Inorganically Connecting Colloidal Nanocrystals Significantly Improves Mechanical Properties.

Understanding and characterizing the mechanical behavior of colloidal nanocrystal (NC) assemblies are important for developing nanocrystalline materials with exceptional mechanical properties for robust electronic, thermoelectric, photovoltaic, and optoelectronic devices. However, the limited ranges of Young's modulus, hardness, and fracture toughness (≲1-10 GPa, ≲50-500 MPa, and ≲10-50 kPa m1/2, respectively) in as-synthesized NC assemblies present challenges for their mechanical stability and therefore their practical applications. In this work, we demonstrate using a combination of nanoindentation measurements and coarse-grained modeling that the mechanical response of assemblies of as-synthesized NCs is governed by the van der Waals interactions of the organic surface ligands. More importantly, we report tremendous ∼60× enhancements in Young's modulus and hardness and an ∼80× enhancement in fracture toughness of CdSe NC assemblies through a simple inorganic Sn2S64- ligand exchange process. Moreover, our observation of softening in nanocrystalline materials with decreasing CdSe NC diameter is consistent with atomistic simulations.

Improving human rights in mental health takes more than just changing the law: An audit of medical assessments in regional community patients in Queensland.

OBJECTIVE: To evaluate the medical assessments of involuntary community patients in a regional mental health service, determine the compliance with requirements under Queensland's Mental Health Act 2016 (the Act) to regularly review orders and assess patients' mental capacity. METHOD: We audited 183 patient records on community treatment authorities (CTAs) to determine whether medical assessments undertaken under the Act included consideration of the person's capacity, and regular reviews by an authorised doctor as required1s205. RESULTS: The audit revealed that 51% of the CTA patients did not comply with legal requirements either to complete a capacity assessment and/or be medically assessed within three months of the last review. CONCLUSIONS: Over 50% of medical assessments did not comply with the legislative requirements to record capacity assessments and review involuntary treatment on at least a three-month basis. However, when the treatment criteria were met, it did not appear to be a basis for CTA revocation. Further research may help determine whether the Mental Health Review Tribunal (Tribunal) could play a greater role in overseeing compliance with the new legislative requirements or if other clinical oversight mechanisms would be appropriate to improve the assessment process.

Quantifying prognosis severity of COVID-19 patients from deep learning based analysis of CT chest images.

The COVID-19 pandemic has affected all the countries in the world with its droplet spread mode. The colossal amount of cases has strained all the healthcare systems due to the serious nature of infections especially for people with comorbidities. A very high specificity Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) test is the principal technique in use for diagnosing the COVID-19 patients. Also, CT scans have helped medical professionals in patient severity estimation & progression tracking of COVID-19 virus. In study we present our own extensible COVID-19 viral infection tracking prognosis technique. It uses annotated dataset of CT chest scan slice images created with the help of medical professionals. The annotated dataset contains bounding box coordinates of different features for COVID-19 detection like ground glass opacities, crazy paving pattern, consolidations, lesions etc. We qualitatively identify the severity of the patient for later prognosis stages in our study to assist medical staff for patient prioritization. First we detected COVID-19 positive patients with pre-trained Siamese Neural Network (SNN) which obtained 87.6% accuracy, 87.1% F1-Score & 95.1% AUC scores. These metrics were achieved after removal of 40% quantitatively highly similar images from the COVID-CT dataset. This reduced dataset was further medically annotated with COVID-19 features for bounding box detection. After this we assigned severity scores to detected COVID-19 features and calculated the cumulative severity score for COVID-19 patients. For qualitative patient prioritization with prognosis clinical assistance information, we finally converted this score into a multi-classification problem which obtained 47% weighted-average F1-score.

Enhancing Thermal Transport in Silicone Composites via Bridging Liquid Metal Fillers with Reactive Metal Co-Fillers and Matrix Viscosity Tuning.

Polymer matrix composites containing room temperature liquid metal (LM) microdroplets offer a unique set of thermo-mechanical characteristics that makes them attractive candidates for high performance thermal interface materials. However, to achieve the desired level of the composite thermal conductivity, effective bridging of such fillers into interconnected percolation networks needs to be induced. Thermal percolation of the LM microdroplets requires two physical barriers to be overcome. First, the LM microdroplets must directly contact each other through the polymer matrix. Second, the native oxide shell on the LM microdroplet must also be ruptured. In this work, we demonstrate that both physical barriers can be penetrated to induce ample bridging of the LM microdroplets and thereby achieve higher thermal conductivity composites. We accomplish this through a synergistic combination of solid silver and LM fillers, tuning of the silicone oil "matrix" viscosity, and sample compression. We selected silver as the solid additive because it rapidly alloys with gallium to form microscale needles that could act as additional paths that aid in connecting the LM droplets. We systematically explore the impact of the composition (filler type, volume fraction, and matrix oil viscosity) and applied pressure on the thermal conductivity and multiscale structure of these composites. We reveal the microscopic mechanism underlying the macroscopic experimental trends and also identify an optimal composition of the multiphase Ag-LM-Silicone oil composite for thermal applications. The identified design knobs offer path for developing tunable LM-based polymer composites for microelectronics cooling, biomedical applications, and flexible electronics.

Total Knee Arthroplasty in a Diagnosed Case of Deep Vein Thrombosis - Our Experience and Review of Literature.

INTRODUCTION: Deep vein thrombosis (DVT) following total knee arthroplasty (TKA) and its associated complication, pulmonary thromboembolism (PTE) remains a challenge for orthopedic surgeons. There are wide ranges of predisposing factors which are both patient specific as well as procedure associated, responsible for DVT. PTE is a well-known fatal complication of DVT which may be life-threatening. Medical management and early mobilization are necessary for the management of DVT. Fatal PTE can be prevented by implantation of inferior vena cava (IVC) filter in at risk patients. CASE REPORT: We are presenting a rare case report of 75-year-old female with severe osteoarthritis of the left knee with DVT of the left lower limb in which TKA was done in a prediagnosed case of DVT. IVC filter placement was done before TKA for prevention of fatal PTE, and medical management was done for DVT. CONCLUSION: Prevention of fatal thromboembolism is of prime importance in the management of DVT. This can be achieved by implanting IVC filter. TKA is necessary for early pain free mobilization of the patient, which prevents progression of DVT and early recovery. IVC filter placement prevents fatal thromboembolism. Hence, treatment of both osteoarthritis of knee by TKA and DVT can be done simultaneously.

Functional outcome after primary hemiarthroplasty in three or four part proximal humerus fracture: A short term followup.

BACKGROUND: Several modalities of treatment are being used for the management of proximal humerus fractures. Primary hemiarthroplasty in proximal humerus fracture is indicated in three or four part fracture or fracture dislocations. It is also indicated if fracture involves a large area of articular cartilage loss and viability of head is doubtful. We studied the functional outcome of hemiarthroplasty in comminuted proximal humerus fracture. MATERIALS AND METHODS: 29 patients of three or four part proximal humerus fractures, (according to Neer's classification) who underwent primary shoulder hemiarthroplasty were included in this retrospective study. 20 patients were of more than 55 years of age. Functional evaluation based on Constant score and radiological assessment by periodic X-rays were done. All patients were operated in a 'beach chair position'. The lesser and greater tuberosities were dissected with their tendinous attachments and were later reattached to the proximal humerus for stability of the prosthesis. Cemented prosthesis was used in all cases. RESULTS: Three patients died and two patients were lost to followup during the course of the study, so 24 patients were finally included in the study. Mean Constant score was 56.62 (range 42.5-65.5) after mean followup of 18.28 months (range 12-24 months). Mean anterior elevation was 118.2° (range 75°-150°) and mean active abduction was 102°(range 50°-135°). Nineteen patients (79.16%) were satisfied about their functional outcome. Proximal migration of tuberosity was present in four patients. These patients had decreased abduction with impingement. One patient had higher placement of prosthesis and one patient had radiolucency at bone cement interface. There were no heterotopic ossification, dislocation, superficial, or deep infection. CONCLUSION: This study showed that hemiarthroplasty in a grossly comminuted proximal humerus fracture is a viable alternative to osteosynthesis. Tuberosity healing plays a main role in good range of motion and better functional outcome after shoulder hemiarthroplasty.

Assessing Correlations of Physicians' Practice Intensity and Certainty During Residency Training.

BACKGROUND: Variation in physicians' practice patterns contributes to unnecessary health care spending, yet the influences of modifiable determinants on practice patterns are not known. Identifying these mutable factors could reduce unnecessary testing and decrease variation in clinical practice. OBJECTIVE: To assess the importance of the residency program relative to physician personality traits in explaining variations in practice intensity (PI), the likelihood of ordering tests and treatments, and in the certainty of their intention to order. METHODS: We surveyed 690 interns and residents from 7 internal medicine residency programs, ranging from small community-based programs to large university residency programs. The surveys consisted of clinical vignettes designed to gauge respondents' preferences for aggressive clinical care, and questions assessing respondents' personality traits. The primary outcome was the participant-level mean response to 23 vignettes as a measure of PI. The secondary outcome was a certainty score (CS) constructed as the proportion of vignettes for which a respondent selected "definitely" versus "probably." RESULTS: A total of 325 interns and residents responded to the survey (47% response rate). Measures of personality traits, subjective norms, demographics, and residency program indicators collectively explained 27.3% of PI variation. Residency program identity was the largest contributor. No personality traits were significantly independently associated with higher PI. The same collection of factors explained 17.1% of CS variation. Here, personality traits were responsible for 63.6% of the explained variation. CONCLUSIONS: Residency program affiliations explained more of the variation in PI than demographic characteristics, personality traits, or subjective norms.

Locked compression plating for peri- and intra-articular fractures around the knee.

OBJECTIVE: To evaluate the role of locked compression plates (LCPs) in management of peri- and intra-articular fractures around the knee. METHODS: Twenty distal femoral and 20 proximal tibial fractures were fixed with LCPs. The types of femoral fractures were A1 (four), A2 (three), A3 (two), C1 (one), C2 (seven) and C3 (three). The types of tibial fractures were A2 (one), A3 (two), B2 (two), C1 (four), C2 (five) and C3 (six). All patients were followed up for up to 18 months (mean, 12 months). Fourteen patients with distal femoral fractures and 19 with proximal tibial fractures underwent surgery using a minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. The others were treated by open reduction. The average time of fixation was 8 days after injury (0-31 days). Knee Society scores were used for clinical and functional assessment. RESULTS: All fractures, except one of the distal femur and one of the proximal tibia, united. The mean union times for distal femoral and proximal tibial fractures were 15.2 and 14.9 weeks, respectively. One patient with a distal femoral fracture had implant failure. One patient was quadriplegic and did not recover the ability to walk. The average Knee Society scores of the remaining 18 patients were 82.66 (excellent) and 77.77 (functional score, good). There was one case of implant failure and one of screw breakage in distal femoral fractures. One case of nonunion occurred in a proximal tibial fracture. CONCLUSION: Provided it is applied with proper understanding of biomechanics, LCP is one of the best available options for management of challenging peri- and intra-articular fractures.