The reaction of H 8 Si 8 O 12 with a chromium oxide surface: a model for stainless steel surface modification

Many metal alloys are susceptible to corrosion, particularly after processing steps such as welding. Chemical vapor deposition (CVD) is an effective way to modify metal surfaces and impart specific physical and chemical properties. A hydrophobic, nanosegmented silicon oxide coating derived from the discrete cluster molecule H 8 Si 8 O 12 has been shown to chemisorb to 302 and 304 stainless steel. To understand better how this cluster binds to steel, a comprehensive study of these clusters adsorbed on chromium oxide was undertaken. IR, XPS and valence-band spectroscopies show convincingly that the clusters are chemisorbed intact on this surface. The coating also readily forms on molybdenum, tungsten, iron and nickel oxides, promising general application to a wide variety of metal alloys. Copyright © 1999 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34739/1/843_ftp.pd

Structure and energetics of the Si-SiO_2 interface

Silicon has long been synonymous with semiconductor technology. This unique role is due largely to the remarkable properties of the Si-SiO_2 interface, especially the (001)-oriented interface used in most devices. Although Si is crystalline and the oxide is amorphous, the interface is essentially perfect, with an extremely low density of dangling bonds or other electrically active defects. With the continual decrease of device size, the nanoscale structure of the silicon/oxide interface becomes more and more important. Yet despite its essential role, the atomic structure of this interface is still unclear. Using a novel Monte Carlo approach, we identify low-energy structures for the interface. The optimal structure found consists of Si-O-Si "bridges" ordered in a stripe pattern, with very low energy. This structure explains several puzzling experimental observations.Comment: LaTex file with 4 figures in GIF forma

Microplastic pollution in deep-sea sediments from the Great Australian Bight

Interest in understanding the extent of plastic and specifically microplastic pollution has increased on a global scale. However, we still know relatively little about how much plastic pollution has found its way into the deeper areas of the world’s oceans. The extent of microplastic pollution in deep-sea sediments remains poorly quantified, but this knowledge is imperative for predicting the distribution and potential impacts of global plastic pollution. To address this knowledge gap, we quantified microplastics in deep-sea sediments from the Great Australian Bight using an adapted density separation and dye fluorescence technique. We analyzed sediment cores from six locations (1–6 cores each, n = 16 total samples) ranging in depth from 1,655 to 3,062 m and offshore distances ranging from 288 to 356 km from the Australian coastline. Microplastic counts ranged from 0 to 13.6 fragments per g dry sediment (mean 1.26 ± 0.68; n = 51). We found substantially higher microplastic counts than recorded in other analyses of deep-sea sediments. Overall, the number of microplastic fragments in the sediment increased as surface plastic counts increased, and as the seafloor slope angle increased. However, microplastic counts were highly variable, with heterogeneity between sediment cores from the same location greater than the variation across sampling sites. Based on our empirical data, we conservatively estimate 14 million tonnes of microplastic reside on the ocean floor

Associations among unit leadership and unit climates for implementation in acute care: a cross-sectional study

Abstract Background Nurse managers have a pivotal role in fostering unit climates supportive of implementing evidence-based practices (EBPs) in care delivery. EBP leadership behaviors and competencies of nurse managers and their impact on practice climates are widely overlooked in implementation science. The purpose of this study was to examine the contributions of nurse manager EBP leadership behaviors and nurse manager EBP competencies in explaining unit climates for EBP implementation in adult medical-surgical units. Methods A multi-site, multi-unit cross-sectional research design was used to recruit the sample of 24 nurse managers and 553 randomly selected staff nurses from 24 adult medical-surgical units from 7 acute care hospitals in the Northeast and Midwestern USA. Staff nurse perceptions of nurse manager EBP leadership behaviors and unit climates for EBP implementation were measured using the Implementation Leadership Scale and Implementation Climate Scale, respectively. EBP competencies of nurse managers were measured using the Nurse Manager EBP Competency Scale. Participants were emailed a link to an electronic questionnaire and asked to respond within 1 month. The contributions of nurse manager EBP leadership behaviors and competencies in explaining unit climates for EBP implementation were estimated using mixed-effects models controlling for nurse education and years of experience on current unit and accounting for the variability across hospitals and units. Significance level was set at α < .05. Results Two hundred sixty-four staff nurses and 22 nurse managers were included in the final sample, representing 22 units in 7 hospitals. Nurse manager EBP leadership behaviors (p < .001) and EBP competency (p = .008) explained 52.4% of marginal variance in unit climate for EBP implementation. Leadership behaviors uniquely explained 45.2% variance. The variance accounted for by the random intercepts for hospitals and units (p < .001) and years of nursing experience in current unit (p < .05) were significant but level of nursing education was not. Conclusion Nurse managers are significantly related to unit climates for EBP implementation primarily through their leadership behaviors. Future implementation studies should consider the leadership of nurse managers in creating climates supportive of EBP implementation.https://deepblue.lib.umich.edu/bitstream/2027.42/143195/1/13012_2018_Article_753.pd

Public Health and Health Sector Crisis Leadership During Pandemics: A Review of the Medical and Business Literature

The global scale and unpredictable nature of the current COVID-19 pandemic have put a significant burden on health care and public health leaders, for whom preparedness plans and evidence-based guidelines have proven insufficient to guide actions. This article presents a review of empirical articles on the topics of “crisis leadership” and “pandemic” across medical and business databases between 2003 (since SARS) and—December 2020 and has identified 35 articles for detailed analyses. We use the articles’ evidence on leadership behaviors and skills that have been key to pandemic responses to characterize the types of leadership competencies commonly exhibited in a pandemic context. Task-oriented competencies, including preparing and planning, establishing collaborations, and conducting crisis communication, received the most attention. However, people-oriented and adaptive-oriented competencies were as fundamental in overcoming the structural, political, and cultural contexts unique to pandemics

Medical Conditions of Nursing Home Admissions

<p>Abstract</p> <p>Background</p> <p>As long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest. Although need factors have a strong impact on nursing home (NH) admission, the diseases causing these functional disabilities are lacking or unclear in the residents' file. We investigated the medical reason (primary diagnosis) of a nursing home admission with respect to the underlying disease.</p> <p>Methods</p> <p>This study is based on two independent, descriptive and comparative studies in Belgium and was conducted at two time points (1993 and 2005) to explore the evolution over twelve years. Data from the subjects were extracted from the resident's file; additional information was requested from the general practitioner, nursing home physician or the head nurse in a face-to-face interview. In 1993 we examined 1332 residents from 19 institutions, and in 2005 691 residents from 7 institutions. The diseases at the time of admission were mapped by means of the International Classification of Diseases - 9th edition (ICD-9). Longitudinal changes were assessed and compared by a chi-square test.</p> <p>Results</p> <p>The main chronic medical conditions associated with NH admission were dementia and stroke. Mental disorders represent 48% of all admissions, somatic disorders 43% and social/emotional problems 8%. Of the somatic disorders most frequently are mentioned diseases of the circulatory system (35%) [2/3 sequels of stroke and 1/5 heart failure], followed by diseases of the nervous system (15%) [mainly Parkinson's disease] and the musculoskeletal system (14%) [mainly osteoarthritis]. The most striking evolution from 1993 to 2005 consisted in complicated diabetes mellitus (from 4.3 to 11.4%; p < 0.0001) especially with amputations and blindness. Symptoms (functional limitations without specific disease) like dizziness, impaired vision and frailty are of relevance as an indicator of admission.</p> <p>Conclusion</p> <p>Diseases like stroke, diabetes and mobility problems are only important for institutionalisation if they cause functional disability. Diabetes related complications as cause of admission increased almost three-fold between 1993 and 2005.</p

Do Market-Level Hospital and Physician Resources Affect Small Area Variation in Hospital Use?

This study evaluates the effect of market-level physician and hospital resources on hospital use. It is anticipated that higher hospital discharges are associated with (1) greater hospital and physician resources, (2) more differentiated hospital and physician resources, and (3) higher levels of teaching intensity in the community. Data on 14 modified diagnostically related groups (DRGs) and 58 hospital market communities in Michigan are analyzed during a 7-year period. Findings indicate that physician resources, hospital resources, differentiation of hospital and physician resources, and teaching intensity contribute only modestly to discharges, holding constant the socioeconomic attributes of the community and adjusting for the variation in hospital use over time. With the inclusion of hospital and physician resource variables, socioeconomic factors remain important determinants of the variation across market communities. Findings are discussed in terms of their implications for health care organizations, managed care programs, and cost control efforts in general.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68450/2/6.pd

A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda

BACKGROUND: Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers’ capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers’ capacity in Eastern Uganda. METHODS: This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers’ capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus. RESULTS: The findings indicate that the participatory action research approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness. CONCLUSIONS: Improved health manager capacity is essential if sustained improvements in health outcomes in lowincome countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability were the key means by which participatory action research strengthened health managers’ capacity. The participatory approach to implementation therefore created opportunities to strengthen health managers’ capacity

Predicting nursing home admission in the U.S: a meta-analysis

Background: While existing reviews have identified significant predictors of nursing home admission, this meta-analysis attempted to provide more integrated empirical findings to identify predictors. The present study aimed to generate pooled empirical associations for sociodemographic, functional, cognitive, service use, and informal support indicators that predict nursing home admission among older adults in the U.S. Methods: Studies published in English were retrieved by searching the MEDLINE, PSYCINFO, CINAHL, and Digital Dissertations databases using the keywords: "nursing home placement," "nursing home entry," "nursing home admission," and "predictors/institutionalization." Any reports including these key words were retrieved. Bibliographies of retrieved articles were also searched. Selected studies included sampling frames that were nationally- or regionally-representative of the U.S. older population. Results: Of 736 relevant reports identified, 77 reports across 12 data sources were included that used longitudinal designs and community-based samples. Information on number of nursing home admissions, length of follow-up, sample characteristics, analysis type, statistical adjustment, and potential risk factors were extracted with standardized protocols. Random effects models were used to separately pool the logistic and Cox regression model results from the individual data sources. Among the strongest predictors of nursing home admission were 3 or more activities of daily living dependencies (summary odds ratio [OR] = 3.25; 95% confidence interval [CI], 2.56–4.09), cognitive impairment (OR = 2.54; CI, 1.44–4.51), and prior nursing home use (OR = 3.47; CI, 1.89–6.37). Conclusion: The pooled associations provided detailed empirical information as to which variables emerged as the strongest predictors of NH admission (e.g., 3 or more ADL dependencies, cognitive impairment, prior NH use). These results could be utilized as weights in the construction and validation of prognostic tools to estimate risk for NH entry over a multi-year period

Deformability of poly(amidoamine) dendrimers

Experimental data indicates that poly(amidoamine) (PAMAM) dendrimers flatten when in contact with a substrate, i.e. they are no longer spherical, but resemble flat disks. In order to better understand the deformation behavior of these branched polymers, a series of atomistic molecular dynamics simulations is performed. The resulting flattened dendrimer conformations are compared to atomic force microscopy (AFM) images of individual dendrimers at air/mica and water/mica interfaces. The ability of the polymers to deform is investigated as a function of dendrimer generation (2-5) and the required energies are calculated. Our modeling results show good agreement with the experimental AFM images, namely that dendrimers are highly flexible and capable of forming multiple interaction sites between most of their branch ends and the substrate. The deformation energy scales with dendrimer generation and does not indicate an increase in stiffness between generations 2 and 5 due to steric effects.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45831/1/10189_2003_Article_10087.pd