Development and Implementation of a Pediatric Nursing Emergency Behavioral Health Assessment Tool.

INTRODUCTION: The national pediatric mental and behavioral health crisis dramatically increased emergency department mental and behavioral health visits and changed emergency nursing practice. Acuity assessment determines patient severity level and supports appropriate resources and interventions. There are no established nursing tools that assess pediatric mental or behavioral health acuity in the emergency department setting. Our goal was to develop and implement the novel pediatric emergency nurse Emergency Behavioral Health Acuity Assessment Tool. METHODS: This quality-improvement project used the plan, do, study, act model to design/refine the Emergency Behavioral Health Acuity Assessment Tool and a non-experimental descriptive design to assess outcomes. The setting was a 47-bed urban level 1 pediatric trauma center with more than 60,000 annual visits. The team designed the tool using published evidence, emergency nurse feedback, and expert opinion. The tool objectively captured patient acuity and suggested acuity-specific nursing interventions. Project outcomes included acuity, length-of-stay, restraint use, and patient/staff injuries. Analyses included descriptive statistics and correlations. RESULTS: With over 3000 annual mental/behavioral-related visits, the emergency department had an average daily census of 23 mental and behavioral health patients. Implementation occurred in August 2021. The Emergency Behavioral Health Acuity Assessment Tool dashboard provided the number of patients, patient location, and acuity. Length-of-stay did not change; however, patient restraint use and patient/staff injuries declined. Number of restraints positively correlated with moderate acuity levels (r = 0.472, P = 0.036). DISCUSSION: For emergency nurses, the Emergency Behavioral Health Acuity Assessment Tool provided an objective measure of patient acuity. Targeted interventions can improve the care of this population.

Improving Care for People Aging with HIV: A Collaborative Quality Improvement Approach.

Nearly 60% of people with HIV in New York State are over 50 years of age. After town halls and a statewide survey of long-term survivors, older people living with HIV, and their providers, the Quality of Care Program of the AIDS Institute in the New York State Department of Health developed a statewide quality improvement project that aimed to improve screening for functional impairments among people aging with HIV. Thirteen sites reported outcomes of a pilot project using a modification of the World Health Organization's Integrated Care of Older People (ICOPE) intrinsic capacity screen in small scale, short cycle tests of change. A total of 1,629 people were found to be eligible for screening, and of these, 638 people were screened. Both clinical and non-clinical sites were able to identify significant areas of need. Positive screens ranged from a low of 17% for the identification of hearing issues to 49% for vision concerns. Only 11% of people with memory or nutritional concerns were referred for services; hearing loss was the domain with the largest number of referrals, at 27%. Although in many cases, when referrals were not made, patients/clients were already under care for the identified functional deficit, in other cases no services were available for referral or patients/clients declined to use the offered service. Sites also responded to the findings of the screen by initiating process changes, and many reported continuing to screen for functional impairments after the close of the pilot. The modified ICOPE screen is still in use in sites throughout the state. This pilot demonstrated that a collaboration between people with lived HIV experience, the New York State Department of Health, clinicians, and service providers could result in improved quality of care for people aging with HIV.

Continuous medium approach to approximate the high concentrated aqueous electrolyte with different types of electrochemical structure.

Superconcentrated aqueous electrolytes have recently emerged as a new class of electrolytes, called water-in-salt electrolytes. They are distinguished, in both weight and volume, by a quantity of salt greater than water. Currently, these electrolytes are attracting major interest, particularly for application in aqueous rechargeable batteries. These electrolytes have only a small amount of free water due to an ultrahigh salt concentration. Consequently, the electrochemical stability window of water is wider than the predicted thermodynamic value of 1.23 V. Hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) have been shown to be shifted to more negative and positive potentials, respectively. The decrease in free water population is recognized as being involved in the increase in the electrochemical stability window of water. Here, we study the quantitative contribution of the decrease in the free water molecule concentration to the permittivity of the solution and of the activity of water to the OER and HER overpotentials when the salt concentration increases. We compare our model with that of Kornyshev and get three types of electrolyte structures: diluted, gradient of water contents, and aggregation. The theoretical calculation of the redox potentials of the OER and HER is compared with the experimentally determined electrochemical properties of aqueous LiTFSI electrolytes.

Hexavalent Ions Insertion in Garnet Li7 La3 Zr2 O12 Toward a Low Temperature Densification Reaction.

Nowadays, solid electrolytes are considered the main alternative to conventional liquid electrolytes in lithium batteries. The fabrication of these materials is however limited by the strict synthesis conditions, requiring high temperatures which can negatively impact the final performances. Here, it is shown that a modification of garnet-based Li7 La3 Zr2 O12 (LLZO) and the incorporation of tellurium can accelerate the synthesis process by lowering the formation temperature of cubic LLZO at temperatures below 700 °C. Optimized synthesis at 750 °C showed a decrease in particle size and cell parameter for samples with higher amounts of Te and the evaluation of electrochemical performances reported for LLZO Te0.25 a value of ionic conductivity of 5,15×10-5  S cm-1 after hot-pressing at 700 °C, two orders of magnitude higher than commercial Al-LLZO undergoing the same working conditions, and the highest value at this densification temperature. Partial segregation of Te-rich phases occurs for high-temperature densification. Our study shows the advantages of Te insertion on the sintering process of LLZO garnet and demonstrates the achievement of highly conductive LLZO with a low-temperature treatment.

Intermolecular Interactions and Electrochemical Studies on Highly Concentrated Acetate-Based Water-in-Salt and Ionic Liquid Electrolytes.

Water-in-salt electrolytes constitute a new class of materials that have distinct properties relative to lower-concentration solutions. A recent approach to further increase the salt concentration and decrease the water content includes the addition of an ionic liquid to a highly concentrated aqueous solution. However, the physicochemical and electrochemical properties of aqueous lithium acetate-1-ethyl-3-methylimidazolium acetate solutions as well as the molecular interactions between electrolyte species have not been characterized. Here, we investigate these properties by evaluation of the ionic conductivity, viscosity, and thermal properties as well as the electrochemical behavior of various electrodes in these electrolytes. The intermolecular interactions are probed by nuclear magnetic resonance and infrared spectroscopies. We find that the addition of the ionic liquid increases the solubility limit of lithium acetate and that with an increase in both acetate salt and ionic liquid concentration in the electrolyte and decrease in water concentration, a strong acetate-water network is formed. The electrochemical stability window increases upon addition of the ionic liquid and reaches a value larger than 5 V for a set of negative Al and positive Ti electrodes in the highest acetate salt/ionic liquid concentration. Preliminary electrochemical charge storage performance measurements of a symmetric device based on two porous carbon electrodes cycled at a current density of 25 mA g-1 delivered a specific capacitance of 20 F g-1 with a Coulombic efficiency higher than 99% using a 1.8 V voltage window.

Physicochemical and Electrochemical Properties of Water-in-Salt Electrolytes.

Aqueous electrolytes are attractive for applications in electrochemical technologies due to features like being eco-friendly, cost effective, and non-flammable. Very recently, superconcentrated aqueous electrolytes, such as so-called water-in-salt, water-in-bisalt, and hydrate melt, have received a significant attention for electrochemical energy storage due to enhanced stability and much wider electrochemical stability window. This Review focuses on the physicochemical properties of the highly concentrated electrolytes that are derived from several analysis techniques and simulation. A summary of most common features such as ions-water interactions, structure of species present in the electrolyte, conductivity, and viscosity of the electrolytes found in the literature are presented as well. In addition, this Review explains how these characteristics affect the electrochemical behavior of the electrolyte such as double layer structure and electrode/electrolyte interface leading to enhanced electrochemical stability of aqueous electrolytes.

Protection of LiFePO4 against Moisture.

In this study, a carbon-coated LiFePO4 (LFP/C) powder was chemically grafted with trifluoromethylphenyl groups in order to increase its hydrophobicity and to protect it from moisture. The modification was carried out by the spontaneous reduction of in situ generated 4-trifluoromethylphenyl ions produced by the diazotization of 4-trifluoromethylaniline. X-ray photoelectron spectroscopy was used to analyze the surface organic species of the modified powder. The hydrophobic properties of the modified powder were investigated by carrying out its water contact angle measurements. The presence of the trifluoromethylphenyl groups on the carbon-coated LiFePO4 powder increased its stability in deionized water and reduced its iron dissolution in the electrolyte used for assembling the battery. The thermogravimetric and inductively coupled plasma atomic emission spectroscopy analyses revealed that 0.2-0.3 wt.% Li was deinserted during grafting and that the loading of the grafted molecules varied from 0.5 to 0.8 wt.% depending on the reaction conditions. Interestingly, the electrochemical performance of the modified LFP/C was not adversely affected by the presence of the trifluoromethylphenyl groups on the carbon surface. The chemical relithiation of the grafted samples was carried out using LiI as the reducing agent and the lithium source in order to obtain fully lithiated grafted powders.

The Facility-Level HIV Treatment Cascade: Using a Population Health Tool in Health Care Facilities to End the Epidemic in New York State.

BACKGROUND: The HIV treatment cascade is a tool for characterizing population-level gaps in HIV care, yet most adaptations of the cascade rely on surveillance data that are ill-suited to drive quality improvement (QI) activities at the facility level. We describe the adaptation of the cascade in health care organizations and report its use by HIV medical providers in New York State (NYS). METHODS: As part of data submissions to the NYS Department of Health, sites that provide HIV medical care in NYS developed cascades using facility-generated data. Required elements included data addressing identification of people living with HIV (PLWH) receiving any service at the facility, linkage to HIV medical care, prescription of antiretroviral therapy (ART), and viral suppression (VS). Sites also submitted a methodology report summarizing how cascade data were collected and an improvement plan identifying care gaps. RESULTS: Two hundred twenty-two sites submitted cascades documenting the quality of care delivered to HIV patients presenting for HIV- or non-HIV-related services during 2016. Of 101 341 PLWH presenting for any medical care, 75 106 were reported as active in HIV programs, whereas 21 509 had no known care status. Sites reported mean ART prescription and VS rates of 94% and 80%, respectively, and 60 distinct QI interventions. CONCLUSIONS: Submission of facility-level cascades provides data on care utilization among PLWH that cannot be assessed through traditional HIV surveillance efforts. Moreover, the facility-level cascade represents an effective tool for identifying care gaps, focusing data-driven improvement efforts, and engaging frontline health care providers to achieve epidemic control.

Electrochemical Behavior of Pyridinium and N-Methyl Pyridinium Cations in Aqueous Electrolytes for CO2 Reduction.

The electrochemical reduction of aqueous pyridinium and N-methyl pyridinium ions is investigated in the absence and presence of CO2 and electrolysis reaction products on glassy carbon, Au, and Pt electrodes are studied. Unlike pyridinium, N-methyl pyridinium is not electroactive at the Pt electrode. The electrochemical reduction of the two pyridine derivatives was found to be irreversible on glassy carbon. These results confirmed the essential role of the N-H bond of the pyridinium cation. In contrast, the electrochemical response of N-methyl pyridinium ion at the glassy carbon electrode suggests that a specific interaction occurs between the glassy carbon surface and the aromatic ring of the pyridinium derivative. For all electrodes, an enhancement of current was observed in the presence of CO2 . However, NMR spectroscopy of the solutions following electrolysis showed no formation of methanol or other possible byproducts of the reduction of CO2 in the presence of either pyridinium derivative ion.

Surface immobilized azomethine for multiple component exchange.

Diazonium chemistry concomitant with in situ electrochemical reduction was used to graft an aryl aldehyde to indium-tin oxide (ITO) coated glass substrates. This served as an anchor for preparing electroactive azomethines that were covalently bonded to the transparent electrode. The immobilized azomethines could undergo multiple step-wise component exchanges with different arylamines. The write-erase-write sequences were electrochemically confirmed. The azomethines could also be reversibly hydrolyzed. This was exploited for multiple azomethine-hydrolysis cycles resulting in discrete electroactive immobilized azomethines. The erase-rewrite sequences were also electrochemically confirmed.

Effects of the Formulations of Silicon-Based Composite Anodes on their Mechanical, Storage, and Electrochemical Properties.

In this work, the effects of the formulation of silicon-based composite anodes on their mechanical, storage, and electrochemical properties were investigated. The electrode formulation was changed through the use of hydrogenated or modified (through the covalent attachment of a binding additive such as polyacrylic acid) silicon and acetylene black or graphene sheets as conducting additives. A composite anode with a covalently grafted binder had the highest elongation without breakages and strong adhesion to the current collector. These mechanical properties depend significantly on the conductive carbon additive used and the use of graphene sheets instead of acetylene black can improve elongation and adhesion significantly. After 180 days of storage under ambient conditions, the electronic conductivity and discharge capacity of the modified silicon electrode showed much smaller decreases in these properties than those of the hydrogenated silicon composite electrode, indicating that the modification can result in passivation and a constant composition of the active material. Moreover, the composite Si anode has a high packing density. Consequently, thin-film electrodes with very high material loadings can be prepared without decreased electrochemical performance.

Self-discharge of electrochemical capacitors based on soluble or grafted quinone.

The self-discharge of hybrid electrochemical capacitors based on the redox activity of electrolyte additives or grafted species to the electrode material is investigated simultaneously for the cell and each individual electrode. Electrochemical capacitors using a redox-active electrolyte consisting in hydroquinone added to the electrolyte solution and a redox-active electrode based on anthraquinone-grafted carbon as a negative electrode are investigated. The results are analyzed by using Conway kinetic models and compared to those of a common electrochemical double layer capacitor. The self-discharge investigation is complemented by charge/discharge cycling and it is shown that processes affecting galvanostatic charge/discharge cycling and the self-discharge rate occurring at each electrode of an electrochemical capacitor are different but related to each other. The electrochemical capacitor containing hydroquinone in the electrolyte exhibits a much quicker self-discharge rate than that using a negative electrode based on grafted anthraquinone with a 50% decay of the cell voltage of the fully charged device in 0.6 and 6 h, respectively. The fast self-discharge of the former is due to the diffusion of benzoquinone molecules (formed at the positive electrode during charging) to the negative electrode, where they are reduced, causing a quick depolarization. The grafting of anthraquinone molecules on the carbon material of the negative electrode led to a much slower self-discharge, which nonetheless occurred, by the reaction of the reduced form of the grafted species with electrolyte species.

A Redox-Active Binder for Electrochemical Capacitor Electrodes.

A promising strategy for increasing the performance of supercapacitors is proposed. Until now, a popular strategy for increasing the specific capacity of the electrode consists of grafting redox molecules onto a high surface area carbon structure to add a faradaic contribution to the charge storage. Unfortunately, the grafting of molecules to the carbon surface leads to a dramatic decrease of the electrochemical performances of the composite material. Herein, we used the organic binder as an active material in the charge/discharge process. Redox molecules were attached onto its polymeric skeleton to obtain a redox binder with the dual functionalities of both the binder and the active material. In this way, the electrochemical performance was improved without detrimentally affecting the properties of the porous carbon. Results showed that the use of a redox binder is promising for enhancing both energy and power densities.

Increasing the Affinity Between Carbon-Coated LiFePO4/C Electrodes and Conventional Organic Electrolyte by Spontaneous Grafting of a Benzene-Trifluoromethylsulfonimide Moiety.

The grafting of benzene-trifluoromethylsulfonimide groups on LiFePO4/C was achieved by spontaneous reduction of in situ generated diazonium ions of the corresponding 4-amino-benzene-trifluoromethylsulfonimide. The diazotization of 4-amino-benzene-trifluoromethylsulfonimide was a slow process that required a high concentration of precursors to promote the spontaneous grafting reaction. Contact angle measurements showed a hydrophilic surface was produced after the reaction that is consistent with grafting of benzene-trifluoromethylsulfonimide groups. Elemental analysis data revealed a 2.1 wt % loading of grafted molecules on the LiFePO4/C powder. Chemical oxidation of the cathode material during the grafting reaction was detected by X-ray diffraction and quantified by inductively coupled plasma atomic emission spectrometry. Surface modification improves the wettability of the cathode material, and better discharge capacities were obtained for modified electrodes at high C-rate. In addition, electrochemical impedance spectroscopy showed the resistance of the modified cathode was lower than that of the bare LiFePO4/C film electrode. Moreover, the modified cathode displayed superior capacity retention after 200 cycles of charge/discharge at 1 C.

Electrochemical formation of an ultrathin electroactive film from 1,10-phenanthroline on a glassy carbon electrode in acidic electrolyte.

The electrochemical reduction of 1,10-phenanthroline in aqueous acidic electrolyte at a glassy carbon electrode led to the covalent modification of the electrode. Thereafter, the deposited film can be switched to an electroactive form by electrochemical oxidation. An electroactive film can be also generated by alternate reductive and oxidative voltammetric cycling in a 1,10-phenanthroline/aqueous sulfuric acid solution. First, the electrochemical procedure for the formation of a film is presented. Second, the morphology and chemical structure of 1,10-phenanthroline coatings were investigated by atomic force microscopy, time-of-flight secondary ion mass spectrometry, X-ray photoelectron spectroscopy, and electrochemical techniques. The ultrathin (<15 nm) electrodeposited films consist of oligomeric species. The coatings deposited in alternate and/or continuous reductive and oxidative steps contain oxygen atoms incorporated into the oligomer backbone. The preliminary results point out the formation of a dione derivative that is responsible for the electroactivity of the grafted layer.

Localized in situ generation of diazonium cations by electrocatalytic formation of a diazotization reagent.

A new one-step electrochemical approach for the localized generation of diazonium cations in the diffusion layer of an electrode by taking advantage of the electrocatalytic properties of the electrode for the formation of the diazotization agent (nitrite) is proposed. Once nitrite anions are formed by electrocatalytic reduction of nitrate, they immediately react with an arylamine to produce the corresponding diazonium cations, which can be electrochemically readily reduced at the electrode surface. By this method, spontaneous modification of the electrode surface can be avoided. Furthermore, because the potential of the electrochemical nitrate reduction depends strongly on the nature of the electrode material, we also demonstrate that selective grafting can be achieved on a surface, which consists of two different materials: copper-gold or copper-glassy carbon substrates.

Catechol-modified activated carbon prepared by the diazonium chemistry for application as active electrode material in electrochemical capacitor.

Activated carbon (Black Pearls 2000) modified with electroactive catechol groups was evaluated for charge storage application as active composite electrode material in an aqueous electrochemical capacitor. High surface area Black Pearls 2000 carbon was functionalized by introduction of catechol groups by spontaneous reduction of catechol diazonium ions in situ prepared in aqueous solution from the corresponding amine. Change in the specific surface area and pore texture of the carbon following grafting was monitored by nitrogen gas adsorption measurements. The electrochemical properties and the chemical composition of the catechol-modified carbon electrodes were investigated by cyclic voltammetry. Such carbon-modified electrode combines well the faradaic capacitance, originating from the redox activity of the surface immobilized catechol groups, to the electrochemical double layer capacitance of the high surface area Black Pearls carbon. Due to the faradaic contribution, the catechol-modified electrode exhibits a higher specific capacitance (250 F/g) than pristine carbon (150 F/g) over a potential range of -0.4 to 0.75 V in 1 M H(2)SO(4). The stability of the modified electrode evaluated by long-time charge/discharge cycling revealed a low decrease of the capacitance of the catechol-modified carbon due to the loss of the catechol redox activity. Nonetheless, it was demonstrated that the benefit of redox groups persists for 10, 000 constant current charge/discharge cycles.

Formation and reactivity of 3-diazopyridinium cations and influence on their reductive electrografting on glassy carbon.

The in situ generation of 3-diazonium cations from 3-aminopyridine and their subsequent stability under experimental conditions used for electrografting of pyridine groups were investigated by spectroscopy and electrochemistry. UV spectroscopy revealed the rapid kinetics for the reaction of 3-aminopyridine with sodium nitrite in HCl to form the 3-diazopyridinium cation with a second-order rate constant of 550 ± 20 L mol(-1) s(-1) at 22 °C. UV spectroscopy showed that the 3-diazopyridinium ion was relatively unstable and its transformation into 3-hydroxypyridine was proven by (1)H NMR. Its hydrolytic decomposition was investigated by NMR and followed first-order kinetics with a rate constant of (53 ± 5) × 10(-3) s(-1) at 22 °C. These results enable us to establish the appropriate conditions for the electrografting of pyridine from the corresponding diazonium cations generated in situ. The electrochemical modification of glassy carbon electrodes with pyridine was characterized by cyclic voltammetry and the resulting grafted layer by electrochemical impedance spectroscopy in the presence of Fe(CN)(6)(3-/4-) as redox probes. The effect of diazotization time before electrochemical reduction on the blocking effect of the grafted layer was investigated and showed that an increase of the diazotization time led to less efficient grafting. The presence of immobilized pyridine on the electrode surface was demonstrated by X-ray photoelectron spectroscopy measurements, and a surface coverage of 8.8 × 10(-10) mol cm(-2) was estimated for the grafted pyridine groups. The significance of these results for researchers using the in situ generation approach for electrochemical and chemical grafting is discussed.

Optimization of the cathode material for nitrate removal by a paired electrolysis process.

Ni, Cu, Cu(90)Ni(10) and Cu(70)Ni(30) were evaluated as cathode materials for the conversion of nitrate to nitrogen by a paired electrolysis process using an undivided flow-through electrolyzer. Firstly, corrosion measurements revealed that Ni and Cu(70)Ni(30) electrodes have a much better corrosion resistance than Cu and Cu(90)Ni(10) in the presence of chloride, nitrate and ammonia. Secondly, nitrate electroreduction experiments showed that the cupro-nickel electrodes are the most efficient for reducing nitrate to ammonia with a selectivity of 100%. Finally, paired electrolysis experiments confirmed the efficiency of Cu(70)Ni(30) and Cu(90)Ni(10) cathodes for the conversion of nitrate to nitrogen. During a typical electrolysis, the concentration of nitrate varied from 620ppm to less than 50ppm NO(3)(-) with an N(2) selectivity of 100% and a mean energy consumption of 20kWh/kg NO(3)(-) (compared to ∼35 and ∼220kWh/kg NO(3)(-) with Cu and Ni cathodes, respectively).