Rapid eye movement sleep behaviour disorder in brain injury: A complex case requiring close coordination of care.

BACKGROUND: Neurorehabilitation is interdisciplinary and cross-sectorial, requiring the coordinated effort of diverse sectors, professions, patients and communities to manage complex condition-related disabilities. A more holistic approach to experimental rehabilitation can incorporate individualized treatment plans into rehabilitation research to improve overall clinical care. OBJECTIVE: This case aims to highlight the benefit of collaboration between neurology, psychiatry, physiatry and rehabilitation therapists to successfully rehabilitate complex patients. CASE PRESENTATION: A 72-year-old gentleman with history of depression, anxiety and sleep difficulties presented to our institution one year after a stroke for help managing exacerbations of his premorbid conditions. The patient had a hemorrhagic stroke which required craniectomy and led to seizures. Past history was unclear regarding what workups had been done but was suggestive of rapid eye movement (REM) sleep behavior disorder (RBD). RESULTS: Given the numerous medications patient had tried in the past and since his stroke, a true multidisciplinary team was needed and his case required close coordination to successfully diagnose the reason for each of his symptoms and to provide treatments and rehabilitation. CONCLUSION: The correct diagnosis was only achieved by clear communication among team members which allowed for optimal treatment and improvement with therapies.

Using small angle x-ray scattering to examine the aggregation mechanism in silica nanoparticle-based ambigels for improved optical clarity.

Silica-based aerogels are a promising low-cost solution for improving the insulation efficiency of single-pane windows and reducing the energy consumption required for space heating and cooling. Two key material properties required are high porosity and small pore sizes, which lead to low thermal conductivity and high optical transparency, respectively. However, porosity and pore size are generally directly linked, where high porosity materials also have large pore sizes. This is unfavorable as large pores scatter light, resulting in reduced transmittance in the visible regime. In this work, we utilized preformed silica colloids to explore methods for reducing pore size while maintaining high porosity. The use of preformed colloids allows us to isolate the effect of solution conditions on porous gel network formation by eliminating simultaneous nanoparticle growth and aggregation found when using typical sol-gel molecular-based silica precursors. Specifically, we used in situ synchrotron-based small-angle x-ray scattering during gel formation to better understand how pH, concentration, and colloid size affect particle aggregation and pore structure. Ex situ characterization of dried gels demonstrates that peak pore widths can be reduced from 15 to 13 nm, accompanied by a narrowing of the overall pore size distribution, while maintaining porosities of 70%-80%. Optical transparency is found to increase with decreasing pore sizes while low thermal conductivities ranging from 95 +/- 13 mW/m K are maintained. Mechanical performance was found to depend primarily on effective density and did not show a significant dependence on solution conditions. Overall, our results provide insights into methods to preserve high porosity in nanoparticle-based aerogels while improving optical transparency.

Communication Between Cancer Patients and Physicians About Complementary and Alternative Medicine: A Systematic Review.

Objectives: Complementary and alternative medicine (CAM) has become increasingly popular among cancer patients and is often used concomitantly with standard cancer therapies. Nonetheless, disclosure of CAM utilization by cancer patients to physicians, along with the provision of information on CAM therapies by physicians, is poor. This review explores the literature to synthesize existing information on communication about CAM usage, reasons for nondisclosure, and the clinical implications thereof. Methods: A search of medical literature published between December 1, 2009, and October 1, 2021 (last searched on April 18, 2022), on communications between physicians and cancer patients about CAM treatments was conducted through MEDLINE and EMBASE. Results were screened for inclusion, dually reviewed, and assessed using the QualSyst quality appraisal instrument. Findings were categorized and synthesized for review. Results: A total of 30 articles were located (n = 8721 total participants), which discussed elements related to patient disclosure of CAM use (n = 16), provider experiences or perceptions related to communication about CAM (n = 3), patterns of this communication (n = 6), and recommendations for effectively discussing CAM with cancer patients (n = 5). Reports indicate that nondisclosure is common throughout the cancer care spectrum. Factors influencing nondisclosure range from patient beliefs and attitudes about their provider, demographic characteristics, disease progression, physician-patient relationship, physician noninquiry, and type of CAM used; ultimately creating a gap in care that may have serious medical implications. Discussion: Many of the studies identified are small and confined to a single-center, hospital-network, or geographic setting, thereby limiting the applicability of findings and recommendations. Nonetheless, improving patient-physician communication is essential in delivering evidence-informed, patient-centered care and crucial for achieving patient satisfaction and positive health outcomes. The lack of adequate CAM dialogue about CAM use increases the risk of adverse interactions with conventional cancer treatments and results in missed opportunities for providers and patients to engage in vital information exchange. Future research and education are necessary to further identify barriers surrounding patient-provider communication about CAM treatments.

A contemporary case file analysis of child sexual abuse in institutional settings in England and Wales.

BACKGROUND: Despite increased institutional safeguards and regularly updated statutory guidance that stresses safeguarding is 'everybody's responsibility', children continue to be sexually abused in institutional contexts in England and Wales. There also remains a lack of contemporary knowledge about institutions' responses to concerns about [risk of] CSA. OBJECTIVE: Reviewing Disclosure and Barring Service (DBS) discretionary-decision case files, as a detailed source of information about CSA in institutions occurring in the last 5 years, the aim of this paper was to understand what institutions knew about CSA and inappropriate behaviours that indicated children could be at risk of harm prior to formal disclosures to the DBS and how institutions did, or did not, respond to this knowledge. PARTICIPANTS AND SETTING: Cases involved 32 male and 11 female barred persons and 19 male and 51 female sexually abused children. METHOD: Thematic analysis was applied to 43 files where decisions were made by the DBS to add individuals to the Children's Barred list (which prevents them by law from working with children) between 2017 and 2020. RESULTS: In 79% of cases there was some level of awareness of concerns relating to inappropriate behaviour or CSA, through rumours and gossip, concerns about professionalism, and observed changes in the behaviour of subsequently barred individuals or victims. There was wide variation in the degree to which institutions responded. In a small number of cases action was taken promptly; however, this was not typical. CONCLUSIONS: Institutions and professionals failed in their duty of care by not taking any action at all, or responding slowly in ways that did not prevent CSA.

Transparent silica aerogel slabs synthesized from nanoparticle colloidal suspensions at near ambient conditions on omniphobic liquid substrates.

This paper presents a novel sol-gel method to synthesize large and thick silica aerogel monoliths at near ambient conditions using a commercial aqueous solution of colloidal silica nanoparticles as building blocks. To achieve slabs with high visible transmittance and low thermal conductivity, the method combines the strategies of (i) synthesizing gels on an omniphobic perfluorocarbon liquid substrate, (ii) aging at temperatures above room temperature, and (iii) performing solvent exchange with a low-surface-tension organic solvent prior to ambient drying. The omniphobic liquid substrates were used to prevent cracking and ensure an optically-smooth surface, while nanoparticle building blocks were small (<10 nm) to limit volumetric light scattering. Gels were aged at temperatures between 25 and 80 °C for up to 21 days to make them stronger and stiffer and to reduce shrinkage and cracking during ambient drying. Ambient drying was achieved by first exchanging water in the gel pores for octane, followed by drying in an octane-rich atmosphere to decrease capillary forces. The synthesized nanoparticle-based silica aerogel monoliths had thicknesses up to 5 mm, diameters up to 10 cm, porosities exceeding 80%, and thermal conductivities as low as 0.08 W m-1 K-1. Notably, the slabs featured visible transmittance exceeding 75% even for slabs as thick as 5 mm. The as-synthesized aerogel monoliths were exposed to TMCS vapor to induce hydrophobic properties resulting in a water contact angle of 140° that prevented water infiltration into the pores and protected the aerogels from water damage. This simple synthesis route conducted at near ambient conditions produces hydrophobic aerogel monoliths with promising optically transparent and thermally insulating properties that can be adhered to glass panes for window insulation and solar-thermal energy conversion applications.

Understanding Stabilization in Nanoporous Intermetallic Alloy Anodes for Li-Ion Batteries Using Operando Transmission X-ray Microscopy.

Tin-based alloying anodes are exciting due to their high energy density. Unfortunately, these materials pulverize after repetitive cycling due to the large volume expansion during lithiation and delithiation; both nanostructuring and intermetallic formation can help alleviate this structural damage. Here, these ideas are combined in nanoporous antimony-tin (NP-SbSn) powders, synthesized by a simple and scalable selective-etching method. The NP-SbSn exhibits bimodal porosity that facilitates electrolyte diffusion; those void spaces, combined with the presence of two metals that alloy with lithium at different potentials, further provide a buffer against volume change. This stabilizes the structure to give NP-SbSn good cycle life (595 mAh/g after 100 cycles with 93% capacity retention). Operando transmission X-ray microscopy (TXM) showed that during cycling NP-SbSn expands by only 60% in area and then contracts back nearly to its original size with no physical disintegration. The pores shrink during lithiation as the pore walls expand into the pore space and then relax back to their initial size during delithiation with almost no degradation. Importantly, the pores remained open even in the fully lithiated state, and structures are in good physical condition after the 36th cycle. The results of this work should thus be useful for designing nanoscale structures in alloying anodes.

Fast-Charging Cathodes from Polymer-Templated Mesoporous LiVPO4F.

Fast-charging cathodes with high operating voltages are critical to the development of high energy and power density lithium-ion batteries. One route to fast-charging battery materials is through the formation of nanoporous networks, but these methods are often limited by the high calcination temperatures required for synthesis. Here, we report the synthesis of carbon-coated nanoporous LiVPO4F with excellent rate capabilities that can be stably cycled up to 4.6 V in standard LiPF6 electrolytes. During charge and discharge at 30C, 110 mAh/g (70% of theoretical capacity) was obtained, and only 9% of capacity was lost after 2000 cycles at 20C. These materials also showed excellent stability, with little self-discharge, an open-circuit voltage of 4.2 V, and a discharge capacity of 139 mAh/g obtained after holding for 12 h. Rate capabilities were further demonstrated in a proof-of-concept full cell made with a nanostructured Nb2O5. These devices were able to deliver 200 mAh/g at 1C and 100 mAh/g at 30C. Finally, operando X-ray diffraction and electrochemical kinetics were further used to provide insight into the nature of fast charging in these materials.

Controlling Thermal Conductivity in Mesoporous Silica Films Using Pore Size and Nanoscale Architecture.

This work investigates the effect of wall thickness on the thermal conductivity of mesoporous silica materials made from different precursors. Sol-gel- and nanoparticle-based mesoporous silica films were synthesized by evaporation-induced self-assembly using either tetraethyl orthosilicate or premade silica nanoparticles. Since wall thickness and pore size are correlated, a variety of polymer templates were used to achieve pore sizes ranging from 3-23 nm for sol-gel-based materials and 10-70 nm for nanoparticle-based materials. We found that the type of nanoscale precursor determines how changing the wall thickness affects the resulting thermal conductivity. The data indicate that the thermal conductivity of sol-gel-derived porous silica decreased with decreasing wall thickness, while for nanoparticle-based mesoporous silica, the wall thickness had little effect on the thermal conductivity. This work expands our understanding of heat transfer at the nanoscale and opens opportunities for tailoring the thermal conductivity of nanostructured materials by means other than porosity and composition.

Improving memory after interruption: exploiting soft constraints and manipulating information access cost.

Forgetting what one was doing prior to interruption is an everyday problem. The recent soft constraints hypothesis (Gray, Sims, Fu, & Schoelles, 2006) emphasizes the strategic adaptation of information processing strategy to the task environment. It predicts that increasing information access cost (IAC: the time, and physical and mental effort involved in accessing information) encourages a more memory-intensive strategy. Like interruptions, access costs are also intrinsic to most work environments, such as when opening documents and e-mails. Three experiments investigated whether increasing IAC during a simple copying task can be an effective method for reducing forgetting following interruption. IAC was designated Low (all information permanently visible), Medium (a mouse movement to uncover target information), or High (an additional few seconds to uncover such information). Experiment 1 found that recall improved across all three levels of IAC. Subsequent experiments found that High IAC facilitated resumption after interruption, particularly when interruption occurred on half of all trials (Experiment 2), and improved prospective memory following two different interrupting tasks, even when one involved the disruptive effect of using the same type of resource as the primary task (Experiment 3). The improvement of memory after interruption with increased IAC supports the prediction of the soft constraints hypothesis. The main disadvantage of a high access cost was a reduction in speed of task completion. The practicality of manipulating IAC as a design method for inducing a memory-intensive strategy to protect against forgetting is discussed.