Dysfunctional stem and progenitor cells impair fracture healing with age

Successful fracture healing requires the simultaneous regeneration of both the bone and vasculature; mesenchymal stem cells (MSCs) are directed to replace the bone tissue, while endothelial progenitor cells (EPCs) form the new vasculature that supplies blood to the fracture site. In the elderly, the healing process is slowed, partly due to decreased regenerative function of these stem and progenitor cells. MSCs from older individuals are impaired with regard to cell number, proliferative capacity, ability to migrate, and osteochondrogenic differentiation potential. The proliferation, migration and function of EPCs are also compromised with advanced age. Although the reasons for cellular dysfunction with age are complex and multidimensional, reduced expression of growth factors, accumulation of oxidative damage from reactive oxygen species, and altered signaling of the Sirtuin-1 pathway are contributing factors to aging at the cellular level of both MSCs and EPCs. Because of these geriatric-specific issues, effective treatment for fracture repair may require new therapeutic techniques to restore cellular function. Some suggested directions for potential treatments include cellular therapies, pharmacological agents, treatments targeting age-related molecular mechanisms, and physical therapeutics. Advanced age is the primary risk factor for a fracture, due to the low bone mass and inferior bone quality associated with aging; a better understanding of the dysfunctional behavior of the aging cell will provide a foundation for new treatments to decrease healing time and reduce the development of complications during the extended recovery from fracture healing in the elderly

Nanomechanical Properties and Phase Transitions in a Double-Walled (5,5)@(10,10) Carbon Nanotube: ab initio Calculations

The structure and elastic properties of (5,5) and (10,10) nanotubes, as well as barriers for relative rotation of the walls and their relative sliding along the axis in a double-walled (5,5)@(10,10) carbon nanotube, are calculated using the density functional method. The results of these calculations are the basis for estimating the following physical quantities: shear strengths and diffusion coefficients for relative sliding along the axis and rotation of the walls, as well as frequencies of relative rotational and translational oscillations of the walls. The commensurability-incommensurability phase transition is analyzed. The length of the incommensurability defect is estimated on the basis of ab initio calculations. It is proposed that (5,5)@(10,10) double-walled carbon nanotube be used as a plain bearing. The possibility of experimental verification of the results is discussed.Comment: 14 page

Evaluation of Broadcast Steam Application with Mustard Seed Meal in Fruiting Strawberry

Soil disinfestation with steam has potential to partially replace fumigants such as methyl bromide, chloropicrin, and 1,3-dichloropropene because it is effective, safer to apply, and has less negative impact on the environment. Here, we compared the efficacy of steam and steam + mustard seed meal (MSM) to chloropicrin on soil disinfection, plant growth, and fruit yield in a strawberry (Fragaria ×ananassa) fruiting field. The MSM was applied at 3368 kg·ha−1 before the steam application. Steam was injected into a 3-m-wide reverse tiller that was set to till 30 to 40 cm deep. Soil temperatures at depths of 10, 20, 25, and 35 cm were monitored. Steam and steam + MSM treatments reduced the viability of purslane seeds and nutsedge tubers, microsclerotia density of Verticillium dahliae, propagule density of Pythium ultimum, cumulative weed densities, and biomass compared with the nontreated control. Moreover, the steam application was as efficacious as chloropicrin on these pests. The growth and fruit yield of strawberries grown on soils previously treated with the steam and steam + MSM treatments were similar to those in the chloropicrin treatment and were higher than those in the nontreated control. Our study indicated that steam, steam + MSM, and chloropicrin are equally effective at suppressing weeds and soilborne pathogens. These results suggest that the steam and steam + MSM treatment can be a practical alternative for soil disinfestation in conventional and organic strawberry fields

Preterm labor: Enhancing assessment competency and reducing variation among telephonic maternity care managers in a managed care organization

Session presented on Saturday, November 7, 2015 and Sunday, November 8, 2015: Introduction/Background: Preterm labor is a major public health issue that has substantial direct and indirect costs including staggering health care costs from prolonged neonatal intensive care unit (NICU) hospitalization; potential long-term health consequences such as cerebral palsy, mental retardation and blindness that can impact overall quality of life; and significant emotional costs for the family from increased levels of stress and potential loss of income. More than 50% of preterm births occur among women with no identifiable risk factors. It is essential that pregnant women be assessed for actual and potential risk factors and educated about their risk status, signs and symptoms of preterm labor, and the importance of early medical intervention. The UPMC Health Plan, a part of the UPMC Health System, is a regional managed care organization located in Pittsburgh, PA. The UPMC Health Plan shares a common set of values with the rest of the system to create a consistent UPMC experience across the continuum for the patients, health plan members, employees, and the communities it serves. A telephonic maternity care management program is available for pregnant members with commercial health insurance, as well as members enrolled in government programs such as Medical Assistance. The program is staffed by thirteen registered nurses with extensive obstetrical nursing experience functioning in the role of maternity care managers. The maternity care manager contacts the member by telephone, completes a comprehensive assessment, and offers prenatal and postpartum education. The average caseload per nurse is 185 members. Purpose: The purposes of this project were to develop a preterm labor competency assessment to identify gaps in existing knowledge and assess the comfort level of thirteen registered nurses in the maternity program working telephonically with pregnant women whom may experience preterm labor during their pregnancy, to develop a preterm labor learning module using current evidence-based research and practice guidelines, and to devise a standardized care pathway to ensure consistency of risk assessment and education provided to UPMC Health Plan members enrolled in the telephonic maternity care management program. Methods: Through the Sigma Theta Tau International (STTI) Maternal-Child Health (MCH) Nurse Leadership Academy, sponsored by Johnson & Johnson, this fellow; Laura Fennimore, the leadership mentor; and Catherine Burns, the STTI MCH faculty advisor, participated in a faculty guided leadership and mentorship program to acquire and enhance leadership skills necessary to facilitate a quality improvement project focused on improving maternal-child outcomes. The Fellow used a team of nine healthcare professionals that consisted of maternity nurse case managers, hospital-based nurses, physicians, and project analysts to help develop the project using a Logic Model framework. Team members conducted a review of literature and current practice guidelines for preterm labor related to risk factors, diagnosis, treatment and pertinent patient education to develop staff education content. A PowerPoint presentation was developed and presented to maternity staff along with a preterm labor resource packet. In addition, the team is developing a standardized preterm labor care pathway to be utilized by all maternity care managers to help reduce variation in assessment of risk and improve pregnancy outcomes. A number of evaluation strategies were used to evaluate the success of the project. A pre/post-education survey using a five point Likert scale was developed and provided to all maternity care managers to assess their overall comfort level related to preterm labor management and caring for women experiencing this pregnancy complication. Since all calls with members are recorded, a call and chart audit tool was developed to evaluate change in care manager behavior related to risk assessment of preterm labor and the consistency of patient education provided pre-education and post-education. Audits are planned for 3 month intervals to determine the extent of nurse behavior change and if change was sustained over time. Constructive feedback and coaching is provided to staff members as needed. The data analysis will include individual and group results. Maternity assessments utilized by the maternity care managers will be revised to improve assessment of risk and identify opportunities for patient education. Results: The pre and post education surveys of the nurse case managers showed improvement in their overall comfort level of nursing care for pregnant women experiencing preterm labor. The mean overall comfort level on the pre-education survey of 4 increased to 4.6 on the post-education survey and an increase of 24% indicating feeling extremely comfortable. All of the nurse case managers indicated that they were extremely likely to incorporate the information provided into nursing practice and 70% rated their comfort level regarding their role as case manager caring for this population as extremely comfortable. The pre-education and post-education call and chart audits results are still being collected and evaluated. Findings will be reported at a later date. Calls and charts audited at the following intervals; pre-education and post-education. Constructive feedback is provided to maternity case managers as individuals and as a group on an ongoing basis to ensure staff remains competent. The electronic medical record template for maternity assessments has been redesigned to enhance risk assessment. Conclusions: The project found that prior to the intervention there was significant variation among the care managers in the assessment of preterm labor risk and patient education provided. In addition, the information provided to members was not consistent with current evidence based practice guidelines. Following the education program, utilization of the written module, use of the improved EMR template, feedback from call and chart audits, and development of a standardized care pathway, the expectation is improved consistency of risk assessment and education provided by the maternity case managers to pregnant women enrolled in the telephonic maternity care management program at UPMC Health Plan. Additionally, the project provided a vehicle for discussions with a variety of obstetrical providers including private and outpatient clinic obstetric practices and the inpatient hospital staff to look at provision of system wide best practices to educate pregnant patients about preterm labor risk factors, reduction and prevention of risks, and early identification of preterm labor to minimize risks and enhance pregnancy outcomes. As a fellow in the STTI MCH Nurse Leadership Academy, the fellow has learned to apply the five Kouzes and Posner leadership principles to her role as manager of the UPMC Health Plan Maternity Program. The fellow models the way through her commitment to the highest standards for professionalism and personal integrity in her daily work with her team and makes exceeding expectations a priority. In the past few months, she has worked closely with her director to inspire a shared vision and challenge the process for changes within the maternity program as the team strives to improve efficiency and effectiveness, and improve member engagement levels. The fellow has enabled others to act by engaging staff in various aspects of this project by involving them in the research for current evidence based practices and the development of preterm labor course content. Staff were also included in the decision making process which helped to facilitate the successful adoption of program changes by the team. The fellow encourages the heart of her team members by actively listening to the personal concerns of her staff, celebrating their personal and professional milestones, and by promoting the maternity program to medical directors, other departments, and to the OB provider community

Interlayer Registry Determines the Sliding Potential of Layered Metal Dichalcogenides: The case of 2H-MoS2

We provide a simple and intuitive explanation for the interlayer sliding energy landscape of metal dichalcogenides. Based on the recently introduced registry index (RI) concept, we define a purely geometrical parameter which quantifies the degree of interlayer commensurability in the layered phase of molybdenum disulphide (2HMoS2). A direct relation between the sliding energy landscape and the corresponding interlayer registry surface of 2H-MoS2 is discovered thus marking the registry index as a computationally efficient means for studying the tribology of complex nanoscale material interfaces in the wearless friction regime.Comment: 13 pages, 7 figure

Teaching Workplace Interprofessional Communication Effectively in Undergraduate Nursing Students

The project used strategies (trigger videos and scripting) to promote skilled communication in student nurses\u27 management of difficult conversations (incivility, delegation, performance issues, and hand-off reports) in the workplace. Practice with student-recorded cell phone videos and scripted responses to trigger videos build students\u27 resilience and self-efficacy fostering healthy work environments

Incorporating Statistical Strategy into Image Analysis to Estimate Effects of Steam and Allyl Isocyanate on Weed Control

Weeds are the major limitation to efficient crop production, and effective weed management is necessary to prevent yield losses due to crop-weed competition. Assessments of the relative efficacy of weed control treatments by traditional counting methods is labor intensive and expensive. More efficient methods are needed for weed control assessments. There is extensive literature on advanced techniques of image analysis for weed recognition, identification, classification, and leaf area, but there is limited information on statistical methods for hypothesis testing when data are obtained by image analysis (RGB decimal code). A traditional multiple comparison test, such as the Dunnett-Tukey-Kramer (DTK) test, is not an optimal statistical strategy for the image analysis because it does not fully utilize information contained in RGB decimal code. In this article, a bootstrap method and a Poisson model are considered to incorporate RGB decimal codes and pixels for comparing multiple treatments on weed control. These statistical methods can also estimate interpretable parameters such as the relative proportion of weed coverage and weed densities. The simulation studies showed that the bootstrap method and the Poisson model are more powerful than the DTK test for a fixed significance level. Using these statistical methods, three soil disinfestation treatments, steam, allyl-isothiocyanate (AITC), and control, were compared. Steam was found to be significantly more effective than AITC, a difference which could not be detected by the DTK test. Our study demonstrates that an appropriate statistical method can leverage statistical power even with a simple RGB index

Evaluation of a Steam Application by a Mobile Applicator for Soil Disinfestation in Strawberry Nurseries

Soil disinfestation with steam has been evaluated in strawberry fruiting fields as a nonchemical method of soil disinfestation; however, little is known about the use of steam for field production of strawberry daughter plants. The objective of this study was to compare daughter plant production in soils previously treated with steam compared to those treated with standard methyl bromide (MB) and chloropicrin (Pic) treatments. A prototype field steam applicator and a self-propelled diesel-fueled steam generator and applicator were tested at two high-elevation nurseries near Macdoel, CA, in Sept. 2018 and Aug. 2020, respectively. The steam application heated the soil above 60 °C for ≈60 minutes to a depth of 25 cm at both nurseries. The pest control efficacy of the steam applications against weeds, Verticillium spp., Tylenchulus semipenetrans, and Pythium ultimum were similar to that of MB:Pic. The stolons and daughter plants densities in fields with steam treatment were similar to those in fields with MB:Pic treatment. Therefore, we suggest that soil disinfestation with steam may be a viable method of producing healthy strawberry plants. However, more research is needed to verify plant sanitation and quality

Engineering Nanomotor Components from Multi-Walled Carbon Nanotubes via Reactive Ion Etching

Abstract. It has been shown that a multi-walled carbon nanotube (MWCNT) can be used as the rotation enabling element for nanoelectromechanical systems. Modification of the MWCNT to create a rotational bearing in previous devices has concentrated on smaller diameter tubes and mechanical methods to create the bearing. We here investigate reactive ion etching of a MWCNT as a means to engineer nanomotor components, including the rotational bearing