Catalyst-free synthesis of copper oxide composites as solar radiative filters.

Copper oxide composites were successfully synthesized by a catalyst-free method, plasma arc technology. The as-synthesized composites were characterized by x-ray diffraction, scanning electron microscopy, transmission electron microscopy, Raman spectroscopy, and x-ray photoelectron spectroscopy. The analysis revealed a mixture of crystalline copper oxide (CuO), cuprous oxide (Cu2O) and copper (Cu) phases of the copper oxide composites constitute of irregularly spheroidal particlesµ with nanoparticles aggregate on the surface. Gas pressure during plasma arc process noticeably influences the composition and solar radiative properties of the composite materials. Among the samples studied, the composites synthesized with an arc current of 80 A and a pressure of 300 Torr exhibited the highest near infrared diffuse reflectance, providing a total solar reflectance of 22.96%. The mixed phase composition together with the nanostructures among the composites are considered to contribute to the excellent near infrared reflectance of copper oxide composites. Low reflectance in the visible region combined with high reflectance in the near infrared region make this composite material a good candidate for solar reflective coating which will demonstrate black appearance but keep a cool surface under solar irradiation.

Understanding Mi'kmaq Women's Experiences Accessing Prenatal Care in Rural Nova Scotia.

Indigenous women experience a higher incidence of maternal complications compared with non-Indigenous women. Despite this, little is known about access to prenatal care for Mi'kmaq women in Nova Scotia. The intent of this study was to gain a more comprehensive understanding of Mi'kmaq women's experiences accessing prenatal care. The findings from this study highlight key implications for nursing practice such as promoting the nurse's role in supporting and advocating for Mi'kmaq women's health and for providing culturally safe care. This research will highlight that access to prenatal care is a complex issue for some women.

Experiences of pregnancy complications: Voices from central Haiti.

The purpose of this study was to explore the lived experience of pregnancy/birth complications in central Haiti from the perspectives of skilled birth attendants (saj fanm), traditional birth attendants (matwons), and postpartum mothers. Hermeneutic phenomenology guided the study. With the assistance of a Creole-English translator, four saj fanm, ten matwons, and seven postpartum mothers were interviewed. Their stories explain barriers and challenges to safe motherhood-serious limitations in transportation, staffing, and lack of the most basic of material resources, but also illustrate tremendous resiliency, spirituality, power of partnerships, and commonsense solutions to problems impacting maternal/newborn health in central Haiti. Haiti has one the world's highest maternal and neonatal mortality, and findings of this study provide perspective of this reality from those most affected by it-Haitian mothers and front-line maternity workers.

Aboriginal Women's Experiences With Gestational Diabetes Mellitus: A Participatory Study With Mi'kmaq Women in Canada.

In Canada, diabetes is 3 to 5 times more common among Aboriginal people than in the general population. Women with a diagnosis of gestational diabetes mellitus have an increased risk of developing glucose intolerance later in life, with almost half developing type II diabetes within 15 years. A participatory action research study using a Two-Eyed Seeing approach was conducted. Conversational interviews with 9 Mi'kmaq women who experienced gestational diabetes mellitus and talking circles were held. Hermeneutic phenomenology was used for data analysis. Themes included life-altering experience; barriers limiting access to health care; social support during pregnancy; and feeling compelled to take action.

Feasibility and impact of an evidence-based program for gastric bypass surgery.

BACKGROUND: Health care in the United States is expensive and quality is variable. The aim of this study was to investigate whether our integrated health system, composed of academic hospitals, a practice plan, and a managed care payer, could reliably implement an evidence-based program for gastric bypass surgery. A secondary aim was to evaluate the impact of the program on clinical outcomes. STUDY DESIGN: A standardized program for delivery of clinical best-practice elements for patients undergoing initial open or laparoscopic Roux-en-Y gastric bypass was implemented in 2008. Best-practice elements were embedded into the workflow. The best-practice elements were refined after reviewing failures observed during the early implementation period. The study period was divided into 3 groups: group α = year preceding program implementation (control), group ß = first year of implementation (unreliable), and group Ω = 2nd to 4th years of implementation (reliable). Outcomes data were collected for all patients who had undergone Roux-en-Y gastric bypass between May 2008 and April 2012 and were compared with a control group from the preceding year using multiple logistic regression analysis. RESULTS: Two thousand and sixty-one patients were studied, with no significant demographic differences between study groups. Best-practice elements delivery was 40% in group ß, but was >90% for group Ω (p < 0.001). Length of stay for group α was 3.5 days and improved to 2.2 days (p < 0.001) for group Ω. Complications and readmission rates improved considerably with reliable delivery of best-practice elements. CONCLUSIONS: Standardization of evidence-based care delivery for Roux-en-Y gastric bypass was feasible and reliable delivery of this pathway improved clinical outcomes.

The Interchangeability of Plasma and Whole Blood Metal Ion Measurement in the Monitoring of Metal on Metal Hips.

One hundred and twenty six paired samples of plasma and whole blood were measured with inductively coupled plasma mass spectrometry technique for metal ions analysis to determine a relationship between them. There was a significant difference between the mean plasma and whole blood concentrations of both cobalt (Co) and chromium (Cr) (p < 0.0001 for both Co and Cr). The mean ratio between plasma and whole blood Cr and Co was 1.56 (range: 0.39-3.85) and 1.54 (range: 0.64-18.26), respectively, but Bland and Altman analysis illustrated that this relationship was not universal throughout the range of concentrations. There was higher variability at high concentrations for both ions. We conclude that both these concentrations should not be used interchangeably and conversion factors are unreliable due to concentration dependent variability.

The language of violence in mental health: shifting the paradigm to the language of peace.

Language used in health care, particularly with vulnerable populations such as those with mental illness, is often violent, rising from historical prejudices and politics of power over others. This creates disharmony and distrust between health care providers and patients and families. Peace involves relationships that nurture ongoing harmony, trust, and constructive solutions. In this descriptive philosophical article, we discuss connections between and among the concepts of peace, health, relational ethics, in relation to nurses' responsibilities, current health care realities, and the language of nursing. We propose a shift in discourse within nurse-patient relationships from oppressive and stigmatizing language to the discourse of peace.

Time to disable the labels that disable: the power of words in nursing and health care with women, children, and families.

Nursing is grounded in communication with others, yet rarely are the words critiqued. Despite an ethical call to honor diversity, promote empowerment, and to do no harm, some of the language used in health care reflects historical prejudices, reductionism, and/or the overarching authority of medical or moral models. This article exposes some of the "harsh words" nurses sometimes unconsciously use, and it suggests alternatives. Influenced by an ethic of social justice and the ethic of relationship with others, an attempt will be made to explore nursing language with women and children. Implications for nursing philosophy and practice will be discussed.

Working with children in end-of-life decision making.

Traditionally, physicians and parents made decisions about children's health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children - of diverse levels of cognitive development - are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children's 'best interest'. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.

The effect of frontloading visits on patient outcomes.

Frontloading, providing 60% of planned visits in the first 2 weeks of the home healthcare episode, was tested in two groups of patients: insulin-dependent patients with diabetes and patients with a primary diagnosis of heart failure. Frontloading was effective for patients with heart failure, decreasing rehospitalization by more than half (39.4-16%), with fewer visits (15.5 vs. 9.5) and equal clinical outcomes and patient satisfaction. There were no significant differences in outcomes for patients with diabetes.

Body mass index and physical function in older women.

OBJECTIVE: We modified existing standardized measurement tools in the Physical Performance Test and tasks from the Frailty and Injuries: Cooperative Studies of Intervention Technique Study to evaluate physical function in older women. Our objectives were (1) to characterize physical function themes based on combinations of tasks (deriving factors or components) and (2) to quantify the correlation between derived factors and body mass index (BMI). RESEARCH METHODS AND PROCEDURES: Nutrition risk screens from enrollees in a Medicare-managed risk program served as the sampling frame. To obtain adequate representation for a range of BMI, a random sample was obtained of 90 women from the following BMI strata: BMI, 22 to <27 kg/m(2); BMI, 27 to <30 kg/m(2); and BMI, > or =30 kg/m(2). Subjects were asked to perform a series of 18 functional tasks during a home visit. RESULTS: The mean age was similar in the three BMI groups with an overall mean age of 71 +/- 4.9 years (SD). Factors characterized by lower-body function, upper-body function, coordination, and strength were responsible for 30%, 11%, 9%, and 9% of the variance in task scores, respectively. BMI, controlling for age, explained 5%, 14%, 3%, and 0% of the variation in these factors, respectively. Higher BMI is associated significantly with poorer upper- and lower-body function but is not associated significantly to strength or coordination. DISCUSSION: Higher BMI seems to differentially impede specific aspects of physical function, especially upper-body function, and to a lesser extent, lower-body function. BMI does not seem to be associated with levels of coordination or strength. Better understanding of how BMI impacts physical function will aid in the design of interventions to promote independent living in elderly, obese women.

Early initiation of enteral feeding after percutaneous endoscopic gastrostomy tube placement.

Enteral feeding through the percutaneous endoscopic gastrostomy (PEG) tube is usually initiated about 12 to 24 hours after insertion of the tube. There have been earlier studies evaluating the efficacy of early initiation of enteral feedings that had encouraging results. However, delayed initiation of feeding following PEG placement continues to be practiced widely. We believe that feeding can be done earlier without any increase in associated morbidity or mortality and with obvious reduction in the need for parenteral nutrition and healthcare costs. We evaluated a protocol to initiate enteral nutrition 4 hours after the PEG tube insertion with subsequent discharge of the outpatients on the same day. We conducted a prospective study to assess the efficacy of early initiation of PEG feeding. We enrolled 77 patients in our study who were having PEG tubes placed for enteral feeding. Only patients who had a PEG placed for gastric venting procedures were excluded from our study. During the course of our study, no patient had to be excluded for the latter reason. Patients were evaluated by the physician performing the procedure, 4 hours after the tube was inserted. Their vital signs were checked, and a thorough abdominal examination was performed. Minimal tenderness around the PEG site was the most frequent finding. Otherwise, all the patients had a benign abdominal examination. The tube was flushed with 60 mL of sterile water. Following the examination, orders were given to restart the feedings. These patients were followed for a 30-day period to evaluate complications associated with PEG tube placement and early initiation of PEG feeding. There was one case of aspiration pneumonia (1.3%) and one death that was attributed to the underlying disease out of our 77 patients. Early initiation of enteral feeding after PEG tube placement can be successfully completed with a systematic protocol and close observation. Not only was this protocol found to be safe, it can also have significant cost savings by eliminating the need for inpatient hospitalization for the procedure.