Structural features affecting the enzymatic digestibility of pine wood pretreated with ionic liquids.

Pretreating lignocellulosic biomass with certain ionic liquids results in structural and chemical changes that make the biomass more digestible by enzymes. In this study, pine wood was pretreated with 1-ethyl-3-methylimidazolium chloride/acetate ([C2 mim]Cl and [C2 mim][OAc]) at different temperatures to investigate the relative importance of substrate features, such as accessible surface area, cellulose crystallinity, and lignin content, on enzymatic digestibility. The ionic liquid pretreatments resulted in glucan conversions ranging from 23% to 84% on saccharification of the substrates, with [C2 mim][OAc] being more effective than [C2 mim]Cl. The pretreatments resulted in no delignification of the wood, some loss of cellulose crystallinity under certain conditions, and varying levels of increased surface area. Enzymatic digestibility closely correlated with accessible surface area and porosity measurements obtained using Simons' staining and thermoporosimetry techniques. Increased accessible surface area was identified as the principal structural feature responsible for the improved enzymatic digestibility.

Helping Individuals With Dementia Live More Fully Through Person-Centered Practices.

Dementia, including Alzheimer's disease, is a health condition saddled with social stigmas and is widely misunderstood. Person-centered care practices can positively improve the psychosocial experience of living with dementia and have become the gold standard for care because of the resulting beneficial outcomes. The purpose of the current article is to describe four person-centered principles that form the foundation for dementia care practice: (a) the idea that individuals can and do live fully with dementia; (b) quality of life depends not only on the care received but also on the value that others put on their abilities and life; (c) being meaningfully engaged and having purpose are vital to well-being; and (d) respect, dignity, and choice are not only foundational to person-centered care but for basic human rights. Although efforts have been made to mandate person-centered practices, challenges remain that can direct future research and practice efforts. [Journal of Gerontological Nursing, 41(11), 9-14.].

National Priorities for Dementia Care: Perspectives of Individuals Living with Dementia and Their Care Partners.

The current article reports the consensus recommendations from individuals living with dementia and their care partners on priorities for public policy and research funding, which were found using a nationwide, Delphi study. A modified snowball sample was used. Listservs, personal contacts, and advocacy groups were asked to distribute the survey. Paper versions were provided upon request. In Rounds 1 and 2 of the study, 388 and 301 responses, respectively, were received. Borda counts produced a ranked order consensus of priorities. Research ranked third, after the need for caregiver support and resources for the provision of long-term care. Education and training in person-centered practices for all care partners was also a high priority. Responses indicated that research funding should be expanded beyond its current emphasis on cure. Policymakers should reconsider the current priorities of the National Alzheimer's Project Act to better address the long-term needs of individuals living with dementia and their care partners.

Person-Centeredness in Home- and Community-Based Services and Supports: Domains, Attributes, and Assisted Living Indicators.

As a result of the Centers for Medicare & Medicaid Services (CMS) interest in creating a unifying definition of "community living" for its Medicaid Home and Community Based Services and Support (HCBS) programs, it needed clarifying descriptors of person-centered (PC) practices in assisted living to distinguish them from institutional ones. Additionally, CMS's proposed language defining "community living" had the unintended potential to exclude many assisted living communities and disadvantage residents who receive Medicaid. This manuscript describes the consensus process through which clarifying language for "community living" and a framework for HCBS PC domains, attributes, and indicators specific to assisted living were developed. It examines the validity of those domains based on literature review, surveys, and stakeholder focus groups, and identifies nine domains and 43 indicators that provide a foundation for defining and measuring PC practice in assisted living. Ongoing efforts using community-based participatory research methods are further refining and testing PC indicators for assisted living to advance knowledge, operational policies, practices, and quality outcomes.

A business planning model to identify new safety net clinic locations.

PURPOSE: Community health clinics serving the poor and underserved are geographically expanding due to changes in U.S. health care policy. This paper describes the experience of a collaborative alliance of health care providers in a large metropolitan area who develop a conceptual and mathematical decision model to guide decisions on expanding its network of community health clinics. DESIGN/METHODOLOGY/APPROACH: Community stakeholders participated in a collaborative process that defined constructs they deemed important in guiding decisions on the location of community health clinics. This collaboration also defined key variables within each construct. Scores for variables within each construct were then totaled and weighted into a community-specific optimal space planning equation. This analysis relied entirely on secondary data available from published sources. FINDINGS: The model built from this collaboration revolved around the constructs of demand, sustainability, and competition. It used publicly available data defining variables within each construct to arrive at an optimal location that maximized demand and sustainability and minimized competition. PRACTICAL IMPLICATIONS: This is a model that safety net clinic planners and community stakeholders can use to analyze demographic and utilization data to optimize capacity expansion to serve uninsured and Medicaid populations. ORIGINALITY/VALUE: Communities can use this innovative model to develop a locally relevant clinic location-planning framework.

Medication administration errors in assisted living: scope, characteristics, and the importance of staff training.

OBJECTIVES: To compare rates of medication errors committed by assisted living staff with different training and to examine characteristics of errors. DESIGN: Observation of medication preparation and passes, chart review, interviews, and questionnaires. SETTING: Stratified random sample of 11 assisted living communities in South Carolina (which permits nonnurses to administer medications) and Tennessee (which does not). PARTICIPANTS: All staff who prepared or passed medications: nurses (one registered nurse and six licensed practical nurses (LPNs)); medication aides (n=10); and others (n=19), including those with more and less training. MEASUREMENTS: Rates of errors related to medication, dose and form, preparation, route, and timing. RESULTS: Medication preparation and administration were observed for 4,957 administrations during 83 passes for 301 residents. The error rate was 42% (20% when omitting timing errors). Of all administrations, 7% were errors with moderate or high potential for harm. The odds of such an error by a medication aide were no more likely than by a LPN, but the odds of one by staff with less training was more than two times as great (odds ratio=2.10, 95% confidence interval=1.27-3.49). A review of state regulations found that 20 states restrict nonnurses to assisting with self-administration of medications. CONCLUSION: Medication aides do not commit more errors than LPNs, but other nonnurses who administered a significant number of medications and assisted with self-administration committed more errors. Consequently, all staff who handle medications should be trained to the level of a medication aide.

Calculating graduation rates.

In recent years, the focus has been on increasing the number of registered nurse (RN) graduates. Numerous states have initiated programs to increase the number and quality of students entering nursing programs, and to expand the capacity of their programs to enroll additional qualified students. However, little attention has been focused on an equally, if not more, effective method for increasing the number of RNs produced-increasing the graduation rate of students enrolling. This article describes a project that undertook the task of compiling graduation data for 15 entry-level programs, standardizing terms and calculations for compiling the data, and producing a regional report on graduation rates of RN students overall and by type of program. Methodology is outlined in this article. This effort produced results that were surprising to program deans and directors and is expected to produce greater collaborative efforts to improve these rates both locally and statewide.

The Gulf Coast Health Services Steering Committee: a business-education partnership to solve the registered nurse shortage.

The need to increase the registered nurse work-force has historically been the concern only of nursing school administrators and educators and, occasionally, the focus of hospital administrators during spikes in demand. How can nursing educators develop and sustain a productive partnership with local hospitals and the business community? The authors describe their experience in creating and developing a long-term, employer-led, and sustainable partnership for increasing their own registered nurse workforce.