Evaluation of a Virtual Team-Based Project Designed to Improve Chronic Wound Patient Care in Ontario, Canada.

OBJECTIVE: To evaluate the effectiveness of the Extension for Community Healthcare Outcomes Ontario Skin and Wound Care project, a virtual team-based endeavor designed to improve the care of patients with chronic wounds. METHODS: The study team conducted phone interviews with healthcare professionals (n = 8) regarding their patients (n = 10). The management recommendations were grouped, and the study participants questioned concerning the implementation of the recommendations. Interviews were recorded and transcribed, and the transcripts were analyzed for common themes. The Queen's University Research Ethics Board approved this study. RESULTS: Interviews documented improvement in 50% of patients; the other half of the patients did not improve because of patient- and healthcare-system barriers. Three of five nonhealing patients were nonadherent regarding compression, and only one of six suggested biopsies were carried out. The investigators noted three primary reasons for the lack of recommendation implementation: (1) could not obtain a diagnostic procedure, (2) lack of a diagnosis, and (3) patient was reluctant to make a lifestyle change. Major themes included problems in care coordination and suboptimal patient and provider education, along with other obstacles to management. CONCLUSIONS: Participants stated that the project provided a beneficial learning experience. The findings highlighted a lack of integrated and coordinated interprofessional chronic wound care.

Ancient proteins resolve the evolutionary history of Darwin's South American ungulates.

No large group of recently extinct placental mammals remains as evolutionarily cryptic as the approximately 280 genera grouped as 'South American native ungulates'. To Charles Darwin, who first collected their remains, they included perhaps the 'strangest animal[s] ever discovered'. Today, much like 180 years ago, it is no clearer whether they had one origin or several, arose before or after the Cretaceous/Palaeogene transition 66.2 million years ago, or are more likely to belong with the elephants and sirenians of superorder Afrotheria than with the euungulates (cattle, horses, and allies) of superorder Laurasiatheria. Morphology-based analyses have proved unconvincing because convergences are pervasive among unrelated ungulate-like placentals. Approaches using ancient DNA have also been unsuccessful, probably because of rapid DNA degradation in semitropical and temperate deposits. Here we apply proteomic analysis to screen bone samples of the Late Quaternary South American native ungulate taxa Toxodon (Notoungulata) and Macrauchenia (Litopterna) for phylogenetically informative protein sequences. For each ungulate, we obtain approximately 90% direct sequence coverage of type I collagen α1- and α2-chains, representing approximately 900 of 1,140 amino-acid residues for each subunit. A phylogeny is estimated from an alignment of these fossil sequences with collagen (I) gene transcripts from available mammalian genomes or mass spectrometrically derived sequence data obtained for this study. The resulting consensus tree agrees well with recent higher-level mammalian phylogenies. Toxodon and Macrauchenia form a monophyletic group whose sister taxon is not Afrotheria or any of its constituent clades as recently claimed, but instead crown Perissodactyla (horses, tapirs, and rhinoceroses). These results are consistent with the origin of at least some South American native ungulates from 'condylarths', a paraphyletic assembly of archaic placentals. With ongoing improvements in instrumentation and analytical procedures, proteomics may produce a revolution in systematics such as that achieved by genomics, but with the possibility of reaching much further back in time.

Wound Bed Preparation 2021.

GENERAL PURPOSE: To present the 2021 update of the Wound Bed Preparation paradigm. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will: 1. Apply wound assessment strategies. 2. Identify patient concerns about wound care. 3. Select management options for healable, nonhealable, and maintenance wounds.

Wound Bed Preparation is a paradigm to optimize chronic wound treatment. This holistic approach examines the treatment of the cause and patient-centered concerns to determine if a wound is healable, a maintenance wound, or nonhealable (palliative). For healable wounds (with adequate blood supply and a cause that can be corrected), moisture balance is indicated along with active debridement and control of local infection or abnormal inflammation. In maintenance and nonhealable wounds, the emphasis changes to patient comfort, relieving pain, controlling odor, preventing infection by decreasing bacteria on the wound surface, conservative debridement of slough, and moisture management including exudate control. In this fourth revision, the authors have reformulated the model into 10 statements. This article will focus on the literature in the last 5 years or new interpretations of older literature. This process is designed to facilitate knowledge translation in the clinical setting and improve patient outcomes at a lower cost to the healthcare system.

Evaluation of Longitudinal and Tubular Compression Treatment for Lower Limb Edema.

BACKGROUND: Many patients with lower limb edema do not tolerate traditional higher-pressure compression devices and require alternative devices for edema control. METHODS: Two systems were evaluated for control of bilateral or unilateral lower limb edema: an elasticized longitudinal stockinette (ELS; EdemaWear; Compression Dynamics, Omaha, Nebraska) and an elasticized tubular bandage (ETB; Tubigrip; Mölnlycke Health Care, Norcross, Georgia). Twenty-five patients were recruited; patients with bilateral edema (n = 12) wore the ELS on one limb, and the ETB on the other. Patients with unilateral edema (n = 13) were randomized to wear either the ELS or ETB. Edema measurements, leg pain, and patient preference were recorded. RESULTS: There were 14 females (56%) and 11 males (44%); mean age was 66 years (range, 32-88 years); and mean body mass index was 40.4 kg/m (range, 26.1-66.9 kg/m). Patients with bilateral edema wearing ELS had a foot-to-leg circumference between 25.5 and 42.9 cm pre-ELS that remained essentially unchanged at 2 weeks. The five patients with unilateral edema using ELS had a 24.3- to 43.7-cm circumference pre-ELS and 24.2- to 42.6-cm range at 2 weeks. The patients with bilateral edema using ETBs had a foot-to-leg circumference of 25.5 to 43.7 cm before treatment, unchanged 2 weeks later. The eight patients with unilateral edema using ETB had a 25.4- to 45.3-cm circumference pre-ETB and 24.8- to 42.0-cm range post-ETB. Mean pain levels decreased from 1.0 at week 0 to 0.5 at week 2. More patients preferred ELS (17/23, 78.3%) over ETB (5/23, 21.7%). CONCLUSIONS: Both systems were easy to apply and provided low compression without increased pain. The ELS was preferred by more patients (78.3%) than ETB (21.7%).

Invariance of experimental observables with respect to coarse-graining in standard and many-body dissipative particle dynamics.

Dissipative particle dynamics (DPD) is a well-established mesoscale simulation method. However, there have been long-standing ambiguities regarding the dependence of its (purely repulsive) force field parameter on temperature as well as the variation of the resulting experimental observables, such as diffusivity or surface tension, with coarse-graining (CG) degree. Here, we rederive the temperature dependence of DPD interaction parameter and revisit the role of the CG degree in standard DPD simulations. Consequently, we derive a scaling of the input variables that renders the system properties invariant with respect to CG degree and illustrate the versatility of the method by computing the surface tensions of binary solvent mixtures. We then extend this procedure to many-body dissipative particle dynamics and, by computing surface tensions of the same mixtures at a range of CG degrees, demonstrate that this newer method, which has not been widely applied so far, is also capable of simulating complex fluids of practical interest.

Validated 60-Second General Foot Screen: A Pilot Trial and Guide to Diagnoses and Treatment.

GENERAL PURPOSE: To provide information on a 60-second General Foot Screen to assist in the prevention and/or identification and management of common foot problems. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Use the 60-second General Foot Screen to assist healthcare professionals in the recognition of common foot problems.2. Identify risk factors, causes, and treatment of selected foot problems. ABSTRACT: Foot health is important to overall patient health. Early diagnosis and treatment of diabetes, neuropathy, fungal foot infections, foot deformity, and vascular disease/lower leg edema can improve patient quality of life. One way to achieve this is effective screening. To this end, researchers piloted a validated 10-item screening tool to assess foot health on 120 patients; 74.17% had at least one positive abnormality, demonstrating the critical importance of these early findings. Only 25.83% of individuals had completely low-risk feet. This easy-to-use tool can assist healthcare professionals in the recognition and treatment of common foot problems. The article also outlines the early signs of disease by screening item and provides a guide to treatment to enable effective prevention and quality care.

Evaluating a Surfactant-Containing Polymeric Membrane Foam Wound Dressing with Glycerin in Patients with Chronic Pilonidal Sinus Disease.

GENERAL PURPOSE: To present an evaluation of a surfactant-containing polymeric membrane foam wound dressing for use on patients with chronic pilonidal sinus disease. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:1. Recall risk factors for and pathophysiology of pilonidal sinus wounds.2. Summarize the evidence-based elements of wound assessment and treatment.3. Identify the study methodology and results. ABSTRACT: To evaluate the clinical use of a surfactant-containing polymeric wound dressing with glycerin in patients with chronic pilonidal sinus wounds.This case series was conducted in an outpatient dermatology and wound clinic. Sixteen patients aged between 18 and 49 years with chronic nonhealing pilonidal sinus wounds over 4 weeks in duration were recruited.Dressing changes were performed daily because of frequent contamination from bowel evacuation, sweating, or frictional forces in the perianal and intergluteal skin. Patients were seen at follow-up visits to the clinic at weeks 4, 8, and 12 from study initiation.Subjects were predominantly males (81% [n = 13]) with a mean age of 23 years. At study initiation, the mean wound duration was 3.2 months, and mean surface area was 3.3 cm (0.18-19.6 cm). The majority of wounds showed signs of superficial infection (63% [n = 10]) and deep infection (88% [n = 14]). At week 12, 10 wounds (63%) had closed, 1 (6%) had decreased in surface area, 2 (13%) had increased in size, and 3 (19%) of the patients were lost to follow-up. Mean pain score was 3.4 at first visit; most patients reported reduction in pain scores by weeks 4 and 12. Participants reported improved mobility and ability to self-apply dressing. No adverse reactions were observed.Use of a surfactant-containing polymeric membrane foam wound dressing with glycerin may have facilitated wound closure in 10 of 13 patients who completed the 12-week study.

Validation of the Healthy Foot Screen: A Novel Assessment Tool for Common Clinical Abnormalities.

GENERAL PURPOSE: The purpose of this learning activity is to provide information about the Healthy Foot Screen, a new tool for assessment of common foot abnormalities. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:1. Recognize prevalence, causes, risk factors, signs, and types of common foot problems.2. Identify the results of this study about the new foot screening tool and its implications in primary care. ABSTRACT: Foot health is a key component of general health and well-being. Nevertheless, feet are often overlooked by healthcare providers and patients. Common foot problems include infections or inflammatory conditions, abnormal nail disorders (eg, onychomycosis), structural bony abnormalities, circulation disorders, and other conditions. The development of an easy-to-use, rapid, clinical tool to assess foot health can facilitate primary care provider recognition and treatment of common foot problems. This study ascertained interrater item reliability and validity from the preliminary version of one such tool called the Healthy Foot Screen.A total of 18 patients from a community dermatology clinic were individually screened by 11 interprofessional healthcare assessors using the preliminary tool. The assessors included a dermatologist/internist, family physicians, nurses, and podiatrists. The initial draft of the Healthy Foot Screen was created through an extensive literature review, complemented by the clinical judgment of the study team. Cronbach α was calculated for each item to determine interrater reliability. A minimum value of 0.6 was set for an item to be included in the final tool. Where applicable, scores for each item on the screen were calculated for right and left lower limbs and then averaged. Assessors were asked to complete a short survey.Interrater reliability scores for items on the screen were as follows: diabetes and smoking, 1.0; neuropathy, 0.988; palpable foot pulse, 0.916; abnormal fourth to fifth toe web space, 0.905; previous ulcer/amputation, 0.869; pitting edema, 0.872; bony abnormality, 0.804; dry bottom of foot, 0.799; toenail infection, 0.793; other spots/lesions,0.688; and red areas/blisters/pustules, 0.659. Generally, assessors found the tool easy to use, although some areas for improvement were noted.The Healthy Foot Screen can facilitate primary care provider diagnosis and treatment of common foot problems.

Update: Topical Antimicrobial Agents for Chronic Wounds.

GENERAL PURPOSE: To provide information on the use of topical antimicrobial agents for the treatment of chronic wounds. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to:1. Examine features of wounds and wound healing as well as the purpose of specific antimicrobial agents.2. Identify potential therapeutic and adverse effects of specific topical antimicrobial agents for the treatment of chronic wounds. ABSTRACT: Bacteria can delay or prevent healing in the surface compartment of a chronic wound or invade the deep and surrounding structures. This article focuses on the superficial compartment and the appropriate use of topical antimicrobial therapies. The authors have reviewed the published evidence for the last 5 years (2012-2017) and extrapolated findings to clinical practice with critical appraisal and synthesis of the recent literature with expert opinion, patient-centered concerns, and healthcare systems perspectives. Summary evidence tables for commonly used topical antimicrobials are included.

The role of Inadine in wound care: a consensus document.

Iodine-based products are antibacterial. The small iodine molecular size is ideally suited to treat surface critical colonisation. Inadine is a 10% povidone iodine dressing with the equivalent of 1% available iodine that is easily extracted from the viscose backing by serum or exudate. The use of hydrophilic polyethylene glycol tulle dressing delivery vehicle allows the dressing to be easily removed by irrigation with potable water or saline. In this study, we developed a short online survey completed by 23 wound-care key opinion leaders from the nursing, medical and podiatry professions. A computerised modified Delphi technique was used to achieve 80% consensus on 11 statements related to the utility and everyday topical wound-care use of this product.

Optimizing the Moisture Management Tightrope with Wound Bed Preparation 2015©.

PURPOSE: To provide an overview of moisture management and its importance in wound care. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Summarize causes and treatments for moisture balance issues of chronic wounds.2. Recognize the properties of dressings used for treatment for moisture management of chronic wounds and antiseptic agent cytotoxicity.3. Explain study findings of the effectiveness of dressing choices for treatment of chronic wounds. OBJECTIVE: To provide an overview of moisture management and its importance in wound care. The authors evaluate the impact of moisture management for optimal wound care and assess current wound management strategies relating to antisepsis and moist wound healing utilizing the wound bed preparation paradigm 2015 update. The discussion distinguishes the form and function of wound care dressing classes available for optimal moisture management. CONCLUSION: Moisture management for chronic wounds is best achieved with modern moist interactive dressings if the wound has the ability to heal.

Just leg pain? Think again: What health leaders must know about peripheral arterial disease.

Approximately 800,000 Canadians have Peripheral Arterial Disease (PAD). Peripheral arterial disease is also a leading cause of limb amputation. Yet public and clinical awareness of PAD is very limited. This article discusses the "Just Leg Pain? Think Again" awareness campaign the Canadian Association of Wound Care has launched in response. This article also summarizes PAD risk factors, screening, linkage with diabetes, treatment and care interventions, PAD care innovations, and the need for policy leadership on this issue.

Si vous pensez que c'est juste un mal de jambe détrompez-vous: ce que les leaders en santé doivent savoir sur la maladie artérielle périphérique.

Environ 800 000 Canadiens ont une maladie artérielle périphérique (MAP), une cause majeure d'amputation. Pourtant, le public et les cliniciens connaissent très peu cette maladie. Le présent article traite de la campagne de sensibilisation Si vous pensez que c'est juste un mal de jambe… détrompez-vous que l'Association canadienne du soin des plaies a lancée pour contrer cette tendance. Il porte également sur les facteurs de risque et le dépistage de la MAP, son lien avec le diabète, son traitement et ses soins, ses innovations en matière de soins de la MAP et la nécessité de faire preuve de leadership sur le plan des politiques.

Sonocrystallization yields monoclinic paracetamol with significantly improved compaction behavior.

Ultrasound-assisted crystallization (sonocrystallization) was used to prepare a mixture of nano- and micrometer-sized crystals of the monoclinic form of paracetamol-a widely used analgesic known for its particularly problematic mechanical behavior under compression (i.e. poor tabletability). The nano- and micrometer-sized crystals yielded a powder which exhibits elastic moduli and bulk cohesions that are significantly higher than those observed in samples consisting of macrometer-sized crystals, thus leading to enhanced tabletability without the use of excipients, particle coating, salt, or cocrystal formation. Experimental compaction and finite element analysis were utilized to rationalize the significantly improved compaction behavior of the monoclinic form of paracetamol.

The electro-structural behaviour of yarn-like carbon nanotube fibres immersed in organic liquids.

Yarn-like carbon nanotube (CNT) fibres are a hierarchically-structured material with a variety of promising applications such as high performance composites, sensors and actuators, smart textiles, and energy storage and transmission. However, in order to fully realize these possibilities, a more detailed understanding of their interactions with the environment is required. In this work, we describe a simplified representation of the hierarchical structure of the fibres from which several mathematical models are constructed to explain electro-structural interactions of fibres with organic liquids. A balance between the elastic and surface energies of the CNT bundle network in different media allows the determination of the maximum lengths that open junctions can sustain before collapsing to minimize the surface energy. This characteristic length correlates well with the increase of fibre resistance upon immersion in organic liquids. We also study the effect of charge accumulation in open interbundle junctions and derive expressions to describe experimental data on the non-ohmic electrical behaviour of fibres immersed in polar liquids. Our analyses suggest that the non-ohmic behaviour is caused by progressively shorter junctions collapsing as the voltage is increased. Since our models are not based on any property unique to carbon nanotubes, they should also be useful to describe other hierarchical structures.

Wound bed preparation 2014 update: management of critical colonization with a gentian violet and methylene blue absorbent antibacterial dressing and elevated levels of matrix metalloproteases with an ovine collagen extracellular matrix dressing.

Wound bed preparation (WBP) is a paradigm for holistic patient care that includes treatment of the cause along with patient-centered concerns before optimizing the components of local wound care (debridement, infection/inflammation, moisture balance, and, when required, the edge effect). This review incorporates a methylene blue and gentian violet bound foam dressing for critical colonization and an ovine collagen extracellular matrix dressing for reduction of elevated levels of matrix metalloproteases into the WBP paradigm.

Tablet ejection: A systematic comparison between force, static friction, and kinetic friction.

The magnitude of the frictional forces during the ejection of porous pharmaceutical tablets plays an important role in determining the occurrence of tabletting defects. Here, we perform a systematic comparison between the maximum ejection force, static friction coefficient, and kinetic friction coefficient. All of these metrics have different physical meanings, corresponding to different stages of ejection. However, experimental limitations have previously complicated comparisons, as static and kinetic friction could not be measured simultaneously. This study presents a method for simultaneously measuring the maximum ejection force, static friction coefficient, and kinetic friction coefficient in situ during tablet ejection in routine compaction simulator experiments. Using this method, we performed a systematic comparison, including variations of (1) ejection speed, (2) compaction pressure, (3) material, and (4) lubrication method. The relative importance of each variable is discussed in detail, including how ejection speed alone can be a decisive factor in tablet chipping. The reliability of the newly developed method is supported by excellent agreement with previous studies and finite element method (FEM) simulations. Finally, we discuss the suitability of friction coefficients derived from Janssen-Walker theory and explanations for the phenomenon of die-wall static friction coefficients with apparent values far above unity.

Effect of Varying Stiffness and Functionalization on the Interfacial Failure Behavior of Isotactic Polypropylene on Hydroxylated γ-Al2O3 by MD Simulation.

This study focuses on polymer-metal joints consisting of isotactic polypropylene (iPP) or iPP grafted with maleic anhydride (iPP-g-MA) and hydroxylated γ-Al2O3, which is a model for an oxidized aluminum surface, and investigates the contributions of the Young's moduli of iPP and iPP-g-MA and chemical functionality (MA groups) in iPP-g-MA to the interfacial failure behaviors using the molecular dynamics (MD) simulation method. First, our calculations demonstrated that the tensile strength observed in interfacial failures of the joints increases as Young's modulus of the polymer in the joints increases. This is because a higher stiffness makes it harder for a void to form within the polymer matrix under the applied tensile strain and to reach the interface. Second, in iPP-g-MA-γ-Al2O3 joints, MA groups work more effectively to improve the interfacial strength as the Young's modulus of the polymer in the joints increases. For iPP-g-MA with a lower Young's modulus, the polymer molecules are pulled off the surface in a peel mode with increasing normal strain due to their greater flexibility. This results in a gradual removal of the MA groups and thus reduces their contribution. Meanwhile, for a higher Young's modulus, iPP-g-MA molecules at the interface are removed in a tensile mode because of their increased stiffness. This leads to more MA groups required to be detached from the surface at the same time to cause interfacial failure, thus increasing the contributions of the MA groups.

Constrained Density Functional Theory: A Potential-Based Self-Consistency Approach.

Chemical reactions, charge transfer reactions, and magnetic materials are notoriously difficult to describe within Kohn-Sham density functional theory, which is strictly a ground-state technique. However, over the last few decades, an approximate method known as constrained density functional theory (cDFT) has been developed to model low-lying excitations linked to charge transfer or spin fluctuations. Nevertheless, despite becoming very popular due to its versatility, low computational cost, and availability in numerous software applications, none of the previous cDFT implementations is strictly similar to the corresponding ground-state self-consistent density functional theory: the target value of constraints (e.g., local magnetization) is not treated equivalently with atomic positions or lattice parameters. In the present work, by considering a potential-based formulation of the self-consistency problem, the cDFT is recast in the same framework as Kohn-Sham DFT: a new functional of the potential that includes the constraints is proposed, where the constraints, the atomic positions, or the lattice parameters are treated all alike, while all other ingredients of the usual potential-based DFT algorithms are unchanged, thanks to the formulation of the adequate residual. Tests of this approach for the case of spin constraints (collinear and noncollinear) and charge constraints are performed. Expressions for the derivatives with respect to constraints (e.g., the spin torque) for the atomic forces and the stress tensor in cDFT are provided. The latter allows one to study striction effects as a function of the angle between spins. We apply this formalism to body-centered cubic iron and first reproduce the well-known magnetization amplitude as a function of the angle between local magnetizations. We also study stress as a function of such an angle. Then, the local collinear magnetization and the local atomic charge are varied together. Since the atomic spin magnetizations, local atomic charges, atomic positions, and lattice parameters are treated on an equal footing, this formalism is an ideal starting point for the generation of model Hamiltonians and machine-learning potentials, computation of second or third derivatives of the energy as delivered from density-functional perturbation theory, or for second-principles approaches.

Highly Oriented Direct-Spun Carbon Nanotube Textiles Aligned by In Situ Radio-Frequency Fields.

Carbon nanotubes (CNTs) individually exhibit exceptional physical properties, surpassing state-of-the-art bulk materials, but are used commercially primarily as additives rather than as a standalone macroscopic product. This limited use of bulk CNT materials results from the inability to harness the superb nanoscale properties of individual CNTs into macroscopic materials. CNT alignment within a textile has been proven as a critical contributor to narrow this gap. Here, we report the development of an altered direct CNT spinning method based on the floating catalyst chemical vapor deposition process, which directly interacts with the self-assembly of the CNT bundles in the gas phase. The setup is designed to apply an AC electric field to continuously align the CNTs in situ during the formation of CNT bundles and subsequent aerogel. A mesoscale CNT model developed to simulate the alignment process has shed light on the need to employ AC rather than DC fields based on a CNT stiffening effect (z-pinch) induced by a Lorentz force. The AC-aligned synthesis enables a means to control CNT bundle diameters, which broadened from 16 to 25 nm. The resulting bulk CNT textiles demonstrated an increase in the specific electrical and tensile properties (up to 90 and 460%, respectively) without modifying the quantity or quality of the CNTs, as verified by thermogravimetric analysis and Raman spectroscopy, respectively. The enhanced properties were correlated to the degree of CNT alignment within the textile as quantified by small-angle X-ray scattering and scanning electron microscopy image analysis. Clear alignment (orientational order parameter = 0.5) was achieved relative to the pristine material (orientational order parameter = 0.19) at applied field intensities in the range of 0.5-1 kV cm-1 at a frequency of 13.56 MHz.