Metals by Micro-Scale Additive Manufacturing: Comparison of Microstructure and Mechanical Properties.

Many emerging applications in microscale engineering rely on the fabrication of 3D architectures in inorganic materials. Small-scale additive manufacturing (AM) aspires to provide flexible and facile access to these geometries. Yet, the synthesis of device-grade inorganic materials is still a key challenge toward the implementation of AM in microfabrication. Here, a comprehensive overview of the microstructural and mechanical properties of metals fabricated by most state-of-the-art AM methods that offer a spatial resolution ≤10 µm is presented. Standardized sets of samples are studied by cross-sectional electron microscopy, nanoindentation, and microcompression. It is shown that current microscale AM techniques synthesize metals with a wide range of microstructures and elastic and plastic properties, including materials of dense and crystalline microstructure with excellent mechanical properties that compare well to those of thin-film nanocrystalline materials. The large variation in materials' performance can be related to the individual microstructure, which in turn is coupled to the various physico-chemical principles exploited by the different printing methods. The study provides practical guidelines for users of small-scale additive methods and establishes a baseline for the future optimization of the properties of printed metallic objects-a significant step toward the potential establishment of AM techniques in microfabrication.

Misdiagnosis of Leiomyosarcoma after Radiofrequency Ablation of Uterine Myomas.

Minimally invasive therapies to treat symptoms of uterine myomas can be effective alternatives to major surgery. Such modalities include pharmacologic agents, uterine artery embolization, magnetic resonance-guided focused ultrasound, and laparoscopic radiofrequency ablation, known as the Acessa procedure. Acessa is used to treat women with symptomatic myomas and was approved by the US Food and Drug Administration in 2012. This case describes a patient who underwent Acessa and subsequently required hysterectomy for refractory symptoms. Pathology of her tumor was initially classified as epithelioid leiomyosarcoma but on subsequent review was classified as benign. This report highlights the challenges of accurate histologic diagnosis in the setting of using new therapeutic modalities. Clinicians should report such interventions to pathologists at the time of surgery to allow for accurate diagnosis.

Composition-Tunable Properties of Cu(Ag) Alloy for Hybrid Bonding Applications.

In the present study, the properties of Cu(Ag) alloy films were studied to evaluate their potential use as an alternate material for interconnection in hybrid bonding. Thin alloy films of Cu(Ag) were deposited by pulsed electrochemical deposition (PED) using a sulfuric acid-based bath, rotating disk electrode, and hot entry. Secondary ion mass spectrometry (SIMS) was used to measure the silver content of the films, with us finding that it decreases with increasing duty cycle. Thereafter, bright field scanning transmission electron microscope (STEM) imaging in combination with energy-dispersive x-ray spectroscopy (EDS) was used to visualize the thin film microstructure and to confirm the uniform distribution of silver throughout the film, with no bands being seen despite the pulsed nature of the deposition. Film resistance was measured by a four-point probe to quantify the impact of Ag content on resistivity, with us finding the expected linear relationship with the Ag content in the film. Furthermore, the coefficient of thermal expansion (CTE) of the films was measured using X-ray diffraction, and modulus and hardness were measured via nanoindentation, revealing linear dependences on the Ag content as well. Notably, the addition of 1.25 atom% Ag resulted in a significant increase in the CTE from 17.9 to 19.3 ppm/K, Young's modulus from 111 to 161 GPa, and film hardness from 1.70 to 3.99 GPa. These simple relationships offer a range of properties tunable via the duty cycle of the pulsed plating, making Cu(Ag) a promising candidate for engineering wafer-to-wafer metal interconnections.

A Rare Case of Vertebral Osteomyelitis and Bilateral Psoas Abscess From an Unknown Source.

We present a case of a 31-year-old Filipino man with vertebral osteomyelitis and bilateral psoas abscesses. Vertebral osteomyelitis is a rare infection of the bone and bone marrow that affects the vertebral column. The patient's initial presentation included a 1-week history of cough, fatigue, diarrhea, fevers, and a 40-pound weight loss. An extensive workup including a computed tomography (CT) scan of the abdomen and pelvis demonstrated bilateral psoas abscesses with subcutaneous air tracking into the right flank. Blood cultures revealed Escherichia coli, Streptococcus anginosus, and Bacteroides. However, with an unclear primary source of infection, the most likely causative factor we believed to be due to immobility.

Myths and facts about safe patient handling in rehabilitation.

As the incidence of injuries associated with patient-handling tasks remains high in the rehabilitation community, interdisciplinary discussions on optimal methods for preventing injuries and ensuring good care continue. A national task force consisting of representatives from the Association of Rehabilitation Nurses, the American Physical Therapy Association, and the Veterans Health Administration identified myths that have been promulgated on both sides of the discussion, focusing especially on rehabilitation practices. The purpose of this article is to dispel these myths by using evidence-based methods. Evidence should be applied in discussions of safe patient handling, and although concern about patient outcomes is critical, there is no evidence that the use of patient-handling technology undermines rehabilitation goals and strong evidence that these practices enhance the safety of rehabilitation care providers. Further research on the impact of safe patient-handling practices on rehabilitation goals and continued communication between rehabilitation providers are recommended.

Postpartum contraception: An exploratory study of lactation consultants' knowledge and practices.

OBJECTIVE: Lactation consultants interact with women during the postpartum period; however, they may not have comprehensive education on postpartum contraception and the impact on breastfeeding. The aims of this study were to assess lactation consultants' knowledge and practices about postpartum contraception and assess whether lactation consultants are interested in more education on postpartum contraception. STUDY DESIGN: We distributed a 30-question survey to self-identified lactation consultants and recruited participants via email, social media and at the 2015 California Breastfeeding Summit. RESULTS: We surveyed a total of 194 lactation consultants. Seventy-seven percent (137/177) stated they offer advice about postpartum contraception and its impact on breastfeeding. The majority of lactation consultants felt the theoretical or proven risks outweighed the benefits or there was an unacceptable health risk for the progestin-only pill 76.3% (100/131), progestin injection 90.1% (118/131) and progestin implant 93.1% (122/131) if used within 21days of delivery. Although 68.7% (92/134) reported prior education on postpartum contraception, 82.1% (110/134) reported wanting more education on this topic, specifically in the form of a webinar 61.9% (83/134). Only 29.9% (40/134) reported knowledge of the United States Centers for Disease Control and Prevention 2011 Medical Eligibility Criteria for Contraceptive Use (USMEC) guidance for postpartum contraception. CONCLUSION: There is a disconnect between the USMEC guidance and lactation consultants' knowledge regarding the safety of immediate postpartum contraception. IMPLICATIONS: This study explores lactation consultants' knowledge and practices about postpartum contraception, demonstrating that more evidence-based education is needed on this topic.

Improving Palliative Care Team Meetings: Structure, Inclusion, and "Team Care".

Increasing demands on palliative care teams point to the need for continuous improvement to ensure teams are working collaboratively and efficiently. This quality improvement initiative focused on improving interprofessional team meeting efficiency and subsequently patient care. Meeting start and end times improved from a mean of approximately 9 and 6 minutes late in the baseline period, respectively, to a mean of 4.4 minutes late (start time) and ending early in our sustainability phase. Mean team satisfaction improved from 2.4 to 4.5 on a 5-point Likert-type scale. The improvement initiative clarified communication about patients' plans of care, thus positively impacting team members' ability to articulate goals to other professionals, patients, and families. We propose several recommendations in the form of a team meeting "toolkit."

Can patients tell when they are unwanted? "Turfing" in residency training.

OBJECTIVES: When a physician believes that the troubles of caring for a patient outweigh the rewards, he or she can move--"turf", the unwanted patient from his or her own to another physician's territory. Physicians receiving such patients can feel burdened by, and resentful about, caring for those who are "turfed" to them by other physicians, yet little is known about the effects such "turf battles" have on patient care. This study aims to discover if "turfed" patients (TPs) experience their hospitalizations differently from patients whose admissions are perceived more favorably by their physicians. DESIGN: Semi-structured, in-depth interviews. POPULATION: Twenty Six English-speaking patients on a medical service in a tertiary care university hospital. OUTCOMES: Hospitalization experiences based on qualitative thematic analysis of interview audiotapes and transcripts. RESULTS: The experience of patients perceived as "turfs" differed from patients deemed more appropriately admitted in two areas: mode of admission and tone of interview themes. TPs were admitted via the emergency department or intra-hospital transfer; unlike the "appropriate" patients (APs), none came from outside hospitals. Although patients in both groups voiced many similar themes, nearly all TP interview themes were unfavorable. AP interviewees, by comparison expressed both favorable and unfavorable themes. TPs were direct and explicit about their anger and frustration, while APs mixed humor with complaints. CONCLUSIONS: "Turfed" patients may have different care experiences from those of patients deemed appropriate for a medical service. Inter-specialty barriers to collegiality and relationship-centered care shape physicians' perceptions of patient appropriateness and desirability and merit further large-scale exploration.

A case report of a rare adnexal tumour: aggressive digital papillary adenocarcinoma.

We report the case of a 78-year-old Caucasian gentleman who presented with a painful swelling in the nail bed of the right middle finger. Following amputation of the right middle phalanx histopathology confirmed aggressive digital papillary adenocarcinoma (ADPA). Further surgical treatment was offered but declined. Approximately 17 months later, the patient was found to have pulmonary metastasis. ADPA is a rare neoplasm of the eccrine sweat glands, which commonly presents as a slow-growing mass between the nail bed and distal interphalangeal joint. The disease is classically aggressive with a 14% chance of metastatic spread. The chance of recurrence is 50% with no or sub-optimal treatment, which reduces to 5% following removal with adequate resection margins. This case shows a prolonged period of disease-free survival, but highlights the need for thorough and aggressive management in cases of ADPA as well as frequent and long-term follow-up.

Metallization of a genetically engineered polypeptide.

Recently, well-ordered biological materials have been exploited to pattern inorganic nanoparticles into linear arrays that are of particular interest for nanoelectronic applications. In this work, a de novo designed E. coli-expressed polypeptide (previously shown to form highly rectilinear, ß-sheet-containing structures) operates as a template for divalent metal cations. EDX and TEM analysis verify the attachment of platinum ions to the histidine-rich fibril surface, which was designed specifically to facilitate attachment of chemical moieties. Following chemical reduction, TEM further confirms the formation of localized zero-valent metal aggregates with sub-nanometer interparticle spacing.

Bilayer fibril formation by genetically engineered polypeptides: preparation and characterization.

A de novo, genetically engineered 687 residue polypeptide expressed in E. coli has been found to form highly rectilinear, beta-sheet containing fibrillar structures. Tapping-mode atomic force microscopy, deep-UV Raman spectroscopy, and transmission electron microscopy definitively established the tendency of the fibrils to predominantly display an apparently planar bilayer or ribbon assemblage. The ordered self-assembly of designed, extremely repetitive, high molecular weight peptides is a harbinger of the utility of similar materials in nanoscience and engineering applications.

Social work with a pet loss support group in a university veterinary hospital.

This article describes the development of a bereavement support group for pet owners in a university veterinary hospital. The group is predicated on the understanding that a human-animal relationship can be strong and the loss of that bond, through the animal's death, can produce a grief reaction, though this problem is often overlooked. The description of the support group is presented in detail so that it may be replicated. Included are: the history of the group, the procedure for making clients aware of the group, the program, the demographics, and problems brought to the group. The discussion and conclusion support the development of interdisciplinary collaborations among veterinarians, owners and social workers in other veterinary hospitals.

Choosing a Running Shoe: Science or Subjectivity?

Choosing a pair of running shoes in today's market is enough to boggle anyone's mind. Here are some suggestions from people who have lived through it.

Facilitating scholarly writing in academic medicine.

Scholarly writing is a critical skill for faculty in academic medicine; however, few faculty receive instruction in the process. We describe the experience of 18 assistant professors who participated in a writing and faculty development program which consisted of 7 monthly 75-minute sessions embedded in a Collaborative Mentoring Program (CMP). Participants identified barriers to writing, developed personal writing strategies, had time to write, and completed monthly writing contracts. Participants provided written responses to open-ended questions about the learning experience, and at the end of the program, participants identified manuscripts submitted for publication, and completed an audiotaped interview. Analysis of qualitative data using data reduction, data display, and conclusion drawing/verification showed that this writing program facilitated the knowledge, skills, and support needed to foster writing productivity. All participants completed at least 1 scholarly manuscript by the end of the CMP. The impact on participants' future academic productivity requires long-term follow-up.