Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

PubMed Central

Kane, Robert L; Wysocki, Andrea; Parashuram, Shriram; Shippee, Tetyana; Lum, Terry

2013-01-01

Background: Dual eligible Medicare and Medicaid beneficiaries consume disproportionate shares of both programs. Objectives: To compare Medicare and Medicaid expenditures of elderly dual eligible beneficiaries with non-dual eligible beneficiaries based on their long-term care (LTC) use. Research Design: Secondary analysis of linked MAX and Medicare data in seven states. Subjects: Dual eligible adults (65+) receiving LTC in institutions, in the community, or not at all; and Medicare non-dual eligibles. Measures: Medicaid acute medical and LTC expenditures per beneficiary year, Medicare expenditures. Results: Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs. Conclusions: Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures. PMID:24753971

Predictors of long-term care placement in persons with dementia: a systematic review and meta-analysis.

PubMed

Cepoiu-Martin, Monica; Tam-Tham, Helen; Patten, Scott; Maxwell, Colleen J; Hogan, David B

2016-11-01

The main objective of this study was to summarize the effects of various individual, caregiver, and system-related factors on the risk of long-term care (LTC) placement for persons with dementia. We searched electronic databases for longitudinal studies reporting on predictors of LTC placement for persons with dementia residing in the community or supportive care settings. We performed meta-analyses with hazard ratios (HRs) of various predictors using random effects models and stratified the HRs with several study variables. Data on predictors not included in the meta-analyses were summarized descriptively. Full-text reviews of 360 papers were performed with data from 37 papers used to calculate pooled HRs for LTC placement of select person with dementia (age, sex, race, marital status, type of dementia, living arrangement, and relationship to caregiver) and caregiver (age, sex, and depressive symptoms) characteristics. White race [HR = 1.67, 95% confidence intervals (CI): 1.41-1.99], greater dementia severity (HR = 1.05, 95% CI: 1.03-1.06), and older age (HR = 1.02, 95% CI: 1.01-1.03) increased the risk of LTC placement. Married persons with dementia (HR = 0.38, 95% CI: 0.16-0.86) and living with their caregiver (HR = 0.72, 95% CI: 0.56-0.92) had a lower risk. Behavioral and psychological symptoms of dementia, the degree of functional impairment, and caregiver burden had a consistent effect on the risk of LTC placement in our descriptive review. We quantified the predictive effect of several risk factors for LTC placement. These estimates could be used to more precisely categorize the risk of institutionalization and potentially link those at higher risk to appropriate services. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Comparison of the predictive validity of diagnosis-based risk adjusters for clinical outcomes.

PubMed

Petersen, Laura A; Pietz, Kenneth; Woodard, LeChauncy D; Byrne, Margaret

2005-01-01

Many possible methods of risk adjustment exist, but there is a dearth of comparative data on their performance. We compared the predictive validity of 2 widely used methods (Diagnostic Cost Groups [DCGs] and Adjusted Clinical Groups [ACGs]) for 2 clinical outcomes using a large national sample of patients. We studied all patients who used Veterans Health Administration (VA) medical services in fiscal year (FY) 2001 (n = 3,069,168) and assigned both a DCG and an ACG to each. We used logistic regression analyses to compare predictive ability for death or long-term care (LTC) hospitalization for age/gender models, DCG models, and ACG models. We also assessed the effect of adding age to the DCG and ACG models. Patients in the highest DCG categories, indicating higher severity of illness, were more likely to die or to require LTC hospitalization. Surprisingly, the age/gender model predicted death slightly more accurately than the ACG model (c-statistic of 0.710 versus 0.700, respectively). The addition of age to the ACG model improved the c-statistic to 0.768. The highest c-statistic for prediction of death was obtained with a DCG/age model (0.830). The lowest c-statistics were obtained for age/gender models for LTC hospitalization (c-statistic 0.593). The c-statistic for use of ACGs to predict LTC hospitalization was 0.783, and improved to 0.792 with the addition of age. The c-statistics for use of DCGs and DCG/age to predict LTC hospitalization were 0.885 and 0.890, respectively, indicating the best prediction. We found that risk adjusters based upon diagnoses predicted an increased likelihood of death or LTC hospitalization, exhibiting good predictive validity. In this comparative analysis using VA data, DCG models were generally superior to ACG models in predicting clinical outcomes, although ACG model performance was enhanced by the addition of age.

The burden of overweight and obesity on long-term care and Medicaid financing.

PubMed

Yang, Zhou; Zhang, Ning

2014-07-01

The obesity rate among the elderly long-term care (LTC) residents in the United States is increasing rapidly. However, there is a paucity of research investigating the burden of obesity on LTC and Medicaid financing. The purpose of this study is to fill the knowledge gap by estimating the burden of overweight and obesity on LTC and Medicaid financing. Using nationally representative Cost and Use Files of Medicare Current Beneficiary Survey from 1997 to 2005, we used 2-part model and cohort-based simulation to evaluate the effect of overweight and obesity on LTC days and Medicaid expenditures across the lifespan among the current elderly population. Combining the per capita estimates with 2010 census, we project future aggregate burden of obesity on LTC demand and Medicaid cost among baby boomers. Obesity and related chronic diseases lead to higher probability to enter LTC facility in a younger age, more LTC days before death, and higher lifetime LTC cost reimbursed by Medicaid. However, such effect is only statistically significant among women, not significant among men. At the population level, we project that overweight and obesity will induce 1.3 billion or more LTC patient days and $68 billion or more Medicaid costs (in 2012 value) among baby boomers. Overweight and obesity among the elderly will bring tremendous burden to LTC providers and Medicaid. Policy makers should keep the burden of obesity on LTC in mind when planning LTC and Medicaid policy reform.

Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003–2011

PubMed Central

Lohman, Matthew; Leslie, Marc; Powell, Virginia

2015-01-01

Objectives. We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide. Methods. Data come from the Virginia Violent Death Reporting System (2003–2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis. Results. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC. Conclusions. LTC may be an important point of engagement in suicide prevention. PMID:25973805

Joining of Gamma Titanium Aluminides

DTIC Science & Technology

2002-09-01

AFRL-ML-WP-TR-2003-4036 JOINING OF GAMMA TITANIUM ALUMINIDES LTC William A. Baeslack, III Metals Branch (AFRL/MLLM) Metals, Ceramics, and...GAMMA TITANIUM ALUMINIDES 5c. PROGRAM ELEMENT NUMBER 62102F 5d. PROJECT NUMBER MO2R 5e. TASK NUMBER 10 6. AUTHOR(S) LTC William A...comparatively discusses the results of research and development performed on the joining of gamma titanium aluminides during the past two decades. Although

Factors related to the decision-making for moving the older adults into long-term care facilities in Taiwan.

PubMed

Hsieh, Yen-Ping; Huang, Ying-Chia; Lan, Shou-Jen; Ho, Ching-Sung

2017-09-01

To investigate the relationships between demographic characteristics of the elderly, type of long-term care (LTC) facilities, and the reasons for moving into LTC facilities. Research participants included people aged over 65 years, living in LTC facilities. A total of 1280 questionnaires were distributed to 111 LTC facilities in Taiwan; 480 questionnaires were retrieved, and 232 were included in the valid sample. The study used a non-linear canonical correlation analysis, which assesses the relationships among similar sets of categorical variables. The results showed that the older adults in quadrant I were characterized by being involved in the decision-making regarding the choice of LTC facilities and received economic support from their children. The older adults in quadrant II mainly lived in LTC facilities to receive medical care, whereas those in quadrant III typically included individuals with low income, who did not choose to live in LTC facilities. Furthermore, those in quadrant IV had positive cognitions associated with LTC facilities. We believe that the results of the present study will facilitate policy-making in the field of LTC, provide reference to the practitioners and the older adults, and identify the types of decisions older adults make when moving into LTC facilities, thus assisting older adults to improve their strategies regarding staying in LTC facilities. Geriatr Gerontol Int 2017; 17: 1319-1327. © 2016 Japan Geriatrics Society.

Impact of Long-Term Care on Retirement Wellness.

PubMed

Rappaport, Anna M

2015-01-01

Retirement wellness is the result of retiring at an appropriate age, saving enough and managing risks appropriately. One of the major risks that often is not addressed effectively is the long-term care (LTC) risk, i.e., the risk of needing help due to physical or cognitive limitations. In 2014, the Society of Actuaries issued a call for papers on the link between LTC and retirement security. This article will discuss the topic of LTC and retirement security broadly, drawing from several of the papers. Some of the topics include the impact of LTC on the individual, family members and caregivers; modeling results showing the impact of LTC on assets needed for a secure retirement; alternative methods of financing LTC; the link between housing decisions and LTC; and some ideas for the future.

An educational video to promote multi-factorial approaches for fall and injury prevention in long-term care facilities

PubMed Central

2014-01-01

Background Older adults living in long term care (LTC) settings are vulnerable to fall-related injuries. There is a need to develop and implement evidence-based approaches to address fall injury prevention in LTC. Knowledge translation (KT) interventions to support the uptake of evidence-based approaches to fall injury prevention in LTC need to be responsive to the learning needs of LTC staff and use mediums, such as videos, that are accessible and easy-to-use. This article describes the development of two unique educational videos to promote fall injury prevention in long-term care (LTC) settings. These videos are unique from other fall prevention videos in that they include video footage of real life falls captured in the LTC setting. Methods Two educational videos were developed (2012–2013) to support the uptake of findings from a study exploring the causes of falls based on video footage captured in LTC facilities. The videos were developed by: (1) conducting learning needs assessment in LTC settings via six focus groups (2) liaising with LTC settings to identify learning priorities through unstructured conversations; and (3) aligning the content with principles of adult learning theory. Results The videos included footage of falls, interviews with older adults and fall injury prevention experts. The videos present evidence-based fall injury prevention recommendations aligned to the needs of LTC staff and: (1) highlight recommendations deemed by LTC staff as most urgent (learner-centered learning); (2) highlight negative impacts of falls on older adults (encourage meaning-making); and, (3) prompt LTC staff to reflect on fall injury prevention practices (encourage critical reflection). Conclusions Educational videos are an important tool available to researchers seeking to translate evidence-based recommendations into LTC settings. Additional research is needed to determine their impact on practice. PMID:24884899

Low-temperature conditioning induces chilling tolerance in stored mango fruit.

PubMed

Zhang, Zhengke; Zhu, Qinggang; Hu, Meijiao; Gao, Zhaoyin; An, Feng; Li, Min; Jiang, Yueming

2017-03-15

In this study, mango fruit were pre-treated with low-temperature conditioning (LTC) at 12°C for 24h, followed by refrigeration at 5°C for 25days before removal to ambient temperature (25°C) to investigate the effects and possible mechanisms of LTC on chilling injury (CI). The results showed that LTC effectively suppressed the development of CI in mango fruit, accelerated softening, and increased the soluble solids and proline content. Furthermore, LTC reduced electrolyte leakage, and levels of malondialdehyde, O 2 - and H 2 O 2 , maintaining membrane integrity. To reveal the molecular regulation of LTC on chilling tolerance in mango fruit, a C-repeat/dehydration-responsive element binding factor (CBF) gene, MiCBF1, was identified and its expression in response to LTC was examined using RT-qPCR. LTC resulted in a higher MiCBF1 expression. These findings suggest that LTC enhances chilling tolerance in mango fruit by inducing a series of physiological and molecular responses. Copyright © 2016 Elsevier Ltd. All rights reserved.

Nursing Information Flow in Long-Term Care Facilities.

PubMed

Wei, Quan; Courtney, Karen L

2018-04-01

 Long-term care (LTC), residential care requiring 24-hour nursing services, plays an important role in the health care service delivery system. The purpose of this study was to identify the needed clinical information and information flow to support LTC Registered Nurses (RNs) in care collaboration and clinical decision making.  This descriptive qualitative study combines direct observations and semistructured interviews, conducted at Alberta's LTC facilities between May 2014 and August 2015. The constant comparative method (CCM) of joint coding was used for data analysis.  Nine RNs from six LTC facilities participated in the study. The RN practice environment includes two essential RN information management aspects: information resources and information spaces. Ten commonly used information resources by RNs included: (1) RN-personal notes; (2) facility-specific templates/forms; (3) nursing processes/tasks; (4) paper-based resident profile; (5) daily care plans; (6) RN-notebooks; (7) medication administration records (MARs); (8) reporting software application (RAI-MDS); (9) people (care providers); and (10) references (i.e., books). Nurses used a combination of shared information spaces, such as the Nurses Station or RN-notebook, and personal information spaces, such as personal notebooks or "sticky" notes. Four essential RN information management functions were identified: collection, classification, storage, and distribution. Six sets of information were necessary to perform RN care tasks and communication, including: (1) admission, discharge, and transfer (ADT); (2) assessment; (3) care plan; (4) intervention (with two subsets: medication and care procedure); (5) report; and (6) reference. Based on the RN information management system requirements, a graphic information flow model was constructed.  This baseline study identified key components of a current LTC nursing information management system. The information flow model may assist health information technology (HIT) developers to consolidate the design of HIT solutions for LTC, and serve as a communication tool between nurses and information technology (IT) staff to refine requirements and support further LTC HIT research. Schattauer GmbH Stuttgart.

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers

PubMed Central

Mosca, Ilaria; van der Wees, Philip J.; Mot, Esther S.; Wammes, Joost J.G.; Jeurissen, Patrick P.T.

2017-01-01

Background: The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU’s European Semester. Methods: This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. Results: The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. Conclusion: The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC, given the demographic- and fiscal circumstances, and the complexities of LTC systems. It also shows the usefulness to learn from policy design and implementation of LTC policy in other countries, within and outside the EU. Researchers can contribute by studying conditions, under which the strategies explored might deliver solutions for policy-makers. PMID:28812803

The future of financing for long-term care: the Own Your Future campaign.

PubMed

Iwasaki, Michiko; McCurry, Susan M; Borson, Soo; Jones, James A

2010-10-01

The purpose of this study was to examine the outreach effort and impact of a joint federal-state campaign, Own Your Future, promoting awareness and planning for long-term care (LTC) in the state of Washington. The study applied survey methodology to evaluate the extent of campaign dissemination, evidence of its impact on LTC planning behaviors, and barriers to purchasing private LTC insurance. A total of 3,198 survey responses from a randomly selected community sample and a Washington State employee sample (ages 51 to 71) were analyzed. Results indicated that the impact of the campaign was limited, both with respect to awareness of the campaign itself and to initiation of LTC planning behaviors. Quantitative data revealed a high prevalence of health-related problems (e.g., obesity, diabetes), inadequate knowledge of basic LTC-related information (e.g., cost, payers), and negative attitudes toward purchasing LTC insurance among respondents. Qualitative analyses suggested that respondents perceived significant problems related to affordability and accountability within the current LTC insurance industry. These possible barriers to the purchase of LTC insurance suggest targets to be addressed by policy makers seeking to find ways to offset the public costs of LTC.

Quercetin attenuates lambda cyhalothrin-induced reproductive toxicity in male rats.

PubMed

Ben Abdallah, Fatma; Fetoui, Hamadi; Zribi, Nassira; Fakhfakh, Feiza; Keskes, Leila

2013-12-01

The aim of this study was to evaluate the possible protective effects of Quercetin (Qe) against oxidative stress induced by λ cyhalothrin (LTC) in reproductive system. Thirty-two male rats were divided into four groups. First group was allocated as the control group. Second group was given a Qe alone while the third group received a LTC alone. Animals in the fourth group were given a Qe with LTC. Caudae epididymis was removed for sperm analysis. Lipid peroxidation (LPO), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione-S-transferase (GST), and reduced glutathione (GSH) were determined in the testis. Additionally, the different histopathologic changes were observed in the testis of animals. LTC exposure significantly increased the abnormal morphology and LPO. On the contrary, sperm motility, viability and count, levels of GSH, and activities of SOD, CAT, GPx, and GST were significantly decreased compared to controls. Qe with LTC offset the decrease in functional sperm parameters, antioxidants enzymatic activities, and nonenzymatic antioxidant levels when compared with LTC-treated rats. Furthermore, LTC showed irregular seminiferous tubules containing only Sertoli cells and Qe with LTC caused regular seminiferous tubules showing spermatogenesis at level of spermatocytes. We conclude that LTC-induced oxidative stress and functional sperm parameters in male rats, and dietary of Qe attenuates the reproductive toxicity of LTC to restore the antioxidant system and sperm parameters in male rats. Copyright © 2011 Wiley Periodicals, Inc.

Implementing routine blood-borne virus testing for HCV, HBV and HIV at a London Emergency Department - uncovering the iceberg?

PubMed

Parry, S; Bundle, N; Ullah, S; Foster, G R; Ahmad, K; Tong, C Y W; Balasegaram, S; Orkin, C

2018-06-01

UK guidelines recommend routine HIV testing in high prevalence emergency departments (ED) and targeted testing for HBV and HCV. The 'Going Viral' campaign implemented opt-out blood-borne virus (BBV) testing in adults in a high prevalence ED, to assess seroprevalence, uptake, linkage to care (LTC) rates and staff time taken to achieve LTC. Diagnosis status (new/known/unknown), current engagement in care, and severity of disease was established. LTC was defined as patient informed plus ⩾1 clinic visit. A total of 6211/24 981 ED attendees were tested (uptake 25%); 257 (4.1%) were BBV positive (15 co-infected), 84 (33%) required LTC. 100/147 (68%) HCV positives were viraemic; 44 (30%) required LTC (13 new, 16 disengaged). 26/54 (48%) HBV required LTC (seven new, 11 disengaged). 16/71 (23%) HIV required LTC (10 new, five disengaged). 26/84 (31%) patients requiring LTC had advanced disease (CD4 1, Fibroscan F3/F4 or liver cancer), including five with AIDS-defining conditions and three hepatocellular carcinomas. There were five BBV-related deaths. BBV prevalence was high (4.1%); most were HCV (2.4%). HIV patients were more successfully and quickly LTC than HBV or HCV patients. ED testing was valuable as one-third of those requiring LTC (new, disengaged or unknown status patients) had advanced disease.

42 CFR 412.503 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... through September 30. LTC-DRG stands for the diagnosis-related group used to classify patient discharges... on or after October 1, 2007, are classified by a severity-adjusted patient classification system, the MS-LTC-DRGs. Any reference to the term “LTC-DRG” shall be considered a reference to the term “MS-LTC...

[Comparison of development and mortality under domestic or institutional care with and without medical rehabilitation : The Hannover morbidity and mortality long-term care study].

PubMed

Seger, W; Sittaro, N-A; Lohse, R; Rabba, J

2013-12-01

Empirical data, representative of the total population, are necessary for medico-actuarial risk calculations. Our study compares mortalities of long-term care (LTC) patients who are covered by statutory health insurance with regard to age and distribution of care levels when in home or institutional care with a special focus on whether rehabilitative care was performed. The data of 88,575 LTC patients were analyzed longitudinally for 10 years, using routine data analyses on the files of the German Federal Health Insurance fund (average observation period 2.5 years, a total of 221,625 observation years). The numbers of LTC patients and their care levels while in home or institutional care were calculated, as were any changes to another care level or discontinuation of LTC benefits (as a result of the need for care falling below the eligibility criteria for care leveI or to death) during 1-10 years after the onset of LTC, always with respect to whether rehabilitative care had taken place or not. For the evaluation of care factors an indicator was developed. Total mortality was found to decline and reactivation to increase considerably for LTC patients after rehabilitation, basically irrespective of their age or care level and in home or institutional care settings as well. Ten years after the onset of care, 30.7 % of the patients with rehabilitation were still in nursing care, 9.8 % were reactivated and 59.5 % deceased. In contrast, only 9.2 % were still in nursing care, 3.7 % reactivated and 87.1 % deceased without rehabilitation. These results are irrespective of age distribution, care level, and residence in home or institutional care settings. The care status of patients, measured by the percentage in reactivation, care level I-III, and death, substantially depends on age at onset and care level and in addition on rehabilitative procedures. Hypotheses for further research are outlined. Rehabilitation has a clear-cut potential for life extension as well as reducing or detaining long-term care if applied to (LTC) patients. The group of rehabilitated LTC patients has a comparatively higher degree of reducing or resolving LTC up to a complete reactivation or prolonging of life in spite of care needed. A successful rehabilitative effect occurs over all age groups and all care levels during home care considerably as well as during institutional care to a lower extent. Differentiation between the age at onset of LTC, care level, and first year and follow-up mortalities is recommended as well as between rehabilitated and nonrehabilitated care patients when undertaking medico-actuarial calculations.

U.S. Army Delayed Entry Program Optimization Model

DTIC Science & Technology

2004-08-01

United States Military Academy West Point, New York 10996 OPERATIONS RESEARCH CENTER OF EXCELLENCE TECHNICAL REPORT No. DSE-TR- 0428 DTIC #: ADAXXXXX...following entries: Author(s) Department of Systems Engineering 2 Mahan Hall West Point, NY 10996 Client USAAC CAR 4 1307 Third Ave., Fort Knox, KY 40121...Wolter, LTC Michael J. Kwinn, Jr., LTC John Halstead DSE-R- 0428 5S. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8

Patient Safety Culture Survey in Pediatric Complex Care Settings: A Factor Analysis.

PubMed

Hessels, Amanda J; Murray, Meghan; Cohen, Bevin; Larson, Elaine L

2017-04-19

Children with complex medical needs are increasing in number and demanding the services of pediatric long-term care facilities (pLTC), which require a focus on patient safety culture (PSC). However, no tool to measure PSC has been tested in this unique hybrid acute care-residential setting. The objective of this study was to evaluate the psychometric properties of the Nursing Home Survey on Patient Safety Culture tool slightly modified for use in the pLTC setting. Factor analyses were performed on data collected from 239 staff at 3 pLTC in 2012. Items were screened by principal axis factoring, and the original structure was tested using confirmatory factor analysis. Exploratory factor analysis was conducted to identify the best model fit for the pLTC data, and factor reliability was assessed by Cronbach alpha. The extracted, rotated factor solution suggested items in 4 (staffing, nonpunitive response to mistakes, communication openness, and organizational learning) of the original 12 dimensions may not be a good fit for this population. Nevertheless, in the pLTC setting, both the original and the modified factor solutions demonstrated similar reliabilities to the published consistencies of the survey when tested in adult nursing homes and the items factored nearly identically as theorized. This study demonstrates that the Nursing Home Survey on Patient Safety Culture with minimal modification may be an appropriate instrument to measure PSC in pLTC settings. Additional psychometric testing is recommended to further validate the use of this instrument in this setting, including examining the relationship to safety outcomes. Increased use will yield data for benchmarking purposes across these specialized settings to inform frontline workers and organizational leaders of areas of strength and opportunity for improvement.

42 CFR 412.515 - LTC-DRG weighting factors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false LTC-DRG weighting factors. 412.515 Section 412.515 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE...-Term Care Hospitals § 412.515 LTC-DRG weighting factors. For each LTC-DRG, CMS assigns an appropriate...

Rationalizing long-lived photo-excited carriers in photocatalyst (La5Ti2CuS5O7) in terms of one-dimensional carrier transport

NASA Astrophysics Data System (ADS)

Suzuki, Yohichi; Singh, Rupashree Balia; Matsuzaki, Hiroyuki; Furube, Akihiro; Ma, Guijun; Hisatomi, Takashi; Domen, Kazunari; Seki, Kazuhiko

2016-09-01

The semiconductor La5Ti2CuS5O7 (LTC) is a potential photocatalyst capable of operating under visible light irradiation and behaves both as a photocathode and anode when embedded onto metal layers. Time-resolved diffuse reflectance (TRDR) measurements were carried out on LTC powder and LTC deposited on Au as the back contact using the particle-transfer method. Results of TRDR measurements of powdered LTC indicated the existence of long-lived photo-excited carriers, and suggested the existence of a mechanism for preventing carrier loss in LTC. Prior research has reported that LTC has a rod-shaped crystal structure and that electrons and holes are transported through different, spatially separated channels. Based on this, we introduced a one-dimensional carrier transport model. By analyzing TRDR data, we extracted material parameters such as the diffusion coefficient of LTC. Theoretical results indicated that a micron-sized LTC particle would be preferable if carriers trapped at the top-surface do contribute to photocatalytic gas generation.

On becoming a coach: a pilot intervention study with managers in long-term care.

PubMed

Cummings, Greta; Mallidou, Anastasia A; Masaoud, Elmabrok; Kumbamu, Ashok; Schalm, Corinne; Spence Laschinger, Heather K; Estabrooks, Carole A

2014-01-01

Health care leaders have called for the development of communication and leadership skills to improve manager-employee relationships, employee job satisfaction, quality care, and work environments. The aim of the study reported here was to pilot how a 2-day coaching workshop ("Coaching for Impressive CARE") conducted as a leadership development strategy influenced frontline care managers' coaching practices in residential long-term care (LTC) settings. We had four objectives: (a) to identify managers' perceptions of their role as a coach of employee performance in LTC facilities, (b) to understand managers' intentions to coach employee performance, (c) to examine opportunities and factors that contributed to or challenged implementation of workshop coaching skills in daily leadership/management practice, and (d) to examine managers' reports of using coaching practices and employee responses after the workshop. We used an exploratory/descriptive design involving pre-/post-workshop surveys, e-mail reminders, and focus groups to examine participation of 21 LTC managers in a 2-day coaching workshop and their use of coaching practices in the workplace. Focus group findings provided examples of how participants used their coaching skills in practice (e.g., communicating empathy) and how staff responded. Factors contributing to and challenging implementation of these coaching skills in the workplace were identified. Attitudes and intentions to be a coach increased significantly, and some coaching skills were used more frequently after the workshop, specifically planning for performance change with employees. The coaching workshop was feasible to implement, well received by participants, influenced their willingness to become coaches, and had some noted impact on their use of coaching behaviors in the workplace. Coaching skills by managers to improve staff performance with residents in LTC facilities can be learned.

Hospitalisation of older people before and after long-term care entry in Auckland, New Zealand.

PubMed

Boyd, Michal; Broad, Joanna B; Zhang, Tony Xian; Kerse, Ngaire; Gott, Merryn; Connolly, Martin J

2016-07-01

global population projections forecast large growth in demand for long-term care (LTC) and acute hospital services for older people. Few studies report changes in hospitalisation rates before and after entry into LTC. This study compares hospitalisation rates 1 year before and after LTC entry. the Older Persons' Ability Level (OPAL) study was a 2008 census-type survey of LTC facilities in Auckland, New Zealand. OPAL resident hospital admissions and deaths were obtained from routinely collected national databases. all 2,244 residents (66% = female) who entered LTC within 12 months prior to OPAL were included. There were 3,363 hospitalisations, 2,424 in 12 months before and 939 in 12 months after entry, and 364 deaths. In the 6 to 12 months before LTC entry, the hospitalisation rate/100 person-years was 67.3 (95% confidence interval [CI] 62.5-72.1). Weekly rates then rose steeply to over 450/100 person-years in the 6 months immediately before LTC entry. In the 6 months after LTC entry, the rate fell to 49.1 (CI 44.9-53.3; RR 0.73 (CI 0.65-0.82, P < 0.0001)) and decreased further 6 to 12 months after entry to 41.1 (CI 37.1-45.1; rate ratio [RR] 0.61 (CI 0.54-0.69, P < 0.0001)). increased hospitalisations a few months before LTC entry suggest functional and medical instability precipitates LTC entry. New residents utilise hospital beds less frequently than when at home before that unstable period. Further research is needed to determine effective interventions to avoid some hospitalisations and possibly also LTC entry. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Medical directors of long-term care facilities: preventing another physician shortage?

PubMed

Frank, C; Seguin, R; Haber, Shelly; Godwin, Marshall; Stewart, G I

2006-06-01

The long-term care (LTC) sector in Canada is expanding, but little attention has been given to medical human resources in this area. Our objective was to seek LTC medical directors' opinions about medical services in LTC and about strategies for recruitment and retention. Mailed survey. Long-term care facilities and nursing homes. Seven hundred five medical directors of LTC facilities across Canada were identified from the Canadian Healthcare Association database. Responses to open- and closed-ended questions and to Likert-type scales. The response rate was 55%. The average age of medical directors was 54 years. Most had started work in LTC because of a vacant position, as opposed to self-perceived skills or training. Most (75.3%) reported satisfaction with their role as medical directors, but 82.7% believed that there was a significant shortage of physicians working in LTC, and 42% had seriously considered leaving their positions. Major sources of satisfaction identified were clinical, especially working with older patients and improving care. Important sources of dissatisfaction were remuneration for LTC work, on-call coverage, and excessive paperwork. Directors suggested increases to fee schedules as the main recruitment and retention strategy, and many believed that increasing exposure to LTC during residency would increase recruitment. Development of larger on-call groups for coverage and alternative methods of remuneration were not cited as important factors. Most did not believe that working in a teaching nursing home would increase their satisfaction. Directors did not think the use of nurse practitioners would alleviate concerns about shortages of physicians. Medical directors of LTC facilities are aging, and many are considering leaving their work in LTC. Without an increase in the number of physicians willing to work in LTC institutions, the current shortage of LTC physicians could increase in the near future. Medical directors' responses to questions could help guide strategies to recruit and retain physicians. Future areas of research should include the perspectives of physicians who are not medical directors and of family medicine residents.

A mobile health technology enabled home-based intervention to treat frailty in adult lung transplant candidates: A pilot study.

PubMed

Singer, Jonathan P; Soong, Allison; Bruun, Alan; Bracha, Ayana; Chin, Greg; Hays, Steven R; Kukreja, Jasleen; Rigler, Julia; Golden, Jeff A; Greenland, John R; Garvey, Chris

2018-05-09

Frailty is prevalent in lung transplant candidates (LTC) and is associated with waitlist delisting or death. We performed a pilot study to assess the safety and feasibility of a home-based, mobile-health technology facilitated intervention to treat frailty in LTC. We performed an 8-week, non-randomized, home-based exercise and nutrition intervention in LTC with Short Physical Performance Battery (SPPB) frailty scores of ≤11. The intervention utilized a customized, mobile device application ("app") enabling monitoring and progression of the intervention in real-time. We aimed to evaluate key process measures. Secondarily, we tested whether the intervention could improve frailty scores quantified by the SPPB and Fried Frailty Phenotype (FFP). 15 subjects enrolled were 63 ±5.7 years old; oxygen requirements ranged from 3-15LPM. Thirteen subjects completed the intervention. Over 108 subject-weeks there were no adverse events. Subjects found the app engaging and easy to work with. SPPB frailty improved in 7 (54%) and FFP improved in 8 (62%). There was a strong trend towards improved frailty scores (SPPB change 1.0±1.9; p=0.08; FFP change -0.6±1.0; p=0.07). In this pilot study, we found that a home-based pre-habilitation program that leverages mobile health technology to target frailty in LTC is well received, safe, and capable of improving physical frailty scores. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

A Military History of Modern Egypt from the Ottoman Conquest to the Ramadan War

DTIC Science & Technology

2007-06-01

A Military History of Modern Egypt from the Ottoman Conquest to the Ramadan War A Monograph by LTC Shams El-Din, Osama Egyptian Army School...Din, Egyptian Army 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES...CONQUEST TO THE RAMADAN WAR by LTC Shams El-Din, Osama, Egyptian Army, 90 pages. Egypt has one of the oldest civilizations and proudest national histories

Organizational factors influencing health information technology adoption in long-term-care facilities.

PubMed

Wang, Tiankai; Wang, Yangmei; Moczygemba, Jackie

2014-01-01

Long-term care (LTC) is an important sector of the health care industry. However, the adoption of health information technology (HIT) systems in LTC facilities lags behind that in other sectors of health care. Previous literature has focused on the financial and technical barriers. This study examined the organizational factors associated with HIT adoption in LTC facilities. A survey of 500 LTC facilities in Texas enabled researchers to compile HIT indexes for further statistical analyses. A general linear model was used to study the associations between the clinical/administrative HIT indexes and organizational factors. The empirical outcomes show that the size of an LTC facility has a significant association with HIT adoption. Rural LTC facilities, especially freestanding ones, adopt less HIT than their urban counterparts, whereas freestanding LTC facilities have the lowest HIT adoption overall. There is not enough evidence to support ownership status as a significant factor in HIT adoption. Some implications are proposed, but further research is necessary.

Challenges Associated With Managing Suicide Risk in Long-Term Care Facilities.

PubMed

O'Riley, Alisa; Nadorff, Michael R; Conwell, Yeates; Edelstein, Barry

2013-06-01

Little information about suicidal ideation and behavior in long-term care (LTC) facilities is available. Nonetheless, the implementation of the Minimum Data Set 3.0 requires that LTC facilities screen their residents for suicide risk and have protocols in place to effectively manage residents' responses. In this article, the authors briefly discuss the risk factors of suicide in the elderly and the problems that suicidal ideation and behavior pose in the LTC environment. The authors explain issues that arise when trying to manage suicide risk in the elderly LTC population with general, traditional approaches. These inherent issues make it difficult to develop an effective protocol for managing suicide risk in LTC facilities, leading the authors to propose their own framework for assessing and managing suicide risk in the LTC setting.

Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers.

PubMed

Mosca, Ilaria; van der Wees, Philip J; Mot, Esther S; Wammes, Joost J G; Jeurissen, Patrick P T

2016-08-17

The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU's European Semester. This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC, given the demographic- and fiscal circumstances, and the complexities of LTC systems. It also shows the usefulness to learn from policy design and implementation of LTC policy in other countries, within and outside the EU. Researchers can contribute by studying conditions, under which the strategies explored might deliver solutions for policy-makers. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Medical directors of long-term care facilities

PubMed Central

Frank, C.; Seguin, R.; Haber, Shelly; Godwin, Marshall; Stewart, G.I.

2006-01-01

OBJECTIVE The long-term care (LTC) sector in Canada is expanding, but little attention has been given to medical human resources in this area. Our objective was to seek LTC medical directors’ opinions about medical services in LTC and about strategies for recruitment and retention. DESIGN Mailed survey. SETTING Long-term care facilities and nursing homes. PARTICIPANTS Seven hundred five medical directors of LTC facilities across Canada were identified from the Canadian Healthcare Association database. MAIN OUTCOME MEASURES Responses to open- and closed-ended questions and to Likert-type scales. RESULTS The response rate was 55%. The average age of medical directors was 54 years. Most had started work in LTC because of a vacant position, as opposed to self-perceived skills or training. Most (75.3%) reported satisfaction with their role as medical directors, but 82.7% believed that there was a significant shortage of physicians working in LTC, and 42% had seriously considered leaving their positions. Major sources of satisfaction identified were clinical, especially working with older patients and improving care. Important sources of dissatisfaction were remuneration for LTC work, on-call coverage, and excessive paperwork. Directors suggested increases to fee schedules as the main recruitment and retention strategy, and many believed that increasing exposure to LTC during residency would increase recruitment. Development of larger on-call groups for coverage and alternative methods of remuneration were not cited as important factors. Most did not believe that working in a teaching nursing home would increase their satisfaction. Directors did not think the use of nurse practitioners would alleviate concerns about shortages of physicians. CONCLUSION Medical directors of LTC facilities are aging, and many are considering leaving their work in LTC. Without an increase in the number of physicians willing to work in LTC institutions, the current shortage of LTC physicians could increase in the near future. Medical directors’ responses to questions could help guide strategies to recruit and retain physicians. Future areas of research should include the perspectives of physicians who are not medical directors and of family medicine residents. PMID:17273484

Oral health-related quality of life in an aging Canadian population

PubMed Central

2012-01-01

Background The purpose of the study is to describe the impact of oral health-related quality of life (OHRQoL) on the lives of pre-seniors and seniors living in Nova Scotia, Canada. Methods This cross-sectional study involved 1461 participants, grouped by age (pre-seniors [45–64] and seniors [65+]) and residential status (long-term care facility [LTC] or community). OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14) in a random digit dialing telephone survey (for community residents) or a face-to-face interview (for LTC residents). Intra-oral examinations were performed by one of six dentists calibrated to W.H.O. standards. Results Approximately one in four pre-seniors and seniors reported at least one OHRQoL impact ‘fairly/very often’. The most commonly reported impacts were within the dimensions ‘physical pain’ and ‘psychological discomfort’. It was found that 12.2% of LTC residents found it uncomfortable to eat any foods ‘fairly/very’ often compared to 7.7% in the community, and 11.6% of LTC residents reported being self-conscious ‘fairly/very often’ compared to 8.2% in the community. Of those residing in the community, pre-seniors (28.8%) reported significantly more impacts than seniors (22.0%); but there were no significant differences in OHRQoL between pre-seniors (21.2%) and seniors (25.3%) in LTC. Pre-seniors living in the community scored significantly higher than community dwelling seniors on prevalence, extent and severity of OHIP-14 scores. Logistic regression revealed that for the community dwelling sample, individuals living in rural areas in addition to those being born outside of Canada were approximately 2.0 times more likely to report an impact ‘fairly/very often’, whereas among the LTC sample, those having a high school education or less were 2.3 times more likely to report an impact. Conclusions Findings indicate that the oral health and OHRQoL of both pre-seniors and seniors in LTC residents is poor. Community dwelling pre-seniors have the highest prevalence rate of oral impacts. PMID:22587387

Radiation Performance of Commercial SiGe HBT BiCMOS-High Speed Operational Amplifiers

NASA Technical Reports Server (NTRS)

Chen, Dakai; Pellish, Jonathan; Phan, Anthony; Kim, Hak; Burns, Sam; Albarian, Rafi; Holcombe, Bruce; Little, Bradley; Salzman, James; LaBel, Kenneth

2010-01-01

We present results on heavy-ion and proton irradiations for commercial SiGe BiCMOS operational amplifiers: LTC6400-20 from Linear Technology and THS4304 from Texas Instruments. We found that the devices are susceptible to heavy-ion-induced SETs. The SET cross-sections increase with increasing operating frequency. The LTC6400 exhibits a LET(sub th) < 7.4 MeV·sq cm/mg for frequencies ranging from 10 to 1000 MHz. The THS4304 exhibits a LET(sub th) < 4.4 MeV·sq cm/mg at 200 MHz; the LET(sub th) decreases with increasing frequency. The significance of the SETs also increases with frequency. The SETs at 1000 MHz can erase several signal cycles. We al.so found that the LTC6400 is relatively robust against 198 and 54 MeV protons. We did not observe angular sensitivity from the proton irradiations.

Predicting extracapsular involvement in prostate cancer through the tumor contact length and the apparent diffusion coefficient.

PubMed

Granja, M F; Pedraza, C M; Flórez, D C; Romero, J A; Palau, M A; Aguirre, D A

To evaluate the diagnostic performance of the length of the tumor contact with the capsule (LTC) and the apparent diffusion coefficient (ADC) map in the prediction of microscopic extracapsular extension in patients with prostate cancer who are candidates for radical prostatectomy. We used receiver operating curves to retrospectively study the diagnostic performance of the ADC map and the LTC as predictors of microscopic extracapsular extension in 92 patients with prostate cancer and moderate to high risk who were examined between May 2011 and December 2013. The optimal cutoff for the ADC map was 0.87× 10 -3 mm 2 /s, which yielded an area under the ROC curve of 72% (95% CI: 57%-86%), corresponding to a sensitivity of 83% and a specificity of 61%. The optimal cutoff for the LTC was 17.5mm, which yielded an area under the ROC curve of 74% (95% CI: 61%-87%), corresponding to a sensitivity of 91% and a specificity of 57%. Combining the two criteria improved the diagnostic performance, yielding an area under the ROC curve of 77% (95% CI: 62%-92%), corresponding to a sensitivity of 77% and a specificity of 61%. We elaborated a logistic regression model, obtaining an area under the ROC curve of 82% (95% CI: 73%-93%). Using quantitative measures improves the diagnostic accuracy of multiparametric magnetic resonance imaging in the staging of prostate cancer. The values of the ADC and LTC were predictors of microscopic extracapsular extension, and the best results were obtained when both values were used in combination. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

Latent trait cortisol (LTC) during pregnancy: Composition, continuity, change, and concomitants.

PubMed

Giesbrecht, Gerald F; Bryce, Crystal I; Letourneau, Nicole; Granger, Douglas A

2015-12-01

Individual differences in the activity of the hypothalamic pituitary adrenal (HPA) axis are often operationalized using summary measures of cortisol that are taken to represent stable individual differences. Here we extend our understanding of a novel latent variable approach to latent trait cortisol (LTC) as a measure of trait-like HPA axis function during pregnancy. Pregnant women (n=380) prospectively collected 8 diurnal saliva samples (4 samples/day, 2 days) within each trimester. Saliva was assayed for cortisol. Confirmatory factor analyses were used to fit LTC models to early morning and daytime cortisol. For individual trimester data, only the daytime LTC models had adequate fit. These daytime LTC models were strongly correlated between trimesters and stable over pregnancy. Daytime LTC was unrelated to the cortisol awakening response and the daytime slope but strongly correlated with the area under the curve from ground. The findings support the validity of LTC as a measure of cortisol during pregnancy and suggest that it is not affected by pregnancy-related changes in HPA axis function. Copyright © 2015 Elsevier Ltd. All rights reserved.

Accepting responsibility for long-term care--a paradox in times of a global nursing shortage?

PubMed

Hirschfeld, Miriam J

2009-03-01

Need for long-term care (LTC) is increasing globally, and nurses have a professional imperative to address the growing need for long-term care (LTC). The author reviews the effect of globalization and the epidemiologic transition upon the growing need for LTC. I also summarize the lessons learned in the developing world, as well as in the industrialized world, based on the existing research evidence. The purpose of this paper is to explain the need for nursing as a profession to accept responsibility for LTC as part of nursing's raison d'etre, despite the global nursing shortage. This includes responsibility for innovative policy, health service, practice, research, nursing education development, and health promotion, because prevention is key to slowing the steep increase in LTC needs. Nurses must develop strategies for clinical practice, management, education, and research in order to increase our ability to meet future needs for LTC.

Impacts of informal caregiver availability on long-term care expenditures in OECD countries.

PubMed

Yoo, Byung-Kwang; Bhattacharya, Jay; McDonald, Kathryn M; Garber, Alan M

2004-12-01

To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. Secondary data analysis, applying fixed- and random-effects models to time-series cross-sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population. Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base. Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male-to-female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full-time/part-time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country. The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long-term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care.

The Influence of Long-Term Care Insurance on the Likelihood of Nursing Home Admission

PubMed Central

Gure, Tanya R.; Kabeto, Mohammed U.; Langa, Kenneth M.

2009-01-01

OBJECTIVES To determine the effect of long-term care (LTC) insurance on nursing home use. DESIGN Longitudinal analysis, 1998 to 2006 waves of the Health Retirement Study. SETTING Community-dwelling nationally representative sample. PARTICIPANTS Nineteen thousand one hundred seventy adults aged 50 and older, 1998 wave. METHODS Two groups of respondents were created at baseline: those with and without an LTC insurance policy. Respondents admitted to the nursing home from 1998 to 2006 were identified. Propensity scores were used to control for known predictors of LTC insurance possession. A Cox proportional hazards model was used to compare the probability of nursing home admission over 8 years of follow-up for respondents possessing LTC insurance and those without a policy. RESULTS Of the 19,170 respondents aged 50 and older in 1998, 1,767 (9.2%) possessed LTC insurance. A total of 1,778 (8.5%) were admitted to a nursing home during the 8-year period: 149 (8.7%) of those with LTC insurance and 1,629 (8.4%) of those without LTC insurance. The hazard ratio, adjusted for propensity score, for those with LTC insurance entering a nursing home compared with those without was 1.07 (95% confidence interval = 0.83–1.38). Likelihood of nursing home admission was relatively low because the low-risk population included in the study, limiting the power to detect small differences in risk of nursing home utilization between groups. CONCLUSION There was no difference in nursing home utilization between low-risk older adults who did and did not possess an LTC insurance policy. PMID:19694868

Efficacy and safety of laxatives for chronic constipation in long-term care settings: A systematic review.

PubMed

Alsalimy, N; Madi, L; Awaisu, A

2018-06-09

Constipation is a common disorder among long-term care (LTC) patients due to several factors. However, there are no systematic reviews investigating the use of laxatives for chronic constipation in LTC settings. This study aims to explore the safety and efficacy of laxatives in LTC patients. A systematic review of randomized controlled trials (RCTs) describing the efficacy and safety of laxatives for chronic constipation in LTC patients was conducted using the following databases and search engines: MEDLINE, Cochrane Database of Systematic Reviews, ScienceDirect, ProQuest and Google Scholar. Two of the investigators independently performed the searches, and the data were extracted using a standardized data abstraction tool. Seven RCTs involving 444 patients were included in the review. These studies included senna (with or without fibre, ie Plantago ovata), lactulose, sodium picosulphate, docusate sodium, docusate calcium, isotonic and hypotonic polyethylene glycol and Chinese herbal medicine. Senna and lactulose were the most studied laxatives in LTC patients, and senna was found to be superior to or as effective as other laxatives. Generally, the frequency and severity of adverse drug reactions (ADRs) were similar between the arms of the studies, and no serious ADRs were reported. Considering the short duration of the trials, the lack of trials including newer laxatives and the low quality of some of the included trials, the long-term efficacy and safety of these laxatives are not conclusive. There is a need to conduct more robust RCTs that include newer agents to evaluate long-term outcomes. © 2018 John Wiley & Sons Ltd.

Applying the Social Ecological Model and Theory of Self-Efficacy in the Worksite Heart Health Improvement Project-PLUS.

PubMed

Doran, Kelly; Resnick, Barbara; Kim, Natalie; Lynn, Donna; McCormick, Tyrell

2017-02-01

Long-term care (LTC) employees are at high risk for cardiovascular disease. Despite the documented benefits of worksite health promotion (WHP) programs for employees and employers and the potential benefits to residents in LTC facilities, LTC employees are rarely offered WHP programs. The purpose of the intervention described in this article is to reduce cardiovascular disease risk factors among LTC workers using a physical activity, nutrition, and stress management WHP implemented during paid work time with 98 LTC staff members. This article describes a 9-month physical activity, nutrition, and stress management WHP intervention delivered during paid work time to reduce the cardiovascular disease risk of employees working in LTC. The intervention is rooted in the social ecological model and social cognitive theory. The intervention is based on formative research and evidence-based practice recommendations and is specifically designed to reduce barriers to intervention participation (e.g., inconsistent break times and unpredictable resident care needs) and enhance motivators to program participation (e.g., enhanced social support). The intervention is ongoing, but measures are described. As more employers offer WHP programs, it is important that programs are tailored to meet specific employee groups and work environments. This article operationalizes a WHP research protocol with LTC employees that can be applied to reduce cardiovascular disease risk in LTC employees or similar employee groups in similar work environments.

Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review

PubMed Central

Mileski, Michael; Vijaykumar, Alekhya Ganta; Viswanathan, Sneha Vishnampet; Suskandla, Ujwala; Chidambaram, Yazhini

2017-01-01

Background Long-term care (LTC) facilities are an important part of the health care industry, providing care to the fastest-growing group of the population. However, the adoption of electronic health records (EHRs) in LTC facilities lags behind other areas of the health care industry. One of the reasons for the lack of widespread adoption in the United States is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities. Objective The objective of this systematic review was to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology. Methods The authors conducted a systematic search of PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and MEDLINE databases. Papers were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 28 papers was selected to be included in the systematic review. Results Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in LTC facilities and enhanced quality outcomes. Approximately 43% (12/28) of the papers reported a mixed impact of EHRs on the management of documentation, and 33% (9/28) of papers reported positive quality outcomes using EHRs. Surprisingly, very few papers demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay, and productivity using EHRs. Conclusions Overall, implementation of EHRs has been found to be effective in the few LTC facilities that have implemented them. Implementation of EHRs in LTC facilities caused improved management of clinical documentation that enabled better decision making. PMID:28963091

Complete subunit structure of the Clostridium botulinum type D toxin complex via intermediate assembly with nontoxic components.

PubMed

Mutoh, Shingo; Kouguchi, Hirokazu; Sagane, Yoshimasa; Suzuki, Tomonori; Hasegawa, Kimiko; Watanabe, Toshihiro; Ohyama, Tohru

2003-09-23

Clostridium botulinum serotype D strains usually produce two types of stable toxin complex (TC), namely, the 300 kDa M (M-TC) and the 660 kDa L (L-TC) toxin complexes. We previously proposed assembly pathways for both TCs [Kouguchi, H., et al. (2002) J. Biol. Chem. 277, 2650-2656]: M-TC is composed by association of neurotoxin (NT) and nontoxic nonhemagglutinin (NTNHA); conjugation of M-TC with three auxiliary types of hemagglutinin subcomponents (HA-33, HA-17, and HA-70) leads to the formation of L-TC. In this study, we found three TC species, 410, 540, and 610 kDa TC species, in the culture supernatant of type D strain 4947. The 540 and 610 kDa TC species displayed banding patterns on SDS-PAGE similar to that of L-TC but with less staining intensity of the HA-33 and HA-17 bands than those of L-TC, indicating that these are intermediate species in the pathway to L-TC assembly. In contrast, the 410 kDa TC species consisted of M-TC and two molecules of HA-70. All of the TC species, except L-TC, demonstrated no hemagglutination activity. When the intermediate TC species were mixed with an isolated HA-33/17 complex, every TC species converted to 650 kDa L-TC with full hemagglutination activity and had the same molecular composition of L-TC. On the basis of titration analysis with the HA-33/17 complex, the stoichiometry of the HA-33/17 complex molecules in the L-TC, 610 kDa, and 540 kDa TC species was estimated as 4, 3, and 2, respectively. In conclusion, the complete subunit composition of mature L-TC is deduced to be a dodecamer assembled by a single NT, a single NTNHA, two HA-70, four HA-33, and four HA-17 molecules.

The feasibility of a public-private long-term care financing plan.

PubMed

Arling, G; Hagan, S; Buhaug, H

1992-08-01

In this study, the feasibility of a public-private long-term care (LTC) financing plan that would combine private LTC insurance with special Medicaid eligibility requirements was assessed. The plan would also raise the Medicaid asset limit from the current $2,000 to the value of an individual's insurance benefits. After using benefits the individual could enroll in Medicaid. Thus, insurance would substitute for asset spend-down, protecting individuals against catastrophic costs. This financing plan was analyzed through a computer model that simulated lifetime LTC use for a middle-income age cohort beginning at 65 years of age. LTC payments from Medicaid, personal income and assets, Medicare, and insurance were projected by the model. Assuming that LTC use and costs would not grow beyond current projections, the proposed plan would provide asset protection for the cohort without increasing Medicaid expenditures. In contrast, private insurance alone, with no change in Medicaid eligibility, would offer only limited asset protection. The results must be qualified, however, because even a modest increase in LTC cost growth or use of care (beyond current projections) could result in substantially higher Medicaid expenditures. Also, private insurance might increase personal LTC expenditures because of the added cost of insuring.

Intergroup Contact: Using Storytelling to Increase Awareness of Lesbian and Gay Older Adults in Long-Term Care Settings.

PubMed

Pelts, Michael D; Galambos, Colleen

2017-01-01

Due to societally imposed stigmatization, lesbian and gay (LG) older adults fear and prolong accessing long-term care (LTC) even though they need LTC at higher rates. Interventions that decrease negative attitudes toward LG older adults among LTC staff are a first step in addressing this problem. In this study, the influence of intergroup contact (IGC) on LTC staff members' attitudes toward LG was explored through the use of storytelling as a training mechanism. An embedded mixed-method approach was employed to collect and analyze responses of 60 LTC staff who participated in a storytelling event. Participants completed pretests, posttests, and participated in audio-recorded group discussions. The findings showed that storytelling had a significant (p =0.001) and positive effect (d =0.57) on participants attitudes toward LG. Qualitative analysis revealed 90 codes, 13 process codes, and 4 themes: making meaning of stories, seeking understanding, application to LTC setting, and debating. When guided by IGC theory, storytelling has potential for positively influencing attitudes of LTC staff members toward LG older adults. There is a need for longitudinal work to further test this model.

Exploring Staff Clinical Knowledge and Practice with LGBT Residents in Long-Term Care: A Grounded Theory of Cultural Competency and Training Needs.

PubMed

Donaldson, Weston V; Vacha-Haase, Tammi

2016-01-01

Existing literature shows that LGBT residents are likely to face suboptimal care in LTC facilities due to prejudice and discriminatory policies. The aim of this project was to assess the LGBT cultural competency of staff working in LTC facilities, identify their current training needs, and develop a framework for understanding LGBT cultural competency among LTC staff and providers. This grounded theory study comprised data from focus groups of interdisciplinary staff from three LTC facilities. Results suggested that LTC staff struggle with how to be sensitive to LGBT residents' needs. Tension appeared to exist between wanting to provide an equal standard of care to all LTC residents and fearing they would show "favoritism" or "special treatment," which might be viewed as unprofessional. Participants indicated training could help to address the ambivalence they experience about providing sensitive care to subpopulations of residents who face stigma and oppression. LTC staff stand to benefit from cultural competency training focused on LGBT residents. Training should be not only informational in nature, but also facilitate greater self-awareness and self-efficacy with respect to providing care to LGBT people.

Methodological development of the interactive INTERLINKS Framework for Long-term Care

PubMed Central

Billings, Jenny; Leichsenring, Kai

2014-01-01

There is increasing international research into health and social care services for older people in need of long-term care (LTC), but problems remain with respect to acquiring robust comparative information to enable judgements to be made regarding the most beneficial and cost-effective approaches. The project ‘INTERLINKS’ (‘Health systems and LTC for older people in Europe’) funded by the EU 7th Framework programme was developed to address the challenges associated with the accumulation and comparison of evidence in LTC across Europe. It developed a concept and method to describe and analyse LTC and its links with the health and social care system through the accumulation of policy and practice examples on an interactive web-based framework for LTC. This paper provides a critical overview of the theoretical and methodological approaches used to develop and implement the INTERLINKS Framework for LTC, with the aim of providing some guidance to researchers in this area. INTERLINKS has made a significant contribution to knowledge but robust evidence and comparability across European countries remain problematic due to the current and growing complexity and diversity of integrated LTC implementation. PMID:25120413

Annual Faculty Research Report of the Department of Systems Engineering and the Operations Research Center for the Academic Year 2006

DTIC Science & Technology

2006-10-01

Senior Investigators: COL Darrall Henderson, Ph.D. LTC Simon R. Goerger, Ph.D. Points of Contact: NAME ADDRESS PHONE OTHER LTC Eric R. Keller...revision. Non-Refereed Publications LTC Tim Trainor*, Dr. Greg Parnell*, LTC Brigitte Kwinn*, MAJ John Brence*, CPT Eric Tollefson*, Ms. Robin Burk*, MAJ...Parnell, Brigitte Kwinn, John Brence, Eric Tollefson, Pat Downes. The US Army Uses Decision Analysis in Designing Its US Installation Regions

Impacts of Informal Caregiver Availability on Long-term Care Expenditures in OECD Countries

PubMed Central

Yoo, Byung-Kwang; Bhattacharya, Jay; McDonald, Kathryn M; Garber, Alan M

2004-01-01

Objective To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. Data Source/Study Setting Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. Study Design Secondary data analysis, applying fixed- and random-effects models to time-series cross-sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population. Data Collection/Extraction Method Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base. Principal Findings Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male-to-female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full-time/part-time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country. Conclusions The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long-term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care. PMID:15544640

A European classification of services for long-term care—the EU-project eDESDE-LTC

PubMed Central

Weber, Germain; Brehmer, Barbara; Zeilinger, Elisabeth; Salvador-Carulla, Luis

2009-01-01

Purpose and theory The eDESDE-LTC project aims at developing an operational system for coding, mapping and comparing services for long-term care (LTC) across EU. The projects strategy is to improve EU listing and access to relevant sources of healthcare information via development of SEMANTIC INTER-OPERABILITY in eHEALTH (coding and listing of services for LTC); to increase access to relevant sources of information on LTC services, and to improve linkages between national and regional websites; to foster cooperation with international organizations (OECD). Methods This operational system will include a standard classification of main types of care for persons with LTC needs and an instrument for mapping and standard description of services. These instruments are based on previous classification systems for mental health services (ESMS), disabilities services (DESDE) and ageing services (DESDAE). A Delphi panel made by seven partners developed a DESDE-LTC beta version, which was translated into six languages. The feasibility of DESDE-LTC is tested in six countries using national focal groups. Then the final version will be developed by the Delphi panel, a webpage, training material and course will be carried out. Results and conclusions The eDESDE-LTC system will be piloted in two EU countries (Spain and Bulgaria). Evaluation will focus primarily on usability and impact analysis. Discussion The added value of this project is related to the right of “having access to high-quality healthcare when and where it is needed” by EU citizens. Due to semantic variability and service complexity, existing national listings of services do not provide an adequate framework for patient mobility.

Pregnancy and linkage to care among women diagnosed with HIV infection in 61 CDC-funded health departments in the United States, 2013.

PubMed

FitzHarris, Lauren F; Hollis, Natasha D; Nesheim, Steven R; Greenspan, Julia L; Dunbar, Erica K

2017-07-01

Timely linkage to HIV care (LTC) following an HIV diagnosis is especially important for pregnant women with HIV to prevent perinatal transmission and improve maternal health. However, limited data are available on LTC among U.S. pregnant women. Our analysis aimed to identify HIV diagnoses among childbearing age (CBA) women (15-44 years old) by pregnancy status and to compare LTC of HIV-infected pregnant women to HIV-infected non-pregnant women. We analyzed 2013 CDC-funded HIV testing data from 61 health departments and 151 directly funded community-based organizations among CBA women. LTC includes linkage at any time after an HIV diagnosis and within 90 days after HIV diagnosis. Pearson's chi-square was used to compare LTC of pregnant and non-pregnant women. Data were analyzed using SAS v9.3. Among the 1,379,860 HIV testing events among CBA women in 2013, 0.3% (n = 3690) were HIV-positive. Among all HIV-positive diagnoses with an available pregnancy status (n = 1987), 7%, (n = 138) were pregnant. Among women with pregnancy status data, LTC any time after an HIV-positive diagnosis was 73.2% for pregnant women and 60.7% for non-pregnant women. LTC within 90 days was 71.7% for pregnant women and 56.2% for non-pregnant women. Pregnancy was associated with LTC any time (p < 0.01) and within 90 days of diagnosis (p < 0.01). Compared with non-pregnant women, a higher proportion of pregnant women with HIV were linked to care overall, and linked within 90 days. Pregnancy appears to facilitate better LTC, but improvements are needed for women overall and pregnant women specifically.

The contribution of low tar cigarettes to environmental tobacco smoke

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chortyk, O.T.; Schlotzhauer, W.S.

A series of low tar cigarettes (LTC) were smoked and the quantities of condensable mainstream (inhaled) and sidestream (between puffs) smoke compounds were determined and compared to those produced by a high tar, nonfilter cigarette. It was found that the LTC produced large quantities of sidestream smoke condensates, about equal to the high tar cigarette, and contained very high levels of toxic or cocarcinogenic phenols. On an equal weight basis, the LTC emitted more of these hazardous compounds into sidestream and environmental tobacco smoke. Higher smoke yields of a flavor additive and a sugar degradation product indicated addition of suchmore » compounds during the manufacture of LTC. It was concluded that, compared to a high tar cigarette, smoking LTC may be better for the smoker, but not for the nearby nonsmoker. Information should be developed to allow smokers to choose LTC that produce lower levels of hazardous compounds in their environmentally emitted sidestream smoke.« less

[Long-term care in Europe. Challenges and strategies in nursing staff management].

PubMed

Kuhlmann, E; Larsen, C

2013-08-01

Across Europe, long-term care (LTC) is one of the most challenging areas of social policy. Despite a growing awareness of the problems and improved data, current institutional reforms are an ineffective response to demographic change. This article aims to provide an overview of the challenges of future nursing and care staff in LTC in Europe, and to discuss the German case in a wider European context. We focus on the nursing workforce and on the link between current and prospective analyses on the demand and offer of LTC services and LTC professionals/nursing staff. We draw on a secondary analysis of the literature and public statistics, especially OECD data. The European comparison shows a high variation in the future demand for LTC. In Germany, a number of problematic trends create a negative scenario: the growing demand for LTC meets with a decrease in nursing staff on the supply side. We conclude by suggesting intervention strategies that may reduce this negative scenario.

Caffeic acid and quercetin protect erythrocytes against the oxidative stress and the genotoxic effects of lambda-cyhalothrin in vitro.

PubMed

Abdallah, Fatma Ben; Fetoui, H; Fakhfakh, F; Keskes, L

2012-01-01

Lambda-cyhalothrin (LTC) is a synthetic pyrethroid with a broad spectrum of insecticidal and acaricidal activities used to control wide range of insect pests in a variety of applications. The aim of this study was to examine (i) the potency of LTC to induce oxidative stress response in rat erythrocytes in vitro and (ii) the role of caffeic acid (20 μM) and/or quercetin (10 μM) in preventing the cytotoxic effects. Erythrocytes were divided into four portions. The erythrocytes of the first portion were incubated for 4 h at 37°C with different concentrations (0, 50 and 100 μM) of LTC. The others portions were pretreated with caffeic acid and/or quercetin for 30 min prior to LTC incubation. Lipid peroxidation, protein oxidation, antioxidant enzyme activities and DNA damage were examined. LTC at different concentrations causes increased levels of lipid peroxidation, protein oxidation, DNA damage and decreased antioxidant enzyme activities. Combined caffeic acid and quercetin pretreatments significantly reduced the levels of lipid peroxidation markers, that is thiobarbituric acid reactive substance (TBARS), protein carbonyls (PCO) and decreased DNA damage in LTC portion. Further, combined caffeic acid and quercetin pretreatment maintain antioxidant enzyme activities and glutathione content near to normal values. These results suggest that LTC exerts its toxic effect by increasing lipid peroxidation, altering the antioxidant enzyme activities and DNA damage. Caffeic acid and quercetin pretreatments prevent the toxic effects of LTC, suggesting their role as a potential antioxidant.

Deciding What Has to Be Done: General William E. DePuy and the 1976 Edition of FM 100-5, Operations (Leavenworth Paper, Number 16)

DTIC Science & Technology

1988-07-01

Teaching Committee LTC Charles D . McKenna, Chief LTC John R . Finch MAJ Stephen D . Coats LTC Andrew N. Morris MAJ Robert E. Gillespie LTC Edward P...Cheryl J. Davis, Editorial Assistant Staff MSG Russell E. Miller Jr. Joan R . Bazajou SSG Patricia E. Clowers Carolyn D . Conway Sharon E. Torres...from Professor Allan R . Millett, The Ohio State University; Colonel Robert A. Doughty (U.S. Army), U.S. Military Academy; and Dr. Roger D . Spiller

Easing the transition: sSupport for the new graduate nurse in long-term care.

PubMed

Burgess, Jennifer; D'Hondt, Allison

2007-01-01

As our population continues to age, more nurses will be needed to enter the specialty of LTC nursing to meet the needs of our senior population. To promote this area of nursing and retain new graduate nurses in LTC, more research is required to support the specific challenges faced by LTC nurses compared with those of other areas of nursing. The authors suggest implementation of support strategies that may include a formal preceptorship program of at least one month in duration, additional clinical support on night shifts, coaching and mentoring models, learning opportunities based on a learning needs assessment, and orientation to the overall culture and environment of the home including time spent with all departments. LTC homes need to examine their approaches to leadership, providing comprehensive orientation and resource support for new graduates and developing strategies specific to their organization's mission and vision that will empower and provide support to ease the unique transition to LTC. These strategies lead to promoting positive relationships, professional development and overall positive outcomes with workplace satisfaction in the LTC setting. The authors encourage federal and provincial government officials to examine this more closely and to better support this effort with the financial resources that are greatly needed in LTC homes to provide the exemplary care that our seniors deserve.

Lambda-cyhalothrin-induced biochemical and histopathological changes in the liver of rats: ameliorative effect of ascorbic acid.

PubMed

Fetoui, Hamadi; Garoui, El Mouldi; Zeghal, Najiba

2009-05-01

Pyrethroid pesticides were used preferably over organochlorines and organophosphates due to their high effectiveness, low toxicity to non-target organisms and easy biodegrability. It has widespread applications in agriculture through the world and in Tunisia. The present study investigates lambda-cyhalothrin (LTC) effects on biochemical parameters, hepatotoxicity and their attenuation by vitamin C. Male Wistar rats were randomly divided into three groups of seven each: a control group (C) and two treated groups during 3 weeks with LTC administrated either alone in drinking water for LTC group or coadministred with vitamin C for LTC+vit C group. Lactate deshydrogenase (LDH) activity was significantly increased in liver (+51%, p<0.001) and in plasma (+40%, p<0.001) compared to those of control group. A significant increase of malondialdehyde (MDA) levels in liver (+53%; p<0.001) associated with a decrease in antioxidants enzyme activities and reduced glutathione (GSH) content was observed in LTC group compared to controls. The administration of vitamin C to LTC+vit C group improved all parameters studied. We conclude that LTC induces oxidative stress and modifies biochemical parameters and histological aspects of liver. Administration of vitamin C alleviates the toxicity induced by this synthetic pyrethroid insecticide.

Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review.

PubMed

Kruse, Clemens Scott; Mileski, Michael; Vijaykumar, Alekhya Ganta; Viswanathan, Sneha Vishnampet; Suskandla, Ujwala; Chidambaram, Yazhini

2017-09-29

Long-term care (LTC) facilities are an important part of the health care industry, providing care to the fastest-growing group of the population. However, the adoption of electronic health records (EHRs) in LTC facilities lags behind other areas of the health care industry. One of the reasons for the lack of widespread adoption in the United States is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities. The objective of this systematic review was to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology. The authors conducted a systematic search of PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and MEDLINE databases. Papers were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 28 papers was selected to be included in the systematic review. Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in LTC facilities and enhanced quality outcomes. Approximately 43% (12/28) of the papers reported a mixed impact of EHRs on the management of documentation, and 33% (9/28) of papers reported positive quality outcomes using EHRs. Surprisingly, very few papers demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay, and productivity using EHRs. Overall, implementation of EHRs has been found to be effective in the few LTC facilities that have implemented them. Implementation of EHRs in LTC facilities caused improved management of clinical documentation that enabled better decision making. ©Clemens Scott Kruse, Michael Mileski, Alekhya Ganta Vijaykumar, Sneha Vishnampet Viswanathan, Ujwala Suskandla, Yazhini Chidambaram. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 29.09.2017.

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012.

PubMed

Papaioannou, A; Kennedy, C C; Ioannidis, G; Cameron, C; Croxford, R; Adachi, J D; Mursleen, S; Jaglal, S

2016-03-01

In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women. This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012. This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC). Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community. Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.

HOW DO WORK HIERARCHIES AND STRICT DIVISIONS OF LABOUR IMPACT CARE WORKERS' EXPERIENCES OF HEALTH AND SAFETY? CASE STUDIESOF LONG TERM CARE IN TORONTO.

PubMed

Syed, I; Daly, T; Armstrong, P; Lowndes, R; Chadoin, M; Naidoo, V

2016-01-01

According to the Canadian Health Care Association (1), there are 2,577 long-term care ("LTC") facilities across Canada, with the largest proportion (33.4%) located in Ontario. Most studies focus on residents' health, with less attention paid to the health and safety experiences of staff. Given that the work performed in Ontario LTC facilities is very gendered, increasingly racialized, task-oriented, and with strict divisions of labour, this paper explores in what ways some of these factors impact workers' experiences of health and safety. The study objectives included the following research question: How are work hierarchies and task orientation experienced by staff? This paper draws on data from rapid team-based ethnographies of the shifting division of labour in LTC due to use of informal carers in six non-profit LTC facilities located in Toronto, Ontario. Our method involved conducting observations and key informant interviews (N=167) with registered nurses, registered practical nurses, personal support workers, dietary aides, recreation therapists, families, privately paid companions, students, and volunteers. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. For observations, researchers were paired and covered shifts between 7 a.m. and 11 p.m., as well as into the late night over six days, at each of the six sites. Detailed ethnographic field notes were written during and immediately following observational fieldwork. Our results indicate that employee stress is linked to the experiences of care work hierarchies, task orientation, and strict divisions of labour between and among various staff designations. Findings from this project confirm and extend current research that demonstrates there are challenging working conditions in LTC, which can result in occupational health and safety problems, as well as stress for individual workers.

CysLT2 receptor activation is involved in LTC4-induced lung air-trapping in guinea pigs.

PubMed

Sekioka, Tomohiko; Kadode, Michiaki; Yonetomi, Yasuo; Kamiya, Akihiro; Fujita, Manabu; Nabe, Takeshi; Kawabata, Kazuhito

2017-01-05

CysLT 1 receptors are known to be involved in the pathogenesis of asthma. However, the functional roles of CysLT 2 receptors in this condition have not been determined. The purpose of this study is to develop an experimental model of CysLT 2 receptor-mediated LTC 4 -induced lung air-trapping in guinea pigs and use this model to clarify the mechanism underlying response to such trapping. Because LTC 4 is rapidly converted to LTD 4 by γ-glutamyltranspeptidase (γ-GTP) under physiological conditions, S-hexyl GSH was used as a γ-GTP inhibitor. In anesthetized artificially ventilated guinea pigs with no S-hexyl GSH treatment, i.v. LTC 4 -induced bronchoconstriction was almost completely inhibited by montelukast, a CysLT 1 receptor antagonist, but not by BayCysLT 2 RA, a CysLT 2 receptor antagonist. The inhibitory effect of montelukast was diminished by treatment with S-hexyl GSH, whereas the effect of BayCysLT 2 RA was enhanced with increasing dose of S-hexyl GSH. Macroscopic and histological examination of lung tissue isolated from LTC 4 -/S-hexyl-GSH-treated guinea pigs revealed air-trapping expansion, particularly at the alveolar site. Inhaled LTC 4 in conscious guinea pigs treated with S-hexyl GSH increased both airway resistance and airway hyperinflation. On the other hand, LTC 4 -induced air-trapping was only partially suppressed by treatment with the bronchodilator salmeterol. Although montelukast inhibition of LTC 4 -induced air-trapping was weak, treatment with BayCysLT 2 RA resulted in complete suppression of this air-trapping. Furthermore, BayCysLT 2 RA completely suppressed LTC 4 -induced airway vascular hyperpermeability. In conclusion, we found in this study that CysLT 2 receptors mediate LTC 4 -induced bronchoconstriction and air-trapping in S-hexyl GSH-treated guinea pigs. It is therefore believed that CysLT 2 receptors contribute to asthmatic response involving air-trapping. Copyright © 2016 Elsevier B.V. All rights reserved.

42 CFR 412.517 - Revision of LTC-DRG group classifications and weighting factors.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Revision of LTC-DRG group classifications and... classifications and weighting factors. (a) CMS adjusts the classifications and weighting factors annually to... the LTC-DRG classifications and recalibration of the weighting factors described in paragraph (a) of...

42 CFR 412.517 - Revision of LTC-DRG group classifications and weighting factors.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Revision of LTC-DRG group classifications and... classifications and weighting factors. (a) CMS adjusts the classifications and weighting factors annually to... the LTC-DRG classifications and recalibration of the weighting factors described in paragraph (a) of...

42 CFR 412.523 - Methodology for calculating the Federal prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... (4) Determining the Federal prospective payment rate for each LTC-DRG. The Federal prospective payment rate for each LTC-DRG is the product of the weighting factors described in § 412.515 and the... payment rate multiplied by the relative weight of the LTC-DRG assigned for that discharge. A hospital's...

42 CFR 412.507 - Limitation on charges to beneficiaries.

Code of Federal Regulations, 2010 CFR

2010-10-01

... prospective payment system. If Medicare has paid the full LTC-DRG payment, that payment applies to the... than the full LTC-DRG payment, that payment only applies to the hospital's costs for those costs or... receives a full LTC-DRG payment under this subpart for covered days in a hospital stay may charge the...

External Hand Forces Exerted by Long-Term Care Staff to Push Floor-Based Lifts: Effects of Flooring System and Resident Weight.

PubMed

Lachance, Chantelle C; Korall, Alexandra M B; Russell, Colin M; Feldman, Fabio; Robinovitch, Stephen N; Mackey, Dawn C

2016-09-01

The aim of this study was to investigate the effects of flooring type and resident weight on external hand forces required to push floor-based lifts in long-term care (LTC). Novel compliant flooring is designed to reduce fall-related injuries among LTC residents but may increase forces required for staff to perform pushing tasks. A motorized lift may offset the effect of flooring on push forces. Fourteen female LTC staff performed straight-line pushes with two floor-based lifts (conventional, motor driven) loaded with passengers of average and 90th-percentile resident weights over four flooring systems (concrete+vinyl, compliant+vinyl, concrete+carpet, compliant+carpet). Initial and sustained push forces were measured by a handlebar-mounted triaxial load cell and compared to participant-specific tolerance limits. Participants rated pushing difficulty. Novel compliant flooring increased initial and sustained push forces and subjective ratings compared to concrete flooring. Compared to the conventional lift, the motor-driven lift substantially reduced initial and sustained push forces and perceived difficulty of pushing for all four floors and both resident weights. Participants exerted forces above published tolerance limits only when using the conventional lift on the carpet conditions (concrete+carpet, compliant+carpet). With the motor-driven lift only, resident weight did not affect push forces. Novel compliant flooring increased linear push forces generated by LTC staff using floor-based lifts, but forces did not exceed tolerance limits when pushing over compliant+vinyl. The motor-driven lift substantially reduced push forces compared to the conventional lift. Results may help to address risk of work-related musculoskeletal injury, especially in locations with novel compliant flooring. © 2016, Human Factors and Ergonomics Society.

Implementation of Telemedicine Consultation to Assess Unplanned Transfers in Rural Long-Term Care Facilities, 2012-2015: A Pilot Study.

PubMed

Hofmeyer, Joshua; Leider, Jonathon P; Satorius, Jennifer; Tanenbaum, Erin; Basel, David; Knudson, Alana

2016-11-01

Public and private entities in the United States spend billions of dollars each year on potentially avoidable hospitalizations. This is a common occurrence in long-term care (LTC) facilities, especially in rural jurisdictions. This article details the creation of a telemedicine approach to assess residents from rural LTC facilities for potential transfer to hospitals. An electronic LTC (eLTC) pilot was conducted in 20 pilot LTC facilities from 2012-2015. Each site underwent technologic assessment and upgrading to ensure that 2-way video communication was possible. A new central "hub" was staffed with advanced practice providers and registered nurses. Long-term care pilot sites were trained and rolled out over 3 years. This article reports development and implementation of the pilot, as well as descriptive statistics associated with provider assessments and averted transfers. Over 3 years, 736 eLTC consultations occurred in pilot sites. One-quarter of consultations occurred between 10 pm and 9 am. Overall, approximately 31% of cases were transferred. This decreased from 54% of cases in 2013 to 17% in 2015. Rural pilot facilities had an average of 23 eLTC consults per site per year. Averted transfers represent a dramatic benefit to the residents, as potentially avoidable hospitalizations cause undue stress and allow for nosocomial infections, among other risks. In addition, averting these unnecessary transfers likely saved the taxpayers of the United States over $5 million in admission-related charges to Centers for Medicare and Medicaid Services (511 avoided transfers × $11,000 per average hospitalization from a LTC facility). Overall, the eLTC pilot showed promise as a proof-of-concept. The pilot's implementation resulted in increasing utilization and promising reductions in unnecessary transfers to emergency departments and hospitalizations. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

Terbium to Quantum Dot FRET Bioconjugates for Clinical Diagnostics: Influence of Human Plasma on Optical and Assembly Properties

PubMed Central

Morgner, Frank; Stufler, Stefan; Geißler, Daniel; Medintz, Igor L.; Algar, W. Russ; Susumu, Kimihiro; Stewart, Michael H.; Blanco-Canosa, Juan B.; Dawson, Philip E.; Hildebrandt, Niko

2011-01-01

Förster resonance energy transfer (FRET) from luminescent terbium complexes (LTC) as donors to semiconductor quantum dots (QDs) as acceptors allows extraordinary large FRET efficiencies due to the long Förster distances afforded. Moreover, time-gated detection permits an efficient suppression of autofluorescent background leading to sub-picomolar detection limits even within multiplexed detection formats. These characteristics make FRET-systems with LTC and QDs excellent candidates for clinical diagnostics. So far, such proofs of principle for highly sensitive multiplexed biosensing have only been performed under optimized buffer conditions and interactions between real-life clinical media such as human serum or plasma and LTC-QD-FRET-systems have not yet been taken into account. Here we present an extensive spectroscopic analysis of absorption, excitation and emission spectra along with the luminescence decay times of both the single components as well as the assembled FRET-systems in TRIS-buffer, TRIS-buffer with 2% bovine serum albumin, and fresh human plasma. Moreover, we evaluated homogeneous LTC-QD FRET assays in QD conjugates assembled with either the well-known, specific biotin-streptavidin biological interaction or, alternatively, the metal-affinity coordination of histidine to zinc. In the case of conjugates assembled with biotin-streptavidin no significant interference with the optical and binding properties occurs whereas the histidine-zinc system appears to be affected by human plasma. PMID:22163719

Transforming long-term care pain management in north america: the policy-clinical interface.

PubMed

Hadjistavropoulos, Thomas; Marchildon, Gregory P; Fine, Perry G; Herr, Keela; Palley, Howard A; Kaasalainen, Sharon; Béland, François

2009-04-01

The undertreatment of pain in older adults who reside in long-term care (LTC) facilities has been well documented, leading to clinical guideline development and professional educational programs designed to foster better pain assessment and management in this population. Despite these efforts, little improvement has occurred, and we postulate that focused attention to public policy and cost implications of systemic change is required to create positive pain-related outcomes. Our goal was to outline feasible and cost-effective clinical and public policy recommendations designed to address the undermanagement of pain in LTC facilities. We arranged a 2-day consensus meeting of prominent United States and Canadian pain and public policy experts. An initial document describing the problem of pain undermanagement in LTC was developed and circulated prior to the meeting. Participants were also asked to respond to a list of relevant questions before arriving. Following formal presentations of a variety of proposals and extensive discussion among clinicians and policy experts, a set of recommendations was developed. We outline key elements of a transformational model of pain management in LTC for the United States and Canada. Consistent with previously formulated clinical guidelines but with attention to readily implementable public policy change in both countries, this transformational model of LTC has important implications for LTC managers and policy makers as well as major quality of life implications for LTC residents.

Long-term care survey reveals challenges. Facilities grapple with five broad issues, including changes in leadership and AIDS.

PubMed

Westhoff, L J; Schaefer, J C

1993-05-01

The Catholic Health Association's 1992 survey of Catholic long-term care (LTC) facilities identified five broad issues LTC facilities face in the 1990s: leadership, system affiliation, community programs, resident issues, and care of persons with AIDS. The transition to lay leadership presents new challenges to the relationship between LTC facilities and their sponsors. Despite the dominance of religious sponsors, an increasing number of laypersons are serving as healthcare administrators both in long-term and acute care. Thirty percent of respondents reported being affiliated with a multi-institutional system. This percentage has changed little in the past few years, although the number of facilities that are system members continues to increase at the fastest rate of any type of LTC facility. Only 27 percent of survey respondents said they provide educational or informational programs for persons in their communities. Thirty-nine percent of system-affiliated LTC facilities reported offering such programs. One encouraging finding shows that 80 percent of facilities have written policies for living wills, 64 percent for designated proxy, and 86 percent for durable power of attorney for healthcare. LTC providers are struggling to determine their role in caring for persons with HIV and AIDS. Only 3.6 percent of respondents care for residents with AIDS. A major problem LTC administrators face is a fear of potential infection of staff or residents.

Clostridium botulinum serotype D neurotoxin and toxin complex bind to bovine aortic endothelial cells via sialic acid.

PubMed

Yoneyama, Tohru; Miyata, Keita; Chikai, Tomoyuki; Mikami, Akifumi; Suzuki, Tomonori; Hasegawa, Kimiko; Ikeda, Toshihiko; Watanabe, Toshihiro; Ohyama, Tohru; Niwa, Koichi

2008-12-01

Botulinum neurotoxin (BoNT) is produced as a large toxin complex (L-TC) associated with nontoxic nonhemagglutinin (NTNHA) and three hemagglutinin subcomponents (HA-70, -33 and -17). The binding properties of BoNT to neurons and L-TC to intestinal epithelial cells are well documented, while those to other tissues are largely unknown. Here, to obtain novel insights into the pathogenesis of foodborne botulism, we examine whether botulinum toxins bind to vascular endothelial cells. BoNT and 750 kDa L-TC (a complex of BoNT, NTNHA and HAs) of Clostridium botulinum serotype D were incubated with bovine aortic endothelial cells (BAECs), and binding to the cells was assessed using sodium dodecyl sulfate polyacrylamide gel electrophoresis and Western blot. Both BoNT and L-TC bound to BAECs, with L-TC showing stronger binding. Binding of BoNT and L-TC to BAECs was significantly inhibited by N-acetyl neuraminic acid in the cell culture medium or by treatment of the cells with neuraminidase. However, galactose, lactose or N-acetyl galactosamine did not significantly inhibit toxin binding to the cells. This is the first report demonstrating that BoNT and L-TC bind to BAECs via sialic acid, and this mechanism may be important in the trafficking pathway of BoNT in foodborne botulism.

Improving the Long-Term Care Referral Process: Insights from Patients and Caregivers

ERIC Educational Resources Information Center

Guihan, Marylou; Hedrick, Susan; Miller, Sara; Reder, Sheri

2011-01-01

Large increases in the need for long-term care (LTC) services are expected as baby boomers age. Little has been published about patient and caregiver preferences for information about LTC. However, our qualitative research findings suggest that potential consumers may find it difficult to obtain accurate and timely information about LTC programs…

Pacific Armies Management Seminar (5th) Held at manila, Republic of the Philippines on 16-20 November 1981.

DTIC Science & Technology

1981-01-01

0. C. Admin Wing, Bashar (BAS) MAJ ENAYET Hussain, General Staff Officer, Operations Directorate, Army Headquarters LTC Hugh M. BAKER, US Defense...L. BUTCHER **LTC Ronald TURNER MAJ Hercules CATALUNA LTC Paul SOMR MAJ ENAYET Hussain MAJ Frederick DREW MAJ SHIN 11 Soon MAJ Brian HALL MAJ TAN Khin

Analysis of costs to dispense prescriptions in independently owned, closed-door long-term care pharmacies.

PubMed

Carroll, Norman V; Rupp, Michael T; Holdford, David A

2014-03-01

The need for accurate calculation of long-term care (LTC) pharmacies' costs to dispense (CTD) has become more important as payers have moved toward reimbursement models based on pharmacies' actual acquisition cost for drug products and the Centers for Medicare Medicaid Services (CMS) has implemented requirements that LTC pharmacies must dispense prescriptions for certain branded drugs in 14-day-or-less quantities. To (a) calculate the average cost that the typical independently owned, closed-door LTC pharmacy currently incurs to dispense and deliver a prescription to the resident of a client LTC facility and (b) estimate how CMS-mandated changes to a 14-day-or-less dispensing cycle would affect the typical LTC pharmacy's average CTD. The data requirements and measurement model were developed by academic researchers in consultation with an industry advisory committee of independent LTC pharmacy owners. A survey instrument was constructed to collect financial and operating data required to calculate the CTD. Surveys were distributed via 3 dissemination channels to approximately 1,000 independently owned, closed-door LTC pharmacies. The National Community Pharmacists Association mailed surveys to their LTC members; 3 major national wholesalers distributed surveys to their LTC customers through their newsletters; and 3 LTC group purchasing organizations distributed the surveys to their members through emails, newsletters, mailings, and/or regional meetings. Each pharmacy's CTD was calculated by dividing total LTC dispensing-related 
costs by the total number of prescriptions dispensed. Dispensing-related costs included costs incurred to physically dispense and deliver prescriptions (e.g., dispensing pharmacists' and technicians' salaries and costs of medication containers) and costs incurred to support the dispensing function (e.g., salaries of delivery and medical records personnel). A model based on dispensing-related fixed, variable, and semivariable costs was developed to examine the impact of shorter dispensing cycles on LTC pharmacies' CTD. A prescription volume increase of 19% was assumed based on converting only solid oral branded drugs to short-cycle dispensing. A diverse sample of 64 closed-door LTC pharmacies returned usable surveys. Sales from dispensing to LTC facilities accounted for more than 98% of total sales. Respondents indicated that they currently dispensed 23% of total doses in 14-day-or-less cycles and 76% in 28-31 day cycles. Most pharmacies used automated medication packaging technology, heat and cold package sealers, bar code systems, sterile compounding hoods, LTC printers or labelers, and electronic prescribing. The median CTD was $13.54 with an interquartile range (25th to 75th percentiles) of $10.51 to $17.66. More than half of dispensing-related costs were from personnel expense, of which pharmacists and managers accounted for more than 40%. The results of the fixed and variable cost modeling suggested that converting solid oral brand-name drugs from 30-day to 14-day dispensing cycles would lower the median per prescription CTD to between $11.63 and $12.54, depending on the assumptions made about the effects of semivariable costs. However, this decrease in per prescription dispensing cost is dwarfed by an increase in total dispensing cost incurred by pharmacies that results from doubling the monthly volume of short-cycle prescriptions that must be dispensed. The result is that the typical LTC pharmacy in our sample incurred a CTD of $13.54 if the medication is dispensed in a 30-day cycle or $23.26 if the medication is dispensed in two 14-day cycles (at a cost of $11.63 for each cycle dispensed). Our results indicated a median CTD of $13.54 for the typical independently owned, closed-door LTC pharmacy. Moving to a shorter cycle would reduce pharmacies' average per-prescription CTD but would increase the number of prescriptions dispensed per month. Our results indicated that transitioning solid oral branded products to 14-day cycles would reduce the median CTD to a minimum of $11.63 but would increase total dispensing costs because each sold oral branded prescription would require twice the number of monthly dispensing events.

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

PubMed Central

2013-01-01

Background The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison. PMID:23768163

Supporting Lesbian, Gay, Bisexual, & Transgender Inclusivity in Long-Term Care Homes: A Canadian Perspective.

PubMed

Sussman, Tamara; Brotman, Shari; MacIntosh, Heather; Chamberland, Line; MacDonnell, Judith; Daley, Andrea; Dumas, Jean; Churchill, Molly

2018-06-01

ABSTRACTIt is critical to ensure that long-term care (LTC) homes are sensitive to the needs of lesbian, gay, bisexual, and transgender (LGBT) older adults. However, the extent to which the LTC home sector has adopted recommended strategies is unknown. This qualitative study reports findings from two initiatives: Semi-structured telephone interviews with Canadian LTC home administrators on strategies adopted to support LGBT inclusivity (n = 32), and discussions with participants attending a 2-day meeting on supporting LGBT inclusivity in LTC (n = 25). We found that LGBT inclusivity training was the most commonly adopted strategy among the LTC homes surveyed. Study findings further suggested that practices more visible to residents and families, such as LGBT-themed programming, inclusive language and symbols, or joint initiatives with LGBT communities, were less commonly adopted because of anticipated negative resident/family reactions. The importance and benefits of comprehensive strategies that include staff, residents, and family are discussed.

From Familiar Faces to Family.

PubMed

Canham, Sarah L; Battersby, Lupin; Fang, Mei Lan; Sixsmith, Judith; Woolrych, Ryan; Sixsmith, Andrew

2016-04-01

Long-term care (LTC) facilities are increasingly intent on creating a "homelike" atmosphere for residents. Although residential staff are integral to the construction of a home within LTC settings, their perceptions have been relatively absent from the literature. Thirty-two LTC staff participants were interviewed about their experiences and perceptions of the physical environment and conceptualizations of home, and thematic analyses were conducted. An overarching category-interpersonal relationships-emerged from our analyses emphasizing the importance of relationships in creating a homelike environment within institutional settings. Sub-themes that inform our understanding include the following: (a) Staff members' perceptions of home; (b) "Their second home": Adjustment to and familiarity in LTC; and (c) "We become family": Relationality makes a home. The study provides evidence to inform current policies and practices in LTC. Specifically, enough time and space should be given to residents and staff to create and maintain personal relationships to make residential care homelike.

Medicaid Long-Term Care: State Variation and the Intergovernmental Lobby.

PubMed

Thompson, Frank J; Cantor, Joel C; Farnham, Jennifer

2016-08-01

Medicaid is vastly more important than Medicare or private insurance in funding long-term care (LTC). However, states vary tremendously in their commitment to Medicaid LTC. This article advances knowledge of the origins, nature, and implications of this variation. After examining the degree of variation in state spending on Medicaid LTC, we show how federal policy has over the past fifty years steadily increased state discretion to shape these services. This decentralization largely reflects the potency of the intergovernmental lobby-governors and other state officials-in influencing federal policy. While fueling state variation, the intergovernmental lobby has also provided valuable political support that has helped Medicaid grow and resist retrenchment. After considering policy options that could mitigate Medicaid LTC inequities rooted in state differences, we assess how the catalytic forces that have fueled growth in Medicaid LTC may be insufficient to protect the program from future erosion. Copyright © 2016 by Duke University Press.

A Phenomenological Study of the Work Environment in Long-Term Care Facilities for the Older Adults.

PubMed

Choi, Sandy Pin Pin; Yeung, Cheryl Chi Yan; Lee, Joseph Kok Long

2018-05-01

Attempts to meet the increasing demand for long-term care (LTC) services have been hindered by acute staff shortages and high turnover. Distinct from previous studies, a descriptive phenomenological approach with van Kaam's controlled explication method was adopted in this study, to delineate how attributes of the LTC work environment shape the workforce crisis. Individual interviews were conducted with 40 LTC workers from 10 facilities in Hong Kong. The results suggest that the work environment in LTC facilities is not only characterized by organization- and job-related attributes that influence staff outcomes but also is a socially constructed concept with derogatory connotations that can influence staff recruitment and retention. Concerted efforts from facility administrators and policy makers are needed to improve the quality of the work environment. Future initiatives should focus on developing a vision and strategic plan to facilitate the rise of the LTC sector as a profession.

A Budget Proposal for China's Public Long-Term Care Policy.

PubMed

Lu, Bei; Liu, Xiaoting; Yang, Mingxu

2017-01-01

Long-term care (LTC) policy is at an experimental stage in China, characterized by various regional pilot programs. The public cost of LTC is difficult to estimate due to a lack of clarity about policy detail from the central government. This article analyzes the current disabled status for vulnerable older people without sufficient financial resources and family supports. It focuses on estimating a safety net public subsidy policy for LTC services in China, both for today and into the future, using China Health and Retirement Longitudinal Survey (CHARLS) data, 2011 wave, with the methods of multinomial logistic regression and simulation. The key contribution is to estimate the future disability trend and LTC public cost based on changes in education, population ageing, and urbanization. Disability prevalence might be decreasing partly due to higher education, urbanization, and better health care, and the overall public LTC costs might be growing by the results of projection.

Approaches to Accountability in Long-Term Care

PubMed Central

Berta, Whitney; Laporte, Audrey; Wodchis, Walter P.

2014-01-01

This paper discusses the array of approaches to accountability in Ontario long-term care (LTC) homes. A focus group involving key informants from the LTC industry, including both for-profit and not-for-profit nursing home owners/operators, was used to identify stakeholders involved in formulating and implementing LTC accountability approaches and the relevant regulations, policies and initiatives relating to accountability in the LTC sector. These documents were then systematically reviewed. We found that the dominant mechanisms have been financial incentives and oversight, regulations and information; professionalism has played a minor role. More recently, measurement for accountability in LTC has grown to encompass an array of fiscal, clinical and public accountability measurement mechanisms. The goals of improved quality and accountability are likely more achievable using these historical regulatory approaches, but the recent rapid increase in data and measurability could also enable judicious application of market-based approaches. PMID:25305396

Characterization of low thermal conductivity PAN-based carbon fibers

NASA Technical Reports Server (NTRS)

Katzman, Howard A.; Adams, P. M.; Le, T. D.; Hemminger, Carl S.

1992-01-01

The microstructure and surface chemistry of eight low thermal conductivity (LTC) PAN-based carbon fibers were determined and compared with PAN-based fibers heat treated to higher temperatures. Based on wide-angle x ray diffraction, the LTC PAN fibers all appear to have a similar turbostratic structure with large 002 d-spacings, small crystallite sizes, and moderate preferred orientation. Limited small-angle x ray scattering (SAXS) results indicate that, with the exception of LTC fibers made by BASF, the LTC fibers do not have well developed pores. Transmission electron microscopy shows that the texture of the two LTC PAN-based fibers studied (Amoco T350/23X and /25X) consists of multiple sets of parallel, wavy, bent layers that interweave with each other forming a complex three dimensional network oriented randomly around the fiber axis. X ray photoelectron spectroscopy (XPS) analysis finds correlations between heat treated temperatures and the surface composition chemistry of the carbon fiber samples.

Private Long-Term Care Insurance: Value to Claimants and Implications for Long-Term Care Financing

ERIC Educational Resources Information Center

Doty, Pamela; Cohen, Marc A.; Miller, Jessica; Shi, Xiaomei

2010-01-01

Purpose: The purpose of this study was to obtain a profile of individuals with private long-term care (LTC) insurance as they begin using paid LTC services and track their patterns of service use, satisfaction with services and insurance, claims denial rates, and transitions over a 28-month period. Design and Methods: Ten LTC insurance companies…

Diagnosed Prevalence and Health Care Expenditures of Mental Health Disorders among Dual Eligible Older People

ERIC Educational Resources Information Center

Lum, Terry Y.; Parashuram, Shriram; Shippee, Tetyana P.; Wysocki, Andrea; Shippee, Nathan D.; Homyak, Patricia; Kane, Robert L.

2013-01-01

Purpose: Little is known about mental health disorders (MHDs) and their associated health care expenditures for the dual eligible elders across long-term care (LTC) settings. We estimated the 12-month diagnosed prevalence of MHDs among dual eligible older adults in LTC and non-LTC settings and calculated the average incremental effect of MHDs on…

76 FR 9503 - Medicare and Medicaid Programs; Requirements for Long-Term Care (LTC) Facilities; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-18

... nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program. These..., as of April 2010, there are 15,713 long-term care (LTC) facilities (commonly referred to as nursing homes) in the U.S. LTC facilities are also referred to as skilled nursing facilities (SNFs) in the...

A Fifth Option for Funding Long-Term Care in Canada - Shift the Resources from Medical Treatment and Universal Pension Entitlements.

PubMed

Emery, J C Herbert

2016-01-01

Needs for non-medical residential care services, long-term care (LTC), will increase over the next 30 years as Canada's population ages. Adams and Vanin (2016) explore four options for raising the public and private monies required to meet LTC needs. In this commentary, I raise a fifth option for finding the resources to meet emerging LTC needs. An alternative approach is to divert resources from Canada's well-resourced, but inefficient, medical treatment system. The dividend of provinces pursuing long overdue reforms to medicare is the liberation of public funds to finance emerging priorities for Canadians like LTC.

Resilience and organisational empowerment among long-term care nurses: effects on patient care and absenteeism.

PubMed

Williams, Jaime; Hadjistavropoulos, Thomas; Ghandehari, Omeed O; Malloy, David C; Hunter, Paulette V; Martin, Ronald R

2016-04-01

To study resilience among long-term care (LTC) nurses and its relationship to organisational empowerment, self-reported quality of care, perceptions of resident personhood (i.e. viewing another person as a person, implying respect) and absenteeism. Although resilience has been examined among nurses, it has not been studied in LTC nurses where resident rates of dementia are high, and nurses may experience stress affecting care and the way residents are perceived. A sample of one hundred and thirty LTC nurses from across North America completed a series of questionnaires. Resilient nurses were more likely to report higher quality of care and to view residents as having higher personhood status (despite deteriorating cognitive function). Resilience was not predictive of absenteeism. Organisational empowerment did not add to the predictive power of resilience. Resilience is of importance in LTC nursing research and future studies could examine this construct in relation to objectively measured resident outcomes. Our findings suggest that interventions to improve LTC staff resilience would be important to pursue and that consideration should be given to resilience in optimizing the match between potential staff members and LTC positions. © 2015 John Wiley & Sons Ltd.

QF-PCR as a substitute for karyotyping of cytotrophoblast for the analysis of chorionic villi: advantages and limitations from a cytogenetic retrospective audit of 44,727 first-trimester prenatal diagnoses.

PubMed

Grati, Francesca R; Malvestiti, Francesca; Grimi, Beatrice; Gaetani, Elisa; Di Meco, Anna Maria; Trotta, Anna; Liuti, Rosaria; Chinetti, Sara; Dulcetti, Francesca; Ruggeri, Anna Maria; Agrati, Cristina; Frascoli, Giuditta; Milani, Silvia; De Toffol, Simona; Martinoni, Lorenza; Paganini, Silvia; Marcato, Livia; Maggi, Federico; Simoni, Giuseppe

2013-05-01

Karyotyping on chorionic villous samples (CVS) includes the analysis of both cytotrophoblast (STC) and mesenchyme (LTC). This approach requires complex laboratory organization and trained technicians. The introduction of quantitative fluorescent polymerase chain reaction (QF-PCR) instead of conventional karyotyping in low-risk pregnancies opened its application in CVS analysis. Discordant QF-PCR and CVS cytogenetic results were reported, and strategies for CVS analysis were introduced to minimize this risk. The possibility to substitute the STC with QF-PCR was reported. The aim of this study is to evaluate benefits and limitations of the approach QF-PCR + LTC compared with the traditional method STC + LTC and to quantify the associated risks of false results. This study is based on a retrospective cytogenetic audit of CVS results (n = 44 727) generated by the STC + LTC analytic approach. False-negative risks related to true fetal mosaicism type IV, imprinting syndromes and maternal contamination in LTC were calculated. Compared with STC + LTC, QF-PCR + LTC approach is associated with a cumulative false-negative risk of ~1/3100-1/4400. Costs and reporting time of STC in a high-throughput cytogenetic lab are similar to a CE-IVD marked QF-PCR analysis. These results should be clearly highlighted in the pre-test counseling and extensively discussed with the couple prior to testing for informed consent. © 2013 John Wiley & Sons, Ltd.

Medicare part D and long-term care: a systematic review of quantitative and qualitative evidence.

PubMed

Pimentel, Camilla B; Lapane, Kate L; Briesacher, Becky A

2013-09-01

In the largest overhaul to Medicare since its creation in 1965, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established Part D in 2006 to improve access to essential medication among disabled and older Americans. Despite previous evidence of a positive impact on the general Medicare population, Part D's overall effects on long-term care (LTC) are unknown. The purpose of this systematic review was to evaluate the literature regarding Part D's impact on the LTC context, specifically costs to LTC residents, providers and payers; prescription drug coverage and utilization; and clinical and administrative outcomes. Four electronic databases [PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Business Fulltext Elite and Science Citation Index Expanded], selected US government and non-profit websites, and bibliographies were searched for quantitative and qualitative studies characterizing Part D in the LTC context. Searches were limited to studies that may have been published between 1 January 2006 (date of Part D implementation) and 8 January 2013. Systematic searches identified 1,624 publications for a three-stage (title, abstract and full-text) review. Included publications were in English language; based in the US; assessed Part D-related outcomes; and included or were directly relevant to LTC residents or settings. News articles, reviews, opinion pieces, letters or commentaries; case reports or case series; simulation or modeling studies; and summaries that did not report original data were excluded. A standardized form was used to abstract study type, study design, LTC setting, sources of data, method of data collection, time periods assessed, unit of observation, outcomes and results. Methodological quality was assessed using modified criteria specific to quantitative and qualitative studies. Eleven quantitative and eight qualitative studies met inclusion criteria. In the seven years since its implementation, Part D decreased out-of-pocket costs among enrolled nursing home residents and potentially increased costs borne by LTC facilities. Coverage of prescription drugs frequently used by older adults was adequate, except for certain drugs and alternative formulations of importance to LTC residents. The use of medications that raise safety concerns was decreased, but overall drug utilization may have been unaffected. Although there was uncertain impact on clinical outcomes, quantitative studies demonstrated evidence of unintended health consequences. Qualitative studies consistently revealed increased administrative burden among providers. Empirical evidence of Part D's LTC impact was sparse. Due to limitations in available types of data, quantitative studies were generically lacking in methodological rigor. Qualitative studies suffered from lack of clarity of reporting. As future studies use clinical Medicare data, study quality is expected to improve. Although LTC-specific policies continue to evolve, it appears that the prescription drug benefit may require further modifications to more effectively provide for LTC residents' unique medication needs and improve their health outcomes. Adjustments may be needed for Part D to be more compatible with LTC prescription drug delivery processes.

Unconventional Warfare in the American Civil War

DTIC Science & Technology

2004-06-18

Miller Thesis Title: Unconventional Warfare in the American Civil War Approved by: , Thesis Committee Chair LTC ( R ) Gregory T. Beck...M.A. , Member LTC ( R ) Richard Barbuto, Ph.D. , Consulting Faculty LTC ( R ) James B. Martin, Ph.D. Accepted this 18th day of...troops and supplies to forward areas. In official correspondence dated 26 May 1864 from Captain A. V. Barringer , Chief Quartermaster, Department of West

Resistance of essential fatty acid-deficient rats to endotoxin-induced increases in vascular permeability

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, E.J.; Cook, J.A.; Spicer, K.M.

Resistance to endotoxin in essential fatty acid-deficient (EFAD) rats is associated with reduced synthesis of certain arachidonic acid metabolites. It was hypothesized that EFAD rats would manifest decreased vascular permeability changes during endotoxemia as a consequence of reduced arachidonic acid metabolism. To test this hypothesis, changes in hematocrit (HCT) and mesenteric localization rate of technetium-labeled human serum albumin (99mTc-HSA) and red blood cells (99mTc-RBC) were assessed in EFAD and normal rats using gamma-camera imaging. Thirty minutes after Salmonella enteritidis endotoxin, EFAD rats exhibited less hemoconcentration as determined by % HCT than normal rats. Endotoxin caused a less severe change inmore » permeability index in the splanchnic region in EFAD rats than in normal rats (1.2 +/- 0.6 x 10(-3)min-1 vs. 4.9 +/- 1.7 x 10(-3)min-1 respectively, P less than 0.05). In contrast to 99mTc-HSA, mesenteric localization of 99mTc-RBC was not changed by endotoxin in control or EFAD rats. Supplementation with ethyl-arachidonic acid did not enhance susceptibility of EFAD rats to endotoxin-induced splanchnic permeability to 99mTc-HSA. Leukotrienes have been implicated as mediators of increased vascular permeability in endotoxin shock. Since LTC3 formation has been reported to be increased in EFA deficiency, we hypothesized that LTC3 may be less potent than LTC4. Thus the effect of LTC3 on mean arterial pressure and permeability was compared to LTC4 in normal rats. LTC3-induced increases in peak mean arterial pressure were less than LTC4 at 10 micrograms/kg (39 +/- 5 mm Hg vs. 58 +/- 4 mm Hg respectively, P less than 0.05) and at 20 micrograms/kg (56 +/- 4 mm Hg vs. 75 +/- 2 mm Hg respectively, P less than 0.05). LY171883 (30 mg/kg), an LTD4/E4 receptor antagonist, attenuated the pressor effect of LTC4, LTD4, and LTC3.« less

Investing in Post-Acute Care Transitions: Electronic Information Exchange Between Hospitals and Long-Term Care Facilities.

PubMed

Cross, Dori A; Adler-Milstein, Julia

2017-01-01

Electronic health information exchange (HIE) is expected to help improve care transitions from hospitals to long-term care (LTC) facilities. We know little about the prevalence of hospital LTC HIE in the United States and what contextual factors may motivate or constrain this activity. Cross-sectional analysis of U.S. acute-care hospitals responding to the 2014 AHA IT Supplement survey and with available readmissions data (n = 1,991). We conducted multivariate logistic regression to explore the relationship between hospital LTC HIE and selected IT and policy characteristics. Over half of the hospitals in our study (57.2%) reported engaging in some form of HIE with LTC providers: 33.9% send-only, 0.5% receive-only, and 22.8% send and receive. Hospitals that engaged in some form of LTC HIE were more likely than those that did not engage to have attested to meaningful use (odds ratio [OR], 1.87; P = .01 for stage 1 and OR, 2.05; P < .01 for stage 2), participate in a regional HIE effort (OR, 1.34; P = .021), and exchange information electronically with other hospitals or ambulatory providers (OR, 4.54; P < .01). Organizational affiliation with a skilled nursing facility (OR, 1.29; P = .041) and higher 30-day readmission rates (OR, 1.19; P = .016) were also associated with LTC HIE, but not accountable care organization nor bundled payment participation. As payment to LTC providers and hospitals increasingly emphasizes total patient care and paying for value, those leading these organizations have new incentives to pursue collaborative relationships. Hospitals appear to be investing in electronic information exchange with LTCs as part of a general strategy to adopt EHRs and engage in HIE, but also potentially to strengthen ties to LTC providers and to reduce readmissions. To achieve widespread connectivity, continued focus on adoption of related health IT infrastructure and greater emphasis on aligning incentives for hospital-LTC care transitions would be valuable. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Medicare program; revisions to FY 2009 Medicare severity-long-term care diagnosis-related group (MS-LTC-DRG) weights. Interim final rule with comment period.

PubMed

2009-06-03

This interim final rule with comment period implements revised Medicare severity long-term care diagnosis-related group (MS-LTC-DRG) relative weights for payment under the long-term care hospital (LTCH) prospective payment system (PPS) for federal fiscal year (FY) 2009. We are revising the MS-LTC-DRG relative weights for FY 2009 due to the misapplication of our established methodology in the calculation of the budget neutrality factor. The revised FY 2009 MS-LTC-DRG relative weights are effective for the remainder of FY 2009 (that is, from June 3, 2009 through September 30, 2009).

[Studies on separation, purification and structure characteristics of a polysaccharide LTC-II from Pyrola corbieri].

PubMed

Mo, Zhengchang; Wu, Lanfang; Yang, Juan; Wang, Daoping

2011-06-01

To characterize the structure of polysaccharide LTC-II obtained from Pyrola corbieri. The polysaccharide was extracted from P. corbieri by hot water and ethanol precipitation. Crude polysaccharide was purified by DEAE-Cellulose chromatography and Sephacryl S-300 HR column chromatography. The purity and molecular weight of polysaccharide was determined by gel permeation chromatography. UV, IR, optical rotation, complete acid hydrolysis, periodate oxydation, Smith degradation, partial acid hydrolysis and methylation analysis were applied to determine the structural features. A homogeneous fraction LTC-II was obtained and its relative molecular mass was 22 000 Da. It consisted of arabinose, mannose, glucose, galactose in the molar ratio of 35. 2: 1.0: 13. 4: 4. 2. LTC-II had a backbone consisting glucose, mannose, galactose and mainly contained (1 --> 6)-linkaged glucose. The side chain possessed arabinose, glucose, galactose and mainly contained (1 --> 5)-linkaged arabinose. The terminal sugar were mainly glucose and galactose. Studies on the preliminary characterization of polysaccharide LTC-II from P. corbieri for the first time.

Individual differences in early adolescents' latent trait cortisol (LTC): Relation to early adversity.

PubMed

Stroud, Catherine B; Chen, Frances R; Doane, Leah D; Granger, Douglas A

2016-09-01

Substantial evidence suggests that youth who experience early adversity exhibit alterations in hypothalamic pituitary adrenal (HPA) axis functioning, thereby increasing risk for negative health outcomes. However, few studies have explored whether early adversity alters enduring trait indicators of HPA axis activity. Using objective contextual stress interviews with adolescents and their mothers to assess early adversity, we examined the cumulative impact of nine types of early adversity on early adolescents girls' latent trait cortisol (LTC). Adolescents (n = 122; M age = 12.39 years) provided salivary cortisol samples three times a day (waking, 30 min post-waking, and bedtime) over 3 days. Latent state-trait modeling indicated that the waking and 30 min post-waking samples contributed to a LTC factor. Moreover, greater early adversity was associated with a lower LTC level. Implications of LTC for future research examining the impact of early adversity on HPA axis functioning are discussed. © 2016 Wiley Periodicals, Inc. Dev Psychobiol 58:700-713, 2016. © 2016 Wiley Periodicals, Inc.

Weighing public and private options for reforming long-term care financing: findings from a national survey of specialists.

PubMed

Miller, Edward Alan; Mor, Vincent; Clark, Melissa

2010-08-01

Deficiencies in current long-term care (LTC) financing models are substantial and must be addressed if the nation is going to meet the needs of the growing population of frail and disabled elders. Because debate over reforming LTC financing has traditionally focused on the relative roles of the public and private sectors, this article examines what characteristics predispose LTC specialists to weigh one approach--public or private--more than the other. Data are derived from a Web-based survey of 1,147 individuals with known or demonstrable experience with LTC, including consumer advocates, provider representatives, policy experts, and public officials. Results suggest that support for spurring private sector mechanisms, bolstering the government's role, and reforming Medicare and Medicaid vary with key characteristics of the respondents, including experiential, attitudinal, and background variables. Findings also suggest consensus that reform of LTC financing should improve on the current public-private partnership in this area.

Financing long-term care: employee needs and attitudes, and the employer's role.

PubMed

Granza, L; Madamba, A; Warshawsky, M

1998-01-01

Because of increasing life expectancies, high costs for nursing home and home health care, declining levels of informal family care, and the stated policy of the federal and state governments to foster self-reliance, individuals are increasingly exposed to the risk of financial ruin from long-term care (LTC) expenses. Yet, because of psychological barriers and aversions, particularly to thinking about residing in a nursing home, most individuals have not purchased LTC insurance. Hence, it may be the responsibility of employers to provide education to employees about LTC and to sponsor either individual or group plans of LTC insurance. Educational efforts may be particularly effective at the time of retirement when employees are in a more serious mood to consider the contingencies of retired life. A formal and perhaps more economical response for employers would be to offer combined life annuity and LTC insurance benefits through the retirement plan, provided certain regulatory and tax barriers can be removed.

Germany's long-term-care insurance: putting a social insurance model into practice.

PubMed

Geraedts, M; Heller, G V; Harrington, C A

2000-01-01

A growing population of elderly has intensified the demand for long-term care (LTC) services. In response to the mounting need, Germany put into effect a LTC Insurance Act in 1995 that introduced mandatory public or private LTC insurance for the entire population of 82 million. The program was based on the organizational principles that define the German social insurance system. Those individuals in the public system and their employers each pay contributions equal to 0.85 percent of each employee's gross wages or salary. Ten percent of the population with the highest incomes have chosen the option of purchasing private long term care insurance. Provisions were made for uniform eligibility criteria, benefits based on level of care needs, cost containment, and quality assurance. Over the first four years of its operation, the system has proved financially sound and has expanded access to organized LTC services. The German system thus may serve as an example for other countries that are planning to initiate social LTC insurance systems in other nations.

How Maryland increased infection prevention and control activity in long-term care facilities, 2003-2008.

PubMed

Roup, Brenda J; Scaletta, Joseph M

2011-05-01

In January 2003, the Maryland Department of Health and Mental Hygiene (DHMH) assessed the state of infection prevention and control (IPC) resources and practices in all long-term care facilities (LTC) in the state. Only 8.1% of facilities that responded employed a trained IPC professional (IP) who managed the facility IPC program. Between 2003 and 2008, the DHMH partnered with long-term care industry trade associations and spearheaded regulatory, educational, and financial initiatives to improve this situation. In January 2008, all LTC facilities in the state were resurveyed to determine the impact of these initiatives on IPC activities. The 2008 survey indicated that 44% of LTC facilities used a trained IP who managed the IPC program, a 5-fold increase from 2003. Unpublished DHMH outbreak data indicated that LTC facilities with a trained IP recognized and reported outbreaks to the local health department 2 days sooner than facilities without a trained IP, resulting in fewer cases of disease. Multiple initiatives with concerned stakeholders and LTC partners over the course of 5 years resulted in increased numbers of LTC facilities with trained IPs who recognized and responded to outbreaks sooner than facilities without trained IPs. Copyright © 2011 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Using the ecological framework to identify barriers and enablers to implementing Namaste Care in Canada's long-term care system.

PubMed

Hunter, Paulette V; Kaasalainen, Sharon; Froggatt, Katherine A; Ploeg, Jenny; Dolovich, Lisa; Simard, Joyce; Salsali, Mahvash

2017-10-01

Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care. Six group interviews were conducted with families, unlicensed staff, and licensed staff at two Canadian LTC homes that were planning to implement Namaste Care. None of the interviewees had prior experience implementing Namaste Care. The resulting qualitative data were analyzed using a template organizing approach. We found that the strongest implementation enablers were positive perceptions of need for the program, benefits of the program, and fit within a resident-centred or palliative approach to care. Barriers included a generally low resource base for LTC, the need to adjust highly developed routines to accommodate the program, and reliance on a casual work force. We conclude that within the Canadian LTC system, positive perceptions of Namaste Care are tempered by concerns about organizational capacity to support new programming.

Training unemployed women for adult day care in Izmir, Turkey: a program evaluation.

PubMed

Hussein, Shereen; Oğlak, Sema

2014-01-01

The proportion of older people in Turkey is increasing steadily with a subsequent growth of long-term care (LTC) needs. There is a scarcity of formal care provisions for residential and particularly nonresidential settings. Thus, formal caregiving is not meeting LTC needs nor attracting workers as a labor option. The authors examine the hypothesis that LTC may offer work opportunities for women unfamiliar with caregiving as an occupation, and also examine the need and acceptance of different types of LTC beyond residential care. The authors evaluate an innovative project introducing these two elements to 76 women in İzmir, Turkey, using an analysis framework that incorporates factors related to applications and progression; management assessment; trainees' self-assessment reflecting on their views on aging; and older people's perception of the experience and its impact on their well-being. Trainees reported a major positive shift in their attitudes toward working in LTC and toward the aging process. Users reported discovering a new dimension to care, which directly affected their quality of life. Overall, this community-based initiative appeared effective in enhancing the awareness of the concept of adult day centers providing a social model of care, and appears promising in addressing the growing need for formal LTC in Turkey.

Measuring Family Members' Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire.

PubMed

Nadin, Shevaun; Miandad, Mohammed Ali; Kelley, Mary Lou; Marcella, Jill; Heyland, Daren K

2017-01-01

Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families' satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families' perceptions of the EOLC experience and to be self-administered. Phase 1 . A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added. The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered. The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach's alpha coefficients (range: .88-.94) indicated internal consistency. This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families' perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning.

Measuring Family Members' Satisfaction with End-of-Life Care in Long-Term Care: Adaptation of the CANHELP Lite Questionnaire

PubMed Central

Miandad, Mohammed Ali; Marcella, Jill; Heyland, Daren K.

2017-01-01

Rationale Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families' satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families' perceptions of the EOLC experience and to be self-administered. Methods and Results Phase 1. A literature review identified key domains of satisfaction with EOLC in LTC, and original survey items were assessed for inclusiveness and relevance. Items were modified, and one item was added. Phase 2 The revised questionnaire was administered to 118 LTC family members and cognitive interviews were conducted. Further modifications were made including reformatting to be self-administered. Phase 3 The new instrument was pilot-tested with 134 family members. Importance ratings indicated good content and face validity. Cronbach's alpha coefficients (range: .88–.94) indicated internal consistency. Conclusion This research adapted and pilot-tested the CANHELP for use in LTC. This paper introduces the new, valid, internally consistent, self-administered tool (CANHELP Lite Family Caregiver LTC) that can be used to measure families' perceptions of and satisfaction with EOLC. Future research should further validate the instrument and test its usefulness for quality improvement and care planning. PMID:28706945

Identification of natural antimicrobial agents to treat dengue infection: In vitro analysis of latarcin peptide activity against dengue virus.

PubMed

Rothan, Hussin A; Bahrani, Hirbod; Rahman, Noorsaadah Abd; Yusof, Rohana

2014-05-31

Although there have been considerable advances in the study of dengue virus, no vaccines or anti-dengue drugs are currently available for humans. Therefore, new approaches are necessary for the development of potent anti-dengue drugs. Natural antimicrobial peptides (AMPs) with potent antiviral activities are potential hits-to-leads for antiviral drug discovery. We performed this study to identify and characterise the inhibitory potential of the latarcin peptide (Ltc 1, SMWSGMWRRKLKKLRNALKKKLKGE) against dengue virus replication in infected cells. The Ltc 1 peptide showed a significantly inhibitory effect against the dengue protease NS2B-NS3pro at 37°C, a physiological human temperature, (IC50, 12.68 ± 3.2 μM), and greater inhibitory effect was observed at 40°C, a temperature similar to a high fever (IC50, 6.58 ± 4.1 μM). A greater reduction in viral load (p.f.u./ml) was observed at simultaneous (0.7 ± 0.3 vs. 7.2 ± 0.5 control) and post-treatment (1.8 ± 0.7 vs. 6.8 ± 0.6 control) compared to the pre-treatment (4.5 ± 0.6 vs. 6.9 ± 0.5 control). Treatment with the Ltc 1 peptide reduced the viral RNA in a dose-dependent manner with EC50 values of 8.3 ± 1.2, 7.6 ± 2.7 and 6.8 ± 2.5 μM at 24, 48 and 72 h, respectively. The Ltc 1 peptide exhibited significant inhibitory effects against dengue NS2B-NS3pro and virus replication in the infected cells. Therefore, further investigation is necessary to develop the Ltc 1 peptide as a new anti-dengue therapeutic.

Use of fall risk increasing drugs in residents of retirement villages: a pilot study of long term care and retirement home residents in Ontario, Canada.

PubMed

Rojas-Fernandez, Carlos; Dadfar, Farzan; Wong, Andrea; Brown, Susan G

2015-10-14

Falls continue to be a problem for older people in long-term care (LTC) and retirement home (RH) settings and are associated with significant morbidity and health care use. Fall-risk increasing drugs (FRIDs) are known to increase fall risk and represent modifiable risk factors. There are limited data regarding the use of FRIDs in contemporary LTC and RH settings, and it has not been well documented to what extent medication regimens are reviewed and modified for those who have sustained falls. The objective of this study is to characterize medication related fall risk factors in LTC and RH residents and on-going use of medications known to increase fall risk. Retrospective chart review of residents aged >65 who sustained one or more falls living in LTC or RH settings. 105 residents who fell one or more times during 2009-2010 were identified with a mean age of 89 years, a mean of nine scheduled medications and seven diagnoses, and 83% were women. Residents in LTC were ostensibly at higher risk for falls relative to those in RH settings as suggested by higher proportion of residents with multiple falls, multiple comorbidities, comorbidities that increase fall risk and visual impairment. Post fall injuries were sustained by 42% of residents, and residents in RH sustained more injuries relative to LTC residents (47 vs 34%). Use of FRIDs such as benzodiazepines, antipsychotic, antidepressant and various antihypertensive drugs was common in the present sample. No medication regimen changes were noted in the 6-month post fall period. The present study documented common use FRIDs by LTC and RH residents with multiple falls. These potentially modifiable falls risk factors are not being adequately addressed in contemporary practice, demonstrating that there is much room for improvement with regards to the safe and appropriate use of medications in LTC and RH residents.

Proliferative status of primitive hematopoietic progenitors from patients with acute myelogenous leukemia (AML).

PubMed

Guan, Y; Hogge, D E

2000-12-01

One possible explanation for the competitive advantage that malignant cells in patients with acute myelogenous leukemia (AML) appear to have over normal hematopoietic elements is that leukemic progenitors proliferate more rapidly than their normal progenitor cell counterparts. To test this hypothesis, an overnight 3H-thymidine (3H-Tdr) suicide assay was used to analyze the proliferative status of malignant progenitors detected in both colony-forming cell (CFC) and long-term culture initiating cell (LTC-IC) assays from the peripheral blood of nine patients with newly diagnosed AML. Culture of AML cells in serum-free medium with 100 ng/ml Steel factor (SF), 20 ng/ml interleukin 3 (IL-3) and 20 ng/ml granulocyte colony-stimulating factor (G-CSF) for 16-24 h maintained the number of AML-CFC and LTC-IC at near input values (mean % input +/- s.d. for CFC and LTC-IC were 78 +/- 33 and 126 +/- 53, respectively). The addition of 20 muCi/ml high specific activity 3H-Tdr to these cultures reduced the numbers of both progenitor cell types from most of the patient samples substantially: mean % kill +/- s.d. for AML-CFC and LTC-IC were 64 +/- 27 and 82 +/- 16, respectively, indicating that a large proportion of both progenitor populations were actively cycling. FISH analysis of colonies from CFC and LTC-IC assays confirmed that most cytogenetically abnormal CFC and LTC-IC were actively cycling (mean % kill +/- s.d.: 68 +/- 26 and 85 +/- 13, respectively). Interestingly, in six patient samples where a significant number of cytogenetically normal LTC-ICs were detected, the % kill of these cells (74 +/- 20) was similar to that of the abnormal progenitors. These data contrast with the predominantly quiescent cell cycle status of CFC and LTC-IC previously observed in steady-state peripheral blood from normal individuals but also provide evidence that a significant proportion of primitive malignant progenitors from AML patients are quiescent and therefore may be resistant to standard chemotherapeutic regimens.

A national long-term care program for the United States. A caring vision. The Working Group on Long-term Care Program Design, Physicians for a National Health Program.

PubMed

Harrington, C; Cassel, C; Estes, C L; Woolhandler, S; Himmelstein, D U

1991-12-04

The financing and delivery of long-term care (LTC) need substantial reform. Many cannot afford essential services; age restrictions often arbitrarily limit access for the nonelderly, although more than a third of those needing care are under 65 years old; Medicaid, the principal third-party payer for LTC, is biased toward nursing home care and discourages independent living; informal care provided by relatives and friends, the only assistance used by 70% of those needing LTC, is neither supported nor encouraged; and insurance coverage often excludes critically important services that fall outside narrow definitions of medically necessary care. We describe an LTC program designed as an integral component of the national health program advanced by Physicians for a National Health Program. Everyone would be covered for all medically and socially necessary services under a single public plan, federally mandated and funded but administered locally. An LTC payment board in each state would contract directly with providers through a network of local public agencies responsible for eligibility determination and care coordination. Nursing homes, home care agencies, and other institutional providers would be paid a global budget to cover all operating costs and would not bill on a per-patient basis. Alternatively, integrated provider organizations could receive a capitation fee to cover a broad range of LTC and acute care services. Individual practitioners could continue to be paid on a fee-for-service basis or could receive salaries from institutional providers. Support for innovation, training of LTC personnel, and monitoring of the quality of care would be greatly augmented. For-profit providers would be compensated for past investments and phased out. Our program would add between $18 billion and $23.5 billion annually to current spending on LTC. Polls indicate that a majority of Americans want such a program and are willing to pay earmarked taxes to support it.

The effectiveness of a nurse practitioner-led pain management team in long-term care: A mixed methods study.

PubMed

Kaasalainen, Sharon; Wickson-Griffiths, Abigail; Akhtar-Danesh, Noori; Brazil, Kevin; Donald, Faith; Martin-Misener, Ruth; DiCenso, Alba; Hadjistavropoulos, Thomas; Dolovich, Lisa

2016-10-01

Considering the high rates of pain as well as its under-management in long-term care (LTC) settings, research is needed to explore innovations in pain management that take into account limited resource realities. It has been suggested that nurse practitioners, working within an inter-professional model, could potentially address the under-management of pain in LTC. This study evaluated the effectiveness of implementing a nurse practitioner-led, inter-professional pain management team in LTC in improving (a) pain-related resident outcomes; (b) clinical practice behaviours (e.g., documentation of pain assessments, use of non-pharmacological and pharmacological interventions); and, (c) quality of pain medication prescribing practices. A mixed method design was used to evaluate a nurse practitioner-led pain management team, including both a quantitative and qualitative component. Using a controlled before-after study, six LTC homes were allocated to one of three groups: 1) a nurse practitioner-led pain team (full intervention); 2) nurse practitioner but no pain management team (partial intervention); or, 3) no nurse practitioner, no pain management team (control group). In total, 345 LTC residents were recruited to participate in the study; 139 residents for the full intervention group, 108 for the partial intervention group, and 98 residents for the control group. Data was collected in Canada from 2010 to 2012. Implementing a nurse practitioner-led pain team in LTC significantly reduced residents' pain and improved functional status compared to usual care without access to a nurse practitioner. Positive changes in clinical practice behaviours (e.g., assessing pain, developing care plans related to pain management, documenting effectiveness of pain interventions) occurred over the intervention period for both the nurse practitioner-led pain team and nurse practitioner-only groups; these changes did not occur to the same extent, if at all, in the control group. Qualitative analysis highlighted the perceived benefits of LTC staff about having access to a nurse practitioner and benefits of the pain team, along with barriers to managing pain in LTC. The findings from this study showed that implementing a nurse practitioner-led pain team can significantly improve resident pain and functional status as well as clinical practice behaviours of LTC staff. LTC homes should employ a nurse practitioner, ideally located onsite as opposed to an offsite consultative role, to enhance inter-professional collaboration and facilitate more consistent and timely access to pain management. Copyright © 2016 Elsevier Ltd. All rights reserved.

Complementary and Integrative Healthcare in a Long-term Care Facility: A Pilot Project.

PubMed

Evans, Roni; Vihstadt, Corrie; Westrom, Kristine; Baldwin, Lori

2015-01-01

The world's population is aging quickly, leading to increased challenges of how to care for individuals who can no longer independently care for themselves. With global social and economic pressures leading to declines in family support, increased reliance is being placed on community- and government-based facilities to provide long-term care (LTC) for many of society's older citizens. Complementary and integrative healthcare (CIH) is commonly used by older adults and may offer an opportunity to enhance LTC residents' wellbeing. Little work has been done, however, rigorously examining the safety and effectiveness of CIH for LTC residents. The goal of this work is to describe a pilot project to develop and evaluate one model of CIH in an LTC facility in the Midwestern United States. A prospective, mixed-methods pilot project was conducted in two main phases: (1) preparation and (2) implementation and evaluation. The preparation phase entailed assessment, CIH model design and development, and training. A CIH model including acupuncture, chiropractic, and massage therapy, guided by principles of collaborative integration, evidence informed practice, and sustainability, was applied in the implementation and evaluation phase. CIH services were provided for 16 months in the LTC facility. Quantitative data collection included pain, quality of life, and adverse events. Qualitative interviews of LTC residents, their family members, and LTC staff members queried perceptions of CIH services. A total of 46 LTC residents received CIH care, most commonly for musculoskeletal pain (61%). Participants were predominantly female (85%) and over the age of 80 years (67%). The median number of CIH treatments was 13, with a range of 1 to 92. Residents who were able to provide self-report data demonstrated, on average, a 15% decline in pain and a 4% improvement in quality of life. No serious adverse events related to treatment were documented; the most common mild and expected side effect was increased pain (63 reports over 859 treatments). Qualitative interviews revealed most residents, family members and LTC staff members felt CIH services were worthwhile due to perceived benefits including pain relief and enhanced psychological and social wellbeing. This project demonstrated that with extensive attention to preparation, one patient-centered model of CIH in LTC was feasible on several levels. Quantitative and qualitative data suggest that CIH can be safely implemented and might provide relief and enhanced wellbeing for residents. However, some aspects of model delivery and data collection were challenging, resulting in limitations, and should be addressed in future efforts.

Immigrants and the US Army: A Study in Readiness and the American Dream

DTIC Science & Technology

2016-05-26

Immigrants and the US Army: A Study in Readiness and the American Dream A Monograph by LTC Che T. Arosemena...Approval Page Name of Candidate: LTC Che T. Arosemena Monograph Title: Immigrants and the US Army: A Study in Readiness and the American Dream Approved by...Abstract Immigrants and the US Army: A Study in Readiness and the American Dream , by LTC Che T. Arosemena, USA, 71

Fires. October-December 08

DTIC Science & Technology

2008-10-01

COL David J. Brost and LTC Richard A. McConnell, both FA 14 excalibur: A New Precision engagement Asset in the Warfighter’s toolkit By LTC Noel D...constitutes neither affirmation of their accuracy nor product endorsements. By Order of the Secretary of the Army: George W. casey Jr. General... Brost and LTC Richard A. McConnell, both FA FA and economic Development in iraq: One Chicken at a Time An Iraqi man unloads crates of chicks in Arab

Factors affecting electronic health record adoption in long-term care facilities.

PubMed

Cherry, Barbara; Carter, Michael; Owen, Donna; Lockhart, Carol

2008-01-01

Electronic health records (EHRs) hold the potential to significantly improve the quality of care in long-term care (LTC) facilities, yet limited research has been done on how facilities decide to adopt these records. This study was conducted to identify factors that hinder and facilitate EHR adoption in LTC facilities. Study participants were LTC nurses, administrators, and corporate executives. Primary barriers identified were costs, the need for training, and the culture change required to embrace technology. Primary facilitators were training programs, well-defined implementation plans, government assistance with implementation costs, evidence that EHRs will improve care outcomes, and support from state regulatory agencies. These results offer a framework of action for policy makers, LTC Leaders, and researchers.

Academic-practice partnerships to promote evidence-based practice in long-term care: oral hygiene care practices as an exemplar.

PubMed

McConnell, Eleanor Schildwachter; Lekan, Deborah; Hebert, Catherine; Leatherwood, Lisa

2007-01-01

Learning in practice disciplines suffers when gaps exist between classroom instruction and students' observations of routine clinical practices.(1) Academic institutions, therefore, have a strong interest in fostering the rapid and effective translation of evidence-based care techniques into routine practice. Long-term care (LTC) practice sites are particularly vulnerable to gaps between classroom teaching and how daily care is implemented, owing to the recent rapid advances in the scientific bases of care for frail older adults, the relative isolation of most LTC sites from academic settings,(2) and the relatively small number of registered nurses (RNs) available in LTC settings who can facilitate translation of research-based practices into care.(3) The aim of this project was to demonstrate the feasibility and value of an academic practice partnership to implement evidence-based approaches to solving resident care problems in LTC, as many scientifically proven practices hold promise for improving resident outcomes yet adoption is often slow.(4) We developed and implemented a clinical practice improvement process, based on diffusion of innovations theory and research,(5-8) to serve as a new model of academic-practice collaboration between a university school of nursing, LTC facility management and direct-care staff, as a means of developing high quality clinical sites for student rotations. The goal was to implement a sustainable evidence-based oral care program as an exemplar of how scientific evidence can be translated into LTC practice. This project focused on oral hygiene because the staff was dissatisfied with their existing resident oral care program, and an evidence-base for oral care in LTC existed that had not yet been incorporated into care routines. This article describes a systematic, replicable process for linking advanced practice registered nurse expertise with staff insights about care systems to reduce the gap between teaching and practice in long-term care settings. Our experience demonstrates that translation of research on oral care practices into LTC practice through academic-practice partnerships is feasible, is associated with positive resident outcomes, and illustrates a process that has broader applicability to other common problems in LTC, where incomplete implementation of an extant research base for practice may inhibit student learning.

Assessing the validity and intra-observer agreement of the MIDAM-LTC; an instrument measuring factors that influence personal dignity in long-term care facilities

PubMed Central

2014-01-01

Background Patients who are cared for in long-term care facilities are vulnerable to lose personal dignity. An instrument measuring factors that influence dignity can be used to better target dignity-conserving care to an individual patient, but no such instrument is yet available for the long-term care setting. The aim of this study was to create the Measurement Instrument for Dignity AMsterdam - for Long-Term Care facilities (MIDAM-LTC) and to assess its validity and intra-observer agreement. Methods Thirteen items specific for the LTC setting were added to the earlier developed, more general MIDAM. The MIDAM-LTC consisted of 39 symptoms or experiences for which presence as well as influence on dignity were asked, and a single item score for overall personal dignity. Questionnaires containing the MIDAM-LTC were administered face-to-face at two moments (with a 1-week interval) to 95 nursing home residents residing on general medical wards of six nursing homes in the Netherlands. Constructs related to dignity (WHO Well-Being Five Index, quality of life and physical health status) were also measured. Ten residents answered the questions while thinking aloud. Content validity, construct validity and intra-observer agreement were examined. Results Nine of the 39 items barely exerted influence on dignity. Eight of them could be omitted from the MIDAM-LTC, because the thinking aloud method revealed sensible explanations for their small influence on dignity. Residents reported that they missed no important items. Hypotheses to support construct validity, about the strength of correlations between on the one hand personal dignity and on the other hand well-being, quality of life or physical health status, were confirmed. On average, 83% of the scores given for each item’s influence on dignity were practically consistent over 1 week, and more than 80% of the residents gave consistent scores for the single item score for overall dignity. Conclusion The MIDAM-LTC has good content validity, construct validity and intra-observer agreement. By omitting 8 items from the instrument, a good balance between comprehensiveness and feasibility is realised. The MIDAM-LTC allows researchers to examine the concept of dignity more closely in the LTC setting, and can assist caregivers in providing dignity-conserving care. PMID:24512296

Adoption factors associated with electronic health record among long-term care facilities: a systematic review

PubMed Central

Kruse, Clemens Scott; Mileski, Michael; Alaytsev, Vyachelslav; Carol, Elizabeth; Williams, Ariana

2015-01-01

Objectives The Health Information Technology for Economic and Clinical Health (HITECH) Act created incentives for adopting electronic health records (EHRs) for some healthcare organisations, but long-term care (LTC) facilities are excluded from those incentives. There are realisable benefits of EHR adoption in LTC facilities; however, there is limited research about this topic. The purpose of this systematic literature review is to identify EHR adoption factors for LTC facilities that are ineligible for the HITECH Act incentives. Setting We conducted systematic searches of Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), Google Scholar and the university library search engine to collect data about EHR adoption factors in LTC facilities since 2009. Participants Search results were filtered by date range, full text, English language and academic journals (n=22). Interventions Multiple members of the research team read each article to confirm applicability and study conclusions. Primary and secondary outcome measures Researchers identified common themes across the literature: specifically facilitators and barriers to adoption of the EHR in LTC. Results Results identify facilitators and barriers associated with EHR adoption in LTC facilities. The most common facilitators include access to information and error reduction. The most prevalent barriers include initial costs, user perceptions and implementation problems. Conclusions Similarities span the system selection phases and implementation process; of those, cost was the most common mentioned. These commonalities should help leaders in LTC facilities align strategic decisions to EHR adoption. This review may be useful for decision-makers attempting successful EHR adoption, policymakers trying to increase adoption rates without expanding incentives and vendors that produce EHRs. PMID:25631311

'I have the world's best job' - staff experience of the advantages of caring for older people.

PubMed

Eldh, Ann Catrine; van der Zijpp, Teatske; McMullan, Christel; McCormack, Brendan; Seers, Kate; Rycroft-Malone, Jo

2016-06-01

Besides a growing demand for safe high-quality care for older people, long-term care (LTC) often struggles to recruit appropriately qualified nursing staff. Understanding what LTC staff value in their work may contribute to a more comprehensive understanding of what can attract staff and support person-centred care. To explore staff experience of the advantages of working in LTC settings for older people. Narrative descriptions of 85 LTC staff in Ireland, the Netherlands and Sweden on what they value in their work were analysed with qualitative content analysis. Ethical approval was obtained according to the requirements of each country, and participants provided informed consent prior to the individual interviews. Working in LTC signifies bonding with the older people residing there, their next of kin and the team members. It means autonomy in one's daily tasks amalgamated with being a part of an affirmative team. Participants reported a sense of accomplishment and fulfilment; caring meant consideration and recognition of the older people and the relationships formed, which provided for professional and personal growth. The sharing of compassion between staff and residents indicated reciprocity of the relationship with residents. The findings may be transferable to LTC in general although they address only the positive aspects of caring for older people and only the experiences of those staff who had consented to take part in the study. The findings add to what underpins the quality of care in nursing homes: compassion in the nurse-resident relationship and person-centred care in LTC. They indicate reciprocity in the relations formed that may contribute to the empowerment of older people, but further studies are needed to explore this in more detail. © 2015 Nordic College of Caring Science.

Longxuetongluo capsule inhibits atherosclerosis progression in high-fat diet-induced ApoE-/- mice by improving endothelial dysfunction.

PubMed

Zheng, Jiao; Liu, Binglin; Lun, Qixing; Gu, Xiaopan; Pan, Bo; Zhao, Yunfang; Xiao, Wei; Li, Jun; Tu, Pengfei

2016-12-01

Chinese dragon's blood has been used to treat blood stasis for thousands of years. Its total phenolic extract (Longxuetongluo capsule, LTC) is used for the treatment of ischemic stroke; however, its protective effect against atherosclerosis remains poorly understood. This paper aims to investigate the antiatherosclerotic effect of LTC and the underlying mechanisms in high-fat diet (HFD)-induced ApoE -/- mice. The levels of plasma lipid and areas of atherosclerotic lesions in the aortic sinus in ApoE -/- mice were evaluated. The effect of LTC on the nitric oxide (NO) production in oxidized low-density lipoprotein (ox-LDL)-stimulated human umbilical vein endothelial cells (HUVECs) was determined. The adhesion of monocytes to ox-LDL-stimulated HUVECs was further studied. LTC at low, medium, and high doses markedly decreased the atherosclerotic lesion areas of the aortic sinus in HFD-induced ApoE -/- mice by 26.4% (p < 0.05), 30.1% (p < 0.05), and 46.5% (p < 0.01), respectively, although it did not improve the dyslipidemia. Furthermore, LTC restored the diminished NO production of ox-LDL-stimulated HUVECs (p < 0.001) and inhibited the adhesion between monocytes and endothelial cells (p < 0.01). LTC appeared to alleviate ox-LDL-stimulated dysfunction of HUVECs, and inhibit the adhesion of monocytes to HUVECs via the MAPK/IKK/IκB/NF-κB signaling pathway, thus decrease atherosclerotic lesions in the aortic sinus in HFD-induced ApoE -/- mice. These findings suggest the potential of LTC for use as an effective agent against atherosclerosis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Single-Event Effect Testing of the Linear Technology LTC6103HMS8#PBF Current Sense Amplifier

NASA Technical Reports Server (NTRS)

Yau, Ka-Yen; Campola, Michael J.; Wilcox, Edward

2016-01-01

The LTC6103HMS8#PBF (henceforth abbreviated as LTC6103) current sense amplifier from Linear Technology was tested for both destructive and non-destructive single-event effects (SEE) using the heavy-ion cyclotron accelerator beam at Lawrence Berkeley National Laboratory (LBNL) Berkeley Accelerator Effects (BASE) facility. During testing, the input voltages and output currents were monitored to detect single event latch-up (SEL) and single-event transients (SETs).

The first year: employment patterns and job perceptions of nursing assistants in a rural setting.

PubMed

Meyer, Deborah; Raffle, Holly; Ware, Lezlee J

2014-09-01

The aim of this study was to follow rural certified nursing assistants (CNAs) (n=123) in the United States for 1 year post-training to identify retention and turnover issues in the long-term care (LTC) setting by exploring the CNAs' perceptions of the LTC work experience.   Turnover among CNAs impacts the quality of care, imposes a financial burden on facilities and taxpayers, and creates increased stress and workloads on those who remain. A longitudinal survey design was used to track individuals completing CNA training for 1 year.   At 1 year post-training, 53.7% of respondents currently worked in LTC, 30.9% worked in LTC and left, and the remaining 15.4% never worked in LTC. While the training site does not appear to impact retention, the first 6 months of employment appear critical. The CNAs cited pay as a reason for leaving LTC, but better pay did not characterize the jobs taken by the CNAs who left. Implications for nursing management. This study highlights the importance of the first 6 months of employment to retention and provides practical information for nurse managers evaluating the resource-effectiveness of hosting training programmes. Additionally, the key issues influencing retention were identified and practical suggestions for nurse managers to improve retention are provided. © 2012 John Wiley & Sons Ltd.

Managing heart failure in the long-term care setting: nurses' experiences in Ontario, Canada.

PubMed

Strachan, Patricia H; Kaasalainen, Sharon; Horton, Amy; Jarman, Hellen; D'Elia, Teresa; Van Der Horst, Mary-Lou; Newhouse, Ian; Kelley, Mary Lou; McAiney, Carrie; McKelvie, Robert; Heckman, George A

2014-01-01

Implementation of heart failure guidelines in long-term care (LTC) settings is challenging. Understanding the conditions of nursing practice can improve management, reduce suffering, and prevent hospital admission of LTC residents living with heart failure. The aim of the study was to understand the experiences of LTC nurses managing care for residents with heart failure. This was a descriptive qualitative study nested in Phase 2 of a three-phase mixed methods project designed to investigate barriers and solutions to implementing the Canadian Cardiovascular Society heart failure guidelines into LTC homes. Five focus groups totaling 33 nurses working in LTC settings in Ontario, Canada, were audiorecorded, then transcribed verbatim, and entered into NVivo9. A complex adaptive systems framework informed this analysis. Thematic content analysis was conducted by the research team. Triangulation, rigorous discussion, and a search for negative cases were conducted. Data were collected between May and July 2010. Nurses characterized their experiences managing heart failure in relation to many influences on their capacity for decision-making in LTC settings: (a) a reactive versus proactive approach to chronic illness; (b) ability to interpret heart failure signs, symptoms, and acuity; (c) compromised information flow; (d) access to resources; and (e) moral distress. Heart failure guideline implementation reflects multiple dynamic influences. Leadership that addresses these factors is required to optimize the conditions of heart failure care and related nursing practice.

Moving to evidence-based practice in long-term care: the role of a Best Practise Resource Centre in two long-term care settings.

PubMed

Brazil, Kevin; Royle, Joan A; Montemuro, Maureen; Blythe, Jennifer; Church, Anne

2004-03-01

In this article, the authors provide an overview on the development of a Long-Term Care Best Practise Resource Centre. The results of both a feasibility study and the outcomes of a 1-year demonstration project are presented. The demonstration project involved a hospital as the information service provider and two demonstration sites, a home care service agency and a nursing home that used the services of the Centre. The goals of the Centre were threefold: provide access to literature for staff in long-term care (LTC) settings; improve the information management skills of health care providers; and support research and the integration of best practices in LTC organizations. The results of the pilot study contributed to the development of a collaborative information access system for LTC clinicians and managers that provides timely, up-to-date information contributing to improving the quality of care for adults receiving LTC. Based on this demonstration project, strategies for successful innovation in LTC are identified.

Inhibition effects of perfluoroalkyl acids on progesterone production in mLTC-1.

PubMed

Zhao, Wei; Cui, Ruina; Wang, Jianshe; Dai, Jiayin

2017-06-01

Perfluoroalkyl substances (PFASs) are a class of fluorine substituted carboxylic acid, sulfonic acid and alcohol, structurally similar to their corresponding parent compounds. Previous study demonstrated the potential endocrine disruption and reproductive toxicity of perfluorooctane sulfonic acid and perfluorooctanoic acid, two dominant PFASs in animals and humans. We explored the relationship between eleven perfluoroalkyl acids (PFAAs) with different carbon chain length and their ability to inhibit progesterone production in mouse Leydig tumor cells (mLTC-1). We found an obvious dose-response relationship between progesterone inhibition rate and PFAA exposure concentration in mLTC-1. The relative inhibition rate of progesterone by PFAAs was linearly related to the carbon chain length and molar refractivity of PFAAs. Mitochondrial membrane potential (MMP) decreased after PFAA exposure at the half-maximal inhibitory effect concentration (IC 50 ) of progesterone production in mLTC-1, while the reactive oxygen species (ROS) content increased significantly. These results imply that the inhibition effect of PFAAs on progesterone production might be due, in part, to ROS damage and the decrease in MMP in mLTC-1. Copyright © 2016. Published by Elsevier B.V.

Adapting the Elder Abuse Suspicion Index© for Use in Long-Term Care: A Mixed-Methods Approach.

PubMed

Ballard, Stephanie A; Yaffe, Mark J; August, Linda; Cetin-Sahin, Deniz; Wilchesky, Machelle

2017-09-01

Currently available elder abuse screening and identification tools have limitations for use in long-term care (LTC). This mixed-methods study sought to explore the appropriateness of using the Elder Abuse Suspicion Index© (a suspicion tool originally created for use with older adults in the ambulatory setting with Mini-Mental State Examination scores ≥ 24) with similarly cognitively functioning persons residing in LTC. Results were informed by a literature review, Internet-based consultations with elder abuse experts across Canada ( n = 19), and data obtained from two purposively selected focus groups ( n = 7 local elder abuse experts; n = 7 experienced front-line LTC clinicians). Analyses resulted in the development of a nine-question tool, the EASI-ltc, designed to raise suspicion of EA in cognitively intact older adults residing in LTC (with little or no cognitive impairment). Notable modifications to the original Elder Abuse Suspicion Index © (EASI) included three new questions to further address neglect and psychological abuse, and a context-specific preamble to orient responders.

Comprehensive Medication Reviews in Long-term Care Facilities: History of Process Implementation and 2015 Results.

PubMed

O'Shea, Terrence E; Zarowitz, Barbara J; Erwin, W Gary

2017-01-01

Since 2013, Part D sponsors have been required to offer comprehensive medication reviews (CMRs) to all beneficiaries enrolled in their medication therapy management (MTM) programs at least annually, including those in long-term care (LTC) settings. Since that time, MTM providers have found that accessing and completing CMRs with beneficiaries is frequently prohibitively complex, since the process often requires a live, face-to-face interactive interview where the beneficiary resides. However, with the migration of the CMR completion rate from a star ratings display measure to an active measure, coupled with the new CMR completion rate cutpoints for 2016, accessing this population for CMR completion has heightened importance. Our proprietary consultant pharmacist (CP) software was programmed in 2012 to produce a cover letter, medication action plan, and personal medication list per CMS standardized format specifications. Using this system, CPs were trained to perform and document CMRs and the interactive interviews. MTM-eligible Part D beneficiaries, identified by several contracted clients as residing in LTC serviced by Omnicare, were provided CMRs and summaries written in CMS standardized format by CPs. Residents with cognitive impairment were identified using 3 data elements in the Minimum Data Set (MDS). In 2015, 7,935 MTM-eligible beneficiaries were identified as receiving medications from an Omnicare pharmacy. After excluding those who were disenrolled by their prescription drug plans, discharged from the LTC facility, or resided in a LTC facility no longer serviced by Omnicare, 5,593 residents were available for CMR completion. Of these, only 3% refused the CMR offer, and 5,392 CMRs (96%) were completed successfully. Thirty-nine percent of residents had cognitive impairment per MDS assessments; in those instances, CMRs were conducted with someone other than the beneficiary. Based on the CMRs and interactive interviews, 7,527 drug therapy problem recommendations were made to prescribers, about 50% of which resulted in an alteration in therapy, including reductions in polypharmacy and high-risk medications. The CMR process and written summary in CMS standardized format works effectively for residents in LTC when performed by CPs in the facility, as evidenced by high completion rates and drug therapy problem identification/resolution. Part D plans should further consider using CPs to conduct CMRs in LTC settings. No outside funding supported this research. All authors are employees of Omnicare, a CVS Health Company, and are stockholders of CVS Health. O'Shea and Zarowitz have received research funding (unrelated to the submitted work) from Acadia, AstraZeneca, and Sunovion. The abstract for this article was presented as a research poster at the Academy of Managed Care and Specialty Pharmacy 2016 Annual Meeting; April 21, 2016; San Francisco, California. Study concept and design were contributed by O'Shea and Zarowitz, along with Erwin. O'Shea collected the data, and data interpretation was performed primarily by O'Shea, along with Zarowitz and Erwin. The manuscript was written by O'Shea, along with Zarowitz, and revised primarily by Zarowitz, along with O'Shea and Erwin.

Increased Risk of Death for Patients on the Waitlist for Liver Transplant Residing at Greater Distance From Specialized Liver Transplant Centers in the United States.

PubMed

Cicalese, Luca; Shirafkan, Ali; Jennings, Kristofer; Zorzi, Daria; Rastellini, Cristiana

2016-10-01

We have previously shown that patients listed for orthotopic liver transplantation (OLT) in United Network for Organ Sharing Region 4 (Texas and Oklahoma) have higher waitlist mortality rates when residing more than 30 miles from specialized liver transplant centers (LTC). Considering that findings might only be exclusive for this region with its peculiarities in terms of having the highest land surface extensions, lowest population densities, and largest rural populations. We investigated the entire OLT patient population in the United States to assess if our previous regional findings are nationally validated and if a rural, micropolitan, or metropolitan residence location affects outcome of waitlisted OLT patients in the nation. Patients waiting for OLT in the United States from 2002 to 2012 were stratified by distance from the patients' residence to LTC and by Rural Urban Commuting Area (RUCA) codes classification. Statistical analyses were performed to evaluate risk of mortality on the waitlist and the likelihood to receive an OLT using a Cox proportional hazards model and a generalized additive model with a logistic link. Survival time and probability of death while on the waitlist for OLT using distance to LTC showed significant increased risk with the distance (P = 0.001 and P < 0.0001, respectively). At the same time, using RUCA classification as the variable did not show significance (P = 0.14 and P = 0.73, respectively). Distance from an LTC is a risk factor of mortality on the waitlist for OLT, whereas RUCA classification is not a significant factor.

"Living in the moment" among cancer survivors who report life-transforming change.

PubMed

Skeath, Perry; Berger, Ann

2017-07-01

Some cancer survivors say that while coping with their illness they have had what they identify as a highly beneficial, personal, life-transforming change (LTC; a self-subscribed condition among participants in this study, not a researcher-defined construct). Previously we found that the content of LTC was highly individual; but certain features of the LTC process were quite uniform. For example, LTC was driven by a very rational desire to remain genuinely functional as a person in the midst of highly stressful circumstances. Our purpose is to further understand LTC by analysis of participants' critique of questionnaire items on positive subjective outcomes. We obtained a set of 67 positive psychosocial questionnaire items from the Psychosocial Impact of Illness (PII) item bank development team of the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information Systems (PROMIS) initiative. The PII items are sourced from a variety of instruments, representing more than one theory of personal growth. This enabled a grounded theory approach, allowing a theory of LTC to emerge from the data. Each of nine cancer survivors participated in a single, two-part session: an hour-long semi-structured qualitative interview regarding their LTC (previously reported), then individually critiquing the 67 items in terms of relevance and importance to their self-reported LTC experience (their critique is analyzed in this article). The PII items were grouped into 20 researcher-defined conceptual themes and average scores for each theme were computed and compared. The theme "living in the moment" (LITM; sometimes referred to as "Being in the moment" in other literature) scored significantly higher than other themes. Qualitative interview transcripts revealed that participants spontaneously used LITM as a coping tactic that reduced worries to manageable levels. These participants noticed subsequently that LITM also produced unexpected substantial benefits in many aspects of their lives unrelated to cancer. This experience motivated increased use of LITM that led to LTC beyond coping with cancer. LITM can be a practical, effective coping tactic to manage worries and promote adaptation to the challenges of a life-threatening illness. Participant interviews indicated the motivation for LITM is not traumatic experience, but seems to be conservation of their own personal resources for coping with increased stresses. Hobfoll's conservation of resources model appears to be more consistent with LITM among our participants than Tedeshi's posttraumatic growth (PTG) model. Several PII items that represent LITM have unfortunately been removed from the current PROMIS PII item bank, indicating a need for improved of item selection criteria. Further research is needed first to identify or develop assessment items that more effectively capture the precursors and phases of LITM, and then develop interventions that facilitate LITM and LTC for patients.

Development of a Collaborative Practice Agreement Template to Promote the Role of the Pharmacist in Managing Urinary Tract Infections in Long-term Care Residents

PubMed Central

Fehrenbacher, Lynne; McDevitt, Kimberly; Palmer, Matthew; Traynor, Laura; Boero, Joe; Crnich, Christopher

2017-01-01

Abstract Background One of the CDC core elements of antimicrobial stewardship in nursing homes emphasizes the promotion of clinical practice change and integration of the dispensing and consultant pharmacist to improve antibiotic use. An opportunity to support this element is via collaborative practice agreements (CPA). A CPA is a voluntary agreement between one or more prescribers and pharmacists which delegates physician authority under defined conditions and/or limitations toward a common goal. The Wisconsin Healthcare-Associated Infections (HAI) in Long-term Care (LTC) Coalition aims to reduce and eliminate HAIs among LTC residents. A coalition emphasis has been to educate caregivers about appropriate evaluation and treatment of suspected urinary tract infection (UTI). Given this focus, we targeted the same cohort for CPA design. Methods A literature review resulted in no report of CPAs being applied to LTC residents on antibiotics for UTI. Recognizing the dispensing and consultant pharmacist role varies by organization, we drafted a multi-layered CPA that can be customized by facility. The draft was reviewed by physicians, pharmacists, and nurses with expertise in infectious diseases, LTC, and CPAs. Through frequent meetings and collaborative editing, consensus was achieved. The final CPA includes antibiotic renal dose adjustment, discontinuation of antibiotics in asymptomatic patients with negative urinalysis or culture, and oral antibiotic modification based on organism susceptibility. Results The CPA template is supported by the WI HAI in LTC Coalition. It has been presented at the state level and is available for use by LTC facilities and pharmacists that may apply any/all level(s) of the CPA. An organization policy template and initial CPA competency for pharmacists have been designed to support implementation. Committed pilot sites have been identified. Conclusion A CPA is an innovative approach to expand the role of the dispensing and consultant pharmacist in antimicrobial stewardship initiatives in the LTC setting. Using an expert panel to develop templated resources that can be customized at the facility level may assist pharmacists and LTC providers in moving forward with this type of clinical practice change. Disclosures All authors: No reported disclosures.

An exploratory study to examine intentions to adopt an evidence-based HIV linkage-to-care intervention among state health department AIDS directors in the United States.

PubMed

Norton, Wynne E

2012-04-02

Widespread dissemination and implementation of evidence-based human immunodeficiency virus (HIV) linkage-to-care (LTC) interventions is essential for improving HIV-positive patients' health outcomes and reducing transmission to uninfected others. To date, however, little work has focused on identifying factors associated with intentions to adopt LTC interventions among policy makers, including city, state, and territory health department AIDS directors who play a critical role in deciding whether an intervention is endorsed, distributed, and/or funded throughout their region. Between December 2010 and February 2011, we administered an online questionnaire with state, territory, and city health department AIDS directors throughout the United States to identify factors associated with intentions to adopt an LTC intervention. Guided by pertinent theoretical frameworks, including the Diffusion of Innovations and the "push-pull" capacity model, we assessed participants' attitudes towards the intervention, perceived organizational and contextual demand and support for the intervention, likelihood of adoption given endorsement from stakeholder groups (e.g., academic researchers, federal agencies, activist organizations), and likelihood of enabling future dissemination efforts by recommending the intervention to other health departments and community-based organizations. Forty-four participants (67% of the eligible sample) completed the online questionnaire. Approximately one-third (34.9%) reported that they intended to adopt the LTC intervention for use in their city, state, or territory in the future. Consistent with prior, related work, these participants were classified as LTC intervention "adopters" and were compared to "nonadopters" for data analysis. Overall, adopters reported more positive attitudes and greater perceived demand and support for the intervention than did nonadopters. Further, participants varied with their intention to adopt the LTC intervention in the future depending on endorsement from different key stakeholder groups. Most participants indicated that they would support the dissemination of the intervention by recommending it to other health departments and community-based organizations. Findings from this exploratory study provide initial insight into factors associated with public health policy makers' intentions to adopt an LTC intervention. Implications for future research in this area, as well as potential policy-related strategies for enhancing the adoption of LTC interventions, are discussed.

Association of Nondisease-Specific Problems with Mortality, Long-Term Care, and Functional Impairment among Older Adults Who Require Skilled Nursing Care after Dialysis Initiation

PubMed Central

Plantinga, Laura; Hall, Rasheeda K.; Mirk, Anna; Zhang, Rebecca; Kutner, Nancy

2016-01-01

Background and objectives The majority of older adults who initiate dialysis do so during a hospitalization, and these patients may require post-acute skilled nursing facility (SNF) care. For these patients, a focus on nondisease-specific problems, including cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy, may be more relevant to outcomes than the traditional disease-oriented approach. However, the association of the burden of nondisease-specific problems with mortality, transition to long-term care (LTC), and functional impairment among older adults receiving SNF care after dialysis initiation has not been studied. Design, setting, participants, & measurements We identified 40,615 Medicare beneficiaries ≥65 years old who received SNF care after dialysis initiation between 2000 and 2006 by linking renal disease registry data with the Minimum Data Set. Nondisease-specific problems were ascertained from the Minimum Data Set. We defined LTC as ≥100 SNF days and functional impairment as dependence in all four essential activities of daily living at SNF discharge. Associations of the number of nondisease-specific problems (≤1, 2, 3, and 4–6) with 6-month mortality, LTC, and functional impairment were examined. Results Overall, 39.2% of patients who received SNF care after dialysis initiation died within 6 months. Compared with those with ≤1 nondisease-specific problems, multivariable adjusted hazard ratios (95% confidence interval) for mortality were 1.26 (1.19 to 1.32), 1.40 (1.33 to 1.48), and 1.66 (1.57 to 1.76) for 2, 3, and 4–6 nondisease-specific problems, respectively. Among those who survived, 37.1% required LTC; of those remaining who did not require LTC, 74.7% had functional impairment. A higher likelihood of transition to LTC (among those who survived 6 months) and functional impairment (among those who survived and did not require LTC) was seen with a higher number of problems. Conclusions Identifying nondisease-specific problems may help patients and families anticipate LTC needs and functional impairment after dialysis initiation. PMID:27733436

Association of Nondisease-Specific Problems with Mortality, Long-Term Care, and Functional Impairment among Older Adults Who Require Skilled Nursing Care after Dialysis Initiation.

PubMed

Bowling, C Barrett; Plantinga, Laura; Hall, Rasheeda K; Mirk, Anna; Zhang, Rebecca; Kutner, Nancy

2016-12-07

The majority of older adults who initiate dialysis do so during a hospitalization, and these patients may require post-acute skilled nursing facility (SNF) care. For these patients, a focus on nondisease-specific problems, including cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy, may be more relevant to outcomes than the traditional disease-oriented approach. However, the association of the burden of nondisease-specific problems with mortality, transition to long-term care (LTC), and functional impairment among older adults receiving SNF care after dialysis initiation has not been studied. We identified 40,615 Medicare beneficiaries ≥65 years old who received SNF care after dialysis initiation between 2000 and 2006 by linking renal disease registry data with the Minimum Data Set. Nondisease-specific problems were ascertained from the Minimum Data Set. We defined LTC as ≥100 SNF days and functional impairment as dependence in all four essential activities of daily living at SNF discharge. Associations of the number of nondisease-specific problems (≤1, 2, 3, and 4-6) with 6-month mortality, LTC, and functional impairment were examined. Overall, 39.2% of patients who received SNF care after dialysis initiation died within 6 months. Compared with those with ≤1 nondisease-specific problems, multivariable adjusted hazard ratios (95% confidence interval) for mortality were 1.26 (1.19 to 1.32), 1.40 (1.33 to 1.48), and 1.66 (1.57 to 1.76) for 2, 3, and 4-6 nondisease-specific problems, respectively. Among those who survived, 37.1% required LTC; of those remaining who did not require LTC, 74.7% had functional impairment. A higher likelihood of transition to LTC (among those who survived 6 months) and functional impairment (among those who survived and did not require LTC) was seen with a higher number of problems. Identifying nondisease-specific problems may help patients and families anticipate LTC needs and functional impairment after dialysis initiation. Copyright © 2016 by the American Society of Nephrology.

Are healthcare aides underused in long-term care? A cross-sectional study on continuing care facilities in Canada.

PubMed

Arain, Mubashir A; Deutschlander, Siegrid; Charland, Paola

2017-05-17

Over the last 10 years, appropriate workforce utilisation has been an important discussion among healthcare practitioners and policy-makers. The role of healthcare aides (HCAs) has also expanded to improve their utilisation. This evolving role of HCAs in Canada has prompted calls for standardised training, education and scope of practice for HCAs. The purpose of this research was to examine the differences in HCAs training and utilisation in continuing care facilities. From June 2014 to July 2015, we conducted a mixed-method study on HCA utilisation in continuing care. This paper presents findings gathered solely from the prospective cross-sectional survey of continuing care facilities (long-term care (LTC) and supportive living (SL)) on HCA utilisation. We conducted this study in a Western Canadian province. The managers of the continuing care facilities (SL and LTC) were eligible to participate in the survey. The pattern of HCAs involvement in medication assistance and other care activities in SL and LTC facilities. We received 130 completed surveys (LTC=64 and SL=52). Our findings showed that approximately 81% of HCAs were fully certified. We found variations in how HCAs were used in SL and LTC facilities. Overall, HCAs in SL were more likely to be involved in medication management such as assisting with inhaled medication and oral medication delivery. A significantly larger proportion of survey respondents from SL facilities reported that medication assistance training was mandatory for their HCAs (86%) compared with the LTC facilities (50%) (p value <0.01). The utilisation of HCAs varies widely between SL and LTC facilities. HCAs in SL facilities may be considered better used according to their required educational training and competencies. Expanding the role of HCAs in LTC facilities may lead to a cost-effective and more efficient utilisation of workforce in continuing care facilities. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Post-closure care of engineered municipal solid waste landfills.

PubMed

Bagchi, Amalendu; Bhattacharya, Abhik

2015-03-01

Post-closure care is divided into perpetual care (PPC) and long-term care (LTC). Guidelines for post-closure care and associated costs are important for engineered municipal solid waste (MSW) landfills. In many states in the USA, landfill owners are required to set aside funds for 30-40 years of LTC. Currently there are no guidelines for PPC, which is also required. We undertook a pilot study, using two landfills (note: average landfill capacity 2.5 million MT MSW waste) in Wisconsin, to establish an approach for estimating the LTC period using field data and PPC funding need. Statistical analysis of time versus concentration data of selected leachate parameters showed that the concentration of most parameters is expected to be at or below the preventive action limit of groundwater and leachate volume will be very low, within 40 years of the LTC period. The gas extraction system may need to be continued for more than 100 years. Due to lack of data no conclusion could be made regarding adequacy of the LTC period for the groundwater monitoring system. The final cover must be maintained for perpetuity. The pilot study shows that although technology is available, the financial liability of maintaining a 'Dry Tomb' design for landfills is significantly higher than commonly perceived. The paper will help landfill professionals to estimate realistic post-closure funding and to develop field-based policies for LTC and PPC of engineered MSW landfills. © The Author(s) 2015.

GIS tools for strategic SB375 planning and program participation

DOT National Transportation Integrated Search

2010-12-02

The just-completed (2009-2010) phase of this project corresponds to the second year of an envisioned three-year initiative on integrated transportation and land use planning supported by the Leonard Transportation Center (LTC) and USDOT, and performe...

Intention to Use Long-Term Care Facilities: Differences beween Korean Pre-elderly and Korean Baby-boomers

PubMed Central

Hong, Michin; Hong, Seunghye; Kim, Mee Hye; Yi, Eun Hye

2016-01-01

With the rapidly increasing number of older adults, dealing with long-term care (LTC) needs becomes an emerging issue in South Korea. This study aims to examine factors affecting the intention to use longtermcare facilities with two groups of young-old adults: (1) Korean pre-elderly (KPE) and (2) Korean babyboomers (KBB). Guided by Andersen’s behavioral model of health service use and prior research, predisposing characters, enabling resources, need factors, availabilities of informal care and self-care activities were used as predictors. In the final analyses, 803 KPE and 966 KBB were included. The results of logistic regression analyses showed different findings in two groups. Age, education, spouse's physicalhealth, and self-care activities for relationship with family and friends are significantly associated with intention to use LTC facilities among KPE. However, income, physical health of respondents, and relationship satisfaction with children are significantly related to intention of use LTC facilities in the group of KBB. This study suggests different LTC needs between KPE and KBB. Health care professionals and policy makers need to consider such differences to provide quality LTC care for them. PMID:27484325

A growing need - HIV education in long-term care.

PubMed

Siou, Kaitlin; Mahan, Maureen; Cartagena, Rod; Chan Carusone, Soo

As people living with HIV (PLHIV) age, knowledge of HIV and the associated care of those aging with HIV will become an increasingly important component of education for long-term care (LTC) providers. This descriptive study piloted two different approaches to distribute narrative-based HIV educational videos. Four LTC facilities were assigned to receive the videos to implement 'as usual' or to receive the videos in addition to blended learning sessions where the videos were shown with facilitated discussion with a nurse educator and a PLHIV. In LTC facilities where external educators were provided, a larger proportion of staff watched the videos. However, increases in staff comfort level providing care to PLHIV were comparable between both groups. Narratives of PLHIV, administrator engagement and coordination of online education were identified as facilitators to improving HIV knowledge and compassion in LTC, while fear of HIV transmission and limited time for education, especially when not mandated or identified as immediately applicable, were identified as barriers. From our findings, HIV-related stigma still exists in LTC and these videos may be a strategy for disseminating basic knowledge about HIV transmission and sensitizing staff to the experience of living with HIV. Copyright © 2016 Elsevier Inc. All rights reserved.

Componential Network for the Recognition of Tool-Associated Actions: Evidence from Voxel-based Lesion-Symptom Mapping in Acute Stroke Patients.

PubMed

Martin, Markus; Dressing, Andrea; Bormann, Tobias; Schmidt, Charlotte S M; Kümmerer, Dorothee; Beume, Lena; Saur, Dorothee; Mader, Irina; Rijntjes, Michel; Kaller, Christoph P; Weiller, Cornelius

2017-08-01

The study aimed to elucidate areas involved in recognizing tool-associated actions, and to characterize the relationship between recognition and active performance of tool use.We performed voxel-based lesion-symptom mapping in a prospective cohort of 98 acute left-hemisphere ischemic stroke patients (68 male, age mean ± standard deviation, 65 ± 13 years; examination 4.4 ± 2 days post-stroke). In a video-based test, patients distinguished correct tool-related actions from actions with spatio-temporal (incorrect grip, kinematics, or tool orientation) or conceptual errors (incorrect tool-recipient matching, e.g., spreading jam on toast with a paintbrush). Moreover, spatio-temporal and conceptual errors were determined during actual tool use.Deficient spatio-temporal error discrimination followed lesions within a dorsal network in which the inferior parietal lobule (IPL) and the lateral temporal cortex (sLTC) were specifically relevant for assessing functional hand postures and kinematics, respectively. Conversely, impaired recognition of conceptual errors resulted from damage to ventral stream regions including anterior temporal lobe. Furthermore, LTC and IPL lesions impacted differently on action recognition and active tool use, respectively.In summary, recognition of tool-associated actions relies on a componential network. Our study particularly highlights the dissociable roles of LTC and IPL for the recognition of action kinematics and functional hand postures, respectively. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Pyrethroid insecticide lambda-cyhalothrin and its metabolites induce liver injury through the activation of oxidative stress and proinflammatory gene expression in rats following acute and subchronic exposure.

PubMed

Aouey, Bakhta; Derbali, Mohamed; Chtourou, Yassine; Bouchard, Michèle; Khabir, Abdelmajid; Fetoui, Hamadi

2017-02-01

Lambda-cyhalothrin (LTC) [α-cyano-3-phenoxybenzyl-3-(2-chloro-3,3,3-trifluoro-1-propenyl)-2,2-dimethylcyclo-propanecarboxylate] is a synthetic type II pyrethroid insecticide commonly used in residential and agricultural areas. The potential hepatotoxicity of pyrethroids remains unclear and could easily be assessed by measuring common clinical indicators of liver disease. To understand more about the potential risks for humans associated with LTC exposure, male adult rats were orally exposed to 6.2 and 31.1 mg/kg bw of LTC for 7, 30, 45, and 60 days. Histopathological changes and alterations of main parameters related to oxidative stress and inflammatory responses in the liver were evaluated. Further, lambda-cyhalothrin metabolites [3-(2-chloro-3,3,3-trifluoroprop-1-enyl)-2,2-dimethyl-cyclopropane carboxylic acid (CFMP), 4-hydroxyphenoxybenzoic acid (4-OH-3-PBA), and 3-phenoxybenzoic acid (3-PBA)] in the liver tissues were identified and quantified by ultra-high-performance liquid chromatography coupled to quadripole time-of-flight mass spectrometry (UHPLC-MS-Q-ToF). Results revealed that LTC exposure significantly increased markers of hepatic oxidative stress in a time-dependent and dose-dependent manner, and this was associated with an accumulation of CFMP and 3-PBA in the liver tissues. In addition, the levels of tumor necrosis factor-α (TNF-α) and interleukin (IL-6 and IL-1β) gene expressions were significantly increased in the liver of exposed rats compared to controls. Correlation analyses revealed that CFMP and 3-PBA metabolite levels in the liver tissues were significantly correlated with the indexes of oxidative stress, redox status, and inflammatory markers in rats exposed to lambda-cyhalothin. Overall, this study provided novel evidence that hepatic damage is likely due to increased oxidative stress and inflammation under the condition of acute and subchronic exposure to lambda-cyhalothrin and that LTC metabolites (CFMP and 3-PBA) could be used as potential biomarker in human biomonitoring studies.

Financing institutional long-term care for the elderly in China: a policy evaluation of new models.

PubMed

Yang, Wei; Jingwei He, Alex; Fang, Lijie; Mossialos, Elias

2016-12-01

A rapid ageing population coupled with changes in family structure has brought about profound implications to social policy in China. Although the past decade has seen a steady increase in public funding to long-term care (LTC), the narrow financing base and vast population have created significant unmet demand, calling for reforms in financing. This paper focuses on the financing of institutional LTC care by examining new models that have emerged from local policy experiments against two policy goals: equity and efficiency. Three emerging models are explored: Social Health Insurance (SHI) in Shanghai, LTC Nursing Insurance (LTCNI) in Qingdao and a means-tested model in Nanjing. A focused systematic narrative review of academic and grey literature is conducted to identify and assess these models, supplemented with qualitative interviews with government officials from relevant departments, care home staff and service users. This paper argues that, although SHI appears to be a convenient solution to fund LTC, this model has led to systematic bias in affordable access among participants of different insurance schemes, and has created a powerful incentive for the over-provision of unnecessary services. The means-tested method has been remarkably constrained by narrow eligibility and insufficiency of funding resources. The LTCNI model is by far the most desirable policy option among the three studied here, but the narrow definition of eligibility has substantively excluded a large proportion of elders in need from access to care, which needs to be addressed in future reforms. This paper proposes three lines of LTC financing reforms for policy-makers: (1) the establishment of a prepaid financing mechanism pooled specifically for LTC costs; (2) the incorporation of more stringent eligibility rules and needs assessment; and (3) reforming the dominant fee-for-service methods in paying LTC service providers. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Factors associated with loss to clinic among HIV patients not yet known to be eligible for antiretroviral therapy (ART) in Mozambique

PubMed Central

Pati, Rituparna; Lahuerta, Maria; Elul, Batya; Okamura, Mie; Alvim, Maria Fernanda; Schackman, Bruce; Bang, Heejung; Fernandes, Rufino; Assan, Americo; Lima, Josue; Nash, Denis

2013-01-01

Introduction Retention in HIV care prior to ART initiation is generally felt to be suboptimal, but has not been well-characterized. Methods We examined data on 37,352 adult pre-ART patients (ART ineligible or unknown eligibility) who enrolled in care during 2005–2008 with >1 clinical visit at 23 clinics in Mozambique. We defined loss to clinic (LTC) as >12 months since the last visit among those not known to have died/transferred. Cox proportional-hazards models were used to examine factors associated with LTC, accounting for clustering within sites. Results Of 37,352 pre-ART patients, 61% had a CD4 count within three months of enrolment (median CD4: 452, IQR: 345–611). 17,598 (47.1%) were ART ineligible and 19,754 (52.9%) were of unknown eligibility status at enrolment because of missing information on CD4 count and/or WHO stage. Kaplan-Meier estimates for LTC at 12 months were 41% (95% CI: 40.2–41.8) and 48% (95% CI: 47.2–48.8), respectively. Factors associated with LTC among ART ineligible patients included male sex (AHRmen_vs_non-pregnant women: 1.5; 95% CI: 1.4–1.6) and being pregnant at enrolment (AHRpregnant_vs_non-pregnant women: 1.3; 95% CI: 1.1–1.5). Older age, more education, higher weight and more advanced WHO stage at enrolment were independently associated with lower risks of LTC. Similar findings were observed among patients whose ART eligibility status was unknown at enrolment. Conclusions Substantial LTC occurred prior to ART initiation among patients not yet known to be eligible for ART, including nearly half of patients without documented ART eligibility assessment. Interventions are needed to target pre-ART patients who may be at higher risk for LTC, including pregnant women and patients with less advanced HIV disease. PMID:23755857

Impact of the raising immunizations safely and effectively (RISE) program on healthcare worker influenza immunization rates in long term care settings.

PubMed

Nace, David A; Handler, Steven M; Hoffman, Erika L; Perera, Subashan

2012-11-01

National influenza immunization rates for healthcare workers (HCW) in long-term care (LTC) remain unacceptably low. This poses a serious public health threat to residents. Prior work has suggested high staff turnover rates as a contributing factor to low immunization rates. There is a critical need to identify and deploy successful models of HCW influenza immunization programs to LTC facilities. This report describes one potential model that has been successfully initiated in a network of LTC facilities. All facilities served by a single regional LTC pharmacy were invited to participate in a HCW influenza immunization program. This voluntary immunization program began in 2005 and continues to the present. As part of the program, the pharmacy promoted organizational change by assuming oversight and control of HCW immunization policies and processes for all facilities. Primary and secondary outcomes are the number of facilities reaching HCW influenza immunization rates of 60% and 80%. Fourteen of the 16 LTC facilities participated. Facilities were diverse and included both nursing and assisted living facilities; unionized and nonunionized facilities; and urban, suburban, and rural facilities. The pharmacy provided educational and communication materials, centralized data collection using a standardized definition for HCW immunization rates, and facility feedback. All 14 LTC facilities achieved the primary goal of 60% and nearly two thirds reached the secondary goal of 80%. Twenty percent reached the new Healthy People 2020 goal of 90%. It is possible for LTC facilities to improve HCW immunization rates using a pharmacy based, voluntary HCW influenza immunization approach. Such an approach may help attenuate the negative influence of staff turnover on HCW immunizations. Attainment of the new Health People 2020 goals still remains a challenge and may require mandatory programs. Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

A new functional method to choose the target lobe for lung volume reduction in emphysema - comparison with the conventional densitometric method.

PubMed

Hetzel, Juergen; Boeckeler, Michael; Horger, Marius; Ehab, Ahmed; Kloth, Christopher; Wagner, Robert; Freitag, Lutz; Slebos, Dirk-Jan; Lewis, Richard Alexander; Haentschel, Maik

2017-01-01

Lung volume reduction (LVR) improves breathing mechanics by reducing hyperinflation. Lobar selection usually focuses on choosing the most destroyed emphysematous lobes as seen on an inspiratory CT scan. However, it has never been shown to what extent these densitometric CT parameters predict the least deflation of an individual lobe during expiration. The addition of expiratory CT analysis allows measurement of the extent of lobar air trapping and could therefore provide additional functional information for choice of potential treatment targets. To determine lobar vital capacity/lobar total capacity (LVC/LTC) as a functional parameter for lobar air trapping using on an inspiratory and expiratory CT scan. To compare lobar selection by LVC/LTC with the established morphological CT density parameters. 36 patients referred for endoscopic LVR were studied. LVC/LTC, defined as delta volume over maximum volume of a lobe, was calculated using inspiratory and expiratory CT scans. The CT morphological parameters of mean lung density (MLD), low attenuation volume (LAV), and 15th percentile of Hounsfield units (15%P) were determined on an inspiratory CT scan for each lobe. We compared and correlated LVC/LTC with MLD, LAV, and 15%P. There was a weak correlation between the functional parameter LVC/LTC and all inspiratory densitometric parameters. Target lobe selection using lowest lobar deflation (lowest LVC/LTC) correlated with target lobe selection based on lowest MLD in 18 patients (50.0%), with the highest LAV in 13 patients (36.1%), and with the lowest 15%P in 12 patients (33.3%). CT-based measurement of deflation (LVC/LTC) as a functional parameter correlates weakly with all densitometric CT parameters on a lobar level. Therefore, morphological criteria based on inspiratory CT densitometry partially reflect the deflation of particular lung lobes, and may be of limited value as a sole predictor for target lobe selection in LVR.

Prediction of Low-Thermal-Conductivity Compounds with First-Principles Anharmonic Lattice-Dynamics Calculations and Bayesian Optimization

NASA Astrophysics Data System (ADS)

Seko, Atsuto; Togo, Atsushi; Hayashi, Hiroyuki; Tsuda, Koji; Chaput, Laurent; Tanaka, Isao

2015-11-01

Compounds of low lattice thermal conductivity (LTC) are essential for seeking thermoelectric materials with high conversion efficiency. Some strategies have been used to decrease LTC. However, such trials have yielded successes only within a limited exploration space. Here, we report the virtual screening of a library containing 54 779 compounds. Our strategy is to search the library through Bayesian optimization using for the initial data the LTC obtained from first-principles anharmonic lattice-dynamics calculations for a set of 101 compounds. We discovered 221 materials with very low LTC. Two of them even have an electronic band gap <1 eV , which makes them exceptional candidates for thermoelectric applications. In addition to those newly discovered thermoelectric materials, the present strategy is believed to be powerful for many other applications in which the chemistry of materials is required to be optimized.

The "leap forward" in nursing home development in urban China: future policy directions.

PubMed

Shum, Michelle H Y; Lou, Vivian W Q; He, Kelly Z J; Chen, Coco C H; Wang, Junfang

2015-09-01

In the past decade, the number of nursing beds in China has increased annually by an average of 10%, reaching 4.3 million in 2013. Although the State Council pushed for further increases to a ratio of 30 nursing home beds per 1000 persons by 2015, service utilization, quality assurance, and regulatory oversight are the inherent challenges in developing an equitable long-term care (LTC) system that can safeguard older persons' rights. We review and analyze both laws and policies in light of demographic and socioeconomic changes and advocate 3 policy directions for LTC development in China: allocating LTC resources with comprehensive eligibility criteria, with particular consideration of family needs; establishing viable quality standards for outcome-driven evaluation; and highlighting standardized monitoring mechanisms in both institutional and home LTC settings. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Does Testosterone Modulate Mood States and Physical Performance in Young Basketball Players?

PubMed

Miloski, Bernardo; Aoki, Marcelo S; de Freitas, Camila G; Schultz de Arruda, Ademir F; de Moraes, Helena S; Drago, Gustavo; Borges, Thiago O; Moreira, Alexandre

2015-09-01

This study aimed to examine and compare mood states profile and physical performance during different training phases between 2 groups of adolescent basketball players that were differentiated according to baseline testosterone concentration (T). The basketball players were submitted to an intensified training period (OVL) followed by a tapering period (TP). Twenty-three young male basketball players initiated the study. Experimental criteria data were used to stratify 16 players into high-testosterone (HTC) or low-testosterone (LTC) concentration groups. All the 16 athletes undertook 5 weeks of OVL followed by a 3-week TP. Saliva sampling, Yo-Yo intermittent recovery level 1 (Yo-Yo IRL1) test and the T-test were conducted at the beginning (T1), after OVL (T2), and after TP (T3). A similar increase in internal training load was observed during OVL when compared with TP in both groups (p < 0.05). No difference in mood states was observed between groups (p > 0.05); however, LTC displayed a higher score for fatigue (p < 0.05) and a lower score for energy index (p < 0.05) in OVL, compared with TP. A significant improvement in the Yo-Yo IRL1 test and the T-test was observed (T1 to T3) (p < 0.05), with no difference between groups (p > 0.05). In conclusion, these results suggest that LTC athletes may be more susceptible to changes in mood states during intensified training periods. In addition, data indicate that a periodized training program successfully improved the physical performance (endurance and agility) of young basketball players; however, this improvement was not affected by testosterone level.

Migrant care workers or migrants working in long-term care? A review of Australian experience.

PubMed

Howe, Anna L

2009-01-01

Discussion of the role of migrant care workers in long-term care (LTC) that has gained increasing attention in the United States and other developed countries in recent years is of particular relevance to Australia, where 24% of the total population is overseas-born, two-thirds of them coming from countries where English is not the primary language. Issues of interest arise regarding meeting LTC workforce demands in general and responding to the particular cultural and linguistic needs of postwar immigrants who are now reaching old age in increasing numbers. This review begins with an account of the overseas-born components of the aged care workforce and then examines this representation with reference to the four factors identified as shaping international flows of care workers in the comparative study carried out for the AARP Public Policy Institute in 2005: migration policies, LTC financing arrangements, worker recruitment and training, and credentialing. The ways in which these factors play out in Australia mean that while overseas-born workers are overrepresented in the LTC workforce, migrant care workers are not identifiable as a marginalized group experiencing disadvantage in employment conditions, nor do they offer a solution to workforce shortages. The Australian experience is different from those of other countries in many respects, but it does show that the experience of migrant care workers is not unique to LTC and points to the need to extend the search for solutions to workforce shortages and improving conditions of all care workers well beyond LTC systems to wider policy settings.

The need for leadership training in long-term care settings.

PubMed

Davis, Jullet A

2016-10-03

Purpose Globally, in 1980, approximately 5.8 per cent of the world population was 65 years old and older. By 2050, this number will more than triple to 16 per cent. From a leadership perspective, there is at least one challenge (among many others challenges) to consider. This paper (viewpoint) aims to provide support for the growing need for academically prepared managers. Design/methodology/approach This paper is a viewpoint which presents several characteristics of the long-term care (LTC) field that support the need for academically trained leaders. Findings LTC leaders in all countries must be sufficiently versed in numerous management areas to provide leadership when called on by those assigned to their care. Given local area variations in population needs present across all countries, it may be unwise to advocate for national, countrywide standardization of requirements. Yet, older adults accessing LTC services should expect a minimum level of knowledge from all of their providers - not just those who provide direct, hands-on care. However, similar to those who provide direct care, leaders should receive competency-based education with specific attention to effective communication skills, team-based approaches to care delivery, information technologies and population health. Originality/value Although much of the extant literature focuses on the delivery of care to older persons, there is a dearth of literature addressing the role of LTC leaders in light of global aging. Establishing a minimum level of academic training and increasing transparency focused on the positive experiences of elders residing in LTC facilities should help dispel the notion that placement in an LTC facility reflects filial failure.

Optimizing Eating Performance for Older Adults With Dementia Living in Long-term Care: A Systematic Review.

PubMed

Liu, Wen; Galik, Elizabeth; Boltz, Marie; Nahm, Eun-Shim; Resnick, Barbara

2015-08-01

Review of research to date has been focusing on maintaining weight and nutrition with little attention on optimizing eating performance. To evaluate the effectiveness of interventions on eating performance for older adults with dementia in long-term care (LTC). A systematic review was performed. Five databases including Pubmed, Medline (OVID), EBM Reviews (OVID), PsychINFO (OVID), and CINAHL (EBSCOHost) were searched between January 1980 and June 2014. Keywords included dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, autonomy, and intervention. Intervention studies that optimize eating performance and evaluate change of self-feeding or eating performance among older adults (≥65 years) with dementia in LTC were eligible. Studies were screened by title and abstract, and full texts were reviewed for eligibility. Eligible studies were classified by intervention type. Study quality was accessed using the Quality Assessment Tool for Quantitative Studies, and level of evidence using the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. Eleven intervention studies (five randomized controlled trials [RCTs]) were identified, and classified into four types: training program, mealtime assistance, environmental modification, and multicomponent intervention. The quality of the 11 studies was generally moderate (four studies were rated as strong, four moderate, and three weak in quality), with the main threats as weak designs, lack of blinding and control for confounders, and inadequate psychometric evidence for measures. Training programs targeting older adults (Montessori methods and spaced retrieval) demonstrated good evidence in decreasing feeding difficulty. Mealtime assistance offered by nursing staff (e.g., verbal prompts and cues, positive reinforcement, appropriate praise and encouragement) also showed effectiveness in improving eating performance. This review provided preliminary support for using training and mealtime assistance to optimize eating performance for older adults with dementia in LTC. Future effectiveness studies may focus on training nursing caregivers as interventionists, lengthening intervention duration, and including residents with varying levels of cognitive impairment in diverse cultures. The effectiveness of training combined with mealtime assistance may also be tested to achieve better resident outcomes in eating performance. © 2015 Sigma Theta Tau International.

An exploratory study to examine intentions to adopt an evidence-based HIV linkage-to-care intervention among state health department AIDS directors in the United States

PubMed Central

2012-01-01

Background Widespread dissemination and implementation of evidence-based human immunodeficiency virus (HIV) linkage-to-care (LTC) interventions is essential for improving HIV-positive patients' health outcomes and reducing transmission to uninfected others. To date, however, little work has focused on identifying factors associated with intentions to adopt LTC interventions among policy makers, including city, state, and territory health department AIDS directors who play a critical role in deciding whether an intervention is endorsed, distributed, and/or funded throughout their region. Methods Between December 2010 and February 2011, we administered an online questionnaire with state, territory, and city health department AIDS directors throughout the United States to identify factors associated with intentions to adopt an LTC intervention. Guided by pertinent theoretical frameworks, including the Diffusion of Innovations and the "push-pull" capacity model, we assessed participants' attitudes towards the intervention, perceived organizational and contextual demand and support for the intervention, likelihood of adoption given endorsement from stakeholder groups (e.g., academic researchers, federal agencies, activist organizations), and likelihood of enabling future dissemination efforts by recommending the intervention to other health departments and community-based organizations. Results Forty-four participants (67% of the eligible sample) completed the online questionnaire. Approximately one-third (34.9%) reported that they intended to adopt the LTC intervention for use in their city, state, or territory in the future. Consistent with prior, related work, these participants were classified as LTC intervention "adopters" and were compared to "nonadopters" for data analysis. Overall, adopters reported more positive attitudes and greater perceived demand and support for the intervention than did nonadopters. Further, participants varied with their intention to adopt the LTC intervention in the future depending on endorsement from different key stakeholder groups. Most participants indicated that they would support the dissemination of the intervention by recommending it to other health departments and community-based organizations. Conclusions Findings from this exploratory study provide initial insight into factors associated with public health policy makers' intentions to adopt an LTC intervention. Implications for future research in this area, as well as potential policy-related strategies for enhancing the adoption of LTC interventions, are discussed. PMID:22471965

Changes in cross-sectional airway areas induced by methacholine, histamine, and LTC4 in asthmatic subjects.

PubMed

Molfino, N A; Slutsky, A S; Hoffstein, V; McClean, P A; Rebuck, A S; Drazen, J M; Zamel, N

1992-09-01

To examine whether leukotrienes, histamine, and methacholine have different sites of bronchoconstrictor action, we studied 8 stable asthmatic subjects (mean age +/- SD, 26 +/- 5 yr) on 3 different days. On each day, a randomized challenge with LTC4, methacholine, or histamine was performed until the dose that provoked a fall of 20% in FEV1 (PC20) was obtained. Complete and partial flow-volume curves as well as area-distance profiles generated by the acoustic reflection technique (ART) at a fixed lung volume were obtained in all subjects before and after each inhalation challenge. No significant differences were found in pulmonary function or baseline cross-sectional airway areas for the different study days. The three agonists provoked significant (p less than 0.05) bronchoconstriction at the level of the main bronchi when identical falls of FEV1 were achieved. Similarly, equal reductions of V30p were elicited by the three agonists. However, LTC4 and methacholine induced additional tracheal constriction but histamine inhalation did not. These differences in the degree of tracheal constriction were statistically significant (p less than 0.05; ANOVA). These results may be explained by distinct pharmacologic properties of the agents used and may have relevance in the understanding of the pathophysiology of asthma.

Meaning in life: the perspective of long-term care residents.

PubMed

Welsh, Darlene; Moore, Sharon L; Getzlaf, Beverley A

2012-07-01

A qualitative approach was used in the exploration of meaning in life for long-term care (LTC) residents. This hermeneutic phenomenological study, as described by van Manen, was conducted using semi-structured interviews with 11 LTC residents from a rural region in Atlantic Canada. Four themes emerged as enhancing meaning in life for the residents in this study: Connectedness, Survival Despite Declining Functional Capacity, Engaging in "Normal" Activities, and Seeking a Place of Refuge. In this article, we describe the emerging themes and the implications for LTC education, practice, and future research. Copyright 2012, SLACK Incorporated.

Impact of Antimicrobial Stewardship on Physician Practice in a Geriatric Facility

PubMed Central

Kassett, Nina; Sham, Rosalind; Aleong, Rosanne; Yang, Daisy; Kirzner, Michael; Craft, Aidlee

2016-01-01

Background There is a paucity of literature describing the implementation of antimicrobial stewardship programs (ASPs) in long-term care (LTC) facilities. The current study evaluated the impact of an ASP that was implemented across a geriatric facility, which included an inpatient specialty hospital and an LTC facility. The program included prospective audits with feedback, multidisciplinary education, information technology interventions, and guideline development. Objective To investigate the impact of the ASP on physicians’ prescribing practices in this geriatric facility. Methods Utilization data for antibiotics commonly used to treat urinary tract infections were retrieved for the period September 1, 2011, to August 31, 2013. The study examined whether there were significant changes in overall antibiotic use, ciprofloxacin use, and physician prescribing behaviour after program implementation in September 2012. Results There was no significant change in the total number of antibiotic prescriptions for urinary tract infections in the hospital or the LTC facility after ASP implementation. Significant reductions were seen in the average days of therapy initially prescribed and the actual days of therapy after ASP implementation in the LTC facility but not the hospital. Across both facilities, significant reductions were seen in the number of ciprofloxacin prescriptions. Conclusions The current study showed that an ASP can affect physicians’ antibiotic prescribing behaviour and antibiotic usage in an LTC environment. PMID:28123192

A retrospective, longitudinal study of factors associated with new antipsychotic medication use among recently admitted long-term care residents.

PubMed

Foebel, Andrea; Ballokova, Anna; Wellens, Nathalie I H; Fialova, Daniela; Milisen, Koen; Liperoti, Rosa; Hirdes, John P

2015-10-19

Use of antipsychotic (AP) medications is high and often inappropriate among institutionalized populations. Little is known about the correlates of new AP drug use following admission to long-term care (LTC) settings. This study investigated the frequency and correlates of new AP drug use among newly admitted LTC residents. This longitudinal, retrospective study used data from the interRAI - Nursing Home Minimum Data Set version 2.0 (MDS 2.0) instrument. Data about demographic, clinical and social characteristics, and medication use, were collected in Ontario, Canada, from 2003-2011 by trained nurses. Residents with complete admission and 3-6 month follow-up data were included (N = 47,768). Multivariate logistic regression analyses, stratified by gender, explored correlates of new AP drug use upon admission to LTC. New AP drug users comprised 7 % of the final cohort. Severe cognitive impairment, dementia, and motor agitation were significantly associated with new AP drug use among both sexes. Additionally, behavioural problems, conflicts with staff and reduced social engagement were strong correlates of new AP drug use. Social factors were as strongly associated with new AP drug use after LTC admission as clinical factors. Strategies to prevent the potential misuse of AP drugs upon LTC admission should consider the social determinants of such prescribing.

Priming effect of platelet activating factor on leukotriene C4 from stimulated eosinophils of asthmatic patients.

PubMed Central

Shindo, K.; Koide, K.; Hirai, Y.; Sumitomo, M.; Fukumura, M.

1996-01-01

BACKGROUND: Eosinophils from asthmatic patients are known to release greater amounts of leukotrienes than normal eosinophils when stimulated by the calcium ionophore A23187. The effect of platelet activating factor (PAF) in priming eosinophils was investigated. METHODS: Eosinophils were obtained from 18 asthmatic patients and 18 healthy donors. Cells separated by the Percoll gradients were incubated with PAF (C-18) for 30 minutes and then stimulated with the calcium ionophore A23187 (2.5 microM) for 15 minutes. The amount of leukotriene C4 (LTC4) in supernatants was measured using a combination of high pressure liquid chromatography and radioimmunoassay. RESULTS: The mean (SD) amount of LTC4 released by eosinophils from asthmatic patients upon stimulation with the calcium ionophore A23187 alone was 27.9 (9.9) ng/10(6) cells (n = 6). The amount of LTC4 released following stimulation with the calcium ionophore A23187 after pretreatment with PAF (1, 5, and 10 microM) was 57.2 (8.9), 75.1 (14.3), and 52.6 (10.7) ng/10(6) cells (n = 6), respectively. Trace amounts of LTC4 (0.9 (0.02) ng/10(6) cells, n = 6) were detected in the supernatant of the cells after stimulation by PAF alone (5 microM). The amount of LTC4 released upon stimulation by calcium ionophore A23187 alone in eosinophils from healthy donors was 10.3 (3.7) ng/10(6) cells (n = 4). The amounts of LTC4 released upon stimulation with calcium ionophore A23187 after pretreatment with PAF at concentrations of 1, 5, and 10 microM were 11.9 (3.5), 17.8 (5.6), and 12.7 (5.1) ng/10(6) cells (n = 4), respectively. Trace amounts of LTC4 (0.6 (0.02) ng/10(6) cells, n = 4) were detected in the supernatant of the cells upon stimulation with PAF alone (5 microM). The amounts of LTC4 released upon stimulation with calcium ionophore A23187 after pretreatment with lyso-PAF at concentrations of 1, 5, and 10 microM (n = 4 or 6) were 30.8 (5.2), 22.9 (5.1), and 27.3 (4.3) ng/10(6) cells (n = 6) from the eosinophils of asthmatic patients and 13.7 (3.3), 15.2 (4.9), and 14.7 (3.8) ng/10(6) cells (n = 4) from the eosinophils of healthy donors. CONCLUSIONS: The results indicated that PAF enhanced LTC4 formation by eosinophils obtained from asthmatic patients stimulated with the calcium ionophore A23187, but not those obtained from normal subjects. PMID:8711647

Effects of resistance training on body composition and functional capacity among sarcopenic obese residents in long-term care facilities: a preliminary study.

PubMed

Chiu, Shu-Ching; Yang, Rong-Sen; Yang, Rea-Jeng; Chang, Shu-Fang

2018-01-22

Aging-related loss of muscle and strength with increased adiposity is prevalent among older people in long-term care (LTC) facilities. Studies have shown that people with sarcopenic obesity (SO) are at high risk of declining physical performance. At present, no interventional studies on residents with SO in nursing homes have been conducted in the literature. The objectives of this study include appraising the changes in body composition and physical performance following resistance training among residents with SO in LTC facilities. This study used a quasiexperimental research design. Residents who are 60 years of age or above and have been living a sedentary lifestyle in LTC facilities for the past 3 months will be eligible for inclusion. The intervention group engaged in chair muscle strength training twice a week for 12 weeks, whereas the control group underwent the usual care. The main variables were physical parameters of being lean and fat, the strength of grip and pinch, and a functional independence measure using descriptive analysis, chi-squared test, t-test, and generalized estimating equation for statistical analysis through SPSS. A total of 64 respondents with SO completed the study. After training, total grip strength (p = 0.001) and total pinch strength (p = 0.014) of the intervention group differed significantly from those of the control group. The right grip strength of the intervention group increased by 1.71 kg (p = 0.003) and the left grip strength improved by 1.35 kg (p = 0.028) compared with baseline values. The self-care scores of the intervention group increased by 2.76 points over baseline scores, particularly for the action of dressing oneself. Although grip strength and self-care scores improved more among those in the intervention group, body fat and skeletal muscle percentages did not differ significantly between the groups after training (p > 0.05). Resistance exercises for elderly residents in LTC facilities may play an important role in helping them maintain physical well-being and improve muscle strength. Clinicaltrials.gov, number NCT02912338 . Retrospectively registered on 09/21/2016.

Hearing Loss and Cognitive-Communication Test Performance of Long-Term Care Residents With Dementia: Effects of Amplification

ERIC Educational Resources Information Center

Hopper, Tammy; Slaughter, Susan E.; Hodgetts, Bill; Ostevik, Amberley; Ickert, Carla

2016-01-01

Purpose: The study aims were (a) to explore the relationship between hearing loss and cognitive-communication performance of individuals with dementia, and (b) to determine if hearing loss is accurately identified by long-term care (LTC) staff. The research questions were (a) What is the effect of amplification on cognitive-communication test…

Hope and connection: the experience of family caregivers of persons with dementia living in a long term care facility

PubMed Central

2013-01-01

Background Hope is a psychosocial resource that is essential for the psychological, spiritual, and physical well-being of family members caring for persons with dementia. A significant positive relationship has been found between hope and well-being in family caregivers of persons with dementia living in the community. However, the hope experience of family caregivers of persons living with dementia in long-term care (LTC) facilities has not been explored. The purpose of this study was to explore the hope experience of family caregivers of persons with dementia living in a LTC facility. Methods Twenty-three open-ended face to face interviews were conducted with 13 family caregivers of residents with dementia in a LTC facility. Family was broadly defined to include relatives and friends. Seven of these participants also reflected on their hope in diaries over a two week period. Interview transcripts and journal texts were analyzed using Thorne’s interpretive description approach. Results The over-arching theme was “hope and connection”. Participants lost hope and felt despair when they perceived they were unable to connect with their family member in the LTC facility. They regained their hope when a connection could be made. Several sub-themes were identified including: accepting where we are, living life in the moment, believing in something, standing together, and balancing dual worlds. Conclusions Hope was important and essential for family caregivers of persons with dementia residing in a LTC facility. The overarching theme of “hope and connection” underscores the importance of maintaining relationships and connection between family members and the person in LTC. Given the paucity of hope research conducted within this population, the study findings provide a foundation for future research. PMID:24138640

Evidence based practice in long term care settings.

PubMed

Specht, Janet K

2013-04-01

The purpose of this manuscript is to discuss the need for use of evidence based practice (EBP) in LTC, the current use of evidence in long term care facilities and what we know about adoption of the use of EBP in LTC. Literature review and reporting of findings from the M-TRAIN study that was a quasi-experimental design to test the effectiveness of an intervention to increase the use of EBPs for urinary incontinence and pain in 48 LTC facilities. Barriers to adopting EBPs include lack of available time, lack of access to current research literature, limited critical appraisal skills, excessive literature to review, non-receptive organizational culture, limited resources, and limited decision-making authority of staff to implement change. Strategies to promote adoption of EBP include the commitment of management; the culture of the home; leadership; staff knowledge, time, and reward; and facility size, complexity, the extent that members are involved outside the facility, NH chain membership, and high level of private pay residents. Findings from the M-TRAIN add, stability of nurse leader and congruency between the leaders perception of their leadership and the staff's perception of the leadership. There is clear evidence of the need and the benefits to residents of LTC and to the health care system yet adoption of EBP continues to be slow and sporadic. There is also evidence for the process of establishing best evidence and many resources to find the available EBPs. The urgent need now is finding ways to best get the EBPs implemented in LTC. There is growing evidence about best methods to do this but continued research is needed. Clearly, residents in LTC deserve the best care possible and EBPs represent an important vehicle by which to do this.

Evaluating the capabilities model of dementia care: a non-randomized controlled trial exploring resident quality of life and care staff attitudes and experiences.

PubMed

Moyle, Wendy; Venturato, Lorraine; Cooke, Marie; Murfield, Jenny; Griffiths, Susan; Hughes, Julian; Wolf, Nathan

2016-07-01

This 12 month, Australian study sought to compare the Capabilities Model of Dementia Care (CMDC) with usual long-term care (LTC), in terms of (1) the effectiveness of the CMDC in assisting care staff to improve Quality Of Life (QOL) for older people with dementia; and (2) whether implementation of the CMDC improved staff attitudes towards, and experiences of working and caring for the person with dementia. A single blind, non-randomized controlled trial design, involving CMDC intervention group (three facilities) and a comparison usual LTC practice control group (one facility), was conducted from August 2010 to September 2011. Eighty-one staff members and 48 family members of a person with dementia were recruited from these four LTC facilities. At baseline, 6 and 12 months, staff completed a modified Staff Experiences of Working with Demented Residents questionnaire (SEWDR), and families completed the Quality of Life - Alzheimer's Disease questionnaire (QOL-AD). LTC staff in the usual care group reported significantly lower SEWDR scores (i.e. less work satisfaction) than those in the CMDC intervention group at 12 months (p = 0.005). Similarly, family members in the comparison group reported significantly lower levels of perceived QOL for their relative with dementia (QOL-AD scores) than their counterparts in the CMDC intervention group at 12 months (p = 0.012). Although the study has a number of limitations the CMDC appears to be an effective model of dementia care - more so than usual LTC practice. The CMDC requires further evaluation with participants from a diverse range of LTC facilities and stages of cognitive impairment.

Psychiatric Symptoms and Barriers to Care in HIV-Infected Individuals Who Are Lost to Care.

PubMed

McLean, Carmen P; Gay, Natalie G; Metzger, David A; Foa, Edna B

Past studies of barriers to HIV care have not comprehensively assessed psychiatric symptoms, and few have assessed barriers to care among people living with HIV (PLWH) who are lost to care (LTC). We examined psychiatric symptoms, barriers to HIV care, and immune functioning in PLWH who were retained in care (RIC; n = 21) or LTC (n = 21). Participants completed diagnostic interviews for posttraumatic stress disorder (PTSD) and other psychiatric disorders, self-report measures of HIV risk behaviors and psychiatric symptoms, and a blood draw to assess viral load. Compared to RIC participants, LTC participants met criteria for a greater number of psychiatric disorders and reported greater depressive symptoms and more barriers to HIV care. There were no group differences in PTSD severity, risk behaviors, or viral load, suggesting that LTC individuals experience greater psychiatric problems and perceive more barriers to care than RIC participants, but are not less likely to have achieved viral suppression.

Micro Data Analysis of Medical and Long-Term Care Utilization Among the Elderly in Japan

PubMed Central

Hashimoto, Hideki; Horiguchi, Hiromasa; Matsuda, Shinya

2010-01-01

Japan is currently experiencing the most rapid population aging among all OECD countries. Increasing expenditures on medical care in Japan have been attributed to the aging of the population. Authors in the recent debate on end-of-life care and long-term care (LTC) cost in the United States and Europe have attributed time to death and non-medical care cost for the aged as a source of rising expenditures. In this study, we analyzed a large sample of local public insurance claim data to investigate medical and LTC expenditures in Japan. We examined the impact of aging, time to death, survivorship, and use of LTC on medical care expenditure for people aged 65 and above. On the basis of these findings, we conclude that age is a contributing factor to the rising expenditures on LTC, and that the contribution of aging to rising medical care expenditures should be distinguished according to survivorship. PMID:20948944

Determinants of turnover among low wage earners in long term care: the role of manager-employee relationships.

PubMed

Matthews, Michael; Carsten, Melissa K; Ayers, Douglas J; Menachemi, Nir

2018-02-27

The demand for Long-Term Care (LTC) is steadily increasing as Baby Boomers age and enter retirement. High turnover rates among employees in LTC creates challenges for supervisors and administrators, and can negatively impact quality of care. This study examines manager-subordinate relationship quality using Leader-Member Exchange Theory (LMX) as an antecedent to turnover among low-wage earners in the LTC environment. Survey data measuring LMX, job satisfaction, and demographic information was collected at time 1, and turnover data was collected 18 months later at time 2. The results reveal that all four LMX dimensions were rated significantly different among subordinates who left versus those who stayed, however, only the LMX dimension of supervisor loyalty was a significant predictor of turnover among low wage earners. Our study adds a more nuanced view of the reasons low-wage employees turnover, and presents implications for clinical managers and LTC organizations more broadly. Copyright © 2017 Elsevier Inc. All rights reserved.

Enhanced low-temperature performance of a multicell LiSOC1sub2 battery

NASA Astrophysics Data System (ADS)

Street, H. K.

A battery pack with a long life, low current, multitap power supply utilizing lithium thionyl chloride cells (LTC) is described. The battery was developed to provide power to a portable solid state recording accelerometer. The battery pack utilizes 10 Li/SOC12 type LTC-7PN keeper 2 cells. These cells are wired in a series parallel arrangement to provide two 6 volt outputs and two negative 3 volt outputs with a single common. Four 301 K ohm resistors are internally mounted and wired to permit an optional continuous 12 microampere current drain from the cells to eliminate voltage delay effects at very low temperatures. The prewired assembly is encapsulated, using Stepen Foam H-102N rigid polyurethane 2 lbs/ft(3) foam, molded to a density of 4 lbs/ft(3).

Long-term care for older lesbian and bisexual women: an analysis of current research and policy.

PubMed

Grigorovich, Alisa

2013-01-01

The Canadian health care system's delivery and policies are often based on a heterosexual nuclear family model. Long-term care (LTC) policy in particular is built on specific assumptions about women and caregiving. Current health care and LTC policies can thus disadvantage and marginalize women who do not fit such constructions, such as older lesbian and bisexual women. Drawing from literature on lesbian, gay, bisexual, and transgender women's health, aging, and caregiving, this article uses a feminist political economy analysis to demonstrate that a gap exists in current research and policy with respect to the LTC needs of older lesbian and bisexual women.

76 FR 51128 - Proposed Collection; Comment Request for Form 1099-LTC

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... Form 1099-LTC, Long-term Care and Accelerated Death Benefits. DATES: Written comments should be... [email protected] . SUPPLEMENTARY INFORMATION: Title: Long-Term Care and Accelerated Death... Accelerated Death Benefits, if you pay any long-term care benefits. Current Actions: There are no changes...

A team-based approach to warfarin management in long term care: A feasibility study of the MEDeINR electronic decision support system

PubMed Central

2010-01-01

Background Previous studies in long-term care (LTC) have demonstrated that warfarin management is suboptimal with preventable adverse events often occurring as a result of poor International Normalized Ratio (INR) control. To assist LTC teams with the challenge of maintaining residents on warfarin in the therapeutic range (INR of 2.0 to 3.0), we developed an electronic decision support system that was based on a validated algorithm for warfarin dosing. We evaluated the MEDeINR system in a pre-post implementation design by examining the impact on INR control, testing frequency, and experiences of staff in using the system. Methods For this feasibility study, we piloted the MEDeINR system in six LTC homes in Ontario, Canada. All128 residents (without a prosthetic valve) who were taking warfarin were included. Three-months of INR data prior to MEDeINR was collected via a retrospective chart audit, and three-months of INR data after implementation of MEDeINR was captured in the central computer database. The primary outcomes compared in a pre-post design were time in therapeutic range (TTR) and time in sub/supratherapeutic ranges based on all INR measures for every resident on warfarin. Secondary measures included the number of monthly INR tests/resident and survey/focus-group feedback from the LTC teams. Results LTC homes in our study had TTR's that were higher than past reports prior to the intervention. Overall, the TTR increased during the MEDeINR phase (65 to 69%), but was only significantly increased for one home (62% to 71%, p < 0.05). The percentage of time in supratherapeutic decreased from 14% to 11%, p = 0.08); there was little change for the subtherapeutic range (21% to 20%, p = 0.66). Overall, the average number of INR tests/30 days decreased from 4.2 to 3.1 (p < 0.0001) per resident after implementation of MEDeINR. Feedback received from LTC clinicians and staff was that the program decreased the work-load, improved confidence in management and decisions, and was generally easy to use. Conclusion Although LTC homes in our sample had TTR's that were relatively high prior to the intervention, the MEDeINR program represented a useful tool to promote optimal TTR, decrease INR venipunctures, streamline processes, and increase nurse and physician confidence around warfarin management. We have demonstrated that MEDeINR was a practical, usable clinical information system that can be incorporated into the LTC environment. PMID:20537178

A controlled investigation of continuing pain education for long-term care staff.

PubMed

Ghandehari, Omeed O; Hadjistavropoulos, Thomas; Williams, Jaime; Thorpe, Lilian; Alfano, Dennis P; Dal Bello-Haas, Vanina; Malloy, David C; Martin, Ronald R; Rahaman, Omar; Zwakhalen, Sandra M G; Carleton, R N; Hunter, Paulette V; Lix, Lisa M

2013-01-01

The underassessment and undertreatment of pain in residents of long-term care (LTC) facilities has been well documented. Gaps in staff knowledge and inaccurate beliefs have been identified as contributors. To investigate the effectiveness of an expert-based continuing education program in pain assessment⁄management for LTC staff. Participants included 131 LTC staff members who were randomly assigned to either an interactive pain education (PE) program, which addressed gaps in knowledge such as medication management, or an interactive control program consisting of general dementia education without a specific clinical focus. Participants attended three sessions, each lasting 3 h, and completed measures of pain-related knowledge and attitudes⁄beliefs before, immediately after and two weeks following the program. Focus groups were conducted with a subset of participants to gauge perception of the training program and barriers to implementing pain-related strategies. Analysis using ANOVA revealed that PE participants demonstrated larger gains compared with control participants with regard to pain knowledge and pain beliefs. Barriers to implementing pain-related strategies certainly exist. Nonetheless, qualitative analyses demonstrated that PE participants reported that they overcame many of these barriers and used pain management strategies four times more frequently than control participants. Contrary to previous research, the present study found that the interactive PE program was effective in changing pain beliefs and improving knowledge. Continuing PE in LTC has the potential to address knowledge gaps among front-line LTC providers.

Long-term care cost drivers and expenditure projection to 2036 in Hong Kong

PubMed Central

Chung, Roger Y; Tin, Keith YK; Cowling, Benjamin J; Chan, King Pan; Chan, Wai Man; Lo, Su Vui; Leung, Gabriel M

2009-01-01

Background Hong Kong's rapidly ageing population, characterised by one of the longest life expectancies and the lowest fertility rate in the world, is likely to drive long-term care (LTC) expenditure higher. This study aims to identify key cost drivers and derive quantitative estimates of Hong Kong's LTC expenditure to 2036. Methods We parameterised a macro actuarial simulation with data from official demographic projections, Thematic Household Survey 2004, Hong Kong's Domestic Health Accounts and other routine data from relevant government departments, Hospital Authority and other LTC service providers. Base case results were tested against a wide range of sensitivity assumptions. Results Total projected LTC expenditure as a proportion of GDP reflected secular trends in the elderly dependency ratio, showing a shallow dip between 2004 and 2011, but thereafter yielding a monotonic rise to reach 3.0% by 2036. Demographic changes would have a larger impact than changes in unit costs on overall spending. Different sensitivity scenarios resulted in a wide range of spending estimates from 2.2% to 4.9% of GDP. The availability of informal care and the setting of formal care as well as associated unit costs were important drivers of expenditure. Conclusion The "demographic window" between the present and 2011 is critical in developing policies to cope with the anticipated burgeoning LTC burden, in concert with the related issues of health care financing and retirement planning. PMID:19775476

Long-term care cost drivers and expenditure projection to 2036 in Hong Kong.

PubMed

Chung, Roger Y; Tin, Keith Yk; Cowling, Benjamin J; Chan, King Pan; Chan, Wai Man; Lo, Su Vui; Leung, Gabriel M

2009-09-24

Hong Kong's rapidly ageing population, characterised by one of the longest life expectancies and the lowest fertility rate in the world, is likely to drive long-term care (LTC) expenditure higher. This study aims to identify key cost drivers and derive quantitative estimates of Hong Kong's LTC expenditure to 2036. We parameterised a macro actuarial simulation with data from official demographic projections, Thematic Household Survey 2004, Hong Kong's Domestic Health Accounts and other routine data from relevant government departments, Hospital Authority and other LTC service providers. Base case results were tested against a wide range of sensitivity assumptions. Total projected LTC expenditure as a proportion of GDP reflected secular trends in the elderly dependency ratio, showing a shallow dip between 2004 and 2011, but thereafter yielding a monotonic rise to reach 3.0% by 2036. Demographic changes would have a larger impact than changes in unit costs on overall spending. Different sensitivity scenarios resulted in a wide range of spending estimates from 2.2% to 4.9% of GDP. The availability of informal care and the setting of formal care as well as associated unit costs were important drivers of expenditure. The "demographic window" between the present and 2011 is critical in developing policies to cope with the anticipated burgeoning LTC burden, in concert with the related issues of health care financing and retirement planning.

Practice variation in the Dutch long-term care and the role of supply-sensitive care: Is access to the Dutch long-term care equitable?

PubMed

Duell, Daisy; Koolman, Xander; Portrait, France

2017-12-01

Universal access and generous coverage are important goals of the Dutch long-term care (LTC) system. It is a legal requirement that everyone eligible for LTC should be able to receive it. Institutional care (IC) made up for 90% of Dutch LTC spending. To investigate whether access to IC is as equitable as the Dutch government aspires, we explored practice variation in entitlements to IC across Dutch regions. We used a unique dataset that included all individual applications for Dutch LTC in January 2010-December 2013 (N = 3,373,358). This dataset enabled an accurate identification of the need for care. We examined the local variation in the probability of being granted long-term IC and in the intensity of the care granted given that individuals have applied for LTC. We also investigated whether the variation observed was related to differences in the local availability of care facilities. Although our analyses indicated the presence of some practice variation, its magnitude was very small by national and international standards (up to 3%). Only a minor part of the practice variation could be accounted for by local supply differences in care facilities. Overall, we conclude that, unlike many other developed countries, the Dutch system ensured equitable access to long-term IC. © 2017 The Authors. Health Economics Published by John Wiley & Sons Ltd.

Integrating Space into an Air Expeditionary Force

DTIC Science & Technology

1999-04-01

National Guard in space. Further thanks go out to Col Andersson, Col Hoapili, CAPT Huffine, LTC Glen Collins, USA, LTC Bill Bayles, USA, Maj Brian Creelman ...should be the senior space professional in theater, regardless of service. The main questions regarding a JSpOTF pertain to this task force’s physical

Long-Term Care: Common Issues and Unknowns

ERIC Educational Resources Information Center

Swartz, Katherine; Miake, Naoko; Farag, Nadine

2012-01-01

All industrialized countries are grappling with a common problem--how to provide assistance of various kinds to their rapidly aging populations. The problem for countries searching for models of efficient and high-quality long-term care (LTC) policies is that fewer than a dozen countries have government-organized, formal LTC policies. Relatively…

LTC1877 High Efficiency Regulator Total Ionizing Dose Test Report

NASA Technical Reports Server (NTRS)

Oldham, Timothy; Pellish, Jonathan; Boutte, Alvin

2012-01-01

This report presents total ionizing dose evaluation data for the Linear Technology Corporation LTC1877 high efficiency monolithic synchronous step-down regulator. Data sheet parameters were tracked as a function of ionizing dose up to a total of 20 krad(SiO2). Control devices were also used.

Global Counterinsurgency: A Way Out of the Global War on Terrorism Quagmire?

DTIC Science & Technology

2008-05-22

disseminating al Qaeda news and information regarding political and military operations, publishing the Arabic daily, Nashrat al- akhbar , and developing...Forces for Counterinsurgency,” Parameters Vol. XXXVI (Summer 2006) 47-62. Cohen, Eliot, LTC Conrad Crane US Army (Retired), LTC Jan Horvath US Army

Factors Affecting Discharge to Home of Geriatric Intermediate Care Facility Residents in Japan.

PubMed

Morita, Kojiro; Ono, Sachiko; Ishimaru, Miho; Matsui, Hiroki; Naruse, Takashi; Yasunaga, Hideo

2018-04-01

To investigate factors associated with lower likelihood of discharge to home from geriatric intermediate care facilities in Japan. Retrospective cohort study. We used data from the nationwide long-term care (LTC) insurance claims database (April 2012-March 2014). Study participants were 342,758 individuals newly admitted to 3,459 geriatric intermediate care facilities during the study period. The primary outcome was discharge to home. We performed a multivariable competing-risk Cox regression with adjustment for resident-, facility-, and region-level characteristics. Resident level of care needs and several medical conditions were included as time-varying covariates. Death, admission to a hospital, and admission to another LTC facility were treated as competing risks. During the 2-year follow-up period, 19% of participants were discharged to home. In the multivariable competing-risk Cox regression, the following factors were significantly associated with lower likelihood of discharge to home: older age, higher level of care need, having several medical conditions, private ownership of the facility, more beds in the facility, and more LTC facility beds per 1,000 adults aged 65 and older in the region. Only 19% of residents were discharged to home. Our results are useful for policy-makers to promote discharge to home of older adults in geriatric intermediate care facilities. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Providing long term care for sex offenders: liabilities and responsibilities.

PubMed

Corson, Tyler Rogers; Nadash, Pamela

2013-11-01

The high risk for recidivism among sex offenders who need long term care (LTC) raises serious issues when they are cared for alongside frail, vulnerable adults. LTC providers must balance offenders' right to access care with other residents' right to be free from abuse and must assess and manage the risks associated with admitting offenders. This article identifies sources of legal liability that derive from sex offender management and discusses the need for the LTC community to develop reasonable, balanced guidance on how best to mitigate the risks associated with sex offenders, protect the rights of all residents, and reduce provider liabilities. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Hancocked: manulife and the limits of private health insurance.

PubMed

Evans, Robert G

2011-08-01

Long-term care (LTC) insurance is a salesman's dream. Millions of well-heeled boomers, anxious to protect their estates from the random expropriation of institutional dependency - what a market! But for Manulife, bleeding $1.5 million a day in LTC claims through subsidiary John Hancock, LTC is a nightmare. Company spokesmen blame unexpected increases in life expectancy. But management's fundamental error was insuring correlated risks. Risk pooling works only when individual risks are uncorrelated. Increases in life expectancy affect all contracts together. Manulife made the same mistake selling equity-linked annuities with guaranteed floors - essentially insuring against stock market declines. Results for shareholders have been catastrophic. Top management, meanwhile, have been honoured and richly rewarded.

Emotional intelligence and health-related quality of life in institutionalised Spanish older adults.

PubMed

Luque-Reca, Octavio; Pulido-Martos, Manuel; Lopez-Zafra, Esther; Augusto-Landa, José María

2015-06-01

This study explores the relationship between emotional intelligence (EI) and health-related quality of life (HRQoL) in a sample of Spanish older adults who are institutionalised in long-term care (LTC) facilities. One hundred fifteen institutionalised individuals (47.82% women; 88.3 ± 7.9 years) from southern Spain completed a set of questionnaires that included measures of EI, health and personality. Data were analysed via hierarchical regression. After controlling for personality and sociodemographic variables, the EI dimensions, emotional comprehension and emotional facilitation, accounted for part of the variance in several HRQoL facets. These dimensions could have an important role in the HRQoL of residents in LTC. Moreover, the use of a performance measure addresses the limitations of previous studies that have relied on self-report measures. These aspects underscore the importance of the results of this study. © 2014 International Union of Psychological Science.

HOW DO WORK HIERARCHIES AND STRICT DIVISIONS OF LABOUR IMPACT CARE WORKERS’ EXPERIENCES OF HEALTH AND SAFETY? CASE STUDIESOF LONG TERM CARE IN TORONTO

PubMed Central

SYED, I.; DALY, T.; ARMSTRONG, P.; LOWNDES, R.; CHADOIN, M.; NAIDOO, V.

2016-01-01

Background According to the Canadian Health Care Association (1), there are 2,577 long-term care (“LTC”) facilities across Canada, with the largest proportion (33.4%) located in Ontario. Most studies focus on residents’ health, with less attention paid to the health and safety experiences of staff. Given that the work performed in Ontario LTC facilities is very gendered, increasingly racialized, task-oriented, and with strict divisions of labour, this paper explores in what ways some of these factors impact workers’ experiences of health and safety. Objectives The study objectives included the following research question: How are work hierarchies and task orientation experienced by staff? Design and Setting This paper draws on data from rapid team-based ethnographies of the shifting division of labour in LTC due to use of informal carers in six non-profit LTC facilities located in Toronto, Ontario. Methods Our method involved conducting observations and key informant interviews (N=167) with registered nurses, registered practical nurses, personal support workers, dietary aides, recreation therapists, families, privately paid companions, students, and volunteers. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. For observations, researchers were paired and covered shifts between 7 a.m. and 11 p.m., as well as into the late night over six days, at each of the six sites. Detailed ethnographic field notes were written during and immediately following observational fieldwork. Results Our results indicate that employee stress is linked to the experiences of care work hierarchies, task orientation, and strict divisions of labour between and among various staff designations. Conclusion Findings from this project confirm and extend current research that demonstrates there are challenging working conditions in LTC, which can result in occupational health and safety problems, as well as stress for individual workers. PMID:28066839

Security basics for long-term care facilities.

PubMed

Green, Martin

2015-01-01

The need for Long-Term Care (LTC) facilities is growing, the author reports, and along with it the need for programs to address the major security concerns of such facilities. In this article he explains how to apply the IAHSS Healthcare Security Industry Guidelines and the Design Guidelines to achieve a safer LTC facility.

Measures of Effectiveness for Rationalization, Standardization, and Interoperability

DTIC Science & Technology

1988-09-01

and Standardization Group, Bonn COL Weichel LTC Corn D-2 U.S. Mission NATO COL Osborne MAJ Brand COL Smith MAJ Brew LTC Sendak Supreme Headquarters...Allie, ý,%vers Europe (SHAPE) COL Hanley CDR Lachlan COL Ross MAJ Heidema COL Solli MAJ Seay COL Tudor NAI 0 Maintenance and Supply Agency (NAMSA) Mr

Using conflict theory to explore the role of nursing home social workers in home- and community-based service utilization.

PubMed

Fogler, Sarah

2009-11-01

Nursing home social work (NHSW) practitioners are central to home- and community-based service (HCBS) utilization. They assist residents with long-term care (LTC) decision-making and coordinate community-based LTC supports and services for older adults transitioning back into the community after a rehabilitative nursing home (NH) stay. As members of multiple groups, they must simultaneously balance the needs of NH residents, the NH organization, and social policies related to LTC. To date, policy research on HCBS has been atheoretical in that it has not accounted for the possible inherent conflicts that adversely affect the discharge planning practices of NHSW practitioners. This article applies the Conflict Theory to (a) explore the competing interests of the NH industry and the nation's government, (b) examine the potential effect of these competing interests on the effectiveness of NHSW discharge planning practices, and (c) present a conceptual framework to further investigate the relationship between NHSW and both individual LTC outcomes and national policy initiatives aimed at increasing HCBS utilization.

Long-term care over an uncertain future: what can current retirees expect?

PubMed

Kemper, Peter; Komisar, Harriet L; Alecxih, Lisa

The leading edge of the baby boom generation is nearing retirement and facing uncertainty about its need for long-term care (LTC). Using a microsimulation model, this analysis projected that people currently turning age 65 will need LTC for three years on average. An important share of needed care will be covered by public programs and some private insurance, but much of the care will be an uninsured private responsibility of individuals and their families--a responsibility that will be distributed unequally. While over a third of those now turning 65 are projected to never receive family care, three out of 10 will rely on family care for more than two years. Similarly, half of people turning 65 will have no private out-of-pocket expenditures for LTC, while more than one in 20 are projected to spend $100,000 or more of their own money (in present discounted value). Policy debate that focuses only on income security and acute care--and the corresponding Social Security and Medicare programs--misses the third, largely private, risk that retirees face: that of needing LTC.

Preparedness in Long-Term Care: A Novel Approach to Address Gaps in Evacuation Tracking.

PubMed

Prot, Emilie Y; Clements, Bruce

2017-02-01

With an aging population, the number of elderly individuals residing in long-term care (LTC) facilities will continue to grow and pose unique challenges to disaster preparedness and response. With this rapidly growing vulnerable population, it becomes imperative to identify enhanced and novel preparedness strategies and measures. LTC residents not only have complicated medical needs, including the timing of dispensing multiple medications, but frequently have cognitive and mobility deficits as well. In nearly every major disaster, elderly populations have suffered disproportionate morbidity and mortality. This is often due to elderly evacuees getting overlooked in the chaos of an initial response. Instituting measures to rapidly recognize this population in a crowd during an evacuation will reduce their risk. This commentary reviews the LTC facility evacuation challenges of the 2013 explosion of the West Fertilizer Company plant in West, Texas, and offers a novel solution of mandating the wearing of pink vests by all nursing home residents in case of an evacuation. The pink vests quickly alert disaster rescue and response workers of LTC residents with special needs. (Disaster Med Public Health Preparedness. 2017;11:28-30).

The policy and politics of the 2015 long-term care reform in the Netherlands.

PubMed

Maarse, J A M Hans; Jeurissen, P P Patrick

2016-03-01

As of 2015 a major reform in LTC is taking place in the Netherlands. An important objective of the reform is to reign in expenditure growth to safeguard the fiscal sustainability of LTC. Other objectives are to improve the quality of LTC by making it more client-tailored. The reform consists of four interrelated pillars: a normative reorientation, a shift from residential to non-residential care, decentralization of non-residential care and expenditure cuts. The article gives a brief overview of these pillars and their underlying assumptions. Furthermore, attention is paid to the political decision-making process and the politics of implementation and evaluation. Perceptions of the effects of the reform so far widely differ: positive views alternate with critical views. Though the reform is radical in various aspects, LTC care will remain a largely publicly funded provision. A statutory health insurance scheme will remain in place to cover residential care. The role of municipalities in publicly funded non-residential care is significantly upgraded. The final section contains a few policy lessons. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

"We don't do it for the money" … The scale and reasons of poverty-pay among frontline long-term care workers in England.

PubMed

Hussein, Shereen

2017-11-01

Demographic trends escalate the demands for formal long-term care (LTC) in the majority of the developed world. The LTC workforce is characterised by its very low wages, the actual scale of which is less well known. This article investigates the scale of poverty-pay in the feminised LTC sector and attempts to understand the perceived reasons behind persisting low wages in the sector. The analysis makes use of large national workforce pay data and a longitudinal survey of care workers, as well as interviews with key stakeholders in the sector. The analysis suggests that there are at least between 10 and 13% of care workers who are effectively being paid under the National Minimum Wage in England. Thematic qualitative analysis of 300 interviews with employers, care workers and service users highlight three key explanatory factors of low pay: the intrinsic nature of LTC work, the value of caring for older people, and marketisation and outsourcing of services. © 2017 John Wiley & Sons Ltd.

Financing long-term care: ex ante, ex post or both?

PubMed

Costa-Font, Joan; Courbage, Christophe; Swartz, Katherine

2015-03-01

This paper attempts to examine the heterogeneity in the public financing of long-term care (LTC) and the wide-ranging instruments in place to finance LTC services. We distinguish and classify the institutional responses to the need for LTC financing as ex ante (occurring prior to when the need arises, such as insurance) and ex post (occurring after the need arises, such as public sector and family financing). Then, we examine country-specific data to ascertain whether the two types of financing are complements or substitutes. Finally, we examine exploratory cross-national data on public expenditure determinants, specifically economic, demographic and social determinants. We show that although both ex ante and ex post mechanisms exist in all countries with advanced industrial economies and despite the fact that instruments are different across countries, ex ante and ex post instruments are largely substitutes for each other. Expenditure estimates to date indicate that the public financing of LTC is highly sensitive to a country's income, ageing of the population and the availability of informal caregiving. Copyright © 2015 John Wiley & Sons, Ltd.

A controlled investigation of continuing pain education for long-term care staff

PubMed Central

Ghandehari, Omeed O; Hadjistavropoulos, Thomas; Williams, Jaime; Thorpe, Lilian; Alfano, Dennis P; Bello-Haas, Vanina Dal; Malloy, David C; Martin, Ronald R; Rahaman, Omar; Zwakhalen, Sandra MG; Carleton, R Nicholas; Hunter, Paulette V; Lix, Lisa M

2013-01-01

BACKGROUND: The underassessment and undertreatment of pain in residents of long-term care (LTC) facilities has been well documented. Gaps in staff knowledge and inaccurate beliefs have been identified as contributors. OBJECTIVES: To investigate the effectiveness of an expert-based continuing education program in pain assessment/management for LTC staff. METHODS: Participants included 131 LTC staff members who were randomly assigned to either an interactive pain education (PE) program, which addressed gaps in knowledge such as medication management, or an interactive control program consisting of general dementia education without a specific clinical focus. Participants attended three sessions, each lasting 3 h, and completed measures of pain-related knowledge and attitudes/beliefs before, immediately after and two weeks following the program. Focus groups were conducted with a subset of participants to gauge perception of the training program and barriers to implementing pain-related strategies. RESULTS: Analysis using ANOVA revealed that PE participants demonstrated larger gains compared with control participants with regard to pain knowledge and pain beliefs. Barriers to implementing pain-related strategies certainly exist. Nonetheless, qualitative analyses demonstrated that PE participants reported that they overcame many of these barriers and used pain management strategies four times more frequently than control participants. CONCLUSIONS: Contrary to previous research, the present study found that the interactive PE program was effective in changing pain beliefs and improving knowledge. Continuing PE in LTC has the potential to address knowledge gaps among front-line LTC providers. PMID:23457681

Mediating Systems of Care: Emergency Calls to Long-Term Care Facilities at Life's End.

PubMed

Waldrop, Deborah P; McGinley, Jacqueline M; Clemency, Brian

2018-04-09

Nursing home (NH) residents account for over 2.2 million emergency department visits yearly; the majority are cared for and transported by prehospital providers (emergency medical technicians and paramedics). The purpose of this study was to investigate prehospital providers' perceptions of emergency calls at life's end. This article focuses on perceptions of end-of-life calls in long-term care (LTC). This pilot study employed a descriptive cross-sectional design. Concepts from the symbolic interaction theory guided the exploration of perceptions and interpretations of emergency calls in LTC facilities. A purposeful sample of prehospital providers was developed from one agency in a small northeastern U.S. city. Semistructured interviews were conducted with 43 prehospital providers to explore their perceptions of factors that trigger emergency end-of-life calls in LTC facilities. Qualitative data analysis involved iterative coding in an inductive process that included open, systematic, focused, and axial coding. Interview themes illustrated the contributing factors as follows: care crises; dying-related turmoil; staffing ratios; and organizational protocols. Distress was crosscutting and present in all four themes. The findings illuminate how prehospital providers become mediators between NHs and emergency departments by managing tension, conflict, and challenges in patient care between these systems and suggest the importance of further exploration of interactions between LTC staff, prehospital providers, and emergency departments. Enhanced communication between LTC facilities and prehospital providers is important to address potentially inappropriate calls and transport requests and to identify means for collaboration in the care of sick frail residents.

Intergovernmental relations and Long Term Care reforms: lessons from the Italian case.

PubMed

Gabriele, Stefania; Tediosi, Fabrizio

2014-05-01

The article aims at analysing the reasons why Italy failed to reform Long Term Care (LTC) policies, focusing on an aspect which has been overlooked: the interplay between LTC policies and the intergovernmental multilevel relationships. In the Italian LTC system, the main central intervention has been the regularisation of migrant care work, while the automatic growth of the cash benefits has accompanied the care needs evolution. Therefore the only institutional change has been a "gradual transformation". The causes of the failure to reform LTC have been mainly related to a strong fragmentation of the policy field, the existence of a universalistic cash benefit, the fiscal constraint. We argue that a further obstacle to reform LTC policies has been the weak and uncertain legislative framework of federalism. The uncertainty on the allocation and distribution of resources and the delay to apply the equalisation mechanism based on needs engendered a lame federalism that contributed to hindering welfare innovations and to increasing the institutional fragmentation. The analysis is partly consistent with previous literature, although it places less emphasis on the role of the constituencies and the scarcity of resources in influencing decisions, focusing more on the implications of the failure to fully realise the federalist reform. This focus shows that to implement institutional change in the welfare system, it is important to take into account the features of the federal governance, the intergovernmental relations, and to address the challenges that are connected to them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Investigating the effect of a single glycine to alanine substitution on interactions of antimicrobial peptide latarcin 2a with a lipid membrane.

PubMed

Idiong, Grace; Won, Amy; Ruscito, Annamaria; Leung, Bonnie O; Hitchcock, Adam P; Ianoul, Anatoli

2011-09-01

Latarcins are linear, α-helical antimicrobial peptides purified from the venom of the Central Asian spider Lachesana tarabaevi, with lytic activity against Gram-positive and Gram-negative bacteria, erythrocytes, and yeast at micromolar concentrations. In this work, we investigated the role of the hinge in latarcin 2a (ltc2a, GLFGKLIKKFGRKAISYAVKKARGKH-COOH), which adopts a helix-hinge-helix conformation in membrane-mimicking environments, on peptide-membrane interactions and its potential effect on the selective toxicity of the peptide. A modified latarcin 2a, ltc2aG11A, obtained by replacing the glycine at position 11 with alanine (ltc2aG11A, GLFGKLIKKFARKAISYAVKKARGKH-COOH), adopts a more rigid structure due to the reduced conformational flexibility. Langmuir monolayer measurements combined with atomic force microscopy and X-ray photoemission electron microscopy (X-PEEM) indicate that both peptides bind and insert preferentially into anionic compared with zwitterionic phospholipid monolayers. Modified ltc2aG11A was found to be more disruptive of supported phospholipid bilayer modeling mammalian cell membrane. However, no considerable difference in lytic activity of the two peptides toward bacterial membrane was found. Overall the data indicate that decrease in the flexibility of ltc2a induced by the modification in the hinge region is likely to increase the peptide's nonspecific interactions with zwitterionic cell membranes and potentially increase its toxicity against eukaryotic cells.

Money well spent: a comparison of hospital operating margin for laparoscopic and open colectomies.

PubMed

Koopmann, M C; Harms, B A; Heise, C P

2007-10-01

Cost analysis after laparoscopic colectomy has been examined, although reports evaluating the effects of laparoscopy on hospital operating margin are lacking. We compared several cost/revenue measures, including hospital operating margin, between open and laparoscopic colectomies at an academic center. Our cost-accounting database was queried for laparoscopic partial (LPC) and total colectomies (LTC), and open partial (OPC) and total colectomies (OTC) to analyze net revenue, total costs, and total hospital operating margin over a 4-year period. Laparoscopic and open colectomy cases were compared, with mean operating margin as the primary outcome. From July, 2002 through May, 2006, 842 patients were included for analysis with 138 undergoing laparoscopic colectomy. Net revenue was higher in the LTC group compared with open (US dollars 30,300 vs US dollars 26,800 [P = .02]), and lower in the LPC group (US dollars 15,300 vs US dollars 21,300 open [P < .0001]). Total costs were reduced in both the LPC and LTC groups compared with open [US dollars 11,700 vs US dollars 17,600 [P < .0001] and US dollars 18,000 vs US dollars 19,400 [P = .0019], respectively). LPC resulted in a similar HOM (US dollars 3,602) compared with OPC (US dollars 3,647; P = .35). LTC resulted in a higher HOM (US dollars 12,300) compared with OTC (US dollars 7,400; P = .02). LTC generates a significantly higher hospital operating margin than an OTC, although the margins are similar for LPC and OPC.

Temporal Trends in Analgesic Use in Long-Term Care Facilities: A Systematic Review of International Prescribing.

PubMed

La Frenais, Francesca L; Bedder, Rachel; Vickerstaff, Victoria; Stone, Patrick; Sampson, Elizabeth L

2018-02-01

To explore global changes in the prescription of analgesic drugs over time in the international long-term care (LTC) population. Systematic review. We included original research articles in English, published and unpublished, that included number of participants, country and year(s) of data collection, and prescription of analgesics (analgesics not otherwise specified, opioids, acetaminophen; scheduled only, or scheduled plus as needed (PRN)). LTC residents. We searched PubMed, EMBASE, CINAHL, International Pharmaceutical Abstracts, PsycINFO, Cochrane, Web of Science, Google Scholar, using keywords for LTC facilities and analgesic medication; hand-searched references of eligible papers; correspondence. Studies were quality rated using an adapted Newcastle-Ottawa scale. Pearson correlation coefficients were generated between percentage of residents prescribed an analgesic and year of data collection. If available, we investigated changes in acetaminophen and opioid prescriptions. Forty studies met inclusion criteria. A moderate correlation (0.59) suggested that scheduled prescription rates for analgesics have increased over time. Similar findings were reflected in scheduled prescriptions for acetaminophen and opioids. No increase was seen when analyzing scheduled plus PRN analgesics. Use of opioids (scheduled plus PRN) appears to have increased over time. Worldwide, use of opioids and acetaminophen has increased in LTC residents. Research is needed to explore whether this reflects appropriate pain management for LTC residents and if PRN medication is used effectively. © 2017 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

Individual differences in early adolescents' latent trait cortisol (LTC): Relation to recent acute and chronic stress.

PubMed

Stroud, Catherine B; Chen, Frances R; Doane, Leah D; Granger, Douglas A

2016-08-01

Research suggests that environmental stress contributes to health by altering the regulation of the hypothalamic pituitary adrenal (HPA) axis. Recent evidence indicates that early life stress alters trait indicators of HPA axis activity, but whether recent stress alters such indicators is unknown. Using objective contextual stress interviews with adolescent girls and their mothers, we examined the impact of recent acute and chronic stress occurring during the past year on early adolescent girls' latent trait cortisol (LTC) level. We also examined whether associations between recent stress and LTC level: a) varied according to the interpersonal nature and controllability of the stress; and b) remained after accounting for the effect of early life stress. Adolescents (n=117;M age=12.39years) provided salivary cortisol samples three times a day (waking, 30min post-waking and bedtime) over 3days. Results indicated that greater recent interpersonal acute stress and greater recent independent (i.e., uncontrollable) acute stress were each associated with a higher LTC level, over and above the effect of early adversity. In contrast, greater recent chronic stress was associated with a lower LTC level. Findings were similar in the overall sample and a subsample of participants who strictly adhered to the timed schedule of saliva sample collection. Implications for understanding the impact of recent stress on trait-like individual differences in HPA axis activity are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Complex role of STIM1 in the activation of store-independent Orai1/3 channels

PubMed Central

Zhang, Wei; González-Cobos, José C.; Jardin, Isaac; Romanin, Christoph; Matrougui, Khalid

2014-01-01

Orai proteins contribute to Ca2+ entry into cells through both store-dependent, Ca2+ release–activated Ca2+ (CRAC) channels (Orai1) and store-independent, arachidonic acid (AA)-regulated Ca2+ (ARC) and leukotriene C4 (LTC4)-regulated Ca2+ (LRC) channels (Orai1/3 heteromultimers). Although activated by fundamentally different mechanisms, CRAC channels, like ARC and LRC channels, require stromal interacting molecule 1 (STIM1). The role of endoplasmic reticulum–resident STIM1 (ER-STIM1) in CRAC channel activation is widely accepted. Although ER-STIM1 is necessary and sufficient for LRC channel activation in vascular smooth muscle cells (VSMCs), the minor pool of STIM1 located at the plasma membrane (PM-STIM1) is necessary for ARC channel activation in HEK293 cells. To determine whether ARC and LRC conductances are mediated by the same or different populations of STIM1, Orai1, and Orai3 proteins, we used whole-cell and perforated patch-clamp recording to compare AA- and LTC4-activated currents in VSMCs and HEK293 cells. We found that both cell types show indistinguishable nonadditive LTC4- and AA-activated currents that require both Orai1 and Orai3, suggesting that both conductances are mediated by the same channel. Experiments using a nonmetabolizable form of AA or an inhibitor of 5-lipooxygenase suggested that ARC and LRC currents in both cell types could be activated by either LTC4 or AA, with LTC4 being more potent. Although PM-STIM1 was required for current activation by LTC4 and AA under whole-cell patch-clamp recordings in both cell types, ER-STIM1 was sufficient with perforated patch recordings. These results demonstrate that ARC and LRC currents are mediated by the same cellular populations of STIM1, Orai1, and Orai3, and suggest a complex role for both ER-STIM1 and PM-STIM1 in regulating these store-independent Orai1/3 channels. PMID:24567509

Sustaining complex interventions in long-term care: a qualitative study of direct care staff and managers.

PubMed

Colón-Emeric, Cathleen; Toles, Mark; Cary, Michael P; Batchelor-Murphy, Melissa; Yap, Tracey; Song, Yuting; Hall, Rasheeda; Anderson, Amber; Burd, Andrew; Anderson, Ruth A

2016-07-16

Little is known about the sustainability of behavioral change interventions in long-term care (LTC). Following a cluster randomized trial of an intervention to improve staff communication (CONNECT), we conducted focus groups of direct care staff and managers to elicit their perceptions of factors that enhance or reduce sustainability in the LTC setting. The overall aim was to generate hypotheses about how to sustain complex interventions in LTC. In eight facilities, we conducted 15 focus groups with 83 staff who had participated in at least one intervention session. Where possible, separate groups were conducted with direct care staff and managers. An interview guide probed for staff perceptions of intervention salience and sustainability. Framework analysis of coded transcripts was used to distill insights about sustainability related to intervention features, organizational context, and external supports. Staff described important factors for intervention sustainability that are particularly challenging in LTC. Because of the tremendous diversity in staff roles and education level, interventions should balance complexity and simplicity, use a variety of delivery methods and venues (e.g., group and individual sessions, role-play/storytelling), and be inclusive of many work positions. Intervention customizability and flexibility was particularly prized in this unpredictable and resource-strapped environment. Contextual features noted to be important include addressing the frequent lack of trust between direct care staff and managers and ensuring that direct care staff directly observe manager participation and support for the program. External supports suggested to be useful for sustainability include formalization of changes into facility routines, using "train the trainer" approaches and refresher sessions. High staff turnover is common in LTC, and providing materials for new staff orientation was reported to be important for sustainability. When designing or implementing complex behavior change interventions in LTC, consideration of these particularly salient intervention features, contextual factors, and external supports identified by staff may enhance sustainability. ClinicalTrial.gov, NCT00636675.

Let’s Talk about Children Evaluation (LTCE) study in northern Finland: a multiple group ecological study of children’s health promotion activities with a municipal and time-trend design

PubMed Central

Kujala, Veikko; Jokinen, Jaana; Ebeling, Hanna; Pohjola, Anneli

2017-01-01

Introduction Making change towards child and family-based and coordinated services is critical to improve quality, outcomes and value. The Let’s Talk about Children (LTC) approach, which consists of brief psychoeducational discussions with parents of kindergarten-aged and school-aged children, has been launched as a municipality-specific programme in the Council of Oulu Region. The aim of this paper is to present a protocol of an ecological study evaluating the group-specific effects of an intervention about LTC activities in a geographically defined population. The programme is designed to promote children’s socioemotional well-being. Methods and analysis A quasi-experimental ecological study protocol is implemented to evaluate whether systematic LTC practices improve children’s well-being. A multi-informant setting covers 30 municipalities in northern Finland and involves all the municipal teachers, social and healthcare workers. In each municipality, a Local Management Team is responsible for implementing the LTC programme and collecting the annual data of LTC discussions and network meetings. The outcome data are retrieved from child welfare statistics and hospital registers. The population data, child welfare statistics and referrals to hospitals was retrieved at baseline (2014), and will be retrieved annually. Furthermore, the annual data of LTC discussions and network meetings will be collected of the years 2015–2018. Ethics and dissemination The study design has been approved by the management of the Oulu University Hospital in accordance with the guidelines given by The Regional Ethics Committee of the Northern Ostrobothnia Hospital District in Oulu, Finland. All data are treated and implemented according to national data security laws. Study findings will be disseminated to provincial and municipal partners, collaborative community groups and the research and development community. The Let’s Talk about Children Evaluation study databases will guide future regional development action and policies. PMID:28710220

Data for improvement and clinical excellence: protocol for an audit with feedback intervention in long-term care.

PubMed

Sales, Anne E; Schalm, Corinne

2010-10-13

There is considerable evidence about the effectiveness of audit coupled with feedback, although few audit with feedback interventions have been conducted in long-term care (LTC) settings to date. In general, the effects have been found to be modest at best, although in settings where there has been little history of audit and feedback, the effects may be greater, at least initially. The primary purpose of the Data for Improvement and Clinical Excellence (DICE) Long-Term Care project is to assess the effects of an audit with feedback intervention delivered monthly over 13 months in four LTC facilities. The research questions we addressed are:1. What effects do feedback reports have on processes and outcomes over time?2. How do different provider groups in LTC and home care respond to feedback reports based on data targeted at improving quality of care? The research team conducting this study comprises researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of monthly feedback reports in nine LTC units in four facilities in Edmonton, Alberta. Data for the feedback reports comes from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated for use in LTC facilities throughout Alberta. Feedback reports consist of one page, front and back, presenting both graphic and textual information. Reports are delivered to all staff working in the four LTC facilities. The primary evaluation uses a controlled interrupted time series design both adjusted and unadjusted for covariates. The concurrent process evaluation uses observation and self-report to assess uptake of the feedback reports. Following the project phase described in this protocol, a similar intervention will be conducted in home care settings in Alberta. Depending on project findings, if they are judged useful by decision makers participating in this research team, we plan dissemination and spread of the feedback report approach throughout Alberta.

Examining the need assessment process by identifying the need profiles of elderly care recipients in the Ten-year Long-Term Care Project (TLTCP) of Taiwan.

PubMed

Liu, Li-Fan; Yao, Hui-Ping

2014-12-01

To deal with the increasing long-term care (LTC) needs of elderly people in Taiwan, the government launched the Ten-year Long-term Care Project (TLTCP) in 2007, and through the care management system, care plans for those in need were distributed and implemented by care managers according to the single assessment process. Based on the emphasis of linking the right need assessment to the care plan, this study aimed to explore the need profiles of LTC recipients with regard to their health indicators to serve as a validity check on the identified dependency levels and care plans in the current care management system. A model based on latent class analysis (LCA) was used for dealing with the issue of health heterogeneity. LCA provides an empirical method that examines the interrelationships among health indicators and characterizes the underlying set of mutually exclusive latent classes that account for the observed indicators. The analysis included a total of 2901 elderly care recipients in the LTC dataset from a southern city, 1 of the 5 major metropolitan areas in Taiwan. The identified dependency levels of the samples and their care plans in need assessment were compared and discussed. Four need profiles were explored in the LTC dataset. Apart from the low (LD) (32.95%) and moderate dependent groups (MD) (17.48%), there were 2 groups identified among the high-dependency levels, including the severe physical and psychological dependency (SPP) (26.37%) and the comorbidities and severe dependency (CSD) groups (23.20%), which in sum were approximately identified as high dependency (HD) by care managers in the LTC dataset. In addition, the CSD group currently costs more for their care plans on average in LTC services (NT. 277,081.15, approximately 9200 USD) than the SPP group (NT. 244,084.21) and the other groups. Need assessment is a key to success in care management in LTC. The results of this study showed the importance of focusing on multifacet indicators, especially the mental and social health indicators in need assessments by improving the unified assessment process to sensitively detect those with various needs and then link them to the right care plan. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Reforming Long-Term Care in the United States: Findings from a National Survey of Specialists

ERIC Educational Resources Information Center

Miller, Edward Alan; Mor, Vincent; Clark, Melissa

2010-01-01

Purpose: Theories of the policy process recognize that policy proposals are typically generated, debated, redrafted, and accepted for consideration through the gradual accumulation of knowledge within communities of specialists. Thus, to inform long-term care (LTC) reform efforts, we conducted a Web-based survey of 1,147 LTC specialists…

Flying beneath the Radar of Health Reform: The Community Living Assistance Services and Supports (CLASS) Act

ERIC Educational Resources Information Center

Miller, Edward Alan

2011-01-01

The Patient Protection and Affordable Care Act attempts to address prevailing deficiencies in long-term care (LTC) financing through the Community Living Assistance Services and Supports (CLASS) Act, a national voluntary LTC insurance program administered by the Federal government. The CLASS Act is intended to supplement rather than supplant…

Assisted Living in Rural America: Results From a National Survey

ERIC Educational Resources Information Center

Hawes, Catherine; Phillips, Charles D.; Holan, Scott; Sherman, Michael; Hutchison, Linnae L.

2005-01-01

Expanding the availability of long-term care (LTC) services and making them more responsive to consumer preferences is an important goal, particularly for elderly people living in rural areas who tend to be older and have greater functional limitations but less access to the range of LTC options available in metropolitan areas. One option that…

Hancocked: Manulife and the Limits of Private Health Insurance

PubMed Central

Evans, Robert G.

2011-01-01

Long-term care (LTC) insurance is a salesman's dream. Millions of well-heeled boomers, anxious to protect their estates from the random expropriation of institutional dependency — what a market! But for Manulife, bleeding $1.5 million a day in LTC claims through subsidiary John Hancock, LTC is a nightmare. Company spokesmen blame unexpected increases in life expectancy. But management's fundamental error was insuring correlated risks. Risk pooling works only when individual risks are uncorrelated. Increases in life expectancy affect all contracts together. Manulife made the same mistake selling equity-linked annuities with guaranteed floors — essentially insuring against stock market declines. Results for shareholders have been catastrophic. Top management, meanwhile, have been honoured and richly rewarded. PMID:22851982

Long term care staff beliefs about evidence based practices for the management of dementia and agitation.

PubMed

Ayalon, Liat; Arean, Patricia; Bornfeld, Heather; Beard, Renee

2009-02-01

Despite a growing literature on effective interventions for Alzheimer's disease (AD) and agitation, the management of these conditions in long term care (LTC) often is inadequate. The goals of the present study were: (a) to evaluate existing beliefs about evidence based practices (EBP) for the management of Alzheimer's disease and agitation among LTC staff; and (b) to evaluate the contribution of demographic and attitudinal variables to LTC staff beliefs about these EBP. A cross sectional study of 371 LTC staff members completed an EBP questionnaire, a short demographic questionnaire, and an attitudinal questionnaire about AD and agitation. Paraprofessional caregivers, those of lower educational level, and ethnic minorities were more likely to be in disagreement with the EBP views examined in this study. Those in disagreement with the EBP views also reported a preference towards not working with residents with AD and agitation and a sense of helplessness associated with such work. Disagreement with EBP views was associated with both normalization and stigmatization of AD and agitation. Paraprofessional caregivers, ethnic minorities, and people of lower educational level are most at need for educational activities about AD and neuropsychiatric symptoms. Educational efforts geared towards changing the belief system of LTC staff should target not only EBP but also information about AD and agitation as conditions that are deviant from the normal aging process, yet non-stigmatizing. It is expected that following EBP will empower staff and improve staff motivation to work with residents with AD and agitation. (c) 2008 John Wiley & Sons, Ltd.

Measuring nursing home resident satisfaction with food and food service: initial testing of the FoodEx-LTC.

PubMed

Crogan, Neva L; Evans, Bronwynne; Velasquez, Donna

2004-04-01

Malnutrition impacts the quality of life and general health of many older persons living in our nation's 20,000 nursing homes (1). Despite the urgency of this issue, no instrument that measures resident satisfaction with food and food service was found in an extensive literature search. The purpose of this article is to describe the development and initial testing of a resident satisfaction with food and food service questionnaire (FoodEx-LTC) in the context of the Quality Nutrition Outcomes-Long-Term Care Model. This pilot study was conducted in two phases. During phase one the instrument was developed, peer-reviewed, and pretested. Phase two further tested the instrument using a correlational design, measuring both intermediate and long-term outcomes found on the Quality Nutrition Outcomes-Long-Term Care Model. Hypothesis testing was used to measure construct validity. 4 of 5 FoodEx-LTC domains were significantly correlated with depression, 2 of 5 with serum albumin. The FoodEx-LTC demonstrates acceptable reliability for a new instrument. The coefficient alpha scores ranged from.69-.87 and test-retest correlations ranged from.55-.89, dependent upon domain. FoodEx-LTC appears to be a valid and reliable measure of resident food and food service satisfaction in nursing homes. This line of inquiry is of great importance because perceived quality of food and food service are strongly related to quality of life for residents in nursing homes, and adequate food intake is integral to maintaining weight and preventing protein-calorie malnutrition among elderly residents.

Predictive and concurrent validity of the Braden scale in long-term care: a meta-analysis.

PubMed

Wilchesky, Machelle; Lungu, Ovidiu

2015-01-01

Pressure ulcer prevention is an important long-term care (LTC) quality indicator. While the Braden Scale is a recommended risk assessment tool, there is a paucity of information specifically pertaining to its validity within the LTC setting. We, therefore, undertook a systematic review and meta-analysis comparing Braden Scale predictive and concurrent validity within this context. We searched the Medline, EMBASE, PsychINFO and PubMed databases from 1985-2014 for studies containing the requisite information to analyze tool validity. Our initial search yielded 3,773 articles. Eleven datasets emanating from nine published studies describing 40,361 residents met all meta-analysis inclusion criteria and were analyzed using random effects models. Pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive values were 86%, 38%, 28%, and 93%, respectively. Specificity was poorer in concurrent samples as compared with predictive samples (38% vs. 72%), while PPV was low in both sample types (25 and 37%). Though random effects model results showed that the Scale had good overall predictive ability [RR, 4.33; 95% CI, 3.28-5.72], none of the concurrent samples were found to have "optimal" sensitivity and specificity. In conclusion, the appropriateness of the Braden Scale in LTC is questionable given its low specificity and PPV, in particular in concurrent validity studies. Future studies should further explore the extent to which the apparent low validity of the Scale in LTC is due to the choice of cutoff point and/or preventive strategies implemented by LTC staff as a matter of course. © 2015 by the Wound Healing Society.

How Can Adult Children Influence Parents’ Long-Term Care Insurance Purchase Decisions?

PubMed Central

Voils, Corrine I.; Coe, Norma B.; Konetzka, R. Tamara; Boles, Jillian; Van Houtven, Courtney Harold

2017-01-01

Abstract Purpose of the Study: Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents’ LTC preferences and plans, including LTCI purchase? Design and Methods: We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method. Results: Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home. Implications: Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake. PMID:25209446

Translating research in elder care: an introduction to a study protocol series

PubMed Central

Estabrooks, Carole A; Hutchinson, Alison M; Squires, Janet E; Birdsell, Judy; Cummings, Greta G; Degner, Lesley; Morgan, Debra; Norton, Peter G

2009-01-01

Background The knowledge translation field is undermined by two interrelated gaps – underdevelopment of the science and limited use of research in health services and health systems decision making. The importance of context in theory development and successful translation of knowledge has been identified in past research. Additionally, examination of knowledge translation in the long-term care (LTC) sector has been seriously neglected, despite the fact that aging is increasingly identified as a priority area in health and health services research. Aims The aims of this study are: to build knowledge translation theory about the role of organizational context in influencing knowledge use in LTC settings and among regulated and unregulated caregivers, to pilot knowledge translation interventions, and to contribute to enhanced use of new knowledge in LTC. Design This is a multi-level and longitudinal program of research comprising two main interrelated projects and a series of pilot studies. An integrated mixed method design will be used, including sequential and simultaneous phases to enable the projects to complement and inform one another. Inferences drawn from the quantitative and qualitative analyses will be merged to create meta-inferences. Outcomes Outcomes will include contributions to (knowledge translation) theory development, progress toward resolution of major conceptual issues in the field, progress toward resolution of methodological problems in the field, and advances in the design of effective knowledge translation strategies. Importantly, a better understanding of the contextual influences on knowledge use in LTC will contribute to improving outcomes for residents and providers in LTC settings. PMID:19664285

Handbook for Program Developers of Associate of Applied Science and Business Degrees at Lima Technical College.

ERIC Educational Resources Information Center

Casto, Robert A.

Intended as a resource for program developers, this handbook illustrates the process of developing program proposals for the associate of applied science and business (AASB) degrees at Lima Technical College (LTC), in Ohio. Following an introduction, section 1 discusses the potential reasons for the addition of a program to the LTC curriculum.…

Office of Naval Research Overview of Corrosion S&T Program

DTIC Science & Technology

2010-12-02

a carbon induced passivity for LTCSS treated austenitic stainless steels - Low temp. allows interstitial C diffusion, but not substitutional...paraequilibrium carburization mechanism(s) that lead to the enhanced corrosion resistance seaw ater crevice corrosion on 316 Stainless Steel LTC...Treated 316 untreated LTC process TTT diagram LTCSS Surface Modification: • Carbon concentrations > 12 at. % in 316 stainless steel while maintaining

A First Cut at Doctrine for Automation of Division Command and Control.

DTIC Science & Technology

1985-12-02

34MSE: Mobile Subscriber Equipmentd," Arm-Y Communicator (Fall 1984), pp. 6-22. 20. Anthony L. Borelli and LTC Raymond J. Leopold, "Enhanced JTIDS: High...three, 1985. I’- pp. 85-8,. Berceau, CPT Stan. "ASAS." C2MUG Bulletin. September 1965, pp. 1-2. Borelli , Anthony L. and Leopold, LTC Raymond J

Sustained Transfer of Knowledge to Practice in Long-Term Care: Facilitators and Barriers of a Mental Health Learning Initiative

ERIC Educational Resources Information Center

Stolee, Paul; McAiney, Carrie A.; Hillier, Loretta M.; Harris, Diane; Hamilton, Pam; Kessler, Linda; Madsen, Victoria; Le Clair, J. Kenneth

2009-01-01

This article explores facilitators and barriers to the impact and sustainability of a learning initiative to increase capacity of long-term care (LTC) homes to manage the mental health needs of older persons, through development of in-house Psychogeriatric Resource Persons (PRPs). Twenty interviews were conducted with LTC staff. Management…

Fiscal Law Course Deskbook (36th)

DTIC Science & Technology

1993-05-01

CONTRACT LAW DIVISION THE JUDGE ADVOCATE GENERAL’S SCHOOL UNITED STATES ARMY CHARLOTTESVILLE, VIRGINIA JA 506...MAY 93 93-13173 CONTRIBUTORS I LTC John T. Jones, Jr. Chief, Contract Law Division LTC Harry L. Dorsey Senior Instructor, Contract Law Division MAJ...Michael A. Killham Instructor, Contract Law Division MAJ Bobby D. Melvin Instructor, Contract Law Division MAJ Michael K. Cameron Instructor, Contract

Resident Characteristics Related to the Lack of Morning Care Provision in Long-Term Care

ERIC Educational Resources Information Center

Simmons, Sandra F.; Durkin, Daniel W.; Rahman, Anna N.; Choi, Leena; Beuscher, Linda; Schnelle, John F.

2013-01-01

Purpose: The purpose of this study was to examine usual long-term care (LTC) practices related to 3 aspects of morning care and determine if there were resident characteristics related to the lack of care. Design and Methods: Participants were 169 long-stay residents in 4 community LTC facilities who required staff assistance with either transfer…

Private long-term care insurance: value to claimants and implications for long-term care financing.

PubMed

Doty, Pamela; Cohen, Marc A; Miller, Jessica; Shi, Xiaomei

2010-10-01

The purpose of this study was to obtain a profile of individuals with private long-term care (LTC) insurance as they begin using paid LTC services and track their patterns of service use, satisfaction with services and insurance, claims denial rates, and transitions over a 28-month period. Ten LTC insurance companies contributed a random sample of 1,474 qualified individuals who were interviewed in-person by a trained nurse and then interviewed telephonically every 4 month for a 28-month period. Used in the analysis were descriptive statistics and techniques for analyzing longitudinal panel data. About 96% of those filing claims were approved for payment. At baseline, 37% received home care, 23% assisted living care, 14% were in a nursing home, and 26% had not yet begun using paid care. Few claimants reported that their policies restricted their choice of providers and most care costs were covered. The average number of care transitions was 1, typically occurring within 4 month of baseline. The less impaired and those in home care settings were most likely to transition between service settings. Having private LTC coverage enabled claimants to exercise their preference for alternatives to nursing home care.

The impact of fall risk assessment on nurse fears, patient falls, and functional ability in long-term care.

PubMed

Dever Fitzgerald, Theresa; Hadjistavropoulos, Thomas; Williams, Jaime; Lix, Lisa; Zahir, Sharmeen; Alfano, Dennis; Scudds, Rhonda

2016-01-01

The purpose of this study was to determine whether providing fall risk information to long-term care (LTC) nurses affects restraint use, activities of daily living (ADL), falls, and nurse fears about patient falls. One-hundred and fifty LTC residents were randomized to a fall risk assessment intervention or care-as-usual group. Hypotheses were tested using analyses of variance and path analyses. Restraint use was associated with lower ADL scores. In the intervention group, there ceased to be significant relationships between nurse fears about falls and patient falls (after controlling for actual patient risk; post-intervention, nurse fears about falls were based on realistic appraisals), and between fears and restraints (i.e. unjustified nurse fears became less likely to lead to unjustified restraint use). No group differences in falls were identified. Despite a lack of group differences in falls, results show initial promise in potentially impacting resident care. Increasing intervention intensity may lead to fall reductions in future research. Given the high prevalence rates of falls in LTC and associated injuries, prevention programs are important. Nurse fears about patient falls may impact upon restraint use which, when excessive, can interfere with the patient's ability to perform ADL. Excessive restraint use, due to unjustified nurse fears, could also lead to falls. Providing accurate, concise information to nursing staff about patient fall risk may aid in reducing the association between unjustified nurse fears and the resulting restraint use that can have potential negative consequences.

Are Baby Boomers Who Care for their Older Parents Planning for their Own Future Long-Term Care Needs?

PubMed Central

FINKELSTEIN, EMILY S.; REID, M. CARRINGTON; KLEPPINGER, ALISON; PILLEMER, KARL; ROBISON, JULIE

2013-01-01

A rapidly expanding number of baby boomers provide care to aging parents. This study examines associations between caregiver status and outcomes related to awareness and anticipation of future long-term care (LTC) needs using 2007 Connecticut Long-Term Care Needs Assessment survey data. Baby boomers who were adult child caregivers (n = 353) vs. baby boomers who were not (n = 1242) were more likely to anticipate some future LTC needs and to have considered certain financing strategies. Although baby boomer adult child caregivers more readily anticipate some future LTC needs, they are not taking specific actions. It is important to address the need for public education directed towards those who are currently (or have recently completed) caring for aging parents. PMID:22239280

Annual Research Progress Report. Fiscal Year 1989. Volume 2

DTIC Science & Technology

1989-10-01

Date : 4 --- ---- Date of Periodic Review - -- Results Objective(s): i) Develop a conscious, tethered or lightly sedated , nonhuman primate model...Approach: All animal studies will be conducted at Incarnate Word College Division of Nursing and the Sciences. All procedures will be done as outlined...Gary Zarr, LTC, AN Academy of Health Sciences Dept/Svc Associate Investigators: Dpartment of Nursing Jeff Serogrham, LTC, AN Key Words: Accumulative

A Comparison of HAART Outcomes between the US Military HIV Natural History Study (NHS) and HIV Atlanta Veterans Affairs Cohort Study (HAVACS)

DTIC Science & Technology

2013-05-01

Acknowledgments The IDCRP HIV Working Group includes: Susan Banks, RN, CAPT Mary Bavaro, MD, Ionut Bebu, PhD, Helen Chun, MD, Nancy Crum- Cianflone, MD, MPH...Cathy Decker, MD, Conner Eggleston, LTC Tomas Ferguson, MD, COL Susan Fraser, MD, MAJ Joshua Hartzell, MD, MAJ Joshua Hawley, MD, LTC Gunther Hsue, MD

Case Study: Realizing the Value of Nurse Practitioners in Long-Term Care.

PubMed

Cole, M Suzanne

2017-01-01

Presently only about 9% of seniors over the age of 75 live in residential care facilities but the anticipated exponential growth of the senior population will put increasing pressure on the need for supportive, continuing care services in the years ahead (CIHI 2017a). They are on average 86 years of age with a diagnosis of dementia (67%) and some cognitive and/or functional impairment (98%) (CIHI 2017b). These compromised seniors are also more likely to use hospital services than others, and in many jurisdictions occupy acute care beds for extended periods because ongoing management of their complex conditions is often not possible within long-term care (LTC) homes. In addition, unnecessary and futile care at the end of life often leads to suffering for individuals and their families (Dobbins 2016), which might otherwise be avoided with the presence of institutionally based providers such as nurse practitioners (NPs). Christian and Barker (2009) identified NPs as a valuable resource to prevent unnecessary hospitalizations which often lead to complications and devastating results for seniors. Although evidence of the positive impact of NPs working in LTC facilities dates back to the 1970s, very few organizations have created and obtained funding support for these positions in LTC settings. This case study illustrates the impact of the NP role in a New Brunswick LTC facility; demonstrating the value of a model that includes an NP collaborating with physicians, nurses and allied health professionals. As shown in this case, the presence of an NP clearly impacted a reduction in emergency room visits and hospitalizations, events that more often than not accelerate further physical, mental and functional decline particularly among the frail elderly. Christian and Barker (2009) described the significant consequences of hospitalization for the elderly patient including irreversible decline in function, delirium and exposure to iatrogenic disease. Having an NP available within LTC affords the residents ongoing monitoring that allows for preemptive and proactive care. NPs providing oversight to the collaborative management of the care of LTC residents has the potential to not only realize cost-avoidance for the healthcare system but also enhance the quality of care for residents and their families. © 2017 Longwoods Publishing.

Let's Talk about Children Evaluation (LTCE) study in northern Finland: a multiple group ecological study of children's health promotion activities with a municipal and time-trend design.

PubMed

Kujala, Veikko; Jokinen, Jaana; Ebeling, Hanna; Pohjola, Anneli

2017-07-13

Making change towards child and family-based and coordinated services is critical to improve quality, outcomes and value. The Let's Talk about Children (LTC) approach, which consists of brief psychoeducational discussions with parents of kindergarten-aged and school-aged children, has been launched as a municipality-specific programme in the Council of Oulu Region. The aim of this paper is to present a protocol of an ecological study evaluating the group-specific effects of an intervention about LTC activities in a geographically defined population. The programme is designed to promote children's socioemotional well-being. A quasi-experimental ecological study protocol is implemented to evaluate whether systematic LTC practices improve children's well-being. A multi-informant setting covers 30 municipalities in northern Finland and involves all the municipal teachers, social and healthcare workers. In each municipality, a Local Management Team is responsible for implementing the LTC programme and collecting the annual data of LTC discussions and network meetings. The outcome data are retrieved from child welfare statistics and hospital registers. The population data, child welfare statistics and referrals to hospitals was retrieved at baseline (2014), and will be retrieved annually. Furthermore, the annual data of LTC discussions and network meetings will be collected of the years 2015-2018. The study design has been approved by the management of the Oulu University Hospital in accordance with the guidelines given by The Regional Ethics Committee of the Northern Ostrobothnia Hospital District in Oulu, Finland. All data are treated and implemented according to national data security laws. Study findings will be disseminated to provincial and municipal partners, collaborative community groups and the research and development community. The Let's Talk about Children Evaluation study databases will guide future regional development action and policies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association

PubMed Central

Florez, Hermes; Huang, Elbert S.; Kalyani, Rita R.; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S.; Taveira, Tracey H.; Haas, Linda B.

2016-01-01

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. PMID:26798150

Joint trajectories of cognitive functioning and challenging behavior for persons living with dementia in long-term care.

PubMed

Robitaille, Annie; Garcia, Linda; McIntosh, Cameron

2015-09-01

The current study examines the longitudinal relationship between dementia-related challenging behaviors (e.g., vocal disruption, physical aggression, repetitive behaviors, and restlessness) and cognitive functioning in the long-term care (LTC) context. A multivariate latent growth curve model within the structural equation modeling (SEM) framework was applied to data collected from 16,804 older adults upon admission to LTC and every 3 months for a period of 2.5 years. Increases in challenging behaviors were characterized by a significant positive linear and negative quadratic trend (i.e., a subtle leveling off at later assessment times), whereas increases in cognitive impairment were characterized by a positive linear trend. On average, individuals who were more cognitively impaired upon entry into LTC and who exhibited a steeper increase in cognitive impairment also exhibited more challenging behaviors at entry into LTC and a steeper increase in challenging behaviors, respectively. At the within-person level, individuals demonstrating an increase in cognitive impairment at a specific occasion were also more likely to demonstrate an increase in challenging behaviors at that same occasion; however, the magnitude of these effects was very small, suggesting limited practical implications. This study provides novel empirical evidence about the coevolution of cognitive impairment and challenging behaviors, going beyond prior research that has been either cross-sectional in nature, examined longitudinal change in only 1 variable, or simply looked at linear trends without attempting to explore the possibility of nonlinear change. Most importantly, this longitudinal examination of persons with dementia living in LTC has implications for how challenging behaviors can be better managed and for how new strategies can be implemented to prevent challenging behaviors. (c) 2015 APA, all rights reserved).

Association between Antidepressants and Fall-Related Injuries among Long-Term Care Residents.

PubMed

Macri, Jennifer C; Iaboni, Andrea; Kirkham, Julia G; Maxwell, Colleen; Gill, Sudeep S; Vasudev, Akshya; Whitehead, Marlo; Seitz, Dallas P

2017-12-01

Antidepressants are associated with an increased risk of falls although little is known of the comparative risks of different types of antidepressants or individuals who are at greatest risk for falls. We examined the association between new use of antidepressants and fall-related injuries among older adults in long-term care (LTC). This was a matched, retrospective cohort study involving LTC residents in Ontario, Canada, from 2008 to 2014. New users of antidepressants were matched to non-users of antidepressants. The primary outcome was any fall resulting in an emergency department (ED) visit or hospitalization within 90 days after exposure. Secondary outcomes included hip fractures, wrist fractures, and falls reported in LTC. Multivariate logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval associated with antidepressants and outcomes. New users of any antidepressant had an increased risk of ED visits or hospitalization for falls within 90 days when compared with individuals not receiving antidepressants (5.2% versus 2.8%; adjusted OR: 1.9, 95% CI: 1.7-2.2). Antidepressants were also associated with an increased risk of all secondary outcomes. The increased risk of fall-related injuries was evident among selective-serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, trazodone, and across multiple patient subgroups. New use of antidepressants is associated with significantly increased risk of falls and fall-related injuries among LTC residents across different patient subgroups and antidepressant classes. The potential risk of fall-related outcomes should be carefully considered when initiating antidepressants among older adults in LTC. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Developing a national role description for medical directors in long-term care

PubMed Central

Rahim-Jamal, Sherin; Quail, Patrick; Bhaloo, Tajudaullah

2010-01-01

OBJECTIVE To develop a national role description for medical directors in long-term care (LTC) based on role functions drawn from the literature and the LTC industry. DESIGN A questionnaire about the role functions identified from the literature was mailed or e-mailed to randomly selected medical directors, directors of care or nursing (DOCs), and administrators in LTC facilities. SETTING Long-term care facilities in Canada randomly selected from regional clusters. PARTICIPANTS Medical directors, DOCs, and administrators in LTC facilities; a national advisory group of medical directors from the Long Term Care Medical Directors Association of Canada; and a volunteer group of medical directors. MAIN OUTCOME MEASURES Respondents were asked to indicate, from the list of identified functions, 1) whether medical directors spent any time on each activity; 2) whether medical directors should spend time on each activity; and 3) if medical directors should spend time on an activity, whether the activity was “essential” or “desirable.” RESULTS An overall response rate of 37% was obtained. At least 80% of the respondents from all 3 groups (medical directors, DOCs, and administrators) highlighted 24 functions they deemed to be “essential” or “desirable,” which were then included in the role description. In addition, the advisory group expanded the role description to include 5 additional responsibilities from the remaining 18 functions originally identified. A volunteer group of medical directors confirmed the resulting role description. CONCLUSION The role description developed as a result of this study brings clarity to the medical director’s role in Canadian LTC facilities; the functions outlined are considered important for medical directors to undertake. The role description could be a useful tool in negotiations pertaining to time commitment and expectations of a medical director and fair compensation for services rendered. PMID:20090058

Leukotriene C4 production by murine mast cells: evidence of a role for extracellular leukotriene A4.

PubMed Central

Dahinden, C A; Clancy, R M; Gross, M; Chiller, J M; Hugli, T E

1985-01-01

The glutathione-containing leukotriene C4 (LTC4) is a major mediator of smooth muscle contraction and is released by mast cells when antigen interacts with cell-bound IgE. Antigen-stimulated mast cells undergo phospholipase activation. We report a pathway of LTC4 production by mast cells that does not require phospholipase activation but depends on the interaction of activated neutrophils with unstimulated mast cells, using as an intermediate extracellular leukotriene A4 (LTA4). The epoxide LTA4 is released by neutrophils and, together with leukotriene B4 and 5-hydroxyeicosatetraenoic acid, constitutes the major lipoxygenase metabolites found in supernatants of stimulated neutrophils. Five minutes after activation of neutrophils by calcium ionophore A23187 we measured 136 pmol of extracellular LTA4 per 10(7) neutrophils (range 40-300, n = 7) by trapping the epoxide with alcohols. Therefore, we conclude that LTA4 is not just an intracellular leukotriene precursor but is released as a lipoxygenase metabolite. LTA4 is known to be stabilized by albumin and is efficiently converted by mast cells into LTC4 even at low LTA4 concentrations. The LTA4 complexed to albumin is converted into LTC4 rapidly and completely within 10-15 min. More than 50% of the LTA4 presented to mast cells is metabolized to LTC4 at concentrations of LTA4 between 0.2 and 2 nmol of LTA4 per 10(7) mast cells. This observation establishes a potential physiologic role for extracellular LTA4. Therefore, interactions between various cell types that release or utilize LTA4 may provide an important metabolic pathway for the production of leukotrienes. PMID:2995976

Developing a national role description for medical directors in long-term care: survey-based approach.

PubMed

Rahim-Jamal, Sherin; Quail, Patrick; Bhaloo, Tajudaullah

2010-01-01

To develop a national role description for medical directors in long-term care (LTC) based on role functions drawn from the literature and the LTC industry. A questionnaire about the role functions identified from the literature was mailed or e-mailed to randomly selected medical directors, directors of care or nursing (DOCs), and administrators in LTC facilities. Long-term care facilities in Canada randomly selected from regional clusters. Medical directors, DOCs, and administrators in LTC facilities; a national advisory group of medical directors from the Long Term Care Medical Directors Association of Canada; and a volunteer group of medical directors. Respondents were asked to indicate, from the list of identified functions, 1) whether medical directors spent any time on each activity; 2) whether medical directors should spend time on each activity; and 3) if medical directors should spend time on an activity, whether the activity was "essential" or "desirable." An overall response rate of 37% was obtained. At least 80% of the respondents from all 3 groups (medical directors, DOCs, and administrators) highlighted 24 functions they deemed to be "essential" or "desirable," which were then included in the role description. In addition, the advisory group expanded the role description to include 5 additional responsibilities from the remaining 18 functions originally identified. A volunteer group of medical directors confirmed the resulting role description. The role description developed as a result of this study brings clarity to the medical director's role in Canadian LTC facilities; the functions outlined are considered important for medical directors to undertake. The role description could be a useful tool in negotiations pertaining to time commitment and expectations of a medical director and fair compensation for services rendered.

The availability and affordability of long-term care for disabled older people in China: The issues related to inequalities in social security benefits.

PubMed

Lei, Peng; Feng, Zhixin; Wu, Zhuochun

2016-01-01

China is experiencing increasing pressure from issues relating to an ageing population. The rationality of different eligibility criteria of the benefits within the social security system has been widely challenged; however, to date, no previous study has explored its association with the availability and affordability of long-term care (LTC). This study evaluates the availability and affordability of Long-Term Care (LTC) services for disabled older people (aged 65 and above) in China, with special attention to the differences among groups in receipt of specific social security benefits. The data of availability and affordability of LTC services for disabled older people is from a nationally representative sample Chinese Longitudinal Healthy Longevity Survey (CLHLS). Three different social security benefits were identified and their effects on the long-term care services for disabled older people were explored. The overall proportions of disabled older people who have only limited or no available or affordable LTC services were remarkably high, especially for those who have moderate or no social security benefits. Compared to those who are entitled to generous social security benefits, older people who have no social security benefits are 18.45 times more likely to be unable to afford health care expenses. The findings imply that policy makers in China could focus on the LTC needs for the social security and socioeconomically disadvantaged (who have limited or no social security benefits and in low household income) disabled older people which could reduce the gap between them and those who are entitled to generous social security benefits. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Development and psychometric testing of the Supportive Supervisory Scale.

PubMed

McGilton, Katherine S

2010-06-01

To describe the development and psychometric testing of the Supportive Supervisory Scale (SSS). The development of the items of the scale was based on Winnicott's relationship theory and on focus groups with 26 healthcare aides (HCAs) and 30 supervisors from six long-term care (LTC) facilities in Ontario, Canada. Content validity of the 15-item instrument was established by a panel of experts. Based on a secondary analysis of data collected from 222 HCAs in 10 LTC facilities in Ontario, Canada, the SSS was subjected to principal components analysis with oblique rotation. A two-factor solution was accepted, which is consistent with the theoretical conceptualization of the instrument. Factor I was labeled Respects Uniqueness and Factor II was labeled Being Reliable. Internal consistency of Factor I was .95, and that of Factor II was .91. Discriminant validity was also established. The focus groups revealed that "being available to staff" while "recognizing the HCA as an individual, and taking a moment to get to know them" was essential to feeling supported by their supervisor. The SSS is a reliable and valid measure of supervisory support of supervisors working in LTC facilities. At the core of supportive supervision is the supervisor's ability to develop and maintain positive relationships with each HCA. It is through respecting the uniqueness of each HCA and being reliable that supervisor-HCA relationships can flourish. Supportive leadership in LTC settings is a major contributor to HCAs' job satisfaction and retention and to quality of patient care. Therefore, a tool developed and tested to measure supervisors' supportive capacities in LTC is primal to evaluate the effectiveness of supervisors in these environments.

Goals of care discussions among hospitalized long-term care residents: Predictors and associated outcomes of care.

PubMed

Wong, Hannah J; Wang, Jamie; Grinman, Michelle; Wu, Robert C

2016-12-01

There are limited data on the occurrence, predictors, and impact of goals of care (GOC) discussions during hospitalization for seriously ill elderly patients, particularly for long-term care (LTC) residents. The study was a retrospective chart review of 200 randomly sampled LTC residents hospitalized via the emergency department and admitted to the general internal medicine service of 2 Canadian academic hospitals, from January 2012 through December 2012. We applied logistic regression models to identify factors associated with, and outcomes of, these discussions. Overall, 9.4% (665 of 7084) of hospitalizations were patients from LTC. In the sample of 200 patients, 37.5% had a documented discussion. No baseline patient characteristic was associated with GOC discussions. Low Glasgow Coma Scale, high respiratory rate, and low oxygen saturation were associated with discussions. Patients with discussions had higher rates of orders for no resuscitation (80% vs 55%) and orders for comfort measures only (7% vs 0%). In adjusted analyses, patients with discussions had higher odds of in-hospital death (52.0, 95% confidence interval [CI]: 6.2-440.4) and 1-year mortality (4.1, 95% CI: 1.7-9.6). Nearly 75% of patients with a change in their GOC did not have this documented in the discharge summary. In hospitalized LTC patients, GOC discussions occurred infrequently and appeared to be triggered by illness severity. Orders for advance directives, in-hospital death, and 1-year mortality were associated with discussions. Rates of GOC documentation in the discharge summary were poor. This study provides direction for developing education and practice standards to improve GOC discussion rates and their communication back to LTC. Journal of Hospital Medicine 2015;11:824-831. © 2015 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Tri-focal Model of Care Implementation: Perspectives of Residents and Family.

PubMed

Hutchinson, Alison; Rawson, Helen; O'Connell, Beverly; Walker, Helen; Bucknall, Tracey; Forbes, Helen; Ostaszkiewicz, Joan; Ockerby, Cherene

2017-01-01

To explore residents' and family members' perceptions of partnership-centered long-term care (LTC) associated with implementation of the Tri-focal Model of Care. The Model promotes partnership-centered care, evidence-based practice, and a positive environment. Its implementation is supported by a specifically designed education program. The Model was implemented over approximately 12 months in seven LTC facilities in Victoria, Australia. A qualitative exploratory-descriptive approach was used. Data were collected using individual and focus group interviews with residents and family members prior to and following implementation of the Model. Data were analyzed thematically. Prior to implementation of the Model, residents described experiencing a sense of disempowerment, and emphasized the importance of communication, engagement, and being a partner in the staff-resident care relationship. Following implementation, residents reported experiencing improved partnership approaches to care, although there were factors that impacted on having a good experience. Family members described a desire to remain involved in the resident's life by establishing good communication and rapport with staff. They acknowledged this was important for partnership-centered care. Following implementation, they described experiencing a partnership with staff, giving them confidence to assist staff and be included in decisions about the resident. The Tri-focal Model of Care can enable residents, family members, and staff to be partners in resident care in LTC settings. With an ageing population, an increasing demand for complex, individualized LTC exists. Delivery of high-quality LTC requires a strategy to implement a partnership-centered approach, involving residents, family members, and staff. © 2016 The Authors. Journal of Nursing Scholarship published by Wiley Periodicals, Inc. on behalf of Society for Journal of Nursing Scholarship.

Health and Functioning of Families of Children With Special Health Care Needs Cared for in Home Care, Long-term Care, and Medical Day Care Settings.

PubMed

Caicedo, Carmen

2015-06-01

To examine and compare child and parent or guardian physical and mental health outcomes in families with children with special health care needs who have medically complex technology-dependent needs in home care, long-term care (LTC), and medical day care (MDC) settings. The number of children requiring medically complex technology-dependent care has grown exponentially. In this study, options for their care are home care, LTC, or MDC. Comparison of child and parent/guardian health outcomes is unknown. Using repeated measures data were collected from 84 dyads (parent/guardian, medically complex technology-dependent child) for 5 months using Pediatric Quality of Life Inventory Generic Core Module 4.0 and Family Impact Module Data analysis: χ(2), RM-ANCOVA. There were no significant differences in overall physical health, mental health, and functioning of children by care setting. Most severely disabled children were in home care; moderately disabled in MDC; children in vegetative state LTC; however, parents perceived children's health across care setting as good to excellent. Parents/guardians from home care reported the poorest physical health including being tired during the day, too tired to do the things they like to do, feeling physically weak, or feeling sick and had cognitive difficulties, difficulties with worry, communication, and daily activities. Parents/guardians from LTC reported the best physical health with time and energy for a social life and employment. Trends in health care policy indicate a movement away from LTC care to care in the family home where data indicate these parents/guardians are already mentally and functionally challenged.

How Can Adult Children Influence Parents' Long-Term Care Insurance Purchase Decisions?

PubMed

Sperber, Nina R; Voils, Corrine I; Coe, Norma B; Konetzka, R Tamara; Boles, Jillian; Van Houtven, Courtney Harold

2017-04-01

Long-term care (LTC) poses a significant strain on public health insurance financing. In response, there is policy interest in bolstering the private long-term care insurance (LTCI) market. Although families are central to LTC provision, their role in LTCI demand remains unclear. The purpose of this study was to obtain in-depth information concerning: (a) How do older parents evaluate the need for LTCI, (b) what role do adult children play? and (c) How do families communicate about parents' LTC preferences and plans, including LTCI purchase? We conducted focus groups with older parents and adult children in diverse markets. Two groups were conducted with older parents who had purchased LTCI and two with parents who had not purchased LTCI. Four groups were conducted with adult children, mixed as to whether their parents had purchased LTCI. Probes were informed by published reasons for purchasing or not purchasing LTCI. We analyzed transcriptions using directed content analysis and constant comparative method. Older parents valued autonomy for themselves and their children. Older parent purchasers regarded LTCI as supporting this value while nonpurchasers perceived limitations. Adult children described unstated expectations that they would care for their parents. Though discussions between parents and children about LTCI were rare, successful influence occurred when children appealed to shared values, specifically avoiding burden and remaining home. Messages that emphasize autonomy over LTC decisions and interventions that start the LTC conversation among families, with attention to shared values, could increase private LTCI uptake. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

WA22 "it's hard to watch people die for a living": embedding the palliative approach into the organisational culture of long term care homes using participatory action research.

PubMed

Kelley, Mary Lou; Kaasalainen, Sharon; McKee, Marg; Marcella, Jill; Gaudet, Alesha; McAnulty, Jessica

2015-04-01

Long term care homes (LTC) in Canada have become a major location of death with 20% or more residents dying each year. Given the increasing age and frailty of residents, this is soon expected to increase to 40%. LTC has struggled to incorporate care of the dying into their day to day practice and culture because death is often absent from formalised policy and protocols. This workshop will share resources created during a 5 year participatory action research project in Ontario, Canada that aimed to improve the quality of life of people who were dying in long term care homes. Through staff participation and empowerment, a process of organisational capacity development was undertaken. An extensive needs assessment was followed by creating an interprofessional palliative care resource team within each home. This team assessed the assets and gaps in their home and guided development of education, policy and clinical practices to address needs. Community partners with expertise in palliative care were engaged to support staff. A framework for palliative care in LTC integrates the palliative approach into the residents' journey from admission to death. Resources for organisational change were developed and organised into a toolkit that is unique to the LTC setting and context, and can be accessed at www.palliativealliance.ca The Quality Palliative Care in Long term Care Toolkit is the first of its kind in Canada. The toolkit can guide LTC management and staff through a process of culture change to incorporate a palliative approach to care. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Elevated Serum Osmolality and Total Water Deficit Indicate Impaired Hydration Status in Long Term Care Residents Regardless of Low or High Body Mass Index

PubMed Central

Marra, Melissa Ventura; Hudson, Abbie L.; Hollingsworth, Emily K.; Long, Emily; Kuertz, Britt; Simmons, Sandra F.; Shotwell, Matthew S.; Silver, Heidi J.

2016-01-01

Background Dehydration is typically associated with underweight and malnutrition in long term care (LTC) settings. Evidence is lacking regarding the influence of the rising prevalence of overweight and obesity on risk factors, prevalence and presentation of dehydration. Objective The aim of this study was to objectively assess hydration status and the adequacy of total water intake, and determine relationships between hydration status, total water intake, and body mass index (BMI) in LTC residents. Design A cross-sectional analysis of baseline data was performed. Participants and setting Baseline data from 247 subjects recruited from 8 community-based LTC facilities participating in two randomized trials comparing nutrient and cost efficacy of between-meal snacks versus oral nutrition supplements. Main outcomes Hydration status was assessed by serum osmolality concentration and total water intakes were quantified by weighed food, beverage, water and oral nutrition supplement (ONS) intake. Statistical analyses Simple and multiple linear regression methods were applied. Results Forty-nine (38.3%) subjects were dehydrated (>300 mOsm/kg) and another 39 (30.5%) had impending dehydration (295–300 mOsm/kg). The variance in serum osmolality was significantly accounted for by blood urea nitrogen level, mental status score, and having diabetes (R2 = 0.46, P < 0.001). Total water intake averaged 1147.2 ± 433.1 mL/d. Thus, 96–100% subjects did not meet estimated requirements, with a deficit range of 700–1800 mL/d. The variance in total water intake was significantly accounted for by type of liquid beverages (thin vs thick), type of ONS, total energy intake, total activities of daily living dependence, sex and BMI (R2 = 0.56, P < 0.001). Conclusions Dehydration and inadequate total water intake is prevalent in LTC residents across all BMI categories. Type of liquid beverages, type of ONS, and type of between-meal snacks are factors that could be targeted for nutrition interventions designed to prevent or reverse dehydration. PMID:27126154

Elevated Serum Osmolality and Total Water Deficit Indicate Impaired Hydration Status in Residents of Long-Term Care Facilities Regardless of Low or High Body Mass Index.

PubMed

Marra, Melissa Ventura; Simmons, Sandra F; Shotwell, Matthew S; Hudson, Abbie; Hollingsworth, Emily K; Long, Emily; Kuertz, Brittany; Silver, Heidi J

2016-05-01

Dehydration is typically associated with underweight and malnutrition in long-term care (LTC) settings. Evidence is lacking regarding the influence of the rising prevalence of overweight and obesity on risk factors, prevalence, and presentation of dehydration. The aim of this study was to objectively assess hydration status and the adequacy of total water intake, and determine relationships between hydration status, total water intake, and body mass index (BMI) in LTC residents. A cross-sectional analysis of baseline data was performed. Baseline data from 247 subjects recruited from eight community-based LTC facilities participating in two randomized trials comparing nutrient and cost-efficacy of between-meal snacks vs oral nutrition supplements (ONS). Hydration status was assessed by serum osmolality concentration and total water intakes were quantified by weighed food, beverage, water, and ONS intake. Simple and multiple linear regression methods were applied. Forty-nine (38.3%) subjects were dehydrated (>300 mOsm/kg) and another 39 (30.5%) had impending dehydration (295 to 300 mOsm/kg). The variance in serum osmolality was significantly accounted for by blood urea nitrogen level, mental status score, and having diabetes (R(2)=0.46; P<0.001). Total water intake averaged 1,147.2±433.1 mL/day. Thus, 96% to 100% of subjects did not meet estimated requirements, with a deficit range of 700 to 1,800 mL/day. The variance in total water intake was significantly accounted for by type of liquid beverages (thin vs thick), type of ONS, total energy intake, total activities of daily living dependence, sex, and BMI (R(2)=0.56; P<0.001). Dehydration and inadequate total water intake is prevalent in LTC residents across all BMI categories. Type of liquid beverages, type of ONS, and type of between-meal snacks are factors that could be targeted for nutrition interventions designed to prevent or reverse dehydration. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Environmental Quality Standards Research on Wastewaters of Army Ammunition Plants

DTIC Science & Technology

1978-06-01

characterization of nitrocellulose wastewaters. We are grateful to LTC Leroy H. Reuter and LTC Robert P. Carnahan of the US Army Medical Research and...analytical methodology was required to characterize the wastes. The techniques used for fingerprinting (showing that the same compound exists although its...examination of the NC wastewaters has somewhat clarified the problem of characterizing the NC and has caused us to change or modify previous

The End-of-Life Experience in Long-Term Care: Five Themes Identified from Focus Groups with Residents, Family Members, and Staff

ERIC Educational Resources Information Center

Munn, Jean C.; Dobbs, Debra; Meier, Andrea; Williams, Christianna S.; Biola, Holly; Zimmerman, Sheryl

2008-01-01

Purpose: We designed this study to examine the end-of-life (EOL) experience in long-term care (LTC) based on input from key stakeholders. Design and Methods: The study consisted of 10 homogeneous focus groups drawn from a purposive sample of LTC residents (2 groups; total n = 11), family caregivers (2 groups; total n = 19), paraprofessional staff…

Identifying Insurgent Infrastructure

DTIC Science & Technology

1990-01-07

104, Underorounds. 7. DA PAM 550-104, Underoroundag p. 52. 8. DA PAM 550-106, Communist Insuroent InfragtructurA, p. 145. Also, LTC Rolando Garcia ...1985), p. 6-2. 30. LTC Rolando Garcia , Philippine Constabulary, interviews by author, 7 and 13 November 1989, Fort Leavenworth, KS. The CPP model was...Assistant U.S. Attorney, U.S. Department of Justice, Western District of Missouri. Inter-view by author. Kansas City, Missouri. 16 October 1989. Garcia

Exposure to lambda-cyhalothrin, a synthetic pyrethroid, increases reactive oxygen species production and induces genotoxicity in rat peripheral blood.

PubMed

Fetoui, Hamadi; Feki, Ameni; Salah, Ghada Ben; Kamoun, Hassen; Fakhfakh, Feiza; Gdoura, Radhouane

2015-05-01

Lambda-cyhalothrin (LTC) is a synthetic pyrethroid with a broad spectrum of insecticidal and acaricidal activities used to control a wide range of insect pests in a variety of applications. However, there is little known about its adverse effects, in particular those related to its genotoxicity in humans. To elucidate the genotoxicity mechanisms of LTC, the micronuclei (MN) frequencies, the levels of reactive oxygen species (ROS), erythrocyte osmotic fragility, nitrite (NO) formation, protein carbonyl (PCO) levels and malondialdehyde (MDA) production were evaluated for a period of 7, 14 and 21 days. Our results show that exposure rat to LTC (1/10DL50 = 6.23 mg/kg) for a period of 7, 14 and 21 days induced a noticeable genotoxic effect in rat peripheral blood evidenced by a significant increase in the frequency of MN only at day 21 of treatment. Significant differences between the two groups were observed in erythrocyte osmotic fragility. Further, a significant (p < 0.01) increase in ROS contents, NO formation, PCO levels and lipid peroxidation in erythrocytes were observed at different times of treatments, suggesting the implication of oxidative stress in its toxicity. These results confirm the genotoxic and the pro-oxidant effects of LTC in rat peripheral blood. © The Author(s) 2013.

Mental Health Care for LGBT Older Adults in Long-Term Care Settings: Competency, Training, and Barriers for Mental Health Providers.

PubMed

Smith, Ronald W; Altman, Jennifer K; Meeks, Suzanne; Hinrichs, Kate Lm

2018-06-07

To assess mental health providers' experience with LGBT older adults in long-term care (LTC) settings and perceived barriers to quality care. Providers (N = 57) completed an online survey on demographics and practice characteristics. They were also asked about: number of LGBT residents they've worked with, relevance of LGBT issues to their practice, preparedness, willingness to learn, hours of formal/informal training, and barriers to providing care to LGBT patients. Respondents were 63% psychologists, 16% social workers, 14% psychiatrists, and 5% nurses, most of whom practiced in LTC consulting roles. Most providers felt working with LGBT issues was relevant to their practice and felt well-prepared and willing to learn, though they were unaware of evidence based practices (EBTs), especially for LTC settings. They had little coursework on LGBT issues, and identified lack of training, stigma, and residents concealing their identity as the greatest barriers to quality care. Mental health providers in LTC facilities would benefit from more training in LGBT-specific mental health problems and evidence-based treatments, and efforts to destigmatize LGBT identities in these settings might improve access to mental health care. LGBT-specific training and EBTs are needed. Facilities need to address stigma with residents and providers.

Characterization of the interaction between subunits of the botulinum toxin complex produced by serotype D through tryptic susceptibility of the isolated components and complex forms.

PubMed

Suzuki, Tomonori; Watanabe, Toshihiro; Mutoh, Shingo; Hasegawa, Kimiko; Kouguchi, Hirokazu; Sagane, Yoshimasa; Fujinaga, Yukako; Oguma, Keiji; Ohyama, Tohru

2005-05-01

The 650 kDa large toxin complex (L-TC) produced by Clostridium botulinum serotype D strain 4947 (D-4947) has a subunit structure composed of unnicked components, i.e. neurotoxin (NT), non-toxic non-haemagglutinin (NTNHA) and three haemagglutinin subcomponents (HA-70, HA-33 and HA-17). In this study, subunit interactions were investigated through the susceptibilities of the toxin components to limited trypsin proteolysis. Additionally, complex forms were reconstituted in vitro by various combinations of individual components. Trypsin treatment of intact D-4947 L-TC led to the formation of mature L-TC with nicks at specific sites of each component, which is usually observed in other strains of serotype D. NT, NTNHA and HA-17 were cleaved at their specific sites in either the single or complex forms, but HA-33 showed no sign of proteolysis. Unlike the other components, HA-70 was digested into random fragments as a single form, but it was cleaved into two fragments in the complex form. Based on the relative position of exposed or hidden regions of the individual components in the complex derived from their tryptic susceptibilities, an assembly model is proposed for the arrangement of individual subunits in the botulinum L-TC.

Evaluation of Cueing Innovation for Pressure Ulcer Prevention Using Staff Focus Groups.

PubMed

Yap, Tracey L; Kennerly, Susan; Corazzini, Kirsten; Porter, Kristie; Toles, Mark; Anderson, Ruth A

2014-07-25

The purpose of the manuscript is to describe long-term care (LTC) staff perceptions of a music cueing intervention designed to improve staff integration of pressure ulcer (PrU) prevention guidelines regarding consistent and regular movement of LTC residents a minimum of every two hours. The Diffusion of Innovation (DOI) model guided staff interviews about their perceptions of the intervention's characteristics, outcomes, and sustainability. This was a qualitative, observational study of staff perceptions of the PrU prevention intervention conducted in Midwestern U.S. LTC facilities (N = 45 staff members). One focus group was held in each of eight intervention facilities using a semi-structured interview protocol. Transcripts were analyzed using thematic content analysis, and summaries for each category were compared across groups. The a priori codes (observability, trialability, compatibility, relative advantage and complexity) described the innovation characteristics, and the sixth code, sustainability, was identified in the data. Within each code, two themes emerged as a positive or negative response regarding characteristics of the innovation. Moreover, within the sustainability code, a third theme emerged that was labeled "brainstormed ideas", focusing on strategies for improving the innovation. Cueing LTC staff using music offers a sustainable potential to improve PrU prevention practices, to increase resident movement, which can subsequently lead to a reduction in PrUs.

Understanding safety culture in long-term care: a case study.

PubMed

Halligan, Michelle H; Zecevic, Aleksandra; Kothari, Anita R; Salmoni, Alan W; Orchard, Treena

2014-12-01

This case study aimed to understand safety culture in a high-risk secured unit for cognitively impaired residents in a long-term care (LTC) facility. Specific objectives included the following: diagnosing the present level of safety culture maturity using the Patient Safety Culture Improvement Tool (PSCIT), examining the barriers to a positive safety culture, and identifying actions for improvement. A mixed methods design was used within a secured unit for cognitively impaired residents in a Canadian nonprofit LTC facility. Semistructured interviews, a focus group, and the Modified Stanford Patient Safety Culture Survey Instrument were used to explore this topic. Data were synthesized to situate safety maturity of the unit within the PSCIT adapted for LTC. Results indicated a reactive culture, where safety systems were piecemeal and developed only in response to adverse events and/or regulatory requirements. A punitive regulatory environment, inadequate resources, heavy workloads, poor interdisciplinary collaboration, and resident safety training capacity were major barriers to improving safety. This study highlights the importance of understanding a unit's safety culture and identifies the PSCIT as a useful framework for planning future improvements to safety culture maturity. Incorporating mixed methods in the study of health care safety culture provided a good model that can be recommended for future use in research and LTC practice.

General Aviation Activity and Avionics Survey 1981.

DTIC Science & Technology

1982-12-01

iso Is188.1 185- SUMk TAM 2-1 19 118 1976 I0 191 YEAR L. TU DAMWD UNU RKVZSWT A 96X CONVID&NCU INIUL FOR T23 IVŕ - 1661 TRUB UM SIM APPUNIX D. Tot...LYC 0320 41500 NT4CNCCULNACO 2002 LTC 0320 4150 ARSRCMF9731 ’?fB7 FRNKLN4AC150 27003 LVC 0320 41509 ARSkCHW1731 01518 FRNILN4ACISO 27003 LTC 0320 4150

Re-introducing Conceptual and Detailed Planning: Differentiating Between Decision Making and Problem Identification

DTIC Science & Technology

2012-05-17

emphasizes its importance. BG Edward Cardon and LTC Steve Leonard point out, “many of the concepts underpinning design are not...70 BG Edward C. Cardon and LTC Steve Leonard, “Unleashing Design; Planning and the Art of Battle Command,” Military Review Mar...Apr (2010): 2. 71 Cardon and Leonard, “Unleashing Design; Planning and the Art of Battle Command,” 3. 33 structured problems using complexity theory

Enhancing Interoperability Among Enlisted Medical Personnel. A Case Study of Military Surgical Technologists

DTIC Science & Technology

2009-01-01

Thomas Manacapilli, Daniel Gershwin, Andrew Baxter, Roland J. Yardley Prepared for the Office of the Secretary of Defense Approved for public release...particularly thank Pete Altman, LTC Kathleen McArthur, CAPT Leigh Wickes, HMCS Douglas Glascoe, HMCM James Menke, Jerral Behnke, LTC Katrina Glavan-Heise, and...TIO Transformation Integration Office TNCC Thomas Nelson Community College TRADOC Training and Doctrine Command TS-C Tech in Surgery—Certified USD

Stakeholder opinions on a transformational model of pain management in long-term care.

PubMed

Hadjistavropoulos, Thomas; Janzen Claude, Jennifer A; Hadjistavropoulos, Heather; Marchildon, Gregory P; Kaasalainen, Sharon; Gallagher, Romayne; Beattie, B Lynn

2011-07-01

Pain in older adults with dementia who reside in long-term care (LTC) facilities tends to be undertreated, despite important guidelines designed to ameliorate this problem. A group of public policy and geriatric pain experts recently concluded that existing guidelines are not being implemented because they fail to take into account policy and resource realities. The group published a set of more feasible guidelines that confront these realities (e.g., a recommendation for very brief pain assessments that can be conducted by nursing staff at least weekly). We asked stakeholders to provide opinions on the possibility of implementation of these guidelines within their LTC facilities. Our results support the feasibility of, interest in, and desirability of implementation. They also support an increased role for nurse leadership in LTC pain management. These results could be used to strengthen advocacy efforts for improvement in pain management. Copyright 2011, SLACK Incorporated.

Long-Term Care Insurance: Does Experience Matter?*

PubMed Central

Coe, Norma B.; Skira, Meghan M.; Van Houtven, Courtney Harold

2015-01-01

We examine whether long-term care (LTC) experience helps explain the low demand for long-term care insurance (LTCI). We test if expectations about future informal care receipt, expectations about inheritance receipt, and LTCI purchase decisions vary between individuals whose parents or in-laws have used LTC versus those who have not. We find parental use of a nursing home decreases expectations that one’s children will provide informal care, consistent with the demonstration effect. Nursing home use by in-laws does not have the same impact, suggesting that individuals are responding to information gained about their own aging trajectory. Nursing home use by either a parent or in-law increases LTCI purchase probability by 0.8 percentage points, with no significant difference in response between parents’ and in-laws’ use. The estimated increase in purchase probability from experience with LTC is about half the previously estimated increase from tax policy-induced price decreases. PMID:25647006

Aging and place in long-term care settings: influences on social relationships.

PubMed

Bonifas, Robin P; Simons, Kelsey; Biel, Barbara; Kramer, Christie

2014-12-01

This article presents results of a qualitative research study that examined how living in a long-term care (LTC) home influences the quality of residents' relationships with peers, family members, and outside friends. Semistructured interviews using a phenomenological approach were conducted with 23 residents of a LTC home. Thematic analysis was employed to illuminate residents' perspectives on the nature of social relationships in this setting. Four key themes were identified that highlight the role of place in social relationships. Residing in a LTC home influences the context of social interactions, impacts their quality and process, clusters individuals with health and functional declines that hinder socialization, and poses structural and cultural barriers that impede social interactions. Health and functional limitations posed the greatest challenge to socialization relative to characteristics of the facility itself. Residents' insights emphasize how personal characteristics influence community culture and the experience of place. © The Author(s) 2014.

Competitive Strategies

DTIC Science & Technology

1988-05-27

Competitive Strategies Individual Essay 6. PERFORMING ORG. REPORT NUMBER 7. AUTHOR(@) S. CONTRACT OR GRANT NUMBER( e ) Robert M. Davis, LTC, AD S...DO FOe 1473 emIotN or, Nov es IS OBSOLETE -JA I Unclassifi fed SECURITY CLASSIFICATION OF THIS PA7. E (Whrn Does Entered) Unclassified SECURITY...focus within the Department of Defense to provide technical and tactical leverage over the Soviets. Competitive Strategies are a management tool which

Science and Technology for the Future Force. FY2006 Summer Study

DTIC Science & Technology

2007-03-01

Panel Members Co-Chairs • Allen Adler • Gil Herrera • Charley Otstott Staff Assistant • Oscar Valent, ASA(ALT) Government Advisors • LTC(P) Keith Edwards...measures to cross- train/ educate personnel Transitioning Technology is a Contact Sport Technology transition from the S&T community to the acquisition...Members Co-Chairs • Allen Adler • Gil Herrera • Charley Otstott Staff Assistant • Oscar Valent, ASA(ALT) Government Advisors • LTC(P) Keith Edwards, ARCIC

Connected. Volume 5, Issue 1, Spring 2013

DTIC Science & Technology

2013-04-18

operational. Fur- thermore, KM will be the force multiplier that allows us to take “KM to the tactical edge”. LTC Mike Kitchens , Chief - Concepts and...KMRs with their du- ties. This handbook is a ’ companion book’ to the KMO handbook, is structured the same way, and has the same perspective. This...general_km_topics/ connected_newsletter AOKMP POCs Jim L. Claunch, 913-684-6793, jimmie.l.claunch.civ@mail.mil LTC Michael Kitchens , 913-684-4498

Privatized Military Operations

DTIC Science & Technology

2007-01-01

James C. Becker Jr, U.S. Marine Corps Lt Col Harry A. Berry , U.S. Air Force LTC Kenneth L. Boehme, U.S. Army Ms. Veronica R. Crutches, Department of...A. Wyche, Defense Logistics Agency Col Lawrence K. Grubbs, U.S. Air Force, PMO Faculty Col Patrick M. Shaw , U.S. Air Force, PMO Faculty LTC (P...unique services to Fortune 100 companies for whom PMO business is a minuscule portion of their annual revenue. Apart from a few dozen large, widely

A Methodology for Capturing and Analyzing Data from Technology Base Seminar Wargames

DTIC Science & Technology

1991-09-01

LONG RANGE FIRES LTC Angus USAFAS Dr. Brown ARO Mr. Campi CECOM LTC De Broux USACACDA COL James ARDEC Mr. Konick HDL Mr. Lavoie AFAU MAJ Martin ARDEC...85.17 2 SUPPLY DISTRIBUTION 81.92 3 RELIABILITY 91.89 1 TAC SUP TRANSPORT 77.91 5 TAC POL TRANSPORT 78.66 4 137 TABLE 7. QUESTION 7. ASSESS THE...C) Logistica nobility ) ( ) ( ) ( ) () ( ) ( Industrial Bass C) ( ) () () C) () ( Soldier Training hSO () ( ) () ( ) ( ) ) ( Nmnpouranagm nt

The Battle of Aschaffenburg: An Example of Late World War 2 Urban Combat in Europe

DTIC Science & Technology

1989-06-02

Division (LTC Abams) German Units - ARMY: Seventh ( Gen . der Inf. Felber) ( Gen . der Inf. Obstfelder, 26 March) CORPS: L)XOII ( Gen . dir Inf. Hahn...4 Armored Division (LTC Abrams) Ist Bn, 104 Infantry (attached to 4 AD) German Units - ARMY: Seventh ( Gen . dir Inf. Obstfelder) CORPS: DOCOII ( Gen ...Haislip) DIVISION: 44 Infantry Division (MG Dean) 45 Infantry Division (MG Fredericks) German Units - ARMY: Seventh ( Gen . dir Inf. Obstfelder) CORPS

The Crucial Role of the Operational Artist: A Case Study of Operation Barbarossa

DTIC Science & Technology

2017-05-25

historical case study helps to develop a better understanding of operational art today. Future studies might focus on the limitations and opportunities...The Crucial Role of the Operational Artist: A Case Study of Operation Barbarossa A Monograph by LTC (GS) Hagen H. Ruppelt German Army...a Case Study of Operation Barbarossa 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) LTC (GS) Hagen H

Migrants' decision-process shaping work destination choice: the case of long-term care work in the United Kingdom and Norway.

PubMed

Christensen, Karen; Hussein, Shereen; Ismail, Mohamed

2017-09-01

Escalating demands for formal long-term care (LTC) result in the reliance on migrant workers in many developed countries. Within Europe, this is currently framed by progressive European immigration policies favouring inter-European mobility. Using the UK and Norway as case studies, this article has two main aims: (1) to document changes in the contribution of European Union (EU) migrants to the LTC sectors in Western Europe, and (2) to gain further understanding of migrants' decision-processes relating to destination and work choices. The UK and Norway provide examples of two European countries with different immigration histories, welfare regimes, labour market characteristics and cultural values, offering a rich comparison platform. The analysis utilizes national workforce datasets and data obtained from migrants working in the LTC sector in the UK and Norway ( n  = 248) and other stakeholders ( n  = 136). The analysis establishes a significant increase in the contribution of EU migrants (particularly from Eastern Europe) to the LTC sector in both the UK and Norway despite their different welfare regimes. The findings also highlight how migrant care workers develop rational decision-processes influenced by subjective perspectives of investments and returns within a context of wider structural migration barriers. The latter includes welfare and social care policies framing the conditions for migrants' individual actions.

Inhibition of histamine and eicosanoid release from dispersed human lung cells in vitro by quinotolast.

PubMed

Okayama, Y; Hiroi, J; Lau, L C; Church, M K

1995-12-01

We have examined the effects of a new anti-allergic drug, quinotolast [sodium 5-(4-oxo-1-phenoxy-4H-quinolizine-3-carboxamido) yetrazolate monohydrate], in inhibiting the release of histamine and the generation of leukotriene (LT) C4 and prostaglandin (PG) D2 from dispersed human lung cells and compared this with those of its active metabolite in the rat, hydroxy quinotolast, and reference drugs, tranilast and sodium cromoglycate (SCG). Quinotolast in the concentration range of 1-100 micrograms/ml inhibited histamine and LTC4 release in a concentration-dependent manner. The inhibitory effect of quinotolast on histamine release from dispersed lung cells was largely independent of the preincubation period, no tachyphylaxis being observed. Hydroxy quinotolast and tranilast showed a weak inhibition of histamine release only when the drugs were added to the cells simultaneously with anti-IgE challenge. Quinotolast, 100 micrograms/ml, and SCG, 1 mM, significantly inhibited PGD2 and LTC4 release. Quinotolast inhibited PGD2 release by 100% and LTC4 release by 54%, whereas SCG inhibited PDG2 release by 33% and LTC4 release by 100%. No cross-tachyphylaxis between quinotolast and SCG was observed. The results demonstrated that quinotolast showed a significant inhibition of inflammatory mediators from human dispersed lung cells, suggesting that quinotolast is a good candidate for a clinical anti-allergic drug.

Similar and yet so different: cash-for-care in six European countries' long-term care policies.

PubMed

Da Roit, Barbara; Le Bihan, Blanche

2010-09-01

In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes-allowances instead of services provided to dependents-represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored. While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require. © 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Fairness and Eligibility to Long-Term Care: An Analysis of the Factors Driving Inequality and Inequity in the Use of Home Care for Older Europeans.

PubMed

Ilinca, Stefania; Rodrigues, Ricardo; Schmidt, Andrea E

2017-10-14

In contrast with the case of health care, distributional fairness of long-term care (LTC) services in Europe has received limited attention. Given the increased relevance of LTC in the social policy agenda it is timely to evaluate the evidence on inequality and horizontal inequity by socio-economic status (SES) in the use of LTC and to identify the socio-economic factors that drive them. We address both aspects and reflect on the sensitivity of inequity estimates to adopting different definitions of legitimate drivers of care need. Using Survey of Health, Ageing and Retirement in Europe (SHARE)data collected in 2013, we analyse differences in home care utilization between community-dwelling Europeans in nine countries. We present concentration indexes and horizontal inequity indexes for each country and results from a decomposition analysis across income, care needs, household structures, education achievement and regional characteristics. We find pro-poor inequality in home care utilization but little evidence of inequity when accounting for differential care needs. Household characteristics are an important contributor to inequality, while education and geographic locations hold less explanatory power. We discuss the findings in light of the normative assumptions surrounding different definitions of need in LTC and the possible regressive implications of policies that make household structures an eligibility criterion to access services.

Similar and Yet So Different: Cash-for-Care in Six European Countries’ Long-Term Care Policies

PubMed Central

Da Roit, Barbara; Le Bihan, Blanche

2010-01-01

Context: In response to increasing care needs, the reform or development of long-term care (LTC) systems has become a prominent policy issue in all European countries. Cash-for-care schemes—allowances instead of services provided to dependents—represent a key policy aimed at ensuring choice, fostering family care, developing care markets, and containing costs. Methods: A detailed analysis of policy documents and regulations, together with a systematic review of existing studies, was used to investigate the differences among six European countries (Austria, France, Germany, Italy, the Netherlands, and Sweden). The rationale and evolution of their various cash-for-care schemes within the framework of their LTC systems also were explored. Findings: While most of the literature present cash-for-care schemes as a common trend in the reforms that began in the 1990s and often treat them separately from the overarching LTC policies, this article argues that the policy context, timing, and specific regulation of the new schemes have created different visions of care and care work that in turn have given rise to distinct LTC configurations. Conclusions: A new typology of long-term care configurations is proposed based on the inclusiveness of the system, the role of cash-for-care schemes and their specific regulations, as well as the views of informal care and the care work that they require. PMID:20860573

Analysis of leukotrienes in cerebrospinal fluid of a reference population and patients with inborn errors of metabolism: further evidence for a pathognomonic profile in LTC(4)-synthesis deficiency.

PubMed

Mayatepek, E; Zelezny, R; Hoffmann, G F

2000-02-25

Cysteinyl leukotrienes (LTC(4), LTD(4), LTE(4)) are potent lipid mediators derived from arachidonate in the 5-lipoxygenase pathway. Recently, the first inborn error of leukotriene synthesis, LTC(4)-synthesis deficiency, has been identified in association with a fatal developmental syndrome. The absence of leukotrienes in cerebrospinal fluid was one of the most striking biochemical findings in this disorder. We analysed leukotrienes in cerebrospinal fluid of patients with a broad spectrum of other well-defined inborn errors of metabolism, including glutathione synthetase deficiency (n=2), Zellweger syndrome (n=3), mitochondrial disorders (n=8), fatty acid oxidation defects (n=7), organic acidurias (n=7), neurotransmitter defects (n=5) and patients with non-specific neurological symptoms, as a reference population (n=120). The concentrations of leukotrienes were not related to age. Representative percentiles were calculated as reference intervals of each leukotriene. In all patients with an inborn error of metabolism concentration of cysteinyl leukotrienes and LTB(4) did not differ from the reference group. Our results indicate that absence of cysteinyl leukotrienes (<5 pg/ml) in association with normal or increased LTB(4) (50.0-67.3 pg/ml) is pathognomonic for LTC(4)-synthesis deficiency. The unique profile of leukotrienes in cerebrospinal fluid in this new disorder is primarily related to the defect and represents a new diagnostic approach.

Barriers to providing palliative care in long-term care facilities

PubMed Central

Brazil, Kevin; Bédard, Michel; Krueger, Paul; Taniguchi, Alan; Kelley, Mary Lou; McAiney, Carrie; Justice, Christopher

2006-01-01

OBJECTIVE To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. DESIGN Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. SETTING All licensed LTC facilities in Ontario with designated medical directors. PARTICIPANTS Medical directors in the facilities. MAIN OUTCOME MEASURES Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. RESULTS Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff’s capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%). CONCLUSION Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care. PMID:17327890

Implementing oral care practices and policy into long-term care: the Brushing up on Mouth Care project.

PubMed

McNally, Mary; Martin-Misener, Ruth; McNeil, Karen; Brillant, Martha; Moorhouse, Paige; Crowell, Sandra; Matthews, Debora; Clovis, Joanne

2015-03-01

Optimal mouth care is integral to the health and quality of life of dependent older adults.Yet, a persistent lack of adequate oral care in long-term care (LTC) facilities exacerbates the burden of disease experienced by residents. The reasons for this are complex and create enormous challenges for care providers, clinicians, and administrators dedicated to comprehensive high quality care. The aim of this study was to develop, implement, and evaluate a comprehensive program for daily mouth care for LTC. A case study design using a participatory and qualitative approach examined how individual, organizational (workplace practices and culture), and system factors (standards and policy) influenced the development and implementation of a comprehensive program to improve the delivery of daily oral care in LTC. The research was undertaken in 3 LTC residences administered under the same health authority and included personal care providers, nurse managers, and directors of care. A comprehensive program for care providers including, education, resources, and organizational guidelines, to improve the delivery of daily mouth care to LTC residents was created, rolled out, and refined over a 12-month period. Data was collected through diary studies, targeted interviews, field notes, oral care activities records, site team meetings, and direct feedback from members of the care team. The oral care intervention resulted in a heightened awareness, support and greater efficiency amongst care team. The presence of a "champion" was a key feature for sustaining processes. Management had a clear role to play to ensure support and accountability for the intervention. Optimizing oral care in long-term care can be achieved through an integrated approach that includes education, provision of resources, an oral care champion, support from managers and administrators, and appropriate organizational policy. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Comprehensive geriatric intervention program with and without weekly class-style exercise: research protocol of a cluster randomized controlled trial in Kyoto-Kameoka Study

PubMed Central

Yoshida, Tsukasa; Yoshinaka, Yasuko; Yoshimoto, Mie; Tanaka, Yoko; Itoi, Aya; Yamagata, Emi; Ebine, Naoyuki; Ishikawa-Takata, Kazuko; Kimura, Misaka

2018-01-01

Objective The number of long-term care (LTC) users and the associated expenditures in Japan are increasing dramatically. The national government recommends LTC prevention through activation of communities. However, there is no clear evidence of the effect of population-based comprehensive geriatric intervention program (CGIP) for restraints of LTC users and the associated expenditures in the future. The aims of the current paper are to describe the study protocol and progress of a cluster randomized controlled trial (RCT) with a CGIP in Kameoka City. Methods The cluster RCT involved random allocation of regions as intervention (n=4,859) and nonintervention (n=7,195). Participants were elderly persons aged ≥65 years without LTC certification who had responded to a mailing survey. The residents living in intervention regions were invited to a physical check-up, and 1,463 people participated (30.3%). These individuals were invited to the CGIP, and 526 accepted. The CGIP comprised instructions on: 1) low-load resistance training using bodyweight, ankle weights, and elastic bands; 2) increasing daily physical activity; 3) oral motor exercise and care; and 4) a well-balanced diet based on a program from Ministry of Health, Labour and Welfare. We allocated the intervention regions randomly into home-based self-care program alone (HB group, 5 regions, n=275) and home-based program+weekly class-style session (CS group, 5 regions, n=251). We evaluated the effects of the CGIP at 12 weeks and at 12 or 15 months on physical function, and are conducting follow-up data collection for an indefinite period regarding LTC certification, medical costs, and mortality. Results and discussion The study was launched with good response rates in each phase. Participants of both groups significantly increased their step counts by ~1,000 per day from the baseline during the CGIP. This RCT will provide valuable information and evidence about effectiveness of a community-based CGIP. PMID:29872280

Sickle erythrocytes and platelets augment lung leukotriene synthesis with downregulation of anti-inflammatory proteins: relevance in the pathology of the acute chest syndrome

PubMed Central

Opene, Michael; Kurantsin-Mills, Joseph; Husain, Sumair

2014-01-01

Abstract Initiation, progression, and resolution of vaso-occlusive pain episodes in sickle cell disease (SCD) have been recognized as reperfusion injury, which provokes an inflammatory response in the pulmonary circulation. Some 5-lipoxygenase (5-lox) metabolites are potent vasoconstrictors in the pulmonary circulation. We studied stimulation of production of the inflammatory eicosanoids leukotrienes (LTs) and prostaglandin E2 (PGE2) by isolated rat lungs perfused with sickle (HbSS) erythrocytes. Our hypothesis is that HbSS erythrocytes produce more LTs than normal (HbAA) erythrocytes, which can induce vaso-occlusive episodes in SCD patients. Lung perfusates were collected at specific time points and purified by high-pressure liquid chromatography, and LTC4 and PGE2 contents were measured by enzyme-linked immunosorbent assay (ELISA). Rat lung explants were also cultured with purified HbAA and HbSS peptides, and 5-lox, cyclooxygenase 1/2, and platelet-activating factor receptor (PAFR) proteins were measured by Western blotting, while prostacyclin and LTs produced by cultured lung explants were measured by ELISA. Lung weight gain and blood gas data were not different among the groups. HbSS-perfused lungs produced more LTC4 and PGE2 than HbAA-perfused lungs: 10.40 ± 0.62 versus 0.92 ± 0.2 ng/g dry lung weight (mean ± SEM; P = 0.0001) for LTC4. Inclusion of autologous platelets (platelet-rich plasma) elevated LTC4 production to 12.6 ± 0.96 and 7 ± 0.60 ng/g dry lung weight in HbSS and HbAA perfusates, respectively. HbSS lungs also expressed more 5-lox and PAFR. The data suggest that HbSS erythrocytes and activated platelets in patient’s pulmonary microcirculation will enhance the synthesis and release of the proinflammatory mediators LTC4 and PGE2, both of which may contribute to onset of the acute chest syndrome in SCD. PMID:25621162

Variation in the days supply field for osteoporosis medications in Ontario.

PubMed

Burden, Andrea M; Huang, Anjie; Tadrous, Mina; Cadarette, Suzanne M

2013-01-01

We examined pharmacy claims for osteoporosis medications dispensed in the community (78 %) and long-term care (LTC) to determine if days supply values matched expected dosing intervals. Results identify potential reporting errors that can have implications for drug exposure misclassification, particularly in LTC where only 59 % of reported values matched expected values. The days supply field is commonly used to examine patterns of drug utilization and classify drug exposure, yet its accuracy has received little attention. We sought to describe the days supply reported for osteoporosis drugs and examine if values matched expected therapeutic dosing intervals. We examined days supply values for osteoporosis medications submitted to the Ontario Drug Benefits program for seniors, 1997-2011. Days supply values were evaluated by dosing regimen and setting (community or long-term care [LTC]) and compared to pre-defined expected values. We defined expected days supply by the therapeutic dosing interval: daily in 7- or 30-day intervals, or as 100 days; weekly in 7- or 30-day intervals; monthly and daily nasal spray in 28- or 30-day intervals; and cyclical etidronate as a 90-day supply. We identified 17,615,404 osteoporosis prescriptions, with 78 % dispensed in the community. Most daily oral prescriptions were dispensed by an expected therapeutic dosing interval (97 %). Annual IV zoledronic acid was most commonly dispensed as a 1-day supply (62 %). Distinct differences in agreement were observed for other regimens, with the expected days supply more commonly reported in community versus LTC: cyclical etidronate (86 % vs. 40 %), weekly (91 % vs. 60 %), monthly (94 % vs. 35 %), and nasal spray (84 % vs. 40 %). Results suggest that inaccuracies in the days supply field exist, particularly among prescriptions dispensed in LTC. Inaccurate reporting may have significant implications for osteoporosis drug exposure misclassification.

Secretion of leukotriene C and other arachidonic acid metabolites by macrophages challenged with immunoglobulin E immune complexes

PubMed Central

1982-01-01

Resident mouse peritoneal macrophages release the slow-reacting substance leukotriene C (LTC) on exposure to particulate IgE immune complexes. Because these cells lose their responsiveness to an IgE stimulus after 4 h in culture, maximum release of 20:4 metabolites is observed before this time. However, a similar diminution in 20:4 metabolism was not observed with a zymosan stimulus. Freshly explanted cells are deficient in intracellular glutathione (GSH) (12.4 +/- 0.4 pmol/micrograms cell protein), but GSH increases to a steady state value of 30-35 pmol/micrograms of cell protein between 3 and 9 h of culture. Because GSH is required for the synthesis of LTC and prostaglandin (PG)E2, cultures challenged immediately after explanation have a diminished capacity to synthesize these 20:4 metabolites and release prostacyclin as the major product. By 4-5 h in culture, macrophages form significant amounts of LTC and PGE2. Under optimum conditions of maximum responsiveness to an IgE stimulus and GSH content (after 4 h of culture), macrophages challenged with latex beads coated with IgE immune complexes synthesize 1.0 +/- 0.3 pmol of LTC/microgram cell protein (60 +/- 18 pmol/10(6) cells) in addition to prostacyclin (8.2 +/- 0.8 pmol/micrograms cell protein) and PGE2 (4.7 +/- 1.5 pmol/micrograms cell protein). These amounts are quantitatively similar to the arachidonic acid metabolites produced by macrophages challenged with IgG immune complex-coated latex beads or zymosan. These data demonstrate that macrophages produce large quantities of LTC and other 20:4 metabolites in response to particle-bound IgE and antigen, provided that the appropriate in vitro conditions are met. The macrophage might, therefore, be a major source of slow-reacting substance and other 20:4 metabolites generated during IgE-mediated reactions in vivo. PMID:6759607

Barriers to providing palliative care in long-term care facilities.

PubMed

Brazil, Kevin; Bédard, Michel; Krueger, Paul; Taniguchi, Alan; Kelley, Mary Lou; McAiney, Carrie; Justice, Christopher

2006-04-01

To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. All licensed LTC facilities in Ontario with designated medical directors. Medical directors in the facilities. Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%). Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care.

Management of Diabetes in Long-term Care and Skilled Nursing Facilities: A Position Statement of the American Diabetes Association.

PubMed

Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B

2016-02-01

Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Rethinking Military Personnel Evaluations

DTIC Science & Technology

2011-03-23

review of references describing this effect, see Stephanie L. Wolfgeher, Inflation of USAF Officer Performance Reports: Analyzing the Organizational...Dennis P. Chapman, "It’s Time for a New Round of OER Reform," Military Review 86, no. 5 (September-October 2006), 100. 23 LTC Briggs is an Operations...Research Analyst who has an interesting, and award- winning, model for predicting promotion rates in the aggregate. David Briggs , "Modeling Army

U.S. Southwest Border Security: An Operational Approach

DTIC Science & Technology

2012-06-08

should be aware that notwithstanding any other provision of law , no person shall be subject to any penalty for failing to comply with a collection...Force – North LEA Law Enforcement Agency LTC Lieutenant Colonel MNC Multi-National Company MOE Measure of Effectiveness MOP Measure of Performance... NAFTA North American Free Trade Agreement NG National Guard ONDCP Office of National Drug Control Policy SGA Small Group Advisor TCO Transnational

Realizing Broadband and Invertible Linear-to-circular Polarization Converter with Ultrathin Single-layer Metasurface

PubMed Central

Li, Zhancheng; Liu, Wenwei; Cheng, Hua; Chen, Shuqi; Tian, Jianguo

2015-01-01

The arbitrary control of the polarization states of light has attracted the interest of the scientific community because of the wide range of modern optical applications that such control can afford. However, conventional polarization control setups are bulky and very often operate only within a narrow wavelength range, thereby resisting optical system miniaturization and integration. Here, we present the basic theory, simulated demonstration, and in-depth analysis of a high-performance broadband and invertible linear-to-circular (LTC) polarization converter composed of a single-layer gold nanorod array with a total thickness of ~λ/70 for the near-infrared regime. This setup can transform a circularly polarized wave into a linearly polarized one or a linearly polarized wave with a wavelength-dependent electric field polarization angle into a circularly polarized one in the transmission mode. The broadband and invertible LTC polarization conversion can be attributed to the tailoring of the light interference at the subwavelength scale via the induction of the anisotropic optical resonance mode. This ultrathin single-layer metasurface relaxes the high-precision requirements of the structure parameters in general metasurfaces while retaining the polarization conversion performance. Our findings open up intriguing possibilities towards the realization of novel integrated metasurface-based photonics devices for polarization manipulation, modulation, and phase retardation. PMID:26667360

Oxidation catalyst

DOEpatents

Ceyer, Sylvia T.; Lahr, David L.

2010-11-09

The present invention generally relates to catalyst systems and methods for oxidation of carbon monoxide. The invention involves catalyst compositions which may be advantageously altered by, for example, modification of the catalyst surface to enhance catalyst performance. Catalyst systems of the present invention may be capable of performing the oxidation of carbon monoxide at relatively lower temperatures (e.g., 200 K and below) and at relatively higher reaction rates than known catalysts. Additionally, catalyst systems disclosed herein may be substantially lower in cost than current commercial catalysts. Such catalyst systems may be useful in, for example, catalytic converters, fuel cells, sensors, and the like.

Dancing the Two-Step in Ontario's Long-term Care Sector: More Deterrence-oriented Regulation = Ownership and Management Consolidation.

PubMed

Daly, Tamara

2015-03-01

This paper explores shifts in public and private delivery over time through an analysis of Ontario's approach to LTC funding and regulation in relation to other jurisdictions in Canada and abroad. The case of Ontario's long-term care (LTC) policy evolution - from the 1940s until early 2013 -- shows how moving from compliance to deterrence oriented regulation can support consolidation of commercial providers' ownership and increase the likelihood of non-profit and public providers outsourcing their management.

Effects of Environment on Infection in Burn Patients

DTIC Science & Technology

1986-01-01

medical archives; NSA, nurses’ station, acute-care patients ; NSB, nurses’ station, intermediate-care patients ; OT", occupational therapy section; QAP...Reprinted from the Archives of Surgery January 1986, Volume 121 Copyright 1986, American Medical Association 00 ’d". CD Y" E LE C; I Effects of...Environment on Infection in Burn Patients LTC Khan Z. Shirani, MC, USA; Albert T. McManus, PhD; LTC George M. Vaughan, MC, USA; COL William F. McManus, MC

Industry Study Report 1992-1993

DTIC Science & Technology

1993-01-01

The July 1992 DoD Science and Technology ( S & r ) program advocates many of these technologies. We support the S &T technical objective roadmaps established...the rate of growth in R &D spending has decreased from an average of 17% per year in the early 1980’ s to 7% in the last half of the 1980’ss. 2-11 Our...Defense LTC Bill R . Moore, USA . Car Earl A. Richardson, USN LTC Raymond L. Rodon, USA Mr. Morris S . Solomon, Defense Mapping Agency Lt Col Robert M

Competent, Confident and Agile? A Study of the U.S. Army Leadership Requirements Model and its Application for U.S. Army Company Commanders

DTIC Science & Technology

2011-06-10

Thesis Committee Chair John M. Persyn, Ph.D. , Member LTC Eric K. Dunahee, M.S. , Member Robert D. Bloomquist, M.A...Accepted this 10th day of June 2011 by: , Director, Graduate Degree Programs Robert F. Baumann, Ph.D. The opinions and conclusions expressed...have been possible without the support of my committee, Dr. John M. Persyn, LTC Eric K. Dunahee and Mr. Robert D. Bloomquist. Thank you for your

A direct numerical simulation of cool-flame affected autoignition in diesel engine-relevant conditions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krisman, Alex; Hawkes, Evatt R.; Talei, Mohsen

In diesel engines, combustion is initiated by a two-staged autoignition that includes both low- and high-temperature chemistry. The location and timing of both stages of autoignition are important parameters that influence the development and stabilisation of the flame. In this study, a two-dimensional direct numerical simulation (DNS) is conducted to provide a fully resolved description of ignition at diesel engine-relevant conditions. The DNS is performed at a pressure of 40 atmospheres and at an ambient temperature of 900 K using dimethyl ether (DME) as the fuel, with a 30 species reduced chemical mechanism. At these conditions, similar to diesel fuel,more » DME exhibits two-stage ignition. The focus of this study is on the behaviour of the low-temperature chemistry (LTC) and the way in which it influences the high-temperature ignition. The results show that the LTC develops as a “spotty” first-stage autoignition in lean regions which transitions to a diffusively supported cool-flame and then propagates up the local mixture fraction gradient towards richer regions. The cool-flame speed is much faster than can be attributed to spatial gradients in first-stage ignition delay time in homogeneous reactors. The cool-flame causes a shortening of the second-stage ignition delay times compared to a homogeneous reactor and the shortening becomes more pronounced at richer mixtures. Multiple high-temperature ignition kernels are observed over a range of rich mixtures that are much richer than the homogeneous most reactive mixture and most kernels form much earlier than suggested by the homogeneous ignition delay time of the corresponding local mixture. Altogether, the results suggest that LTC can strongly influence both the timing and location in composition space of the high-temperature ignition.« less

Study of defect structures in 6H-SiC a/m-plane pseudofiber crystals grown by hot-wall CVD epitaxy

DOE PAGES

Goue, Ouloide Y.; Raghothamachar, Balaji; Yang, Yu; ...

2015-11-25

Structural perfection of silicon carbide (SiC) single crystals is essential to achieve high-performance power devices. A new bulk growth process for SiC proposed by researchers at NASA Glenn Research Center, called large tapered crystal (LTC) growth, based on axial fiber growth followed by lateral expansion, could produce SiC boules with potentially as few as one threading screw dislocation per wafer. In this study, the lateral expansion aspect of LTC growth is addressed through analysis of lateral growth of 6H-SiC a/m-plane seed crystals by hot-wall chemical vapor deposition. Preliminary synchrotron white-beam x-ray topography (SWBXT) indicates that the as-grown boules match themore » polytype structure of the underlying seed and have a faceted hexagonal morphology with a strain-free surface marked by steps. SWBXT Laue diffraction patterns of transverse and axial slices of the boules reveal streaks suggesting the existence of stacking faults/polytypes, and this is confirmed by micro-Raman spectroscopy. Transmission x-ray topography of both transverse and axial slices reveals inhomogeneous strains at the seed–epilayer interface and linear features propagating from the seed along the growth direction. Micro-Raman mapping of an axial slice reveals that the seed contains high stacking disorder, while contrast extinction analysis (g·b and g·b×l) of the linear features reveals that these are mostly edge-type basal plane dislocations. Further high-resolution transmission electron microscopy investigation of the seed–homoepilayer interface also reveals nanobands of different SiC polytypes. A model for their formation mechanism is proposed. Lastly, the implication of these results for improving the LTC growth process is addressed.« less

Lachesana tarabaevi, an expert in membrane-active toxins.

PubMed

Kuzmenkov, Alexey I; Sachkova, Maria Y; Kovalchuk, Sergey I; Grishin, Eugene V; Vassilevski, Alexander A

2016-08-15

In the present study, we show that venom of the ant spider Lachesana tarabaevi is unique in terms of molecular composition and toxicity. Whereas venom of most spiders studied is rich in disulfide-containing neurotoxic peptides, L. tarabaevi relies on the production of linear (no disulfide bridges) cytolytic polypeptides. We performed full-scale peptidomic examination of L. tarabaevi venom supported by cDNA library analysis. As a result, we identified several dozen components, and a majority (∼80% of total venom protein) exhibited membrane-active properties. In total, 33 membrane-interacting polypeptides (length of 18-79 amino acid residues) comprise five major groups: repetitive polypeptide elements (Rpe), latarcins (Ltc), met-lysines (MLys), cyto-insectotoxins (CIT) and latartoxins (LtTx). Rpe are short (18 residues) amphiphilic molecules that are encoded by the same genes as antimicrobial peptides Ltc 4a and 4b. Isolation of Rpe confirms the validity of the iPQM (inverted processing quadruplet motif) proposed to mark the cleavage sites in spider toxin precursors that are processed into several mature chains. MLys (51 residues) present 'idealized' amphiphilicity when modelled in a helical wheel projection with sharply demarcated sectors of hydrophobic, cationic and anionic residues. Four families of CIT (61-79 residues) are the primary weapon of the spider, accounting for its venom toxicity. Toxins from the CIT 1 and 2 families have a modular structure consisting of two shorter Ltc-like peptides. We demonstrate that in CIT 1a, these two parts act in synergy when they are covalently linked. This finding supports the assumption that CIT have evolved through the joining of two shorter membrane-active peptides into one larger molecule. © 2016 The Author(s). published by Portland Press Limited on behalf of the Biochemical Society.

Nursing Work in Long-Term Care: An Integrative Review.

PubMed

Montayre, Jed; Montayre, Jasmine

2017-11-01

Evidence suggests that delivery of good nursing care in long-term care (LTC) facilities is reflected in nurses' descriptions of the factors and structures that affect their work. Understanding the contemporary nature of nursing work in aged care will influence policies for improving current work structures in this practice setting. The current review aims to present a contemporary perspective of RNs' work in LTC facilities. A comprehensive search and purposeful selection of the literature was conducted using CINAHL, PubMed, Medline, Scopus, and Google Scholar databases. Nine studies were eligible for review. Common themes revealed that nursing work in aged care settings is characterized by RNs providing indirect care tasks-primarily care coordination, engaging in non-nursing activities, and having an expanded and overlapping role. As care providers, aged care RNs do not always provide direct care as part of their nursing work. The scope of RN work beyond its clinical nature or performance of non-nursing tasks adds complexity in clarifying RN work roles in aged care. [Journal of Gerontological Nursing, 43(11), 41-49.]. Copyright 2017, SLACK Incorporated.

The effectiveness of empowering in-service training programs for foreign nurse aides in community-based long-term care facilities.

PubMed

Wu, Li-yu; Yin, Teresa J C; Li, I-chuan

2005-01-01

The objective of the study was to examine the effectiveness of empowering in-service training programs for foreign nurse aides working in community-based long-term care (LTC) facilities. The design was a pretest and post-test design with experiment and control groups. The sample consisted of purposeful sampling from 10 LTC facilities in the Shihlin and Peitou areas of Taipei. A total of 35 foreign nurse aides participated in this study; 16 in the experimental group and 19 in the control group. The experimental group attended the training program for a 3-month period, whereas the control group did not receive any training. The research findings reveal that the training program was effective in increasing the work stress of workload/scheduling (Z = 2.01, p

Clinical Nursing Leadership Education in Long-Term Care: Intervention Design and Evaluation.

PubMed

Fiset, Valerie; Luciani, Tracy; Hurtubise, Alyssa; Grant, Theresa L

2017-04-01

The main objective of the current case study was to investigate the perceived leadership learning needs and feasibility of delivering leadership education to registered staff involved in direct care in long-term care (LTC) homes. The study was conducted in Ontario, Canada, and participants included RNs, registered practical nurses, and nursing administrators. Phase 1 bilingual web-based survey and bilingual focus group needs assessment data supported a preference for external training along with in-house mentoring to support sustainability. An intervention designed using insights gained from Phase 1 data was delivered via a 2-day, in-person workshop. Phases 2 and 3 evaluation survey data identified aspects of leadership training for LTC that require ongoing refinement. Findings suggest that communication skills and managing day-to-day nursing demands in the context of regulatory frameworks were areas of particular interest for leadership training in the LTC setting. [Journal of Gerontological Nursing, 43(4), 49-56.]. Copyright 2017, SLACK Incorporated.

Implementing a knowledge translation intervention in long-term care: feasibility results from the Vitamin D and Osteoporosis Study (ViDOS).

PubMed

Kennedy, Courtney C; Thabane, Lehana; Ioannidis, George; Adachi, Jonathan D; Papaioannou, Alexandra

2014-12-01

To evaluate the feasibility of implementing an interdisciplinary, multifaceted knowledge translation intervention within long-term care (LTC) and to identify any challenges that should be considered in designing future studies. Cluster randomized controlled trial. Forty LTC homes across the province of Ontario, Canada. LTC teams composed of physicians, nurses, pharmacists, and other staff. Cluster-level feasibility measures, including recruitment, retention, data completion, and participation in the intervention. A process evaluation was completed by directors of care indicating which process/policy changes had been implemented. Recruitment and retention rates were 22% and 63%, respectively. Good fidelity with the intervention was achieved, including attendance at educational meetings. After ViDOS, 7 process indicators were being newly implemented by more than 50% of active intervention homes. Despite recruitment and retention challenges, the multifaceted intervention produced a number of policy/process changes and had good intervention fidelity. This study is registered at ClinicalTrials.gov NCT01398527. Copyright © 2014. Published by Elsevier Inc.

Ethical perspectives on emerging assistive technologies: insights from focus groups with stakeholders in long-term care facilities.

PubMed

Dorsten, Aimee-Marie; Sifford, K Susan; Bharucha, Ashok; Mecca, Laurel Person; Wactlar, Howard

2009-03-01

ASSISTIVE TECHNOLOGIES ARE RELATIVELY novel tools for research and daily care in long-term care (LTC) facilities that are faced with the burgeoning of the older adult population and dwindling staffing resources. The degree to which stakeholders in LTC facilities are receptive to the use of these technologies is poorly understood. Eighteen semi-structured focus groups and one interview were conducted with relevant groups of stakeholders at seven LTC facilities in southwestern Pennsylvania. Common themes identified across all focus groups centered on concerns for privacy, autonomy, cost, and safety associated with implementation of novel technologies. The relative importance of each theme varied by stakeholder group as well as the perceived severity of cognitive and/or physical disability. Our findings suggest that ethical issues are critical to acceptance of novel technologies by their end users, and that stakeholder groups are interdependent and require shared communication about the acceptance of these emerging technologies.

Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long-term-care facilities--Mississippi, North Carolina, and Los Angeles County, California, 2003-2004.

PubMed

2005-03-11

Regular monitoring of blood glucose levels is an important component of routine diabetes care. Capillary blood is typically sampled with the use of a fingerstick device and tested with a portable glucometer. Because of outbreaks of hepatitis B virus (HBV) infections associated with glucose monitoring, CDC and the Food and Drug Administration (FDA) have recommended since 1990 that fingerstick devices be restricted to individual use. This report describes three recent outbreaks of HBV infection among residents in long-term-care (LTC) facilities that were attributed to shared devices and other breaks in infection-control practices related to blood glucose monitoring. Findings from these investigations and previous reports suggest that recommendations concerning standard precautions and the reuse of fingerstick devices have not been adhered to or enforced consistently in LTC settings. The findings underscore the need for education, training, adherence to standard precautions, and specific infection-control recommendations targeting diabetes-care procedures in LTC settings.

"Here for the residents": a case study of cultural competence of personal support workers in a long-term care home.

PubMed

Tayab, Aysha; Narushima, Miya

2015-03-01

This study explores the perception of cultural competence of personal support workers (PSWs) in a long-term care (LTC) home in Ontario. As Canada's demography becomes older and more diverse, LTC homes will increasingly accommodate residents from various cultural backgrounds. However, few studies have examined cultural competence among PSWs in the LTC home setting. The study employed a qualitative case study approach. Data collection and analysis were conducted in three phases: document analysis of organizational policies, a key informant interview with the Director of Care, and two focus groups with PSWs. Our findings illuminated the PSWs' broad definition of culture, the process of developing cultural competence and its strong connections to person-centered care, and the organizational factors that facilitate or hinder PSWs' cultural competence. The ambiguous perception of cultural competence reported by PSWs suggests the need for more education and further research on this topic. © The Author(s) 2014.

Advancing nursing leadership in long-term care.

PubMed

O'Brien, Jennifer; Ringland, Margaret; Wilson, Susan

2010-05-01

Nurses working in the long-term care (LTC) sector face unique workplace stresses, demands and circumstances. Designing approaches to leadership training and other supportive human-resource strategies that reflect the demands of the LTC setting fosters a positive work life for nurses by providing them with the skills and knowledge necessary to lead the care team and to address resident and family issues. Through the St. Joseph's Health Centre Guelph demonstration site project, funded by the Nursing Secretariat of Ontario's Ministry of Health and Long-Term Care, the Excelling as a Nurse Leader in Long Term Care training program and the Mentor Team program were developed to address these needs. Evaluation results show that not only have individual nurses benefitted from taking part in these programs, but also that the positive effects were felt in other parts of the LTC home (as reported by Directors of Care). By creating a generally healthier work environment, it is anticipated that these programs will also have a positive effect on recruitment and retention.

An exploration of older Hong Kong residents' willingness to make copayments toward vouchers for community care.

PubMed

Fu, Yuan Yuan; Chui, Ernest Wing-Tak; Law, Chi Kin; Zhao, XinYi; Lou, Vivian W Q

2018-05-10

Because of its rapidly aging population, Hong Kong faces great challenges in the provision and financing of long-term care (LTC) and needs to explore sustainable funding mechanisms. However, there is a paucity of research on older people's willingness to pay (WTP) for LTC services in Hong Kong. This study utilizes data collected in Hong Kong in 2011 (N = 536) to investigate older people's receptivity to this financing mode by assessing their co-payments for a community care service voucher scheme and then testing how potential factors affect respondents' amount of co-payment. Results show that respondents' WTP was positively associated with family financial support, financial condition, and positive attitudes toward this novel policy and negatively associated with family caregiving support. Direct and moderating effects of family financial support on WTP were found. The policy-related implications of LTC financing to improve older people's acceptance of co-payment mechanisms, financial condition, and shared responsibility of care are discussed.

Barriers to physical activity and restorative care for residents in long-term care: a review of the literature.

PubMed

Benjamin, Kathleen; Edwards, Nancy; Ploeg, Jenny; Legault, Frances

2014-01-01

Despite the benefits of physical activity, residents living in long-term care (LTC) are relatively sedentary. Designing successful physical activity and restorative care programs requires a good understanding of implementation barriers. A database search (2002-2013) yielded seven studies (nine articles) that met our inclusion criteria. We also reviewed 31 randomized controlled trials (RCTs) to determine if the authors explicitly discussed the barriers encountered while implementing their interventions. Eleven RCTs (13 articles) included a discussion of the barriers. Hence, a total of 18 studies (22 articles) were included in this review. Barriers occurred at resident (e.g., health status), environmental (e.g., lack of space for physical activity), and organizational (e.g., staffing and funding constraints) levels. These barriers intersect to adversely affect the physical activity of older people living in LTC. Future studies targeting physical activity interventions for residents living in LTC are needed to address these multiple levels of influence.

Ultra-wideband high-efficiency reflective linear-to-circular polarization converter based on metasurface at terahertz frequencies.

PubMed

Jiang, Yannan; Wang, Lei; Wang, Jiao; Akwuruoha, Charles Nwakanma; Cao, Weiping

2017-10-30

The polarization conversion of electromagnetic (EM) waves, especially linear-to-circular (LTC) polarization conversion, is of great significance in practical applications. In this study, we propose an ultra-wideband high-efficiency reflective LTC polarization converter based on a metasurface in the terahertz regime. It consists of periodic unit cells, each cell of which is formed by a double split resonant square ring, dielectric layer, and fully reflective gold mirror. In the frequency range of 0.60 - 1.41 THz, the magnitudes of the reflection coefficients reach approximately 0.7, and the phase difference between the two orthogonal electric field components of the reflected wave is close to 90° or -270°. The results indicate that the relative bandwidth reaches 80% and the efficiency is greater than 88%, thus, ultra-wideband high-efficiency LTC polarization conversion has been realized. Finally, the physical mechanism of the polarization conversion is revealed. This converter has potential applications in antenna design, EM measurement, and stealth technology.

Long-term care insurance: Does experience matter?

PubMed

Coe, Norma B; Skira, Meghan M; Van Houtven, Courtney Harold

2015-03-01

We examine whether long-term care (LTC) experience helps explain the low demand for long-term care insurance (LTCI). We test if expectations about future informal care receipt, expectations about inheritance receipt, and LTCI purchase decisions vary between individuals whose parents or in-laws have used LTC versus those who have not. We find parental use of a nursing home decreases expectations that one's children will provide informal care, consistent with the demonstration effect. Nursing home use by in-laws does not have the same impact, suggesting that individuals are responding to information gained about their own aging trajectory. Nursing home use by either a parent or in-law increases LTCI purchase probability by 0.8 percentage points, with no significant difference in response between parents' and in-laws' use. The estimated increase in purchase probability from experience with LTC is about half the previously estimated increase from tax policy-induced price decreases. Copyright © 2015 Elsevier B.V. All rights reserved.

The Influence of Organizational Systems on Information Exchange in Long-Term Care Facilities: An Institutional Ethnography.

PubMed

Caspar, Sienna; Ratner, Pamela A; Phinney, Alison; MacKinnon, Karen

2016-06-01

Person-centered care is heavily dependent on effective information exchange among health care team members. We explored the organizational systems that influence resident care attendants' (RCAs) access to care information in long-term care (LTC) settings. We conducted an institutional ethnography in three LTC facilities. Investigative methods included naturalistic observations, in-depth interviews, and textual analysis. Practical access to texts containing individualized care-related information (e.g., care plans) was dependent on job classification. Regulated health care professionals accessed these texts daily. RCAs lacked practical access to these texts and primarily received and shared information orally. Microsystems of care, based on information exchange formats, emerged. Organizational systems mandated written exchange of information and did not formally support an oral exchange. Thus, oral information exchanges were largely dependent on the quality of workplace relationships. Formal systems are needed to support structured oral information exchange within and between the microsystems of care found in LTC. © The Author(s) 2016.

Longxuetongluo Capsule Improves Erythrocyte Function against Lipid Peroxidation and Abnormal Hemorheological Parameters in High Fat Diet-Induced ApoE−/− Mice

PubMed Central

Zheng, Jiao; Liu, Binglin; Lun, Qixing; Yao, Weijuan; Zhao, Yunfang; Xiao, Wei; Huang, Wenzhe; Wang, Yonghua; Li, Jun; Tu, Pengfei

2016-01-01

Chinese dragon's blood, the red resin of Dracaena cochinchinensis, one of the renowned traditional medicines, has been used to facilitate blood circulation and disperse blood stasis for thousands of years. Phenolic compounds are considered to be responsible for its main biological activities. In this study, total phenolic compounds of Chinese dragon's blood were made into capsule (Longxuetongluo Capsule, LTC) and their effects on the abnormal hemorheological properties were examined by high fat diet (HFD) induced ApoE−/− mice. Compared to the model group, LTC recovered the abnormal hemorheological parameters in HFD-induced ApoE−/− mice by reducing whole blood viscosity (WBV) at high rate and improving erythrocyte function. In conclusion, LTC could ameliorate erythrocyte deformability and osmotic fragility through the reduction of lipid peroxidation on plasma and erythrocyte membranes in HFD-induced ApoE−/− mice, which supported the traditional uses of Chinese dragon's blood as an effective agent for improving blood microcirculation in hypercholesterolemia. PMID:26649134

High-Flux, High Performance H2O2 Catalyst Bed for ISTAR

NASA Technical Reports Server (NTRS)

Ponzo, J.

2005-01-01

On NASA's ISTAR RBCC program packaging and performance requirements exceeded traditional H2O2 catalyst bed capabilities. Aerojet refined a high performance, monolithic 90% H202 catalyst bed previously developed and demonstrated. This approach to catalyst bed design and fabrication was an enabling technology to the ISTAR tri-fluid engine. The catalyst bed demonstrated 55 starts at throughputs greater than 0.60 lbm/s/sq in for a duration of over 900 seconds in a physical envelope approximately 114 of traditional designs. The catalyst bed uses photoetched plates of metal bonded into a single piece monolithic structure. The precise control of the geometry and complete mixing results in repeatable, quick starting, high performing catalyst bed. Three different beds were designed and tested, with the best performing bed used for tri-fluid engine testing.

Activities of daily living in nursing home and home care settings: a retrospective 1-year cohort study.

PubMed

Lee, Tae Wha; Cho, Eunhee; Yim, Eun Shil; Lee, Hye Sun; Ko, Yu Kyung; Kim, Bok Nam; Kim, Sinhye

2015-02-01

Korea introduced universal long-term care insurance (LTCI) for physically dependent older adults in 2008. Older adults, their family members, and policy makers in Korea want to know patient outcomes in different care modalities because older adults who have a similar functional status and LTC needs can choose either nursing home care or home care. The aim of this study was to compare activities of daily living (ADLs) in nursing home care and home care settings for physically dependent older adults in Korea. A retrospective 1-year cohort study using national LTCI data. This study used the LTCI dataset from the National Health Insurance Service in Korea. Participants were identified from among those in the LTCI dataset who enrolled from July 2008 to June 2010. We extracted a sample consisting of 22,557 older adults who consistently received either nursing home care (n = 11,678) or home care (n = 10,879) for 1 year. The outcome variable was change in ADLs after 1 year. Covariates were an older adult's home geographical region, LTC level, age, sex, primary caregiver, Medicaid beneficiary status, bedridden status, medical diagnosis, baseline ADLs, cognitive function, behavioral problems, nursing and special treatment, and rehabilitation needs. Multiple regression analysis of all participants unmatched and a paired t-test with a propensity-score-matched cohort were performed to explain the association of changes in ADLs with the types of LTC. Multiple regression analysis with all participants (n = 22,557) unmatched showed that compared with older adults who received home care, those who received nursing home care had deteriorated further in terms of ADLs after 1 year (β = 0.44108, P < .0001). After propensity-score matching, paired t-test analysis also found that the ADLs of older adults had deteriorated less in the home care group compared with the nursing home group after 1 year (P < .0001). The ADLs of older adults who received home care showed significantly less deterioration than those of the older adults in nursing home care after 1 year. The ADLs of older adults could differ according to the type of LTC they receive, and home care could result in better maintenance of ADLs than nursing home care. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

The leukotriene E4 puzzle: finding the missing pieces and revealing the pathobiologic implications.

PubMed

Austen, K Frank; Maekawa, Akiko; Kanaoka, Yoshihide; Boyce, Joshua A

2009-09-01

The intracellular parent of the cysteinyl leukotrienes (cysLTs), leukotriene (LT) C(4), is formed by conjugation of LTA(4) and reduced glutathione by LTC(4) synthase in mast cells, eosinophils, basophils, and macrophages. After extracellular export, LTC(4) is converted to LTD(4) and LTE(4) through sequential enzymatic removal of glutamic acid and then glycine. Only LTE(4) is sufficiently stable to be prominent in biologic fluids, such as urine or bronchoalveolar lavage fluid, of asthmatic individuals and at sites of inflammation in animal models. LTE(4) has received little attention because it binds poorly to the classical type 1 and 2 cysLT receptors and is much less active on normal airways than LTC(4) or LTD(4). However, early studies indicated that LTE(4) caused skin swelling in human subjects as potently as LTC(4) and LTD(4), that airways of asthmatic subjects (particularly those that were aspirin sensitive) were selectively hyperresponsive to LTE(4), and that a potential distinct LTE(4) receptor was present in guinea pig trachea. Recent studies have begun to uncover receptors selective for LTE(4): P2Y(12), an adenosine diphosphate receptor, and CysLT(E)R, which was observed functionally in the skin of mice lacking the type 1 and 2 cysLT receptors. These findings prompt a renewed focus on LTE(4) receptors as therapeutic targets that are not currently addressed by available receptor antagonists.

The influence of care provider access to structural empowerment on individualized care in long-term-care facilities.

PubMed

Caspar, Sienna; O'Rourke, Norm

2008-07-01

Implementing management initiatives that enable formal caregivers to provide quality, individualized care to older adults in long-term-care (LTC) facilities is increasingly important given that the number of LTC residents is projected to triple by 2031. The objective of this study was to explore the relationship between care provider access to structural empowerment and the provision of individualized care in LTC. We computed structural equation models separately for registered nurses and licensed practical nurses (n = 242) and care aides (n = 326) to examine the relationship between access to empowerment structures (i.e., informal power, formal power, information, support, resources, opportunity) and the provision of individualized care. We subsequently undertook invariance analyses to determine if the association between empowerment structures and reported provision of individualized care differed between caregiver groups. Access to structural empowerment had a statistically significant, positive association with provision of individualized care for both groups. For registered nurses/licensed practical nurses and care aides, empowerment explained 50% and 45% of observed variance in individualized care, respectively. These notable percentages did not differ significantly between caregiver groups. Of the empowerment structures, support, especially in the form of access to educational opportunities and recognition for a job well done, seems to be particularly significant to care providers. Findings from this study suggest that provision of individualized care in LTC may be enhanced when formal caregivers have appreciable access to empowerment structures.

FINAL Report LTC-DOE DE-EE0000537

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gibbs, Michelle

2013-02-28

At the time of LTC’s application we were home to a small / mid-sized Wind Energy Research and Teaching Center, funded in part by We Energies, and offered the state of Wisconsin’s first Associate of Applied Science (A.A.S.) Degree in Wind Energy Technology. With President Obama promising investment in wind, LTC and its partners were uniquely situated to meet the challenge through an organized career pathways approach that utilized industry drivers and occupationally verified curriculum to train the workers who “transform our energy sector.” LTC’s employer partners validated the findings of the “20% Wind Energy by 2030: Increasing Wind Energy'smore » Contribution to U.S. Electricity Supply” report by the US Department of Energy which recognized programs like LTC’s as an “excellent beginning,” noting that many more like them are necessary to meet the challenges of the 20% Wind scenario.One of the focuses of the study was the lack of trained technicians to work on installation and maintenance of renewables (and more specifically for our grant application wind turbines). LTC’s goal, made possible with the funding provided in this grant, was to increase the number of skilled graduates to help meet this national objective. LTC was already a leader in wind for the state of Wisconsin but wanted to upscale from a single school to a statewide (and potentially regional) center for wind energy. LTC planned to leverage our facilities, curriculum, and faculty expertise to meet this goal.« less

Cysteinyl leukotrienes C4 and D4 downregulate human mast cell expression of toll-like receptors 1 through 7.

PubMed

Karpov, V; Ilarraza, R; Catalli, A; Kulka, M

2018-01-01

Cysteinyl leukotrienes (CysLT) are potent inflammatory lipid molecules that mediate some of the pathophysiological responses associated with asthma such as bronchoconstriction, vasodilation and increased microvascular permeability. As a result, CysLT receptor antagonists (LRA), such as montelukast, have been used to effectively treat patients with asthma. We have recently shown that mast cells are necessary modulators of innate immune responses to bacterial infection and an important component of this innate immune response may involve the production of CysLT. However, the effect of LRA on innate immune receptors, particularly on allergic effector cells, is unknown. This study determined the effect of CysLT on toll-like receptor (TLR) expression by the human mast cell line LAD2. Real-time PCR analysis determined that LTC4, LTD4 and LTE4 downregulated mRNA expression of several TLR. Specifically in human CD34+-derived human mast cells (HuMC), LTC4 inhibited expression of TLR1, 2, 4, 5, 6 and 7 while LTD4 inhibited expression of TLR1-7. Montelukast blocked LTC4-mediated downregulation of all TLR, suggesting that these effects were mediated by activation of the CysLT1 receptor (CysLT1R). Flow cytometry analysis confirmed that LTC4 downregulated surface expression of TLR2 which was blocked by montelukast. These data show that CysLT can modulate human mast cell expression of TLR and that montelukast may be beneficial for innate immune responses mediated by mast cells.

The Challenges of Adopting a Culture of Mission Command in the US Army

DTIC Science & Technology

2015-05-23

NUMBER 6. AUTHOR(S) LTC(P) James W. Wright 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND...the development and implementation of high- end information technology creates a paradox for mission command. 15. SUBJECT TERMS Mission command...centralized control and less risk. Likewise, the development and implementation of high- end information technology creates a paradox for mission

Microwave assisted synthesis of biarlys by Csbnd C coupling reactions with a new chitosan supported Pd(II) catalyst

NASA Astrophysics Data System (ADS)

Baran, Talat; Menteş, Ayfer

2016-10-01

In this study a new type chitosan-based support has been produced for Pd(II) catalyst and its catalytic performance in Suzuki Csbnd C reactions has been studied under microwave irradiation without using any solvent. The chemical identification of the catalyst was performed using TG/DTG, FTIR, UV-Vis ICP-OES, SEM/EDAX, 13C NMR, molar conductivity, XRD and magnetic moment techniques. The performance of this new Pd(II) catalyst was studied in Suzuki Csbnd C reactions. The Pd(II) catalyst exhibited a good catalytic performance in very short time (4 min) by giving high TONs and TOFs with low amount of the catalyst (0.015 mol%). The catalyst also had reusability and did not lose its activity until six runs.

Power generation in microbial fuel cells using platinum group metal-free cathode catalyst: Effect of the catalyst loading on performance and costs

NASA Astrophysics Data System (ADS)

Santoro, Carlo; Kodali, Mounika; Herrera, Sergio; Serov, Alexey; Ieropoulos, Ioannis; Atanassov, Plamen

2018-02-01

Platinum group metal-free (PGM-free) catalyst with different loadings was investigated in air breathing electrodes microbial fuel cells (MFCs). Firstly, the electrocatalytic activity towards oxygen reduction reaction (ORR) of the catalyst was investigated by rotating ring disk electrode (RRDE) setup with different catalyst loadings. The results showed that higher loading led to an increased in the half wave potential and the limiting current and to a further decrease in the peroxide production. The electrons transferred also slightly increased with the catalyst loading up to the value of ≈3.75. This variation probably indicates that the catalyst investigated follow a 2x2e- transfer mechanism. The catalyst was integrated within activated carbon pellet-like air-breathing cathode in eight different loadings varying between 0.1 mgcm-2 and 10 mgcm-2. Performance were enhanced gradually with the increase in catalyst content. Power densities varied between 90 ± 9 μWcm-2 and 262 ± 4 μWcm-2 with catalyst loading of 0.1 mgcm-2 and 10 mgcm-2 respectively. Cost assessments related to the catalyst performance are presented. An increase in catalyst utilization led to an increase in power generated with a substantial increase in the whole costs. Also a decrease in performance due to cathode/catalyst deterioration over time led to a further increase in the costs.

Dancing the Two-Step in Ontario’s Long-term Care Sector: More Deterrence-oriented Regulation = Ownership and Management Consolidation

PubMed Central

Daly, Tamara

2016-01-01

This paper explores shifts in public and private delivery over time through an analysis of Ontario’s approach to LTC funding and regulation in relation to other jurisdictions in Canada and abroad. The case of Ontario’s long-term care (LTC) policy evolution – from the 1940s until early 2013 -- shows how moving from compliance to deterrence oriented regulation can support consolidation of commercial providers’ ownership and increase the likelihood of non-profit and public providers outsourcing their management. PMID:27777495

New Manning System Field Evaluation

DTIC Science & Technology

1986-03-01

tckovics Un,!,d LTC Larry H. tng.anam, Ph.D. zust n - Farts R. Ki~rk.land, Ph.0. CharLene S. Lewis, Ph.D. David H. MarLowe, h.D ByDlstribuatoflf LTC James...parcticipacing agencies) wich an updaCe of WTAZ&’s current HMS research accivicies; (Z) Co raise Issues chac varranc, discassson among Che agencies...provides a summacy of che uniCs Chac have compLeced Che first LcecaCIon of ch•e Soldier VILL quesctona~ve as weLil as projeccLons .or cthe second and

Study on Endurance and Performance of Impregnated Ruthenium Catalyst for Thruster System.

PubMed

Kim, Jincheol; Kim, Taegyu

2018-02-01

Performance and endurance of the Ru catalyst were studied for nitrous oxide monopropellant thruster system. The thermal decomposition of N2O requires a considerably high temperature, which make it difficult to be utilized as a thruster propellant, while the propellant decomposition temperature can be reduced by using the catalyst through the decomposition reaction with the propellant. However, the catalyst used for the thruster was frequently exposed to high temperature and high-pressure environment. Therefore, the state change of the catalyst according to the thruster operation was analyzed. Characterization of catalyst used in the operation condition of the thruster was performed using FE-SEM and EDS. As a result, performance degradation was occurred due to the volatilization of Ru catalyst and reduction of the specific surface area according to the phase change of Al2O3.

Novel anode catalyst for direct methanol fuel cells.

PubMed

Basri, S; Kamarudin, S K; Daud, W R W; Yaakob, Z; Kadhum, A A H

2014-01-01

PtRu catalyst is a promising anodic catalyst for direct methanol fuel cells (DMFCs) but the slow reaction kinetics reduce the performance of DMFCs. Therefore, this study attempts to improve the performance of PtRu catalysts by adding nickel (Ni) and iron (Fe). Multiwalled carbon nanotubes (MWCNTs) are used to increase the active area of the catalyst and to improve the catalyst performance. Electrochemical analysis techniques, such as energy dispersive X-ray spectrometry (EDX), X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), and X-ray photoelectron spectroscopy (XPS), are used to characterize the kinetic parameters of the hybrid catalyst. Cyclic voltammetry (CV) is used to investigate the effects of adding Fe and Ni to the catalyst on the reaction kinetics. Additionally, chronoamperometry (CA) tests were conducted to study the long-term performance of the catalyst for catalyzing the methanol oxidation reaction (MOR). The binding energies of the reactants and products are compared to determine the kinetics and potential surface energy for methanol oxidation. The FESEM analysis results indicate that well-dispersed nanoscale (2-5 nm) PtRu particles are formed on the MWCNTs. Finally, PtRuFeNi/MWCNT improves the reaction kinetics of anode catalysts for DMFCs and obtains a mass current of 31 A g(-1) catalyst.

Novel Anode Catalyst for Direct Methanol Fuel Cells

PubMed Central

Basri, S.; Kamarudin, S. K.; Daud, W. R. W.; Yaakob, Z.; Kadhum, A. A. H.

2014-01-01

PtRu catalyst is a promising anodic catalyst for direct methanol fuel cells (DMFCs) but the slow reaction kinetics reduce the performance of DMFCs. Therefore, this study attempts to improve the performance of PtRu catalysts by adding nickel (Ni) and iron (Fe). Multiwalled carbon nanotubes (MWCNTs) are used to increase the active area of the catalyst and to improve the catalyst performance. Electrochemical analysis techniques, such as energy dispersive X-ray spectrometry (EDX), X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), and X-ray photoelectron spectroscopy (XPS), are used to characterize the kinetic parameters of the hybrid catalyst. Cyclic voltammetry (CV) is used to investigate the effects of adding Fe and Ni to the catalyst on the reaction kinetics. Additionally, chronoamperometry (CA) tests were conducted to study the long-term performance of the catalyst for catalyzing the methanol oxidation reaction (MOR). The binding energies of the reactants and products are compared to determine the kinetics and potential surface energy for methanol oxidation. The FESEM analysis results indicate that well-dispersed nanoscale (2–5 nm) PtRu particles are formed on the MWCNTs. Finally, PtRuFeNi/MWCNT improves the reaction kinetics of anode catalysts for DMFCs and obtains a mass current of 31 A g−1 catalyst. PMID:24883406

Power generation in microbial fuel cells using platinum group metal-free cathode catalyst: Effect of the catalyst loading on performance and costs.

PubMed

Santoro, Carlo; Kodali, Mounika; Herrera, Sergio; Serov, Alexey; Ieropoulos, Ioannis; Atanassov, Plamen

2018-02-28

Platinum group metal-free (PGM-free) catalyst with different loadings was investigated in air breathing electrodes microbial fuel cells (MFCs). Firstly, the electrocatalytic activity towards oxygen reduction reaction (ORR) of the catalyst was investigated by rotating ring disk electrode (RRDE) setup with different catalyst loadings. The results showed that higher loading led to an increased in the half wave potential and the limiting current and to a further decrease in the peroxide production. The electrons transferred also slightly increased with the catalyst loading up to the value of ≈3.75. This variation probably indicates that the catalyst investigated follow a 2x2e - transfer mechanism. The catalyst was integrated within activated carbon pellet-like air-breathing cathode in eight different loadings varying between 0.1 mgcm -2 and 10 mgcm -2 . Performance were enhanced gradually with the increase in catalyst content. Power densities varied between 90 ± 9 μWcm -2 and 262 ± 4 μWcm -2 with catalyst loading of 0.1 mgcm -2 and 10 mgcm -2 respectively. Cost assessments related to the catalyst performance are presented. An increase in catalyst utilization led to an increase in power generated with a substantial increase in the whole costs. Also a decrease in performance due to cathode/catalyst deterioration over time led to a further increase in the costs.

The effect of lengthening life expectancy on future pension and long-term care expenditure in England, 2007 to 2032.

PubMed

Malley, Juliette; Hancock, Ruth; Murphy, Mike; Adams, John; Wittenberg, Raphael; Comas-Herrera, Adelina; Curry, Chris; King, Derek; James, Sean; Morciano, Marcello; Pickard, Linda

2011-01-01

The aim of this analysis is to examine the effect of different assumptions about future trends in life expectancy (LE) on the sustainability of the pensions and long-term care (LTC) systems. The context is the continuing debate in England about the reform of state pensions and the reform of the system for financing care and support. Macro and micro simulation models are used to make projections of future public expenditure on LTC services for older people and on state pensions and related benefits, making alternative assumptions on increases in future LE. The projections cover the period 2007 to 2032 and relate to England. Results are presented for a base case and for specified variants to the base case. The base case assumes that the number of older people by age and gender rises in line with the Office for National Statistics' principal 2006-based population projection for England. It also assumes no change in disability rates, no changes in patterns of care, no changes in policy and rises in unit care costs and real average earnings by 2 per cent per year. Under these assumptions public expenditure on pensions and related benefits is projected to rise from 4.7 per cent of Gross Domestic Product (GDP) in 2007 to 6.2 per cent of GDP in 2032 and public expenditure on LTC from 0.9 per cent of GDP in 2007 to 1.6 per cent of GDP in 2032. Under a very high LE variant to the GAD principal projection, however, public expenditure on pensions and related benefits is projected to reach 6.8 per cent of GDP in 2032 and public expenditure on LTC 1.7 per cent of GDP in 2032. Policymakers developing reform proposals need to recognise that, since future LE is inevitably uncertain and since variant assumptions about future LE significantly affect expenditure projections, there is a degree of uncertainty about the likely impact of demographic pressures on future public expenditure on pensions and LTC.

Functional characterization of individual human hematopoietic stem cells cultured at limiting dilution on supportive marrow stromal layers.

PubMed Central

Sutherland, H J; Lansdorp, P M; Henkelman, D H; Eaves, A C; Eaves, C J

1990-01-01

A major goal of current hematopoiesis research is to develop in vitro methods suitable for the measurement and characterization of stem cells with long-term in vivo repopulating potential. Previous studies from several centers have suggested the presence in normal human or murine marrow of a population of very primitive cells that are biologically, physically, and pharmacologically different from cells detectable by short-term colony assays and that can give rise to the latter in long-term cultures (LTCs) containing a competent stromal cell layer. In this report, we show that such cultures can be used to provide a quantitative assay for human "LTC-initiating cells" based on an assessment of the number of clonogenic cells present after 5-8 weeks. Production of derivative clonogenic cells is shown to be absolutely dependent on the presence of a stromal cell feeder. When this requirement is met, the clonogenic cell output (determined by assessment of 5-week-old cultures) is linearly related to the input cell number over a wide range of cell concentrations. Using limiting dilution analysis techniques, we have established the frequency of LTC-initiating cells in normal human marrow to be approximately 1 per 2 X 10(4) cells and in a highly purified CD34-positive subpopulation to be approximately 1 per 50-100 cells. The proliferative capacity exhibited by individual LTC-initiating cells cultured under apparently identical culture conditions was found to be highly variable. Values for the number of clonogenic cells per LTC-initiating cell in 5-week-old cultures ranged from 1 to 30 (the average being 4) with similar levels being detected in positive 8-week-old cultures. Some LTC-initiating cells are multipotent as evidenced by their generation of erythroid as well as granulopoietic progeny. The availability of a system for quantitative analysis of the proliferative and differentiative behavior of this newly defined compartment of primitive human hematopoietic cells should facilitate future studies of specific genetic or microenvironmental parameters involved in the regulation of these cells. Images PMID:2333304

Pressure ulcer prevention in long-term-care facilities: a pilot study implementing standardized nurse aide documentation and feedback reports.

PubMed

Horn, Susan D; Sharkey, Siobhan S; Hudak, Sandra; Gassaway, Julie; James, Roberta; Spector, William

2010-03-01

To design and facilitate implementation of practice-based evidence changes associated with decreases in pressure ulcer (PrU) development in long-term-care (LTC) facilities and promote these practices as part of routine care. Pre/post observational study. Frail older adult residents in 11 US LTC facilities. Project facilitators assisted frontline multidisciplinary teams (certified nurse aides [CNAs], nurses, and dietitians/dietary aides) to develop streamlined standardized CNA documentation and weekly reports to identify high-risk residents and to integrate clinical reports into day-to-day practice and clinical decision making. The program was called "Real-Time Optimal Care Plans for Nursing Home QI" (Real-Time). Prevalence of PrUs using Centers for Medicare & Medicaid Services (CMS) quality measures (QMs), number of in-house-acquired PrUs, and number and completeness of CNA documentation forms. Seven study LTC facilities that reported data to CMS experienced a combined 33% (SD, 36.1%) reduction in the CMS high-risk PrU QM in 18 months and reduction in newly occurring PrUs (number of ulcers in the fourth quarter of 2003: range, 2-19; and in the third quarter of 2005: range, 1-6). Five of these LTC facilities that fully implemented Real-Time experienced a combined 48.1% (SD, 23.4%) reduction in the CMS high-risk PrU QM. Ten facilities reduced by an average of 2 to 5 their number of CNA documentation forms; CNA weekly documentation completeness reached a consistent level of 90% to 95%, and 8 facilities integrated the use of 2 to 4 weekly project reports in routine clinical decision making. Quality improvement efforts that provide access to focused and timely clinical information, facilitate change, and promote staff working together in multidisciplinary teams impacted clinical outcomes. Prevention of PrUs showed a trend of improvement in facilities that fully integrated tools to identify high-risk residents into day-to-day practice. CNA documentation facilitated better information for clinical decision making. More than 70 additional LTC facilities across the United States are implementing this QI program.

Joint Duty Prerequisite for Promotion to 07 (Brigadier General

DTIC Science & Technology

1989-03-13

NUMBER)(O LTC Julius E. Coats, Jr. 9. PERFORMING ORGANIZATIN NAME AND ADDRESS I0. PROGRAM ELEMENT. PROJECT. tASK U.S. Army War College AREA 4 WORK...new personnel policy; to wit, the Army leadership at all levels should view joint duty re- quirement for selection for flag officer with a positive...the Army leadership at all levels should view joint duty requirement for selection for flag officer with a positive attitude, not as a means for

Using the FoodEx-LTC to assess institutional food service practices through nursing home residents' perspectives on nutrition care.

PubMed

Evans, Bronwynne C; Crogan, Neva L

2005-01-01

Background. Undernutrition occurs in approximately 2 of every 5 nursing home residents, negatively influencing their health and quality of life. The purposes of this study were to collect data about institutional meal preparation and food service practices that promote or retard adequate nutritional intake and to evaluate residents' food and food service satisfaction. Methods. The FoodEx-LTC, a simple, 44-item, 5-subscale questionnaire that measures food and food service satisfaction, was administered to 61 residents. Serum albumin and body mass index gauged the nutritional status of each resident. SPSS for Windows, version 10, was used for analyses. Results. Overall, 89% of residents were satisfied or somewhat satisfied with the food service. Of those who ate in the dining room, 44% had to wait to go back to their rooms, presenting a quality of life issue. Fifty-two percent received food they hated, 56% often received the same food, and 59% received food always cooked the same way. Most residents (75%) felt comfortable refusing food they did not like, but 65% did not complain. Most (79%) wanted to choose what to eat, but only 54% believed that choosing when to eat was important. Conclusions. The FoodEx-LTC, used to monitor nutrition care in nursing homes, incorporates residents' views into service delivery and responds to the Health Care Finance Administration's Nutritional and Hydration Awareness Campaign, part of the federal Nursing Home Initiative. Using the FoodEx-LTC to identify residents' perspectives may promote resident satisfaction and dietary intake through adaptation of nursing home food and food service practices.

Exploring dental student participation in interdisciplinary care team conferences in long-term care.

PubMed

Huynh, Jeremy; Donnelly, Leeann R; Brondani, Mario A

2017-06-01

The purpose of this study was to explore how the participation of dental hygiene students in interdisciplinary care conferences conducted in long-term care (LTC) facilities influenced the staff's awareness of oral health, the student's provision of care as well as the student's ability to work on an interdisciplinary team. Oral health in LTC continues to be poor despite many educational and clinical interventions. The care of a frail elder requires an interdisciplinary team approach, yet dental professionals are often absent from these teams. As an educational intervention, dental hygiene students, in addition to providing clinical care to residents and education to staff in a LTC facility, have been participating in interdisciplinary care conferences for 4 years. Nine LTC facility staff and eight students participated in two focus groups and five personal interviews to discuss their experiences of the care conferences. Narratives were transcribed verbatim and thematic analysis was conducted. Four major themes emerged that described the essence of the experience of involving dental professionals within interdisciplinary care conference: (i) addressing oral health, (ii) reciprocal learning, (iii) dealing with complexity and (iv) impact of collaborative care. Overall, students found the educational intervention to be worthwhile that allowed for the development of interdisciplinary skills and a greater understanding of dental geriatrics. The dental support in care conferences was welcomed by the staff as it facilitated a new way of exchanging knowledge and experiences so that a more holistic approach to care could be undertaken by all. © 2017 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population.

PubMed

Ouslander, Joseph G; Maslow, Katie

2012-12-01

Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

To What Extent Is Long-term Care Representative of Elderly Care? A Case Study of Elderly Care Financing in Lombardy, Italy

PubMed Central

Brenna, Elenka; Gitto, Lara

2017-01-01

The ageing of European population has been rapidly increasing during the last decades, and the problem of elderly care financing has become an issue for policy-makers. Long-term care (LTC) financing is considered a suitable proxy of the resources committed to elderly care by each government, but the preciseness of this approximation depends on the extent to which LTC is representative of elderly care within each country. Since there is a broad heterogeneity in LTC funding, organization and setting among European States, it is difficult to find a common parameter representing the public resources destined to the elderly care. We address these topics employing as a case study an Italian region, Lombardy, which in terms of population, dimension, healthcare organization and economic development could be compared to other European countries. The method we suggest, which consists basically in a careful estimate of all the public resources employed in the provision of services exclusively destined to the elderly, could be applied, with the due differences, to other European countries or regions. PMID:28812846

Concept analysis of good death in long term care residents.

PubMed

Krishnan, Preetha

2017-01-02

The purpose of this concept analysis paper is to delineate the meaning of good death in long term care (LTC) settings and examine its implications for nursing. The Walker and Avant (2011) method was chosen for this analysis. An in depth literature review identifies uses of the concept and determines the defining attributes of the good death. This paper also illustrates case presentations, antecedents, consequences, empirical referents and implications for clinical practice to clarify the concept of 'good death' in this population. In LTC, death is experienced frequently and is considered the ultimate outcome for most admissions. Much of the existing research on end-of-life care has focused on community dwelling cancer patients whose death trajectory is predictable and who may remain cognitively intact until actively dying. In contrast, the LTC population is older and more likely to suffer from dementia and experience chronic illness for long periods prior to death, and they follow a less predictable death trajectory. In this century, death became the province of older people and the assurance of a good death became the responsibility of those caring for them.

Voluntarily Stopping Eating and Drinking: A Practical Approach for Long-Term Care Facilities.

PubMed

Gruenewald, David A

2018-06-05

Some residents of long-term care (LTC) facilities with lethal or serious chronic illnesses may express a wish to hasten their death by voluntarily stopping eating and drinking (VSED). LTC facility clinicians, administrators, and staff must balance resident safety, moral objections to hastened death, and other concerns with resident rights to autonomy, self-determination, and bodily integrity. Initially, requests for hastened death, including VSED must be treated as opportunities to uncover underlying concerns. After a concerted effort to address root causes of suffering, some residents will continue to request hastened death. Rigorous resident assessment, interdisciplinary care planning, staff training, and clear and complete documentation are mandatory. In addition, an independent second opinion from a consultant with palliative care and/or hospice expertise is indicated to help determine the most appropriate response. When VSED is the only acceptable option to relieve suffering of residents with severe chronic and lethal illnesses, facilitating VSED requests honors resident-centered care. The author offers practice suggestions and a checklist for LTC facilities and staff caring for residents requesting and undergoing VSED.

Simulating the impact of long-term care policy on family eldercare hours.

PubMed

Ansah, John P; Matchar, David B; Love, Sean R; Malhotra, Rahul; Do, Young Kyung; Chan, Angelique; Eberlein, Robert

2013-04-01

To understand the effect of current and future long-term care (LTC) policies on family eldercare hours for older adults (60 years of age and older) in Singapore. The Social Isolation Health and Lifestyles Survey, the Survey on Informal Caregiving, and the Singapore Government's Ministry of Health and Department of Statistics. An LTC Model was created using system dynamics methodology and parameterized using available reports and data as well as informal consultation with LTC experts. In the absence of policy change, among the elderly living at home with limitations in their activities of daily living (ADLs), the proportion of those with greater ADL limitations will increase. In addition, by 2030, average family eldercare hours per week are projected to increase by 41 percent from 29 to 41 hours. All policy levers considered would moderate or significantly reduce family eldercare hours. System dynamics modeling was useful in providing policy makers with an overview of the levers available to them and in demonstrating the interdependence of policies and system components. © Health Research and Educational Trust.

Introducing health gains in location-allocation models: A stochastic model for planning the delivery of long-term care

NASA Astrophysics Data System (ADS)

Cardoso, T.; Oliveira, M. D.; Barbosa-Póvoa, A.; Nickel, S.

2015-05-01

Although the maximization of health is a key objective in health care systems, location-allocation literature has not yet considered this dimension. This study proposes a multi-objective stochastic mathematical programming approach to support the planning of a multi-service network of long-term care (LTC), both in terms of services location and capacity planning. This approach is based on a mixed integer linear programming model with two objectives - the maximization of expected health gains and the minimization of expected costs - with satisficing levels in several dimensions of equity - namely, equity of access, equity of utilization, socioeconomic equity and geographical equity - being imposed as constraints. The augmented ε-constraint method is used to explore the trade-off between these conflicting objectives, with uncertainty in the demand and delivery of care being accounted for. The model is applied to analyze the (re)organization of the LTC network currently operating in the Great Lisbon region in Portugal for the 2014-2016 period. Results show that extending the network of LTC is a cost-effective investment.

Nano-array based monolithic catalysts: Concept, rational materials design and tunable catalytic performance

DOE PAGES

Ren, Zheng; Guo, Yanbing; Gao, Pu-Xian

2015-03-20

Monolithic catalysts, also known as structured catalysts, represent an important catalyst configuration widely used in automotive, chemical, and energy industries. However, several issues associated with washcoat based monolithic catalyst preparation are ever present, such as compromised materials utilization efficiency due to a less-than-ideal wash coating process, difficulty in precise and optimum microstructure control and lack of structure-property correlation. Here, in this mini-review, we introduce the concept of nano-array catalyst, a new type of monolithic catalyst featuring high catalyst utilization efficiency, good thermal/mechanical robustness, and catalytic performance tunability. A comprehensive overview is presented with detailed discussion of the strategies for nano-arraymore » catalyst preparation and rational catalytic activity adjustment enabled by the well-defined nano-array geometry. Specifically their scalable fabrication processes are reviewed in conjunction with discussion of their various catalytic oxidation reaction performances at low temperature. Finally, we hope this review will serve as a timely and useful research guide for rational design and utilization of the new type of monolithic catalysts.« less

Synthesis H-Zeolite catalyst by impregnation KI/KIO3 and performance test catalyst for biodiesel production

NASA Astrophysics Data System (ADS)

Widayat, W.; Rizky Wicaksono, Adit; Hakim Firdaus, Lukman; Okvitarini, Ndaru

2016-02-01

The objective of this research is to produce H-catalyst catalyst that was impregnated with KI/KIO3. The catalyst was analyzed about surface area, X-Ray Diffraction (XRD) and performance test of catalyst for biodiesel production. An H-Zeolite catalyst was synthesized from natural zeolite with chemical treatment processing, impregnation KI/KIO3 and physical treatment. The results shows that the surface area of the catalyst by 27.236 m2/g at a concentration of 5% KI. XRD analysis shows peak 2-θ at 23.627o indicating that KI was impregnated on H-zeolite catalyst. The catalyst was tested in production of biodiesel using palm oil with conventional methods for 3 hour at temperature of 70-80 oC. The result for conversion Fatty Acid Methyl Ester (FAME) reached maximum value on 87.91% under production process using catalyst 5% KIO3-H zeolite.

Imphal-Kohima: Encirclement, 8 March-22 June 1944 (CSI Battlebook 10-C)

DTIC Science & Technology

1984-05-01

REPORT NUMBER 7. AUTHOR(-.YtlAiJ Will-iiam J.j’Higgins, LTC A~dul Al- S. CONTRACT OR GRANT NUMBER(&) Murshed ,4 fAJ Dennis R. Bi rchall.4~ 11che R.W...William J. Higgins LTC Abdul Al- Murshed MAJ Rodney S. Lusey MAJ Dennis R. Birchall MAJ Michael K. Mehaffe’. ’AJ Michael R. Harrison MAJ Randy W. Mills...and March, the soil is parched and hard. Rice paddies, and many of the smaller lakes and ma rhes in the Imphal Plain are dry. Moving men and vehicles

Effect of polymer binders in anode catalyst layer on performance of alkaline direct ethanol fuel cells

NASA Astrophysics Data System (ADS)

Li, Y. S.; Zhao, T. S.; Liang, Z. X.

In preparing low-temperature fuel cell electrodes, a polymer binder is essential to bind discrete catalyst particles to form a porous catalyst layer that simultaneously facilitates the transfer of ions, electrons, and reactants/products. For two types of polymer binder, namely, an A3-an anion conducting ionomer and a PTFE-a neutral polymer, an investigation is made of the effect of the content of each binder in the anode catalyst layer on the performance of an alkaline direct ethanol fuel cell (DEFC) with an anion-exchange membrane and non-platinum (non-Pt) catalysts. Experiments are performed by feeding either ethanol (C 2H 5OH) solution or ethanol-potassium hydroxide (C 2H 5OH-KOH) solution. The experimental results for the case of feeding C 2H 5OH solution without added KOH indicate that the cell performance varies with the A3 ionomer content in the anode catalyst layer, and a content of 10 wt.% exhibits the best performance. When feeding C 2H 5OH-KOH solution, the results show that: (i) in the region of low current density, the best performance is achieved for a membrane electrode assembly without any binder in the anode catalyst layer; (ii) in the region of high current density, the performance is improved with incorporation of PTFE binder in the anode catalyst layer; (iii) the PTFE binder yields better performance than does the A3 binder.

Catalyst and electrode research for phosphoric acid fuel cells

NASA Technical Reports Server (NTRS)

Antoine, A. C.; King, R. B.

1987-01-01

An account is given of the development status of phosphoric acid fuel cells' high performance catalyst and electrode materials. Binary alloys have been identified which outperform the baseline platinum catalyst; it has also become apparent that pressurized operation is required to reach the desired efficiencies, calling in turn for the use of graphitized carbon blacks in the role of catalyst supports. Efforts to improve cell performance and reduce catalyst costs have led to the investigation of a class of organometallic cathode catalysts represented by the tetraazaannulenes, and a mixed catalyst which is a mixture of carbons catalyzed with an organometallic and a noble metal.

Armored Cavalry and Reconnaissance: A Doctrinal Shortfall in Force Structure

DTIC Science & Technology

1988-04-15

LTC CHARLES S. ROUSEK ŝ. PERFORMING ORGANIZATION NAME AND ADDRESS 10. PROGRAM ELEMENT. PROJECT, TASK AREA & WORK UNIT NUMBERS US ARMY WAR COLLEGE...paradox the Israeli% sufered when they commited the basicerosith Ym Kippur War which evolved from their victory in the Six 08V War -the structuring and...the readiness, standards, training, and esprit of the affected units. This pav’t of the "One Army Concept" works and should be exploited on a one for

Force XXI: Directions in Digitization - Symposium Report.

DTIC Science & Technology

1996-08-21

J. KWINN, JR. LTC DAVID W. HUTCHISON COL JAMES L. KAYS 7 . PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) USMA OPERATIONS RESEARCH CENTER WEST...I would also like to acknowledge the many people who worked hard to put on this symposium: Colonel James L. Kays for providing the vision, faith...Appendix D-5: Organi2ation D-5-1 Appendix D-6: Interoperability D-6-1 Appendix D- 7 : Readiness D- 7 -1 Annex E: Transcripts from Symposium E-l Annex F

Public Employee Unions and the Post Commander.

DTIC Science & Technology

1982-04-01

sector employees joining unions was addressed in June, 1981 while the author was a student in a graduate degree program . Then, as now, my bias was anti...AD-A116 168 ARMY WAR COLL CARLISLE BARRACKS PA F/6 5/1 PUBLIC EMPLOYEE UNIONS AND THE POST COMMANDER. (U) APR 82 E L DANIEL UNCLASSIFIED u mm um(u pp...COVERED Public Employee Unions and the Post Commander Student Essay 6. PERFORMING ORG. REPORT NUMBER 7. AUTHOR(s) 8. CONTRACT OR GRANT NUMBER(S) LTC

Graphitized Carbon: A Promising Stable Cathode Catalyst Support Material for Long Term PEMFC Applications.

PubMed

Mohanta, Paritosh Kumar; Regnet, Fabian; Jörissen, Ludwig

2018-05-28

Stability of cathode catalyst support material is one of the big challenges of polymer electrolyte membrane fuel cells (PEMFC) for long term applications. Traditional carbon black (CB) supports are not stable enough to prevent oxidation to CO₂ under fuel cell operating conditions. The feasibility of a graphitized carbon (GC) as a cathode catalyst support for low temperature PEMFC is investigated herein. GC and CB supported Pt electrocatalysts were prepared via an already developed polyol process. The physical characterization of the prepared catalysts was performed using transmission electron microscope (TEM), X-ray Powder Diffraction (XRD) and inductively coupled plasma optical emission spectrometry (ICP-OES) analysis, and their electrochemical characterizations were conducted via cyclic voltammetry(CV), rotating disk electrode (RDE) and potential cycling, and eventually, the catalysts were processed using membrane electrode assemblies (MEA) for single cell performance tests. Electrochemical impedance spectroscopy (EIS) and scanning electrochemical microscopy (SEM) have been used as MEA diagonostic tools. GC showed superior stability over CB in acid electrolyte under potential conditions. Single cell MEA performance of the GC-supported catalyst is comparable with the CB-supported catalyst. A correlation of MEA performance of the supported catalysts of different Brunauer⁻Emmett⁻Teller (BET) surface areas with the ionomer content was also established. GC was identified as a promising candidate for catalyst support in terms of both of the stability and the performance of fuel cell.

Understanding low temperature oxidation activity of nanoarray-based monolithic catalysts: from performance observation to structural and chemical insights

DOE PAGES

Du, Shoucheng; Tang, Wenxiang; Guo, Yanbing; ...

2016-12-30

Monolithic catalysts have been widely used in automotive, chemical, and energy relevant industries. Nano-array based monolithic catalysts have been developed, demonstrating high catalyst utilization efficiency and good thermal/mechanical robustness. Compared with the conventional wash-coat based monolithic catalysts, they have shown advances in precise and optimum microstructure control and feasibility in correlating materials structure with properties. Recently, the nano-array based monolithic catalysts have been studied for low temperature oxidation of automotive engine exhaust and exhibited interesting and promising catalytic activities. Here, this review focuses on discussing the key catalyst structural parameters that affect the catalytic performance from the following aspects, (1)more » geometric shape and crystal planes, (2) guest atom doping and defects, (3) array size and size-assisted active species loading, and (4) the synergy effect of metal oxide in composite nano-arrays. Prior to the discussion, an overview of the current status of synthesis and development of the nano-array based monolithic catalysts is introduced. The performance of these materials in low temperature simulated engine exhaust oxidation is also demonstrated. Finally, we hope this review will elucidate the science and chemistry behind the good oxidation performance of the nanoarray- based monolithic catalysts, and serve as a timely and useful research guide for rational design and further improvement of the nano-array based monolithic catalysts for automobile emission control.« less

Understanding low temperature oxidation activity of nanoarray-based monolithic catalysts: from performance observation to structural and chemical insights

DOE Office of Scientific and Technical Information (OSTI.GOV)

Du, Shoucheng; Tang, Wenxiang; Guo, Yanbing

Monolithic catalysts have been widely used in automotive, chemical, and energy relevant industries. Nano-array based monolithic catalysts have been developed, demonstrating high catalyst utilization efficiency and good thermal/mechanical robustness. Compared with the conventional wash-coat based monolithic catalysts, they have shown advances in precise and optimum microstructure control and feasibility in correlating materials structure with properties. Recently, the nano-array based monolithic catalysts have been studied for low temperature oxidation of automotive engine exhaust and exhibited interesting and promising catalytic activities. Here, this review focuses on discussing the key catalyst structural parameters that affect the catalytic performance from the following aspects, (1)more » geometric shape and crystal planes, (2) guest atom doping and defects, (3) array size and size-assisted active species loading, and (4) the synergy effect of metal oxide in composite nano-arrays. Prior to the discussion, an overview of the current status of synthesis and development of the nano-array based monolithic catalysts is introduced. The performance of these materials in low temperature simulated engine exhaust oxidation is also demonstrated. Finally, we hope this review will elucidate the science and chemistry behind the good oxidation performance of the nanoarray- based monolithic catalysts, and serve as a timely and useful research guide for rational design and further improvement of the nano-array based monolithic catalysts for automobile emission control.« less

Responsiveness to montelukast is associated with bronchial hyperresponsiveness and total immunoglobulin E but not polymorphisms in the leukotriene C4 synthase and cysteinyl leukotriene receptor 1 genes in Korean children with exercise-induced asthma (EIA).

PubMed

Lee, S-Y; Kim, H-B; Kim, J-H; Kim, B-S; Kang, M-J; Jang, S-O; Seo, H-J; Hong, S-J

2007-10-01

As previous studies have shown that cysteinyl leukotrienes are important mediators in exercise-induced bronchoconstriction (EIB), and leukotriene receptor antagonists (LTRAs) such as montelukast have been shown to improve post-exercise bronchoconstrictor responses, we herein investigated whether clinical responsiveness to montelukast was associated with polymorphisms in the genes encoding leukotriene C4 synthase (LTC4S) and cysteinyl leukotriene receptor 1 (CysLTR1) and/or clinical parameters in Korean asthmatic children with EIB. The study population consisted of 100 asthmatic children with EIB. The individuals studied were given exercise challenge tests before and after receiving montelukast (5 mg/day) for 8 weeks. Responders were defined as children showing>10% post-treatment improvement in forced expiratory volume in 1 s (FEV1). The LTC4S A(-444)C and CysLTR1 T(+927)C polymorphisms were genotyped by PCR-restriction fragment length polymorphism analysis. Of 100 enrolled children, 68 were classified as responders and 32 were classified as non-responders. No significant association was observed between montelukast responsiveness and LTC4S or CysLTR1 genotype, either alone or in combination. In contrast, montelukast-induced improvement in FEV(1) after exercise was correlated with higher pre-treatment PC20 (methacholine) values (r=0.210, P=0.036) and lower total IgE levels (r=-0.216, P=0.031). The LTC4S A(-444)C and CysLTR1 T(+927)C genotypes do not appear to be useful for predicting clinical responsiveness to montelukast, whereas bronchial hyperresponsiveness and total IgE appear to predict the degree of montelukast responsiveness in Korean asthmatic children with EIB.

Differentiation stage-specific regulation of primitive human hematopoietic progenitor cycling by exogenous and endogenous inhibitors in an in vivo model.

PubMed

Cashman, J D; Clark-Lewis, I; Eaves, A C; Eaves, C J

1999-12-01

Nonobese diabetic/severe combined immunodeficient (NOD/SCID) mice transplanted with human cord blood or adult marrow cells and injected 6 weeks posttransplant with 2 daily doses of transforming growth factor-beta(1) (TGF-beta(1)), monocyte chemoattractant protein-1 (MCP-1), or a nonaggregating form of macrophage inflammatory protein-1alpha (MIP-1alpha) showed unique patterns of inhibition of human progenitor proliferation 1 day later. TGF-beta(1) was active on long-term culture initiating cells (LTC-IC) and on primitive erythroid and granulopoietic colony-forming cells (HPP-CFC), but had no effect on mature CFC. MCP-1 inhibited the cycling of both types of HPP-CFC but not LTC-IC. MIP-1alpha did not inhibit either LTC-IC or granulopoietic HPP-CFC but was active on erythroid HPP-CFC and mature granulopoietic CFC. All of these responses were independent of the source of human cells transplanted. LTC-IC of either human cord blood or adult marrow origin continue to proliferate in NOD/SCID mice for many weeks, although the turnover of all types of human CFC in mice transplanted with adult human marrow (but not cord blood) is downregulated after 6 weeks. Interestingly, administration of either MIP-1beta, an antagonist of both MIP-1alpha and MCP-1 or MCP-1(9-76), an antagonist of MCP-1 (and MCP-2 and MCP-3), into mice in which human marrow-derived CFC had become quiescent, caused the rapid reactivation of these progenitors in vivo. These results provide the first definition of stage-specific inhibitors of human hematopoietic progenitor cell cycling in vivo. In addition they show that endogenous chemokines can contribute to late graft failure, which can be reversed by the administration of specific antagonists.

Audio-computer-assisted survey interview and patient navigation to increase chronic viral hepatitis diagnosis and linkage to care in urban health clinics.

PubMed

de la Torre, A N; Castaneda, I; Ahmad, M; Ekholy, N; Tham, N; Herrera, I B; Beaty, P; Malapero, R J; Ayoub, F; Slim, J; Johnson, M B

2017-12-01

Intravenous drug use and sexual practices account for 60% of hepatitis C (HCV) and B (HBV) infection. Disclosing these activities can be embarrassing and reduce risk reporting, blood testing and diagnosis. In diagnosed patients, linkage to care remains a challenge. Audio-computer-assisted survey interview (Audio-CASI) was used to guide HCV and HBV infection testing in urban clinics. Risk reporting, blood testing and serology results were compared to historical controls. A patient navigator (PN) followed up blood test results and provided patients with positive serology linkage to care (LTC). Of 1932 patients surveyed, 574 (30%) were at risk for chronic viral hepatitis. A total of 254 (44.3%) patients were tested, 34 (13.5%) had serology warranting treatment evaluation, and 64% required HBV vaccination. Of 16 patients with infection, seven HCV and three HBV patients started treatment following patient LTC. Of 146 HBV-naïve patients, 70 completed vaccination. About 75% and 49% of HCV antibody and HBV surface antigen-positive patients were born between 1945 and 1965. Subsequently, automated HCV testing of patients born between 1945 and 1965 was built into our hospital electronic medical records. Average monthly HCV antibody testing increased from 245 (January-June) to 1187 (July-October). Patient navigator directed LTC for HCV antibody-positive patients was 61.6%. In conclusion, audio-CASI can identify patients at risk for HCV or HBV infection and those in need of HBV vaccination in urban medical clinics. Although blood testing once a patient is identified at risk for infection needs to increase, a PN is useful to provide LTC of newly diagnosed patients. © 2017 John Wiley & Sons Ltd.

Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: perspectives of licensed nursing staff.

PubMed

McGilton, Katherine S; Boscart, Veronique M; Brown, Maryanne; Bowers, Barbara

2014-06-01

Turnover of licensed nursing staff in long-term care (LTC) settings (e.g., nursing homes) is a mounting concern and is associated with poor quality of care and low staff morale. Retention and turnover research in LTC have focused primarily on direct care workers (i.e., nurse aides) leaving the issues largely unexplored for licensed nursing staff (i.e., registered nurses and licensed practical nurses). The main objective of this study was to understand factors that influence nurses' intentions to remain employed at their current job. Qualitative descriptive study. Seven nursing homes in Ontario, Canada. A convenience sample of forty-one licensed LTC nurses. Data were collected through focus groups conducted at each of the participating nursing homes. Focus group discussions were transcribed verbatim. Directed content analysis was used to identify and develop themes. Work conditions were a salient element affecting nurses' intention to stay and included impact of regulations on nurse role flexibility and professional judgment, an underfunded system contributing to insufficient resources and staffing, and a lack of supportive leadership. Factors promoting nurses' willingness to stay included the development of meaningful relationships with residents and staff and opportunities for learning and professional development. Nurses also considered personal and life circumstances (e.g., marital status and seniority) when discussing intention to stay. Nurses in this study weighed positive and negative work-related factors as well as personal circumstances to determine their intent to stay. Developing a more individualized approach to address attrition of licensed nurses in LTC may be the most successful strategy for improving retention of highly skilled staff in this sector. Copyright © 2013 Elsevier Ltd. All rights reserved.

Antipsychotics and dementia in Canada: a retrospective cross-sectional study of four health sectors.

PubMed

Rios, Sebastian; Perlman, Christopher M; Costa, Andrew; Heckman, George; Hirdes, John P; Mitchell, Lori

2017-10-23

Antipsychotic medications are not recommended for the management of symptoms of dementia, particularly among persons with no behavioral or psychological symptoms. We examine patterns of antipsychotic medication use among persons with dementia across health sectors in Canada, with a focus on factors related to use among those without behavioral or psychotic symptoms. Using a retrospective cross-sectional design, this study examines antipsychotic use among adults aged 65 or older with dementia in home care (HC), complex continuing care (CCC), long-term care (LTC), and among alternate level care patients in acute hospitals (ALC). Using clinical data from January 1, 2009 to December 31, 2014, the prevalence of antipsychotic medication use was estimated by the presence of behavioral and psychotic symptoms. Logistic regression was used to identify sector specific factors associated with antipsychotic use in the absence of behavioral and psychotic symptoms. The total prevalence of antipsychotic use among older adults with dementia was 26% in HC, 54% in ALC, 41% in CCC, and 48% in LTC. This prevalence ranged from 38% (HC) to 73% (ALC) for those with both behavioral and psychotic symptoms and from 15% (HC) to 31% (ALC) among those with no symptoms. The regression models identified a number of variables were related to antipsychotic use in the absence of behavior or psychotic symptoms, such as bipolar disorder (OR = 6.63 in CCC; OR = 5.52 in LTC), anxious complaints (OR = 1.54 in LTC to 2.01 in CCC), and wandering (OR = 1.83 in ALC). Potentially inappropriate use of antipsychotic medications is prevalent among older adults with dementia across health sectors. The variations in prevalence observed from community to facility based care suggests that system issues may exist in appropriately managing persons with dementia.

Administrators' perspectives on end-of-life care for cancer patients in Japanese long-term care facilities.

PubMed

Fukahori, Hiroki; Miyashita, Mitsunori; Morita, Tatsuya; Ichikawa, Takayuki; Akizuki, Nobuya; Akiyama, Miki; Shirahige, Yutaka; Eguchi, Kenji

2009-10-01

The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

Intestinal microbiota and innate immunity-related gene alteration in cirrhotic rats with liver transplantation.

PubMed

Xie, Y R; Liu, S L; Liu, X; Luo, Z B; Zhu, B; Li, Z F; Li, L J; He, Y; Jiang, L; Li, H; Ruan, B

2011-12-01

The present study investigated the alteration of intestinal microbiota, innate immunity-related genes, and bacterial translocation in rats with cirrhosis and liver transplantation. Specific pathogen-free Sprague-Dawley rats were randomized into 4 groups: (1) normal controls (N); (2) liver cirrhosis (LC); (3) normal control groups with liver transplantation (LTN); and (4) liver cirrhosis with liver transplantation (LTC). We examined plasma endotoxin, bacterial tacslocation, denaturing gradient gel electrophoresis (DGGE) profile of intestinal mucosa-associated bacteria, abundance of key bacterial populations, and expression of innate immunity-related gene. The LTC and LC group, showed higher endotoxin levels (1.08±0.73 EU/mL and 0.74±0.70 EU/mL, respectively) than the N group (0.27±0.13 EU/mL; P<.05). the incidence of bacterial translocation (BT) to liver and mesenteric lymph nodes (MLN), and the number of total bacteria were increased significantly in the LTC and LC groups compared with the N group (P<.05). The counts of Lactobacilli and Bacteroides were lower, whereas Enterobacteria were higher in the LC than the N group (P<.05). Mucins (MUC2, MUC3) and Toll-like receptors (TLR2, TLR4) messenger RNA (mRNA) expression were significantly higher in the LC and LTC groups than the N group (P<.05). The marked difference between the groups in the overall structure of the bacterial community was also generated by DGGE profiles. Liver cirrhosis disturbs intestinal microbiota and innate immunity-related genes, which contributes to endotoxemia and bacterial translocation. These had not completely recovered in cirrhotic rats until 1 month after orthotopic liver transplantation. Copyright © 2011 Elsevier Inc. All rights reserved.

Janus at the Crossroads: Perspectives on Long-term Care Trajectories for Older Women With Dementia in a Canadian Context.

PubMed

Cloutier, Denise S; Penning, Margaret J

2017-02-01

Janus, the two-faced, Roman god of beginnings and transitions, is used as a metaphor to explore our personal narratives and our quantitative research on the experiences of older women with dementia in long-term care (LTC). Two research questions are addressed: (a) How do our quantitative data map onto our mothers' experiences? (b) What lessons do our mothers' experiences offer for the care of older women with dementia? Informed by a life-course perspective, we triangulate administrative data on 3,717 women with dementia receiving LTC in British Columbia, Canada, with personal narratives-the stories of our mothers who made the transition from home care into residential (nursing home) care. Our quantitative data reveal that the home care to residential care transition is the most common LTC trajectory for women with dementia who are most likely to be widowed and living alone in suburban areas. On entry into residential care, they exhibit greater frailty in terms of activities of daily living, cognition, aggression, and incontinence. Our personal narrative data on our mothers reveals that the relatively straightforward pathways through LTC for women with dementia, are often considerably more complex in a real-world context. Attention is drawn to the public and private services, hospitalization patterns, and substantial communication gaps experienced by our moms and families. A life-course perspective, and qualitative and quantitative data facilitate understanding the care journeys-health and service trajectories of older women with dementia. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Six-month outcomes of co-occurring delirium, depression, and dementia in long-term care.

PubMed

McCusker, Jane; Cole, Martin G; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Vu, Minh; Belzile, Eric

2014-12-01

To describe the 6-month outcomes of co-occurring delirium (full syndrome and subsyndromal symptoms), depression, and dementia in a long-term care (LTC) population. Observational, prospective cohort study with 6-month follow-up conducted from 2005 to 2009. Seven LTC facilities in the province of Quebec, Canada. Newly admitted and long-term residents recruited consecutively from lists of residents aged 65 and older admitted for LTC, with stratification into groups with and without severe cognitive impairment. The study sample comprised 274 residents with complete data at baseline on delirium, dementia, and depression. Outcomes were 6-month mortality, functional decline (10-point decline from baseline on 100-point Barthel scale), and cognitive decline (3-point decline on 30-point Mini-Mental State Examination). Predictors included delirium (full syndrome or subsyndromal symptoms, using the Confusion Assessment Method), depression (Cornell Scale for Depression in Dementia), and dementia (chart diagnosis). The baseline prevalences of delirium, subsyndromal symptoms of delirium (SSD), depression, and dementia were 11%, 44%, 19%, and 66%, respectively. By 6 months, 10% of 274 had died, 19% of 233 had experienced functional decline, and 17% of 246 had experienced cognitive decline. An analysis using multivariable generalized linear models found the following significant interaction effects (P < .15): between depression and dementia for mortality, between delirium and depression for functional decline, and between SSD and dementia for cognitive decline. Co-occurrence of delirium, SSD, depression, and dementia in LTC residents appears to affect some 6-month outcomes. Because of limited statistical power, it was not possible to draw conclusions about the effects of the co-occurrence of some syndromes on poorer outcomes. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Characterization and modulation of canine mast cell derived eicosanoids

PubMed Central

Lin, Tzu-Yin; London, Cheryl A.

2013-01-01

Mast cells play an important role in both innate and acquired immunity as well as several pathological conditions including allergy, arthritis and neoplasia. They influence these processes by producing a variety of mediators including cytokines, chemokines and eicosanoids. Very little is currently known about the spectrum of inflammatory mediators, particularly eicosanoids (prostaglandins and leukotrienes), produced by canine mast cells. This is important since modulating mast cell derived eicosanoids may help in the treatment of autoimmune and inflammatory disorders. The purpose of this study was to investigate the spectrum of eicosanoids produced by normal canine mast cells and to evaluate the effects of cytokines and non-steroidal anti-inflammatory mediators (NSAIDS) on eicosanoid production and release. Canine bone marrow derived cultured mast cells (cBMCMCs) expressed COX-1, COX-2, and 5-LOX and synthesized and released PGD2, PGE2, LTB4, and LTC4 following activation by a variety of stimuli. The selective COX-2 NSAIDs carprofen (Rimadyl®) and deracoxib (Deramaxx®) inhibited PGD2 and PGE2 production but only slightly inhibited LTB4 and LTC4. The mixed COX-1/COX-2 inhibitor piroxicam blocked PGD2 and PGE2 production, but upregulated LTC4 following treatment while tepoxilan (Zubrin®), a pan COX/LOX inhibitor, markedly reduced the production of all eicosanoids. The LOX inhibitor nordihydroguaiaretic acid (NDGA) prevented LTB4/LTC4 release and BMBMC degranulation. Pre-incubation of cBMCMCs with IL-4 and SCF sensitized these cells to degranulation in response to substance P. In conclusion, canine BMCMCs produce an array of eicosanoids similar to those produced by mast cells from other species. Tepoxilan appeared to be the most effective NSAID for blocking eicosanoid production and thus may be useful for modulating mast cell mediated responses in dogs. PMID:20036014

Multidimensional team-based intervention using musical cues to reduce odds of facility-acquired pressure ulcers in long-term care: a paired randomized intervention study.

PubMed

Yap, Tracey L; Kennerly, Susan M; Simmons, Mark R; Buncher, Charles R; Miller, Elaine; Kim, Jay; Yap, Winston Y

2013-09-01

To test the effectiveness of a pressure ulcer (PU) prevention intervention featuring musical cues to remind all long-term care (LTC) staff (nursing and ancillary) to help every resident move or reposition every 2 hours. Twelve-month paired-facility two-arm (with one-arm crossover) randomized intervention trial. Ten midwestern U.S. LTC facilities. Four treatment facilities received intervention during Months 1 to 12, four comparison facilities received intervention during Months 7 to 12, and two pseudo-control facilities received no intervention. LTC facility residents (N = 1,928). All facility staff received in-person education, video, and handouts, and visiting family members received informational pamphlets on PU prevention and an intervention featuring musical cues. Nurse-led multidisciplinary staff teams presented the cues as prompts for staff and family to reposition residents or remind them to move. Musical selections (with and without lyrics) customized to facility preferences were played daily over the facility intercom or public address system every 2 hours for the 12-hour daytime period. Primary outcome measure was the frequency of new facility-acquired PUs divided by the total number of facility Minimum Data Set (MDS) resident assessments conducted during the study period. Odds of a new PU were lower in intervention facilities (P = .08) for MDS 2.0 assessments and were significantly lower (P = .05) for MDS 3.0. Mean odds ratios suggested intervention facility residents were 45% less likely than comparison facility residents to develop a new PU. Customized musical cues that prompt multidisciplinary staff teams to encourage or enable movement of all residents hold promise for reducing facility-acquired PUs in LTC settings. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Quantitative fluorescent polymerase chain reaction for rapid prenatal diagnosis of fetal aneuploidies in chorionic villus sampling in a single institution

PubMed Central

Shin, You Jung; Kim, Do Jin; Ryu, Hyun Mee; Kim, Moon Young; Han, Jung Yeol; Choi, June Seek

2016-01-01

Objective To validate quantitative fluorescent polymerase chain reaction (QF-PCR) via chorionic villus sampling (CVS) for the diagnosis of fetal aneuploidies. Methods We retrospectively reviewed the medical records of consecutive pregnant women who had undergone CVS at Cheil General Hospital between December 2009 and June 2014. Only cases with reported QF-PCR before long-term culture (LTC) for conventional cytogenetic analysis were included, and the results of these two methods were compared. Results A total of 383 pregnant women underwent QF-PCR and LTC via CVS during the study period and 403 CVS specimens were collected. The indications of CVS were as follows: abnormal first-trimester ultrasonographic findings, including increased fetal nuchal translucency (85.1%), advanced maternal age (6.8%), previous history of fetal anomalies (4.2%), and positive dual test results for trisomy 21 (3.9%). The results of QF-PCR via CVS were as follows: 76 (18.9%) cases were identified as trisomy 21 (36 cases), 18 (33 cases), or 13 (seven cases), and 4 (1.0%) cases were suspected to be mosaicism. All results of common autosomal trisomies by QF-PCR were consistent with those of LTC and there were no false-positive findings. Four cases suspected as mosaicism in QF-PCR were confirmed as non-mosaic trisomies of trisomy 21 (one case) or trisomy 18 (three cases) in LTC. Conclusion QF-PCR via CVS has the advantage of rapid prenatal screening at an earlier stage of pregnancy for common chromosomal trisomies and thus can reduce the anxiety of parents. In particular, it can be helpful for pregnant women with increased fetal nuchal translucency or abnormal first-trimester ultrasonographic findings. PMID:27896246

Attractiveness of employment sectors for physical therapists in Ontario, Canada (1999-2007): implication for the long term care sector

PubMed Central

2012-01-01

Background Recruiting and retaining health professions remains a high priority for health system planners. Different employment sectors may vary in their appeal to providers. We used the concepts of inflow and stickiness to assess the relative attractiveness of sectors for physical therapists (PTs) in Ontario, Canada. Inflow was defined as the percentage of PTs working in a sector who were not there the previous year. Stickiness was defined as the transition probability that a physical therapist will remain in a given employment sector year-to-year. Methods A longitudinal dataset of registered PTs in Ontario (1999-2007) was created, and primary employment sector was categorized as ‘hospital’, ‘community’, ‘long term care’ (LTC) or ‘other.’ Inflow and stickiness values were then calculated for each sector, and trends were analyzed. Results There were 5003 PTs in 1999, which grew to 6064 by 2007, representing a 21.2% absolute growth. Inflow grew across all sectors, but the LTC sector had the highest inflow of 32.0%. PTs practicing in hospitals had the highest stickiness, with 87.4% of those who worked in this sector remaining year-to-year. The community and other employment sectors had stickiness values of 78.2% and 86.8% respectively, while the LTC sector had the lowest stickiness of 73.4%. Conclusion Among all employment sectors, LTC had highest inflow but lowest stickiness. Given expected increases in demand for services, understanding provider transitional probabilities and employment preferences may provide a useful policy and planning tool in developing a sustainable health human resource base across all employment sectors. PMID:22643111

NOVEL RU-NI-S ELECTRODE CATALYST FOR PEMFC

EPA Science Inventory

The expected results from this project include:

• a new formula and preparation procedures for Ru-Ni-S catalyst;
• demonstration of CO and S tolerance of the new catalyst;
• a small size PEMFC with Ru-Ni-S catalyst and good performance; an...

• Electrochemical performance and durability of carbon supported Pt catalyst in contact with aqueous and polymeric proton conductors.

  PubMed

  Andersen, Shuang Ma; Skou, Eivind

  2014-10-08

  Significant differences in catalyst performance and durability are often observed between the use of a liquid electrolyte (e.g., sulfuric acid), and a solid polymer electrolyte (e.g., Nafion). To understand this phenomenon, we studied the electrochemical behavior of a commercially available carbon supported platinum catalyst in four different electrode structures: catalyst powder (CP), catalyst ionomer electrode (CIE), half membrane electrode assembly (HMEA), and full membrane electrode assembly (FMEA) in both ex situ and in situ experiments under a simulated start/stop cycle. We found that the catalyst performance and stability are very much influenced by the presence of the Nafion ionomers. The proton conducting phase provided by the ionomer and the self-assembled electrode structure render the catalysts a higher utilization and better stability. This is probably due to an enhanced dispersion, an improved proton-catalyst interface, the restriction of catalyst particle aggregation, and the improved stability of the ionomer phase especially after the lamination. Therefore, an innovative electrode HMEA design for ex-situ catalyst characterization is proposed. The electrode structure is identical to the one used in a real fuel cell, where the protons transport takes place solely through solid state proton conducting phase.

• Core-shell rhodium sulfide catalyst for hydrogen evolution reaction / hydrogen oxidation reaction in hydrogen-bromine reversible fuel cell

  NASA Astrophysics Data System (ADS)

  Li, Yuanchao; Nguyen, Trung Van

  2018-04-01

  Synthesis and characterization of high electrochemical active surface area (ECSA) core-shell RhxSy catalysts for hydrogen evolution oxidation (HER)/hydrogen oxidation reaction (HOR) in H2-Br2 fuel cell are discussed. Catalysts with RhxSy as shell and different percentages (5%, 10%, and 20%) of platinum on carbon as core materials are synthesized. Cyclic voltammetry is used to evaluate the Pt-equivalent mass specific ECSA and durability of these catalysts. Transmission electron microscopy (TEM), X-ray Photoelectron spectroscopy (XPS) and Energy-dispersive X-ray spectroscopy (EDX) techniques are utilized to characterize the bulk and surface compositions and to confirm the core-shell structure of the catalysts, respectively. Cycling test and polarization curve measurements in the H2-Br2 fuel cell are used to assess the catalyst stability and performance in a fuel cell. The results show that the catalysts with core-shell structure have higher mass specific ECSA (50 m2 gm-Rh-1) compared to a commercial catalyst (RhxSy/C catalyst from BASF, 6.9 m2 gm-Rh-1). It also shows better HOR/HER performance in the fuel cell. Compared to the platinum catalyst, the core-shell catalysts show more stable performance in the fuel cell cycling test.

• [Ex vivo expansion and clonal variation of CD34(+)CD59(+) cells from bone marrow in children with paroxysmal nocturnal hemoglobinuria].

  PubMed

  Xiao, Juan; Wu, Yong-Ji; Han, Bing; Dong, Hong-Yan; Chen, Shi-Ping

  2013-08-01

  To investigate the isolation, purification and ex vivo expansion of CD34(+)CD59(+) cells from the bone marrow of children with paroxysmal nocturnal hemoglobinuria (PNH), to evaluate the capability of long-term hematopoietic reconstruction of the expanded CD34(+)CD59(+) cells, and to provide a laboratory basis for novel treatment of PNH. CD34(+)CD59(+) cells were isolated from the bone marrow mononuclear cells of children with PNH using immunomagnetic beads and flow cytometer in sequence. The isolated cells were subjected to ex vivo expansion in the presence of different combinations of hematopoietic growth factors for two weeks. The colony-forming cells and long-term culture-initiating cells (LTC-ICs) were cultured and counted. The optimal combination of hematopoietic growth factors for ex vivo expansion was stem cell factor+interleukin (IL)-3+IL-6+FLT3 ligand+thrombopoietin+ery-thropoietin, and maximum expansion (30.4 ± 6.7 folds) was seen on day 7 of days 4 to 14 of ex vivo expansion. After ex vivo expansion, CD34(+)CD59(+) cells remained CD59-positive, retained strong capability of forming colony-forming units, and could still form LTC-ICs. There was no significant difference in capability of forming LTC-ICs between CD34(+)CD59(+) cells before and after expansion. The expansion capability of CD34(+)CD59(+) cells from children with PNH was significantly lower than that of CD34(+) cells from normal controls (P<0.01). The CD34(+)CD59(+) cells from children with PNH can be expanded in vitro. Post-expansion CD34(+)CD59(+) cells retain capability of long-term hematopoietic reconstruction. CD34(+)CD59(+) cells showed no trend towards PNH clone during culture. Ex vivo expansion of CD34(+)CD59(+) cells from children with PNH might be practical in performing autologous transplantation clinically for these children.

• Effects of a gerotranscendence educational program on gerotranscendence recognition, attitude towards aging and behavioral intention towards the elderly in long-term care facilities: A quasi-experimental study.

  PubMed

  Lin, Yen-Chun; Wang, Chi-Jane; Wang, Jing-Jy

  2016-01-01

  Caregivers in long-term care (LTC) facilities have to uphold a positive attitude toward the elderly, so they will be more willing to provide the elderly with care of higher quality. Theory of Gerotranscendence is a theory which can assist the elderly in developing more mature and intellectual state of mind. It is hoped that the caregivers who receive gerotranscendence education may apply its concept to the care for the elderly. To evaluate the effects of the gerotranscendence educational program on caregivers' gerotranscendence recognition, attitude towards aging, and behavioral intention towards caring for the elderly. A quasi-experimental design with repeated measures was conducted. A total of 41 caregivers in LTC facilities participated and completed the study. Participants were invited to participate in a 2-day gerotranscendence educational program, and measurement took place at baseline, the end of the program (post-test) and three months after the program (follow-up test). The research tools included Gerotranscendence Recognition Scale-Chinese version, Aging Attitude scale, and Caregivers' Behavioral Intention Scale. This study used GLM repeated measures to perform analysis. There was a statistically significant difference in three repeated measures of participants' gerotranscendence recognition and behavior intention toward caring for the elderly (p=.002, .002, respectively) but not in the aging attitude score (p=.21). The post hoc comparison showed that the scores of these two outcomes in the post-test were significantly higher than those in the pre-test (p=.000; .024). However, the scores in the follow-up test were almost the same as those in the pre-test. The gerotranscendence educational program had timely effects on caregivers' gerotranscendence recognition and behavioral intention towards aging, and so caregivers working in LTC facilities may require ongoing training in the gerotranscendence educational program to ensure that these positive effects remain strong. Copyright © 2015 Elsevier Ltd. All rights reserved.

• Efficient low-temperature soot combustion by bimetallic Ag-Cu/SBA-15 catalysts.

  PubMed

  Wen, Zhaojun; Duan, Xinping; Hu, Menglin; Cao, Yanning; Ye, Linmin; Jiang, Lilong; Yuan, Youzhu

  2018-02-01

  In this study, the effects of copper (Cu) additive on the catalytic performance of Ag/SBA-15 in complete soot combustion were investigated. The soot combustion performance of bimetallic Ag-Cu/SBA-15 catalysts was higher than that of monometallic Ag and Cu catalysts. The optimum catalytic performance was acquired with the 5Ag 1 -Cu 0.1 /SBA-15 catalyst, on which the soot combustion starts at T ig =225°C with a T 50 =285°C. The temperature for 50% of soot combustion was lower than that of conventional Ag-based catalysts to more than 50°C (Aneggi et al., 2009). Physicochemical characterizations of the catalysts indicated that addition of Cu into Ag could form smaller bimetallic Ag-Cu nanolloy particles, downsizing the mean particle size from 3.7nm in monometallic catalyst to 2.6nm in bimetallic Ag-Cu catalyst. Further experiments revealed that Ag and Cu species elicited synergistic effects, subsequently increasing the content of surface active oxygen species. As a result, the structure modifications of Ag by the addition of Cu strongly intensified the catalytic performance. Copyright © 2017. Published by Elsevier B.V.

• Stability of High-Performance Pt-Based Catalysts for Oxygen Reduction Reactions.

  PubMed

  Lin, Rui; Cai, Xin; Zeng, Hao; Yu, Zhuoping

  2018-04-01

  Due to their environmental sustainability and high efficiency, proton-exchange-membrane fuel cells (PEMFCs) are expected to be an essential type of energy source for electric vehicles, energy generation, and the space industry in the coming decades. Here, the recent developments regarding shape-controlled nanostructure catalysts are reviewed, with a focus on the stability of high-performance Pt-based catalysts and related mechanisms. The catalysts, which possess great activity, are still far from meeting the requirements of their applications, due to stability issues, especially in membrane electrode assemblies (MEAs). Thus, solutions toward the comprehensive performance of Pt-based catalysts are discussed here. The research trends and related theories that can promote the application of Pt-based catalysts are also provided. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

• Enhanced MEA Performance for PEMFCs under Low Relative Humidity and Low Oxygen Content Conditions via Catalyst Functionalization

  DOE Office of Scientific and Technical Information (OSTI.GOV)

  Xin, Le; Yang, Fan; Xie, Jian

  2017-01-01

  This work demonstrates that functionalizing annealed-Pt/Ketjen black EC300j (a-Pt/KB) and dealloyed-PtNi/Ketjen black EC300j (d-PtNi/KB) catalysts using p-phenyl sulfonic acid can effectively enhance performance in the membrane electrode assemblies (MEAs) of proton exchange membrane fuel cells (PEMFCs). The functionalization increased the size of both Pt and PtNi catalyst particles and resulted in the further leaching of Ni from the PtNi catalyst while promoting the formation of nanoporous PtNi nanoparticles. The size of the SO3H-Pt/KB and SO3H-PtNi/KB carbon-based aggregates decreased dramatically, leading to the formation of catalyst layers with narrower pore size distributions.MEA tests highlighted the benefits of the surface functionalization, inmore » which the cells with SO3H-Pt/KB and SO3H-PtNi/KB cathode catalysts showed superior high current density performance under reduced RH conditions, in comparison with cells containing annealed Pt/KB (a-Pt/KB) and de-alloyed PtNi/KB (d-PtNi/KB) catalysts. The performance improvement was particularly evident when using reactant gases with low relative humidity, indicating that the hydrophilic functional groups on the carbon improved the water retention in the cathode catalyst layer. These results show a new avenue for enhancing catalyst performance for the next generation of catalytic materials for PEMFCs.« less

• Bringing Person- and Family-Centred Care Alive in Home, Community and Long-Term Care Organizations.

  PubMed

  Bender, Danielle; Holyoke, Paul

  2016-01-01

  It is now more important than ever for person- and family-centred care (PFCC) to be at the forefront of program and service design and delivery; yet, to date, very little guidance is available to assist home, community and long-term care (LTC) organizations to operationalize this concept and overcome inherent challenges. This article provides a list of practical strategies for healthcare leaders to promote and support a culture shift towards PFCC in their organizations and identifies and addresses five common concerns. The unique opportunities and challenges for practicing PFCC in home, community and LTC settings are also discussed.

• Fostering supportive learning environments in long-term care: the case of WIN A STEP UP.

  PubMed

  Craft Morgan, Jennifer; Haviland, Sara B; Woodside, M Allyson; Konrad, Thomas R

  2007-01-01

  The education of direct care workers (DCWs) is key to improving job quality and the quality of care in long-term care (LTC). This paper describes the successful integration of a supervisory training program into a continuing education intervention (WIN A STEP UP) for DCWs, identifies the factors that appear to influence the integration of the learning into practice, and discusses the implications for educators. The WIN A STEP UP program achieved its strongest results when the DCW curriculum was paired with Coaching Supervision. Attention to pre-training, training and post-training conditions is necessary to successfully integrate learning into practice in LTC.

• Drug Use among Seniors on Public Drug Programs in Canada, 2012.

  PubMed

  Proulx, Jeff; Hunt, Jordan

  2015-01-01

  Seniors take more drugs than younger Canadians because, on average, they have a higher number of chronic conditions. Although taking multiple medications may be necessary to manage these conditions, it is important to consider the benefits and risks of each medication and the therapeutic goals of the patient. This article provides an in-depth look at the number and types of drugs used by seniors using drug claims data from the CIHI's National Prescription Drug Utilization Information System Database, representing approximately 70% of seniors in Canada. In 2012, almost two-thirds (65.9%) of seniors on public drug programs had claims for five or more drug classes, while 27.2% had claims for 10 or more, and 8.6% had claims for 15 or more. The most commonly used drug class was statins, used by nearly half (46.6%) of seniors. Nearly two-thirds (60.9%) of seniors living in long-term care (LTC) facilities had claims for 10 or more drug classes. Proton pump inhibitors were the most commonly used drug class among seniors living in LTC facilities (used by 37.0% of seniors in LTC facilities), while statins ranked seventh (29.8%).

• Still-Born Autonomy Insurance Plan in Quebec: An Example of a Public Long-Term Care Insurance System in Canada.

  PubMed

  Hébert, Réjean

  2016-01-01

  Funding long-term care (LTC) is a challenge under the existing Beveridgean universal healthcare system. The Autonomy Insurance (AI) plan developed in Quebec was an attempt to introduce public LTC insurance into our healthcare system. The AI benefit was based on an assessment of the needs of older people and those with disabilities using a disability scale (SMAF) and case-mix classification system (Iso-SMAF Profiles). Under the plan, the benefit would be used to fund public institutions or purchase services from private organizations. Case managers were responsible for assessments and helping users and their families plan services and decide how to use the AI benefit. Funding AI was based on general tax revenues without capitalized funding, under a separate protected budget program. Projections were made for the additional budget needed to support AI, which would have mitigated the forecast increase in LTC spending due to population aging. All the legal, administrative, funding, training and contractual issues were dealt with, for implementation of the plan in April 2015. Unfortunately, the project was still-born for political reasons, but it demonstrates the feasibility of this essential innovation for Canada.

• Why don't people buy long-term-care insurance?

  PubMed

  Cramer, Anne Theisen; Jensen, Gail A

  2006-07-01

  The objective of this article was to assess the determinants of an individual's decision to purchase long-term-care (LTC) insurance. This article focuses on the decision to purchase a new policy as opposed to renewing an existing policy. This study gave special consideration to the role of policy price, the savings associated with buying a policy now as opposed to later, the purchaser's education, and the purchaser's income. Using data from the 2002 Health and Retirement Survey, we estimated logistic regressions to model consumer decisions to purchase LTC insurance. We explored several alternative measures of the price of a policy. Price was a significant determinant in decisions to purchase coverage. The demand for coverage, however, was price inelastic, with elasticities ranging from -0.23 to -0.87, depending on the specification of the model. The education level and income of the purchaser were also important. This analysis provides the first estimates of price elasticity of demand for LTC insurance. The finding that demand is very price inelastic suggests that state initiatives that effectively subsidize premiums as a way of stimulating purchases are likely to meet with very limited success in the present environment.

• Differences by Sexual Orientation in Expectations About Future Long-Term Care Needs Among Adults 40 to 65 Years Old.

  PubMed

  Henning-Smith, Carrie; Gonzales, Gilbert; Shippee, Tetyana P

  2015-11-01

  We examined whether and how lesbian, gay, and bisexual (LGB) adults between 40 and 65 years of age differ from heterosexual adults in long-term care (LTC) expectations. Our data were derived from the 2013 National Health Interview Survey. We used ordered logistic regression to compare the odds of expected future use of LTC among LGB (n = 297) and heterosexual (n = 13 120) adults. We also used logistic regression models to assess the odds of expecting to use specific sources of care. All models controlled for key socioeconomic characteristics. Although LGB adults had greater expectations of needing LTC in the future than their heterosexual counterparts, that association was largely explained by sociodemographic and health differences. After control for these differentials, LGB adults were less likely to expect care from family and more likely to expect to use institutional care in old age. LGB adults may rely more heavily than heterosexual adults on formal systems of care. As the older population continues to diversify, nursing homes and assisted living facilities should work to ensure safety and culturally sensitive best practices for older LGB groups.

• Differences by Sexual Orientation in Expectations About Future Long-Term Care Needs Among Adults 40 to 65 Years Old

  PubMed Central

  Gonzales, Gilbert; Shippee, Tetyana P.

  2015-01-01

  Objectives. We examined whether and how lesbian, gay, and bisexual (LGB) adults between 40 and 65 years of age differ from heterosexual adults in long-term care (LTC) expectations. Methods. Our data were derived from the 2013 National Health Interview Survey. We used ordered logistic regression to compare the odds of expected future use of LTC among LGB (n = 297) and heterosexual (n = 13 120) adults. We also used logistic regression models to assess the odds of expecting to use specific sources of care. All models controlled for key socioeconomic characteristics. Results. Although LGB adults had greater expectations of needing LTC in the future than their heterosexual counterparts, that association was largely explained by sociodemographic and health differences. After control for these differentials, LGB adults were less likely to expect care from family and more likely to expect to use institutional care in old age. Conclusions. LGB adults may rely more heavily than heterosexual adults on formal systems of care. As the older population continues to diversify, nursing homes and assisted living facilities should work to ensure safety and culturally sensitive best practices for older LGB groups. PMID:26378822

• Two distinct HLA-A0201-presented epitopes of the Wilms tumor antigen 1 can function as targets for leukemia-reactive CTL.

  PubMed

  Bellantuono, Ilaria; Gao, Liquan; Parry, Suzanne; Marley, Steve; Dazzi, Francesco; Apperley, Jane; Goldman, John M; Stauss, Hans J

  2002-11-15

  Using the allo-restricted T-cell approach to circumvent tolerance, we have previously identified a cytotoxic T-lymphocyte (CTL) epitope in the transcription factor Wilms tumor antigen 1 (WT1) presented by HLA-A0201 (A2) class I molecules. Here we describe an additional A2-presented epitope and show that CTLs against both epitopes kill WT1-expressing leukemia cell lines. Colony-forming assays demonstrated that both types of CTL killed CD34(+) progenitor cells from A2(+) leukemia patients, but not from A2(+) healthy individuals. The long-term culture-initiating cell (LTC-IC) assay was used to analyze the killing activity of WT1-specific CTLs against the more immature fraction of CD34(+) cells. The CTLs killed LTC-ICs of patients with chronic myelogenous leukemia (CML), whereas the function of normal CD34(+) progenitor/stem cells was not inhibited. Together, the data show that CTLs specific for 2 distinct peptide epitopes of WT1 can discriminate between normal and leukemia LTC-ICs, suggesting that such CTLs have the potential to selectively kill CML progenitor/stem cells.

Effect of ONO-1078, a leukotriene antagonist, on capsaicin- and substance P-induced bronchoconstriction and airway microvascular leakage in guinea pigs.

PubMed

Wei, E Q; Liu, J W; Zhang, L F; Zhang, W P; Bian, R L

1996-05-01

To study the effect of 4-oxo-8-[p-(4-phenylbutyloxy) benzoylamino]-2-(tetrazol-5-yl)-4H-1-benzopyran hemihydrate (ONO-1078), a specific leukotriene antagonist, on capsaicin (Cap)-sensitive sensory nerve functions in the airways, and clarify the modulating roles of endogenous peptido-leukotrienes. Changes in intrapulmonary pressure (IPP), Evans blue extravasation in airways, and contraction of bronchial smooth muscles of guinea pigs induced by Cap, substance P (SP) and leukotriene C4 (LTC4) were observed. Cap (0.05 mg.kg-1, i.v.), SP (1 microgram.kg-1, i.v.) and LTC4 (0.5 microgram.kg-1, i.v.) enhanced IPP, and Evans blue extravasation in bronchi and intrapulmonary airways. ONO-1078 0.03 mg.kg-1, i.v. completely blocked the responses to LTC4, attenuated those to Cap, but had no effect to SP. In isolated bronchial smooth muscles, ONO-1078 (1 mumol.L-1) inhibited the contractile response to Cap, but not to SP. ONO-1078 partly inhibits Cap-sensitive sensory nerve actions in airways, but has no direct effect on SP, a sensory neuropeptide.

Effects of home-based long-term care services on caregiver health according to age.

PubMed

Chen, Ming-Chun; Kao, Chi-Wen; Chiu, Yu-Lung; Lin, Tzu-Ying; Tsai, Yu-Ting; Jian, Yi-Ting Zhang; Tzeng, Ya-Mei; Lin, Fu-Gong; Hwang, Shu-Ling; Li, Shan-Ru; Kao, Senyeong

2017-10-23

Caregiver health is a crucial public health concern due to the increasing number of elderly people with disabilities. Elderly caregivers are more likely to have poorer health and be a care recipient than younger caregivers. The Taiwan government offers home-based long-term care (LTC) services to provide formal care and decrease the burden of caregivers. This study examined the effects of home-based LTC services on caregiver health according to caregiver age. This cross-sectional study included a simple random sample of care recipients and their caregivers. The care recipients had used LTC services under the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. Data were collected through self-administered questionnaires from September 2012 to January 2013. The following variables were assessed for caregivers: health, sex, marital status, education level, relationship with care recipient, quality of relationship with care recipient, job, household monthly income, family income spent on caring for the care recipient (%) and caregiving period. Furthermore, the following factors were assessed for care recipients: age, sex, marital status, education level, living alone, number of family members living with the care recipient, quality of relationship with family and dependency level. The health of the caregivers and care recipients was measured using a self-rated question (self-rated health [SRH] was rated as very poor, poor, fair, good and very good). The study revealed that home nursing care was significantly associated with the health of caregivers aged 65 years or older; however, caregivers aged less than 65 who had used home nursing care, rehabilitation or respite care had poorer health than those who had not used these services. In addition, the following variables significantly improved the health of caregivers aged 65 years or older: caregiver employment, 20% or less of family income spent on caregiving than 81%-100% and higher care recipient health. The involvement of daughters-in-law, rather than spouses, and care recipient health were positively related to the health of caregivers aged less than 65 years. The findings suggest that home-based LTC service use benefits the health of elderly caregivers. By contrast, home-based LTC service use may be negatively correlated with the health of the caregivers aged less than 65 years.

Work autonomy of certified nursing assistants in long-term care facilities: discrepant perceptions between nursing supervisors and certified nursing assistants.

PubMed

Liu, Li-Fan; Liu, Wei-Pei; Wang, Jong-Yi

2011-09-01

Despite increasing demand of certified nursing assistants (CNAs) in long-term care (LTC) facilities, their work autonomy delegated by nursing supervisors remains ambiguous and varied. This study investigates the CNAs' role in LTC facilities by examining the degrees of work autonomy of CNAs from the perspectives of nursing supervisors and CNAs. Whether the characteristics of institutions including ownership of facilities, bed size, staffing levels, and the occupancy rate affected the CNAs' work autonomy and delegations was also examined. A stratified random sampling method was used to sample LTC facilities in Taiwan. A self-administered structured questionnaire was answered by a senior nursing supervisor and CNA in each sampled institution for their perception of work autonomy in the 5 main aspects of CNAs' job contents: personal care, affiliated nursing care, auxiliary medical service, social care, and administration services. Student t test and general linear models (GLM) were used to test the mean differences of CNAs' work autonomy and their relationship with the institutions' characteristics. Nursing supervisors and CNAs both rated the highest scores of work autonomy in the aspect of personal care, and the lowest scores in the aspect of affiliated nursing care. However, the nursing supervisors expected higher work autonomy of CNAs on the work items particularly in affiliated nursing care and auxiliary medical services than did the CNAs (P < .05). The institutional-level factors were significantly associated with perceptions of nursing supervisors toward CNAs' work autonomy. The ownership (hospital-based or freestanding homes), sizes (capacity), occupancy rates, CNA staff numbers of the long-term care facilities, and resident numbers were related to the CNAs' work autonomy as perceived by their nursing supervisors. No difference between the aspects of administration activities and social care was seen. There are discordance views towards CNAs' work autonomy both in nursing supervisors and CNAs across different settings in LTC institutions. The characteristics of institutions influence perceptions of CNAs' work autonomy as perceived by nursing supervisors. Clear and mandated regulation of CNA job contents is needed for their work identity and autonomy to improve the quality of care in LTC facilities. Copyright © 2011 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

Does long-term care use within primary health care reduce hospital use among older people in Norway? A national five-year population-based observational study

PubMed Central

2011-01-01

Background Population ageing may threaten the sustainability of future health care systems. Strengthening primary health care, including long-term care, is one of several measures being taken to handle future health care needs and budgets. There is limited and inconsistent evidence on the effect of long-term care on hospital use. We explored the relationship between the total use of long-term care within public primary health care in Norway and the use of hospital beds when adjusting for various effect modifiers and confounders. Methods This national population-based observational study consists of all Norwegians (59% women) older than 66 years (N = 605676) (13.2% of total population) in 2002-2006. The unit of analysis was defined by municipality, age and sex. The association between total number of recipients of long-term care per 1000 inhabitants (LTC-rate) and hospital days per 1000 inhabitants (HD-rate) was analysed in a linear regression model. Modifying and confounding effects of socioeconomic, demographic and geographic variables were included in the final model. We defined a difference in hospitalization rates of more than 1000 days per 1000 inhabitants as clinically important. Results Thirty-one percent of women and eighteen percent of men were long-term care users. Men had higher HD-rates than women. The crude association between LTC-rate and HD-rate was weakly negative. We identified two effect modifiers (age and sex) and two strong confounders (travel time to hospital and mortality). Age and sex stratification and adjustments for confounders revealed a positive statistically significant but not clinically important relationship between LTC-rates and hospitalization for women aged 67-79 years and all men. For women 80 years and over there was a weak but negative relationship which was neither statistically significant nor clinically important. Conclusions We found a weak positive adjusted association between LTC-rates and HD-rates. Opposite to common belief, we found that increased volume of LTC by itself did not reduce pressure on hospitals. There still is a need to study integrated care models for the elderly in the Norwegian setting and to explore further why municipalities far away from hospital achieve lower use of hospital beds. PMID:22029775

Hydrophobic and hydrophilic nanosheet catalysts with high catalytic activity and recycling stability through control of the outermost ligand

NASA Astrophysics Data System (ADS)

Ko, Younji; Kim, Donghee; Kwon, Cheong Hoon; Cho, Jinhan

2018-04-01

In this study, we introduce hydrophobic and hydrophilic graphene oxide nanosheet (GON) catalysts prepared by consecutive ligand replacement of hydrophobically stabilized magnetic and catalytic nanoparticles (NPs); it exhibits high catalytic activity, fast magnetic response, and good dispersion in both nonpolar and aqueous media, allowing high loading amount of magnetic and catalytic NPs onto GON sheets. More specifically, these GON catalysts showed a high product yield of 66-99% and notable recyclability (93% of the initial product yield after 10 reaction cycles) in a Suzuki-Miyaura reaction in nonpolar media, outperforming the performance of the conventional hydrophilic GON catalysts. Additional coating of a hydrophilic layer onto GON catalysts also showed the notable performance (product yield ∼99%) in catalytic reactions performed in aqueous media. Given that ligand-controlled catalytic NPs adsorbed onto 2D nanosheets can be used as hydrophobic and hydrophilic stabilizers as well as catalysts, our approach can provide a tool for developing and designing 2D-nanosheet catalysts with high performance in nonpolar and polar media.

Reactor for tracking catalyst nanoparticles in liquid at high temperature under a high-pressure gas phase with X-ray absorption spectroscopy.

PubMed

Nguyen, Luan; Tao, Franklin Feng

2018-02-01

Structure of catalyst nanoparticles dispersed in liquid phase at high temperature under gas phase of reactant(s) at higher pressure (≥5 bars) is important for fundamental understanding of catalytic reactions performed on these catalyst nanoparticles. Most structural characterizations of a catalyst performing catalysis in liquid at high temperature under gas phase at high pressure were performed in an ex situ condition in terms of characterizations before or after catalysis since, from technical point of view, access to the catalyst nanoparticles during catalysis in liquid phase at high temperature under high pressure reactant gas is challenging. Here we designed a reactor which allows us to perform structural characterization using X-ray absorption spectroscopy including X-ray absorption near edge structure spectroscopy and extended X-ray absorption fine structure spectroscopy to study catalyst nanoparticles under harsh catalysis conditions in terms of liquid up to 350 °C under gas phase with a pressure up to 50 bars. This reactor remains nanoparticles of a catalyst homogeneously dispersed in liquid during catalysis and X-ray absorption spectroscopy characterization.

40 CFR 63.4363 - How do I establish the add-on control device operating limits during the performance test?

Code of Federal Regulations, 2010 CFR

2010-07-01

... performance test, you must monitor and record the temperature at the inlet to the catalyst bed and the temperature difference across the catalyst bed at least once every 15 minutes during each of the three test... temperature at the inlet to the catalyst bed and the average temperature difference across the catalyst bed...

Rambutan-like CNT-Al2O3 scaffolds for high-performance cathode catalyst layers of polymer electrolyte fuel cells

NASA Astrophysics Data System (ADS)

Chang, KwangHyun; Cho, Seonghun; Lim, Eun Ja; Park, Seok-Hee; Yim, Sung-Dae

2018-03-01

Rambutan-like CNT-Al2O3 scaffolds are introduced as a potential candidate for CNT-based catalyst supports to overcome the CNT issues, such as the easy bundling in catalyst ink and the poor pore structure of the CNT-based catalyst layers, and to achieve high MEA performance in PEFCs. Non-porous α-phase Al2O3 balls are introduced to enable the growth of multiwalled CNTs, and Pt nanoparticles are loaded onto the CNT surfaces. In a half-cell, the Pt/CNT-Al2O3 catalyst shows much higher durability than those of a commercial Pt/C catalyst even though it shows lower oxygen reduction reaction (ORR) activity than Pt/C. After using the decal process for MEA formation, the Pt/CNT-Al2O3 shows comparable initial performance characteristics to Pt/C, overcoming the lower ORR activity, mainly due to the facile oxygen transport in the cathode catalyst layers fabricated with the CNT-Al2O3 scaffolds. The Pt/CNT-Al2O3 also exhibits much higher durability against carbon corrosion than Pt/C owing to the durable characteristics of CNTs. Systematic analysis of single cell performance for both initial and after degradation is provided to understand the origin of the high initial performance and durable behavior of Pt/CNT-Al2O3-based catalyst layers. This will provide insights into the design of electrocatalysts for high-performance MEAs in PEFCs.

Synthesis of Pt/rGO catalysts with two different reducing agents and their methanol electrooxidation activity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vu, Thu Ha Thi, E-mail: ptntd2004@yahoo.fr; Tran, Thanh Thuy Thi, E-mail: tranthithanhthuygl@gmail.com; Le, Hong Ngan Thi

2016-01-15

Highlights: • Pt/rGO catalysts were successfully synthesized using either NaBH{sub 4} or ethylene glycol. • Synthesis using NaBH{sub 4} could improve electrocatalytic towards methanol oxidation of Pt/rGO catalyst. • 40%Pt/rGO synthesized using NaBH{sub 4} showed the best electrocatalytic performance. - Abstract: The synthesis processes of Platinum (Pt) on reduced graphene oxide (rGO) catalysts from graphene oxide (GO) using two reducing agents including sodium borohydride and ethylene glycol is reported. Structure and morphology of Pt/rGO catalysts are characterized by X-ray powder diffraction, transmission electron microscopy, Raman spectroscopy, and X-ray photoelectron spectroscopy. Electrocatalytic methanol oxidation properties of these catalysts are evaluated bymore » cyclic voltammetry and chronoamperometry. The results show that catalyst synthesized using sodium borohydride has a higher metallic Pt content and an improved catalytic performance in comparison to catalyst synthesized using ethylene glycol. Moreover, effect of Pt loading amount on electrocatalytic methanol oxidation performance of catalysts synthesized using sodium borohydride is systematically investigated. The optimal Pt loading amount on graphene is determined to be 40%.« less

Turning Biodiesel Waste Glycerol into 1,3-Propanediol: Catalytic Performance of Sulphuric acid-Activated Montmorillonite Supported Platinum Catalysts in Glycerol Hydrogenolysis.

PubMed

Samudrala, Shanthi Priya; Kandasamy, Shalini; Bhattacharya, Sankar

2018-05-10

Direct C-O hydrogenolysis of bioglycerine to produce 1,3-propanediol selectively is a vital technology that can expand the scope of biodiesel industry and green chemical production from biomass. Herein we report sulphuric acid-activated montmorillonite clay supported platinum nanoparticles as highly effective solid acid catalysts for the selective production of 1,3-propanediol from glycerol. The catalytic performances of the catalysts were investigated in the hydrogenolysis of glycerol with a fixed bed reactor under ambient pressure. The results were found promising and showed that the activation of montmorillonite by sulphuric acid incorporated Brønsted acidity in the catalyst and significantly improved the selectivity to 1,3-propanediol. The catalytic performance of different platinum loaded catalysts was examined and 2 wt% Pt/S-MMT catalyst presented superior activity among others validating 62% 1,3-propanediol selectivity at 94% glycerol conversion. The catalytic activity of 2Pt/S-MMT was systematically investigated under varying reaction parameters including reaction temperature, hydrogen flow rate, glycerol concentration, weight hourly space velocity, and contact time to derive the optimum conditions for the reaction. The catalyst stability, reusability and structure-activity correlation were also elucidated. The high performance of the catalyst could be ascribed to well disperse Pt nanoparticles immobilized on acid-activated montmorillonite, wider pore-structure and appropriate acid sites of the catalyst.

KF-loaded mesoporous Mg-Fe bi-metal oxides: high performance transesterification catalysts for biodiesel production.

PubMed

Tao, Guiju; Hua, Zile; Gao, Zhe; Zhu, Yan; Zhu, Yan; Chen, Yu; Shu, Zhu; Zhang, Lingxia; Shi, Jianlin

2013-09-21

Using newly developed mesoporous Mg-Fe bi-metal oxides as supports, a novel kind of high performance transesterification catalysts for biodiesel production has been synthesized. More importantly, the impregnation solvent was for the first time found to substantially affect the structures and catalytic performances of the resultant transesterification catalysts.

Computationally Probing the Performance of Hybrid, Heterogeneous, and Homogeneous Iridium-Based Catalysts for Water Oxidation

DOE Office of Scientific and Technical Information (OSTI.GOV)

García-Melchor, Max; Vilella, Laia; López, Núria

2016-04-29

An attractive strategy to improve the performance of water oxidation catalysts would be to anchor a homogeneous molecular catalyst on a heterogeneous solid surface to create a hybrid catalyst. The idea of this combined system is to take advantage of the individual properties of each of the two catalyst components. We use Density Functional Theory to determine the stability and activity of a model hybrid water oxidation catalyst consisting of a dimeric Ir complex attached on the IrO 2(110) surface through two oxygen atoms. We find that homogeneous catalysts can be bound to its matrix oxide without losing significant activity.more » Hence, designing hybrid systems that benefit from both the high tunability of activity of homogeneous catalysts and the stability of heterogeneous systems seems feasible.« less

Which long-term care residents should be asked to complete a customer satisfaction survey?

PubMed

Van De Water, Margaret S; Kutner, Michael; Parmelee, Patricia A; Johnson, Theodore

2003-01-01

(1) To compare staff members' opinions of long-term care (LTC) residents' ability to complete a customer satisfaction survey (CSS) with a measure of cognition (MDS-COGS) derived from Minimum Data Set data; and (2) to examine the association between CSS answer reliability and MDS-COGS score. Retrospective comparison of the staff's assessment and MDS-COGS score for each respondent, as well as a prospective comparison of MDS-COGS scores with reliability measures from repeated survey administration. A 100-bed Veterans Affairs (VA) nursing home. We administered a CSS designed by our VA network following an assigned protocol. We later calculated each respondent's MDS-COGS score (grouped into 4 categories) and compared it with the staff's opinion of whether that resident was "capable of responding" (yes/no) to a CSS. We subsequently modified the CSS for low reading level and low vision, and randomly selected 40 LTC residents for repeated survey administration (T1 and T2 1 week later). Test-retest reliability was estimated by examining the extent to which T1 and T2 answers agreed (agreed exactly; meaningfully agreed as defined by VA network personnel who designed the survey; or meaningfully agreed as decided by paper authors). Staff judged that 25 of 76 LTC residents were not and 51 of 76 were capable of responding to the CSS. In 82% of cases, MDS-COGS score category and staff opinion agreed ("no cognitive impairment"/"mild-moderate cognitive impairment" with "able to complete"; and "moderate-severe cognitive impairment"/"severe cognitive impairment" with "unable to complete"). Cohen's kappa was 0.57 with a P value of <0.001. Of the 40 LTC residents randomly selected for repeated survey administration, 32 successfully completed surveys at T1 and T2. Higher MDS-COGS scores, suggesting greater cognitive impairment, were significantly associated with lower answer reliability. The answers given by LTC residents changed meaningfully (by network criteria) from T1 to T2 by 12%, 27%, and 28% across categories of no-to-mild cognitive impairment, mild-to-moderate impairment, and moderate-to-severe impairment, respectively. The rate of decline in reliability, however, was small for each unit of increase in MDS-COGS. Although the staff's opinions about residents' ability to complete a CSS were significantly associated with an objective MDS-COGS assessment, staff nonetheless failed on several occasions to let cognitively intact residents complete their own surveys. Although higher MDS-COGS scores were significantly related to lower reliability, there were no natural cut-points in the data to suggest a participate/do not participate line and the trend line between MDS-COGS level, and percent of questions answered reliably was not very strong. These results suggest that LTC residents with mild to moderate dementia might be capable of reliably answering certain types of customer satisfaction surveys.

Final Project Report: Development of Micro-Structural Mitigation Strategies for PEM Fuel Cells: Morphological Simulations and Experimental Approaches

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wessel, Silvia; Harvey, David

2013-06-28

The durability of PEM fuel cells is a primary requirement for large scale commercialization of these power systems in transportation and stationary market applications that target operational lifetimes of 5,000 hours and 40,000 hours by 2015, respectively. Key degradation modes contributing to fuel cell lifetime limitations have been largely associated with the platinum-based cathode catalyst layer. Furthermore, as fuel cells are driven to low cost materials and lower catalyst loadings in order to meet the cost targets for commercialization, the catalyst durability has become even more important. While over the past few years significant progress has been made in identifyingmore » the underlying causes of fuel cell degradation and key parameters that greatly influence the degradation rates, many gaps with respect to knowledge of the driving mechanisms still exist; in particular, the acceleration of the mechanisms due to different structural compositions and under different fuel cell conditions remains an area not well understood. The focus of this project was to address catalyst durability by using a dual path approach that coupled an extensive range of experimental analysis and testing with a multi-scale modeling approach. With this, the major technical areas/issues of catalyst and catalyst layer performance and durability that were addressed are: 1. Catalyst and catalyst layer degradation mechanisms (Pt dissolution, agglomeration, Pt loss, e.g. Pt in the membrane, carbon oxidation and/or corrosion). a. Driving force for the different degradation mechanisms. b. Relationships between MEA performance, catalyst and catalyst layer degradation and operational conditions, catalyst layer composition, and structure. 2. Materials properties a. Changes in catalyst, catalyst layer, and MEA materials properties due to degradation. 3. Catalyst performance a. Relationships between catalyst structural changes and performance. b. Stability of the three-phase boundary and its effect on performance/catalyst degradation. The key accomplishments of this project are: • The development of a molecular-dynamics based description of the carbon supported-Pt and ionomer system • The development of a composition-based, 1D-statistical Unit Cell Performance model • A modified and improved multi-pathway ORR model • An extension of the existing micro-structural catalyst model to transient operation • The coupling of a Pt Dissolution model to the modified ORR pathway model • The Development A Semi-empirical carbon corrosion model • The integration and release of an open-source forward predictive MEA performance and degradation model • Completion of correlations of BOT (beginning of test) and EOT (end of test) performance loss breakdown with cathode catalyst layer composition, morphology, material properties, and operational conditions • Catalyst layer durability windows and design curves • A design flow path of interactions from materials properties and catalyst layer effective properties to performance loss breakdown for virgin and degraded catalyst layers In order to ensure the best possible user experience we will perform a staged release of the software leading up to the webinar scheduled in October 2013. The release schedule will be as follows (please note that the manual will be released with the beta release as direct support is provided in Stage 1): • Stage 0 - Internal Ballard Release o Cross check of compilation and installation to ensure machine independence o Implement code on portable virtual machine to allow for non-UNIX use (pending) • Stage 1 - Alpha Release o The model code will be made available via a GIT, sourceforge, or other repository (under discussion at Ballard) for download and installation by a small pre-selected group of users o Users will be given three weeks to install, apply, and evaluate features of the code, providing feedback on issues or software bugs that require correction prior to beta release • Stage 2 - Beta Release o The model code repository is opened to the general public on a beta release concept, with a mechanism for bug tracking and feedback from a large user group o Code will be tracked and patched for any discovered bugs or relevant feedback from the user community, upon the completion of three months without a major bug submission the code will be moved to a full version release • Stage 3 - Full Version Release o Code is version to revision 1.0 and that version is frozen in development/patching« less

Morphological effect of BiVO4 catalysts on degradation of aqueous paracetamol under visible light irradiation.

PubMed

Hu, Changying; Xu, Jie; Zhu, Yaqi; Chen, Acong; Bian, Zhaoyong; Wang, Hui

2016-09-01

Morphological effect of bismuth vanadate (BiVO4) on visible light-driven catalytic degradation of aqueous paracetamol was carefully investigated using four monoclinic BiVO4 catalysts. The catalysts with different morphologies were controllably prepared by a hydrothermal method without any additions. The prepared catalysts were fully characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), and UV-Vis diffuse reflectance spectroscopy (DRS). Under the visible light irradiation, these catalysts with different morphology were investigated to degrade aqueous paracetamol contaminant. The degradation effects were evaluated based on the catalyst morphology, solution pH, initial paracetamol concentration, and catalyst dosage. Cube-like BiVO4 powders exhibited excellent photocatalytic performance. The optimal photocatalytic performance of the cube-like BiVO4 in degrading paracetamol was achieved.

Effect of Graphitic Content on Carbon Supported Catalyst Performance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Patel, Anant; Artyushkova, Kateryna; Atanassov, Plamen

2011-07-01

The effect of graphitic content on carbon supported platinum catalysts was investigated in order to investigate its influence on catalyst performance. Four catalysts of varying surface areas and graphitic content were analyzed using XPS, HREELS, and tested using RDE experiments. The catalysts were also heat treated at 150oC and 100%RH as means to uniformly age them. The heat treated samples were analyzed using the same methods to determine what changes had occurred due to this aging process. When compared to the BOL catalysts, heat treated catalysts displayed increased graphitic carbon and platinum metalic content, however they also showed depressed catalyticmore » activity. The primary cause is still under investigation, though it is believed to be related to loss of amorphous carbon content.« less

The Bosch Process-Performance of a Developmental Reactor and Experimental Evaluation of Alternative Catalysts

NASA Technical Reports Server (NTRS)

Abney, Morgan B.; Mansell, J. Matthew

2010-01-01

Bosch-based reactors have been in development at NASA since the 1960's. Traditional operation involves the reduction of carbon dioxide with hydrogen over a steel wool catalyst to produce water and solid carbon. While the system is capable of completely closing the loop on oxygen and hydrogen for Atmosphere Revitalization, steel wool requires a reaction temperature of 650C or higher for optimum performance. The single pass efficiency of the reaction over steel wool has been shown to be less than 10% resulting in a high recycle stream. Finally, the formation of solid carbon on steel wool ultimately fouls the catalyst necessitating catalyst resupply. These factors result in high mass, volume and power demands for a Bosch system. Interplanetary transportation and surface exploration missions of the moon, Mars, and near-earth objects will require higher levels of loop closure than current technology cannot provide. A Bosch system can provide the level of loop closure necessary for these long-term missions if mass, volume, and power can be kept low. The keys to improving the Bosch system lie in reactor and catalyst development. In 2009, the National Aeronautics and Space Administration refurbished a circa 1980's developmental Bosch reactor and built a sub-scale Bosch Catalyst Test Stand for the purpose of reactor and catalyst development. This paper describes the baseline performance of two commercially available steel wool catalysts as compared to performance reported in the 1960's and 80's. Additionally, the results of sub-scale testing of alternative Bosch catalysts, including nickel- and cobalt-based catalysts, are discussed.

Dehydration of glycerol over niobia-supported silicotungstic acid catalysts.

PubMed

Lee, Young Yi; Ok, Hye Jeong; Moon, Dong Ju; Kim, Jong Ho; Park, Nam Cook; Kim, Young Chul

2013-01-01

Liquid-phase dehydration of glycerol to acrolein over nanosized niobia-supported silicotungstic acid catalysts was performed to investigate the effect of the silicotungstic acid loading on the catalytic performance of the catalysts. The catalysts were prepared by following an impregnation method with different HSiW loadings in the range of 10-50 wt%. The prepared catalysts were characterized by N2 physisorption, XRD, FT-IR, TPD of ammonia, and TGA. Dehydration of glycerol was conducted in an autoclave reactor under the conditions of controlled reaction temperatures under corresponding pressure. Increasing HSiW loading rapidly increased the acidity of HSiW/Nb205 catalyst and rate of glycerol conversion, but acrolein selectivity decreased due to enhanced deactivation of the catalyst by carbon deposit. Consequently, it was confirmed that catalytic activity for the dehydration of glycerol to acrolein was dependant on the acidity of catalyst and can be controlled by HSiW loading.

Durability testing at 5 atmospheres of advanced catalysts and catalyst supports for gas turbine engine combustors

NASA Technical Reports Server (NTRS)

Olson, B. A.; Lee, H. C.; Osgerby, I. T.; Heck, R. M.; Hess, H.

1980-01-01

The durability of CATCOM catalysts and catalyst supports was experimentally demonstrated in a combustion environment under simulated gas turbine engine combustor operating conditions. A test of 1000 hours duration was completed with one catalyst using no. 2 diesel fuel and operating at catalytically-supported thermal combustion conditions. The performance of the catalyst was determined by monitoring emissions throughout the test, and by examining the physical condition of the catalyst core at the conclusion of the test. Tests were performed periodically to determine changes in catalytic activity of the catalyst core. Detailed parametric studies were also run at the beginning and end of the durability test, using no. 2 fuel oil. Initial and final emissions for the 1000 hours test respectively were: unburned hydrocarbons (C3 vppm):0, 146, carbon monoxide (vppm):30, 2420; nitrogen oxides (vppm):5.7, 5.6.

1400164

NASA Image and Video Library

2014-03-10

ELEASA WILSON, KRAIG TERSIGNI, JUSTIN CARTLEDGE MISSION OPERATIONS LABORATORY - LABORATORY TRAINING COMPLEX (LTC), BUILDING 4663, EXPRESS RACK TRAINING, EMERALD BRICK (POWER DISTRIBUTION FOR EXPRESS RACK LAPTOP).

Technology for advanced liquefaction processes: Coal/waste coprocessing studies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cugini, A.V.; Rothenberger, K.S.; Ciocco, M.V.

1995-12-31

The efforts in this project are directed toward three areas: (1) novel catalyst (supported and unsupported) research and development, (2) study and optimization of major operating parameters (specifically pressure), and (3) coal/waste coprocessing. The novel catalyst research and development activity has involved testing supported catalysts, dispersed catalysts, and use of catalyst testing units to investigate the effects of operating parameters (the second area) with both supported and unsupported catalysts. Several supported catalysts were tested in a simulated first stage coal liquefaction application at 404{degrees}C during this performance period. A Ni-Mo hydrous titanate catalyst on an Amocat support prepared by Sandiamore » National laboratories was tested. Other baseline experiments using AO-60 and Amocat, both Ni-Mo/Al{sub 2}O{sub 3} supported catalysts, were also made. These experiments were short duration (approximately 12 days) and monitored the initial activity of the catalysts. The results of these tests indicate that the Sandia catalyst performed as well as the commercially prepared catalysts. Future tests are planned with other Sandia preparations. The dispersed catalysts tested include sulfated iron oxide, Bayferrox iron oxide (iron oxide from Miles, Inc.), and Bailey iron oxide (micronized iron oxide from Bailey, Inc.). The effects of space velocity, temperature, and solvent-to-coal ratio on coal liquefaction activity with the dispersed catalysts were investigated. A comparison of the coal liquefaction activity of these catalysts relative to iron catalysts tested earlier, including FeOOH-impregnated coal, was made. These studies are discussed.« less

Bimetallic platinum group metal-free catalysts for high power generating microbial fuel cells

NASA Astrophysics Data System (ADS)

Kodali, Mounika; Santoro, Carlo; Herrera, Sergio; Serov, Alexey; Atanassov, Plamen

2017-10-01

M1-M2-N-C bimetallic catalysts with M1 as Fe and Co and M2 as Fe, Co, Ni and Mn were synthesized and investigated as cathode catalysts for oxygen reduction reaction (ORR). The catalysts were prepared by Sacrificial Support Method in which silica was the template and aminoantipyrine (AAPyr) was the organic precursor. The electro-catalytic properties of these catalysts were investigated by using rotating ring disk (RRDE) electrode setup in neutral electrolyte. Fe-Mn-AAPyr outperformed Fe-AAPyr that showed higher performances compared to Fe-Co-AAPyr and Fe-Ni-AAPyr in terms of half-wave potential. In parallel, Fe-Co-AAPyr, Co-Mn-AAPyr and Co-Ni-AAPyr outperformed Co-AAPyr. The presence of Co within the catalyst contributed to high peroxide production not desired for efficient ORR. The catalytic capability of the catalysts integrated in air-breathing cathode was also verified. It was found that Co-based catalysts showed an improvement in performance by the addition of second metal compared to simple Co- AAPyr. Fe-based bimetallic materials didn't show improvement compared to Fe-AAPyr with the exception of Fe-Mn-AAPyr catalyst that had the highest performance recorded in this study with maximum power density of 221.8 ± 6.6 μWcm-2. Activated carbon (AC) was used as control and had the lowest performances in RRDE and achieved only 95.6 ± 5.8 μWcm-2 when tested in MFC.

Organometallic catalysts for primary phosphoric acid fuel cells

NASA Technical Reports Server (NTRS)

Walsh, Fraser

1987-01-01

A continuing effort by the U.S. Department of Energy to improve the competitiveness of the phosphoric acid fuel cell by improving cell performance and/or reducing cell cost is discussed. Cathode improvement, both in performance and cost, available through the use of a class of organometallic cathode catalysts, the tetraazaannulenes (TAAs), was investigated. A new mixed catalyst was identified which provides improved cathode performance without the need for the use of a noble metal. This mixed catalyst was tested under load for 1000 hr. in full cell at 160 to 200 C in phosphoric acid H3PO4, and was shown to provide stable performance. The mixed catalyst contains an organometallic to catalyze electroreduction of oxygen to hydrogen peroxide and a metal to catalyze further electroreduction of the hydrogen peroxide to water. Cathodes containing an exemplar mixed catalyst (e.g., Co bisphenyl TAA/Mn) operate at approximately 650 mV vs DHE in 160 C, 85% H3PO4 with oxygen as reactant. In developing this mixed catalyst, a broad spectrum of TAAs were prepared, tested in half-cell and in a rotating ring-disk electrode system. TAAs found to facilitate the production of hydrogen peroxide in electroreduction were shown to be preferred TAAs for use in the mixed catalyst. Manganese (Mn) was identified as a preferred metal because it is capable of catalyzing hydrogen peroxide electroreduction, is lower in cost and is of less strategic importance than platinum, the cathode catalyst normally used in the fuel cell.

Low-Temperature CO-Oxidation Catalysts for Long-Life CO2 Lasers

NASA Technical Reports Server (NTRS)

Schryer, David R. (Editor); Hoflund, Gar B. (Editor)

1990-01-01

Low-temperature CO-oxidation catalysts are necessary for closed-cycle pulsed CO2 lasers as well as for other applications, including air purification. The papers presented in this volume discuss several such catalysts, including information on catalyst preparation, techniques for enhancing catalyst performance, laboratory and laser test results, and mechanistic considerations.

TiO2 Nanotube-Carbon (TNT-C) as Support for Pt-based Catalyst for High Methanol Oxidation Reaction in Direct Methanol Fuel Cell.

PubMed

Abdullah, M; Kamarudin, S K; Shyuan, L K

2016-12-01

In this study, TiO 2 nanotubes (TNTs) were synthesized via a hydrothermal method using highly concentrated NaOH solutions varying from 6 to 12 M at 180 °C for 48 h. The effects of the NaOH concentration and the TNT crystal structure on the performance for methanol oxidation were investigated to determine the best catalyst support for Pt-based catalysts. The results showed that TNTs produced with 10 M NaOH exhibited a length and a diameter of 550 and 70 nm, respectively; these TNTs showed the best nanotube structure and were further used as catalyst supports for a Pt-based catalyst in a direct methanol fuel cell. The synthesized TNT and Pt-based catalysts were analysed by FESEM, TEM, BET, EDX, XRD and FTIR. The electrochemical performance of the catalysts was investigated using cyclic voltammetry (CV) and chronoamperometric (CA) analysis to further understand the methanol oxidation in the direct methanol fuel cell (DMFC). Finally, the result proves that Pt-Ru/TNT-C catalyst shows high performance in methanol oxidation as the highest current density achieved at 3.3 mA/cm 2 (normalised by electrochemically active surface area) and high catalyst tolerance towards poisoning species was established.

The Evolution of the American Modern Light Field Gun

DTIC Science & Technology

1978-06-09

8217riiiH IRVO1.WI [ON Oil THlE AMERI CAN MODKR’.IN LICH M)irF I C.UN I~ filimerit ’ ~ -ents for t rAT R F AT CI CS DISCLAI I Ar NI S THIS DOCUMENT IS...individuals in developing this thesis. LTC’ Ilhrold W. NeLson MAJ Robert A. Doughty LTC Henry L. Snyder, Ph . D. i’v " ~.i • r * TABLE OF CONTENTS I1 I L o...York: John Wiley and Sons, Inc., 1946), pp. 214ŝ., s "I- THIS P.AU~I B 4~~ ~~~ 4 r.4aa&cP reallgt d that safer guns with increased rates of fire

Sustained transfer of knowledge to practice in long-term care: facilitators and barriers of a mental health learning initiative.

PubMed

Stolee, Paul; McAiney, Carrie A; Hillier, Loretta M; Harris, Diane; Hamilton, Pam; Kessler, Linda; Madsen, Victoria; Le Clair, J Kenneth

2009-01-01

This article explores facilitators and barriers to the impact and sustainability of a learning initiative to increase capacity of long-term care (LTC) homes to manage the mental health needs of older persons, through development of in-house Psychogeriatric Resource Persons (PRPs). Twenty interviews were conducted with LTC staff. Management support, particularly designation of time for PRP activities, development of PRP teams, and supportive learning strategies were significant factors affecting sustained knowledge transfer. Continuing education that is provided and evaluated on an ongoing basis, secures management commitment, is integrated within a broader system strategy, and provides on-the-job support has the greatest potential to affect care.

Development of SiC Large Tapered Crystal Growth

NASA Technical Reports Server (NTRS)

Neudeck, Phil

2011-01-01

Research Focus Area: Power Electronics, Temperature Tolerant Devices. Demonstrate initial feasibility of totally new "Large Tapered Crystal" (LTC) process for growing vastly improved large-diameter wide-band gap wafers. Addresses Targets: The goal of this research is to experimentally investigate and demonstrate feasibility of the key unproven LTC growth processes in SiC. Laser-assisted growth of long SiC fiber seeds. Radial epitaxial growth enlargement of seeds into large SiC boules. Uniqueness and Impacts open a new technology path to large-diameter SiC and GaN wafers with 1000-fold defect density improvement at 2-4 fold lower cost. Leapfrog improvement in wide band gap power device capability and cost.

“That model is sooooo last millennium!” Residential long term care as a system, not a place

PubMed Central

Ziemba, Rosemary; Perry, Tam E.; Takahashi, Beverly; Algase, Donna

2010-01-01

The current quandary with the design of existing long term care (LTC) settings results from focus on structures (“institutions”) instead of on a system of supports and services that transcends physical and traditional boundaries across settings, including nursing homes, assisted living residences and the home. Supported by analysis of the commonalities, socio-historical and political contexts, core values and fallacies of social and medical models in existing and emerging LTC options, a holistic model is proposed based on new core values which facilitate community and family integration, and which asserts dignity and personhood as universal attributes in an array of settings. PMID:20640176

3D Polymer Hydrogel for High-Performance Atomic Fe and Mn Catalysts for Oxygen Reduction in Challenging Acids

NASA Astrophysics Data System (ADS)

Qiao, Zhi

Current platinum group metal (PGM)-free carbon nanocomposite catalysts for the oxygen reduction reaction (ORR) in acidic electrolyte often suffer from rapid degradation associated with carbon corrosion due to the use of large amount of the amorphoous carbon black supports. Here, we developed a new concept of using freestanding 3D hydrogel to design support-free Fe-N-C catalysts. A 3D polyaniline (PANI)-based hydrogel approach was used for preparing a new type of single atomic iron site-rich catalyst, which has exhibited exceptionally enhanced activity and stability compared to conventional Fe-N-C catalysts supported on amorphous carbon blacks. The achieved performance metric on the hydrogel PANI-Fe catalysts is one of the best ever reported PGM-free catalysts, reaching a half-wave potential up to 0.83 V vs. RHE and only leaving 30 mV gap with Pt/C catalysts (60mugPt/cm 2) in challenging acidic media. Remarkable ORR stability was accomplished as well on the same catalyst evidenced by using harsh potential cycling tests. The well dispersion of atomic iron into partially graphitized carbon, featured with dominance of micropores and porous network structures, is capable of accommodating increased number of active sites, strengthening local bonding among iron, nitrogen and carbon, and facilitating mass transfer. On the other hand, in order to decrease the produced Fenton reagent, which will oxidize the proton exchange membrane and ionomer in membrane electrode assembly (MEA), we produce Mn-based catalysts by this novel hydrogel method. This is the first time that Mn-based catalysts can show such outstanding performance in acid media, whose half-wave potential is up to 0.80 V vs. RHE. The work related to the performance improvement is still in processing. We believe the 3D polymer hydrogel approach would be a new pathway to advance PGM-free catalysts.

Durability testing at one atmosphere of advanced catalysts and catalyst supports for automotive gas turbine engine combustors, part 1

NASA Technical Reports Server (NTRS)

Heck, R. M.; Chang, M.; Hess, H.; Carrubba, R.

1977-01-01

The durability of catalysts and catalyst supports in a combustion environment was experimentally demonstrated. A test of 1000 hours duration was completed with two catalysts, using diesel fuel and operating at catalytically supported thermal combustion conditions. The performance of the catalysts was determined by monitoring emissions throughout the test, and by examining the physical condition of the catalyst core at the conclusion of the test. The test catalysts proved to be capable of low emissions operation after 1000 hours diesel aging, with no apparent physical degradation of the catalyst support.

Poisoning of a Silica-Supported Cobalt Catalyst due to Presence of Sulfur Impurities in Syngas during Fischer–Tropsch Synthesis: Effects of Chelating Agent

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bambal, Ashish S.; Guggilla, Vidya S.; Kugler, Edwin L.

2014-04-09

The effects of sulfur impurities on the performance of cobalt-based Fischer–Tropsch catalysts are evaluated under industrially relevant operating conditions of temperature, pressure, and impurity levels. Chelating agents (CAs) were used to modify the SiO 2 support, and the performances of the CA-modified catalysts are compared with conventional Co/SiO 2 catalysts. For both the Co/SiO 2 and CA-modified catalysts, the presence of sulfur in the inlet syngas results in a notable drop in the CO conversion, an undesired shift in the hydrocarbon selectivity toward short-chain hydrocarbons, more olefins in the products, and lower product yields. In the post-poisoning stage, i.e., aftermore » termination of sulfur introduction in the inlet syngas, the CA-modified catalysts recover activity and selectivity (to some extent at least), whereas such trends are not observed for the base-case, i.e., unmodified Co/SiO 2 catalyst. Finally, the improved performance of the CA-modified catalysts in the presence of sulfur is attributed to higher densities of active sites.« less

Study of superhydrophobic electrosprayed catalyst layers using a localized reference electrode technique

NASA Astrophysics Data System (ADS)

Chaparro, A. M.; Ferreira-Aparicio, P.; Folgado, M. A.; Brightman, E.; Hinds, G.

2016-09-01

The performance of electrosprayed cathode catalyst layers in a polymer electrolyte membrane fuel cell (PEMFC) is studied using a localized reference electrode technique. Single cells with an electrosprayed cathode catalyst layer show an increase of >20% in maximum power density under standard testing conditions, compared with identical cells assembled with a conventional, state-of-the-art, gas diffusion cathode. When operated at high current density (1.2 A cm-2) the electrosprayed catalyst layers show more homogeneous distribution of the localized cathode potential, with a standard deviation from inlet to outlet of <50 mV, compared with 79 mV for the conventional gas diffusion cathode. Higher performance and homogeneity of cell response is attributed to the superhydrophobic nature of the macroporous electrosprayed catalyst layer structure, which enhances the rate of expulsion of liquid water from the cathode. On the other hand, at low current densities (<0.5 A cm-2), the electrosprayed layers exhibit more heterogeneous distribution of cathode potential than the conventional cathodes; this behavior is attributed to less favorable kinetics for oxygen reduction in very hydrophobic catalyst layers. The optimum performance may be obtained with electrosprayed catalyst layers employing a high Pt/C catalyst ratio.

Catalyst recycling via specific non-covalent adsorption on modified silicas.

PubMed

Kluwer, Alexander M; Simons, Chretien; Knijnenburg, Quinten; van der Vlugt, Jarl Ivar; de Bruin, Bas; Reek, Joost N H

2013-03-14

This article describes a new strategy for the recycling of a homogeneous hydroformylation catalyst, by selective adsorption of the catalyst to tailor-made supports after a batchwise reaction. The separation of the catalyst from the product mixture is based on selective non-covalent supramolecular interactions between a ligand and the support. Changing the solvent releases the active catalyst back into the reactor and allows a subsequent batch reaction with the recycled active catalyst. For this purpose, the bidentate NixantPhos ligand has been equipped with a pyridine group. The corresponding rhodium pre-catalyst [Rh(Nix-py)(acac)] (acac = acetylacetonate) forms a very selective, active and highly stable catalyst, and able to reach a turnover number (TON) of 170 000 in a single run (reaction performed in nearly neat 1-octene, S/C ratio of 200 000, at 140 °C, 20 bars syngas pressure). Various commercially available supports have been explored in binding studies and recycling experiments. The end-capped silica-alumina performs the best so far with respect to ligand-adsorbing properties for the current purpose. Although this system has not been fully optimized, four recycling runs could be performed successfully.

Effect of H2O2 injection patterns on catalyst bed characteristics

NASA Astrophysics Data System (ADS)

Kang, Hongjae; Lee, Dahae; Kang, Shinjae; Kwon, Sejin

2017-01-01

The decomposition process of hydrogen peroxide can be applied to a bipropellant thruster, as well as to monopropellant thruster. To provide a framework for the optimal design of the injector and catalyst bed depending on a type of thruster, this research scrutinizes the effect of injection patterns of the propellant on the performance of the catalyst bed. A showerhead injector and impinging jet injector were tested with a 50 N monopropellant thruster. Manganese oxide/γ-alumina catalyst and manganese oxide/lanthanum-doped alumina catalyst were prepared and tested. The showerhead injector provided a fast response time, suitable for pulse mode operation. The impinging jet injector mitigated the performance instability and catalyst attrition that is favorable for large scale bipropellant thrusters. The design of a dual catalyst bed was conceptually proposed based on the data obtained from firing tests.

Effect of calcination temperature of a copper ferrite synthesized by a sol-gel method on its structural characteristics and performance as Fenton catalyst to remove gallic acid from water.

PubMed

López-Ramón, María V; Álvarez, Miguel A; Moreno-Castilla, Carlos; Fontecha-Cámara, María A; Yebra-Rodríguez, África; Bailón-García, Esther

2018-02-01

A copper ferrite synthesized by a sol-gel combustion method was calcined at different temperatures up to 800°C, determining changes in its structural characteristics and magnetic measurements and studying its catalytic performance in gallic acid removal by Fenton reaction. The main objective was to study the effect of the calcination temperature of copper ferrite on its crystalline phase formation and transformation, activity and metal ion leaching. The cubic-to-tetragonal transformation of the spinel occurred via its reaction with the CuO phase, displacing Fe 3+ ions in B (octahedral) sites out of the spinel structure by the following reaction: 2Fe 3+ B +3CuO→Fe 2 O 3 +3Cu 2+ B . The catalysts showed superparamagnetic or substantial superparamagnetic behaviour. At higher calcination temperatures, catalyst activity was lower, and Cu ion leaching was markedly decreased. There was no Fe ion leaching with any catalyst. The as-prepared catalyst showed better catalytic performance than a commercial copper ferrite. Leached Cu ions acted as homogeneous catalysts, and their contribution to the overall removal mechanism was examined. Cu 2 O present in the as-prepared catalysts made only a small contribution to their activity. Finally, the reutilization of various catalysts was studied by performing different catalytic cycles. Copyright © 2017 Elsevier Inc. All rights reserved.

Hydrogen production by steam reforming of liquefied natural gas over a nickel catalyst supported on mesoporous alumina xerogel

NASA Astrophysics Data System (ADS)

Seo, Jeong Gil; Youn, Min Hye; Cho, Kyung Min; Park, Sunyoung; Song, In Kyu

Mesoporous alumina xerogel (A-SG) is prepared by a sol-gel method for use as a support for a nickel catalyst. The Ni/A-SG catalyst is then prepared by an impregnation method, and is applied to hydrogen production by steam reforming of liquefied natural gas (LNG). The effect of the mesoporous alumina xerogel support on the catalytic performance of Ni/A-SG catalyst is investigated. For the purpose of comparison, a nickel catalyst supported on commercial alumina (A-C) is also prepared by an impregnation method (Ni/A-C). Both the hydroxyl-rich surface and the electron-deficient sites of the A-SG support enhance the dispersion of the nickel species on the support during the calcination step. The formation of the surface nickel aluminate phase in the Ni/A-SG catalyst remarkably increases the reducibility and stability of the catalyst. Furthermore, the high-surface area and the well-developed mesoporosity of the Ni/A-SG catalyst enhance the gasification of surface hydrocarbons that are adsorbed in the reaction. In the steam reforming of LNG, the Ni/A-SG catalyst exhibits a better catalytic performance than the Ni/A-C catalyst in terms of LNG conversion and hydrogen production. Moreover, the Ni/A-SG catalyst shows strong resistance toward catalyst deactivation.

ENVIRONMENTAL TECHNOLOGY VERIFICATION, TEST REPORT OF MOBILE SOURCE EMISSIONS CONTROL DEVICES/CLEAN DIESEL TECHNOLOGIES FUEL BORNE CATALYST WITH CLEANAIR SYSTEM'S DIESEL OXIDATION CATALYST

EPA Science Inventory

The Environmental Technology Verification report discusses the technology and performance of the Fuel-Borne Catalyst with CleanAir System's Diesel Oxidation Catalyst manufactured by Clean Diesel Technologies, Inc. The technology is a fuel-borne catalyst used in ultra low sulfur d...

Chemotaxis of primitive hematopoietic cells in response to stromal cell–derived factor-1

PubMed Central

Jo, Deog-Yeon; Rafii, Shahin; Hamada, Tsuneyoshi; Moore, Malcolm A.S.

2000-01-01

Stromal cell–derived factor-1 (SDF-1) provides a potent chemotactic stimulus for CD34+ hematopoietic cells. We cultured mobilized peripheral blood (PB) and umbilical cord blood (CB) for up to 5 weeks and examined the migratory activity of cobblestone area–forming cells (CAFCs) and long-term culture–initiating cells (LTC-ICs) in a transwell assay. In this system, SDF-1 or MS-5 marrow stromal cells placed in the lower chamber induced transmembrane and transendothelial migration by 2- and 5-week-old CAFCs and LTC-ICs in 3 hours. Transmigration was blocked by preincubation of input CD34+ cells with antibody to CXCR4. Transendothelial migration of CB CAFCs and LTC-ICs was higher than that of PB. We expanded CD34+ cells from CB in serum-free medium with thrombopoietin, flk-2 ligand, and c-kit ligand, with or without IL-3 and found that CAFCs cultured in the absence of IL-3 had a chemotactic response equivalent to noncultured cells, even after 5 weeks. However, addition of IL-3 to the culture reduced this response by 20–50%. These data indicate that SDF-1 induces chemotaxis of primitive hematopoietic cells signaling through CXCR4 and that the chemoattraction could be downmodulated by culture ex vivo. PMID:10619866

Hypertension management in the oldest old: Findings from a large long-term care facility.

PubMed

Schwinn, Susan; McKay, Robin; Dinkel, Shirley; Mansfield, Bobbe; Da Cunha, Brooke Faria; Cummins, Savanna; Brunin, Krystal

2017-03-01

The purpose of this quality improvement project was to evaluate hypertension (HTN) management in patients 80 years of age and older who reside in a large, long-term care (LTC) facility. A retrospective chart audit was conducted on 75 charts of patients 80 years of age and older and who had a diagnosis of HTN. Using the 2011 American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Expert Consensus Document on Management of Hypertension in the Elderly as a guide, blood pressure readings, significant comorbidities, and antihypertensive medication utilization were analyzed. LTC residents in this sample were often not treated according to expert recommendations. Specifically, analysis revealed overtreatment of uncomplicated HTN and undertreatment of those with comorbid conditions. Additionally, those with diabetes mellitus and chronic kidney disease were infrequently prescribed ace inhibitors/angiotensin receptor blockers, as recommended. Utilizing evidence-based practice (EBP) guidelines affords the best avenue for providing safe and effective treatment of HTN. While expert recommendations are available, researchers seldom recruit frail elders in LTC facilities into treatment investigations. In the absence of population-specific EBP guidelines, nurse practitioners must rely on expert opinion and diagnostic reasoning to individualize HTN treatment to this unique and vulnerable population. ©2016 American Association of Nurse Practitioners.

Neoliberal Long-Term Care: From Community to Corporate Control.

PubMed

Polivka, Larry; Luo, Baozhen

2017-09-23

Publicly (mainly Medicaid) funded long-term care (LTC) services have evolved from a nursing home dominated system of service to a much more balanced system including home- and community-based services (HCBS) programs over the last 30 years. The HCBS programs have been largely administered by the state and local level nonprofit aging networks (ANs) consisting of Area Agencies on Aging and thousands of service providers. Over the last decade, however, for-profit HMOs administered primarily by large insurance companies have begun to displace AN organizations. State policymakers have embraced for-profit privatizations under the rationale that this approach will generate greater savings, efficiencies, and higher quality outcomes than the traditional public or private nonprofit models of program administration. As we show here, there is very little evidence for this rationale; yet, this lack of evidence has not prevented the continuing growth of for-profit managed LTC programs supported more by an ideology of market fundamentalism than empirical evidence. We also describe six possible consequences of the trend toward corporate control of public LTC services in the years ahead. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Minimizing hydrodynamic stress in mammalian cell culture through the lobed Taylor-Couette bioreactor.

PubMed

Sorg, Robin; Tanzeglock, Timm; Soos, Miroslav; Morbidelli, Massimo; Périlleux, Arnaud; Solacroup, Thomas; Broly, Hervé

2011-12-01

The objective of the present study was to investigate the effect of hydrodynamic stress heterogeneity on metabolism and productivity of an industrial mammalian cell line. For this purpose, a novel Lobed Taylor-Couette (LTC) mixing unit combining a narrow distribution of hydrodynamic stresses and a membrane aeration system to prevent cell damage by bubble bursting was developed. A hydrodynamic analysis of the LTC was developed to reproduce, in a uniform hydrodynamic environment, the same hydrodynamic stress encountered locally by cells in a stirred tank, particularly at the large scale, e.g., close and far from the impeller. The developed LTC was used to simulate the stress values near the impeller of a laboratory stirred tank bioreactor, equal to about 0.4 Pa, which is however below the threshold value leading to cell death. It was found that the cells actively change their metabolism by increasing lactate production and decreasing titer while the consumption of the main nutrients remains substantially unchanged. When considering average stress values ranging from 1 to 10 Pa found by other researchers to cause physiological response of cells to the hydrodynamic stress in heterogeneous stirred vessels, our results are close to the lower boundary of this interval. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Micronutrients on the Menu: Enhancing the Quality of Food in Long-term Care for Regular, Nontherapeutic Menus.

PubMed

Lam, Ivy T; Keller, Heather H; Duizer, Lisa; Stark, Ken

2015-06-01

Micronutrient (vitamin and mineral) deficiencies may exacerbate prevalent health conditions occurring in long-term care (LTC) residents, and current food provision may potentiate this problem. A micronutrient-focused, food-first approach to menu planning may address this gap by emphasizing nutrient-dense foods. The objectives were to determine if: (i) selected LTC menus met micronutrient and Canada's Food Guide (CFG) recommendations, and (ii) recommendations can be met through food alone with strategic menu planning. Regular, nontherapeutic menus (week 1, all meals) from diverse LTC homes (n = 5) across Canada were analyzed for micronutrient content using Food Processor and CFG servings. Site dietitians confirmed menu analyses. Five super-menus were created and analyzed for comparison. The nutrient content of the menus varied significantly across homes. Micronutrients of greatest concern were (mean ± SD) vitamin D (8.90 ± 5.29 µg/d) and vitamin E (5.13 ± 1.74 mg/d). Folate, magnesium, and potassium were also below recommendations. Super-menus of equal food volume met recommendations for all micronutrients except vitamin D (56%), vitamin E (84%), and potassium (85%). Meeting most micronutrient recommendations is possible with creative and deliberate menu planning. Knowledge translation of best practices is needed.

Turnover of regulated nurses in long-term care facilities.

PubMed

Chu, Charlene H; Wodchis, Walter P; McGilton, Katherine S

2014-07-01

To describe the relationship between nursing staff turnover in long-term care (LTC) homes and organisational factors consisting of leadership practices and behaviours, supervisory support, burnout, job satisfaction and work environment satisfaction. The turnover of regulated nursing staff [Registered Nurses (RNs) and Registered Practical Nurses (RPNs)] in LTC facilities is a pervasive problem, but there is a scarcity of research examining this issue in Canada. The study was conceptualized using a Stress Process model. Distinct surveys were distributed to administrators to measure organisational factors and to regulated nurses to measure personal and job-related sources of stress and workplace support. In total, 324 surveys were used in the linear regression analysis to examine factors associated with high turnover rates. Higher leadership practice scores were associated with lower nursing turnover; a one score increase in leadership correlated with a 49% decrease in nursing turnover. A significant inverse relationship between leadership turnover and nurse turnover was found: the higher the administrator turnover the lower the nurse turnover rate. Leadership practices and administrator turnover are significant in influencing regulated nurse turnover in LTC. Long-term care facilities may want to focus on building good leadership and communication as an upstream method to minimize nurse turnover. © 2013 John Wiley & Sons Ltd.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lucachick, Glenn; Curran, Scott; Storey, John Morse

Our work explores the volatility of particles produced from two diesel low temperature combustion (LTC) modes proposed for high-efficiency compression ignition engines. It also explores mechanisms of particulate formation and growth upon dilution in the near-tailpipe environment. Moreover, the number distribution of exhaust particles from low- and mid-load dual-fuel reactivity controlled compression ignition (RCCI) and single-fuel premixed charge compression ignition (PPCI) modes were experimentally studied over a gradient of dilution temperature. Particle volatility of select particle diameters was investigated using volatility tandem differential mobility analysis (V-TDMA). Evaporation rates for exhaust particles were compared with V-TDMA results for candidate pure n-alkanesmore » to identify species with similar volatility characteristics. The results show that LTC particles are mostly comprised of material with volatility similar to engine oil alkanes. V-TDMA results were used as inputs to an aerosol condensation and evaporation model to support the finding that smaller particles in the distribution are comprised of lower volatility material than large particles under primary dilution conditions. Although the results show that saturation levels are high enough to drive condensation of alkanes onto existing particles under the dilution conditions investigated, they are not high We conclude that observed particles from LTC operation must grow from low concentrations of highly non-volatile compounds present in the exhaust.« less

Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation.

PubMed

Hadjistavropoulos, Thomas; Williams, Jaime; Kaasalainen, Sharon; Hunter, Paulette V; Savoie, Maryse L; Wickson-Griffiths, Abigail

2016-01-01

Background. Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.

A scoping review and research synthesis on financing and regulating oral care in long-term care facilities.

PubMed

MacEntee, Michael I; Kazanjian, Arminee; Kozak, Jean-Francois; Hornby, Kathy; Thorne, Sally; Kettratad-Pruksapong, Matana

2012-06-01

Oral health care for frail elders is grossly inadequate almost everywhere, and our knowledge of regulating and financing oral care in this context is unclear. This scoping study examined and summarised the published literature available and the gaps in knowledge about regulating and financing oral care in long-term care (LTC) facilities. We limited the electronic search to reports on regulating and financing oral care, including reports, commentaries, reviews and policy statements on financing and regulating oral health-related services. The broad electronic search identified 1168 citations, which produced 42 references, including 26 pieces of grey literature for a total of 68 papers. Specific information was found on public and private funding of care and on difficulties regulating care because of professional segregation, difficulties assessing need for care, uncertainty on appropriateness of treatments and issues around scope of professional practice. A wide range of information along with 19 implications and 18 specific gaps in knowledge emerged relevant to financing and regulating oral healthcare services in LTC facilities. Effort has been given to enhancing oral care for frail elders, but there is little agreement on how the care should be regulated or financed within the LTC sector. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

Auto-Thermal Reforming of Jet-A Fuel over Commercial Monolith Catalysts: MicroReactor Evaluation and Screening Test Results

NASA Technical Reports Server (NTRS)

Yen, Judy C. H.; Tomsik, Thomas M.

2004-01-01

This paper describes the results of a series of catalyst screening tests conducted with Jet-A fuel under auto-thermal reforming (ATR) process conditions at the research laboratories of SOFCo-EFS Holdings LLC under Glenn Research Center Contract. The primary objective is to identify best available catalysts for future testing at the NASA GRC 10-kW(sub e) reformer test facility. The new GRC reformer-injector test rig construction is due to complete by March 2004. Six commercially available monolithic catalyst materials were initially selected by the NASA/SOFCo team for evaluation and bench scale screening in an existing 0.05 kW(sub e) microreactor test apparatus. The catalyst screening tests performed lasted 70 to 100 hours in duration in order to allow comparison between the different samples over a defined range of ATR process conditions. Aging tests were subsequently performed with the top two ranked catalysts as a more representative evaluation of performance in a commercial aerospace application. The two catalyst aging tests conducted lasting for approximately 600 hours and 1000 hours, respectively.

Magnetic solid base catalyst CaO/CoFe2O4 for biodiesel production: Influence of basicity and wettability of the catalyst in catalytic performance

NASA Astrophysics Data System (ADS)

Zhang, Pingbo; Han, Qiuju; Fan, Mingming; Jiang, Pingping

2014-10-01

A novel magnetic solid base catalyst CaO/CoFe2O4 was successfully prepared with CoFe2O4 synthesized by hydrothermal method as the magnetic core and applied to the transesterification of soybean oil for the production of biodiesel. The magnetic solid base catalysts were characterized by a series of techniques including CO2-TPD, powder XRD, TGA, TEM and the contact angle measurement of the water droplet. It was demonstrated that CaO/CoFe2O4 has stronger magnetic strength indicating perfect utility for repeated use and better basic strength. Compared with CaO/ZnFe2O4 and CaO/MnFe2O4, solid base catalyst CaO/CoFe2O4 has better catalytic performance, weaker hydroscopicity and stronger wettability, demonstrating that catalytic performance was relative to both basicity of catalyst and the full contact between the catalyst and the reactants, but the latter was a main factor in the catalytic system.

Chiral catalysts immobilized on achiral polymers: effect of the polymer support on the performance of the catalyst.

PubMed

Altava, Belén; Burguete, M Isabel; García-Verdugo, Eduardo; Luis, Santiago V

2018-04-23

Positive effects of the polymeric support on the performance of supported chiral catalysts, in terms of activity, stability and selectivity-enantioselectivity, have been reported when the support is properly selected and optimized opening the way to the design of more efficient catalytic systems.

Analysis of the North Carolina long-term care polypharmacy initiative: a multiple-cohort approach using propensity-score matching for both evaluation and targeting.

PubMed

Trygstad, Troy K; Christensen, Dale B; Wegner, Steve E; Sullivan, Rob; Garmise, Jennifer M

2009-09-01

The high cost and undesirable consequences of polypharmacy are well-recognized problems among elderly long-term care (LTC) residents. Despite the implementation of the 1987 Omnibus Budget Reconciliation Act, which requires pharmacist review of drug regimens in this setting, medical and drug costs for LTC residents have continued to increase. This study evaluates the North Carolina Long-Term Care Polypharmacy Initiative, a large-scale medication therapy management program (MTMP) that combined drug utilization review activities with drug regimen review techniques. This was a prospective records-based study that used a difference-in-difference model with both historical and nonintervention group controls. To ensure equivalence among subjects, propensity scoring was used to match study subjects from participating LTC facilities with comparison subjects from nonparticipating facilities. Residents with interventions were grouped for analysis by intervention type-retrospective only, prospective only, or dual type (residents with both prospective and retrospective interventions)-and by intervention stage-review, recommendation, and drug change-plus an all-inclusive "all types" grouping that aggregated groups by intervention type, for a total of 10 total cohorts. In the overall population of 5255 study subjects identified, a US $21.63 per member per month drug-cost savings was observed. Although only 1 of 10 cohorts had a change in the number of drug fills, substantial reductions in 2 of 5 types of drug alerts were observed in all 10 cohorts. A reduction in the relative risk for hospitalization (0.84 [95% CI, 0.71-1.00]) was observed in the cohort of residents receiving a retrospective review. This Initiative suggests that an MTMP can be quickly launched in a large number of LTC facility residents to produce monetary drug-cost savings and improved health outcomes. Additionally, the evaluation of this program illustrates the utility of using propensity scoring techniques to target future intervention groups in a cost-effective manner.

Expanding Home-Based Primary Care to American Indian Reservations and Other Rural Communities: An Observational Study.

PubMed

Kramer, B Josea; Creekmur, Beth; Mitchell, Michael N; Saliba, Debra

2018-04-01

Home-based primary care (HBPC) is a comprehensive, interdisciplinary program to meet the medical needs of community-dwelling populations needing long-term care (LTC). The U.S. Department of Veterans Affairs (VA) expanded its HBPC program to underserved rural communities, including American Indian reservations, providing a "natural laboratory" to study change in access to VA LTC benefits and utilization outcomes for rural populations that typically face challenges in accessing LTC medical support. Pretest-Posttest quasi-experimental approach with interrupted time-series design using linked VA, Medicare, and Indian Health Service (IHS) records. American Indian reservations and non-Indian communities in rural HBPC catchment areas. 376 veterans (88 IHS beneficiaries, 288 non-IHS beneficiaries) with a HBPC length of stay of 12 months or longer. Baseline demographic and health characteristics, activities of daily living (ADL), previous VA enrollment, and hospital admissions and emergency department (ED) visits as a function of time, accounting for IHS beneficiary and functional statuses. For HBPC users, VA enrollment increased by 22%. At baseline, 30% of IHS and non-IHS beneficiaries had 2 or more ADLs impairments; IHS populations were younger (P < .001) and had more diagnosed chronic diseases (P = .007). Overall, hospital admissions decreased by 0.10 (95% confidence interval (CI) = -0.14 to -0.05) and ED visits decreased by 0.13 (95% CI = -0.19 to -0.07) in the 90 days after HBPC admission (Ps < .001) and these decreases were maintained over 1 year follow-up. Before HBPC, probability of hospital admission was 12% lower for IHS than non-IHS beneficiaries (P = .02). Introducing HBPC to rural areas increased access to LTC and enrollment for healthcare benefits, with equitable outcomes in IHS and non-IHS populations. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

E-learning education solutions for caregivers in long-term care (LTC) facilities: new possibilities.

PubMed

MacDonald, C J; Walton, R

2007-11-01

Online learning (referred to as e-learning throughout this article) has proved to be a useful tool for delivering accessible and convenient education to busy clinical healthcare workers. The ABS Management Company specifically designed a program to provide nurses and caregivers with the necessary knowledge and skills to improve the quality of care and the quality of life for the geriatric population in long-term care (LTC) facilities. The purpose of the "Online Solutions: Quality Education for Quality Care in Long-Term Care" program is to use new educational pedagogies and innovative ways to conceptualise and deliver healthcare education to meet the complex issues and concerns of caregivers in LTC facilities. During the one-year period that data were collected for this study, 881 caregivers completed the eight (one-hour) modules in the program. Of these, 753 (85%) completed the optional assessment (both the pre and post tests) for one or more of the eight modules. Therefore, of the 881 employees who reviewed all eight modules (881x8 = 7048 modules), 1046 modules (15%) had both pre-post test data upon which to build the analysis. Information from the evaluation revealed learner improvement in pre-post test scores in excess of 10%, suggesting an increase in new and relevant skills and knowledge related to abuse and neglect, elopement, infection control, nutrition and hydration, pressure ulcers, provision of basic care and restraints. Moreover, the data indicated a reduction in the use of restraints and occurrence of pressure ulcers, suggesting that learners applied new knowledge and skills in the workplace. Finally, staff turnover rates decreased more than 20% suggesting greater job satisfaction after participating in the program. The research findings point to an urgent and unmet need to provide more accessible just-in-time, just-for-you education programs for caregivers in LTC facilities to ensure quality and efficient services to residents and their families.

Study protocol for the Flooring for Injury Prevention (FLIP) Study: a randomised controlled trial in long-term care.

PubMed

Lachance, Chantelle C; Feldman, Fabio; Laing, Andrew C; Leung, Pet Ming; Robinovitch, Stephen N; Mackey, Dawn C

2016-12-01

A promising strategy for reducing the incidence and severity of fall-related injuries in long-term care (LTC) is to decrease the ground surface stiffness, and the subsequent forces applied to the body parts at impact, through installation of compliant flooring that does not substantially affect balance or mobility. Definitive evidence of the effects of compliant flooring on fall-related injuries in LTC is lacking. The Flooring for Injury Prevention (FLIP) Study is designed to address this gap. The FLIP Study is a 4-year, parallel-group, 2-arm, randomised controlled superiority trial of flooring in 150 resident rooms at a LTC site. The primary objective is to determine whether compliant flooring reduces serious fall-related injuries relative to control flooring. Intervention (2.54 cm SmartCells compliant; 74 rooms) and control (2.54 cm plywood; 76 rooms) floorings were installed over the top of existing concrete floors and covered with identical 2.00 mm vinyl. The primary outcome is serious fall-related injury, defined as any impact-related injury due to a fall in a study room that results in Emergency Department visit or hospital admission. Secondary outcomes include minor fall-related injury, any fall-related injury, falls, number of fallers, fractures, and healthcare utilisation and costs for serious fall-related injuries. Randomisation of study rooms, and residents in rooms, was stratified by residential unit, and flooring assignments were concealed. Outcome ascertainment began September 2013. Results from the FLIP Study will provide evidence about the effects of compliant flooring on fall-related injuries in LTC and will guide development of safer environments for vulnerable older adults. NCT01618786. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Evaluation of the sustained implementation of a mental health learning initiative in long-term care.

PubMed

McAiney, Carrie A; Stolee, Paul; Hillier, Loretta M; Harris, Diane; Hamilton, Pam; Kessler, Linda; Madsen, Victoria; Le Clair, J Kenneth

2007-10-01

This paper describes an innovative education program for the management of mental health problems in long-term care (LTC) homes and the evaluation of its longer-term sustainability. Since 1998, the "Putting the P.I.E.C.E.S. Together" learning initiative has been providing education sessions and related learning strategies aimed at developing the knowledge and skills of health professionals who care for older persons with complex physical and mental health needs and associated behaviors, in Ontario, Canada. A major focus of this province-wide initiative was the development of in-house Psychogeriatric Resource Persons (PRPs). Evaluation of this initiative included the completion of pre- and post-education questionnaires (over three data collection time periods) assessing learner confidence (N = 1,024 and 792, for pre- and post-education, respectively) and session evaluation questionnaires gathering feedback on the session (N = 2,029 across all sessions). A survey of LTC homes in Ontario (N = 439, 79% of the homes in the province) was conducted to assess longer-term sustainability. Ratings of the sessions indicated that they were relevant to learners' clinical practice. There were significant increases in ratings of ability to recognize and understand challenging behaviors and mental health problems, and in ability to use a variety of assessment tools. Few homes (15%) do not have a PRP; over 50% of the staff who completed the first session in 1999 continue to serve as a PRP and to apply learned skills. A learning initiative with supportive and reinforcing strategies can develop in-house PRPs to enhance the care of the elderly in LTC. Incorporation of PRP functions into job descriptions and management support contributed to the success of this initiative. This study highlights the importance of work environments that support and reinforce the use of learned skills to the success of continuing education and quality improvement initiatives in LTC.

Mobilization of primitive and committed hematopoietic progenitors in nonhuman primates treated with defibrotide and recombinant human granulocyte colony-stimulating factor.

PubMed

Carlo-Stella, Carmelo; Di Nicola, Massimo; Longoni, Paolo; Milani, Raffaella; Milanesi, Marco; Guidetti, Anna; Haanstra, Krista; Jonker, Margaret; Cleris, Loredana; Magni, Michele; Formelli, Franca; Gianni, Alesssandro M

2004-01-01

The aim of this study was to evaluate the capacity of defibrotide in enhancing cytokine-induced hematopoietic mobilization in rhesus monkeys. Animals received recombinant human granulocyte colony-stimulating factor (rhG-CSF, 100 microg/kg/day SC for 5 days) and, after a 4- to 6-week washout period, were remobilized with defibrotide (15 mg/kg/hour continuous intravenous for 5 days) plus rhG-CSF. Hematopoietic mobilization was evaluated by complete blood counts, differential counts, as well as frequency and absolute numbers of colony-forming cells (CFCs), high-proliferative potential CFCs (HPP-CFCs), and long-term culture-initiating cells (LTC-ICs). Compared to baseline values, rhG-CSF increased circulating CFCs, HPP-CFCs, and LTC-ICs by 158-, 125-, and 67-fold, respectively; the same figures for defibrotide/rhG-CSF were 299-, 1452-, and 295-fold, respectively. Defibrotide/rhG-CSF treatment compared to rhG-CSF alone increased CFCs, HPP-CFCs, and LTC-ICs by 1.4- (35,089 vs 25,825, p< or =0.02), 6- (4358 vs 748, p< or =0.02), and 5-fold (884 vs 168, p< or =0.04), respectively. We then evaluated the effects of a 2-day defibrotide treatment associated with a 5-day rhG-CSF treatment. Compared to rhG-CSF, defibrotide/rhG-CSF increased the mobilization of CFCs, HPP-CFCs, and LTC-ICs by 2- (31,128 vs 15,527, p< or =0.05), 8- (5361 vs 660, p< or =0.01), and 8-fold (954 vs 119, p< or =0.01), respectively. Our data demonstrate that in nonhuman primates: 1) defibrotide enhances rhG-CSF-elicited mobilization of primitive and committed progenitors; and 2) a 2-day defibrotide injection is as effective as a 5-day injection.

Hip fracture prevention strategies in long-term care: a survey of Canadian physicians' opinions.

PubMed

Sawka, Anna M; Ismaila, Nofisat; Raina, Parminder; Thabane, Lehana; Straus, Sharon; Adachi, Jonathan D; Gafni, Amiram; Papaioannou, Alexandra

2010-11-01

To garner Canadian physicians' opinions on strategies to reduce hip fractures in long-term care (LTC) facilities, focusing on secondary prevention. A cross-sectional survey using a mailed, self-administered, written questionnaire. Canada. Family physician members of the Ontario Long-Term Care Association (n = 165) and all actively practising geriatricians registered in the Canadian Medical Directory (n = 81). The strength of recommendations for fracture-reduction strategies in LTC and barriers to implementing these strategies. Of the 246 physicians sent the questionnaire, 25 declined study materials and were excluded. Of the 221 remaining, 120 responded for a response rate of 54%. About two-thirds of respondents were family physicians (78 of 120) and the rest were mostly geriatricians. Most respondents strongly recommended the following secondary prevention strategies for use in LTC after hip fracture: calcium, vitamin D, oral aminobisphosphonates, physical therapy, and environmental modification (such as handrails). Most respondents either did not recommend or recommended limited use of etidronate, intravenous bisphosphonates, calcitonin, raloxifene, testosterone (for hypogonadal men), and teriparatide. Postmenopausal hormone therapy was discouraged or not recommended by most respondents. Support was mixed for the use of hip protectors, B vitamins, and folate. Barriers to implementation identified by most respondents included a lack of strong evidence of hip fracture reduction (for B vitamins and folate, cyclic etidronate, and testosterone), side effects (for postmenopausal hormone therapy), poor compliance (for hip protectors), and expense (for intravenous bisphosphonates and teriparatide). Some respondents cited side effects or poor compliance as barriers to using calcium and potent oral bisphosphonates. Canadian physicians favour the use of calcium, vitamin D, potent oral bisphosphonates, physical therapy, and evironmental modifications for LTC residents after hip fracture. Further study at the clinical and administrative levels is required to find ways to overcome the specific barriers to implementation and effectiveness of these interventions.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

The objective of the contract is to consolidate the advances made during the previous contract in the conversion of syngas to motor fuels using Molecular Sieve-containing catalysts and to demonstrate the practical utility and economic value of the new catalyst/process systems with appropriate laboratory runs. Work on the program is divided into the following six tasks: (1) preparation of a detailed work plan covering the entire performance of the contract; (2) preliminary techno-economic assessment of the UCC catalyst/process system; (3) optimization of the most promising catalyst developed under prior contract; (4) optimization of the UCC catalyst system in a mannermore » that will give it the longest possible service life; (5) optimization of a UCC process/catalyst system based upon a tubular reactor with a recycle loop containing the most promising catalyst developed under Tasks 3 and 4 studies; and (6) economic evaluation of the optimal performance found under Task 5 for the UCC process/catalyst system. Progress reports are presented for tasks 2 through 5. 232 figs., 19 tabs.« less

The Experimental Measurement of Local and Bulk Oxygen Transport Resistances in the Catalyst Layer of Proton Exchange Membrane Fuel Cells.

PubMed

Wang, Chao; Cheng, Xiaojing; Lu, Jiabin; Shen, Shuiyun; Yan, Xiaohui; Yin, Jiewei; Wei, Guanghua; Zhang, Junliang

2017-12-07

Remarkable progress has been made in reducing the cathodic Pt loading of PEMFCs; however, a huge performance loss appears at high current densities, indicating the existence of a large oxygen transport resistance associated with the ultralow Pt loading catalyst layer. To reduce the Pt loading without sacrificing cell performance, it is essential to illuminate the oxygen transport mechanism in the catalyst layer. Toward this goal, an experimental approach to measure the oxygen transport resistance in catalyst layers is proposed and realized for the first time in this study. The measuring approach involves a dual-layer catalyst layer design, which consists of a dummy catalyst layer and a practical catalyst layer, followed by changing the thickness of dummy layer to respectively quantify the local and bulk resistances via limiting current measurements combined with linear extrapolation. The experimental results clearly reveal that the local resistance dominates the total resistance in the catalyst layer.

Methanol Steam Reforming Promoted by Molten Salt-Modified Platinum on Alumina Catalysts

PubMed Central

Kusche, Matthias; Agel, Friederike; Ní Bhriain, Nollaig; Kaftan, Andre; Laurin, Mathias; Libuda, Jörg; Wasserscheid, Peter

2014-01-01

We herein describe a straight forward procedure to increase the performance of platinum-on-alumina catalysts in methanol steam reforming by applying an alkali hydroxide coating according to the “solid catalyst with ionic liquid layer” (SCILL) approach. We demonstrate by diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS) and temperature-programmed desorption (TPD) studies that potassium doping plays an important role in the catalyst activation. Moreover, the hygroscopic nature and the basicity of the salt modification contribute to the considerable enhancement in catalytic performance. During reaction, a partly liquid film of alkali hydroxides/carbonates forms on the catalyst/alumina surface, thus significantly enhancing the availability of water at the catalytically active sites. Too high catalyst pore fillings with salt introduce a considerable mass transfer barrier into the system as indicated by kinetic studies. Thus, the optimum interplay between beneficial catalyst modification and detrimental mass transfer effects had to be identified and was found on the applied platinum-on-alumina catalyst at KOH loadings around 7.5 mass %. PMID:25124120

High-performance oxygen reduction catalysts in both alkaline and acidic fuel cells based on pre-treating carbon material and iron precursor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Song, Ping; Barkholtz, Heather M.; Wang, Ying

We demonstrate a new and simple method for pre-treating the carbon material and iron precursor to prepare oxygen reduction reaction (ORR) catalysts, which can produce super-high performance and stability in alkaline solution, with high performance in acid solution. This strategy using cheap materials is simply controllable. Moreover, it has achieved smaller uniform nanoparticles to exhibit high stability, and the synergetic effect of Fe and N offered much higher performance in ORR than commercial Pt/C, with high maximum power density in alkaline and acid fuel cell test. So it can make this kind of catalysts be the most promising alternatives ofmore » Pt-based catalysts with best performance/price.« less

Ultra-high-performance core–shell structured Ru@Pt/C catalyst prepared by a facile pulse electrochemical deposition method

DOE PAGES

Chen, Dan; Li, Yuexia; Liao, Shijun; ...

2015-08-03

Core–shell structured catalysts, made by placing either a monolayer or a thin layer of a noble metal on relatively cheap core-metal nanoparticles, are fascinating and promising fuel cell catalysts due to their high utilization of noble metals. Here, we report our development of a core–shell structured catalyst, Ru@Pt/C, generated by a novel and facile pulse electrochemical deposition (PED) approach. We demonstrate that compared with a commercial Pt/C catalyst, this novel catalyst achieves over four times higher mass activity towards the anodic oxidation of methanol, and 3.6 times higher mass activity towards the cathodic reduction of oxygen. Importantly, we find thatmore » the intrinsic activity of Pt in this Ru@Pt/C catalyst is doubled due to the formation of the core–shell structure. The catalyst also shows superior stability: even after 2000 scans, it still retains up to 90% of the peak current. As a result, our findings demonstrate that this novel PED approach is a promising method for preparing high-performance core–shell catalysts for fuel cell applications.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

The objective of the contract is to consolidate the advances made during the previous contract in the conversion of syngas to motor fuels using Molecular Sieve-containing catalysts and to demonstrate the practical utility and economic value of the new catalyst/process systems with appropriate laboratory runs. Work on the program is divided into the following six tasks: (1) preparation of a detailed work plan covering the entire performance of the contract; (2) preliminary techno-economic assessment of the UCC catalyst/process system; (3) optimization of the most promising catalysts developed under prior contract; (4) optimization of the UCC catalyst system in a mannermore » that will give it the longest possible service life; (5) optimization of a UCC process/catalyst system based upon a tubular reactor with a recycle loop; and (6) economic evaluation of the optimal performance found under Task 5 for the UCC process/catalyst system. Accomplishments are reported for Tasks 2 through 5.« less

Catalyst and process development for synthesis gas conversion to isobutylene. Quarterly report, October 1, 1992--December 31, 1992

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anthony, R.G.; Akgerman, A.

1993-02-01

The objectives of this project are to develop a new catalyst, the kinetics for this catalyst, reactor models for trickle bed, slurry and fixed bed reactors, and simulate the performance of fixed bed trickle flow reactors, slurry flow reactors, and fixed bed gas phase reactors for conversion of a hydrogen lean synthesis gas to isobutylene. The goals for the quarter include: (1) Conduct experiments using a trickle bed reactor to determine the effect of reactor type on the product distribution. (2) Use spherical pellets of silica as a support for zirconia for the purpose of increasing surface, area and performancemore » of the catalysts. (3) Conduct exploratory experiments to determine the effect of super critical drying of the catalyst on the catalyst surface area and performance. (4) Prepare a ceria/zirconia catalyst by the precipitation method.« less

Experimental study of isopropanol dehydrogenation over amorphous alloy raney nickel catalysts

NASA Astrophysics Data System (ADS)

Xin, Fang; Xu, Min; Li, Xun-Feng; Huai, Xiu-Lan

2013-12-01

The dehydrogenation reaction of isopropanol occurring at low temperature is of great industrial importance. It is a key procedure in isopropanol/acetone/hydrogen chemical heat pump system. An experimental investigation was performed to study the behavior of the liquid phase dehydrogenation of isopropanol over amorphous alloy Raney nickel catalysts. Un-promoted and promoted catalysts were used and their performances were compared under various catalyst amounts, acetone content in the reactant and reaction temperature ranging from 348 K to 355 K. It is found that there exists an optimum catalyst concentration which is about 0.34 g in 300 ml isopropanol. The temperature has evident effect on the reaction. The presence of activities of Fe-promoted catalyst decrease slightly compared to the un-promoted catalyst when the temperature are 348 K and 351 K. Besides, the reaction rate decreases almost linearly with the increase of acetone volume fraction in the reactant.

Hydrothermal Synthesis of Platinum-Group-Metal-Free Catalysts: Structural Elucidation and Oxygen Reduction Catalysis

DOE PAGES

Gokhale, Rohan; Tsui, Lok-Kun; Roach, Kristin; ...

2017-12-07

In this paper, a hydrothermal approach to generate a platinum-group-metal-free (PGM-free) Fe-N-C catalyst for the oxygen reduction reaction (ORR) is introduced. The process involves partial carbonization by hydrothermal means followed by thermal treatment to obtain the final catalysts. Detailed X-ray scattering analysis of the glucose-imidazole catalysts (termed as GLU-IMID-C catalysts), obtained for the first time with the use of CarbonXS GUI program, reveals the presence of face-centered cubic (FCC) iron nanoparticles embedded in partially graphitic carbon in all catalyst variations. We also report the physical characterization of these catalysts by using X-ray photoelectron spectroscopy, Brunauer-Emmett-Teller surface area analysis, and transmissionmore » electron microscopy. The electrocatalytic behavior of the catalysts towards oxygen reduction is studied separately in acidic and alkaline electrolytes by rotating ring disk electrode measurements. The catalysts exhibit high ORR activity in acidic (0.5 M H 2SO 4) and alkaline (0.1 M KOH) electrolytes. Lastly, a precursor structure-performance relationship of these catalysts and their performance trends in both electrolytes has been discussed in this work.« less

Hydrothermal Synthesis of Platinum-Group-Metal-Free Catalysts: Structural Elucidation and Oxygen Reduction Catalysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gokhale, Rohan; Tsui, Lok-Kun; Roach, Kristin

In this paper, a hydrothermal approach to generate a platinum-group-metal-free (PGM-free) Fe-N-C catalyst for the oxygen reduction reaction (ORR) is introduced. The process involves partial carbonization by hydrothermal means followed by thermal treatment to obtain the final catalysts. Detailed X-ray scattering analysis of the glucose-imidazole catalysts (termed as GLU-IMID-C catalysts), obtained for the first time with the use of CarbonXS GUI program, reveals the presence of face-centered cubic (FCC) iron nanoparticles embedded in partially graphitic carbon in all catalyst variations. We also report the physical characterization of these catalysts by using X-ray photoelectron spectroscopy, Brunauer-Emmett-Teller surface area analysis, and transmissionmore » electron microscopy. The electrocatalytic behavior of the catalysts towards oxygen reduction is studied separately in acidic and alkaline electrolytes by rotating ring disk electrode measurements. The catalysts exhibit high ORR activity in acidic (0.5 M H 2SO 4) and alkaline (0.1 M KOH) electrolytes. Lastly, a precursor structure-performance relationship of these catalysts and their performance trends in both electrolytes has been discussed in this work.« less

Development of attrition resistant iron-based Fischer-Tropsch catalysts

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

2000-09-20

The Fischer-Tropsch (F-T) reaction provides a way of converting coal-derived synthesis gas (CO+H{sub 2}) to liquid fuels. Since the reaction is highly exothermic, one of the major problems in control of the reaction is heat removal. Recent work has shown that the use of slurry bubble column reactors (SBCRs) can largely solve this problem. The use of iron-based catalysts is attractive not only due to their low cost and ready availability, but also due to their high water-gas shift activity which makes it possible to use these catalysts with low H{sub 2}/CO ratios. However, a serious problem with use ofmore » Fe catalysts in a SBCR is their tendency to undergo attrition. This can cause fouling/plugging of downstream filters and equipment, makes the separation of catalyst from the oil/wax product very difficult if not impossible, and results a steady loss of catalyst from the reactor. The objective of this research is to develop robust iron-based Fischer-Tropsch catalysts that have suitable activity, selectivity and stability to be used in the slurry bubble column reactor. Specifically we aim to develop to: (1) improve the performance and preparation procedure of the high activity, high attrition resistant, high alpha iron-based catalysts synthesized at Hampton University (2) seek improvements in the catalyst performance through variations in process conditions, pretreatment procedures and/or modifications in catalyst preparation steps and (3) investigate the performance in a slurry reactor. The effort during the reporting period has been devoted to effects of pretreating procedures, using H{sub 2}, CO and syngas (H{sub 2}/CO = 0.67) as reductants, on the performance (activity, selectivity and stability with time) of a precipitated iron catalyst (100Fe/5Cu/4.2K/10SiO{sub 2} on a mass basis ) during F-T synthesis were studied in a fixed-bed reactor.« less

The influences of microwave irradiation and polyol precursor pH on Cu/AC catalyst and its CO oxidation performance

NASA Astrophysics Data System (ADS)

Chuang, Kui-Hao; Shih, Kaimin; Wey, Ming-Yen

2012-10-01

This study evaluated the effects of microwave irradiation parameters and the pH of the polyol precursor on the morphological features and catalytic performances of Cu/activated carbon (AC) catalysts. Experimental results of carbon monoxide (CO) oxidation indicated that the highest catalytic activity is achieved when the Cu/AC catalyst is prepared with microwave irradiation at 700 W for 60 s. Scanning electron microscopy revealed the presence of beneficial small copper aciculae on the Cu/AC catalyst under such a microwave irradiation scheme. Further investigation of operational parameters found that the performance of Cu/AC catalysts is enhanced by adopting a pH = 12 polyol precursor solution. With the observation that small cube copper ( 16 nm) aggregates form when a pH = 12 polyol precursor solution is used, this study also demonstrated the importance of controlling the morphology of metal nanoparticles on Cu/AC catalysts when using the microwave-assisted polyol method.

40 CFR Table 6 to Subpart Zzzz of... - Continuous Compliance With Emission Limitations, and Other Requirements

Code of Federal Regulations, 2014 CFR

2014-07-01

... >500 HP located at a major source of HAP a. Reduce CO emissions and using an oxidation catalyst, and... not using an oxidation catalyst, and using a CPMS i. Conducting semiannual performance tests for CO to... RICE exhaust and using oxidation catalyst or NSCR i. Conducting semiannual performance tests for...

40 CFR Table 6 to Subpart Zzzz of... - Continuous Compliance With Emission Limitations, and Other Requirements

Code of Federal Regulations, 2013 CFR

2013-07-01

... >500 HP located at a major source of HAP a. Reduce CO emissions and using an oxidation catalyst, and... not using an oxidation catalyst, and using a CPMS i. Conducting semiannual performance tests for CO to... RICE exhaust and using oxidation catalyst or NSCR i. Conducting semiannual performance tests for...

Thermally stable single-atom platinum-on-ceria catalysts via atom trapping

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jones, John; Xiong, Haifeng; DelaRiva, Andrew

2016-07-08

Catalysts based on single atoms of scarce precious metals can lead to more efficient use through enhanced reactivity and selectivity. However, single atoms on catalyst supports can be mobile and aggregate into nanoparticles when heated at elevated temperatures. High temperatures are detrimental to catalyst performance unless these mobile atoms can be trapped. We used ceria powders having similar surface areas but different exposed surface facets. When mixed with a platinum/ aluminum oxide catalyst and aged in air at 800°C, the platinum transferred to the ceria and was trapped. Polyhedral ceria and nanorods were more effective than ceria cubes at anchoringmore » the platinum. Performing synthesis at high temperatures ensures that only the most stable binding sites are occupied, yielding a sinter-resistant, atomically dispersed catalyst.« less

Enhanced performance of a novel anodic PdAu/VGCNF catalyst for electro-oxidation in a glycerol fuel cell.

PubMed

Yahya, N; Kamarudin, S K; Karim, N A; Masdar, M S; Loh, K S

2017-11-25

This study presents a novel anodic PdAu/VGCNF catalyst for electro-oxidation in a glycerol fuel cell. The reaction conditions are critical issues affecting the glycerol electro-oxidation performance. This study presents the effects of catalyst loading, temperature, and electrolyte concentration. The glycerol oxidation performance of the PdAu/VGCNF catalyst on the anode side is tested via cyclic voltammetry with a 3 mm 2 active area. The morphology and physical properties of the catalyst are examined using X-ray diffraction (XRD), field emission scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) spectroscopy. Then, optimization is carried out using the response surface method with central composite experimental design. The current density is experimentally obtained as a response variable from a set of experimental laboratory tests. The catalyst loading, temperature, and NaOH concentration are taken as independent parameters, which were evaluated previously in the screening experiments. The highest current density of 158.34 mAcm -2 is obtained under the optimal conditions of 3.0 M NaOH concentration, 60 °C temperature and 12 wt.% catalyst loading. These results prove that PdAu-VGCNF is a potential anodic catalyst for glycerol fuel cells.

Method of depositing a catalyst on a fuel cell electrode

DOEpatents

Dearnaley, Geoffrey; Arps, James H.

2000-01-01

Fuel cell electrodes comprising a minimal load of catalyst having maximum catalytic activity and a method of forming such fuel cell electrodes. The method comprises vaporizing a catalyst, preferably platinum, in a vacuum to form a catalyst vapor. A catalytically effective amount of the catalyst vapor is deposited onto a carbon catalyst support on the fuel cell electrode. The electrode preferably is carbon cloth. The method reduces the amount of catalyst needed for a high performance fuel cell electrode to about 0.3 mg/cm.sup.2 or less.

40 CFR 57.302 - Performance level of interim constant controls.

Code of Federal Regulations, 2010 CFR

2010-07-01

... limitation shall take into account unavoidable catalyst deterioration in sulfuric acid plants, but may prescribe the frequency of catalyst screening or replacement. The NSO shall also prohibit the smelter owner... completely fill all available catalyst bed stages with sufficient catalyst; (iii) Inability of the gas pre...

On the Preparation and Testing of Fuel Cell Catalysts Using the Thin Film Rotating Disk Electrode Method.

PubMed

Inaba, Masanori; Quinson, Jonathan; Bucher, Jan Rudolf; Arenz, Matthias

2018-03-16

We present a step-by-step tutorial to prepare proton exchange membrane fuel cell (PEMFC) catalysts, consisting of Pt nanoparticles (NPs) supported on a high surface area carbon, and to test their performance in thin film rotating disk electrode (TF-RDE) measurements. The TF-RDE methodology is widely used for catalyst screening; nevertheless, the measured performance sometimes considerably differs among research groups. These uncertainties impede the advancement of new catalyst materials and, consequently, several authors discussed possible best practice methods and the importance of benchmarking. The visual tutorial highlights possible pitfalls in the TF-RDE testing of Pt/C catalysts. A synthesis and testing protocol to assess standard Pt/C catalysts is introduced that can be used together with polycrystalline Pt disks as benchmark catalysts. In particular, this study highlights how the properties of the catalyst film on the glassy carbon (GC) electrode influence the measured performance in TF-RDE testing. To obtain thin, homogeneous catalyst films, not only the catalyst preparation, but also the ink deposition and drying procedures are essential. It is demonstrated that an adjustment of the ink's pH might be necessary, and how simple control measurements can be used to check film quality. Once reproducible TF-RDE measurements are obtained, determining the Pt loading on the catalyst support (expressed as Pt wt%) and the electrochemical surface area is necessary to normalize the determined reaction rates to either surface area or Pt mass. For the surface area determination, so-called CO stripping, or the determination of the hydrogen underpotential deposition (Hupd) charge, are standard. For the determination of the Pt loading, a straightforward and cheap procedure using digestion in aqua regia with subsequent conversion of Pt(IV) to Pt(II) and UV-vis measurements is introduced.

On the Preparation and Testing of Fuel Cell Catalysts Using the Thin Film Rotating Disk Electrode Method

PubMed Central

Inaba, Masanori; Quinson, Jonathan; Bucher, Jan Rudolf; Arenz, Matthias

2018-01-01

We present a step-by-step tutorial to prepare proton exchange membrane fuel cell (PEMFC) catalysts, consisting of Pt nanoparticles (NPs) supported on a high surface area carbon, and to test their performance in thin film rotating disk electrode (TF-RDE) measurements. The TF-RDE methodology is widely used for catalyst screening; nevertheless, the measured performance sometimes considerably differs among research groups. These uncertainties impede the advancement of new catalyst materials and, consequently, several authors discussed possible best practice methods and the importance of benchmarking. The visual tutorial highlights possible pitfalls in the TF-RDE testing of Pt/C catalysts. A synthesis and testing protocol to assess standard Pt/C catalysts is introduced that can be used together with polycrystalline Pt disks as benchmark catalysts. In particular, this study highlights how the properties of the catalyst film on the glassy carbon (GC) electrode influence the measured performance in TF-RDE testing. To obtain thin, homogeneous catalyst films, not only the catalyst preparation, but also the ink deposition and drying procedures are essential. It is demonstrated that an adjustment of the ink's pH might be necessary, and how simple control measurements can be used to check film quality. Once reproducible TF-RDE measurements are obtained, determining the Pt loading on the catalyst support (expressed as Pt wt%) and the electrochemical surface area is necessary to normalize the determined reaction rates to either surface area or Pt mass. For the surface area determination, so-called CO stripping, or the determination of the hydrogen underpotential deposition (Hupd) charge, are standard. For the determination of the Pt loading, a straightforward and cheap procedure using digestion in aqua regia with subsequent conversion of Pt(IV) to Pt(II) and UV-vis measurements is introduced. PMID:29608166

Manganese-cerium oxide catalysts prepared by non-thermal plasma for NO oxidation: Effect of O2 in discharge atmosphere

NASA Astrophysics Data System (ADS)

Liu, Lu; Zheng, Chenghang; Wu, Shenghao; Gao, Xiang; Ni, Mingjiang; Cen, Kefa

2017-09-01

Non-thermal plasma with different O2 concentration in discharge atmosphere was applied to synthesize manganese and cerium mixed-oxides catalysts, which were compared in NO oxidation activity. Discharge atmosphere displayed a crucial influence on the performance of the catalysts prepared by plasma. Relatively low O2 concentration in discharge atmosphere allows synthesizing manganese-cerium oxides catalysts in a moderate environment and therefore is favorable for better physicochemical properties which lead to superior catalytic behavior. The best catalyst was obtained by treatment with 10% O2/N2 plasma and presented over 80% NO conversion in the temperature range of 275-325 °C, whereas catalyst prepared in pure O2 discharge atmosphere had the same activity with a catalyst prepared by calcinations. A correlation between the surface properties of the plasma prepared catalysts and its catalytic activity in NO oxidation is proposed. The amount of the surface adsorbed oxygen has an obvious linear correlation with the amount of Ce3+, the H2 consumption at low temperatures and the catalytic performance. The superior catalytic performance is mainly attributed to the stronger interaction between manganese oxides and ceria, and the formation of poorly crystallized Mn-O-Ce phase in the catalyst which resulted from the slow decomposition of nitrates and organics during plasma treatment. Catalysts prepared in relatively low O2 concentration have large specific surface area and is abundant in Ce3+ species and active oxygen species. The study suggests that plasma treatment with proper discharge gas components is a promising method to prepare effective manganese- cerium oxides catalyst for NO oxidation.

Prevalence of Skin Tears in Elderly Patients: A Retrospective Chart Review of Incidence Reports in 6 Long-term Care Facilities.

PubMed

Hawk, Joyce; Shannon, Mary

2018-04-01

The incidence and prevalence of skin tears in long-term care (LTC) facilities has not been well established. To ascertain the point prevalence of reported skin tears, a retrospective review of incident reports was performed in 6 LTC facilities in western Pennsylvania from November 1, 2016 through December 31, 2016. Report data, including resident age; gender; mobility limitations; skin tear location, number, and cause (if known); occurrence time (7 am to 3 pm, 3 pm to 11 pm, or 11 pm to 7 am nursing shift); and history of previous skin tears, were abstracted. All data were entered into a statistical analysis program and analyzed using descriptive statistics. Period prevalence was used to determine prevalence rate; an independent t test was used to compare the presence of skin tears between genders. Differences between location and cause of skin tears were evaluated using a multinomial test of related proportions. A test of proportions was used to evaluate skin tear occurrence time (nursing shift) differences. The overall point prevalence rate was 9% (N = 1253 residents) ranging from 6 to 28 skin tears per facility. The average age of residents with a skin tear (n = 119) was 83.5 years. The majority (111, 93%) had mobility limitations. Falls accounted for 38 skin tears (31.9%), followed by propelling in a wheelchair (18, 15.1%; X2 =7.14; P = .008). Forearm skin tears (37, 31.1%) occurred significantly more frequently than lower leg skin tears (19, 16%; P = .016). Significantly more skin tears occurred during the 7 am to 3 pm shift (47, 39.5%) and 3 pm to 11 pm shift (49, 41.2%) than during the 11 pm to 7 am shift (23, 19.3%; X2 = 5.78; P <.01). The results of this study confirm skin tears are a significant problem among elderly residents in LTC, especially because the reported rate is likely lower than the actual rate. Research to further elucidate the incidence and prevalence of skin tears and associated risk factors is needed to help develop evidence-based risk assessment, classification systems, treatment guidelines, and preventive measures.

Performance comparison of low-temperature direct alcohol fuel cells with different anode catalysts

NASA Astrophysics Data System (ADS)

Zhou, W. J.; Zhou, B.; Li, W. Z.; Zhou, Z. H.; Song, S. Q.; Sun, G. Q.; Xin, Q.; Douvartzides, S.; Goula, M.; Tsiakaras, P.

Low-temperature polymer electrolyte membrane fuel cells directly fed by methanol and ethanol were investigated employing carbon supported Pt, PtSn and PtRu as anode catalysts, respectively. Employing Pt/C as anode catalyst, both direct methanol fuel cell (DMFC) and direct ethanol fuel cell (DEFC) showed poor performances even in presence of high Pt loading on anode. It was found that the addition of Ru or Sn to the Pt dramatically enhances the electro-oxidation of both methanol and ethanol. It was also found that the single cell adopting PtRu/C as anode shows better DMFC performance, while PtSn/C catalyst shows better DEFC performance. The single fuel cell using PtSn/C as anode catalyst at 90 °C shows similar power densities whenever fueled by methanol or ethanol. The cyclic voltammetry (CV) and single fuel cell tests indicated that PtRu is more suitable for DMFC while PtSn is more suitable for DEFC.

Fuel cell performance of palladium-platinum core-shell electrocatalysts synthesized in gram-scale batches

DOE Office of Scientific and Technical Information (OSTI.GOV)

Khateeb, Siddique; Su, Dong; Guerreo, Sandra

This article presents the performance of palladium-platinum core-shell catalysts (Pt/Pd/C) for oxygen reduction synthesized in gram-scale batches in both liquid cells and polymer-electrolyte membrane fuel cells. Core-shell catalyst synthesis and characterization, ink fabrication, and cell assembly details are discussed. The Pt mass activity of the Pt/Pd core-shell catalyst was 0.95 A mg –1 at 0.9 V measured in liquid cells (0.1 M HClO4), which was 4.8 times higher than a commercial Pt/C catalyst. The performances of Pt/Pd/C and Pt/C in large single cells (315 cm 2) were assessed under various operating conditions. The core-shell catalyst showed consistently higher performance thanmore » commercial Pt/C in fuel cell testing. A 20–60 mV improvement across the whole current density range was observed on air. Sensitivities to temperature, humidity, and gas composition were also investigated and the core-shell catalyst showed a consistent benefit over Pt under all conditions. However, the 4.8 times activity enhancement predicated by liquid cell measurements was not fully realized in fuel cells.« less

Fuel cell performance of palladium-platinum core-shell electrocatalysts synthesized in gram-scale batches

DOE PAGES

Khateeb, Siddique; Su, Dong; Guerreo, Sandra; ...

2016-05-03

This article presents the performance of palladium-platinum core-shell catalysts (Pt/Pd/C) for oxygen reduction synthesized in gram-scale batches in both liquid cells and polymer-electrolyte membrane fuel cells. Core-shell catalyst synthesis and characterization, ink fabrication, and cell assembly details are discussed. The Pt mass activity of the Pt/Pd core-shell catalyst was 0.95 A mg –1 at 0.9 V measured in liquid cells (0.1 M HClO4), which was 4.8 times higher than a commercial Pt/C catalyst. The performances of Pt/Pd/C and Pt/C in large single cells (315 cm 2) were assessed under various operating conditions. The core-shell catalyst showed consistently higher performance thanmore » commercial Pt/C in fuel cell testing. A 20–60 mV improvement across the whole current density range was observed on air. Sensitivities to temperature, humidity, and gas composition were also investigated and the core-shell catalyst showed a consistent benefit over Pt under all conditions. However, the 4.8 times activity enhancement predicated by liquid cell measurements was not fully realized in fuel cells.« less

Performance of (CoPC)n catalyst in active lithium-thionyl chloride cells

NASA Technical Reports Server (NTRS)

Shah, Pinakin M.

1990-01-01

An experimental study was conducted with anode limited D size cells to characterize the performance of an active lithium-thionyl chloride (Li/SOCl2) system using the polymeric cobalt phthalocyanine, (CoPC)n, catalyst in carbon cathodes. The author describes the results of this experiment with respect to initial voltage delays, operating voltages, and capacities. The effectiveness of the preconditioning methods evolved to alleviate passivation effects on storage are also discussed. The results clearly demonstrated the superior high rate capability of cells with the catalyst. The catalyst did not adversely impact the performance of cells after active storage for up to 6 months, while retaining its beneficial influences.

Catalytic combustion of methane over commercial catalysts in presence of ammonia and hydrogen sulphide.

PubMed

Hurtado, Paloma; Ordóñez, Salvador; Vega, Aurelio; Díez, Fernando V

2004-05-01

The performance of different commercially available catalysts (supported Pd, Pt, Rh, bimetallic Pd-Pt, and Cr-Cu-Ti oxide catalyst) for the oxidation of methane, alone and in presence of ammonia and hydrogen sulphide is studied in this work. Catalysts performance was evaluated both in terms of activity and resistance to poisoning. The main conclusions are that supported Pd and Rh, present the highest activities for methane oxidation, both alone and in presence of ammonia, whereas they are severely poisoned in presence of H2S. Pt and Cr-Cu-Ti are less active but more sulphur resistant, but their activity is lower than the residual activity of sulphur-deactivated Pd and Rh catalysts. The Pd-Pt catalyst exhibits low activity and it is quickly deactivated in presence of hydrogen sulphide.

Selective liquid phase oxidation of benzyl alcohol to benzaldehyde by tert-butyl hydroperoxide over γ-Al2O3 supported copper and gold nanoparticles

NASA Astrophysics Data System (ADS)

Ndolomingo, Matumuene Joe; Meijboom, Reinout

2017-03-01

Benzyl alcohol oxidation to benzaldehyde was performed by tert-butyl hydroperoxide (TBHP) in the absence of any solvent using γ-Al2O3 supported copper and gold nanoparticles. Li2O and ionic liquids were used as additive and stabilizers for the synthesis of the catalysts. The physico-chemical properties of the catalysts were characterized by atomic absorption spectroscopy (AAS), X-ray diffraction spectroscopy (XRD), N2 absorption/desorption (BET), transmission electron microscopy (TEM), scanning electron microscopy (SEM), thermogravimetric analysis (TGA) and temperature programmed reduction (TPR), whereas, the oxidation reaction was followed by gas chromatography with a flame ionization detector (GC-FID). The as prepared catalysts exhibited good catalytic performance in terms of conversion and selectivity towards benzaldehyde. The performance of the Au-based catalysts is significantly higher than that of the Cu-based catalysts. For both Cu and Au catalysts, the conversion of benzyl alcohol increased as the reaction proceeds, while the selectivity for benzaldehyde decreased. Moreover, the catalysts can be easily recycled and reused with neither significant loss of activity nor selectivity. A kinetic study for the Cu and Au-catalyzed oxidation of benzyl alcohol to benzyldehyde is reported. The rate at which the oxidation of benzyl alcohol is occurring as a function of catalyst and oxidant amounts was investigated, with the apparent rate constant, kapp being proportional to the amount of nano catalyst and oxygen present in the system.

Nitrogen-Coordinated Single Cobalt Atom Catalysts for Oxygen Reduction in Proton Exchange Membrane Fuel Cells

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Xiao Xia; Cullen, David A.; Pan, Yung-Tin

Due to the Fenton reaction, the presence of Fe and peroxide in electrodes generates free radicals causing serious degradation of the organic ionomer and the membrane. Pt-free and Fe-free cathode catalysts therefore are urgently needed for durable and inexpensive proton exchange membrane fuel cells (PEMFCs). In this paper, a high-performance nitrogen-coordinated single Co atom catalyst is derived from Co-doped metal-organic frameworks (MOFs) through a one-step thermal activation. Aberration-corrected electron microscopy combined with X-ray absorption spectroscopy virtually verifies the CoN 4 coordination at an atomic level in the catalysts. Through investigating effects of Co doping contents and thermal activation temperature, anmore » atomically Co site dispersed catalyst with optimal chemical and structural properties has achieved respectable activity and stability for the oxygen reduction reaction (ORR) in challenging acidic media (e.g., half-wave potential of 0.80 V vs reversible hydrogen electrode (RHE). The performance is comparable to Fe-based catalysts and 60 mV lower than Pt/C -60 μg Pt cm -2). Fuel cell tests confirm that catalyst activity and stability can translate to high-performance cathodes in PEMFCs. Finally, the remarkably enhanced ORR performance is attributed to the presence of well-dispersed CoN 4 active sites embedded in 3D porous MOF-derived carbon particles, omitting any inactive Co aggregates.« less

Nitrogen-Coordinated Single Cobalt Atom Catalysts for Oxygen Reduction in Proton Exchange Membrane Fuel Cells

DOE PAGES

Wang, Xiao Xia; Cullen, David A.; Pan, Yung-Tin; ...

2018-01-24

Due to the Fenton reaction, the presence of Fe and peroxide in electrodes generates free radicals causing serious degradation of the organic ionomer and the membrane. Pt-free and Fe-free cathode catalysts therefore are urgently needed for durable and inexpensive proton exchange membrane fuel cells (PEMFCs). In this paper, a high-performance nitrogen-coordinated single Co atom catalyst is derived from Co-doped metal-organic frameworks (MOFs) through a one-step thermal activation. Aberration-corrected electron microscopy combined with X-ray absorption spectroscopy virtually verifies the CoN 4 coordination at an atomic level in the catalysts. Through investigating effects of Co doping contents and thermal activation temperature, anmore » atomically Co site dispersed catalyst with optimal chemical and structural properties has achieved respectable activity and stability for the oxygen reduction reaction (ORR) in challenging acidic media (e.g., half-wave potential of 0.80 V vs reversible hydrogen electrode (RHE). The performance is comparable to Fe-based catalysts and 60 mV lower than Pt/C -60 μg Pt cm -2). Fuel cell tests confirm that catalyst activity and stability can translate to high-performance cathodes in PEMFCs. Finally, the remarkably enhanced ORR performance is attributed to the presence of well-dispersed CoN 4 active sites embedded in 3D porous MOF-derived carbon particles, omitting any inactive Co aggregates.« less

Nitrogen-Coordinated Single Cobalt Atom Catalysts for Oxygen Reduction in Proton Exchange Membrane Fuel Cells.

PubMed

Wang, Xiao Xia; Cullen, David A; Pan, Yung-Tin; Hwang, Sooyeon; Wang, Maoyu; Feng, Zhenxing; Wang, Jingyun; Engelhard, Mark H; Zhang, Hanguang; He, Yanghua; Shao, Yuyan; Su, Dong; More, Karren L; Spendelow, Jacob S; Wu, Gang

2018-03-01

Due to the Fenton reaction, the presence of Fe and peroxide in electrodes generates free radicals causing serious degradation of the organic ionomer and the membrane. Pt-free and Fe-free cathode catalysts therefore are urgently needed for durable and inexpensive proton exchange membrane fuel cells (PEMFCs). Herein, a high-performance nitrogen-coordinated single Co atom catalyst is derived from Co-doped metal-organic frameworks (MOFs) through a one-step thermal activation. Aberration-corrected electron microscopy combined with X-ray absorption spectroscopy virtually verifies the CoN 4 coordination at an atomic level in the catalysts. Through investigating effects of Co doping contents and thermal activation temperature, an atomically Co site dispersed catalyst with optimal chemical and structural properties has achieved respectable activity and stability for the oxygen reduction reaction (ORR) in challenging acidic media (e.g., half-wave potential of 0.80 V vs reversible hydrogen electrode (RHE). The performance is comparable to Fe-based catalysts and 60 mV lower than Pt/C -60 μg Pt cm -2 ). Fuel cell tests confirm that catalyst activity and stability can translate to high-performance cathodes in PEMFCs. The remarkably enhanced ORR performance is attributed to the presence of well-dispersed CoN 4 active sites embedded in 3D porous MOF-derived carbon particles, omitting any inactive Co aggregates. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

An Investigation of Methyl Viologen Functionalized Reduced Graphene Oxide: Chitosan as a Support for Pt Nanoparticles Towards Ethanol Electrooxidation

NASA Astrophysics Data System (ADS)

Ekrami-Kakhki, Mehri-Saddat; Farzaneh, Nahid; Abbasi, Sedigheh; Beitollahi, Hadi; Ekrami-Kakhki, Seyed Ali

2018-05-01

In this research, graphene oxide was prepared by a modified Hummers' method, and then functionalized with 1, 1'-dimethyl-4, 4'-bipyridinium dichloride (MV), and chitosan (CH) to get a MV-RGO-CH support. Pt nanoparticles were prepared on this support to get Pt/MV-RGO-CH catalyst. The morphology and microstructure of Pt/MV-RGO-CH catalyst were characterized with transmission electron microscopy image and X-ray diffraction analysis. The electrocatalytic activity of the prepared catalyst towards ethanol oxidation was investigated by carbon monoxide stripping voltammetry, cyclic voltammetry, and electrochemical impedance spectroscopy techniques. The effects of some experimental parameters such as scan rate, ethanol concentration, and temperature were investigated for ethanol electrooxidation at Pt/MV-RGO-CH catalyst. Durability of the catalyst was also investigated. The electrocatalytic performance of Pt/MV-RGO-CH catalyst for ethanol oxidation was compared with those of Pt/CH and Pt/MV-RGO catalysts. The higher electrocatalytic performance of Pt/MV-RGO-CH than Pt/CH and Pt/MV-RGO catalysts towards ethanol electrooxidation indicated that Pt/MV-RGO-CH could be a promising catalyst for application in direct ethanol fuel cells.

A novel multi-functional magnetic Fe-Ti-V spinel catalyst for elemental mercury capture and callback from flue gas.

PubMed

Yang, Shijian; Guo, Yongfu; Yan, Naiqiang; Wu, Daqing; He, Hongping; Xie, Jiangkun; Qu, Zan; Yang, Chen; Jia, Jinping

2010-11-28

A novel magnetic Fe-Ti-V spinel catalyst showed an excellent performance for elemental mercury capture at 100 °C, and the formed HgO can be catalytically decomposed by the catalyst at 300 °C to reclaim elemental mercury and regenerate the catalyst.

High performance, high durability non-precious metal fuel cell catalysts

DOEpatents

Wood, Thomas E.; Atanasoski, Radoslav; Schmoeckel, Alison K.

2016-03-15

This invention relates to non-precious metal fuel cell cathode catalysts, fuel cells that contain these catalysts, and methods of making the same. The fuel cell cathode catalysts are highly nitrogenated carbon materials that can contain a transition metal. The highly nitrogenated carbon materials can be supported on a nanoparticle substrate.

An Overview of Recent Development in Composite Catalysts from Porous Materials for Various Reactions and Processes

PubMed Central

Xie, Zaiku; Liu, Zhicheng; Wang, Yangdong; Yang, Qihua; Xu, Longya; Ding, Weiping

2010-01-01

Catalysts are important to the chemical industry and environmental remediation due to their effective conversion of one chemical into another. Among them, composite catalysts have attracted continuous attention during the past decades. Nowadays, composite catalysts are being used more and more to meet the practical catalytic performance requirements in the chemical industry of high activity, high selectivity and good stability. In this paper, we reviewed our recent work on development of composite catalysts, mainly focusing on the composite catalysts obtained from porous materials such as zeolites, mesoporous materials, carbon nanotubes (CNT), etc. Six types of porous composite catalysts are discussed, including amorphous oxide modified zeolite composite catalysts, zeolite composites prepared by co-crystallization or overgrowth, hierarchical porous catalysts, host-guest porous composites, inorganic and organic mesoporous composite catalysts, and polymer/CNT composite catalysts. PMID:20559508

Preparation and catalytic performance of copper-containing magnetic catalysts for degradation of azo dye (direct violet).

PubMed

Duan, Qiannan; Lee, Jianchao; Chen, Han; Zheng, Yunyun

2017-12-01

A novel magnetically separable magnetic activated carbon supporting-copper (MCAC) catalyst for catalytic wet peroxide oxidation (CWPO) was prepared by chemical impregnation. The prepared samples were characterized by X-ray diffraction (XRD), Brunauer-Emmett-Teller (BET) method, and scanning electron microscopy (SEM) equipped with energy dispersive spectrometry (EDS). The catalytic performance of the catalysts was evaluated by direct violet (D-BL) degradation in CWPO experiments. The influence of preparative and operational parameters (dipping conditions, calcination temperature, catalyst loading H 2 O 2 dosage, pH, reaction temperature, additive salt ions and initial D-BL concentration) on degradation performance of CWPO process was investigated. The resulting MCAC catalyst showed higher reusability in direct violet oxidation than the magnetic activated carbon (MAC). Besides, dynamic tests also showed the maximal degradation rate reached 90.16% and its general decoloring ability of MCAC was 34 mg g -1 for aqueous D-BL.

Toluene decomposition performance and NOx by-product formation during a DBD-catalyst process.

PubMed

Guo, Yufang; Liao, Xiaobin; Fu, Mingli; Huang, Haibao; Ye, Daiqi

2015-02-01

Characteristics of toluene decomposition and formation of nitrogen oxide (NOx) by-products were investigated in a dielectric barrier discharge (DBD) reactor with/without catalyst at room temperature and atmospheric pressure. Four kinds of metal oxides, i.e., manganese oxide (MnOx), iron oxide (FeOx), cobalt oxide (CoOx) and copper oxide (CuO), supported on Al2O3/nickel foam, were used as catalysts. It was found that introducing catalysts could improve toluene removal efficiency, promote decomposition of by-product ozone and enhance CO2 selectivity. In addition, NOx was suppressed with the decrease of specific energy density (SED) and the increase of humidity, gas flow rate and toluene concentration, or catalyst introduction. Among the four kinds of catalysts, the CuO catalyst showed the best performance in NOx suppression. The MnOx catalyst exhibited the lowest concentration of O3 and highest CO2 selectivity but the highest concentration of NOx. A possible pathway for NOx production in DBD was discussed. The contributions of oxygen active species and hydroxyl radicals are dominant in NOx suppression. Copyright © 2014. Published by Elsevier B.V.

Methanol steam reforming promoted by molten salt-modified platinum on alumina catalysts.

PubMed

Kusche, Matthias; Agel, Friederike; Ní Bhriain, Nollaig; Kaftan, Andre; Laurin, Mathias; Libuda, Jörg; Wasserscheid, Peter

2014-09-01

We herein describe a straight forward procedure to increase the performance of platinum-on-alumina catalysts in methanol steam reforming by applying an alkali hydroxide coating according to the "solid catalyst with ionic liquid layer" (SCILL) approach. We demonstrate by diffuse reflectance infrared Fourier transform spectroscopy (DRIFTS) and temperature-programmed desorption (TPD) studies that potassium doping plays an important role in the catalyst activation. Moreover, the hygroscopic nature and the basicity of the salt modification contribute to the considerable enhancement in catalytic performance. During reaction, a partly liquid film of alkali hydroxides/carbonates forms on the catalyst/alumina surface, thus significantly enhancing the availability of water at the catalytically active sites. Too high catalyst pore fillings with salt introduce a considerable mass transfer barrier into the system as indicated by kinetic studies. Thus, the optimum interplay between beneficial catalyst modification and detrimental mass transfer effects had to be identified and was found on the applied platinum-on-alumina catalyst at KOH loadings around 7.5 mass%. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Novel methods of stabilization of Raney-Nickel catalyst for fuel-cell electrodes

NASA Astrophysics Data System (ADS)

Al-Saleh, M. A.; Sleem-Ur-Rahman; Kareemuddin, S. M. M. J.; Al-Zakri, A. S.

Two new methods of stabilizing Raney-Nickel (Raney-Ni) catalyst for making fuel-cell anodes were studied. In the first method, the catalyst was oxidized with aqueous H 2O 2 solution, while in the second, oxygen/air (O 2/air) was used in a slurry reactor. Effects of different concentrations of H 2O 2 (5-25 wt.%) and different pressures (10-20 psig) of gas were investigated. The stabilized catalyst was characterized using BET surface area, scanning electron microscopy (SEM) and X-ray diffraction (XRD). The catalyst was used in fuel-cell anodes and the electrochemical performance was determined in an alkaline half-cell. The results were compared with electrodes prepared using conventionally stabilized catalysts. The hydrogen peroxide-treated catalyst has higher BET surface area and produces electrodes with lower polarization. In addition to this, H 2O 2 treatment is convenient, fast and needs simple equipment which involves no instrumentation. Use of oxygen in a slurry reactor to stabilize the catalyst is also convenient but electrode performance is relatively poor.

Fly ash zeolite catalyst support for Fischer-Tropsch synthesis

NASA Astrophysics Data System (ADS)

Campen, Adam

This dissertation research aimed at evaluating a fly ash zeolite (FAZ) catalyst support for use in heterogeneous catalytic processes. Gas phase Fischer-Tropsch Synthesis (FTS) over a fixed-bed of the prepared catalyst/FAZ support was identified as an appropriate process for evaluation, by comparison with commercial catalyst supports (silica, alumina, and 13X). Fly ash, obtained from the Wabash River Generating Station, was first characterized using XRD, SEM/EDS, particle size, and nitrogen sorption techniques. Then, a parametric study of a two-step alkali fusion/hydrothermal treatment process for converting fly ash to zeolite frameworks was performed by varying the alkali fusion agent, agent:flyash ratio, fusion temperature, fused ash/water solution, aging time, and crystallization time. The optimal conditions for each were determined to be NaOH, 1.4 g NaOH: 1 g fly ash, 550 °C, 200 g/L, 12 hours, and 48 hours. This robust process was applied to the fly ash to obtain a faujasitic zeolite structure with increased crystallinity (40 %) and surface area (434 m2/g). Following the modification of fly ash to FAZ, ion exchange of H+ for Na+ and cobalt incipient wetness impregnation were used to prepare a FTS catalyst. FTS was performed on the catalysts at 250--300 °C, 300 psi, and with a syngas ratio H2:CO = 2. The HFAZ catalyst support loaded with 11 wt% cobalt resulted in a 75 % carbon selectivity for C5 -- C18 hydrocarbons, while methane and carbon dioxide were limited to 13 and 1 %, respectively. Catalyst characterization was performed by XRD, N2 sorption, TPR, and oxygen pulse titration to provide insight to the behavior of each catalyst. Overall, the HFAZ compared well with silica and 13X supports, and far exceeded the performance of the alumina support under the tested conditions. The successful completion of this research could add value to an underutilized waste product of coal combustion, in the form of catalyst supports in heterogeneous catalytic processes.

Tuning Catalytic Performance through a Single or Sequential Post-Synthesis Reaction(s) in a Gas Phase

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shan, Junjun; Zhang, Shiran; Choksi, Tej

2016-12-05

Catalytic performance of a bimetallic catalyst is determined by geometric structure and electronic state of the surface or even the near-surface region of the catalyst. Here we report that single and sequential postsynthesis reactions of an as-synthesized bimetallic nanoparticle catalyst in one or more gas phases can tailor surface chemistry and structure of the catalyst in a gas phase, by which catalytic performance of this bimetallic catalyst can be tuned. Pt–Cu regular nanocube (Pt–Cu RNC) and concave nanocube (Pt–Cu CNC) are chosen as models of bimetallic catalysts. Surface chemistry and catalyst structure under different reaction conditions and during catalysis weremore » explored in gas phase of one or two reactants with ambient-pressure X-ray photoelectron spectroscopy (AP-XPS) and extended X-ray absorption fine structure (EXAFS) spectroscopy. The newly formed surface structures of Pt–Cu RNC and Pt–Cu CNC catalysts strongly depend on the reactive gas(es) used in the postsynthesis reaction(s). A reaction of Pt–Cu RNC-as synthesized with H2 at 200 °C generates a near-surface alloy consisting of a Pt skin layer, a Cu-rich subsurface, and a Pt-rich deep layer. This near-surface alloy of Pt–Cu RNC-as synthesized-H2 exhibits a much higher catalytic activity in CO oxidation in terms of a low activation barrier of 39 ± 4 kJ/mol in contrast to 128 ± 7 kJ/mol of Pt–Cu RNC-as synthesized. Here the significant decrease of activation barrier demonstrates a method to tune catalytic performances of as-synthesized bimetallic catalysts. A further reaction of Pt–Cu RNC-as synthesized-H2 with CO forms a Pt–Cu alloy surface, which exhibits quite different catalytic performance in CO oxidation. It suggests the capability of generating a different surface by using another gas. The capability of tuning surface chemistry and structure of bimetallic catalysts was also demonstrated in restructuring of Pt–Cu CNC-as synthesized.« less

Need for optimizing catalyst loading for achieving affordable microbial fuel cells.

PubMed

Singh, Inderjeet; Chandra, Amreesh

2013-08-01

Microbial fuel cell (MFC) technology is a promising technology for electricity production together with simultaneous water treatment. Catalysts play an important role in deciding the MFC performance. In most reports, effect of catalyst - both type and quantity is not optimized. In this paper, synthesis of nanorods of MnO2-catalyst particles for application in Pt-free MFCs is reported. The effect of catalyst loading i.e., weight ratio, with respect to conducting element and binder has been optimized by employing large number of combinations. Using simple theoretical model, it is shown that too high (or low) concentration of catalysts result in loss of MFC performance. The operation of MFC has been investigated using domestic wastewater as source of bio-waste for obtaining real world situation. Maximum power density of ∼61 mW/m(2) was obtained when weight ratio of catalyst and conducting species was 1:1. Suitable reasons are given to explain the outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

The objective of the contract is to consolidate the advances made during the previous contract in the conversion of syngas to motor fuels using Molecular Sieve-containing catalysts and to demonstrate the practical utility and economic value of the new catalyst/process systems with appropriate laboratory runs. Work on the program is divided into the following six tasks: (1) preparation of a detailed work plan covering the entire performance of the contract; (2) techno-economic studies that will supplement those that are presently being carried out by MITRE; (3) optimization of the most promising catalysts developed under prior contract; (4) optimization of themore » UCC catalyst system in a manner that will give it the longest possible service life; (5) optimization of a UCC process/catalyst system based upon a tubular reactor with a recycle loop containing the most promising catalyst developed under Tasks 3 and 4 studies; and (6) economic evaluation of the optimal performance found under Task 5 for the UCC process/catalyst system. Progress reports are presented for Tasks 1, 3, 4, and 5.« less

Six-month trajectories of self-reported depressive symptoms in long-term care.

PubMed

McCusker, Jane; Cole, Martin G; Voyer, Philippe; Monette, Johanne; Champoux, Nathalie; Ciampi, Antonio; Vu, Minh; Belzile, Eric; Bai, Chun

2016-01-01

Depression is a common problem in long-term care (LTC) settings. We sought to characterize depression symptom trajectories over six months among older residents, and to identify resident characteristics at baseline that predict symptom trajectory. This study was a secondary analysis of data from a six-month prospective, observational, and multi-site study. Severity of depressive symptoms was assessed with the 15-item Geriatric Depression Scale (GDS) at baseline and with up to six monthly follow-up assessments. Participants were 130 residents with a Mini-Mental State Examination score of 15 or more at baseline and of at least two of the six monthly follow-up assessments. Individual resident GDS trajectories were grouped using hierarchical clustering. The baseline predictors of a more severe trajectory were identified using the Proportional Odds Model. Three clusters of depression symptom trajectory were found that described "lower," "intermediate," and "higher" levels of depressive symptoms over time (mean GDS scores for three clusters at baseline were 2.2, 4.9, and 9.0 respectively). The GDS scores in all groups were generally stable over time. Baseline predictors of a more severe trajectory were as follows: Initial GDS score of 7 or more, female sex, LTC residence for less than 12 months, and corrected visual impairment. The six-month course of depressive symptoms in LTC is generally stable. Most residents who experience a more severe symptom trajectory can be identified at baseline.

Improving food and fluid intake for older adults living in long-term care: a research agenda.

PubMed

Keller, Heather; Beck, Anne Marie; Namasivayam, Ashwini

2015-02-01

Poor food and fluid intake and malnutrition are endemic among older adults in long-term care (LTC), yet feasible and sustainable interventions that target key determinants and improve person-centered outcomes remain elusive. Without a comprehensive study addressing a range of determinants to identify those that are of greatest importance for targeting with interventions, expert consensus can be used to develop a research agenda. International experts and stakeholders convened for a 2-day meeting to participate in a nominal group process to identify and prioritize determinants of food and fluid intake for persons living in LTC. Top determinants to address with intervention research included social interactions of residents at mealtime; self-feeding ability; the dining environment; the attitudes, knowledge, and skills of staff; adequate time to eat/availability of staff to provide assistance; sensory properties of the food; hospitality and mealtime logistics; choice and variety in the dining experience; and nutrient density of food. Multimodal interventions that could target these prioritized determinants were also suggested. This consensus process has resulted in a prioritized research agenda for the development and testing of interventions to improve food and fluid intake of older adults living in LTC. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

A "Wii" bit of fun: the effects of adding Nintendo Wii(®) Bowling to a standard exercise regimen for residents of long-term care with upper extremity dysfunction.

PubMed

Hsu, Jason K; Thibodeau, Richard; Wong, Stephanie J; Zukiwsky, Daniel; Cecile, Sara; Walton, David M

2011-04-01

The aims of this randomized, single-blind crossover trial were to investigate the effect of adding a simulated bowling video game via the Nintendo Wii(®) gaming system to the standard exercise regimen of cognitively intact residents of long-term care (LTC) with upper extremity dysfunction and to identify individual characteristics that might predict improvement. Residents (n=34) were recruited through two LTC facilities in southwestern Ontario and were randomized into a standard exercise (SG) or standard exercise plus Wii bowling (Wii) arm. After 4 weeks of intervention, the groups were crossed over to the opposite arm. Outcomes included measures of pain intensity and bothersomeness, physical activity enjoyment, and a six-item measure of functional capacity designed specifically for residents of LTC. Results suggest that subjects improved on all outcomes from pre- to postintervention but that only enjoyment of activity showed a significant difference between the SG and Wii groups. Effect sizes (Cohen's d) ranged from small (0.30 for bothersomeness) to large (1.77 for functional capacity). Responders, defined as those subjects who reported any degree of improvement following the Wii intervention, were less likely to complain of stiffness or shoulder symptoms and were more likely to complain of hand symptoms than non-responders. Limitations in interpretation and recommendations for future research are presented.

Volatility characterization of nanoparticles from single and dual-fuel low temperature combustion in compression ignition engines

DOE PAGES

Lucachick, Glenn; Curran, Scott; Storey, John Morse; ...

2016-03-10

Our work explores the volatility of particles produced from two diesel low temperature combustion (LTC) modes proposed for high-efficiency compression ignition engines. It also explores mechanisms of particulate formation and growth upon dilution in the near-tailpipe environment. Moreover, the number distribution of exhaust particles from low- and mid-load dual-fuel reactivity controlled compression ignition (RCCI) and single-fuel premixed charge compression ignition (PPCI) modes were experimentally studied over a gradient of dilution temperature. Particle volatility of select particle diameters was investigated using volatility tandem differential mobility analysis (V-TDMA). Evaporation rates for exhaust particles were compared with V-TDMA results for candidate pure n-alkanesmore » to identify species with similar volatility characteristics. The results show that LTC particles are mostly comprised of material with volatility similar to engine oil alkanes. V-TDMA results were used as inputs to an aerosol condensation and evaporation model to support the finding that smaller particles in the distribution are comprised of lower volatility material than large particles under primary dilution conditions. Although the results show that saturation levels are high enough to drive condensation of alkanes onto existing particles under the dilution conditions investigated, they are not high We conclude that observed particles from LTC operation must grow from low concentrations of highly non-volatile compounds present in the exhaust.« less

Measuring Work Engagement, Psychological Empowerment, and Organizational Citizenship Behavior Among Health Care Aides.

PubMed

Ginsburg, Liane; Berta, Whitney; Baumbusch, Jennifer; Rohit Dass, Adrian; Laporte, Audrey; Reid, R Colin; Squires, Janet; Taylor, Deanne

2016-04-01

Health care aides (HCAs) provide most direct care in long-term care (LTC) and home and community care (HCC) settings but are understudied. We validate three key work attitude measures to better understand HCAs' work experiences: work engagement (WEng), psychological empowerment (PE), and organizational citizenship behavior (OCB-O). Data were collected from 306 HCAs working in LTC and HCC, using survey items for WEng, PE, and OCB-O adapted for HCAs. Psychometric evaluation involved confirmatory factor analysis (CFA). Predictive validity (correlations with measures of job satisfaction and turnover intention) and internal consistency reliability were examined. CFA supported a one-factor model of WEng, a four-factor model of PE, and a one-factor model of OCB-O. HCC workers scored higher than LTC workers on Self-determination (PE) and lower on Impact, demonstrating concurrent validity. WEng and PE correlated with worker outcomes (job satisfaction, turnover intention, and OCB-O), demonstrating predictive validity. Reliability and validity analyses indicated sound psychometric properties overall. Study results support psychometric properties of measures of WEng, PE, and OCB-O for HCAs. Knowledge of HCAs' work attitudes and behaviors can inform recruitment programs, incentive systems, and retention/training strategies for this vital group of care providers. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Pulmonary epithelial cancer cells and their exosomes metabolize myeloid cell-derived leukotriene C4 to leukotriene D4[S

PubMed Central

Lukic, Ana; Ji, Jie; Idborg, Helena; Samuelsson, Bengt; Palmberg, Lena

2016-01-01

Leukotrienes (LTs) play major roles in lung immune responses, and LTD4 is the most potent agonist for cysteinyl LT1, leading to bronchoconstriction and tissue remodeling. Here, we studied LT crosstalk between myeloid cells and pulmonary epithelial cells. Monocytic cells (Mono Mac 6 cell line, primary dendritic cells) and eosinophils produced primarily LTC4. In coincubations of these myeloid cells and epithelial cells, LTD4 became a prominent product. LTC4 released from the myeloid cells was further transformed by the epithelial cells in a transcellular manner. Formation of LTD4 was rapid when catalyzed by γ-glutamyl transpeptidase (GGT)1 in the A549 epithelial lung cancer cell line, but considerably slower when catalyzed by GGT5 in primary bronchial epithelial cells. When A549 cells were cultured in the presence of IL-1β, GGT1 expression increased about 2-fold. Also exosomes from A549 cells contained GGT1 and augmented LTD4 formation. Serine-borate complex (SBC), an inhibitor of GGT, inhibited conversion of LTC4 to LTD4. Unexpectedly, SBC also upregulated translocation of 5-lipoxygenase (LO) to the nucleus in Mono Mac 6 cells, and 5-LO activity. Our results demonstrate an active role for epithelial cells in biosynthesis of LTD4, which may be of particular relevance in the lung. PMID:27436590

"Now I Don't Have to Guess": Using Pamphlets to Encourage Residents and Families/Friends to Engage in Advance Care Planning in Long-Term Care.

PubMed

Sussman, Tamara; Kaasalainen, Sharon; Bui, Matthew; Akhtar-Danesh, Noori; Mintzberg, Susan; Strachan, Patricia

2017-01-01

Objective: This article explores whether access to illness trajectory pamphlets for five conditions with high prevalence in long-term care (LTC) can encourage residents and families/friends to openly engage in advance care planning (ACP) discussions with one another and with health providers. Method: In all, 57 residents and families/friends in LTC completed surveys and 56 participated in seven focus groups that explored whether the pamphlets supported ACP engagement. Results: Survey results suggested that access to pamphlets encouraged residents and families/friends to reflect on future care (48/57, 84%), clarified what questions to ask (40/57, 70%), and increased comfort in talking about end of life (EOL) care (36/57, 63%). Discussions between relatives and friends/families (32/57, 56%) or with health providers (21/57, 37%) were less common. Focus group deliberations illuminated that while reading illness-specific information was validating, a tendency to protect one another from an emotional topic, prevented residents and families/friends from conversing with one another about EOL issues. Discussion: Having access to pamphlets with information about EOL care provides important and welcome opportunities for reflection for both residents in LTC and their families/friends. Moving residents and families/friends from reflecting on issues to discussing them together could require staff support through planned care conferences or staff initiated conversations at the bedside.

To What Extent Is Long-term Care Representative of Elderly Care? A Case Study of Elderly Care Financing in Lombardy, Italy.

PubMed

Brenna, Elenka; Gitto, Lara

2017-02-25

The ageing of European population has been rapidly increasing during the last decades, and the problem of elderly care financing has become an issue for policy-makers. Long-term care (LTC) financing is considered a suitable proxy of the resources committed to elderly care by each government, but the preciseness of this approximation depends on the extent to which LTC is representative of elderly care within each country. Since there is a broad heterogeneity in LTC funding, organization and setting among European States, it is difficult to find a common parameter representing the public resources destined to the elderly care. We address these topics employing as a case study an Italian region, Lombardy, which in terms of population, dimension, healthcare organization and economic development could be compared to other European countries. The method we suggest, which consists basically in a careful estimate of all the public resources employed in the provision of services exclusively destined to the elderly, could be applied, with the due differences, to other European countries or regions. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Immobilization of molecular catalysts in supported ionic liquid phases.

PubMed

Van Doorslaer, Charlie; Wahlen, Joos; Mertens, Pascal; Binnemans, Koen; De Vos, Dirk

2010-09-28

In a supported ionic liquid phase (SILP) catalyst system, an ionic liquid (IL) film is immobilized on a high-surface area porous solid and a homogeneous catalyst is dissolved in this supported IL layer, thereby combining the attractive features of homogeneous catalysts with the benefits of heterogeneous catalysts. In this review reliable strategies for the immobilization of molecular catalysts in SILPs are surveyed. In the first part, general aspects concerning the application of SILP catalysts are presented, focusing on the type of catalyst, support, ionic liquid and reaction conditions. Secondly, organic reactions in which SILP technology is applied to improve the performance of homogeneous transition-metal catalysts are presented: hydroformylation, metathesis reactions, carbonylation, hydrogenation, hydroamination, coupling reactions and asymmetric reactions.

Effect of Particle Size and Operating Conditions on Pt 3Co PEMFC Cathode Catalyst Durability

DOE PAGES

Gummalla, Mallika; Ball, Sarah; Condit, David; ...

2015-05-29

The initial performance and decay trends of polymer electrolyte membrane fuel cells (PEMFC) cathodes with Pt 3Co catalysts of three mean particle sizes (4.9 nm, 8.1 nm, and 14.8 nm) with identical Pt loadings are compared. Even though the cathode based on 4.9 nm catalyst exhibited the highest initial electrochemical surface area (ECA) and mass activity, the cathode based on 8.1 nm catalyst showed better initial performance at high currents. Owing to the low mass activity of the large particles, the initial performance of the 14.8 nm Pt3Co-based electrode was the lowest. The performance decay rate of the electrodes withmore » the smallest Pt 3Co particle size was the highest and that of the largest Pt 3Co particle size was lowest. Interestingly, with increasing number of decay cycles (0.6 to 1.0 V, 50 mV/s), the relative improvement in performance of the cathode based on 8.1 nm Pt 3Co over the 4.9 nm Pt 3Co increased, owing to better stability of the 8.1 nm catalyst. The electron microprobe analysis (EMPA) of the decayed membrane-electrode assembly (MEA) showed that the amount of Co in the membrane was lower for the larger particles, and the platinum loss into the membrane also decreased with increasing particle size. This suggests that the higher initial performance at high currents with 8.1 nm Pt 3Co could be due to lower contamination of the ionomer in the electrode. Furthermore, lower loss of Co from the catalyst with increased particle size could be one of the factors contributing to the stability of ECA and mass activity of electrodes with larger cathode catalyst particles. To delineate the impact of particle size and alloy effects, these results are compared with prior work from our research group on size effects of pure platinum catalysts. The impact of PEMFC operating conditions, including upper potential, relative humidity, and temperature on the alloy catalyst decay trends, along with the EMPA analysis of the decayed MEAs, are reported.« less

Catalyst Development for Hydrogen Peroxide Rocket Engines

NASA Technical Reports Server (NTRS)

Morlan, P. W.; Wu, P.-K.; Ruttle, D. W.; Fuller, R. P.; Nejad, A. S.; Anderson, W. E.

1999-01-01

The development of various catalysts of hydrogen peroxide was conducted for the applications of liquid rocket engines. The catalyst development includes silver screen technology, solid catalyst technology, and homogeneous catalyst technology. The silver screen technology development was performed with 85% (by weight) hydrogen peroxide. The results of this investigation were used as the basis for the catalyst design of a pressure-fed liquid-fueled upper stage engine. Both silver-plated nickel 200 screens and pure silver screens were used as the active metal catalyst during the investigation, The data indicate that a high decomposition efficiency (greater than 90%) of 85% hydrogen peroxide can be achieved at a bed loading of 0.5 lbm/sq in/sec with both pure silver and silver plated screens. Samarium oxide coating, however, was found to retard the decomposition process and the catalyst bed was flooded at lower bed loading. A throughput of 200 lbm of hydrogen peroxide (1000 second run time) was tested to evaluate the catalyst aging issue and performance degradation was observed starting at approximately 400 seconds. Catalyst beds of 3.5 inch in diameter was fabricated using the same configuration for a 1,000-lbf rocket engine. High decomposition efficiency was obtained with a low pressure drop across the bed. Solid catalyst using precious metal was also developed for the decomposition of hydrogen peroxide from 85% to 98% by weight. Preliminary results show that the catalyst has a strong reactivity even after 15 minutes of peroxide decomposition. The development effort also includes the homogeneous catalyst technology. Various non-toxic catalysts were evaluated with 98% peroxide and hydrocarbon fuels. The results of open cup drop tests indicate an ignition delay around 11 ms.

Design and assembly of a catalyst bed gas generator for the catalytic decomposition of high concentration hydrogen peroxide propellants and the catalytic combustion of hydrocarbon/air mixtures

NASA Technical Reports Server (NTRS)

Lohner, Kevin A. (Inventor); Mays, Jeffrey A. (Inventor); Sevener, Kathleen M. (Inventor)

2004-01-01

A method for designing and assembling a high performance catalyst bed gas generator for use in decomposing propellants, particularly hydrogen peroxide propellants, for use in target, space, and on-orbit propulsion systems and low-emission terrestrial power and gas generation. The gas generator utilizes a sectioned catalyst bed system, and incorporates a robust, high temperature mixed metal oxide catalyst. The gas generator requires no special preheat apparatus or special sequencing to meet start-up requirements, enabling a fast overall response time. The high performance catalyst bed gas generator system has consistently demonstrated high decomposition efficiency, extremely low decomposition roughness, and long operating life on multiple test articles.

Ce-Sn binary oxide catalyst for the selective catalytic reduction of NOx by NH3

NASA Astrophysics Data System (ADS)

Liu, Zhiming; Feng, Xu; Zhou, Zizheng; Feng, Yongjun; Li, Junhua

2018-01-01

Ce-Sn binary oxide catalysts prepared by the hydrothermal method have been investigated for the selective catalytic reduction (SCR) of NOx with NH3. Compared with pure CeO2 and SnO2, Ce-Sn binary oxide catalyst showed significantly higher NH3-SCR activity. Moreover, Ce-Sn catalyst showed high resistance against H2O and SO2. The high catalytic performance of Ce-Sn binary oxide is attributed to the synergetic effect between Ce and Sn species, which not only enhances the redox property of the catalyst but also increases the Lewis acidity, thus promoting the adsorption and activation of NH3 species, which contributes to improving the NH3-SCR performance.

Effect of preparation method and CuO promotion in the conversion of ethanol into 1,3-butadiene over SiO₂-MgO catalysts.

PubMed

Angelici, Carlo; Velthoen, Marjolein E Z; Weckhuysen, Bert M; Bruijnincx, Pieter C A

2014-09-01

Silica-magnesia (Si/Mg=1:1) catalysts were studied in the one-pot conversion of ethanol to butadiene. The catalyst synthesis method was found to greatly influence morphology and performance, with materials prepared through wet-kneading performing best both in terms of ethanol conversion and butadiene yield. Detailed characterization of the catalysts synthesized through co-precipitation or wet-kneading allowed correlation of activity and selectivity with morphology, textural properties, crystallinity, and acidity/basicity. The higher yields achieved with the wet-kneaded catalysts were attributed to a morphology consisting of SiO2 spheres embedded in a thin layer of MgO. The particle size of the SiO2 catalysts also influenced performance, with catalysts with smaller SiO2 spheres showing higher activity. Temperature-programmed desorption (TPD) measurements showed that best butadiene yields were obtained with SiO2-MgO catalysts characterized by an intermediate amount of acidic and basic sites. A Hammett indicator study showed the catalysts' pK(a) value to be inversely correlated with the amount of dehydration by-products formed. Butadiene yields could be further improved by the addition of 1 wt% of CuO as promoter to give butadiene yields and selectivities as high as 40% and 53%, respectively. The copper promoter boosts the production of the acetaldehyde intermediate changing the rate-determining step of the process. TEM-energy-dispersive X-ray (EDX) analyses showed CuO to be present on both the SiO2 and MgO components. UV/Vis spectra of promoted catalysts in turn pointed at the presence of cluster-like CuO species, which are proposed to be responsible for the increased butadiene production. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Highly Durable Supportless Pt Hollow Spheres Designed for Enhanced Oxygen Transport in Cathode Catalyst Layers of Proton Exchange Membrane Fuel Cells.

PubMed

Dogan, Didem C; Cho, Seonghun; Hwang, Sun-Mi; Kim, Young-Min; Guim, Hwanuk; Yang, Tae-Hyun; Park, Seok-Hee; Park, Gu-Gon; Yim, Sung-Dae

2016-10-10

Supportless Pt catalysts have several advantages over conventional carbon-supported Pt catalysts in that they are not susceptible to carbon corrosion. However, the need for high Pt loadings in membrane electrode assemblies (MEAs) to achieve state-of-the-art fuel cell performance has limited their application in proton exchange membrane fuel cells. Herein, we report a new approach to the design of a supportless Pt catalyst in terms of catalyst layer architecture, which is crucial for fuel cell performance as it affects water management and oxygen transport in the catalyst layers. Large Pt hollow spheres (PtHSs) 100 nm in size were designed and prepared using a carbon template method. Despite their large size, the unique structure of the PtHSs, which are composed of a thin-layered shell of Pt nanoparticles (ca. 7 nm thick), exhibited a high surface area comparable to that of commercial Pt black (PtB). The PtHS structure also exhibited twice the durability of PtB after 2000 potential cycles (0-1.3 V, 50 mV/s). A MEA fabricated with PtHSs showed significant improvement in fuel cell performance compared to PtB-based MEAs at high current densities (>800 mA/cm 2 ). This was mainly due to the 2.7 times lower mass transport resistance in the PtHS-based catalyst layers compared to that in PtB, owing to the formation of macropores between the PtHSs and high porosity (90%) in the PtHS catalyst layers. The present study demonstrates a successful example of catalyst design in terms of catalyst layer architecture, which may be applied to a real fuel cell system.

Catalytic fast pyrolysis of white oak wood in-situ using a bubbling fluidized bed reactor

USDA-ARS?s Scientific Manuscript database

Catalytic fast pyrolysis was performed on white oak wood using two zeolite-type catalysts as bed material in a bubbling fluidized bed reactor. The two catalysts chosen, based on a previous screening study, were Ca2+ exchanged Y54 (Ca-Y54) and a proprietary ß-zeolite type catalyst (catalyst M) both ...

Nitrogen-doped Carbon Derived from ZIF-8 as a High-performance Metal-free Catalyst for Acetylene Hydrochlorination

NASA Astrophysics Data System (ADS)

Chao, Songlin; Zou, Fang; Wan, Fanfan; Dong, Xiaobin; Wang, Yanlin; Wang, Yuxuan; Guan, Qingxin; Wang, Guichang; Li, Wei

2017-01-01

Acetylene hydrochlorination is a major industrial technology for manufacturing vinyl chloride monomer in regions with abundant coal resources; however, it is plagued by the use of mercury(II) chloride catalyst. The development of a nonmercury catalyst has been extensively explored. Herein, we report a N-doped carbon catalyst derived from ZIF-8 with both high activity and quite good stability. The acetylene conversion reached 92% and decreased slightly during a 200 h test at 220 °C and atmospheric pressure. Experimental studies and theoretical calculations indicate that C atoms adjacent to the pyridinic N are the active sites, and coke deposition covering pyridinic N is the main reason for catalyst deactivation. The performance of those N-doped carbons makes it possible for practical applications with further effort. Furthermore, the result also provides guidance for designing metal-free catalysts for similar reactions.

Silicene Catalyzed Reduction of Nitrobenzene to Aniline: a Computational Study

NASA Astrophysics Data System (ADS)

Morrissey, Christopher; He, Haiying

The reduction of nitrobenzene to aniline has a broad range of applications in the production of rubbers, dyes, agrochemicals, and pharmaceuticals. Currently, use of metal catalysts is the most popular method of performing this reaction on a large scale. These metal catalysts usually require high-temperature and/or high-pressure reaction conditions, and produce hazardous chemicals. This has led to a call for more environmentally friendly nonmetal catalysts. Recent studies suggest that silicene, the recently discovered silicon counterpart of graphene, could potentially work as a nonmetal catalyst due to its unique electronic property and strong interactions with molecules containing nitrogen and oxygen. In this computational study, we have investigated the plausibility of using silicene as a catalyst for the reduction of nitrobenzene. Possible reaction mechanisms will be discussed with a highlight of the difference between silicene and metal catalysts. . All calculations were performed in the framework of density functional theory.

A questionnaire to examine food service satisfaction of elderly residents in long-term care facilities.

PubMed

Lengyel, Christina O; Smith, Joan T; Whiting, Susan J; Zello, Gordon A

2004-01-01

The purpose of this study was to develop a survey tool for assessing the satisfaction of elderly long-term care (LTC) residents with the meals and food services they receive, as well as to assess quality of life issues related to eating. Food service delivery should be provided in an environment that fosters autonomy, interpersonal relations, and security. The questionnaire was administered as face-to-face interviews with 205 residents (> or = 65 years of age) of 13 LTC facilities in Saskatoon, Saskatchewan, Canada (participation rate = 67%). Residents expressed some concern with food variety, quality, taste, and appearance, and with the posting of menus. Quality of life issues were mostly positive; however, residents were less satisfied with areas related to their autonomy such as food choice and snack availability.

Discovery of Implementation Factors That Lead to Technology Adoption in Long-Term Care.

PubMed

Schoville, Rhonda R

2017-10-01

The current exploratory, qualitative study discovered and clarified implementation factors that led to technology adoption in long-term care (LTC). The Integrated Technology Implementation model guided the study of an electronic health record used in three LTC settings. Thirty key stakeholders (i.e., directors of nursing, nurses, and certified nurse aides) participated in focus groups or interviews. Findings indicated experiences were more similar than different among groups and facilities. Five major implementation themes supported by a variety of minor themes were identified. Implications for nursing include that leaders must be knowledgeable and committed to the change and engage staff throughout the implementation process. In addition, various communication and education strategies are required. [Journal of Gerontological Nursing, 43(10), 21-26.]. Copyright 2017, SLACK Incorporated.