Local interaction Strategies and Capacity for Better Care in Nursing Homes: A Multiple Case Study

To describe relationship patterns and management practices in nursing homes (NHs) that facilitate or pose barriers to better outcomes for residents and staff. Methods: We conducted comparative, multiple-case studies in selected NHs (N = 4). Data were collected over six months from managers and staff (N = 406), using direct observations, interviews, and document reviews. Manifest content analysis was used to identify and explore patterns within and between cases. Results: Participants described interaction strategies that they explained could either degrade or enhance their capacity to achieve better outcomes for residents; people in all job categories used these 'local interaction strategies'. We categorized these two sets of local interaction strategies as the 'common pattern' and the 'positive pattern' and summarize the results in two models of local interaction. Conclusions: The findings suggest the hypothesis that when staff members in NHs use the set of positive local interaction strategies, they promote inter-connections, information exchange, and diversity of cognitive schema in problem solving that, in turn, create the capacity for delivering better resident care. We propose that these positive local interaction strategies are a critical driver of care quality in NHs. Our hypothesis implies that, while staffing levels and skill mix are important factors for care quality, improvement would be difficult to achieve if staff members are not engaged with each other in these ways.National Institutes of Health 2 R01NR003178-04A2Claude A. Pepper Older American's Independence Center AG-11268Paul A. Beeson Award NIA AG024787VA Health Services Research and Development EDU 08-417John A. Hartford Building Academic Geriatric Nursing Claire M. Fagin FellowshipBusiness Administratio

Nonlocal effects in high energy charged particle beams

Within the framework of the thermal wave model, an investigation is made of the longitudinal dynamics of high energy charged particle beams. The model includes the self-consistent interaction between the beam and its surroundings in terms of a nonlinear coupling impedance, and when resistive as well as reactive parts are included, the evolution equation becomes a generalised nonlinear Schroedinger equation including a nonlocal nonlinear term. The consequences of the resistive part on the propagation of particle bunches are examined using analytical as well as numerical methods.Comment: 6 pages, 6 figures, uses RevTeX

An EXAFS study of rare-earth phosphate glasses in the vicinity of the metaphosphate composition

A study of rare-earth phosphate glasses, in the vicinity of the metaphosphate composition, has been undertaken at different temperatures using the extended X-ray absorption fine structure (EXAFS) facility at the Synchrotron Radiation Source, Daresbury Laboratory, UK. The metaphosphate-like glasses examined contained the rare-earth elements La, Sm. Eu and Gd as R3+ ions. The experiments were carried out at room temperature, 145 and 79 K. The data show that the first shell surrounding rare-earth ions contains only oxygen atoms at a mean distance of similar to 2.2-2.4 Angstrom. The 'Iantfianide contraction' is clearly observed, i.e., the R-O distance decreases with increasing atomic number. The observed R(-O) coordination numbers are in the range 5-7. A second correlation shell was found associated with phosphorus atoms around the central rare-earth atom (similar to 3.5 Angstrom), and another rare-earth:oxygen correlation was also identified (similar to 4 Angstrom). Static disorder dominates the Debye-Waller term, but thermal disorder is not negligible. Within the accuracy of the EXAFS data, no significant structural variations were observed over the temperature range studied. We conclude that the anomalous bulk properties are associated with either subtle structural features or primarily due to rare-earth ion Interactions

Antihypertensive treatment decreases arterial stiffness at night but not during the day. Results from the Hypertension in the Very Elderly Trial

The main Hypertension in the Very Elderly Trial (HYVET) demonstrated a very marked reduction in cardiovascular events by treating hypertensive participants 80 years or older with a low dose, sustained release prescription of indapamide (indapamide SR, 1.5 mg) to which was added a low dose of an angiotensin converting enzyme inhibitor in two-thirds of cases (perindopril 2–4 mg). This report from the ambulatory blood pressure sub-study investigates whether changes in arterial stiffness and ambulatory blood pressure (BP) could both explain the benefits observed in the main trial. A total of 139 participants were randomized to placebo [67] and to active treatment [72] and had both day and night observations of BP and arterial stiffness as determined from the Q wave Korotkoff diastolic (QKD) interval. The QKD interval was 5.6 ms longer (p = 0.017) in the actively treated group at night than in the placebo group. This was not true for the more numerous daytime readings so that 24-h results were similar in the two groups. The QKD interval remained longer at night in the actively treated group even when adjusted for systolic pressure, heart rate and height. The reduced arterial stiffness at night may partly explain the marked benefits observed in the main trial

Vortices and extreme black holes: the question of flux expulsion

It has been claimed that extreme black holes exhibit a phenomenon of flux expulsion for abelian Higgs vortices, irrespective of the relative width of the vortex to the black hole. Recent work by two of the authors showed a subtlety in the treatment of the event horizon, which cast doubt on this claim. We analyse in detail the vortex/extreme black hole system, showing that while flux expulsion can occur, it does not do so in all cases. We give analytic proofs for both expulsion and penetration of flux, in each case deriving a bound for that behaviour. We also present extensive numerical work backing up, and refining, these claims, and showing in detail how a vortex can end on a black hole in all situations. We also calculate the backreaction of the vortex on the geometry, and comment on the more general vortex-black hole system.Comment: 28 pages revtex, 10 figures, minor changes, reference adde

Effective action and motion of a cosmic string

We examine the leading order corrections to the Nambu effective action for the motion of a cosmic string, which appear at fourth order in the ratio of the width to radius of curvature of the string. We determine the numerical coefficients of these extrinsic curvature corrections, and derive the equations of motion of the worldsheet. Using these equations, we calculate the corrections to the motion of a collapsing loop, a travelling wave, and a helical breather. From the numerical coefficients we have calculated, we discuss whether the string motion can be labelled as `rigid' or `antirigid,' and hence whether cusp or kink formation might be suppressed or enhanced.Comment: 24 pages revtex, 12 figure

Sex steroid hormones in relation to Barrett’s esophagus: An analysis of the FINBAR Study

Previously we observed strong positive associations between circulating concentrations of free testosterone and free dihydrotestosterone (DHT) in relation to Barrett’s esophagus in a US male military population. To replicate these findings, we conducted a second study of sex steroid hormones and Barrett’s esophagus in the Factors Influencing the Barrett/Adenocarcinoma Relationship (FINBAR) Study based in Northern Ireland and Ireland. We used mass spectrometry to quantitate EDTA plasma concentrations of nine sex steroid hormones and ELISA to quantitate sex hormone binding globulin in 177 male Barrett’s esophagus cases and 185 male general population controls within the FINBAR Study. Free testosterone, free DHT, and free estradiol were estimated using standard formulas. Multivariable logistic regression estimated odds ratios (OR) and 95% confidence intervals (95%CI) of associations between exposures and Barrett’s esophagus. While plasma hormone and sex hormone binding globulin concentrations were not associated with all cases of Barrett’s esophagus, we did observe positive associations with estrogens in younger men (e.g., estrone + estradiol ORcontinuous per ½ IQR=2.92, 95%CI:1.08, 7.89), and free androgens in men with higher waist-to-hip ratios (e.g., free testosterone ORcontinuous per ½ IQR=2.71, 95%CI:1.06, 6.92). Stratification by body mass index, antireflux medications, and geographic location did not materially affect the results. This study found evidence for associations between circulating sex steroid hormones and Barrett’s esophagus in younger men and men with higher waist-to-hip ratios. Further studies are necessary to elucidate whether sex steroid hormones are consistently associated with esophageal adenocarcinogenesis.<br/

Compassion Fatigue: An Application of the Concept to Informal Caregivers of Family Members with Dementia

Introduction. Compassion fatigue is a concept used with increasing frequency in the nursing literature. The objective of this paper is to identify common themes across the literature and to apply these themes, and an existing model of compassion fatigue, to informal caregivers for family members with dementia. Findings. Caregivers for family members with dementia may be at risk for developing compassion fatigue. The model of compassion fatigue provides an informative framework for understanding compassion fatigue in the informal caregiver population. Limitations of the model when applied to this population were identified as traumatic memories and the emotional relationship between parent and child, suggesting areas for future research. Conclusions. Research is needed to better understand the impact of compassion fatigue on informal caregivers through qualitative interviews, to identify informal caregivers at risk for compassion fatigue, and to provide an empirical basis for developing nursing interventions for caregivers experiencing compassion fatigue

Banks' risk assessment of Swedish SMEs

Building on the literatures on asymmetric information and risk taking, this paper applies conjoint experiments to investigate lending officers' probabilities of supporting credit to established or existing SMEs. Using a sample of 114 Swedish lending officers, we test hypotheses concerning how information on the borrower's ability to repay the loan; alignment of risk preferences; and risk sharing affect their willingness to grant credit. Results suggest that features that reduce the risk to the bank and shift the risk to the borrower have the largest impact. The paper highlights the interaction between factors that influence the credit decision. Implications for SMEs, banks and research are discussed

Performance deficits of NK1 receptor knockout mice in the 5 choice serial reaction time task: effects of d Amphetamine, stress and time of day.

Background The neurochemical status and hyperactivity of mice lacking functional substance P-preferring NK1 receptors (NK1R-/-) resemble abnormalities in Attention Deficit Hyperactivity Disorder (ADHD). Here we tested whether NK1R-/- mice express other core features of ADHD (impulsivity and inattentiveness) and, if so, whether they are diminished by d-amphetamine, as in ADHD. Prompted by evidence that circadian rhythms are disrupted in ADHD, we also compared the performance of mice that were trained and tested in the morning or afternoon. Methods and Results The 5-Choice Serial Reaction-Time Task (5-CSRTT) was used to evaluate the cognitive performance of NK1R-/- mice and their wildtypes. After training, animals were tested using a long (LITI) and a variable (VITI) inter-trial interval: these tests were carried out with, and without, d-amphetamine pretreatment (0.3 or 1 mg/kg i.p.). NK1R-/- mice expressed greater omissions (inattentiveness), perseveration and premature responses (impulsivity) in the 5-CSRTT. In NK1R-/- mice, perseveration in the LITI was increased by injection-stress but reduced by d-amphetamine. Omissions by NK1R-/- mice in the VITI were unaffected by d-amphetamine, but premature responses were exacerbated by this psychostimulant. Omissions in the VITI were higher, overall, in the morning than the afternoon but, in the LITI, premature responses of NK1R-/- mice were higher in the afternoon than the morning. Conclusion In addition to locomotor hyperactivity, NK1R-/- mice express inattentiveness, perseveration and impulsivity in the 5-CSRTT, thereby matching core criteria for a model of ADHD. Because d-amphetamine reduced perseveration in NK1R-/- mice, this action does not require functional NK1R. However, the lack of any improvement of omissions and premature responses in NK1R-/- mice given d-amphetamine suggests that beneficial effects of this psychostimulant in other rodent models, and ADHD patients, need functional NK1R. Finally, our results reveal experimental variables (stimulus parameters, stress and time of day) that could influence translational studies