Driving in Massachusetts: When to Stop and Who Should Decide?

The purpose of this exploratory research was to assess three stakeholders’ perceptions of the locus of responsibility for driving cessation and identify the criteria that should be included in that decision. The stakeholder groups studied were law enforcement officers, physicians, and the general public age 50 years and older. Defining areas of agreement and disagreement across stakeholders will be valuable for informing policy makers who may be considering statewide or national initiatives. Findings will also be useful for public information and training

Recovery of Alumina From Coal Fly Ash By High Temperature Chlorination

The recovery of metals from low value sources will help reduce our national demand for foreign resources. The ash from bituminous type coals contains about 20 percent aluminum oxide and 20 percent iron oxides by weight. Recovery of these metals would provide an alternate source to the ores now used. The iron and aluminum materials in fly ash are recoverable by high temperature chlorination. Passing dry chlorine gas through a bed of nonmagnetic fly ash maintained at 850 to 900 degrees C. chlorinates the iron and aluminum constituents forming volatile compounds which are carried from the bed by the exit gas stream. In exploratory runs, 55 percent of the aluminum has been recovered as aluminum chloride in a nearly silica-free state

The Magnetic Fraction of Coal Fly Ash: Its Separation, Properties, and Utilization

A laboratory-size electromagnetic device has been built to separate the high-iron magnetic fraction from coal fly ash. Fly ash, the fine particulate matter produced when pulverized coal is burned, contains an average of 18 wt. percent iron expressed as Fe2O3 found in a distinctive fraction of finely divided, dense, largely spheroidal particles of high magnetic susceptibility. Seventy to eighty percent of the iron in bituminous coal fly ash is found in this fraction which represents about 20 weight percent or 10 volume percent of the fly ash. In this work the iron-rich fraction has been characterized as to particle size, composition, and density. It appears to have a market potential as a material for preparation of high-density media used in coal washing and other mineral dressing processes. Dense-media material, which costs about $100 per metric ton, is being utilized in increasingly large quantities as the demand for washed coal expands. The magnetic fraction also appears to have potential as a source of iron. If further processing can reduce the silica level found in the fraction as it is separated from the ash, pellets with a composition similar to taconite can be prepared for use as blast furnace feed. Separation and use of this fraction of the coal ash could be profitable for utility companies and could be the beginning of the utilization of the large amount of ash which now constitutes a waste disposal problem

The Frank J. Manning Certificate in Gerontology Alumni Survey: 21 Years of Service to Elders

The Certificate Program in Gerontology at the University of Massachusetts Boston, a large urban university, was established in 1979 as part of an Administration on Aging (AoA) grant to develop and expand services to the elderly citizens of the Commonwealth of Massachusetts. In 1984, a line item was added to the state budget by the legislature and governor establishing the Gerontology Institute at the University of Massachusetts Boston and ensuring the continuation of training, research, and policy and advocacy work on behalf of and with Massachusetts’ elders (O’Brien, 1996). Upon Frank J. Manning’s death in 1986, the program was renamed the “Manning Certificate Program” in honor of Manning, a retired labor leader and an enthusiastic advocate of senior rights who was a charismatic and powerful leader of Massachusetts elders in the 1960s and 1970s. This report describes the measurable outcomes of that well-established program. Specifically, alumni representing classes since 1980 were surveyed to learn the extent of their involvement in employment, advocacy, and volunteer experiences in working with elders since completion of the Manning Certificate. Insights were also gained from other outcomes of their learning experiences in terms of their own aging and assistance with the aging of family members and friends. This study will help document the value of certificate-level training in Gerontology for its students and for the communities they serve

Functional outcomes of patients undergoing anterolateral versus anteromedial approaches of the ankle for pilon fractures

Pilon fractures of the distal tibia remain a treatment challenge to orthopedists. Careful preoperative planning is crucial to achieving desirable clinical outcomes, but currently the literature does not reach a consensus on which surgical approach is optimal. This study examines functional outcomes of two of the most common surgical approaches for pilon fractures, the traditional anteromedial approach and the more recently described anterolateral approach. The anterolateral approach is thought to produce better outcomes because of the greater amount of visualization into the articular surface and greater soft tissue coverage for the implant

Specific Alterations in Complement Protein Activity of Little Brown Myotis (Myotis lucifugus) Hibernating in White-Nose Syndrome Affected Sites

White-nose syndrome (WNS) is the most devastating condition ever reported for hibernating bats, causing widespread mortality in the northeastern United States. The syndrome is characterized by cutaneous lesions caused by a recently identified psychrophilic and keratinophylic fungus (Geomyces destructans), depleted fat reserves, atypical behavior, and damage to wings; however, the proximate cause of mortality is still uncertain. To assess relative levels of immunocompetence in bats hibernating in WNS-affected sites compared with levels in unaffected bats, we describe blood plasma complement protein activity in hibernating little brown myotis (Myotis lucifugus) based on microbicidal competence assays using Escherichia coli, Staphylococcus aureus and Candida albicans. Blood plasma from bats collected during mid-hibernation at WNS-affected sites had higher bactericidal ability against E. coli and S. aureus, but lower fungicidal ability against C. albicans when compared with blood plasma from bats collected at unaffected sites. Within affected sites during mid-hibernation, we observed no difference in microbicidal ability between bats displaying obvious fungal infections compared to those without. Bactericidal ability against E. coli decreased significantly as hibernation progressed in bats collected from an affected site. Bactericidal ability against E. coli and fungicidal ability against C. albicans were positively correlated with body mass index (BMI) during late hibernation. We also compared complement activity against the three microbes within individuals and found that the ability of blood plasma from hibernating M. lucifugus to lyse microbial cells differed as follows: E. coli>S. aureus>C. albicans. Overall, bats affected by WNS experience both relatively elevated and reduced innate immune responses depending on the microbe tested, although the cause of observed immunological changes remains unknown. Additionally, considerable trade-offs may exist between energy conservation and immunological responses. Relationships between immune activity and torpor, including associated energy expenditure, are likely critical components in the development of WNS

Study of How Adiposity in Pregnancy has an Effect on outcomeS (SHAPES):protocol for a prospective cohort study

Introduction Maternal obesity increases the risk of multiple maternal and infant pregnancy complications, such as gestational diabetes and pre-eclampsia. Current UK guidelines use body mass index (BMI) to identify which women require additional care due to increased risk of complications. However, BMI may not accurately predict which women will develop complications during pregnancy as it does not determine amount and distribution of adipose tissue. Some adiposity measures (eg, waist circumference, ultrasound measures of abdominal visceral fat) can better identify where body fat is stored, which may be useful in predicting those women who need additional care.Methods and analysis This prospective cohort study (SHAPES, Study of How Adiposity in Pregnancy has an Effect on outcomeS) aims to evaluate the prognostic performance of adiposity measures (either alone or in combination with other adiposity, sociodemographic or clinical measures) to estimate risk of adverse pregnancy outcomes. Pregnant women (n=1400) will be recruited at their first trimester ultrasound scan (11+2–14+1 weeks’) at Newcastle upon Tyne National Health Service Foundation Trust, UK. Early pregnancy adiposity measures and clinical and sociodemographic data will be collected. Routine data on maternal and infant pregnancy outcomes will be collected from routine hospital records. Regression methods will be used to compare the different adiposity measures with BMI in terms of their ability to predict pregnancy complications. If no individual measure performs better than BMI, multivariable models will be developed and evaluated to identify the most parsimonious model. The apparent performance of the developed model will be summarised using calibration, discrimination and internal validation analyses.Ethics and dissemination Ethical favourable opinion has been obtained from the North East: Newcastle & North Tyneside 1 Research Ethics Committee (REC reference: 22/NE/0035). All participants provide informed consent to take part in SHAPES. Planned dissemination includes peer-reviewed publications and additional dissemination appropriate to target audiences, including policy briefs for policymakers, media/social-media coverage for public and conferences for researchTrial registration number ISRCTN82185177

Novel role of extracellular matrix protein 1 (ECM1) in cardiac aging and myocardial infarction

© 2019 Hardy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction The prevalence of heart failure increases in the aging population and following myocardial infarction (MI), yet the extracellular matrix (ECM) remodeling underpinning the development of aging- and MI-associated cardiac fibrosis remains poorly understood. A link between inflammation and fibrosis in the heart has long been appreciated, but has mechanistically remained undefined. We investigated the expression of a novel protein, extracellular matrix protein 1 (ECM1) in the aging and infarcted heart. Methods Young adult (3-month old) and aging (18-month old) C57BL/6 mice were assessed. Young mice were subjected to left anterior descending artery-ligation to induce MI, or transverse aortic constriction (TAC) surgery to induce pressure-overload cardiomyopathy. Left ventricle (LV) tissue was collected early and late post-MI/TAC. Bone marrow cells (BMCs) were isolated from young healthy mice, and subject to flow cytometry. Human cardiac fibroblast (CFb), myocyte, and coronary artery endothelial & smooth muscle cell lines were cultured; human CFbs were treated with recombinant ECM1. Primary mouse CFbs were cultured and treated with recombinant angiotensin-II or TGF-β1. Immunoblotting, qPCR and mRNA fluorescent in-situ hybridization (mRNA-FISH) were conducted on LV tissue and cells. Results ECM1 expression was upregulated in the aging LV, and in the infarct zone of the LV early post-MI. No significant differences in ECM1 expression were found late post-MI or at any time-point post-TAC. ECM1 was not expressed in any resident cardiac cells, but ECM1 was highly expressed in BMCs, with high ECM1 expression in granulocytes. Flow cytometry of bone marrow revealed ECM1 expression in large granular leucocytes. mRNA-FISH revealed that ECM1 was indeed expressed by inflammatory cells in the infarct zone at day-3 post-MI. ECM1 stimulation of CFbs induced ERK1/2 and AKT activation and collagen-I expression, suggesting a pro-fibrotic role. Conclusions ECM1 expression is increased in ageing and infarcted hearts but is not expressed by resident cardiac cells. Instead it is expressed by bone marrow-derived granulocytes. ECM1 is sufficient to induce cardiac fibroblast stimulation in vitro. Our findings suggest ECM1 is released from infiltrating inflammatory cells, which leads to cardiac fibroblast stimulation and fibrosis in aging and MI. ECM1 may be a novel intermediary between inflammation and fibrosis

Cigarette Smoke-Induced Placental Adrenomedullin Expression and Trophoblast Cell Invasion

Smoking in pregnancy reduces preeclampsia risk, but the mechanism of this effect is unknown. Prior studies have demonstrated that women with preeclampsia have lower placental adrenomedullin (AM) expression, and cigarette smoke extract (CSE) treatment of placental trophoblast cells in culture increases AM cellular production. We hypothesized that CSE alters trophoblast invasion through an AM-mediated mechanism, and that placental AM expression is greater among smokers. HTR-8/SVneo trophoblast cells were incubated for 24 hours in Matrigel-invasion chambers with 6 treatment groups: nonstimulated (NS), AM, AM inhibitor (AM22-52), 1% CSE, AM + AM22-52, and 1% CSE + AM22-52. Cells that penetrated the lower surface of the chambers were quantified, invasion indices were calculated, and compared using a 1-way analysis of variance with Bonferroni corrections for multiple comparisons. Trophoblast cells treated with both AM and 1% CSE demonstrated increased cellular invasion compared to NS controls (1.5-fold [P < .01] and 1.45-fold [P < .01], respectively). Cotreatment with the AM inhibitor significantly attenuated the increased invasion seen with both AM and CSE alone. Next, the placental tissue was obtained from 11 smokers and 11 nonsmokers at term and processed for immunohistochemistry (IHC) and real-time quantitative polymerase chain reaction (PCR) for AM. Placentas from smokers demonstrated more intense AM staining and increased AM gene (ADM) expression compared to placentas from nonsmokers (P = .004 for IHC, P = .022 for PCR). The CSE increases trophoblast cell invasion through an AM-mediated process, and placental AM expression is increased among term smokers compared to nonsmokers. These findings provide evidence that the AM pathway may play a role in the protection from preeclampsia seen in smokers