gain an understanding of what those unmet needs are, who sees them, and what participants, caregivers and support brokers think might reduce this problem. Using a collective or multiple case study approach to understand this phenomenon, unmet needs were sorted into five categories using real life experiences of respondents. Unmet needs for assistance in managing the employer and budget tasks of self-direction were also captured.This paper discusses situations where the clinician researchers documented needs that were not expressed by the care recipients and provides a picture of where and why unmet needs remain.The paper concludes with strategies for reducing unmet needs and training future social workers.

In the United States, under the Cash and Counseling or budget authority model of self-directed personal assistance where the participant manages his or her own services and supports, the Support Broker role was established to assist and coach the participant. The support broker role grew out of a person-centered planning process where focus groups and surveys helped ascertain what potential participants wanted to help them establish a self-directed alternative. But, despite this role being described in policy guidance from the Center for Medicare and Medicaid, little research has been conducted examining the functions, activities and usefulness of this position. This study draws on 76 ethnographic case studies with early Cash and Counseling participants, examines what participants and their caregivers actually saw the support broker doing, and looks at what the participants found helpful and less than helpful. Participants and family caregivers saw support broker duties as falling into four areas: Coaching, Problem Solving, Advocacy and Monitoring. Equally important was how the support broker performed these duties. Key aspects of quality included: Familiarity, Supportive Relationship, Proactive Engagement, Responsiveness, Knowledge and Cultural Friendliness. These findings can provide the basis for establishing quality indicators for self-direction.

The downstream demand for professionals with competence in Interprofessional Collaboration (IPC) has contributed to the substantial growth in the upstream demand for interprofessional education (IPE). The majority of IPE programs focuses exclusively on direct care practitioners and seldom include those responsible for the administration and management of care. Unfortunately, complex reimbursement mechanisms along with the multiple agencies and departments regulating the delivery, evaluation, and reimbursement of care can result in unintended barriers to IPC and eventually IPE. The Healthcare Services Planning and Management Program (HSPMP) is an innovative model of IPE that was designed to improve system wide collaboration among those responsible for the reimbursement, management and administration of the delivery of care. Although HSPMP was not developed in the US, this innovative model has the potential to develop the systemic integration needed to break down the barriers to the delivery and evaluation of IPE and IPC.  The aim of this article is to introduce HSPMP to the US as a model of IPE that could help facilitate better integration of the US health care system and help to reduce some of the consequences resulting from the current fragmented system of care.