Toward a new definition of surface energy for late transition metals.

Surface energy is a top-importance stability descriptor of transition metal-based catalysts. Here, we combined density functional theory (DFT) calculations and a tiling scheme measuring surface areas of metal structures to develop a simple computational model predicting the average surface energy of metal structures independently of their shape. The metals considered are W, Ru, Co, Ir, Ni, Pd, Pt, Cu, Ag and Au. Lorentzian trends derived from the DFT data proved effective at predicting the surface energy of metallic surfaces but not for metal clusters. We used machine-learning protocols to build an algorithm that improves the Lorentzian trend's accuracy and is able to predict the surface energies of metal surfaces of any crystal structure, i.e., face-centred cubic, hexagonal close-packed, and body-centred cubic, but also of nanostructures and sub-nanometer clusters. The machine-learning neural network takes easy-to-compute geometric features to predict metallic moieties surface energies with a mean absolute error of 0.091 J m-2 and an R2 score of 0.97.

Computed Tomography for Pediatric Pelvic Fractures in Pediatric Versus Adult Trauma Centers.

BACKGROUND: Pediatric pelvic fractures are a significant source of morbidity for children in the United States. In the era of specialized care, the relationship between trauma center designation and outcomes remains unknown. We hypothesized that there would be no difference in patient outcomes when treated at adult trauma centers (ATCs), pediatric trauma centers (PTCs), or dual trauma centers (DTCs). MATERIALS AND METHODS: We used the National Trauma Data Bank to identify pediatric (≤14 y) patients suffering pelvic fractures in 2013-2015. DTCs were defined as centers with level I or II trauma designation for both pediatric and adult care. Primary outcomes included mortality, complications, and computed tomography (CT) utilization. RESULTS: There were 4260 patients who met study criteria. Of these, 1290 (22%) were treated at ATCs, 1332 (30%) at PTCs, and 2120 (48%) at DTCs. Pediatric patients treated at ATCs were more likely to suffer a complication or receive a CT scan. On multivariate analysis, patients treated at PTCs and DTCs were significantly less likely to have a recorded complication or receive head, thoracic, or whole-body CT scans compared with ATCs. DTCs, but not PTCs, used fewer abdominal CT scans. Mortality rates were not predicted by center designation. CONCLUSIONS: For pediatric pelvic fractures, centers with pediatric trauma designation (PTCs and DTCs) appear to have better outcomes despite significantly less use of CT scans. Further studies are needed to determine optimal management of pediatric pelvic fractures while minimizing exposure to ionizing radiation. LEVEL OF EVIDENCE: Level III Retrospective.

DFT benchmark studies on representative species and poisons of methane steam reforming on Ni(111).

Ni catalysts used in methane steam reforming (MSR) are highly susceptible to poisoning by carbon-based species, which poses a major impediment to the productivity of industrial operations. These species encompass graphitic carbon-like formations that are typically modelled as graphene. First principles-based approaches, such as density functional theory (DFT) calculations, can provide valuable insight into the mechanism of graphene growth in the MSR reaction. It is, however, critical that a DFT model of this reaction can accurately describe the interactions of Ni(111) with the MSR intermediates as well as graphene. In this work, a systematic benchmark study has been carried out to identify a suitable DFT functional for the graphene-MSR system. The binding energies of graphene and important MSR species, as well as the reaction energies of methane dissociation and carbon oxidation, were computed on Ni(111) using GGA functionals, DFT-D and van der Waals density functionals (vdW-DF). It is well-established that the GGA functionals are inadequate for describing graphene-Ni(111) interactions. In the case of vdW-DF, the optPBE-vdW functional predicts the binding energies of graphene and several important MSR species with reasonable accuracy; however, it provides poor estimates of CO and O binding energies. Among the DFT-D functionals, PBE-D3 and PBE-dDsC have been found to exhibit acceptable accuracy for graphene and most MSR species (excluding adsorbed CO), and therefore, both functionals are promising for elucidating carbon-based catalytic poisoning in the MSR reaction. Overall, no single DFT functional could estimate the binding energies of all the species with equally high accuracy.

The impact of the COVID-19 pandemic and governor mandated stay at home order on emergency department super utilizers.

BACKGROUND: Despite the trend of rising Emergency Department (ED) visits over the past decade, researchers have observed drastic declines in number of ED visits due to the COVID-19 pandemic. The purpose of the current study was to examine the impact of the COVID-19 pandemic and governor mandated Stay at Home Order on ED super utilizers. METHODS: This was a retrospective chart review of patients presenting to the 12 emergency departments of the Franciscan Mission of Our Lady Hospital System in Louisiana between January 1, 2018 and December 31, 2020. Patients who were 18 years of age or older and had four ED visits within a one-year period (2018, 2019, or 2020) were classified as super-utilizers. We examined number and category of visits for the baseline period (January 2018 - March 2020), the governor's Stay at Home Order, and the subsequent Reopening Phases through December 31, 2020. RESULTS: The number of visits by super utilizers decreased by over 16% when the Stay at Home Order was issued. The average number of visits per week rose from 1010.63 during the Stay at Home Order to 1198.09 after the Stay at Home Order was lifted, but they did not return to Pre-COVID levels of approximately 1400 visits per week in 2018 and 2019. When categories of visits were examined, this trend was found for emergent visits (p < 0.001) and visits related to injuries (p < 0.001). Non-emergent visits declined during the Stay at Home Order compared to the baseline period (p < 0.001), and did not increase significantly during reopening compared to the Stay at Home Order (p = 0.87). There were no changes in number of visits for psychiatric purposes, alcohol use, or drug use during the pandemic. CONCLUSIONS: Significant declines in emergent visits raise concerns that individuals who needed ED treatment did not seek it due to COVID-19. However, the finding that super utilizers with non-emergent visits continued to visit the ED less after the Stay at Home Order was lifted raises questions for future research that may inform policy and interventions for inappropriate ED use.

The Association of Payer Status and Injury Patterns in Pediatric Bicycle Injuries.

BACKGROUND: Bicycle injuries continue to cause significant morbidity in the United States. How insurance status affects outcomes in children with bicycle injuries has not been defined. We hypothesized that payer status would not impact injury patterns or outcomes in pediatric bicycle-related accidents. METHODS: The National Trauma Data Bank was used to identify pediatric (≤18 y) patients involved in bicycle-related crashes admitted in year 2016. Patients with private insurance were compared with all others (uninsured, Medicaid, and Medicare). RESULTS: There were 5619 patients that met study criteria. Of these, 2500 (44%) had private insurance. Privately insured were older (12 y versus 11, P < 0.001), more likely to be white (77% versus 56%, P < 0.001), and more likely to wear a helmet (26% versus 9%, P < 0.001). On multivariate analysis, factors associated with traumatic brain injury included age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.06-1.08; P < 0.001) and helmet use (OR, 0.64; 95% CI, 0.55-0.74; P < 0.001). Patients without private insurance were significantly less likely to wear a helmet (OR, 0.52; 95% CI, 0.44-0.63; P < 0.001). Uninsured patients had significantly higher odds of a fatal injury (OR, 4.43; 95% CI, 1.52-12.92; P = 0.006). CONCLUSIONS: Uninsured children that present to a trauma center after a bicycle accident are more likely to die. Although helmet use reduced the odds of traumatic brain injury, minorities and children without private insurance were less likely to be helmeted. Public health interventions should increase helmet access to children without private insurance, especially uninsured children.

Machine learning to extract communication and history-taking skills in OSCE transcripts.

OBJECTIVES: Observed Structured Clinical Exams (OSCEs) allow assessment of, and provide feedback to, medical students. Clinical examiners and standardised patients (SP) typically complete itemised checklists and global scoring scales, which have known shortcomings. In this study, we applied machine learning (ML) to label some communication skills and interview content information in OSCE transcripts and to compare several ML methodologies by performance and transferability. METHODS: One-hundred and twenty-one transcripts of two OSCE scenarios were manually annotated per utterance across 19 communication skills and content areas. Utterances were converted to two types of numeric sentence vector representations and were paired with three types of ML algorithms. First, ML models (MLMs) were evaluated using a five K-fold cross-validation technique on all transcripts in one scenario to generate precision and recall, and their harmonic mean, F1 scores. Second, ML models were trained on all 101 transcripts from scenario 1 and tested for transferability on 20 scenario 2 transcripts. RESULTS: Performance testing in the K-fold cross-validation demonstrated relatively high mean F1 scores: median 0.87 and range 0.53-0.98 across all 19 labels. Transferability testing demonstrated success: F1 median 0.76 and range 0.46-0.97. The combination of a bi-directional long short-term memory neural network (biLSTM) algorithm with GenSen numeric sentence vector representations was associated with greater F1 scores across both performance and transferability (P < .005). CONCLUSIONS: We report the first application of ML in the context of student-SP OSCEs. We demonstrated that several MLMs automatically labelled OSCE transcripts for a range of interview content and some clinical communications skills. Some MLMs achieved greater performance and transferability. Optimised MLMs could provide automated and accurate assessment of OSCEs with potential to track student progress and identify areas for further practice.

Intravenous fluid bolus rates and pediatric diabetic ketoacidosis resolution.

BACKGROUND: Recent data have challenged the notion that rapid intravenous fluid administration results in adverse neurologic outcomes in children with diabetic ketoacidosis (DKA). While many physicians still administer a cautious 10 cc/kg bolus of intravenous fluids for pediatric DKA patients, there may be benefits to using a larger bolus. METHODS: This was a retrospective chart review of all pediatric patients with DKA presenting to a single emergency department (ED) between 2013 and 2015. Patients who received a bolus of 10 cc/kg or less in the ED were compared to patients who received >10 cc/kg of fluids. The primary outcome was the difference in hospital length-of-stay between the two groups. Secondarily, we compared groups with regards to the time to bicarbonate normalization. RESULTS: In sum, 170 pediatric DKA ED visits were analyzed. Patients who received a 10 cc/kg bolus or less of fluids in the ED had a mean hospital length-of-stay > that was 0.38 days longer (95% CI: 0.006 to 0.75 days) than those who received >10 cc/kg. On multivariable regression analysis, the difference between groups was diminished and no longer statistically significant. The time to bicarbonate normalization was 0.12 days longer (95% CI -0.029 to 0.27) in the 10 cc/kg or less group than the >10 cc/kg group. CONCLUSIONS: After adjustment for confounders, no statistically significant differences in outcomes were seen in pediatric DKA patients who received a 10 cc/kg bolus or less compared to those who received a larger initial bolus.

Efficient Non-dissociative Activation of Dinitrogen to Ammonia over Lithium-Promoted Ruthenium Nanoparticles at Low Pressure.

There is an exciting possibility to decentralize ammonia synthesis for fertilizer production or energy storage without carbon emission from H2 obtained from renewables at small units operated at lower pressure. However, no suitable catalyst has yet been developed. Ru catalysts are known to be promoted by heavier alkali dopants. Instead of using heavy alkali metals, Li is herein shown to give the highest rate through surface polarisation despite its poorest electron donating ability. This exceptional promotion rate makes Ru-Li catalysts suitable for ammonia synthesis, which outclasses industrial Fe counterparts by at least 195 fold. Akin to enzyme catalysis, it is for the first time shown that Ru-Li catalysts hydrogenate end-on adsorbed N2 stabilized by Li+ on Ru terrace sites to ammonia in a stepwise manner, in contrast to typical N2 dissociation on stepped sites adopted by Ru-Cs counterparts, giving new insights in activating N2 by metallic catalysts.

Experience with curative radiotherapy for cervix cancer in the Bahamas for 2006-2016.

BACKGROUND: Cervix cancer is a significant health problem. As access to quality care in Small Island Developing States improves, and cancer centers become established, providers of care can summarize local experience to benchmark system quality and look for ways to further improve value. METHODS: This is a retrospective study of all cases of cervix cancer managed 2006-2016 at The Cancer Centre Bahamas, in conjunction with Princess Margaret Hospital, Nassau, affiliated with The University of West Indies. Seventy-two women received curative radiotherapy or chemoradiotherapy. Herein are reported presenting characteristics, treatments, waiting and overall treatment times, plus outcomes of recurrence, survival, and adverse events. RESULTS: For 68 newly diagnosed cases, median waiting time (diagnosis to commencing treatment) was 110 days. It was 90 days for those 47 cases who had no prior surgery or neoadjuvant chemotherapy. Overall, 99% of intended external radiotherapy fractions, 74% of brachytherapy sessions, and 79% of concurrent weekly chemotherapy were administered. For all 72 cases, median overall treatment time was 63 days; and for the 47 case sub-group, it was 78 days during 2006-2010 and 65 days during 2011-2016 (p = 0.005), so improving over calendar time. Four cases experienced grade 3-4 toxicities. Twelve had urological complications from disease or treatment. Five cases experienced local failure; eight experienced distant failure. Newly diagnosed stage 2B (26/72) had a 2-year survival of 71%. CONCLUSION: This report demonstrates the impact of providing curative radiation-based treatments for cervical cancer in a small state. It suggests ways to further improve operations and justifies additional research.

The prostate cancer screening clinic in the Bahamas: a model for low- and middle-income countries.

PURPOSE: Grand Bahama (pop. 51,000) is an island within the Bahamas archipelago. A local chapter of International Us TOO Prostate Cancer Support Group (UTGB) has led an annual community-based prostate cancer screening clinic in Grand Bahama each September since 2009. Features of this initiative, characteristics of attendees, and a description of found cancers were summarized to determine the clinic's value and to guide improvements. METHOD: We analyzed the established clinic from 2012 to 2015, wherein UTGB attracted corporate funding, volunteers managed clinics, and health professionals provided healthcare services. An explicit algorithm was used to sort clients by age, comorbidities, and findings from digital rectal examinations, and prostate-specific antigen (PSA) values, to determine which clients would undergo secondary assessment and prostate biopsy. RESULTS: Overall, 1,844 males were registered (mean age 57.6 years), and only 149 men attended on more than one occasion for a total of 1,993 clinic visit. The urologist reviewed 315 men in secondary follow-up, for elevated PSA and/or an abnormal digital rectal examination. Of these, 45 men fulfilled criteria for trans-rectal ultrasound biopsy, and there were 40 found cases of prostate cancer, for a positive-predictive value of 89%. By D'Amico risk-stratification, these 40 cases were low (10%), intermediate (40%), and high risk (50%). The urologist counseled all 40 cases and facilitated access to standard care. CONCLUSION: This study suggests that low-resource countries can advance cost-effective screening clinics, apply policy guidelines, and provide services within acceptable standards of care. It is the expectation, with a sustained effort and community participation over the ensuing years, that earlier disease presentation will occur and, consequently, a concomitant decrease in the disease-specific mortality.

Outcomes of treatment in men with prostate cancer at the cancer centre Bahamas.

PURPOSE: This is a first report from The Bahamas of management and long-term outcomes in men with non-metastatic prostate cancer treated with radiotherapy, with or without androgen deprivation therapy, from 2004 to 2016. METHODS: Patients were characterized by baseline factors, stratified by risk groups using tumor stage (clinical T-stage), prostate-specific antigen (PSA) test result and Gleason grade, and sorted by treatment combinations (by radiation volume and use of androgen deprivation). RESULTS: Overall, 205/216 men were Afro-Caribbean. Median age was 66. There were 18 low-, 77 intermediate-, and 121 high-risk patients, treated with prostate-only versus pelvis plus prostate radiotherapy, many receiving 2 years of androgen suppression. Time to commence radiation was about 6 months from initial diagnosis. In those not relapsing, global PSA nadir was reached in 4 years and was under 1.0, reduced from a mean at baseline of 31. At 10 years, disease-free experience (32 relapses) was 68% and overall survival was 87%, although only 2/12 deaths were related to prostate cancer. This experience compares favorably with recently published outcomes from other countries using very similar treatments. CONCLUSIONS: This study establishes benchmark statistics from diagnosis to long-term follow-up. Outcomes in Bahamian men are consistent with expectations from risk-stratified guidelines followed in developed countries.

Single-step synthesis of crystalline h-BN quantum- and nanodots embedded in boron carbon nitride films.

Herein we report on the synthesis and characterization of novel crystalline hexagonal boron nitride (h-BN) quantum- and nanodots embedded in large-area boron carbon nitride (BCN) films. The films were grown on a Cu substrate by an atmospheric pressure chemical vapour deposition technique. Methane, ammonia, and boric acid were used as precursors for C, N and B to grow these few atomic layer thick uniform films. We observed that both the size of the h-BN quantum/nanodots and thickness of the BCN films were influenced by the vaporization temperature of boric acid as well as the H3BO3 (g) flux over the Cu substrate. These growth conditions were easily achieved by changing the position of the solid boric acid in the reactor with respect to the Cu substrate. Atomic force microscope (AFM) and TEM analyses show a variation in the h-BN dot size distribution, ranging from nanodots (∼224 nm) to quantum dots (∼11 nm) as the B-source is placed further away from the Cu foil. The distance between the B-source and the Cu foil gave an increase in the C atomic composition (42 at% C-65 at% C) and a decrease in both B and N contents (18 at% B and 14 at% N to 8 at% B and 7 at% N). UV-vis absorption spectra showed a higher band gap energy for the quantum dots (5.90 eV) in comparison with the nanodots (5.68 eV) due to a quantum confinement effect. The results indicated that the position of the B-source and its reaction with ammonia plays a significant role in controlling the nucleation of the h-BN quantum- and nanodots. The films are proposed to be used in solar cells. A mechanism to explain the growth of h-BN quantum/nanodots in BCN films is reported.

Clinical and financial implications of emergency department visits for synthetic marijuana.

BACKGROUND: Many users believe that synthetic cannabinoids offer a safe and legal means of getting high. However, spikes in emergency department visits have been associated with use of synthetic cannabinoids. The purpose of the current study was to document emergency department visits from three large hospitals in one metropolitan area over a two month period. METHOD: This was a retrospective chart review examining 218 patients presenting to three inner city emergency departments between March and April 2014. Data collected included demographic information, information regarding ED diagnosis and treatment, signs and symptoms, ancillary testing, ED disposition, and cost of the medical treatment. RESULTS: The majority of patients (75.7%) were discharged after ED workup, but 12.4% were admitted for medical treatment and 11.5% were admitted for psychiatric treatment. Ten patients (4.6%) were admitted to the ICU. Symptoms experienced most frequently include: hypertension, tachycardia, agitation, drowsiness, nausea, and confusion. Cluster analysis revealed four symptom clusters of individuals presenting after using synthetic cannabinoids: 1) confusion, hostility, agitation, 2) nausea, vomiting, abdominal pain, 3) drowsiness, and 4) the absence of these symptoms. CONCLUSION: This study has three important findings. First, significant ED resources are being used to treat individuals presenting due to effects of synthetic cannabis. Second, synthetic cannabis is not a benign substance. Third, while the hostile and agitated user is generally presented in the media, this study finds significant heterogeneity in presentation. Further research is needed to fully understand the implications of synthetic cannabinoid use.

Do they see dead people? Cultural factors and sensitivity in screening for schizophrenia spectrum disorders.

OBJECTIVE: Schizophrenia spectrum disorders (SSDs), are diagnosed more frequently among African-Americans (AAs) than Caucasians. It has been suggested that cultural differences in symptom presentation and endorsement (including reporting spiritual/religious experiences) may influence this disparity. The current study investigated the relationship between endorsement of spiritual auditory and visual hallucinations and subsequent diagnosis of SSD among AA patients. DESIGN: Participants (N = 471 AAs) completed the Mini International Neuropsychiatric Interview-Plus (MINI-Plus) Screening Interview as part of their intake to a HIV outpatient clinic. Endorsement of auditory or visual (A/V) hallucinations was explored with the MINI-Plus Psychotic Disorder Module and questions regarding the content of the unusual experience. RESULTS: Logistic regression indicated that endorsement of A/V hallucinations significantly predicted a SSD (OR = 41.6, 95% CI 13.7-126.0, p < .001). However, when hallucinations were spiritual in nature, odds of an SSD fell dramatically (OR = 0.22, 95% CI 0.07-0.64, p < .001). CONCLUSIONS: The current study indicates that not all visual and auditory hallucinations are symptomatic of a psychotic disorder in AA patients. Many of these experiences may be related to spirituality. Clinicians assessing AA patients need to query content of, meaning attributed to, and distress associated with A/V unusual experiences.

Suicide attempts presenting to trauma centers: trends across age groups using the National Trauma Data Bank.

BACKGROUND: This study sought to examine the epidemiology and mortality of violent suicide attempts presenting to trauma centers and to describe differences in male and female suicide attempters presenting to trauma centers by decade of age. METHOD: Data from the National Trauma Data Bank (American College of Surgeons) years 2010-2012 were used for this study. E-codes indicative of self-inflicted injury (e950-e959) were used to identify violent suicide attempts. Incidents were categorized by decade of age at admission. We examined the effects of age and sex on rates of violent suicide attempts, mechanism used, and mortality. RESULTS: In all, 36035 violent suicide attempts were identified in the National Trauma Data Bank. Proportion of in-hospital mortality differed significantly with age (P< .001). Individuals aged 20 to 29 years had a significantly higher number of attempts with 15.6% mortality, whereas individuals aged 80 plus year had fewer attempts but with 45.9% mortality. There were significant interactions between sex and age on lethality of suicide attempts (P< .01) and mechanism chosen (P< .01), with men being more likely to use firearms across age groups. CONCLUSION: This study highlights the importance of examining the epidemiology of suicide attempts across sex and age. There are significant differences in rate of attempts, lethality of mechanism, and in-hospital mortality. Future studies should continue to investigate violent suicide attempts to design and implement effective treatment strategies targeted toward specific populations.

Using Mental Health Outreach Teams in the Emergency Department to Improve Engagement in Treatment.

Engagement in treatment for a person having a behavioral health crisis is critical to fully address the concerns of the individual as well as to prevent future crises. This study explored the benefits of establishing outreach visits from a local community mental health provider to psychiatric patients in an emergency department. Using retrospective analysis of data collected by a local mental health agency, the effect of receiving face to face contact in the emergency room with a community mental health worker (and/or telephone follow up) was compared to no outreach interaction. The effect of this intervention was a significant increase in initial appointment attendance at the local mental health clinic in the aftermath of a psychiatric crisis. Community mental health services provided in partnership with community emergency departments may improve patient engagement in aftercare and consequently help alleviate future behavioral health crises as well as return visits to the emergency department.

Patients' comprehension of their emergency department encounter: a pilot study using physician observers.

STUDY OBJECTIVE: The current study examines patients' comprehension of their emergency department (ED) encounter, using physician observers to document both physician communication and details of the encounter. METHODS: Eighty-nine patients were recruited from a convenience sample in an urban ED. To be included in this study, patients had to have low triage levels (4 and 5) and be discharged from the ED. Physician observers were present throughout the encounter, documenting physician communication and procedures performed. Patients were then interviewed by physician observers about their communication with physicians, accuracy in recalling facts about the encounter, and understanding of information provided during the encounter. RESULTS: The majority of patients were black and had a high school education. Physicians typically engaged in behaviors related to building rapport and diagnosing patients. However, physicians informed patients about test results and diagnoses less frequently. In terms of patients' accuracy and understanding of the visit, patients were generally aware of basic facts in regard to their ED encounter (ie, whether they had blood drawn), but 65.9% of patients demonstrated less than "good" understanding in at least 1 area assessed. CONCLUSION: The findings of the current study indicate physicians could improve communication with patients, particularly in regard to care received in the ED. This study also indicates that a large percentage of patients fail to understand information about their ED encounter even when physicians provide it. A primary limitation of the current study is the relatively homogenous physician sample.

A modified filgrastim regimen does not reduce pain burden compared to pegfilgrastim in women receiving chemotherapy for non-metastatic breast cancer.

PURPOSE: The short half-life of filgrastim allows for modification in the dose or duration of prophylaxis to limit inconvenience, adverse effects, and cost. The objectives of this study were to characterize and compare pain and neutropenic events between filgrastim and pegfilgrastim. METHODS: A prospective, observational study was performed. Eligible patients had non-metastatic breast cancer and were to receive adjuvant or neo-adjuvant chemotherapy with prophylaxis for febrile neutropenia. The prophylaxis used was a fixed-dose regimen of filgrastim 300 µg subcutaneously once daily for 7 days or pegfilgrastim 6 mg subcutaneously for 1 day. Participants completed a pain diary once a day for 14 days commencing the evening of the patient's first chemotherapy. Telephone interviews occurred at two instances within 2 weeks after their first treatment. The primary endpoints of this study were the difference in pain and incidences of neutropenia. Muscle pain, pain burden, and potential risk factors for pain were also explored. RESULTS: A total of 142 women were enrolled, 94 with pegfilgrastim and 48 with filgrastim. Filgrastim was associated with worse joint and muscle pain compared to pegfilgrastim. Joint pain was present in 38 and 26 % of diary entries for filgrastim and pegfilgrastim, respectively (p = 0.009). The mean AUC for joint pain score across 14 days, normalized to 100, were 6.0 for pegfilgrastim and 8.6 for filgrastim in patients receiving non-docetaxel chemotherapy and 14.6 for pegfilgrastim and 21.5 for filgrastim in patients receiving docetaxel-based chemotherapy (p = 0.037). Muscle pain patterns and frequencies were similar to joint pain. There were no statistical differences in febrile neutropenia and neutropenic events. CONCLUSIONS: Both filgrastim and pegfilgrastim caused significant pain burden. A fixed-dose regimen of filgrastim may be effective, but offers no advantage to minimize muscle or joint pain and, in fact, appears to cause greater and more frequent pain.

Smartphones in medicine: emerging practices in an academic medical center.

Advances in mobile phone technology now provide a myriad of resources to physicians' fingertips. However, the medical profession continues to struggle with potential for misuse of these devices. There is a need for better understanding of physicians' uses of smartphones in order to establish guidelines for appropriate and professional behavior. The purpose of the current study was to survey physicians' and medical students' practices concerning smartphone use in the healthcare setting. Physicians and medical students were asked to complete anonymous surveys regarding uses of smartphones within the past month in various healthcare settings. Overall, the participants reported distinctly different patterns in the uses they made of their phones in different settings (P<.001), with most individuals engaging in most behaviors while on break but few using their smartphones while with patients or during procedures. It appears that physicians and medical students make decisions about using their smartphones according to some combination of three considerations: degree of relevance to patient care, the appropriateness of the behavior in front of patients, and the issue of how disruptive that behavior may be.

The influence of the Hubbard U parameter in simulating the catalytic behaviour of cerium oxide.

The seemingly unique redox and oxygen storage properties of cerium oxide (ceria) lead to broad practical application. However, the theoretical treatment of ceria can be troublesome due to the localised nature of the f-electrons and the self-interaction error associated with Density Functional Theory (DFT). DFT + U has been a widely used method to correct for these errors when probing specific physical material properties. However, due to the empirical nature of the U correction it is not immediately obvious that correcting certain bulk properties leads to the correct description of catalytic reactivity at surfaces. We propose an approach to choosing the U parameter using adsorption properties that provides a consistent method to simulate catalytic properties of ceria. We go on to show that combining the derived ceria energetics with those of adsorption at metal surfaces, allow us to construct transition metal-oxide pairings to develop a redox screening model for catalysis.