Analysis of the quasi-nonlocal approximation of linear and circular chains in the plane

We give an analysis of the stability and displacement error for linear and circular atomistic chains in the plane when the atomistic energy is approximated by the Cauchy-Born continuum energy and by the quasi-nonlocal atomistic-to-continuum coupling energy. We consider atomistic energies that include Lennard-Jones type nearest neighbor and next nearest neighbor pair-potential interactions. Previous analyses for linear chains have shown that the Cauchy-Born and quasi-nonlocal approximations reproduce (up to the order of the lattice spacing) the atomistic lattice stability for perturbations that are constrained to the line of the chain. However, we show that the Cauchy-Born and quasi-nonlocal approximations give a finite increase for the lattice stability of a linear or circular chain under compression when general perturbations in the plane are allowed. We also analyze the increase of the lattice stability under compression when pair-potential energies are augmented by bond-angle energies. Our estimates of the largest strain for lattice stability (the critical strain) are sharp (exact up to the order of the lattice scale). We then use these stability estimates and modeling error estimates for the linearized Cauchy-Born and quasi-nonlocal energies to give an optimal order (in the lattice scale) {\em a priori} error analysis for the approximation of the atomistic strain in $\ell^2_\epsilon$ due to an external force.Comment: 27 pages, 0 figure

Effects of Patient-Directed Music Intervention on Anxiety and Sedative Exposure in Critically Ill Patients Receiving Mechanical Ventilatory Support: A Randomized Clinical Trial

Importance: Alternatives to sedative medications, such as music, may alleviate the anxiety associated with ventilatory support. Objective: To test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients. Design, Setting, and Patients: Randomized clinical trial that enrolled 373 patients from 12 intensive care units (ICUs) at 5 hospitals in the Minneapolis-St Paul, Minnesota, area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86% were white, 52% were female, and the mean (SD) age was 59 (14) years. The patients had a mean (SD) Acute Physiology, Age and Chronic Health Evaluation III score of 63 (21.6) and a mean (SD) of 5.7 (6.4) study days. Interventions: Self-initiated PDM (n = 126) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, self-initiated use of noise-canceling headphones (NCH; n = 122), or usual care (n = 125). Main Outcomes and Measures: Daily assessments of anxiety (on 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency). Results: Patients in the PDM group listened to music for a mean (SD) of 79.8 (126) (median [range], 12 [0-796]) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean (SD) of 34.0 (89.6) (median [range], 0 [0-916]) minutes/day. The mixed-models analysis showed that at any time point, patients in the PDM group had an anxiety score that was 19.5 points lower (95% CI, −32.2 to −6.8) than patients in the usual care group (P = .003). By the fifth study day, anxiety was reduced by 36.5% in PDM patients. The treatment × time interaction showed that PDM significantly reduced both measures of sedative exposure. Compared with usual care, the PDM group had reduced sedation intensity by −0.18 (95% CI, −0.36 to −0.004) points/day (P = .05) and had reduced frequency by −0.21 (95% CI, −0.37 to −0.05) points/day (P = .01). The PDM group had reduced sedation frequency by −0.18 (95% CI, −0.36 to −0.004) points/day vs the NCH group (P = .04). By the fifth study day, the PDM patients received 2 fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity. Conclusions and Relevance: Among ICU patients receiving acute ventilatory support for respiratory failure, PDM resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH. Trial Registration: clinicaltrials.gov Identifier: NCT00440700 Critically ill mechanically ventilated patients receive intravenous sedative and analgesic medications to reduce anxiety and promote comfort and ventilator synchrony. These potent medications are often administered at high doses for prolonged periods and are associated with adverse effects such as bradycardia, hypotension, gut dysmotility, immobility, weakness, and delirium.1-3 Despite protocols and sedation assessment tools that guide clinicians, patients still experience significant levels of anxiety.4,5 Unrelieved anxiety and fear are not only unpleasant symptoms that clinicians want to palliate, but increased sympathetic nervous system activity can cause dyspnea and increased myocardial oxygen demand.6 Sustained anxiety and sympathetic nervous system activation can decrease the ability to concentrate, rest, or relax.6,7 Mechanically ventilated patients have little control over pharmacological interventions to relieve anxiety; dosing and frequency of sedative and analgesic medications are controlled by intensive care unit (ICU) clinicians. Interventions are needed that reduce anxiety, actively involve patients, and minimize the use of sedative medications. Nonpharmacological interventions such as relaxing music are effective in reducing anxiety while reducing medication administration.8,9 Music is a powerful distractor that can alter perceived levels of anxiety10 by occupying attention channels in the brain with meaningful, auditory stimuli11 rather than stressful environmental stimuli. Listening to preferred, relaxing music has reduced anxiety in mechanically ventilated patients in limited trials.12-15 It is not known if music can reduce anxiety throughout the course of ventilatory support, or reduce exposure to sedative medications. We evaluated if a patient-directed music (PDM) intervention could reduce anxiety and sedative exposure in ICU patients receiving mechanical ventilation

Development of a Workshop for Older Adult Volunteers Using a Life Strengths Guide With Clients

The purpose of this project is to develop a training workshop that teaches older adult volunteers about a Life Strengths Interview Guide that can be used when working with clients. The framework of the workshop focuses on Erik Erikson\u27s life cycle theory with a strengths perspective. The interview guide is divided into eight sections that relate to Erikson\u27s eight psychosocial stages of life. Each section contains questions related to a specific stage in life and is intended to get the client talking about the strengths that are found in these specific areas of his or her life. The workshop is intended to give older adult volunteers who will be using the guide with their clients some background on the stages of life, information on the importance of looking for strengths in older adulthood, and practice in how to apply the questions in the guide to their work with clients

Beyond the Patient: Nursing Presence With Families During the Perioperative Period

Nurses have used the intervention of caring for many years, but little attention has been given to describing the phenomenon of nursing presence in the perioperative setting. The purpose of this research was to learn more about the experience of the connection of the family to the nurse who kept them informed during the perioperative period. A hermeneutic phenomenological approach was utilized to identify patterns of caring, connecting, and transpersonal nursing presence described by the family of surgical patients. Five women were interviewed for this study. Transcribed interviews became the phenomenological texts for my hermeneutic analysis. Essential themes were uncovered that captured the essence of their experience. The women described the nurse\u27s presence as a relationship that involved a kind of being with. They expressed a remarkable feeling knowing that someone cared, and described a special connection with someone they had just met. The presence of the nurse was an important factor in feeling reassured, even though time seemed endless. Perioperative nurses must understand the impact of nursing presence with families, and transform their nursing practice

A Century of Child Placing: 1900-1998

The following historical study explored and analyzed the policies in child welfare from 1900-1999 with a special emphasis on the last twenty years. The research attempted to discover common ideologies from the last century and to compare and contrast modern day child welfare practices to the turn of the twentieth century child welfare practices. Using content analysis, this qualitative study examined historical and current documents in search of common factors in the last century in the field of child welfare mid the placing out of children. The data revealed areas in the field of child welfare that have been present throughout the century and areas that have recurred time and again. Those areas are; The use of volunteers in this field, large caseloads, prevention, collaboration, confusing agencies within the system, removal from home based on income and the confusion over which agency has jurisdiction or responsibility. I believe if social workers are aware of social work\u27s historical background it can help us in our current practice of working with families and the legal syste

A Study of the Crisis Leadership Model at Marshall University

This research addresses the question: what factors contribute to a group successfully navigating times of crisis and what roles does the leader play in this navigation. Given recent events such as the terrorist attacks of September 11th, 2001, the tsunami that devastated Indonesia in 2004, the catastrophic force of Hurricane Katrina in 2005 and the most recent earthquake in 2010 that decimated Haiti, coupled with the current tenuous international political climate, the need to understand how groups move through crisis and what role leadership plays is vitally important. To study this question, the crisis of Marshall University will be analyzed. On November 14th, 1970, a chartered Southern Airways flight carrying the Marshall University football team, coaching staff and many members of the community, crashed outside Huntington, West Virginia. There were no survivors. Left behind were two assistant coaches and three varsity players that were not aboard the flight. After much deliberation, the university decided to carry on with the football program and hired Jack Lengyel of Wooster College to lead the rebuilding effort. A case study of the Marshall University football program will be conducted for this research. During this research, literature in the field of crisis management will be reviewed, literature in the area of storytelling within the context of leadership will be reviewed, the crisis of the plane crash and its aftermath will be analyzed, an interview with Coach Lengyel will be conducted, and a crisis leadership model will be developed for the purpose of determining how effectively a given leader navigates times of crisis

Followership and the Dance of Lead and Follow

The purpose of this study is to show how thinking about leadership changes when followers are valued. Traditionally, leadership studies focus on leaders-who they are, what characteristics they possess and what they do. Even when followers are mentioned in the literature, it is easy to overlook them. The main questions addressed here are: What is followership about? and How does thinking about leadership change when the focus is placed on followers? Two authors, Robert Kelley and Ira Chaleff have written books about followers from the perspective of the follower. Additional research has shown that a paradigm shift is underway to a new world view in which relationships are fundamental to understanding reality. It is this new mindset which recognizes the importance of followers in relationship with leaders. However, followers need a more positive image. Dance, particularly Argentine Tango, is a good metaphor for leaders and followers in a dynamic and positive leadership relationship

The Amount of Prenatal Care in Women Thirty-five Years and Older and It\u27s Effects on Birth Weight, Gestational Age and Apgar Scores

Background Prenatal care is essential to the health of mothers and their babies. It is unclear what aspects of prenatal care influence maternal and infant health the most. The purpose of this study was to determine if the amount of prenatal care visits a woman thirty-five years or older receives impacts the newborn\u27s health, Methods The medical records of all women thirty-five years of age and older who gave birth at Cambridge Allina Medical Center in a one-year period were reviewed. The number of prenatal care visits for each subject was correlated with the birth weight, gestational age and Apgar scores of her infant. Results A positive correlation was determined between increasing birth weight and amount of prenatal visits, increasing gestational age and amount of prenatal visits, and increasing Apgar scores and amount of prenatal visits. However, these correlations were found to not be statistically significant using a p \u3c 0.05. Conclusions It is not clear how big of an impact the amount of prenatal care visits has on birth outcomes. Further research with a larger and more diverse population should be done to determine how strong of a connection there is between prenatal care and birth weight, gestational age and Apgar scores

Motivation for Medicine: What Factors Influence Men and Women to Enter Physician Assistant School Versus Medical School?

Background The purpose of this study was to distinguish what factors were most significant in medical and physician assistant student\u27s decision to enter medicine, in addition to comparing male and female student\u27s motivation. Methods A survey consisting of potential motives or deterrents for entering medicine was given to medical and PA students. Results were analyzed using an independent T-test. Results PA students reported greater significance on the duration of academic and clinical training, the ability to balance work and family, the opportunity to achieve a high income, dealing with malpractice allegations and the need to be on-call as motives for entering PA school. When male students were compared, male PA students reported greater significance on the ability to balance work with family and the appropriate level of independence within their profession as motives for entering PA school. When female students were compared, female PA students reported greater significance on the opportunity to achieve high income, social prestige/status, duration of academic and professional training, ability to balance work and family responsibilities, and the need to be on-call as motives for entering PA school. Conclusions There was a strong resemblance between medical and PA students in regard to their motivation for entering medicine with no significant differences between genders within medical or PA school. Female students reported greater variance in their decision to enter medical or PA school, when compared with male students

Perceived Leadership Development as a Result of Martial Arts Training

The purpose of this study is to determine the impact of martial arts training on the individual\u27s leadership in the workplace. Martial arts training develops leadership skills and traits that include self-control, focus, attaining goals, and respect of self and others. The research was conducted using a survey tool to explore if perceived leadership traits were learned within a martial arts training school and transferred to the workplace. The survey was completed by adult students of the National Karate Schools in Minnesota. The statements referred to non-physical skills learned in martial arts and if those skills were evident in the workplace. Martial arts\u27 training does impact leadership skills and traits according to the results of the survey