Photopolymerization of Limonene Dioxide and Vegetable Oils as Biobased 3D-Printing Stereolithographic Formulation.

Epoxidized vegetable oils and limonene dioxide, a bis-epoxide derived from the terpene limonene, are photo-copolymerized to yield highly crosslinked networks with high conversion of all epoxide groups at ambient temperature. However, the slow polymerization of such biobased formulation polymerizes is not compatible for a use in a commercial SLA 3D printer. Adding an acrylated epoxidized vegetable oil to the bis-epoxide leads to a decrease of curing time and an increase in LDO conversion to polymer. For example, in a 60:40 wt:wt mixture of LDO and epoxidized soybean oil, the conversions of both exocyclic and endocyclic epoxide groups of LDO are ≥95%. These formulations were successfully used in SLA 3D printers, leading to generation of hard and dry complex objects using biobased formulations.

[L'impossible quête des préposées aux bénéficiaires pour actualiser la bientraitance visée dans les politiques publiques du Québec.The impossible quest of health care aides to actualize the good treatment targeted in Quebec's public policies.]

Notre recherche visait à mettre en lumière les pratiques bientraitantes des préposées aux bénéficiaires en milieux d'hébergement pour aînés au Québec. L'objet de l'article est de faire ressortir la dichotomie entre les définitions de la bientraitance et son opérationnalisation. Dans la première partie, la notion de bientraitance dans le cadre de deux politiques gouvernementales québécoises est présentée. Ensuite, il est question du travail des préposées aux bénéficiaires en tant que vectrices de cette bientraitance dans la pratique. La troisième partie présente les résultats de notre recherche qui viennent soulever trois constats remettant en cause l'applicabilité des politiques publiques en cette matière : l'absence de reconnaissance d'un métier par définition bientraitant; les injonctions normatives à l'encontre du sens attribué à la bientraitance, et les obstacles organisationnels et sociopolitiques à la bientraitance. Ces constats sont réexaminés à la lumière des écrits dans la discussion, laquelle ouvre sur la notion de maltraitance organisationnelle.

Promoting scholarship in improvement science: A model for academic clinical departments.

Introduction: Clinical departments at academic medical centers strive to deliver clinical care, provide education and training, support faculty development, and promote scholarship. These departments have experienced increasing demands to improve the quality, safety, and value of care delivery. However, many academic departments lack a sufficient number of clinical faculty members with expertise in improvement science to lead initiatives, teach, and generate scholarship. In this article, we describe the structure, activities, and early outcomes of a program within an academic department of medicine to promote scholarly improvement work. Methods: The Department of Medicine at the University of Vermont Medical Center launched a Quality Program with three primary goals: (a) improve care delivery, (b) provide education and training, and (c) promote scholarship in improvement science. The program serves as a resource center for students, trainees and faculty, offering education and training, analytic support, consultation in design and methodology, and project management. It strives to integrate education, research, and care delivery to learn, apply evidence and improve health care. Results: Over the first 3 years of full implementation, the Quality Program supported an average of 123 projects annually, including prospective clinical quality improvement initiatives, retrospective assessment of clinical programs and practices, and curriculum development and evaluation. The projects have yielded a total of 127 scholarly products, defined as peer-reviewed publications and abstracts, posters, and oral presentations at local, regional, and national conferences. Conclusions: The Quality Program may serve as a practical model for promoting care delivery improvement, training, and scholarship in improvement science while advancing the goals of a learning health system at the level of an academic clinical department. Dedicated resources within such departments offer the potential to enhance care delivery while promoting academic success for faculty and trainees in improvement science.

Prescribing and deprescribing in very old age: perceptions of very old adults, caregivers and health professionals.

BACKGROUND: although they are major consumers of medications, there is little evidence-based data to guide prescribing and deprescribing of medications for very old adults (80+ years). OBJECTIVES: to discover the perceptions of very old adults, caregivers and health professionals in order to further examine the clinical and ethical issues raised by prescribing and deprescribing in very old age. METHODS: individual interviews were conducted with very old adults (n = 10) and caregivers (n = 6), whereas group interviews were conducted with health professionals (n = 11). The themes covered included perceptions of medication use, polypharmacy, deprescribing and patient-health professional relationships. Thematic analysis was used to identify areas of convergence and divergence. RESULTS: very old adults are satisfied with the medications they are taking, do not see the need to reduce their medication use and consider their doctor as the expert who should make the decisions regarding treatment. The perceptions of caregivers are similar to those of older adults, whereas health professionals believe that very old adults take a lot of inappropriate medications and list multiple barriers to deprescribing. All participants describe a normalisation of medication use with ageing. CONCLUSION: there is a dichotomy between the perception of the very old adults/caregivers and that of health professionals regarding the safety of medication in very old age. A cultural change regarding medication use seems essential to optimise therapy and support deprescribing in clinical practice since the potential issues raised by researchers do not resonate with the main stakeholders.

The SoyaGen Project: Putting Genomics to Work for Soybean Breeders.

The SoyaGen project was a collaborative endeavor involving Canadian soybean researchers and breeders from academia and the private sector as well as international collaborators. Its aims were to develop genomics-derived solutions to real-world challenges faced by breeders. Based on the needs expressed by the stakeholders, the research efforts were focused on maximizing realized yield through optimization of maturity and improved disease resistance. The main deliverables related to molecular breeding in soybean will be reviewed here. These include: (1) SNP datasets capturing the genetic diversity within cultivated soybean (both within a worldwide collection of > 1,000 soybean accessions and a subset of 102 short-season accessions (MG0 and earlier) directly relevant to this group); (2) SNP markers for selecting favorable alleles at key maturity genes as well as loci associated with increased resistance to key pathogens and pests (Phytophthora sojae, Heterodera glycines, Sclerotinia sclerotiorum); (3) diagnostic tools to facilitate the identification and mapping of specific pathotypes of P. sojae; and (4) a genomic prediction approach to identify the most promising combinations of parents. As a result of this fruitful collaboration, breeders have gained new tools and approaches to implement molecular, genomics-informed breeding strategies. We believe these tools and approaches are broadly applicable to soybean breeding efforts around the world.

'Good Treatment' in Residential Care Settings in Quebec: Meanings, Practices and Conditions.

The concept of 'bientraitance'(good treatment) of older adults was introduced in Quebec policy a few years prior to the pandemic, and its significance from the perspectives of those directly involved in care remains underexplored. Centring these perspectives, this article presents findings from a study of the meanings, practices and conditions of good treatment. Data was collected at three different residential care settings through world cafés with residents, staff, management, volunteers and family members (n = 61) and through interviews with care aides (n = 13). The study results indicate that those directly involved in care identify good treatment as fundamentally oriented towards developing and maintaining good relationships with residents; as contingent upon interpersonal, material, and organizational factors; and as requiring (more) time. Given the need for radical reform within Quebec's residential care settings revealed by the pandemic, it is imperative that these perspectives inform the changes introduced.

A Comprehensive Update of the Incidence and Demographics of Laryngoceles in Adults.

OBJECTIVE: To provide updated data on the incidence, types, and demographics of laryngoceles in the adult population. METHODS: We searched the medical archives of our institute for computed tomography (CT) studies acquired between January 1, 2007 and December 31, 2017 in which the term "laryngocele" appeared in the radiology reports. Two of the authors reviewed relevant images for the presence, type, distribution, and laterality of true laryngoceles. Demographic and clinical data were extracted from medical records and the incidence was calculated. RESULTS: Laryngoceles were detected in 53 out of the 79 893 patients with relevant CT data, which equates to an incidence of 151 per 2.5 million (0.06:1000) patients per year. The male:female ratio was 3:1, average age was 60 (±18) years, and incidence peaked among patients in the sixth decade of life. Nine patients (17%) had known laryngeal cancer; however, the majority of the cohort did not have follow up clinic visits. CONCLUSION: Our study demonstrates that the incidence of laryngoceles is much greater than previously reported. In most cases, the diagnosis of a laryngocele was an incidental radiological finding. Male gender predilection and age at presentation are in agreement with previous reports. Association of laryngoceles with laryngeal cancer could not be calculated due to low rates of follow ups. LEVEL OF EVIDENCE: 3.

Barriers and facilitators linked to discharge destination following inpatient rehabilitation after traumatic brain injury in older adults: a qualitative study.

PURPOSE: To identify facilitators and barriers associated with returning home for older adults having received inpatient rehabilitation after traumatic brain injury (TBI). METHODS: A qualitative design was used. Five older patients with TBI and four family caregivers were interviewed and six healthcare professionals participated in a focus group. RESULTS: Main facilitators to returning home highlighted by all participants were: (1) Patient's adequate health condition and functional status, (2) Access to health and other services at home, (3) Availability of help from a family caregiver. Conversely, if one of these factors was not met, it represented a barrier. Other facilitators identified were (4) Attachment to one's home, (5) Feeling of commitment toward a loved one, (6) Having the possibility of going through a transitional phase, (7) United front between the patient and the family caregiver towards a return home. Additional barriers to returning home included: (8) Incongruent perspectives, and (9) Unclear knowledge about available health and other services at home. CONCLUSION: The results of this study could be translated into a practical tool to guide patients, families and professionals in the decision about returning home or exploring an alternative option after inpatient rehabilitation for TBI in older adults.IMPLICATIONS FOR REHABILITATIONWhen orienting an older patient home or to an alternative living environment after a traumatic brain injury (TBI), the perspective of rehabilitation professionals can differ from that of patients and caregivers.Professionals tend to emphasize security, whereas patients and caregivers' focus on the well-being associated with home and on the importance of being with their loved one.Integrating the views, values and wishes of older patients with TBI and their caregivers will support a shared decision-making approach for orientation after rehabilitation.

How are our residents doing on trauma tonight? The frequency of overnight resident-faculty report discrepancies in trauma patients.

PURPOSE: To determine if preliminary radiology reports issued overnight (10 pm to 7 am) on adult trauma patients cause major changes of high clinical significance or patient harm. METHODS: Following extraction of preliminary and final radiology reports from the report server, presence of changes was determined by an automated text differential checker. If text changes were present, reports were then subsequently manually graded by an attending radiologist and placed in category by degree of severity. 81 weeks of trauma report data were analyzed by two faculty radiologists. RESULTS: Of the 6063 preliminary reports from 1214 separate overnight trauma patients, 65.5% had no changes in final report text. The remaining reports were graded: A 8.9% (503), B 17.2% (1005), C 7.0% (426), and D 1.3% (100). No reports demonstrated a major change of high clinical significance (E) or patient harm (F). CONCLUSION: Most preliminary report changes were minor and had no clinical significance. Furthermore, the few that were deemed to be major changes were of little clinical significance, particularly in the setting of the other traumatic injuries that the patient may have sustained. No negative patient safety events were caused by an error in a radiology resident preliminary report.

Lanthanide dodecyl sulfates, a potent family of catalysts for the preparation of biobased epoxy thermosets.

Lanthanide dodecyl sulfates, LnDSx, are remarkably effective to catalyze the reaction of diepoxides with diamines in the liquid and solid states, a key reaction in the formation of epoxy thermosets. Among all lanthanides, the lanthanum complex LaNa(DS)4(H2O)2 is the most active, allowing a decrease of 60 kJ mol-1 of the activation energy between polyethylene imine and limonene dioxide, a biobased epoxy monomer.

Impact of the COVID-19 Pandemic on Older Adults: Rapid Review.

BACKGROUND: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. OBJECTIVE: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. METHODS: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework-Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. RESULTS: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. CONCLUSIONS: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers.

Resident-faculty overnight discrepancy rates as a function of number of consecutive nights during a week of night float.

OBJECTIVES: In 2018, the ACGME (Accreditation Council for Graduate Medical Education) made a change to the maximum permissible number of consecutive nights a resident trainee can be on "night float," from six to seven nights. To our knowledge, although investigators have studied overall discrepancy rates and discrepancy rates as a function of shift length or perceived workload of a particular shift, no study has been performed to evaluate resident-faculty discrepancy rates as a quality/performance proxy, to see whether resident performance declines as a function of the number of consecutive nights. Our hypothesis is that we would observe a progressive increase in significant overnight resident - attending discrepancies over the 7 days' time. METHODS: A total of 8,488 reports were extracted between 4/26/2019 to 8/22/2019 retrospectively. Data was obtained from the voice dictation system report server. Exported query was saved as a .csv file format and analyzed using Python packages. A "discrepancy checker" was created to search all finalized reports for the departmental standard heading of "Final Attending Report," used to specify any significant changes from the preliminary interpretation. RESULTS: Model estimates varied on different days however there were no trends or patterns to indicate a deterioration in resident performance throughout the week. There were comparable probabilities throughout the week, with 2.17% on Monday, 2.35% on Thursday and 2.05% on Friday. CONCLUSIONS: Our results reveal no convincing trend in terms of overnight report discrepancies between the preliminary report generated by the night float resident and the final report issued by a faculty the following morning. These results are in support of the ACGME's recent change in the permissible number of consecutive nights on night float. We did not prove our hypothesis that resident performance on-call in the domain of report accuracy would diminish over seven consecutive nights while on the night float rotation. Our results found that performance remained fairly uniform over the course of the week.

Terminology, Definitions, and Classification in the Imaging of Laryngoceles.

OBJECTIVE: We aim to better define the anatomy, criteria, and classification of laryngoceles, and to raise the awareness to potential mimickers and anatomical variants leading to misdiagnosis. METHODS: A retrospective review of all computed tomography studies, performed over a decade, with the diagnosis of "laryngocele" in the radiological report in a tertiary medical center. All relevant studies were reviewed by two independent readers for the presence of true laryngoceles. RESULTS: One hundred and twelve patients were included; average age was 54 (±18). Re-read of scans with 3D reconstructions resulted in detecting 58 (52%) true laryngoceles, with 19.5% bilateral laryngoceles. Anatomical variants and laryngocele mimickers formerly misdiagnosed as laryngoceles included 26/54 (48%) prominent ventricles, 19/54 (35%) saccules not meeting criteria for laryngocele, 8/54 (15%) prominent pyriform sinuses and one tracheal diverticulum. CONCLUSIONS: Intimate knowledge of the laryngeal anatomy, the criteria for a laryngocele and anatomical variants as well mimickers, is the key to avoid radiological misdiagnosis.

A model for classification of invasive fungal rhinosinusitis by computed tomography.

Our purpose was to classify acute invasive fungal rhinosinusitis (AIFR) caused by Mucor versus Aspergillus species by evaluating computed tomography radiological findings. Two blinded readers retrospectively graded radiological abnormalities of the craniofacial region observed on craniofacial CT examinations obtained during initial evaluation of 38 patients with eventually pathology-proven AIFR (13:25, Mucor:Aspergillus). Binomial logistic regression was used to analyze correlation between variables and type of fungi. Score-based models were implemented for analyzing differences in laterality of findings, including the 'unilateral presence' and 'bilateral mean' models. Binary logistic regression was used, with Score as the only predictor and Group (Mucor vs Aspergillus) as the only outcome. Specificity, sensitivity, positive predictive value, negative predictive value and accuracy were determined for the evaluated models. Given the low predictive value of any single evaluated anatomical site, a 'bilateral mean' score-based model including the nasal cavity, maxillary sinuses, ethmoid air cells, sphenoid sinus and frontal sinuses yielded the highest prediction accuracy, with Mucor induced AIFR correlating with higher prevalence of bilateral findings. The odds ratio for the model while integrating the above anatomical sites was 12.3 (p < 0.001). PPV, NPV, sensitivity, specificity and accuracy were 0.85, 0.82, 0.92, 0.69 and 0.84 respectively. The abnormal radiological findings on craniofacial CT scans of Mucor and Aspergillus induced AIFR could be differentiated based on laterality, with Mucor induced AIFR associated with higher prevalence of bilateral findings.

Interview Techniques Utilized in Radiology Resident Selection-A Survey of the APDR.

RATIONALE AND OBJECTIVES: To evaluate interview techniques currently used in the selection of diagnostic radiology resident candidates and to identify factors influencing the use of alternative interview techniques. MATERIALS AND METHODS: An anonymous 25 question e-mail survey was provided to 319 active members of the Association of Program Directors in Radiology. The survey included questions on residency demographics, organization of resident applicant interviews, types of interview techniques utilized, scoring and ranking of applicants, and facets of the interview/application felt most important to the selection process. Statistical analysis was performed to identify factors associated with the use of alternative interview techniques. RESULTS: 93.7% of responding programs use traditional interview techniques, with 92% using unblinded, unstructured interviews, 8% blinded, unstructured interviews. Structured interview questions were incorporated in 22%. Few programs used alternative techniques like the multiple mini-interview. None of the programs used written prompts during the interview, 3% used casual visual cognitive testing, 10% used panel interview techniques, and none used formal personality testing. For ranking candidates in the match, the most important facets considered were USMLE Step scores, performance on the interview, clinical course grades, and letters of reference. Factors associated with use of alternative techniques were domains associated with program size and number of faculty. CONCLUSION: The majority of radiology training programs still rely upon the traditional unblinded interview technique. There is an opportunity for training programs to examine alternative techniques that reduce bias and may provide better insight into other aspects of the candidate that may not be as readily highlighted with the traditional, unblinded interview.

Data Fusion Architectures for Orthogonal Redundant Inertial Measurement Units.

This work looks at the exploitation of large numbers of orthogonal redundant inertial measurement units. Specifically, the paper analyses centralized and distributed architectures in the context of data fusion algorithms for those sensors. For both architectures, data fusion algorithms based on Kalman filter are developed. Some of those algorithms consider sensors location, whereas the others do not, but all estimate the sensors bias. A fault detection algorithm, based on residual analysis, is also proposed. Monte-Carlo simulations show better performance for the centralized architecture with an algorithm considering sensors location. Due to a better estimation of the sensors bias, the latter provides the most precise and accurate estimates and the best fault detection. However, it requires a much longer computational time. An analysis of the sensors bias correlation is also done. Based on the simulations, the biases correlation has a small effect on the attitude rate estimation, but a very significant one on the acceleration estimation.

Satellite Launcher Navigation with One Versus Three IMUs: Sensor Positioning and Data Fusion Model Analysis.

Using multiple IMUs allows both their distribution along vehicle structures and a reliance on integration methods, which is not possible with a single IMU. This paper addresses the issue of relying on three IMUs instead of only one of a higher quality in the context of a satellite launcher. The impact of the IMU positions was tested by comparing collocated IMUs against IMUs installed in the head of each launcher stage. For multi-IMU configurations, three integration methods were tested: all IMUs fused in a single INS, multiple INSs fused in a stacked filter, and multiple INSs fused in a stacked filter with geometrical constraints. All navigation solutions were aided by a three-axis attitude reference sensor and were tested with and without a GPS receiver. The results show that distributing IMUs along the launcher structure does not improve navigation performances compared to having them collocated. The fusion of multiple IMUs in one INS provides equivalent results as one IMU. However, fusing multiple INSs greatly reduces estimation errors. Performances are further improved with the addition of geometrical constraints. During long GPS outages, relative velocity and position constraints should not be exploited, as they may lead to filter divergence.

Speaking Out and Being Heard Residents' Committees in Quebec's Residential Long-Term Care Centre.

Residents' councils in Quebec's residential and long-term care centres have the mandate to promote the improvement of living conditions for residents, to assess their level of satisfaction, and to defend their rights. Based on two studies on the autonomy of councils, we examined how committees can express themselves on topics other than those the management is already aware of, to reveal various previously unknown aspects of the services, and to voice unexpressed concerns. We are especially interested in what makes management receptive, or not, to what the committee members say. The councils' ability to express them selves is, in fact, inseparable from its capacity to listen to the management teams, and we seek to determine the conditions required to perform this dual capacity.

Clinical, psychosocial, and central correlates of quality of life in myotonic dystrophy type 1 patients.

AIMS: To identify sociodemographic, clinical, and central correlates of health-related quality of life (HRQoL) in DM1 patients. METHODS: 200 DM1 patients had assessments of muscular impairment, CTG repeats, and intelligence. Validated instruments were used to assess sociodemographic and clinical factors as well as social support, social participation, daytime sleepiness, fatigue, personality, mood, and quality of life. Regression analysis was used to identify correlates of SF-36 physical and mental component summary scores. RESULTS: Patients scored lower on all SF-36 physical health subscales compared with normative data but did not differ with respect to mental health function. Regression analysis revealed that psychological distress, fatigue, severe muscular impairment, emotional stability, not having worked within the last 12 months, and lower intellectual quotient were associated with lower scores in physical health function. Moreover, neuroticism, daytime sleepiness, dissatisfaction with social participation, and lower conscientiousness were associated with lower scores in mental health function. CONCLUSION: DM1 has an impact on SF-36 physical summary scores but not on mental summary scores. Factors such as fatigue, daytime sleepiness, psychological distress, unemployment, and social participation dissatisfaction that significantly affect HRQoL in DM1 are amenable to treatment and psychosocial interventions, namely by providing care that integrate health, social, and community services.