The feasibility of using technology to enhance the transition of palliative care for rural patients.

Palliative care services for patients with life-limiting conditions enhance their quality of life. Most palliative care services, however, are located in hospitals with limited transitional care for patients who live in distant locations. The long-term goal of this program of research is to use existing technology for virtual visits to provide transitional care for patients initially hospitalized in an urban setting by a nurse practitioner located closer to patients' homes in distant, rural settings. The purpose of this proof-of-concept study was to determine the resources needed to use the system (efficiency) and the quality of the audio and visual components (effectiveness) to conduct virtual visits between a clinician at an academic center and community-dwelling adults living in rural locations. Guided by the Technology Acceptance Model, a mixed-methods field design was used. Because of the burden of testing technology with patients with life-limiting conditions, the sample included eight healthy adults. Participant satisfaction and perceptions of the ease of using the technology were also measured. Virtual visits were conducted using a 3G-enabled Apple iPad, cellular phone data service, and a Web-based video conference service. Participants and clinicians perceived the technology as easy to use. Observations revealed the importance of the visual cues provided by the technology to enhance communication, engagement, and satisfaction. Findings from this study will inform a subsequent study of technology-enhanced transitional care with palliative care patients.

Reducing pediatric overweight: nurse-delivered motivational interviewing in primary care.

The purpose of this study was to test the Let's Go 5-2-1-0 program delivered through motivational interviewing by nurses with 4-18-year-old overweight children and parents in primary care (PC). A quasi-experimental design allocated 60 control families to standard clinical care (SCC) and 70 families to SCC plus the 5-2-1-0 intervention. Drop-out rates were 9 and 35% at 6 months and 25 and 41% at 12 months, respectively for control and intervention participants. BMI percentile trended (p = .057) toward decline (M change = -3.0 versus -1.5) for intervention children at 6 months (n = 52 control, 44 intervention), and nonsignificantly (p = 0.14) for both groups (43 control, 40 intervention) at 12 months (controls -1.9, intervention -4.6). Intervention effects were found for self-reported daily fruit/vegetable consumption, physical activity, and screen time. Satisfaction was high. Further study of the PC nursing intervention is warranted.

Broad spectral response using carbon nanotube/organic semiconductor/C60 photodetectors.

We demonstrate that photogenerated excitons in semiconducting carbon nanotubes (CNTs) can be efficiently dissociated by forming a planar heterojunction between CNTs wrapped in semiconducting polymers and the electron acceptor, C(60). Illumination of the CNTs at their near-infrared optical band gap results in the generation of a short-circuit photocurrent with peak external and internal quantum efficiencies of 2.3% and 44%, respectively. Using soft CNT-hybrid materials systems combining semiconducting small molecules and polymers, we have fabricated broad-band photodetectors with a specific detectivity >10(10) cm Hz(1/2) W(1-) from lambda = 400 to 1450 nm and a response time of tau = 7.2 +/- 0.2 ns.

Comparison of Cervical Range-of-Motion Restriction and Craniofacial Tissue-Interface Pressure With 2 Adjustable and 2 Standard Cervical Collars.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: The aim of the study was to compare and contrast the restrictiveness and tissue-interface pressure (TIP) characteristics of 2 standard and 2 adjustable cervical collars. SUMMARY OF BACKGROUND DATA: This study compared the restrictiveness and TIP of 4 commercially available cervical collars (2 standard and 2 adjustable). Adjustable collars offer potential advantages of individualized fit for patients and decreased inventory for institutions. The overall goal was to determine whether the adjustable collars provided the same benefits of cervical range-of-motion (CROM) restriction as the standard collars without increasing TIP and risk of pressure-related complications. METHODS: A total of 48 adult volunteer subjects (24 men and 24 women) were fitted with 4 collars (Aspen, Aspen Vista, Miami J, and Miami J Advanced) in random order. Data collection included assessment of CROM restrictiveness and measurement of TIP on the mandible and occiput in upright and supine positions. The experimental, repeated measures design stratified the sample by body mass index (BMI) and sex. RESULTS: All collars restricted CROM as compared with no collar (P ≤ 0.001 each). Aspen was more restrictive than Aspen Vista and Miami J in 4 movement planes (P ≤ 0.003 each), but not significantly different from Miami J Advanced. The Miami J standard collar was associated with significantly lower peak TIPs on all sites and in all positions compared with Aspen (P ≤ 0.001), Miami J Advanced (P < 0.001), and Aspen Vista (P = 0.01 for mandible site and upright position, P < 0.001 for remaining sites and positions). Increased peak TIP correlated with high BMI across all collar types, but was significantly lower for the Miami J collar than the Aspen collar. CONCLUSION: All collars, compared with no collar, significantly restricted CROM. Although the collar-to-collar comparisons were statistically significant, the differences may have little clinical significance in the acutely injured trauma patient. The Miami J standard collar had the lowest overall TIP in both sites and positions. Ongoing effort should be devoted to staff education in proper sizing and fit, particularly for patients with high BMI.