Investigation of the mechanism of gamma irradiation effect on bovine bone.

Radiation sterilization is an effective method of bone sterilization prior to bone graft transplantation. Gamma irradiation affects the biological and mechanical properties of bone; depending on the dose of radiation. The effect of gamma irradiation on bone mechanical properties is an unwanted phenomenon. However the mechanism of the effect of irradiation on bone mechanical properties is not properly understood. In this research paper the mechanism of the effect of gamma irradiation on bovine bone is investigated using scanning electron microscopy, energy-dispersive X-rays spectroscopy and Fourier transform infrared spectroscopy techniques. Gamma irradiation affects the mineral and fiber composition of bovine bone. The mineral content of bone especially calcium, magnesium and phosphorus decrease with increasing dose of gamma radiation. At Nano-level gamma irradiation alter amide I, amide II and amide III collagen contents. High dose gamma irradiation induces collagen cross-linking reaction in bone and degrades bone properties.

Care Management to Reduce Disparities and Control Hypertension in Primary Care: A Cost-effectiveness Analysis.

BACKGROUND: Project ReD CHiP (reducing disparities and controlling hypertension in primary care) care management was a clinic-based intervention that aimed to improve blood pressure control through improved care coordination and provide self-management support to patients from racially and socioeconomically. OBJECTIVE: To evaluate the cost-effectiveness of ReD CHiP care management versus standard care to treat hypertension in diverse communities. RESEARCH DESIGN: Microsimulation model from a health care sector perspective over 15 years. We used the published literature to inform our model including the ReD CHiP trial and the age-specific and race-specific cardiovascular disease risk equations. Deterministic and probabilistic sensitivity analyses were conducted to assess the uncertainty. SUBJECTS: Primary prevention in a racially diverse setting. MEASURES: Costs per quality-adjusted life years (QALYs) to produce an incremental cost-effectiveness ratio (ICER). RESULTS: ReD CHiP had an increase of $2114 and 0.04 QALYs. The ICER was $52,850/QALY. Predominately African American (ICER: $48,250/QALY) and elderly populations (ie, age 65+) derived value from ReD CHiP (ICER: $39,525/QALY). The value of ReD CHiP varied with changes in the reduction in systolic blood pressure (5 mm Hg reduction, ICER: $133,300/QALY; 15 mm Hg reduction, ICER: $18,767/QALY). Probabilistic sensitivity analysis indicated that ReD CHiP CM was cost-effective in over 90% of simulations, based on a willingness-to-pay of $100,000/QALY. CONCLUSIONS: ReD CHiP care management is cost-effective to prevent negative consequences of hypertension. African American and elderly patients have more favorable ICERs, recommending targeted interventions to improve health equity among vulnerable patient populations.

The Role of Care Management as a Population Health Intervention to Address Disparities and Control Hypertension: A Quasi-Experimental Observational Study.

OBJECTIVE: We studied whether care management is a pragmatic solution for improving population blood pressure (BP) control and addressing BP disparities between Blacks and Whites in routine clinical environments. DESIGN: Quasi-experimental, observational study. SETTING AND PARTICIPANTS: 3,964 uncontrolled hypertensive patients receiving primary care within the last year from one of six Baltimore clinics were identified as eligible. INTERVENTION: Three in-person sessions over three months with registered dietitians and pharmacists who addressed medication titration, patient adherence to healthy behaviors and medication, and disparities-related barriers. MAIN MEASURES: We assessed the population impact of care management using the RE-AIM framework. To evaluate effectiveness in improving BP, we used unadjusted, adjusted, and propensity-score matched differences-in-differences models to compare those who completed all sessions with partial completers and non-participants. RESULTS: Of all eligible patients, 5% participated in care management. Of 629 patients who entered care management, 245 (39%) completed all three sessions. Those completing all sessions on average reached BP control (mean BP 137/78) and experienced 9 mm Hg systolic blood pressure (P<.001) and 4 mm Hg DBP (P=.004) greater improvement than non-participants; findings did not vary in adjusted or propensity-score matched models. Disparities in systolic and diastolic BP between Blacks and Whites were not detectable at completion. CONCLUSIONS: It may be possible to achieve BP control among both Black and White patients who participate in a few sessions of care management. However, the very limited reach and patient challenges with program completion should raise significant caution with relying on care management alone to improve population BP control and eliminate related disparities.

Fragmentation in specialist care and stage III colon cancer.

BACKGROUND: Patients with cancer frequently transition between different types of specialists and across care settings. This study explored how frequently the surgical and medical oncology care of stage III colon cancer patients occurred across more than 1 hospital and whether this was associated with mortality and costs. METHODS: This was a retrospective Surveillance, Epidemiology, and End Results-Medicare cohort study of 9075 stage III colon cancer patients diagnosed between 2000 and 2009 who had received both surgical and medical oncology care within 1 year of their diagnosis. Patients were assigned to the hospital at which they had undergone their cancer surgery and to their oncologist's primary hospital, and then they were characterized according to whether these hospitals were the same or different. Outcomes included all-cause mortality, subhazards for colon cancer-specific mortality, and costs of care at 12 months. RESULTS: Thirty-seven percent of the patients received their surgical and medical oncology care from different hospitals. Rural patients were less likely than urban patients to receive medical oncology care from the same hospital (odds ratio, 0.62; 95% confidence interval, 0.43-0.90). Care from the same hospital was not associated with reduced all-cause or colon cancer-specific mortality but resulted in lower costs (8% of the median cost) at 12 months (dollars saved, $5493; 95% confidence interval, $1799-$9525). CONCLUSIONS: The delivery of surgical and medical oncology care at the same hospital was associated with lower costs; however, reforms seeking to improve outcomes and lower costs through the integration of complex care will need to address the significant proportion of patients receiving care at more than 1 hospital.

Provider perspectives on essential functions for care management in the collaborative treatment of hypertension: the P.A.R.T.N.E.R. framework.

BACKGROUND: Care management has become a widespread strategy for improving chronic illness care. However, primary care provider (PCP) participation in programs has been poor. Because the success of care management relies on provider engagement, understanding provider perspectives is necessary. OBJECTIVE: Our goal was to identify care management functions most valuable to PCPs in hypertension treatment. DESIGN: Six focus groups were conducted to discuss current challenges in hypertension care and identify specific functions of care management that would improve care. PARTICIPANTS: The study included 39 PCPs (participation rate: 83 %) representing six clinics, two of which care for large African American populations and four that are in underserved locations, in the greater Baltimore metropolitan area. APPROACH: This was a qualitative analysis of focus groups, using grounded theory and iterative coding. KEY RESULTS: Providers desired achieving blood pressure control more rapidly. Collaborating with care managers who obtain ongoing patient data would allow treatment plans to be tailored to the changing life conditions of patients. The P.A.R.T.N.E.R. framework summarizes the care management functions that providers reported were necessary for effective collaboration: Partner with patients, providers, and the community; Arrange follow-up care; Resolve barriers to adherence; Track treatment response and progress; Navigate the health care system with patients; Educate patients & Engage patients in self-management; Relay information between patients and/or provider(s). CONCLUSIONS: The P.A.R.T.N.E.R. framework is the first to offer a checklist of care management functions that may promote successful collaboration with PCPs. Future research should examine the validity of this framework in various settings and for diverse patient populations affected by chronic diseases.

The Contribution of Age and Weight to Blood Pressure Levels Among Blacks and Whites Receiving Care in Community-Based Primary Care Practices.

We examined whether race and age, risk factors for obesity and hypertension, affect the association of obesity with elevated blood pressure (BP). Using electronic medical record data, we conducted a cross-sectional study of adult patients seen at 6 Maryland primary care clinics from September 2011 through June 2012. The risk for higher BP among patients younger than 65 years and in an elevated weight category was greater for both races but was higher for whites than blacks. For patients aged 65 years or older, weight had little impact on systolic BP, suggesting that approaches involving weight loss to address elevated BP should focus on populations younger than 65.

Rationale and design of a randomized controlled trial evaluating community health worker-based interventions for the secondary prevention of acute coronary syndromes in India (SPREAD).

BACKGROUND: There is a need to evaluate and implement cost-effective strategies to improve adherence to treatments in coronary heart disease. There are no studies from low- to middle income countries (LMICs) evaluating trained community health worker (CHW)-based interventions for the secondary prevention of coronary heart disease. METHODS: We designed a hospital-based, open randomized trial of CHW-based interventions versus standard care. Patients after an acute coronary syndrome (ACS) were randomized to an intervention group (a CHW-based intervention package, comprising education tools to enhance self-care and adherence, and regular follow-up by the CHW) or to standard care for 12 months during which study outcomes were recorded. The CHWs were trained over a period of 6 months. The primary outcome measure was medication adherence. The secondary outcomes were differences in adherence to lifestyle modification, physiological parameters (blood pressure [BP], body weight, body mass index [BMI], heart rate, lipids), and major adverse cardiovascular events. RESULTS: We recruited 806 patients stabilized after an ACS from 14 hospitals in 13 Indian cities. The mean age was 56.4 (± 11.32) years, and 17.2% were females. A high prevalence of risk factors such as hypertension (43.4%), diabetes (31.9%), tobacco consumption (35.4%), and inadequate physical activity (70.5%) was documented. A little over half had ST-elevation myocardial infarction (53.7%), and 46.3% had non-ST-elevation myocardial infarction or unstable angina. CONCLUSION: The CHW interventions and training for SPREAD have been developed and adapted for local use. The results and experience of this study will be important to counter the burden of cardiovascular diseases in low- to middle income countries.

Nasopharyngeal Airway in the Trachea: A Case Report.

We report a case of a cannulated nasopharyngeal airway (NPA) in a patient having a neurological deficit, absent gag reflex, and no clinically obvious signs of respiratory distress. The patient had two episodes of vomiting before admission and was admitted with the initial working diagnosis of aspiration pneumonia; however, a preliminary chest X-ray (CXR) revealed an NPA, sitting vertically in the airway. It is our emphasis that thorough clinical history and radiological imaging are of paramount importance in prompt management of such airway complications.

Processing-Microstructure-Properties of Columns in Thermal Barrier Coatings: A Study of Thermo-Chemico-Mechanical Durability.

Contemporary gas turbine engines rely on thermal barrier coatings (TBCs), which protect the structural components of the engine against degradation at extremely high operating temperatures (1300-1500 °C). The operational efficiencies of aircraft engines have seen significant improvement in recent years, primarily through the increase in operating temperatures; however, the longevity of TBCs can be potentially impacted by several types of degradation mechanisms. In this comprehensive study, a wide range of novel columnar suspension plasma sprayed (SPS) coatings were developed for their erosion, calcium-magnesium-aluminum-silicate (CMAS), and furnace cycling test (FCT) performance. Through a comprehensive investigation, the first of its kind, we achieved a range of SPS microstructures by modifying the spray parameters and measuring their microhardness, fracture toughness, column densities, and residual stresses using Raman spectroscopy. We were able to produce dendritic, lateral, branched, and columnar microstructures with a unique set of processing parameters. Coatings enhanced with a refined columnar microstructure, achieved by modulating the distance from the plasma torch, exhibited superior thermal cycling resilience. Conversely, the development of a columnar microstructure with dendritic branches, obtained by decreasing the robot's traversal speed during deposition, bolstered resistance to erosion and minimized damage from molten CMAS infiltration, thereby notably augmenting the coating's lifespan and robustness. The pursuit of the optimal columnar microstructure led to the conclusion that for each SPS coating, a general framework of optimization needs to be conducted to achieve their desired thermo-chemico-mechanical resistance as the properties required for TBCs are intertwined.

Improving primary care access for rural women Veterans: the Boost Team.

Objectives: To improve healthcare access for rural cisgender women and gender diverse Veterans, we created the "Boost Team," a clinician-driven telehealth outreach service to connect this population to Veterans Health Administration (VHA) services. Methods: Between 9/2021 and 2/2022, we conducted a needs assessment in the Veterans Integrated Service Network (VISN) 21 and used those data to develop an outreach intervention. We piloted a clinician-led outreach intervention in 3/2022, and formally deployed an outreach team in 9/2022. Results: The needs assessment uncovered opportunities to educate Veterans, staff, and clinicians about available VHA women's health services, and a need for easily-accessible gender-sensitive services. During the pilot, 58% (7/12) rural cisgender women Veterans were successfully contacted, all reported positive experiences with the intervention. The formal outreach team launched in 9/2022 and consists of a nurse practitioner (NP), scheduler, Peer Support Specialist, and medical director. From 9/2022 to 12/2022 the Boost NP called 110 rural cisgender women and gender diverse Veterans and spoke to 65 (59%) of them. Common care needs identified and addressed included care coordination, new referrals, medication management, and diagnostics. Discussion: Data from Boost show that clinician-led outreach can engage rural cisgender women and gender diverse Veterans in VHA services, there is a desire for more gender-sensitive services, and there is a need for systems-level improvements to allow for improved care coordination and decreased leakage outside of VHA. Using robust strategies grounded in implementation sciences, we will continue conducting a program evaluation to study the impact of Boost and scale and expand the program.

3-[(3-Benzoyl-4-hy-droxy-1,1-dioxo-2H-1λ,2-benzothia-zin-2-yl)meth-yl]benzo-nitrile.

There are two independent mol-ecules in the asymmetric unit of the title compound, C(23)H(17)N(2)O(4)S, with significant differences in their conformations, e.g. the benzene rings of the benzothia-zine and benzonitrile units are inclined at 28.19 (10) and 17.89 (7)° in the two mol-ecules, with the centroids of the rings separated by 3.975 (2) and 3.637 (2) Å, respectively. Moreover, the N-C-C-C torsion angles involving the benzoyl group are 14.3 (5) and 8.2 (5)° in the two mol-ecules, showing different degrees of rotation of this group. In both mol-ecules, the heterocyclic thia-zine rings adopt half-chair conformations, with the S and N atoms displaced by 0.427 (6) and 0.365 (6) Å, respectively, in one mol-ecule and by 0.356 (6) and 0.432 (6) Å, respectively, in the other, on opposite sides of the mean planes formed by the remaining ring atoms. The crystal structure is stabilized by inter-molecular C-H⋯O hydrogen bonds and further consolidated by intra-molecular O-H⋯O hydrogen bonds.

2-[2-(2-Chloro-phen-yl)-2-oxoeth-yl]-2,3-dihydro-1λ(6),2-benzothia-zole-1,1,3-trione.

The asymmetric unit of the title compound, C(15)H(10)ClNO(4)S, contains two independent conformers wherein the 2-chloro-phenyl group in one is rotated by approximately 180° compared to the other mol-ecule. This affects the S-N-C-C(=O) and N-C-C(=O)-C torsion angles giving vlaues of -87.0 (2) and 158.7 (2)° in one mol-ecule and -104.3 (2) and -173.4 (2)° in the other. The benzisothia-zole ring systems in the two mol-ecules are essentially planar (r.m.s. deviations = 0.017 and 0.010 Å) and form dihedral angles of 73.53 (7) and 73.26 (6)° with the benzene rings. In the crystal, there are weak π-π inter-actions between the benzene rings of the benzisothia-zole groups and symmetry-related chloro-benzene rings with centroid-centroid distances of 3.6178 (13) and 3.6267 (15) Å. In addition, pairs of weak inter-molecular C-H⋯O hydrogen bonds form inversion dimers which are connected by further C-H⋯O hydrogen bonds into a three-dimensional network.

2-(3,4-Dimethyl-5,5-dioxo-2H,4H-pyrazolo-[4,3-c][1,2]benzothia-zin-2-yl)-1-(4-meth-oxy-phen-yl)ethanone.

In the title mol-ecule, C(20)H(19)N(3)O(4)S, the heterocyclic thia-zine ring adopts a half-chair conformation with the S and N atoms displaced by 0.492 (6) and 0.199 (6) Å, respectively, on opposite sides from the mean plane formed by the remaining ring atoms. The ethanone group lies at an angle of 9.4 (2)° with respect to the benzene ring, which lies almost perpendicular to the pyrazole ring, with a dihedral between the two planes of 78.07 (9)°. In the crystal, mol-ecules are linked by weak C-H⋯O hydrogen bonds.

Formation and crystallization of TiO2 nanostructures on various surfaces.

A comparative study of the synthesis of TiO2 nanorods on fluorine-doped tin oxide (FTO) glass, Si, SiO2, Si/Ta, Si/TiN, Si/TiN/Ti and Si/HFO2 substrates by hydrothermal reaction is presented. Detailed analysis on the growth of TiO2 on pre-annealed Si/TiN/Ti and HfO2 (HFO) surfaces is also given. For Si/TiN/Ti, a pre-annealing procedure led to the transformation of Ti to a TiO2 layer which acts as a seed for aligned growth of TiO2 nanorods. In contrast, Si/HFO does not provide a nucleation site for the formation of aligned nanorods. Various samples were prepared by varying the synthesis conditions, i.e. pre- and post-annealing temperatures and hydrothermal reaction time to figure out the optimum conditions which lead to unidirectional and highly aligned nanorods. X-ray diffraction, scanning electron microscopy, ultraviolet-visible spectroscopy and Raman spectroscopy were used to study structural, morphological and optical properties of synthesized samples. It is found that TiO2 nanorods exhibit a rutile phase on the Si/Ti/TiN and Si/HFO substrates, but highly oriented vertical growth of nanorods has been observed only on pre-annealed Si/TiN/Ti substrates. On the other hand, TiO2 nanorods form dandelion-like structures on Si/HFO substrates. Growth of vertically oriented TiO2 nanorods on Si/TiN/Ti is attributed to the TiO2 seed layer which forms after the process of pre-annealing of substrates at a suitable temperature. Variation in hydrothermal reaction time and post-annealing temperature brings further improvement in crystallinity and morphology of nanorods. This work shows that the pre-annealed Si/TiN/Ti substrate is the optimal choice to achieve vertically oriented, highly aligned TiO2 nanorods.

An Interdisciplinary Approach to the Management of Individuals With Tracheostomy.

BACKGROUND: Study objectives were to identify the proportion of tracheostomy subjects with successful decannulation, time to decannulation after ICU discharge, and predictors of long-term tracheostomy based on an interdisciplinary team approach. METHODS: This retrospective cohort study recruited all adult tracheostomy patients admitted between January 2016 and December 2018. Long-term tracheostomy patients with recurrent admissions and compromised airway and patients with neck tumors obstructing the airway were excluded. Data regarding subjects' demographics, comorbidities, Glasgow coma score (GCS), feeding, ICU discharge date, decannulation date, and outcome were collected. The interdisciplinary team members included tracheostomy resource nurse; respiratory therapist; speech clinician; ear, nose, and throat specialist; and rehab medicine specialist. RESULTS: Of the 221 subjects followed during the study period, 16% (36/221) were excluded, and the remaining 84% (185/221) underwent the decannulation protocol. Subjects who failed capping multiple times 114/185 (62%) were labeled long term and did not progress to decannulation. We successfully decannulated 71/185 subjects (38%), and none developed decannulation failure. Forty deaths occurred during hospitalization, but none was due to tracheostomy complications. The median time to decannulation after ICU discharge was 47 d. Predictors of long-term tracheostomy were GCS < 11 (odds ratio [OR] 5.6 [95% CI 2.7-12.0]), age ≥ 65 y (OR 4.5 [95% CI (2.1-10.0]), comorbidities ≥ 2 (OR 4.0 [95% CI 1.5-11.2]), and female sex (OR 3.0 [95% CI 1.3-7.4]). The proportion of subjects with long-term tracheostomy significantly increased with the total number of predictors (Fisher exact test, P < .001). CONCLUSIONS: Long-term tracheostomy was a common outcome among subjects with a tracheostomy. Older age, low GCS, female gender, and the number of comorbidities were significant long-term tracheostomy predictors. Further studies to assess outcomes and predictors of tracheostomy are needed.

Differences in patient satisfaction with virtual telephone clinics in a tertiary referral centre for otolaryngology during and after lockdown measures during the SARS-Cov2 pandemic.

INTRODUCTION: The SARS-Cov2 pandemic has caused considerable disruption to provision of routine outpatient care. This pandemic has necessitated a more modern and innovative approach to clinics, which could potentially change outpatient organisation and improve efficiency in the long term. Telephone clinics are the most practical way to deliver healthcare at a distance. AIM: The purpose of the present study was to assess patient satisfaction with a virtual telephone clinic in a tertiary referral centre for otolaryngology first during the height of the SARS-Cov2 pandemic, and subsequently at a physical follow-up appointment after easing of "lockdown" measures. METHODS: Patients were enrolled prospectively via a telephone interview over a 1-week period during the height of the "lockdown" measures, and subsequently at a physical appointment when measures eased. RESULTS: Overall, patients responded very positively in the anonymised questionnaire at the time of their virtual appointment. However, at a subsequent physical appointment, there was a reduction in overall favourable responses from patients. While patients still thought virtual clinics were a good idea and convenient in the context of SARS-Cov2, we noted a reduction in satisfaction in other key aspects of their care. Notably, patients were less likely to think that virtual clinics were able to properly address their condition. CONCLUSION: While virtual clinics remain a useful tool during the height of lockdown measures during the SARS-Cov2 pandemic, we did note a significant reduction in favourable responses to virtual appointments over physical ones upon easing of lockdown measures. Patients remained cautious in suggesting that outpatient appointments may be replaced by virtual clinics.

Metallic skeleton promoted two-phase durable icephobic layers.

HYPOTHESIS: The accretion of ice on component surfaces often causes severe impacts or accidents in modern industries. Applying icephobic surface is considered as an effective solution to minimise the hazards. However, the durability of the current icephobic surface and coatings for long-term service remains a great challenge. Therefore, it is indeed to develop new durable material structures with great icephobic performance. EXPERIMENTS: A new design concept of combining robust porous metallic skeletons and icephobic filling was proposed. Nickel/polydimethylsiloxane (PDMS) two-phase layer was prepared using porous Ni foam skeletons impregnated with PDMS as filling material by a two-step method. FINDINGS: Good icephobicity and mechanical durability have been verified. Under external force, micro-cracks could easily initiate at the ice/solid interface due to the small surface cavities and the difference of local elastic modulus between the ice and PDMS, which would promote the ice fracture and thus lead to low ice adhesion strength. The surface morphology and icephobicity almost remain unchanged after water-sand erosion, showing greatly improved mechanical durability. By combining the advantages of the mechanical durability of porous Ni skeleton and the icephobicity of PDMS matrix, the Ni foam/PDMS two-phase layer demonstrates great potentials for ice protection with long-term service time.

(E)-3-(2-Chloro-6-methyl-3-quinol-yl)-1-(2,3-dihydro-1,4-benzodioxin-6-yl)prop-2-en-1-one.

In the title mol-ecule, C(21)H(16)ClNO(3), the quinoline and benzene rings are inclined at 56.96 (6)° with respect to each other and the dioxine ring is in a twist-chair conformation. The structure is devoid of any classical hydrogen bonds. Rather weak inter-molecular hydrogen-bonding inter-actions of the types C-H⋯N and C-H⋯O are present, consolidating the crystal structure.

Resilient and agile engineering solutions to address societal challenges such as coronavirus pandemic.

The world is witnessing tumultuous times as major economic powers including the US, UK, Russia, India, and most of Europe continue to be in a state of lockdown. The worst-hit sectors due to this lockdown are sales, production (manufacturing), transport (aerospace and automotive) and tourism. Lockdowns became necessary as a preventive measure to avoid the spread of the contagious and infectious "Coronavirus Disease 2019" (COVID-19). This newly identified disease is caused by a new strain of the virus being referred to as Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS CoV-2; formerly called 2019-nCoV). We review the current medical and manufacturing response to COVID-19, including advances in instrumentation, sensing, use of lasers, fumigation chambers and development of novel tools such as lab-on-the-chip using combinatorial additive and subtractive manufacturing techniques and use of molecular modelling and molecular docking in drug and vaccine discovery. We also offer perspectives on future considerations on climate change, outsourced versus indigenous manufacturing, automation, and antimicrobial resistance. Overall, this paper attempts to identify key areas where manufacturing can be employed to address societal challenges such as COVID-19.