A Multidimensional Approach to Improve Cardiovascular Quality Measure Documentation in a Native American Population

Native Americans are more likely than white counterparts to be diagnosed with heart disease (Office of Minority Health [OMH], 2017). The scholarly project was conducted in response to the need for improvement in cardiovascular lifestyle interventions for Native Americans and their documentation to meet Government Performance Results Act quality measures. The clinical question addressed was: what is an evidence-based multidimensional approach to improve cardiovascular quality measure documentation in a Native American primary care clinic? The multidimensional interventions included educational sessions for Community Health Representatives (CHRs), a provider education session on appropriate documentation in order to satisfy quality measures, chart review of pre and post intervention education documentation and a five year quality measure sustainability plan. The Health Promotion Theory and Kotter’s Change Model were used to develop and implement the intervention. The results indicated a small increase in heart healthy habits (7.7%) amongst CHRs, and small positive changes in heart healthy knowledge, with a 12.1% increase in knowledge on the first group of questions and a 16.2% increase in knowledge on the second group of heart healthy knowledge questions. The results of the provider intervention were favorable with a 28.3% increase in provider knowledge. Chart review was undertaken to determine if there was a significant difference between documented patient education by providers before and after the session. The results indicated a statistically significant change in properly documented education (p = 0.0198). The intervention was effective with a medium effect size (60%) in terms of increasing documentation of patient education which was the missing link the clinic needed in order to increase capture of cardiovascular quality metrics. The five- year strategic quality plan will help guide organizational stakeholders in the continued attainment of quality measures

Monitoring Gearbox Using a Wireless Temperature Node Powered by Thermal Energy Harvesting Module

Condition monitoring (CM) of gearbox is a crucial activity due to its importance in power transmission for many industrial applications. Monitoring temperature is an effective mean to collect useful information about the healthy conditions of the gearbox. This study investigates the use of a novel wireless temperature node to monitor and diagnose different faults on a gearbox transmission system under different conditions. The wireless temperature node was fabricated with a novel feature that it is supplied by a thermoelectric generator module mounted on the gearbox house to be monitored so that the measurement system avoids the shortage of using a wired power sources or the requirement for recharging or changing batteries. Moreover, the temperatures from lubricating oils and housing are modelled empirically to implement a model based detection. The results show that this monitoring approach allows a number of common faults: tooth breakage, oil shortage, and shaft misalignment to be separated under different loads, which demonstrates the outstanding performance of the proposed system and thus suitable for online and automated condition monitoring

Modeling the binding of H-NS to DNA

Bacterial chromosomal DNA is organized within a structure called the nucleoid, which is distinctly different from the rest of the cytoplasm. Bacteria have a number of nucleoid-associated proteins that influence the organization of the nucleoid by bending, wrapping or bridging DNA. The Histone-like Nucleoid Structuring protein H-NS can bridge DNA by binding to two separate DNA duplexes, or shield the DNA by binding to distant sites on the same duplex, depending on external conditions. H-NS occurs in Gram-negative enterobacteria and silences genes involved in bacterial virulence and antibiotic resistance

Celecoxib: considerations regarding its potential disease-modifying properties in osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease characterized by progressive loss of articular cartilage, subchondral bone sclerosis, osteophyte formation, and synovial inflammation, causing substantial physical disability, impaired quality of life, and significant health care utilization. Traditionally, non-steroidal anti-inflammatory drugs (NSAIDs), including selective cyclooxygenase (COX)-2 inhibitors, have been used to treat pain and inflammation in OA. Besides its anti-inflammatory properties, evidence is accumulating that celecoxib, one of the selective COX-2 inhibitors, has additional disease-modifying effects. Celecoxib was shown to affect all structures involved in OA pathogenesis: cartilage, bone, and synovium. As well as COX-2 inhibition, evidence indicates that celecoxib also modulates COX-2-independent signal transduction pathways. These findings raise the question of whether celecoxib, and potentially other coxibs, is more than just an anti-inflammatory and analgesic drug. Can celecoxib be considered a disease-modifying osteoarthritic drug? In this review, these direct effects of celecoxib on cartilage, bone, and synoviocytes in OA treatment are discussed

The Molecular Profile of Synovial Fluid Changes upon Joint Distraction and is Associated with Clinical Response in Knee Osteoarthritis

Objective: Surgical knee joint distraction (KJD) leads to clinical improvement in knee osteoarthritis (OA) and also apparent cartilage regeneration by magnetic resonance imaging. We investigated if alteration of the joint’s mechanical environment during the 6 week period of KJD was associated with a molecular response in synovial fluid, and if any change was associated with clinical response.Method: 20 individuals undergoing KJD for symptomatic radiographic knee OA had SF sampled at baseline, midpoint and endpoint of distraction (6 weeks). SF supernatants were measured by immunoassay for 10 predefined mechanosensitive molecules identified in our previous pre-clinical studies. The composite Knee injury and OA Outcome Score-4 (KOOS4) was collected at baseline, 3, 6 and 12 months.Results: 13/20 (65%) were male with mean age 54±5yrs. All had Kellgren-Lawrence grade≥2 knee OA. 6/10 analytes showed statistically significant change in SF over the 6 weeks distraction (activin A;TGFβ-1;MCP-1;IL-6;FGF-2;LTBP2), P<0.05. Of these, all but activin A increased. Those achieving the minimum clinically important difference of 10 points for KOOS4 over 6 months showed greater increases in FGF-2 and TGFβ-1 than non-responders. An increase in IL-8 during the 6 weeks of KJD was associated with significantly greater improvement in KOOS4 over 12 months.Conclusion: Detectable, significant molecular changes are observed in SF following KJD, that are remarkably consistent between individuals. Preliminary findings appear to suggest that increases in some molecules are associated with clinically meaningful responses. Joint distraction may provide a potential opportunity in the future to define regenerative biomarker(s) and identify pathways that drive intrinsic cartilage repair