Morphology and performance relationship studies on biodegradable ternary blends of poly(3-hydroxybutyrate-co-3-hydroxyvalerate), polylactic acid,and polypropylene carbonate

A biodegradable ternary blend fabricated from polylactic acid (PLA), poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) and polypropylene carbonate (PPC) with a good balance of stiffness and toughness via optimizing the composition ratio and morphological structure is, to the best of the authors'' knowledge, reported here for the first time. The optimal blend formulation is comprised of 20% PLA, 40% PHBV, and 40% PPC, which possesses a tensile strength measuring 44 MPa and an elongation at break measuring at 215%. Thermal performance analysis revealed an HDT value of 72 °C. The Harkins equation predicts that the three immiscible polymers formed a complete wetting morphology, which was confirmed by scanning electrical microscopy. As the PPC content of the ternary blends is increased, the material undergoes morphological transition from droplet to co-continuous structure, resulting in significant improvement of elongation at break (approximately 40 times higher than that of the PLA–PHBV binary blend). Excellent stiffness and over 200% elongation at break make these sustainable ternary blends feasible for use in packaging as substitutes for certain non-biodegradable petroleum-based single use plastics.

Morphological arrangement leads to biodegradable stiffness–toughness–HDT balanced ternary blends.     

Development of starch based intelligent films by incorporating anthocyanins of butterfly pea flower and TiO2 and their applicability as freshness sensors for prawns during storage

Intelligent pH sensitive starch films were developed by incorporation of anthocyanin pigment extracted from butterfly pea flower (BPE) and nanosized TiO₂ using the method of solution casting. This research work evaluated the influence of BPE and TiO₂ on the physical and structural properties of starch films. The physical properties of the starch films could be significantly altered by the addition of BPE and or TiO₂. The starch films S/BPE and S/BPE/TiO₂ exhibited higher barrier properties against water vapour as compared to the control films. Incorporation of BPE and TiO₂ could decrease the thickness and moisture content of films. S, S/BPE starch films were transparent and, S/TiO₂ and S/BPE/TiO₂ films were opaque. Control starch films were colourless, whereas S/BPE films have purple colour. Owing to the inclusion of BPE and TiO₂ particles, structural characterization by X-ray diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR) did not show any major changes in polymer structure. Thermogravimetric analysis revealed that the addition of TiO₂ enhanced the thermal stability of starch films to a significant extent. The color of different starch-based films was determined using the CIE Lab scale under different pH conditions and compared with the control. The fabricated (S/BPE and S/BPE/TiO₂) films exhibited visually perceptible colour changes in the pH range between 1 and 12. Consequently these films could be used as intelligent pH indicators for monitoring the freshness of prawn seafood samples. During the storage of prawn food samples for 6 days, the color of the film changed from light pink to green which is a clear indication of spoilage of food material.

Anthocyanin extracted from butterfly pea flower incorporated starch/TiO₂ films are excellent pH indicator for monitoring the freshness of food sample.     

Impaired vascular function in exercising anovulatory premenopausal women is associated with low bone mineral density

In estrogen‐deficient post‐menopausal women, osteoporosis shares a common link with cardiovascular disease risk, including endothelial dysfunction. The current study sought to examine associations between bone mineral density (BMD) and endothelial function in estrogen‐deficient premenopausal women with exercise‐associated menstrual disturbances. Recreationally trained women (24.3 ± 0.8 years; overall mean ± SEM) who were estrogen deficient (amenorrheic or eumenorrheic anovulatory cycles; E2Def; n = 13) or estrogen replete (eumenorrheic ovulatory cycles; E2Rep; n = 14) were studied. Total body and lumbar BMD (L1‐L4) were determined using dual‐energy X‐ray absorptiometry. Serum markers of oxidative stress (oxidized low‐density lipoprotein; OxLDL), energy deficiency (triiodothyronine), and bone turnover (osteocalcin, c‐telopeptide X, P1NP) were assessed. Estrogen exposure was determined by assessing daily urinary estrone‐3‐glucuronide (E1G) across a monitoring period. Calf blood flow (CBF), an index of endothelial function, was measured using strain‐gauge plethysmography. CBF, total body and L1‐L4 BMD, triiodothyronine and E1G were lower (P < 0.05), and c‐telopeptide crosslinks higher (P < 0.05) in E2Def. Osteocalcin and OxLDL did not differ (P > 0.05) between groups. L1‐L4 BMD, osteocalcin, and E1G were the strongest predictors of CBF (R²=0.615, P < 0.001). CBF was the strongest predictor of L1‐L4 BMD (R²=0.478, P < 0.001). L1‐L4 (r = 0.558, P = 0.008) and CBF (r = 0.534, P = 0.004) were independently correlated with E1G. In young recreationally trained premenopausal women with anovulatory menstrual disturbances, low CBF predicts decreased lumbar BMD, suggesting impaired peripheral endothelial function may predict early unfavorable changes in bone metabolism. This finding may be of relevance in the early detection of cardiovascular and bone health decrements in otherwise healthy estrogen‐deficient premenopausal women.     

Radiographic predictors of IMRT for treating regional lymph nodes in breast cancer

Regional nodal irradiation (RNI) is an essential part of the treatment of high risk early stage (Stage IIb) and locally advanced (Stage III) breast cancer. Acceptable radiation plans can usually be achieved using 3-dimensional conformal radiation therapy with deep-inspiration breath hold to limit dose to the heart, although in some cases intensity-modulated radiation therapy produces superior results. The goal of this study is to identify radiographic parameters that predict the need for IMRT when delivering RNI. We retrospectively examined breast cancer patients treated with comprehensive RNI including internal mammary lymph nodes, supraclavicular lymph nodes, and undissected axillary lymph nodes at our institution from January 2016 to February 2018. Radiographic parameters including lung volume, internal mammary lymph nodes depth, modified central lung distance (mCLD), tangent length, and target height were recorded. Univariate and multivariate logistic regression was performed using IMRT as a binary endpoint (yes/no). A total of 46 patients were evaluated, of which 9 (20%) required IMRT. Five of the 9 (56%) IMRT patients were postmastectomy with a tissue expander in place. There was an increased likelihood of IMRT per 0.5 cm increase in mCLD (odds ratios [OR]: 3.27; 95% confidence interval [CI]: 1.39 to 9.63; p = 0.01) and per 1 cm increase in target height (OR: 1.77; 95% CI: 1.08 to 3.40; p = 0.04). A threshold value of 3.38 cm was identified for mCLD (OR 10.3; 95% CI: 2.14 to 61.4; p value = 0.005), and 25.2 cm for target height (OR 10.9; 95% CI: 2.19 to 82.7; p value = 0.007). When delivering RNI, larger values of mCLD and target height corresponded to the use of IMRT. Further investigations are warranted to confirm these findings, which may improve the efficiency of the treatment planning process and in turn patient care.     

The Current State of Teleradiology Across the United States: A National Survey of Radiologists’ Habits,Attitudes, and Perceptions on Teleradiology Practice

PurposeTo explore the current state of teleradiology practice, defined as the interpretation of imaging examinations at a different facility from where the examination was performed.MethodsA national survey addressing radiologists’ habits, attitudes, and perceptions regarding teleradiology was distributed by e-mail to a random sample of ACR members in early 2019.ResultsAmong 731 of 936 respondents who indicated a non-teleradiologist primary work setting, 85.6% reported performing teleradiology within the past 10 years and 25.4% reported that teleradiology represents a majority of their annual imaging volumes; 84.4% performed teleradiology for internal examinations and 45.7% for external examinations; 46.2% performed teleradiology for rural areas and 37.2% for critical access hospitals; 91.3% performed teleradiology during weekday normal business hours and 44.5% to 79.6% over evening, overnight, and weekend hours. In all, 76.9% to 86.2% perceived value from teleradiology for geographic, after-hours, and multispecialty coverage, as well as reduced interpretation turnaround times. The most common challenges for teleradiology were electronic health record access (62.8%), quality assurance (53.8%), and technologist proximity (48.4%). The strategy most commonly considered useful for improving teleradiology was technical interpretation standards (33.3%). Radiologists in smaller practices were less likely to perform teleradiology or performed teleradiology for lower fractions of work, were less likely to experience coverage advantages of teleradiology, and reported larger implementation challenges, particularly relating to electronic health records and prior examination access.ConclusionDespite historic concerns, teleradiology is widespread throughout modern radiology practice, helping practices achieve geographic, after-hours, and multispecialty coverage; reducing turnaround times; and expanding underserved access. Nonetheless, quality assurance of offsite examinations remains necessary. IT integration solutions could help smaller practices achieve teleradiology’s benefits.     

Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study

Objective

To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission.

Data Sources

EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017–February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019–July 2021).

Study Design

We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted.

Data Extraction

We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay.

Principal Findings

In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI −0.57, −0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (β = 0.01; 95% CI −0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI −0.88, −0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA.

Conclusions

Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.