Nonlinear viscoelastic characterization of polymer materials using a dynamic-mechanical methodology

Polymer materials retrieved from LDEF exhibit nonlinear constitutive behavior; thus the authors present a method to characterize nonlinear viscoelastic behavior using measurements from dynamic (oscillatory) mechanical tests. Frequency-derived measurements are transformed into time-domain properties providing the capability to predict long term material performance without a lengthy experimentation program. Results are presented for thin-film high-performance polymer materials used in the fabrication of high-altitude scientific balloons. Predictions based upon a linear test and analysis approach are shown to deteriorate for moderate to high stress levels expected for extended applications. Tests verify that nonlinear viscoelastic response is induced by large stresses. Hence, an approach is developed in which the stress-dependent behavior is examined in a manner analogous to modeling temperature-dependent behavior with time-temperature correspondence and superposition principles. The development leads to time-stress correspondence and superposition of measurements obtained through dynamic mechanical tests. Predictions of material behavior using measurements based upon linear and nonlinear approaches are compared with experimental results obtained from traditional creep tests. Excellent agreement is shown for the nonlinear model

Middle Segment Pancreatectomy: A Useful Tool in the Management of Pancreatic Neoplasms

Small, benign, or low-grade malignant tumors located in the neck of the pancreas are usually treated with enucleation. However, if enucleation is too risky because of possible damage of the main pancreatic duct, standard pancreatic resections are performed. Such operations can lead to impaired long-term exocrine–endocrine function. Middle segment pancreatectomy consists of a limited resection of the midportion of the pancreas and can be performed in selected patients affected by tumors of the pancreatic neck. Middle segment pancreatectomy is a safe and feasible procedure for treating tumors of the pancreatic neck; in experienced hands it is associated with no mortality but with high morbidity, even if the rate of “clinical” pancreatic fistula is about 20%. Moreover, it allows a surgeon to preserve pancreatic parenchyma and consequently long-term endocrine and exocrine pancreatic function

The effects of integrated care: a systematic review of UK and international evidence

BACKGROUND: Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS: The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS: One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS: Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION: Prospero registration number: 42016037725

Interview with A. Hamblin Letton, MD, FACS

An Interview with A. Hamblin Letton, MD by N. Don Macon. An MDA-TV Presentation. Department of Medical Communication. Presented by The University of Texas System Cancer Center. M. D. Anderson Hospital and Tumor Institute. MDAH #778-1-77. Video recorded 8/11/1977. Runtime is 26:34 minutes. See more at https://archives.library.tmc.edu/avv-ic084-068

Accessory spleen presenting as acute abdomen: A case report and operative management

Accessory spleens are found in 10–30% of patients and are asymptomatic. Rarely, torsion of an accessory spleen can cause abdominal pain and acute abdomen. We present the case of an 8-year-old girl who arrives to the emergency room with left upper quadrant abdominal pain. CT scan revealed a non-enhancing soft tissue mass and multiple small splenules. Laparoscopy revealed a torsed accessory spleen and malrotation. Accessory spleen is a common congenital anomaly that is frequently asymptomatic. Rarely, an accessory spleen may become torsed around its vascular pedicle resulting in severe abdominal pain. Treatment is surgical resection. Torsion of accessory splenic tissue is a rare cause of acute abdomen in pediatric patients