Reducing Rehospitalizations of Nursing Home Residents through Telehealth: A Quality Improvement Program

Hospital readmissions in nursing home residents are a major problem affecting health care outcomes, resident quality of life, and costs. Telehealth has been shown to improve care delivery for persons with chronic conditions and has promise for reducing nursing home rehospitalizations. The purpose of this Doctor of Nursing Practice (DNP) project was to explore nurses’ knowledge, attitudes, beliefs, and self-reported use of telehealth in caring for Skilled Nursing Facility (SNF) residents with the goal of developing an evidence-based educational program for the facility. A convenience sampling approach was used. Participants, all registered nurses (RNs), were recruited from a local SNF. A 35-item online survey was developed and modified from Kowitlawakul’s (2008) eICU Acceptance Survey based on the Telehealth Acceptance Model (TAM). Twenty-four RNs of the eligible 75 RNs completed the survey (participation rate of 32%), a majority (75%, n = 18) were women, and worked the dayshift (75%, n = 18 ). Most of the nurses felt telehealth was easy to use (n =16, 72.7%), felt comfortable using telehealth (n= 17, 77.3%), and believed telehealth provides more time for patient care (n =14, 63.6%). Fifty percent (n =12) of the participants did not think telehealth would enhance job effectiveness and 48% (n =11) did not believe telehealth would increase job productivity. The primary finding from this quality improvement project (QIP) was that although most staff had a positive perspective toward the use of telehealth, approximately half of nurses reported telehealth does not increase productivity or enhance job effectiveness. These findings indicate staff may benefit from an evidence-based educational program focused on the value of telehealth in preventing SNF resident rehospitalizations

REMOVED: Application of Lipid Membranes for Triggered-Drug Delivery Using an Alternating Magnetic Field

This article has been removed: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).This article has been removed at the request of the Executive Publisher.This article has been removed because it was published without the permission of the author(s)

Ultrastructural Analysis of Enamel Formation During in vitro Development Using Chemically-Defined Medium

To test the hypothesis that enamel biomineralization is regulated by sequential expression of an intrinsic genetic program, we designed experiments to determine if a serumless, chemically-defined medium is permissive for position-dependent ameloblast differentiation and subsequent enamel tissue-specific biomineralization in vitro. In the absence of serum or other exogenous growth factors, Swiss Webster strain mouse embryonic (15-and 16-days gestation) mandibular first molar tooth organs (cap stage) developed within 21 days in vitro into well-defined molar tooth organs expressing dentine and enamel biomineralization. Analysis of data obtained from von Kossa histochemistry for calcium salt formation, as well as ultrastructural information obtained from x-ray microanalysis, electron diffraction, transmission electron microscopy and scanning electron microscopy documented tissue-specific patterns of calcium hydroxyapatite formation in the absence of scrum within organotypic cultures in vitro. An as yet unknown intrinsic genetic program regulates enamel formation in vitro

Computational modeling and fluorescence microscopy characterization of a two-phase magnetophoretic microsystem for continuous-flow blood detoxification

Magnetic beads can be functionalized to capture and separate target pathogens from blood for extracorporeal detoxification. The beads can be magnetically separated from a blood stream and collected into a coflowing buffer solution using a two-phase liquid-liquid continuous-flow microfluidic device in the presence of an external field. However, device design and process optimization, i.e. high bead recovery with minimum blood loss or dilution remain a substantial technological challenge. We introduce a CFD-based Eulerian-Lagrangian computational model that enables the rational design and optimization of such systems. The model takes into account dominant magnetic and hydrodynamic forces on the beads as well as coupled bead-fluid interactions. Fluid flow (Navier-Stokes equations) and mass transfer (Fick's law) between the coflowing fluids are solved numerically, while the magnetic force on the beads is predicted using analytical methods. The model is demonstrated via application to a prototype device and used to predict key performance metrics; degree of bead separation, flow patterns, and mass transfer, i.e. blood diffusion to the buffer phase. The impact of different process variables and parameters-flow rates, bead and magnet dimensions and fluid viscosities-on both bead recovery and blood loss or dilution is quantified for the first time. The performance of the prototype device is characterized using fluorescence microscopy and the experimental results are found to match theoretical predictions within an absolute error of 15%. While the model is demonstrated here for analysis of a detoxification device, it can be readily adapted to a broad range of magnetically-enabled microfluidic applications, e.g. bioseparation, sorting and sensing

Structure of exotic three-body systems

The classification of large halos formed by two identical particles and a core is systematically addressed according to interparticle distances. The root-mean-square distances between the constituents are described by universal scaling functions obtained from a renormalized zero-range model. Applications for halo nuclei, $^{11}$Li and $^{14}$Be, and for atomic $^4$He$_3$ are briefly discussed. The generalization to four-body systems is proposed.Comment: Contribution to the International workshop "Critical Stability of Few-Body Quantum Systems". To be published in "Few-Body Systems

BUB-1 targets PP2A:B56 to regulate chromosome congression during meiosis I in C. elegans oocytes

Protein Phosphatase 2A (PP2A) is a heterotrimer composed of scaffolding (A), catalytic (C), and regulatory (B) subunits. PP2A complexes with B56 subunits are targeted by Shugoshin and BUBR1 to protect centromeric cohesion and stabilise kinetochore-microtubule attachments in yeast and mouse meiosis. In Caenorhabditis elegans, the closest BUBR1 orthologue lacks the B56-interaction domain and Shugoshin is not required for meiotic segregation. Therefore, the role of PP2A in C. elegans female meiosis is unknown. We report that PP2A is essential for meiotic spindle assembly and chromosome dynamics during C. elegans female meiosis. BUB-1 is the main chromosome-targeting factor for B56 subunits during prometaphase I. BUB-1 recruits PP2A:B56 to the chromosomes via a newly identified LxxIxE motif in a phosphorylation-dependent manner, and this recruitment is important for proper chromosome congression. Our results highlight a novel mechanism for B56 recruitment, essential for recruiting a pool of PP2A involved in chromosome congression during meiosis I

Cohesive-zone modelling of the deformation and fracture of spot-welded joints

The deformation and failure of spot-welded joints have been successfully modelled using a cohesive-zone model for fracture. This has been accomplished by implementing a user-defined, three-dimensional, cohesive-zone element within a commercial finite-element package. The model requires two material parameters for each mode of deformation. Results show that the material parameters from this type of approach are transferable for identical spot welds in different geometries where a single parameter (such as maximum stress) is not. The approach has been demonstrated using a model system consisting of spot-welded joints made from 5754 aluminium sheets. The techniques for determining the cohesive fracture parameters for both nugget fracture and nugget pullout are described in this paper. It has been demonstrated that once the appropriate cohesive parameters for a weld are determined, quantitative predictions can be developed for the strengths, deformations and failure mechanisms of different geometries with nominally identical welds.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73187/1/j.1460-2695.2005.00919.x.pd

Evidence for Efimov quantum states in an ultracold gas of cesium atoms

Systems of three interacting particles are notorious for their complex physical behavior. A landmark theoretical result in few-body quantum physics is Efimov's prediction of a universal set of bound trimer states appearing for three identical bosons with a resonant two-body interaction. Counterintuitively, these states even exist in the absence of a corresponding two-body bound state. Since the formulation of Efimov's problem in the context of nuclear physics 35 years ago, it has attracted great interest in many areas of physics. However, the observation of Efimov quantum states has remained an elusive goal. Here we report the observation of an Efimov resonance in an ultracold gas of cesium atoms. The resonance occurs in the range of large negative two-body scattering lengths, arising from the coupling of three free atoms to an Efimov trimer. Experimentally, we observe its signature as a giant three-body recombination loss when the strength of the two-body interaction is varied. We also detect a minimum in the recombination loss for positive scattering lengths, indicating destructive interference of decay pathways. Our results confirm central theoretical predictions of Efimov physics and represent a starting point with which to explore the universal properties of resonantly interacting few-body systems. While Feshbach resonances have provided the key to control quantum-mechanical interactions on the two-body level, Efimov resonances connect ultracold matter to the world of few-body quantum phenomena.Comment: 18 pages, 3 figure

Numerical analysis of bead magnetophoresis from flowing blood in a continuous-flow microchannel: implications to the bead-fluid interactions

In this work, we report a numerical flow-focused study of bead magnetophoresis inside a continuous-flow microchannel in order to provide a detailed analysis of bead motion and its effect on fluid flow. The numerical model involves a Lagrangian approach and predicts the bead separation from blood and their collection into a flowing buffer by the application of a magnetic field generated by a permanent magnet. The following scenarios are modelled: (i) one-way coupling wherein momentum is transferred from the fluid to beads, which are treated as point particles, (ii) two-way coupling wherein the beads are treated as point particles and momentum is transferred from the bead to the fluid and vice versa, and (iii) two-way coupling taking into account the effects of bead volume in fluid displacement. The results indicate that although there is little difference in the bead trajectories for the three scenarios, there is significant variation in the flow fields, especially when high magnetic forces are applied on the beads. Therefore, an accurate full flow-focused model that takes into account the effects of the bead motion and volume on the flow field should be solved when high magnetic forces are employed. Nonetheless, when the beads are subjected to medium or low magnetic forces, computationally inexpensive models can be safely employed to model magnetophoresis.Financial support from the Spanish Ministry of Economy and Competitiveness under the projects CTQ2015-72364-EXP and CTQ2015-66078-R (MINECO/FEDER) is gratefully acknowledged. Jenifer Gómez-Pastora also thanks the FPI postgraduate research grant (BES-2013-064415). Edward P. Furlani gratefully acknowledges fnancial support from the U.S. National Science Foundation, through Award CBET-1337860