Preparing Family Caregivers to Recognize Delirium Symptoms in Older Adults After Elective Hip or Knee Arthroplasty

Objectives To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers. Design Mixed-method, pre–post quasi-experimental design. Setting A Midwest Veterans Affairs Medical Center and a nonprofit health system. Participants Forty-one family caregiver-older adult dyads provided consent; 34 completed the intervention. Intervention Four telephone-based education modules using vignettes were completed during the 3 weeks before the older adult\u27s hospital admission for elective hip or knee replacement. Each module required 20 to 30 minutes. Measurements Interviews were conducted before the intervention and 2 weeks and 2 months after the older adult\u27s hospitalization. A researcher completed the Confusion Assessment Method (CAM) and a family caregiver completed the Family Version of the Confusion Assessment Method (FAM-CAM) 2 days after surgery to assess the older adults for delirium symptoms. Results Family caregivers’ knowledge of delirium symptoms improved significantly from before the intervention to 2 weeks after the intervention and was maintained after the older adult\u27s hospitalization. They also were able to recognize the presence and absence of delirium symptoms in the vignettes included in the intervention and in the older adult after surgery. In 94% of the cases, the family caregiver rating on the FAM-CAM approximately 2 days after the older adult\u27s surgery agreed with the researcher rating on the CAM. Family caregivers expressed satisfaction with the intervention and stated that the information was helpful. Conclusion Delivery of a telephone-based intervention appears feasible. All family caregivers who began the program completed the four education modules. Future studies evaluating the effectiveness of the educational program should include a control group

First-order nature of the ferromagnetic phase transition in (La-Ca)MnO_3 near optimal doping

Neutron scattering has been used to study the nature of the ferromagnetic transition in single crystals of La_0.7Ca_0.3MnO_3 and La_0.8Ca_0.2MnO_3, and polycrystalline samples of La_0.67Ca_0.33MnO_3 and La_5/8Ca_3/8MnO_3 where the naturally occurring O-16 can be replaced with the O-18 isotope. Small angle neutron scattering on the x=0.3 single crystal reveals a discontinuous change in the scattering at the Curie temperature for wave vectors below ~0.065 A^-1. Strong relaxation effects are observed for this domain scattering, for the magnetic order parameter, and for the quasielastic scattering, demonstrating that the transition is not continuous in nature. There is a large oxygen isotope effect observed for the T_C in the polycrystalline samples. For the optimally doped x=3/8 sample we observed T_C(O-16)=266.5 K and T_C(O-18)=261.5 K at 90% O-18 substitution. The temperature dependence of the spin-wave stiffness is found to be identical for the two samples despite changes in T_C. Hence, T_C is not solely determined by the magnetic subsystem, but instead the ferromagnetic phase is truncated by the formation of polarons which cause an abrupt transition to the paramagnetic, insulating state. Application of uniaxial stress in the x=0.3 single crystal sharply enhances the polaron scattering at room temperature. Measurements of the phonon density-of-states show only modest differences above and below T_C and between the two different isotopic samples.Comment: 13 pages, 16 figures, submitted to Phys. Rev.

Regression/eradication of gliomas in mice by a systemically-deliverable ATF5 dominant-negative peptide.

Malignant gliomas have poor prognosis and urgently require new therapies. Activating Transcription Factor 5 (ATF5) is highly expressed in gliomas, and interference with its expression/function precipitates targeted glioma cell apoptosis in vitro and in vivo. We designed a novel deliverable truncated-dominant-negative (d/n) form of ATF5 fused to a cell-penetrating domain (Pen-d/n-ATF5-RP) that can be intraperitoneally/subcutaneously administered to mice harboring malignant gliomas generated; (1) by PDGF-B/sh-p53 retroviral transformation of endogenous neural progenitor cells; and (2) by human U87-MG xenografts. In vitro Pen-d/n-ATF5-RP entered into glioma cells and triggered massive apoptosis. In vivo, subcutaneously-administered Pen-d/n-ATF5-RP passed the blood brain barrier, entered normal brain and tumor cells, and then caused rapid selective tumor cell death. MRI verified elimination of retrovirus-induced gliomas within 8-21 days. Histopathology revealed growth-suppression of intracerebral human U87-MG cells xenografts. For endogenous PDGF-B gliomas, there was no recurrence or mortality at 6-12 months versus 66% mortality in controls at 6 months. Necropsy and liver-kidney blood enzyme analysis revealed no adverse effects on brain or other tissues. Our findings thus identify Pen-d/n-ATF5-RP as a potential therapy for malignant gliomas

The Role of Nurse Practitioners in Meeting the Need for Child and Adolescent Services: a Statewide Survey

The high prevalence of child and adolescent mental health disorders coupled with shortages in ageappropriate mental health services pose a significant problem likely to be exacerbated over time. A survey was designed to identify the current status of and need for child and adolescent psychiatrists (CAPs) and mental health services, as well as strategies and recommendations to address identified needs in the state of New York. Key informants from each county and New York City were surveyed by telephone (N = 58). Most respondents identified a shortage of child and adolescent psychiatry services and reported that when CAPs are unavailable, nurse practitioners (NPs) are currently among the top four professional groups who prescribe and/or monitor psychotropic medication. Almost half of the respondents (48%) identified employing NPs with advanced certification in child and adolescent psychiatry as a promising strategy to improve access to care. Addressing the shortage of CAPs can provide an opportunity for the nursing profession to advance its role in the provision of mental health services to youth

The Role of Nurse Practitioners in Meeting the Need for Child and Adolescent Services: a Statewide Survey

The high prevalence of child and adolescent mental health disorders coupled with shortages in ageappropriate mental health services pose a significant problem likely to be exacerbated over time. A survey was designed to identify the current status of and need for child and adolescent psychiatrists (CAPs) and mental health services, as well as strategies and recommendations to address identified needs in the state of New York. Key informants from each county and New York City were surveyed by telephone (N = 58). Most respondents identified a shortage of child and adolescent psychiatry services and reported that when CAPs are unavailable, nurse practitioners (NPs) are currently among the top four professional groups who prescribe and/or monitor psychotropic medication. Almost half of the respondents (48%) identified employing NPs with advanced certification in child and adolescent psychiatry as a promising strategy to improve access to care. Addressing the shortage of CAPs can provide an opportunity for the nursing profession to advance its role in the provision of mental health services to youth

State oversight of polypharmacy and psychotropic medication use among individuals with intellectual and developmental disabilities: a three state case study

Adults with intellectual and developmental disabilities (IDD) are prescribed more medications than the general population, placing them at significantly higher risk for issues due to taking multiple medications (polypharmacy). There are currently no clear national standards for the administration of medications given this risk. The following policy analysis explores state policies related to prescription medication oversight. This analysis pays particular attention to the use of medications that alter one’s mental state (psychotropics) among people with IDD who receive home and community-based services (HCBS) in the United States. The article outlines current efforts implemented to reduce medication-related risks for people with IDD in three states and explores the similarities and differences across strategies. This policy analysis aims to initiate conversation and encourage further consideration and deliberation necessary to move toward clear and concrete guidelines for the oversight of medication regimens

Temperature and field dependence of the phase separation, structure, and magnetic ordering in La1−x_{1-x}Cax_xMnO3_3, (x=0.47x=0.47, 0.50, and 0.53)

Neutron powder diffraction measurements, combined with magnetization and resistivity data, have been carried out in the doped perovskite La$_{1-x}$Ca$_x$MnO$_3$ ($x=0.47$, 0.50, and 0.53) to elucidate the structural, magnetic, and electronic properties of the system around the composition corresponding to an equal number of Mn3+ and Mn4+. At room temperature all three samples are paramagnetic and single phase, with crystallographic symmetry Pnma. The samples then all become ferromagnetic (FM) at $T_C\approx 265$ K. At $\sim 230$ K, however, a second distinct crystallographic phase (denoted A-II) begins to form. Initially the intrinsic widths of the peaks are quite large, but they narrow as the temperature decreases and the phase fraction increases, indicating microscopic coexistence. The fraction of the sample that exhibits the A-II phase increases with decreasing temperature and also increases with increasing Ca doping, but the transition never goes to completion to the lowest temperatures measured (5 K) and the two phases therefore coexist in this temperature-composition regime. Phase A-II orders antiferromagnetically (AFM) below a N\'{e}el temperature $T_N \approx 160$ K, with the CE-type magnetic structure. Resistivity measurements show that this phase is a conductor, while the CE phase is insulating. Application of magnetic fields up to 9 T progressively inhibits the formation of the A-II phase, but this suppression is path dependent, being much stronger for example if the sample is field-cooled compared to zero-field cooling and then applying the field. The H-T phase diagram obtained from the diffraction measurements is in good agreement with the results of magnetization and resistivity.Comment: 12 pages, 3 tables, 11 figure

EYM equations in the presence of q-stars

We study Einstein-Yang-Mills equations in the presence of gravitating non-topological soliton field configurations, of q-ball type. We produce numerical solutions, stable with respect to gravitational collapse and to fission into free particles, and we study the effect of the field strength and the eigen-frequency to the soliton parameters. We also investigate the formation of such soliton stars when the spacetime is asymptotically anti de Sitter.Comment: 11 pages, to appear in Phys. Rev.