Developing a Non-Pharmacological Intervention Programme for Wandering in People with Dementia: Recommendations for Healthcare Providers in Nursing Homes.

BACKGROUND: Wandering among people with dementia (PwD) is associated with a high risk of injury and death. The stigma of dementia prevents Chinese dementia families from seeking information and support earlier, which increases the demand for long-term care facilities. Despite universal recognition of the importance of care facilities, healthcare providers in care facilities still lack the relevant nursing knowledge and skills, including non-pharmacological interventions (NPIs) that have been proven to be effective in preventing wandering. Systematic and culturally appropriate NPI programmes for healthcare providers to manage wandering among PwD in long-term care facilities are still lacking. We aimed to develop an evidence-based and culturally appropriate NPI programme for wandering in PwD to guide healthcare providers in nursing homes to prevent wandering and its adverse outcomes. METHODS: The NPI programme was developed according to the framework of the Belgian Centre for Evidence-Based Medicine (CEBAM). We, (1) performed a systematic literature search to summarize the available evidence, (2) developed evidence-based recommendations for the NPI programme based on the existing evidence, and (3) carried out a validation process to revise the content of the recommendations and to determine the grades of recommendations, including group meetings with experts and a survey for end-users. RESULTS: Based on 22 publications and validation from 7 experts and 76 end users, we developed 21 recommendations covering 4 domains: (1) caregiver education, (2) preventing excessive wandering, (3) promoting safe walking, and (4) preventing people with dementia from going missing. We created almost all recommendations of the four domains with accompanying levels of evidence and grades of recommendations. CONCLUSIONS: By combining the evidence with expert and end-user opinions, a comprehensive NPI programme was developed to support institutional healthcare providers to prevent wandering and its adverse outcomes. The benefits of this programme are currently being tested.

Residual Stress and Ferroelastic Domain Reorientation in Declamped {001} Pb(Zr0.3Ti0.7)O3 Films.

Ferroelectric films are often constrained by their substrates and subject to scaling effects, including suppressed dielectric permittivity. In this work, the thickness dependence of intrinsic and extrinsic contributions to the dielectric properties was elucidated. A novel approach to quantitatively deconstruct the relative permittivity into three contributions (intrinsic, reversible extrinsic, and irreversible extrinsic) was developed using a combination of X-ray diffraction (XRD) and Rayleigh analysis. In situ synchrotron XRD was used to understand the influence of residual stress and substrate clamping on the domain state, ferroelastic domain reorientation, and electric field-induced strain. For tetragonal {001} textured Pb0.99(Zr0.3Ti0.7)0.98Nb0.02O3 thin films clamped to an Si substrate, a thickness-dependent in-plane tensile stress developed during processing, which dictates the domain distribution over a thickness range of 0.27- [Formula: see text]. However, after the films were partially declamped from the substrate and annealed, the residual stress was alleviated. As a result, the thickness dependence of the volume fraction of c -domains largely disappeared, and the out-of-plane lattice spacings ( d ) for both a - and c -domains increased. The volume fraction of c -domains was used to calculate the intrinsic relative permittivity. The reversible Rayleigh coefficient was then used to separate the intrinsic and reversible extrinsic contributions. The reversible extrinsic response accounted for ~50% of the overall relative permittivity (measured at 50 Hz and alternating current (ac) field of 0.5·Ec ) and was thickness dependent even after poling and upon release.

Phenomenological Model for Defect Interactions in Irradiated Functional Materials.

The ability to tailor the performance of functional materials, such as semiconductors, via careful manipulation of defects has led to extraordinary advances in microelectronics. Functional metal oxides are no exception - protonic-defect-conducting oxides find use in solid oxide fuel cells (SOFCs) and oxygen-deficient high-temperature superconductors are poised for power transmission and magnetic imaging applications. Similarly, the advantageous functional responses in ferroelectric materials that make them attractive for use in microelectromechanical systems (MEMS), logic elements, and environmental energy harvesting, are derived from interactions of defects with other defects (such as domain walls) and with the lattice. Chemical doping has traditionally been employed to study the effects of defects in functional materials, but complications arising from compositional heterogeneity often make interpretation of results difficult. Alternatively, irradiation is a versatile means of evaluating defect interactions while avoiding the complexities of doping. Here, a generalized phenomenological model is developed to quantify defect interactions and compare material performance in functional oxides as a function of radiation dose. The model is demonstrated with historical data from literature on ferroelectrics, and expanded to functional materials for SOFCs, mixed ionic-electronic conductors (MIECs), He-ion implantation, and superconductors. Experimental data is used to study microstructural effects on defect interactions in ferroelectrics.