The impact of badmouthing of medical specialties to medical students.

OBJECTIVES: This study aimed to evaluate the proportion of Irish medical students exposed to 'badmouthing' of different specialities and to ascertain: the degree of criticism of specialities based on the seniority of clinical or academic members of staff; if 'badmouthing' influenced student career choice in psychiatry; and attitudes of medical students towards psychiatry as a speciality and career choice. METHODS: Medical students in three Irish universities were invited to complete an online survey to determine the frequency and effect of non-constructive criticism on choice of medical specialty. The online questionnaire was distributed to Royal College of Surgeons in Ireland (RCSI), University of Galway (UoG) and University College Dublin (UCD) in the academic year 2020-2021. RESULTS: General practice (69%), surgery (65%) and psychiatry (50%) were the most criticised specialties. Criticism was most likely to be heard from medical students. 46% of students reported reconsidering a career in psychiatry due to criticism from junior doctors. There was a positive perception of psychiatry with 27% of respondents considering psychiatry as a first-choice specialty. CONCLUSIONS: Criticism of psychiatry by doctors, academics and student peers negatively influences students' career choice, which could be contributing to recruitment difficulties in psychiatry.

Calculating Pairwise Similarity of Polymer Ensembles via Earth Mover's Distance.

Synthetic polymers, in contrast to small molecules and deterministic biomacromolecules, are typically ensembles composed of polymer chains with varying numbers, lengths, sequences, chemistry, and topologies. While numerous approaches exist for measuring pairwise similarity among small molecules and sequence-defined biomacromolecules, accurately determining the pairwise similarity between two polymer ensembles remains challenging. This work proposes the earth mover's distance (EMD) metric to calculate the pairwise similarity score between two polymer ensembles. EMD offers a greater resolution of chemical differences between polymer ensembles than the averaging method and provides a quantitative numeric value representing the pairwise similarity between polymer ensembles in alignment with chemical intuition. The EMD approach for assessing polymer similarity enhances the development of accurate chemical search algorithms within polymer databases and can improve machine learning techniques for polymer design, optimization, and property prediction.

High-throughput experimentation for discovery of biodegradable polyesters.

The consistent rise of plastic pollution has stimulated interest in the development of biodegradable plastics. However, the study of polymer biodegradation has historically been limited to a small number of polymers due to costly and slow standard methods for measuring degradation, slowing new material innovation. High-throughput polymer synthesis and a high-throughput polymer biodegradation method are developed and applied to generate a biodegradation dataset for 642 chemically distinct polyesters and polycarbonates. The biodegradation assay was based on the clear-zone technique, using automation to optically observe the degradation of suspended polymer particles under the action of a single Pseudomonas lemoignei bacterial colony. Biodegradability was found to depend strongly on aliphatic repeat unit length, with chains less than 15 carbons and short side chains improving biodegradability. Aromatic backbone groups were generally detrimental to biodegradability; however, ortho- and para-substituted benzene rings in the backbone were more likely to be degradable than metasubstituted rings. Additionally, backbone ether groups improved biodegradability. While other heteroatoms did not show a clear improvement in biodegradability, they did demonstrate increases in biodegradation rates. Machine learning (ML) models were leveraged to predict biodegradability on this large dataset with accuracies over 82% using only chemical structure descriptors.

Community Resource for Innovation in Polymer Technology (CRIPT): A Scalable Polymer Material Data Structure.

The Community Resource for Innovation in Polymer Technology (CRIPT) data model is designed to address the high complexity in defining a polymer structure and the intricacies involved with characterizing material properties.

Concentration-Driven Self-Assembly of PS-b-PLA Bottlebrush Diblock Copolymers in Solution.

Bottlebrush polymers are a class of semiflexible, hierarchical macromolecules with unique potential for shape-, architecture-, and composition-based structure-property design. It is now well-established that in dilute to semidilute solution, bottlebrush homopolymers adopt a wormlike conformation, which decreases in extension (persistence length) as the concentration and molecular overlap increase. By comparison, the solution phase self-assembly of bottlebrush diblock copolymers (BBCP) in a good solvent remains poorly understood, despite critical relevance for solution processing of ordered phases and photonic crystals. In this work, we combine small-angle X-ray scattering, coarse-grained simulation, and polymer synthesis to map the equilibrium phase behavior and conformation of a set of large, nearly symmetric PS-b-PLA bottlebrush diblock copolymers in toluene. Three BBCP are synthesized, with side chains of number-averaged molecular weights of 4500 (PS) and 4200 g/mol (PLA) and total backbone degrees of polymerization of 100, 255, and 400 repeat units. The grafting density is one side chain per backbone repeat unit. With increasing concentration in solution, all three polymers progress through a similar structural transition: from dispersed, wormlike chains with concentration-dependent (decreasing) extension, through the onset of disordered PS/PLA compositional fluctuations, to the formation of a long-range ordered lamellar phase. With increasing concentration in the microphase-separated regimes, the domain spacing increases as individual chains partially re-extend due to block immiscibility. Increases in the backbone degree of polymerization lead to changes in the scattering profiles which are consistent with the increased segregation strength. Coarse-grained simulations using an implicit side-chain model are performed, and concentration-dependent self-assembly behavior is qualitatively matched to experiments. Finally, using the polymer with the largest backbone length, we demonstrate that lamellar phases develop a well-defined photonic band gap in solution, which can be tuned across the visible spectrum by varying polymer concentration.

New approach in programming sequentially implanted children: Towards balanced dynamic ranges (DR).

There is a tendency for children undergoing sequential cochlear implant after a long period of unilateral implant use to have a smaller dynamic range in their second implant compared to their first implant. This study aimed to investigate if balancing the dynamic ranges between the two implants influenced functional outcomes in sequentially implanted children. Nineteen participants with long inter-implant time delays were randomly assigned to a study group or a control group. Children in the study group received progressive minimal changes to both first and second implants over a period of nine months to achieve balanced dynamic ranges, while the children in the control group received only changes to their sequential implant. Functional outcomes were collected 24-months after sequential implantation and consisted of speech discrimination scores, spatial localisation, device use and quality of life measures. Results show that spatial discrimination skills improved over time for both groups of children; however children in the study group had smaller localisation errors compared with the children in the control group. No other differences between the two groups were observed. Balanced dynamic ranges in sequentially implanted children can contribute to better performance, particularly in spatial discrimination tasks that rely in inter-aural level differences.

Rapid, interface-driven domain orientation in bottlebrush diblock copolymer films during thermal annealing.

Favorable polymer-substrate interactions induce surface orientation fields in block copolymer (BCP) melts. In linear BCP processed near equilibrium, alignment of domains generally persists for a small number of periods (∼4-6 D0) before randomization of domain orientation. Bottlebrush BCP are an emerging class of materials with distinct chain dynamics stemming from substantial molecular rigidity, enabling rapid assembly at ultrahigh (>100 nm) domain periodicities with strong photonic properties (structural color). This work assesses interface-induced ordering in PS-b-PLA bottlebrush diblock copolymer films during thermal annealing between planar surfaces. To clearly observe the decay in orientational order from surface to bulk, we choose to study micron-scale films spanning greater than 200 lamellar periods. In situ optical microscopy and transmission UV-Vis spectroscopy are used to monitor photonic properties during annealing and paired with ex situ UV-Vis reflection measurement, cross-sectional scanning electron microscopy (SEM), and small-angle X-ray scattering (SAXS) to probe the evolution of domain microstructure. Photonic properties were observed to saturate within minutes of annealing at 150 °C, with distinct variation in transmission response as a function of film thickness. The depth of the highly aligned surface region was found to vary stochastically in the range of 30-100 lamellar periods, with the sharpness of the orientation gradient decreasing substantially with increasing film thickness. This observation suggests a competition between growth of aligned, heterogeneously nucleated, grains at the surface and orientationally isotropic, homogeneously nucleated, grains throughout the bulk. This work demonstrates the high potential of bottlebrush block copolymers in rapid fabrication workflows and provides a point of comparison for future application of directed self-assembly to BBCP ordering.

Pathogenesis and management of Brugada syndrome in schizophrenia: A scoping review.

CONTEXT: Excess cardiovascular morbidity and an increased prevalence of sudden cardiac death (SCD) contributes to premature mortality in schizophrenia. Brugada syndrome (BrS) is an important but underrecognized cause of SCD. It is more commonly seen in schizophrenia than in general population controls. METHODS: We conducted a scoping review to describe the pathogenesis of BrS in schizophrenia and to identify the psychotropic medications that increase the risk of unmasking BrS and associated ventricular arrhythmias resulting in SCD. FINDINGS: Schizophrenia and BrS share similar calcium channel abnormalities, which may result in aberrant myocardial conductivity. It remains uncertain if there is a genetic pre-disposition for BrS in a subset of patients with schizophrenia. However, the unmasking of Brugada ECG patterns with the use of certain antipsychotics and antidepressants increases the risk of precipitating SCD, independent of QT prolongation. CONCLUSIONS AND FUTURE DIRECTIONS: Specific cardiology assessment and interventions may be required for the congenital or unmasked Brugada ECG pattern in schizophrenia. The current long-term standard of care for BrS is an implantable cardioverter defibrillator (ICD), but post-implantation psychological effects must be considered. Careful use of antipsychotic and other psychotropic medications is necessary to minimize proarrhythmic effects due to impact on cardiac sodium and calcium ion channels. When prescribing such drugs to patients with schizophrenia, clinicians should be mindful of the potentially fatal unmasking of Brugada ECG patterns and how to manage it. We present recommendations for psychiatrists managing this patient population.

Tunable structural color of bottlebrush block copolymers through direct-write 3D printing from solution.

Additive manufacturing of functional materials is limited by control of microstructure and assembly at the nanoscale. In this work, we integrate nonequilibrium self-assembly with direct-write three-dimensional (3D) printing to prepare bottlebrush block copolymer (BBCP) photonic crystals (PCs) with tunable structure color. After varying deposition conditions during printing of a single ink solution, peak reflected wavelength for BBCP PCs span a range of 403 to 626 nm (blue to red), corresponding to an estimated change in d-spacing of >70 nm (Bragg- Snell equation). Physical characterization confirms that these vivid optical effects are underpinned by tuning of lamellar domain spacing, which we attribute to modulation of polymer conformation. Using in situ optical microscopy and solvent-vapor annealing, we identify kinetic trapping of metastable microstructures during printing as the mechanism for domain size control. More generally, we present a robust processing scheme with potential for on-the-fly property tuning of a variety of functional materials.

General route to design polymer molecular weight distributions through flow chemistry.

The properties of a polymer are known to be intrinsically related to its molecular weight distribution (MWD); however, previous methodologies of MWD control do not use a design and result in arbitrary shaped MWDs. Here we report a precise design to synthesis protocol for producing a targeted MWD design with a simple to use, and chemistry agnostic computer-controlled tubular flow reactor. To support the development of this protocol, we constructed general reactor design rules by combining fluid mechanical principles, polymerization kinetics, and experiments. The ring opening polymerization of lactide, the anionic polymerization of styrene, and the ring opening metathesis polymerization are used as model polymerizations to develop the reactor design rules and synthesize MWD profiles. The derivation of a mathematical model enables the quantitative prediction of the experimental results, and this model provides a tool to explore the limits of any MWD design protocol.

Color, structure, and rheology of a diblock bottlebrush copolymer solution.

A structure-property-process relation is established for a diblock bottlebrush copolymer solution, through a combination of rheo-neutron scattering, imaging, and rheological measurements. Polylactic acid-b-polystyrene diblock bottlebrush copolymers were dispersed in toluene with a concentration of 175 mg ml-1, where they self-assembled into a lamellar phase. All measurements were carried out at 5 °C. The solution color, as observed in reflection, is shown to be a function of the shear rate. Under equilibrium and near-equilibrium conditions, the solution has a green color. At low shear rates the solution remains green, while at intermediate rates the solution is cyan. At the highest rates applied the solution is indigo. The lamellar spacing is shown to be a decreasing function of shear rate, partially accounting for the color change. The lamellae are oriented 'face-on' with the wall under quiescence and low shear rates, while a switch to 'edge-on' is observed at the highest shear rates, where the reflected color disappears. The intramolecular distance between bottlebrush polymers does not change with shear rate, although at high shear rates, the bottlebrush polymers are preferentially aligned in the vorticity direction within the lamellae. We therefore form a consistent relation between structure and function, spanning a wide range of length scales and shear rates.

The impossible gallbladder: aspiration as an alternative to conversion.

BACKGROUND: Laparoscopic cholecystectomy is the standard of care for symptomatic gallstone disease but when laparoscopic removal proves impossible the standard advice is to convert to open surgery. This jettisons the advantages of laparoscopy for a procedure which surgeons no longer perform routinely, so it may no longer be the safest practice. We hypothesised that gallbladder aspiration would be a safer alternative when laparoscopic removal is impossible. METHODS: A retrospective analysis was performed of all laparoscopic cholecystectomies attempted under one surgeon's care over 19 years, and the outcomes of gallbladder aspiration were compared with the standard conversion-to-open procedure within the same institution. RESULTS: Of 757 laparoscopic cholecystectomies attempted, 714 (94.3%) were successful, while 40 (5.3%) were impossible laparoscopically and underwent gallbladder aspiration. Interval cholecystectomy was later performed in 34/40 (85%). Only 3/757 (0.4%) were converted to open. No aspiration-related complications occurred and excessive bile leakage from the gallbladder was not observed. During this time 1209 laparoscopic cholecystectomies were attempted by other surgeons in the institution of which 55 (4.55%) were converted to open and 22 (40%) had procedure-associated complications. There was a significant difference in the mean (± SEM) post-operative hospital stay between laparoscopic gallbladder aspiration [3.12 (± 0.558) days] and institutional conversion-to-open cholecystectomy [9.38 (± 1.04) days] (p < 0.001), with attendant cost savings. CONCLUSION: Laparoscopic gallbladder aspiration is a safe alternative to conversion when inflammation makes cholecystectomy impossible laparoscopically, especially in the sickest patients and for surgeons with limited open surgery experience. This approach minimises morbidity and permits laparoscopic cholecystectomy in the majority after a suitable interval or referral of predicted difficult cases to specialist hepatobiliary centres.

Mechanistic and Kinetic Studies of the Ring Opening Metathesis Polymerization of Norbornenyl Monomers by a Grubbs Third Generation Catalyst.

The mechanism of ring-opening metathesis polymerization (ROMP) for a set of functionalized norbornenyl monomers initiated by a Grubbs third generation precatalyst [(H2IMes)(pyr)2(Cl)2Ru═CHPh] was investigated. Through a series of 12C/13C and 1H/2H kinetic isotope effect studies, the rate-determining step for the polymerization was determined to be the formation of the metallacyclobutane ring. This experimental result was further validated through DFT calculations showing that the highest energy transition state is metallacyclobutane formation. The effect of monomer stereochemistry (exo vs endo) of two types of ester substituted monomers was also investigated. Kinetic and spectroscopic evidence supporting the formation of a six-membered chelate through coordination of the proximal polymer ester to the Ru center is presented. This chelation and its impact on the rate of polymerization are shown to vary based on the monomer employed and its stereochemistry. The combination of this knowledge led to the derivation of a generic rate law describing the rate of polymerization of norbornene monomers initiated by a Grubbs third generation catalyst.

Dilute solution structure of bottlebrush polymers.

Bottlebrush polymers are a class of macromolecules that have recently found use in a wide variety of materials, ranging from lubricating brushes and nanostructured coatings to elastomeric gels that exhibit structural colors. These polymers are characterized by dense branches extending from a central backbone and thus have properties distinct from linear polymers. It remains a challenge to specifically understand conformational properties of these molecules, due to the wide range of architectural parameters that can be present in a system, and thus there is a need to accurately characterize and model these molecules. In this paper, we use a combination of viscometry, light scattering, and computer simulations to gain insight into the conformational properties of dilute solution bottlebrush polymers. We focus on a series of model bottlebrushes consisting of a poly(norbornene) (PNB) backbone with poly(lactic acid) (PLA) side chains. We demonstrate that intrinsic viscosity and hydrodynamic radius are experimental observations sensitive to molecular architecture, exhibiting distinct differences with different choices of branches and backbone lengths. Informed by the atomistic structure of this PNB-PLA system, we rationalize a coarse-grained simulation model that we evaluate using a combination of Brownian dynamics and Monte Carlo simulations. We show that this exhibits quantitative matching to experimental results, enabling us to characterize the overall shape of the bottlebrush via a number of metrics that can be extended to more general bottlebrush architectures.

Macromolecules with programmable shape, size, and chemistry.

Shape, size, and composition are the most fundamental design features, enabling highly complex functionalities. Despite recent advances, the independent control of shape, size, and chemistry of macromolecules remains a synthetic challenge. We report a scalable methodology to produce large, well-defined macromolecules with programmable shape, size, and chemistry that combines reactor engineering principles and controlled polymerizations. Specifically, bottlebrush polymers with conical, ellipsoidal, and concave architectures are synthesized using two orthogonal polymerizations. The chemical versatility is highlighted by the synthesis of a compositional asymmetric cone. The strong agreement between predictions and experiments validates the precision that this methodology offers.

Catalytic synthesis of functionalized (polar and non-polar) polyolefin block copolymers.

Herein, we report a methodology for the synthesis of polyolefin containing block-copolymers using a catalytic postpolymerization modification strategy. The most common polyolefin grades are converted into macroinitiators using a cross-metathesis reaction. These functionalized polyolefins are then used to initiate living: coordinative ring opening polymerization of lactide, anionic ring opening polymerization of epoxide, and radical polymerization of styrene to yield the corresponding block copolymers. The high activity of the catalysts employed in the different steps offers improved practicality for scalable synthesis.

Kinetic Study of Living Ring-Opening Metathesis Polymerization with Third-Generation Grubbs Catalysts.

The rate of living ring-opening metathesis polymerization (ROMP) of N-hexyl-exo-norbornene-5,6-dicarboximide initiated by Grubbs third-generation catalyst precursors [(H2IMes)(py)2(Cl)2Ru═CHPh] and [(H2IMes)(3-Br-py)2(Cl)2Ru═CHPh] is measured to be independent of catalyst concentration. This result led to the development of a rate law describing living ROMP initiated by a Grubbs third-generation catalyst that includes an inverse first-order dependency in pyridine. Additionally, it is demonstrated that one of the two pyridines coordinated to the solid catalyst is fully dissociated in solution. The monopyridine adduct formation is confirmed in solution by 1H DOSY (diffusion-ordered NMR spectroscopy), and a Van't Hoff analysis of the equilibrium between mono- and dipyridine adducts (extrapolated Keq,0 ∼ 0.5 at 25 °C). Finally, the difference in polymerization rates between two catalyst precursors is demonstrated to correspond to the difference in coordination strength between the two pyridines, suggesting that the catalytic species involved in the polymerization's rate-determining step is not coordinated to pyridine.

Development and Mechanistic Study of Quinoline-Directed Acyl C-O Bond Activation and Alkene Oxyacylation Reactions.

The intramolecular addition of both an alkoxy and acyl substituent across an alkene, oxyacylation of alkenes, using rhodium catalyzed C-O bond activation of an 8-quinolinyl ester is described. Our unsuccessful attempts at intramolecular carboacylation of ketones via C-C bond activation ultimately informed our choice to pursue and develop the intramolecular oxyacylation of alkenes via quinoline-directed C-O bond activation. We provide a full account of our catalyst discovery, substrate scope, and mechanistic experiments for quinoline-directed alkene oxyacylation.