On the Effectiveness of Visual Arts Therapy for Traumatic Experiences: A Systematic Review and Meta-Analysis.

Arts therapy is a popular intervention used to work through the effects of traumatic experience. We evaluate previous reviews and report a meta-analysis of the effectiveness of arts therapy following trauma for reducing symptoms of PTSD, enhancing positive outcomes (e.g., quality of life) and decreasing negative outcomes (e.g., depression). Database searches identified 21 (N = 868) randomised controlled trials (RCTs). Outcomes were categorised as PTSD specific, positive non-PTSD specific and negative non-PTSD specific. Several moderators were tested: age, diagnosis type, trauma type, intervention instruction, control type, therapy mode and therapy duration. Overall, random-effects analysis indicated that arts therapy was favoured relative to control for positive non-PTSD-specific outcomes (g = 1.53, p < 0.001), but not for negative non-PTSD-specific (p = 0.069) or PTSD-specific outcomes (g = 0.89, p = 0.052). Regression analyses indicated that arts therapy was effective in reducing PTSD-specific outcomes in children (Z = 2.81, df = 1, p = 0.005), positive non-PTSD-specific outcomes in group-based arts therapy (Z = -2.40, df = 1, p = 0.016, I2 = 57.33) and for reducing negative non-PTSD outcomes following acute traumas (e.g., combat-related trauma or sexual abuse) (Q = 10.70, df = 3, p = 0.013, I2 = 77.09). We highlight the need for additional RCTs and standardised protocols to address heterogeneity. Our review provides an important benchmark for gauging the effectiveness of arts therapy in the treatment of trauma.

Effect of Linker Structure and Functionalization on Secondary Gas Formation in Metal-Organic Frameworks.

Rare-earth terephthalic acid (BDC)-based metal-organic frameworks (MOFs) are promising candidate materials for acid gas separation and adsorption from flue gas streams. However, previous simulations have shown that acid gases (H2O, NO2, and SO2) react with the hydroxyl on the BDC linkers to form protonated acid gases as a potential degradation mechanism. Herein, gas-phase computational approaches were used to identify the formation energies of these secondary protonated acid gases across multiple BDC linker molecules. Formation energies for secondary protonated acid gases were evaluated using both density functional theory (DFT) and correlated wave function methods for varying BDC-gas reaction mechanisms. Upon validation of DFT to reproduce wave function calculation results, rotated conformational linkers and chemically functionalized BDC linkers with -OH, -NH2, and -SH were investigated. The calculations show that the rotational conformation affects the molecule stability. Double-functionalized BDC linkers, where two functional groups are substituted onto BDC, showed varied reaction energies depending on whether the functional groups donate or withdraw electrons from the aromatic system. Based on these results, BDC linker design must balance adsorption performance with degradation via linker dehydrogenation for the design of stable MOFs for acid gas separations.

Discovery of Complex Binding and Reaction Mechanisms from Ternary Gases in Rare Earth Metal-Organic Frameworks.

Understanding the selectivity of metal-organic frameworks (MOFs) to complex acid gas streams will enable their use in industrial applications. Herein, ab initio molecular dynamic simulations (AIMD) were used to simulate ternary gas mixtures (H2 O-NO2 -SO2 ) in rare earth 2,5-dihydroxyterephthalic acid (RE-DOBDC) MOFs. Stronger H2 O gas-metal binding arose from thermal vibrations in the MOF sterically hindering access of SO2 and NO2 molecules to the metal sites. Gas-gas and gas-linker interactions within the MOF framework resulted in the formation of multiple secondary gas species including HONO, HNO2 , NOSO, and HNO3 - . Four gas adsorption sites were identified along with a new de-protonation reaction mechanism not observable through experiment. This study not only provides valuable information on competitive gas binding energies in the MOF, it also provides important chemical insights into transient chemical reactions and mechanisms.

Investigation of Metastable Low Dimensional Halometallates.

The solvothermal synthesis, structure determination and optical characterization of five new metastable halometallate compounds, [1,10-phenH][Pb3.5I8] (1), [1,10-phenH2][Pb5I12]·(H2O) (2), [1,10-phen][Pb2I4] (3), [1,10-phen]2[Pb5Br10] (4) and [1,10-phenH][SbI4]·(H2O) (5), are reported. The materials exhibit rich structural diversity and exhibit structural dimensionalities that include 1D chains, 2D sheets and 3D frameworks. The optical spectra of these materials are consistent with bandgaps ranging from 2.70 to 3.44 eV. We show that the optical behavior depends on the structural dimensionality of the reported materials, which are potential candidates for semiconductor applications.

Interplay between London Dispersion, Hubbard U, and Metastable States for Uranium Compounds.

High-throughput computational studies of lanthanide and actinide chemistry with density-functional theory are complicated by the need for Hubbard U corrections, which ensure localization of the f-electrons, but can lead to metastable states. This work presents a systematic investigation of the effects of both Hubbard U value and metastable states on the predicted structural and thermodynamic properties of four uranium compounds central to the field of nuclear fuels: UC, UN, UO2, and UCl3. We also assess the impact of the exchange-hole dipole moment (XDM) dispersion correction on the computed properties. Overall, the choice of Hubbard U value and inclusion of a dispersion correction cause larger variations in the computed geometric properties than result from metastable states. The weak dependence of structure optimization on metastable states should simplify future high-throughput calculations on actinides. Conversely, addition of the dispersion correction is found to offset the repulsion introduced by the Hubbard U term and provides greatly improved agreement with experiment for both cell volumes and heats of formation. The XDM dispersion correction is largely invariant to the chosen U value, making it a robust dispersion correction for actinide systems.

Flux Growth of Uranyl Titanates: Rare Examples of TiO4 Tetrahedra and TiO5 Square Bipyramids.

Single crystals of four new uranyl titanates have been grown via the flux growth method using mixed alkali halide fluxes. Na2(UO2)(TiO)O3 and KNa(UO2)(TiO)O3 have analogous layered structures containing titanyl (TiO2+) units coordinated into TiO5 square pyramids. Cs2(UO2)TiO4 crystallizes in the Cs2USiO6 structure type and is a rare example of a structure containing TiO4 tetrahedra. Cs2(UO2)Ti2O6 crystallizes in a new tunnel structure and contains the also rare TiO5 trigonal bipyramids. DFT studies were performed to understand the bonding in the observed titanate polyhedra. Furthermore, the luminescence properties of the compounds are reported, and leaching studies are reported for Cs2(UO2)Ti2O6.

Incarceration of the Posterior Tibial Tendon in an Isolated Comminuted Medial Malleolus Fracture.

Isolated medial malleolar fractures are a less common presentation of an ankle fracture. Treatment is not universally accepted, although many have agreed that any displacement warrants anatomic reduction and fixation. We present a case of an isolated, comminuted medial malleolar fracture that was displaced secondary to entrapment of the posterior tibial tendon between the fracture fragments requiring surgical intervention. The patient was treated with prompt open reduction and internal fixation and had an excellent functional outcome at 1 year. When open reduction and internal fixation of the medial malleolus is indicated, a thorough exploration of the zone of injury is required to identify and adequately address any surrounding pathologic features beyond just the disrupted bony anatomy. To the best of our knowledge, this specific injury has never been previously reported and emphasizes the importance of understanding the local anatomy and how restoration of the distorted anatomy is vital to optimize patient function.

Predicting and managing heat dissipation from a neural probe.

Light stimulating neural probes are rapidly increasing our understanding of neural pathways. Relocating the externally coupled light source to the probe tip has the potential to dramatically improve the flexibility of the technique. However, this approach would generate heat within the embedded probe where even minor temperature excursions could easily damage tissues under study. A COMSOL model was used to study the thermal effects of these heated probes in the brain including blood perfusion and metabolic heating, and to investigate the effect of passive methods for improving heat dissipation. The probe temperature initially decreases with insertion depth, and then becomes steady. Extending the probe beyond the heated region has a similar effect, while increasing the size of the heated region steadily decreases the probe temperature. Increasing the thermal conductivity of the probe promotes spreading, decreasing the probe temperature. The effects of insertion depth and probe power dissipation were experimentally tested with a microfabricated, heated mock neural probe. The heated probe was tested in 0.65 % agarose gel at room temperature and in ex vivo cow brain at body temperature. The thermal resistance between the probe and the neural tissue or agarose gel was determined at a range of insertion depths and compared to the COMSOL model.

Design Principles Guiding Solvent Size Selection in ZIF-Based Type 3 Porous Liquids for Permanent Porosity.

Porous liquids (PLs), which are solvent-based systems that contain permanent porosity due to the incorporation of a solid porous host, are of significant interest for the capture of greenhouse gases, including CO2. Type 3 PLs formed by using metal-organic frameworks (MOFs) as the nanoporous host provide a high degree of chemical turnability for gas capture. However, pore aperture fluctuation, such as gate-opening in zeolitic imidazole framework (ZIF) MOFs, complicates the ability to keep the MOF pores available for gas adsorption. Therefore, an understanding of the solvent molecular size required to ensure exclusion from MOFs in ZIF-based Type 3 PLs is needed. Through a combined computational and experimental approach, the solvent-pore accessibility of exemplar MOF ZIF-8 was examined. Density functional theory (DFT) calculations identified that the lowest-energy solvent-ZIF interaction occurred at the pore aperture. Experimental density measurements of ZIF-8 dispersed in various-sized solvents showed that ZIF-8 adsorbed solvent molecules up to 2 Å larger than the crystallographic pore aperture. Density analysis of ZIF dispersions was further applied to a series of possible ZIF-based PLs, including ZIF-67, -69, -71(RHO), and -71(SOD), to examine the structure-property relationships governing solvent exclusion, which identified eight new ZIF-based Type 3 PL compositions. Solvent exclusion was driven by pore aperture expansion across all ZIFs, and the degree of expansion, as well as water exclusion, was influenced by ligand functionalization. Using these results, a design principle was formulated to guide the formation of future ZIF-based Type 3 PLs that ensures solvent-free pores and availability for gas adsorption.

Perceived comfort level of medical students and residents in handling clinical ethics issues.

BACKGROUND: Studies have shown that medical students and residents believe that their ethics preparation has been inadequate for handling ethical conflicts. The objective of this study was to determine the self-perceived comfort level of medical students and residents in confronting clinical ethics issues. METHODS: Clinical medical students and residents at the University of Maryland School of Medicine completed a web-based survey between September 2009 and February 2010. The survey consisted of a demographic section, questions regarding the respondents' sense of comfort in handling a variety of clinical ethics issues, and a set of knowledge-type questions in ethics. RESULTS: Survey respondents included 129 medical students (response rate of 40.7%) and 207 residents (response rate of 52.7%). There were only a few clinical ethics issues with which more than 70% of the respondents felt comfortable in addressing. Only a slight majority (60.8%) felt prepared, in general, to handle clinical situations involving ethics issues, and only 44.1% and 53.2% agreed that medical school and residency training, respectively, helped prepare them to handle such issues. Prior ethics training was not associated with these responses, but there was an association between the level of training (medical students vs residents) and the comfort level with many of the clinical ethics issues. CONCLUSIONS: Medical educators should include ethics educational methods within the context of real-time exposure to medical ethics dilemmas experienced by physicians-in-training.

Sound power and acoustic efficiency of an installed GE F404 jet engine.

Classical jet noise theory indicates that radiated sound power is proportional to the jet velocity raised to the eighth and third powers for subsonic and supersonic jets, respectively. To connect full-scale measurements with classical jet noise theory, this letter presents sound power and acoustic efficiency values for an installed GE-F404 engine. When subsonic, the change in sound power follows the eighth-power law, and the sound power change approximately follows the third-power law at supersonic conditions, with an acoustic efficiency of ∼0.5-0.6%. However, the OAPWL increase from subsonic to supersonic jet velocities is greater than would be predicted.

Experimental and Computational Mechanisms that Govern Long-Term Stability of CO2-Adsorbed ZIF-8-Based Porous Liquids.

Porous liquids (PLs) based on the zeolitic imidazole framework ZIF-8 are attractive systems for carbon capture since the hydrophobic ZIF framework can be solvated in aqueous solvent systems without porous host degradation. However, solid ZIF-8 is known to degrade when exposed to CO2 in wet environments, and therefore the long-term stability of ZIF-8-based PLs is unknown. Through aging experiments, the long-term stability of a ZIF-8 PL formed using the water, ethylene glycol, and 2-methylimidazole solvent system was systematically examined, and the mechanisms of degradation were elucidated. The PL was found to be stable for several weeks, with no ZIF framework degradation observed after aging in N2 or air. However, for PLs aged in a CO2 atmosphere, formation of a secondary phase occurred within 1 day from the degradation of the ZIF-8 framework. From the computational and structural evaluation of the effects of CO2 on the PL solvent mixture, it was identified that the basic environment of the PL caused ethylene glycol to react with CO2 forming carbonate species. These carbonate species further react within the PL to degrade ZIF-8. The mechanisms governing this process involves a multistep pathway for PL degradation and lays out a long-term evaluation strategy of PLs for carbon capture. Additionally, it clearly demonstrates the need to examine the reactivity and aging properties of all components in these complex PL systems in order to fully assess their stabilities and lifetimes.

Can a Computer-based Force Feedback Hip Fracture Skills Simulator Improve Clinical Task Performance? A Cadaveric Validation Study.

BACKGROUND: This cadaveric study seeks to determine whether skills acquired on the simulator translate to improved performance of the clinical task. We hypothesized that completion of simulator training modules would improve performance of percutaneous hip pinning. METHODS: Eighteen right-handed medical students from two academic institutions were randomized: trained (n = 9) and untrained (n = 9). The trained group completed nine simulator-based modules of increasing difficulty, designed to teach techniques of placing wires in an inverted triangle construct in a valgus-impacted femoral neck fracture. The untrained group had a brief simulator introduction but did not complete the modules. Both groups received a hip fracture lecture, an explanation and pictorial reference of an inverted triangle construct, and instruction on using the wire driver. Participants then placed three 3.2 mm guidewires in cadaveric hips in an inverted triangle construct under fluoroscopy. Wire placement was evaluated with CT at 0.5 mm sections. RESULTS: The trained group significantly outperformed the untrained group in most parameters (P ≤ 0.05). CONCLUSIONS: The results suggest that a force feedback simulation platform with simulated fluoroscopic imaging using an established, increasingly difficult series of motor skills training modules has potential to improve clinical performance and might offer an important adjunct to traditional orthopaedic training.

Identification and Decomposition of Uranium Oxychloride Phases in Oxygen-Exposed UCl3 Salt Compositions.

Complementary X-ray absorption fine structure (XAFS) spectroscopy and Raman spectroscopy studies were conducted on several UCl3 concentrations in several chloride salt compositions. The samples were 5% UCl3 in LiCl (S1), 5% UCl3 in KCl (S2), 5% UCl3 in LiCl-KCl eutectic (S3), 5% UCl3 in LiCl-KCl eutectic (S4), 50% UCl3 in KCl (S5), and 20% UCl3 in KCl (S6) molar concentrations. Sample S3 had UCl3 sourced from Idaho National Laboratory (INL), and all other samples were UCl3 sourced from TerraPower. The initial compositions were prepared in an inert and oxygen-free atmosphere. XAFS measurements were performed in the atmosphere at a beamline, and Raman spectroscopy was conducted inside a glovebox. Raman spectra were able to confirm initial UCl3. XAFS and later Raman spectra measured, however, did not correctly match the literature and computational spectra for the prepared UCl3 salt. Rather, the data shows some complex uranium oxychloride phases at room temperature that transition into uranium oxides upon heating. Oxygen pollution due to failure of the sealing mechanism can result in oxidation of the UCl3 salts. The oxychlorides present may be both a function of the unknown O2 exposure concentration, depending on the source of the leak and the salt composition. Evidence of this oxychloride claim and its subsequent decomposition is justified in this work.

Correlational Approach to Predict the Enthalpy of Mixing for Chloride Melt Systems.

A methodology to estimate the heat of mixing (Δmix H) for salt liquids in unexplored AkCl-AnCl x /LnCl x (Ak = alkali, An = actinide, Ln = lanthanide) systems is developed. It improves upon previous empirical approaches by eliminating the need for arbitrarily choosing the required composition at maximum short-range ordering, the minimum Δmix H prior to performing the estimation, which avoids the intrinsic ambiguity of that approach. This semiempirical method has computationally reproduced the behavior of NaCl-UCl3 and KCl-UCl3 systems, providing Δmix H values that agree well with the reported measurements within a propagated two standard deviations (2σ). The capability of the approach is demonstrated in its application to the entirety of the AkCl-UCl3 and AkCl-PuCl3 systems, the results from which have facilitated the accurate thermodynamic modeling of these and other AkCl-AnCl3/LnCl3 systems. The resultant assessed Gibbs energy functions and models have been incorporated in the Molten Salt Thermal Properties Database-Thermochemical (MSTDB-TC).

Dramatic Enhancement of Rare-Earth Metal-Organic Framework Stability Via Metal Cluster Fluorination.

Rare-earth polynuclear metal-organic frameworks (RE-MOFs) have demonstrated high durability for caustic acid gas adsorption and separation based on gas adsorption to the metal clusters. The metal clusters in the RE-MOFs traditionally contain RE metals bound by µ3-OH groups connected via organic linkers. Recent studies have suggested that these hydroxyl groups could be replaced by fluorine atoms during synthesis that includes a fluorine-containing modulator. Here, a combined modeling and experimental study was undertaken to elucidate the role of metal cluster fluorination on the thermodynamic stability, structure, and gas adsorption properties of RE-MOFs. Through systematic density-functional theory calculations, fluorinated clusters were found to be thermodynamically more stable than hydroxylated clusters by up to 8-16 kJ/mol per atom for 100% fluorination. The extent of fluorination in the metal clusters was validated through a 19F NMR characterization of 2,5-dihydroxyterepthalic acid (Y-DOBDC) MOF synthesized with a fluorine-containing modulator. 19F magic-angle spinning NMR identified two primary peaks in the isotropic chemical shift (δiso) spectra located at -64.2 and -69.6 ppm, matching calculated 19F NMR δiso peaks at -63.0 and -70.0 ppm for fluorinated systems. Calculations also indicate that fluorination of the Y-DOBDC MOF had negligible effects on the acid gas (SO2, NO2, H2O) binding energies, which decreased by only ∼4 kJ/mol for the 100% fluorinated structure relative to the hydroxylated structure. Additionally, fluorination did not change the relative gas binding strengths (SO2 > H2O > NO2). Therefore, for the first time the presence of fluorine in the metal clusters was found to significantly stabilize RE-MOFs without changing their acid-gas adsorption properties.

The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction.

BACKGROUND: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. METHODS: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. RESULTS: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. CONCLUSION: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopaedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. TYPE OF STUDY: Cadaveric Study.

In Situ Determination of Speciation and Local Structure of NaCl-SrCl2 and LiF-ZrF4 Molten Salts.

Understanding the local environment of the metal atoms in salt melts is important for modeling the properties of melts and predicting their behavior and thus helping enable the development of technologies such as molten salt reactors and solar-thermal power systems and new approaches to recycling rare-earth metals. Toward that end, we have developed an in situ approach for measuring the coordination of metals in molten salt coupling X-ray absorption spectroscopy (XAS) and Raman spectroscopy. Our approach was demonstrated for two salt mixtures (1.9 and 5 mol % SrCl2 in NaCl, 0.8 and 5 mol % ZrF4 in LiF) at up to 1100 °C. Near-edge (X-ray absorption near-edge structure, XANES) and extended X-ray absorption fine structure (EXAFS) spectra were measured. The EXAFS response was modeled using ab initio FEFF calculations. Strontium's first shell is observed to be coordinated with chlorine (Sr2+-Cl-) and zirconium's first shell is coordinated by fluorine (Zr4+-F-), both having coordination numbers that decrease with increasing temperature. Multiple zirconium complexes are believed to be present in the melt, which may interfere and distort the EXAFS spectra and result in an anomalously low zirconium first shell coordination number. The use of boron nitride (BN) powder as a salt diluent for XAFS measurements was found to not interfere with measurements and thus can be used for investigations of such systems.

Current surgical practice for septic arthritis of the knee in the United States.

For septic arthritis of the knee, we attempted to determine: the preferred surgical technique in the United-States (US), the believed "gold-standard" treatment among others. This was performed by an electronic-survey distributed to all academic orthopaedic faculty throughout the US. The preferred method was arthroscopy (69.8%). Arthroscopy is believed to be the gold-standard in 27.0%, arthrotomy in 29.4%, while 43.5% believe no gold-standard exists. In conclusion the majority of surgeons prefer arthroscopy when managing a native, septic knee in an adult patient. However, there is no national consensus on a gold-standard treatment or the role of synovectomy.

Suture button compared with K-wire fixation for maintenance of posttrapeziectomy space height in a cadaver model of lateral pinch.

PURPOSE: Hematoma distraction arthroplasty has regained popularity as a treatment for thumb carpometacarpal arthritis with reports of satisfactory results. Our goal was to investigate the use of a suture button device to maintain the posttrapeziectomy space height of the thumb metacarpal. Our hypothesis is that a suture button that suspends the thumb metacarpal from the second metacarpal, when applied to the hematoma distraction arthroplasty technique, would provide subsidence resistance comparable to traditional K-wire fixation. METHODS: Ten fresh frozen matched pairs of human cadaveric arms were used. After open trapeziectomy, suspension of the thumb metacarpal was performed with either a 1.4-mm (0.045-inch) K-wire advanced through the base of the thumb metacarpal into the second metacarpal shaft or a suture button device that suspended the thumb metacarpal from the second metacarpal shaft. Cyclic pinch was simulated by using a lateral pinch model previously described and validated. Lateral pinch is simulated by loading the extensor pollicis longus, adductor pollicis, abductor pollicis brevis, and flexor pollicis longus in a 1:5:6:10 ratio. Dynamic pinch is achieved with cyclic unloading of the abductor pollicis brevis, adductor pollicis, and flexor pollicis longus tendons. Measurements were made of the height of excised trapeziums, the distance from the metacarpal base to the scaphoid after trapeziectomy (trapeziectomy space height) at time zero, both loaded and unloaded, and at sequential loading cycles of 1,000, 2,000, 3,000, 4,000, 5,000, and 10,000 cycles. RESULTS: Student t-test evaluation showed no significant differences between the groups in initial trapeziectomy space height (p = .10), postfixation trapeziectomy space height (p = .10), or loss of trapeziectomy space height between precycling and after 10,000 cycles (p = .80). CONCLUSIONS: Suture button fixation maintains similar posttrapeziectomy space height and prevents subsidence of the thumb metacarpal when compared with K-wire fixation in this model. This technique may allow for earlier range of motion after the hematoma distraction arthroplasty.