Ab initio density functional investigation of B_24 cluster: Rings, Tubes, Planes, and Cages

We investigate the equilibrium geometries and the systematics of bonding in various isomers of a 24-atom boron cluster using Born-Oppenheimer molecular dynamics within the framework of density functional theory. The isomers studied are the rings, the convex and the quasiplanar structures, the tubes and, the closed structures. A staggered double-ring is found to be the most stable structure amongst the isomers studied. Our calculations reveal that a 24-atom boron cluster does form closed 3-d structures. All isomers show staggered arrangement of nearest neighbor atoms. Such a staggering facilitates $sp^2$ hybridization in boron cluster. A polarization of bonds between the peripheral atoms in the ring and the planar isomers is also seen. Finally, we discuss the fusion of two boron icosahedra. We find that the fusion occurs when the distance between the two icosahedra is less than a critical distance of about 6.5a.u.Comment: 8 pages, 9 figures in jpeg format Editorially approved for publication in Phys. Rev.

The Critical Care Recovery Center: An Innovative Collaborative Care Model for ICU Survivors

Five million Americans require admission to ICUs annually owing to life-threatening illnesses. Recent medical advances have resulted in higher survival rates for critically ill patients, who often have significant cognitive, physical, and psychological sequelae, known as postintensive care syndrome (PICS). This growing population threatens to overwhelm the current U.S. health care system, which lacks established clinical models for managing their care. Novel innovative models are urgently needed. To this end, the pulmonary/critical care and geriatrics divisions at the Indiana University School of Medicine joined forces to develop and implement a collaborative care model, the Critical Care Recovery Center (CCRC). Its mission is to maximize the cognitive, physical, and psychological recovery of ICU survivors. Developed around the principles of implementation and complexity science, the CCRC opened in 2011 as a clinical center with a secondary research focus. Care is provided through a pre-CCRC patient and caregiver needs assessment, an initial diagnostic workup visit, and a follow-up visit that includes a family conference. With its sole focus on the prevention and treatment of PICS, the CCRC represents an innovative prototype aimed at modifying post–critical illness morbidities and improving the ICU survivor's quality of life

Ongoing Medical Management to Maximize Health and Well-being for Persons Living With Dementia

Background and Objectives: Persons living with dementia have complex care needs including memory loss that should be taken into account by providers and family caregivers involved with their care. The prevalence of comorbid conditions in people with dementia is high and, thus, how primary care, community providers and family caregivers provide best practice care, person-centered care is important. Research Design and Methods: Care providers should understand the ongoing medical management needs of persons living with dementia in order to maximize their quality of life, proactively plan for their anticipated needs, and be as well prepared as possible for health crises that may occur. Results: This article provides eight practice recommendations intended to promote understanding and support of the role of nonphysician care providers in educating family caregivers about ongoing medical management to improve the wellbeing of persons living with dementia. Discussion and Implications: Key among these are recommendations to use nonpharmacological interventions to manage behavioral and psychological symptoms of dementia as the first line of treatment and recommendations on how to best support the use and discontinuation of pharmacological interventions as necessary

The relationship between nurses' clinical competency and job stress in Ahvaz university hospital, 2013

زمینه و هدف: صلاحیت بالینی پرستاری، شایستگی کاربرد همزمان دانش، مهارت، نگرش ها و ارزش ها در مراقبت از بیمار است که به دلیل اهمیت آن اخیراً مورد توجه بیشتری قرار گرفته است. با توجه به اهمیت روز افزون موضوع صلاحیت پرستاری، شناخت عوامل مرتبط با آن و از جمله استرس شغلی ضروری به نظر می رسد؛ لذا مطالعه حاضر با هدف تعیین رابطه صلاحیت بالینی و استرس شغلی پرستاران شاغل در بیمارستان های دانشگاهی شهر اهواز در سال1392 انجام شد. روش بررسی: در این پژوهش توصیفی- تحلیلی که به صورت مقطعی در طی سال 1392 انجام شد، 80 نفر پرستار شاغل در بیمارستان های آموزشی شهر اهواز از طریق نمونه گیری تصادفی انتخاب و وارد مظالعه شدند. ابزار گردآوری داده ها شامل پرسشنامه های استرس شغلی Osipow و پرسشنامه صلاحیت بالینی Benner بود که به صورت خود ایفاء تکمیل گردیدند. میزان صلاحیت بالینی پرستاران ارزیابی و ارتباط آن با استرس شغلی تعیین شد. یافته ها: بیشتر پرستاران (3/81 درصد) دارای استرس شغلی متوسط بودند. میانگین نمره کل صلاحیت بالینی پرستاران 48/18± 15/61 بود. آزمون همبستگی پیرسون نشان داد که بین استرس شغلی و صلاحیت بالینی پرستاران در تمام حیطه های آن همبستگی منفی و معنی داری وجود دارد (01/0>P). همچنین بین میزان استرس شغلی و بکارگیری صلاحیت بالینی کل ارتباط معنی داری وجود داشت (001/0>P). نتیجه گیری: بر اساس نتایج مطالعه حاضر، افزایش استرس شغلی پرستاران با کاهش صلاحیت های بالینی آنها رابطه دارد که بایستی مورد توجه مدیران پرستاری قرار گیرد

Risk factors for the progression of mild cognitive impairment to dementia

The increasing prevalence of cognitive impairment among the older adult population warrants attention to the identification of practices that may minimize the progression of early forms of cognitive impairment, including the transitional stage of mild cognitive impairment (MCI), to permanent stages of dementia. This article identifies both markers of disease progress and risk factors linked to the progression of MCI to dementia. Potentially modifiable risk factors may offer researchers a point of intervention to modify the effect of the risk factor and to minimize the future burden of dementia

Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults

Background Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use. Objective This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics. Methods Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy. Self-report usability was assessed by the System Usability Scale and performance-based usability data were collected for each task through observation. A subset of 17 participants contributed data on feasibility, assessed by self-reported attitudes (feeling informed) and behaviors (speaking to a physician), with confirmation following a physician visit. Results Overall usability was acceptable or better, with 100% of participants completing each Brain Buddy task and a mean System Usability Scale score of 78.8, corresponding to “Good” to “Excellent” usability. Observed usability issues included higher rates of errors, hesitations, and need for assistance on three tasks, particularly those requiring data entry. Among participants contributing to feasibility data, 100% felt better informed after using Brain Buddy and 94% planned to speak to their physician about their anticholinergic related risk. On follow-up, 82% reported having spoken to their physician, a rate independently confirmed by physicians. Conclusion Consumer-facing technology can be a low-cost, scalable intervention to improve older adults’ medication safety, by informing and empowering patients. User-centered design and evaluation with demographically heterogeneous clinical samples uncovers correctable usability issues and confirms the value of interventions targeting consumers as agents in shared decision making and behavior change

Examining the benefits and harms of Alzheimer's disease screening for family members of older adults: study protocol for a randomized controlled trial

BACKGROUND: Multiple national expert panels have identified early detection of Alzheimer's disease and related dementias (ADRD) as a national priority. However, the United States Preventive Services Task Force (USPSTF) does not currently support screening for ADRD in primary care given that the risks and benefits are unknown. The USPSTF stresses the need for research examining the impact of ADRD screening on family caregiver outcomes. METHODS: The Caregiver Outcomes of Alzheimer's Disease Screening (COADS) is a randomized controlled trial that will examine the potential benefits or harms of ADRD screening on family caregivers. It will also compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening. COADS will enroll 1800 dyads who will be randomized into three groups (n = 600/group): the 'Screening Only' group will receive ADRD screening at baseline and disclosure of the screening results, with positive-screen participants receiving a list of local resources for diagnostic follow-up; the 'Screening Plus' group will receive ADRD screening at baseline coupled with disclosure of the screening results, with positive-screen participants referred to a dementia collaborative care program for diagnostic evaluation and potential care; and the control group will receive no screening. The COADS trial will measure the quality of life of the family member (the primary outcome) and family member mood, anxiety, preparedness and self-efficacy (the secondary outcomes) at baseline and at 6, 12, 18 and 24 months. Additionally, the trial will examine the congruence of depressive and anxiety symptoms between older adults and family members at 6, 12, 18 and 24 months and compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening between the two groups randomized to screening (Screening Only versus Screening Plus). DISCUSSION: We hypothesize that caregivers in the screening arms will express higher levels of health-related quality of life, lower depressive and anxiety symptoms, and better preparation for caregiving with higher self-efficacy at 24 months. Results from this study will directly inform the National Plan to Address Alzheimer's Disease, the USPSTF and other organizations regarding ADRD screening and early detection policies