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.

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.

PREVALENCE AND RISK FACTORS OF ANAPLASMA INFECTIONS IN EASTERN MOOSE (ALCES ALCES AMERICANA) AND WINTER TICKS (DERMACENTOR ALBIPICTUS) IN MAINE, USA.

Eastern moose (Alces alces americana) are heavily parasitized by winter ticks (Dermacentor albipictus), the dominant cause of increased calf mortality in the northeastern US. Although much work has focused on the direct negative effects of winter tick on moose, it remains unknown whether diseases transmitted by ticks may also affect moose health or pose a risk to other species. We explored the role that moose and winter ticks play in transmission of the tick-borne bacterial pathogens, Anaplasma spp., which cause mild to severe illness in humans and domestic animals. Our objectives were to 1) estimate the prevalence of Anaplasma spp. in moose and winter ticks; 2) determine the phylogenetic placement of these strains with respect to those found in other hosts and vectors; and 3) explore risk factors of Anaplasma infection in moose. A total of 157 moose (142 calves, 15 adults) were captured in western (n=83) and northern (n=74) Maine in 2017 and 2018. We screened for Anaplasma spp. in moose whole blood samples using a genus-specific PCR assay targeting the 16S rRNA gene. Over half (54%) of the moose were infected with Anaplasma bacteria, with a greater proportion of moose harboring Anaplasma-infections in the western (67%) versus northern study areas (38%). Male moose exhibited a higher prevalence than did females (63% vs. 47%). In contrast, Anaplasma spp. prevalence in winter ticks was low (<1%). Sequencing and phylogenetic analysis revealed that the single Anaplasma strain in moose was highly divergent from the strain in winter ticks and most closely related to an uncharacterized North American cervid strain. We conclude that winter ticks are unlikely to play a significant role in Anaplasma transmission to moose; however, high infection prevalence warrants further investigation into the impacts of Anaplasma spp. infection on moose health.

A Meta-Analysis of Conductive and Strong Carbon Nanotube Materials.

A study of 1304 data points collated over 266 papers statistically evaluates the relationships between carbon nanotube (CNT) material characteristics, including: electrical, mechanical, and thermal properties; ampacity; density; purity; microstructure alignment; molecular dimensions and graphitic perfection; and doping. Compared to conductive polymers and graphitic intercalation compounds, which have exceeded the electrical conductivity of copper, CNT materials are currently one-sixth of copper's conductivity, mechanically on-par with synthetic or carbon fibers, and exceed all the other materials in terms of a multifunctional metric. Doped, aligned few-wall CNTs (FWCNTs) are the most superior CNT category; from this, the acid-spun fiber subset are the most conductive, and the subset of fibers directly spun from floating catalyst chemical vapor deposition are strongest on a weight basis. The thermal conductivity of multiwall CNT material rivals that of FWCNT materials. Ampacity follows a diameter-dependent power-law from nanometer to millimeter scales. Undoped, aligned FWCNT material reaches the intrinsic conductivity of CNT bundles and single-crystal graphite, illustrating an intrinsic limit requiring doping for copper-level conductivities. Comparing an assembly of CNTs (forming mesoscopic bundles, then macroscopic material) to an assembly of graphene (forming single-crystal graphite crystallites, then carbon fiber), the ≈1 µm room-temperature, phonon-limited mean-free-path shared between graphene, metallic CNTs, and activated semiconducting CNTs is highlighted, deemphasizing all metallic helicities for CNT power transmission applications.

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%).

Definitions of local density in density-dependent potentials for mixtures.

Density-dependent potentials are frequently used in materials simulations because of their approximate description of many-body effects at minimal computational cost. However, in order to apply such models to multicomponent systems, an appropriate definition of total local particle density is required. Here, we discuss two definitions of local density in the context of many-body dissipative particle dynamics. We show that only a potential which combines local densities from all particle types in its argument gives physically meaningful results for all composition ratios. Drawing on the ideas from metal potentials, we redefine local density such that it can accommodate different intertype interactions despite the constraint to keep the main interaction parameter constant, known as Warren's no-go theorem, and generalize the many-body potential to heterogeneous systems. We then show via simulation how liquid-liquid and liquid-solid coexistence can arise just by tuning the interaction parameters.

Unprecedented dipole alignment in α-phase nylon-11 nanowires for high-performance energy-harvesting applications.

Dipole alignment in ferroelectric polymers is routinely exploited for applications in charge-based applications. Here, we present the first experimental realization of ideally ordered dipole alignment in α-phase nylon-11 nanowires. This is an unprecedented discovery as dipole alignment is typically only ever achieved in ferroelectric polymers using an applied electric field, whereas here, we achieve dipole alignment in as-fabricated nanowires of 'non-ferroelectric' α-phase nylon-11, an overlooked polymorph of nylon proposed 30 years ago but never practically realized. We show that the strong hydrogen bonding in α-phase nylon-11 serves to enhance the molecular ordering, resulting in exceptional intensity and thermal stability of surface potential. This discovery has profound implications for the field of triboelectric energy harvesting, as the presence of an enhanced surface potential leads to higher mechanical energy harvesting performance. Our approach therefore paves the way towards achieving robust, high-performance mechanical energy harvesters based on this unusual ordered phase of nylon-11.

High throughput production of single-wall carbon nanotube fibres independent of sulfur-source.

Floating catalyst chemical vapor deposition (FC-CVD) methods offer a highly scalable strategy for single-step synthesis and assembly of carbon nanotubes (CNTs) into macroscopic textiles. However, the non-uniform axial temperature profile of a typical reactor, and differing precursor breakdown temperatures, result in a broad distribution of catalyst particle sizes. Spun CNT fibres therefore contain nanotubes with varying diameters and wall numbers. Herein, we describe a general FC-CVD approach to obtain relatively large yields of predominantly single-wall CNT fibres, irrespective of the growth promoter (usually a sulfur compound). By increasing carrier gas (hydrogen) flow rate beyond a threshold whilst maintaining a constant C : H2 mole ratio, CNTs with narrower diameters, a high degree of graphitization (G : D ratio ∼100) and a large throughput are produced, provided S : Fe ratio is sufficiently low. Analysis of the intense Raman radial breathing modes and asymmetric G bands, and a shift in the main nanotube population from thermogravimetric data, show that with increasing flow rate, the fibres are enriched with small diameter, metallic CNTs. Transmission electron microscopy corraborates our primary observation from Raman spectroscopy that with high total flow rates, the fibres produced consist of predominantly small diameter SWCNTs.

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.

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.

A cross-sectional assessment of diabetes self-management, education and support needs of Syrian refugee patients living with diabetes in Bekaa Valley Lebanon.

BACKGROUND: Patients with diabetes require knowledge and skills to self-manage their disease, a challenging aspect of treatment that is difficult to address in humanitarian settings. Due to the lack of literature and experience regarding diabetes self-management, education and support (DSMES) in refugee populations, Medecins Sans Frontieres (MSF) undertook a DSMES survey in a cohort of diabetes patients seen in their primary health care program in Lebanon. METHODS: Structured interviews were conducted with diabetes patients in three primary care clinics between January and February 2015. Scores (0-10) were calculated to measure diabetes core knowledge in each patient (the DSMES score). Awareness of long-term complications and educational preferences were also assessed. Analyses were conducted using Stata software, version 14.1 (StataCorp). Simple and multiple linear regression models were used to determine associations between various patient factors and the DSMES Score. RESULTS: A total of 292 patients were surveyed. Of these, 92% had type 2 diabetes and most (70%) had been diagnosed prior to the Syrian conflict. The mean DSMES score was 6/10. Having secondary education, previous diabetes education, a 'diabetes confidant', and insulin use were each associated with a higher DSMES Score. Lower scores were significantly more likely to be seen in participants with increasing age and in patients who were diagnosed during the Syrian conflict. Long-term complications of diabetes most commonly known by patients were vision related complications (68% of patients), foot ulcers (39%), and kidney failure (38%). When asked about the previous Ramadan, 56% of patients stated that they undertook a full fast, including patients with type 1 diabetes. Individual and group lessons were preferred by more patients than written, SMS, telephone or internet-based educational delivery models. CONCLUSIONS: DSMES should be patient and context appropriate. The variety and complexities of humanitarian settings provide particular challenges to its appropriate provision. Understanding patient baseline DSMES levels and needs provides a useful basis for humanitarian organizations seeking to provide diabetes 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.

The effect of crystal structure on the electromechanical properties of piezoelectric Nylon-11 nanowires.

Crystal structure is crucial in determining the properties of piezoelectric polymers, particularly at the nanoscale where precise control of the crystalline phase is possible. Here, we investigate the electromechanical properties of three distinct crystalline phases of Nylon-11 nanowires using advanced scanning probe microscopy techniques. Stiff α-phase nanowires exhibited a low piezoelectric response, while relatively soft δ'-phase nanowires displayed an enhanced piezoelectric response.

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.

Photonic Sorting of Aligned, Crystalline Carbon Nanotube Textiles.

Floating catalyst chemical vapor deposition uniquely generates aligned carbon nanotube (CNT) textiles with individual CNT lengths magnitudes longer than competing processes, though hindered by impurities and intrinsic/extrinsic defects. We present a photonic-based post-process, particularly suited for these textiles, that selectively removes defective CNTs and other carbons not forming a threshold thermal pathway. In this method, a large diameter laser beam rasters across the surface of a partly aligned CNT textile in air, suspended from its ends. This results in brilliant, localized oxidation, where remaining material is an optically transparent film comprised of few-walled CNTs with profound and unique improvement in microstructure alignment and crystallinity. Raman spectroscopy shows substantial D peak suppression while preserving radial breathing modes. This increases the undoped, specific electrical conductivity at least an order of magnitude to beyond that of single-crystal graphite. Cryogenic conductivity measurements indicate intrinsic transport enhancement, opposed to simply removing nonconductive carbons/residual catalyst.

The impact of team based interprofessional comprehensive assessments on the diagnosis and management of diabetic foot ulcers: A retrospective cohort study.

BACKGROUND: Diabetic foot ulcers (DFU) are increasingly prevalent, and associated with significant morbidity, mortality, and cost. An interprofessional approach to DFU management is critical given the etiological complexity involved. This study aimed to assess the impact of an interprofessional team approach on DFU diagnosis and management for a cohort of patients receiving treatment in an Ontario Canada home care setting. METHODS: A retrospective cohort study of patients attending a large regional Community Care Access Centre (CCAC) between February 11, 2013-September 30, 2014 was conducted. Following CCAC referral, patients were assessed by an interprofessional team at the Toronto Regional Wound Healing Centre (TRWHC). Those aged > 18 years with a DFU of > 6 weeks duration were included. The primary outcome was the precision of the initial diagnosis relating to DFU etiology (i.e. neuropathic, ischemic or mixed etiology). Secondary outcomes included wound healing, and infection parameters. Analysis was completed with STATA 13.1 (College Stn., TX) of pre-determined outcomes with 2 sided α of 0.05. RESULTS: A total of 308 patients were screened, and 49 patients (67.3% male) of mean age 64.2 years (SD 13.7) with a diagnosis of DFU > 6 weeks duration were included for analysis. Of these, 95% were referred with unspecified DFU, and were reclassified to a precise diagnosis relating to etiology, including neuropathy, ischemia or neuroischemic etiology following TRWHC assessment (p < 0.001). For secondary outcomes post-assessment, healability assessment was conducted for a greater proportion of patients (100% versus 44%, p < 0.001). Infection was identified in a greater number of patients (p = 0.04), and of the 35 patients, 94.5% had deep and surrounding infection, and 88.0% were initiated on systemic antibiotics. Vascular insufficiency was diagnosed in an additional 14.3% of the cohort (p = 0.03). Offloading/footwear assessment was conducted in all patients compared with 30.6% prior to referral (p < 0.001) Dressing change frequency decreased significantly following TRWHC assessment (pre: 4.31/week; post: 3.54/week; p = 0.03). Pain scores decreased (2.18 to 1.67) on the numerical rating scale but this was not statistically significant at the final TRWHC assessment. Notably, 36.7% (18/49) reported improved quality of life by the second TRWHC encounter. CONCLUSIONS: Interprofessional care teams are associated with improved diagnostic acumen and wound healing outcomes over conventional community care services. Initiatives including best practice interprofessional diabetic foot care pathways are recommended with timely vascular management of ischemia, treatment of deep and surrounding infection as well as the availability of foot care and footwear.

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.