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1.
Proc Natl Acad Sci U S A ; 119(37): e2207449119, 2022 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-36067325

RESUMO

The elementary CuO2 plane sustaining cuprate high-temperature superconductivity occurs typically at the base of a periodic array of edge-sharing CuO5 pyramids. Virtual transitions of electrons between adjacent planar Cu and O atoms, occurring at a rate t/ℏ and across the charge-transfer energy gap [Formula: see text], generate "superexchange" spin-spin interactions of energy [Formula: see text] in an antiferromagnetic correlated-insulator state. However, hole doping this CuO2 plane converts this into a very-high-temperature superconducting state whose electron pairing is exceptional. A leading proposal for the mechanism of this intense electron pairing is that, while hole doping destroys magnetic order, it preserves pair-forming superexchange interactions governed by the charge-transfer energy scale [Formula: see text]. To explore this hypothesis directly at atomic scale, we combine single-electron and electron-pair (Josephson) scanning tunneling microscopy to visualize the interplay of [Formula: see text] and the electron-pair density nP in Bi2Sr2CaCu2O8+x. The responses of both [Formula: see text] and nP to alterations in the distance δ between planar Cu and apical O atoms are then determined. These data reveal the empirical crux of strongly correlated superconductivity in CuO2, the response of the electron-pair condensate to varying the charge-transfer energy. Concurrence of predictions from strong-correlation theory for hole-doped charge-transfer insulators with these observations indicates that charge-transfer superexchange is the electron-pairing mechanism of superconductive Bi2Sr2CaCu2O8+x.

2.
Proc Natl Acad Sci U S A ; 119(31): e2206481119, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35895680

RESUMO

Electron-pair density wave (PDW) states are now an intense focus of research in the field of cuprate correlated superconductivity. PDWs exhibit periodically modulating superconductive electron pairing that can be visualized directly using scanned Josephson tunneling microscopy (SJTM). Although from theory, intertwining the d-wave superconducting (DSC) and PDW order parameters allows a plethora of global electron-pair orders to appear, which one actually occurs in the various cuprates is unknown. Here, we use SJTM to visualize the interplay of PDW and DSC states in Bi2Sr2CaCu2O8+x at a carrier density where the charge density wave modulations are virtually nonexistent. Simultaneous visualization of their amplitudes reveals that the intertwined PDW and DSC are mutually attractive states. Then, by separately imaging the electron-pair density modulations of the two orthogonal PDWs, we discover a robust nematic PDW state. Its spatial arrangement entails Ising domains of opposite nematicity, each consisting primarily of unidirectional and lattice commensurate electron-pair density modulations. Further, we demonstrate by direct imaging that the scattering resonances identifying Zn impurity atom sites occur predominantly within boundaries between these domains. This implies that the nematic PDW state is pinned by Zn atoms, as was recently proposed [Lozano et al., Phys. Rev. B 103, L020502 (2021)]. Taken in combination, these data indicate that the PDW in Bi2Sr2CaCu2O8+x is a vestigial nematic pair density wave state [Agterberg et al. Phys. Rev. B 91, 054502 (2015); Wardh and Granath arXiv:2203.08250].

3.
Nat Commun ; 12(1): 6087, 2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34667154

RESUMO

An unidentified quantum fluid designated the pseudogap (PG) phase is produced by electron-density depletion in the CuO2 antiferromagnetic insulator. Current theories suggest that the PG phase may be a pair density wave (PDW) state characterized by a spatially modulating density of electron pairs. Such a state should exhibit a periodically modulating energy gap [Formula: see text] in real-space, and a characteristic quasiparticle scattering interference (QPI) signature [Formula: see text] in wavevector space. By studying strongly underdoped Bi2Sr2CaDyCu2O8 at hole-density ~0.08 in the superconductive phase, we detect the 8a0-periodic [Formula: see text] modulations signifying a PDW coexisting with superconductivity. Then, by visualizing the temperature dependence of this electronic structure from the superconducting into the pseudogap phase, we find the evolution of the scattering interference signature [Formula: see text] that is predicted specifically for the temperature dependence of an 8a0-periodic PDW. These observations are consistent with theory for the transition from a PDW state coexisting with d-wave superconductivity to a pure PDW state in the Bi2Sr2CaDyCu2O8 pseudogap phase.

4.
Nat Mater ; 20(11): 1480-1484, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34462570

RESUMO

The most essential characteristic of any fluid is the velocity field, and this is particularly true for macroscopic quantum fluids1. Although rapid advances2-7 have occurred in quantum fluid velocity field imaging8, the velocity field of a charged superfluid-a superconductor-has never been visualized. Here we use superconducting-tip scanning tunnelling microscopy9-11 to image the electron-pair density and velocity fields of the flowing electron-pair fluid in superconducting NbSe2. Imaging of the velocity fields surrounding a quantized vortex12,13 finds electronic fluid flow with speeds reaching 10,000 km h-1. Together with independent imaging of the electron-pair density via Josephson tunnelling, we visualize the supercurrent density, which peaks above 3 × 107 A cm-2. The spatial patterns in electronic fluid flow and magneto-hydrodynamics reveal hexagonal structures coaligned to the crystal lattice and quasiparticle bound states14, as long anticipated15-18. These techniques pave the way for electronic fluid flow visualization studies of other charged quantum fluids.

5.
Maturitas ; 144: 23-28, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33358204

RESUMO

Older adults who fall recurrently (i.e., 2 or more falls/year) are at risk of functional decline and mortality. Understanding which risk factors for recurrent falls are most important will inform secondary fall prevention strategies that can reduce recurrent falls risk. Thus, we conducted a systematic review with meta-analysis to determine the relative risk of recurrent falls for different types of falls risk factors. MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched on April 25, 2019 (Prospero Registration: CRD42019118888). We included peer-reviewed prospective studies which examined risk factors that contributed to recurrent falls in adults aged ≥ 60 years. Using the falls risk classification system of Lord and colleagues, we classified each risk factor into one of the following domains: 1) balance and mobility; 2) environmental; 3) psychological; 4) medical; 5) medication; 6) sensory and neuromuscular; or 7) sociodemographic. We calculated the summary relative risk (RR) for each domain and evaluated the risk of bias and quality of reporting. Twenty-two studies were included in this systematic review and meta-analysis. Four domains predicted recurrent falls: balance and mobility (RR:1.32;95 % CI:[1.10, 1.59]), medication (RR:1.53;95 % CI:[1.11, 2.10]), psychological (RR:1.35;95 % CI:[1.03, 1.78]), and sensory and neuromuscular (RR:1.51;95 % CI:[1.18, 1.92]). Each of these four domains can be viewed as a marker of frailty. The risk of bias was low, and the study quality was high (minimum:19/22). Older adults with markers of frailty are up to 53 % more likely to experience recurrent falls. Strategies that identify and resolve frailty markers should be a frontline approach to preventing recurrent falls.


Assuntos
Acidentes por Quedas , Idoso , Humanos , Fatores de Risco
6.
Nano Lett ; 20(11): 8001-8007, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-32985892

RESUMO

The quantum anomalous Hall (QAH) effect appears in ferromagnetic topological insulators (FMTIs) when a Dirac mass gap opens in the spectrum of the topological surface states (SSs). Unaccountably, although the mean mass gap can exceed 28 meV (or ∼320 K), the QAH effect is frequently only detectable at temperatures below 1 K. Using atomic-resolution Landau level spectroscopic imaging, we compare the electronic structure of the archetypal FMTI Cr0.08(Bi0.1Sb0.9)1.92Te3 to that of its nonmagnetic parent (Bi0.1Sb0.9)2Te3, to explore the cause. In (Bi0.1Sb0.9)2Te3, we find spatially random variations of the Dirac energy. Statistically equivalent Dirac energy variations are detected in Cr0.08(Bi0.1Sb0.9)1.92Te3 with concurrent but uncorrelated Dirac mass gap disorder. These two classes of SS electronic disorder conspire to drastically suppress the minimum mass gap to below 100 µeV for nanoscale regions separated by <1 µm. This fundamentally limits the fully quantized anomalous Hall effect in Sb2Te3-based FMTI materials to very low temperatures.

7.
Proc Natl Acad Sci U S A ; 117(26): 14805-14811, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32546526

RESUMO

The defining characteristic of hole-doped cuprates is d-wave high temperature superconductivity. However, intense theoretical interest is now focused on whether a pair density wave state (PDW) could coexist with cuprate superconductivity [D. F. Agterberg et al., Annu. Rev. Condens. Matter Phys. 11, 231 (2020)]. Here, we use a strong-coupling mean-field theory of cuprates, to model the atomic-scale electronic structure of an eight-unit-cell periodic, d-symmetry form factor, pair density wave (PDW) state coexisting with d-wave superconductivity (DSC). From this PDW + DSC model, the atomically resolved density of Bogoliubov quasiparticle states [Formula: see text] is predicted at the terminal BiO surface of Bi2Sr2CaCu2O8 and compared with high-precision electronic visualization experiments using spectroscopic imaging scanning tunneling microscopy (STM). The PDW + DSC model predictions include the intraunit-cell structure and periodic modulations of [Formula: see text], the modulations of the coherence peak energy [Formula: see text] and the characteristics of Bogoliubov quasiparticle interference in scattering-wavevector space [Formula: see text] Consistency between all these predictions and the corresponding experiments indicates that lightly hole-doped Bi2Sr2CaCu2O8 does contain a PDW + DSC state. Moreover, in the model the PDW + DSC state becomes unstable to a pure DSC state at a critical hole density p*, with empirically equivalent phenomena occurring in the experiments. All these results are consistent with a picture in which the cuprate translational symmetry-breaking state is a PDW, the observed charge modulations are its consequence, the antinodal pseudogap is that of the PDW state, and the cuprate critical point at p* ≈ 19% occurs due to disappearance of this PDW.

8.
Nature ; 580(7801): 65-70, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32238945

RESUMO

The defining characteristic1,2 of Cooper pairs with finite centre-of-mass momentum is a spatially modulating superconducting energy gap Δ(r), where r is a position. Recently, this concept has been generalized to the pair-density-wave (PDW) state predicted to exist in copper oxides (cuprates)3,4. Although the signature of a cuprate PDW has been detected in Cooper-pair tunnelling5, the distinctive signature in single-electron tunnelling of a periodic Δ(r) modulation has not been observed. Here, using a spectroscopic technique based on scanning tunnelling microscopy, we find strong Δ(r) modulations in the canonical cuprate Bi2Sr2CaCu2O8+δ that have eight-unit-cell periodicity or wavevectors Q ≈ (2π/a0)(1/8, 0) and Q ≈ (2π/a0)(0, 1/8) (where a0 is the distance between neighbouring Cu atoms). Simultaneous imaging of the local density of states N(r, E) (where E is the energy) reveals electronic modulations with wavevectors Q and 2Q, as anticipated when the PDW coexists with superconductivity. Finally, by visualizing the topological defects in these N(r, E) density waves at 2Q, we find them to be concentrated in areas where the PDW spatial phase changes by π, as predicted by the theory of half-vortices in a PDW state6,7. Overall, this is a compelling demonstration, from multiple single-electron signatures, of a PDW state coexisting with superconductivity in Bi2Sr2CaCu2O8+δ.

9.
Proc Natl Acad Sci U S A ; 117(10): 5222-5227, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32094178

RESUMO

Sr2RuO4 has long been the focus of intense research interest because of conjectures that it is a correlated topological superconductor. It is the momentum space (k-space) structure of the superconducting energy gap [Formula: see text] on each band i that encodes its unknown superconducting order parameter. However, because the energy scales are so low, it has never been possible to directly measure the [Formula: see text] of Sr2RuO4 Here, we implement Bogoliubov quasiparticle interference (BQPI) imaging, a technique capable of high-precision measurement of multiband [Formula: see text] At T = 90 mK, we visualize a set of Bogoliubov scattering interference wavevectors [Formula: see text] consistent with eight gap nodes/minima that are all closely aligned to the [Formula: see text] crystal lattice directions on both the α and ß bands. Taking these observations in combination with other very recent advances in directional thermal conductivity [E. Hassinger et al., Phys. Rev. X 7, 011032 (2017)], temperature-dependent Knight shift [A. Pustogow et al., Nature 574, 72-75 (2019)], time-reversal symmetry conservation [S. Kashiwaya et al., Phys. Rev B, 100, 094530 (2019)], and theory [A. T. Rømer et al., Phys. Rev. Lett. 123, 247001 (2019); H. S. Roising, T. Scaffidi, F. Flicker, G. F. Lange, S. H. Simon, Phys. Rev. Res. 1, 033108 (2019); and O. Gingras, R. Nourafkan, A. S. Tremblay, M. Côté, Phys. Rev. Lett. 123, 217005 (2019)], the BQPI signature of Sr2RuO4 appears most consistent with [Formula: see text] having [Formula: see text] [Formula: see text] symmetry.

10.
Nature ; 571(7764): 234-239, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31270461

RESUMO

Magnetic monopoles1-3 are hypothetical elementary particles with quantized magnetic charge. In principle, a magnetic monopole can be detected by the quantized jump in magnetic flux that it generates upon passage through a superconducting quantum interference device (SQUID)4. Following the theoretical prediction that emergent magnetic monopoles should exist in several lanthanide pyrochlore magnetic insulators5,6, including Dy2Ti2O7, the SQUID technique has been proposed for their direct detection6. However, this approach has been hindered by the high number density and the generation-recombination fluctuations expected of such thermally generated monopoles. Recently, theoretical advances have enabled the prediction of the spectral density of magnetic-flux noise from monopole generation-recombination fluctuations in these materials7,8. Here we report the development of a SQUID-based flux noise spectrometer and measurements of the frequency and temperature dependence of magnetic-flux noise generated by Dy2Ti2O7 crystals. We detect almost all of the features of magnetic-flux noise predicted for magnetic monopole plasmas7,8, including the existence of intense magnetization noise and its characteristic frequency and temperature dependence. Moreover, comparisons of simulated and measured correlation functions of the magnetic-flux noise indicate that the motions of magnetic charges are strongly correlated. Intriguingly, because the generation-recombination time constant for Dy2Ti2O7 is in the millisecond range, magnetic monopole flux noise amplified by SQUID is audible to humans.

11.
Nature ; 570(7762): 484-490, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31217587

RESUMO

For centuries, the scientific discovery process has been based on systematic human observation and analysis of natural phenomena1. Today, however, automated instrumentation and large-scale data acquisition are generating datasets of such large volume and complexity as to defy conventional scientific methodology. Radically different scientific approaches are needed, and machine learning (ML) shows great promise for research fields such as materials science2-5. Given the success of ML in the analysis of synthetic data representing electronic quantum matter (EQM)6-16, the next challenge is to apply this approach to experimental data-for example, to the arrays of complex electronic-structure images17 obtained from atomic-scale visualization of EQM. Here we report the development and training of a suite of artificial neural networks (ANNs) designed to recognize different types of order hidden in such EQM image arrays. These ANNs are used to analyse an archive of experimentally derived EQM image arrays from carrier-doped copper oxide Mott insulators. In these noisy and complex data, the ANNs discover the existence of a lattice-commensurate, four-unit-cell periodic, translational-symmetry-breaking EQM state. Further, the ANNs determine that this state is unidirectional, revealing a coincident nematic EQM state. Strong-coupling theories of electronic liquid crystals18,19 are consistent with these observations.

12.
Proc Natl Acad Sci U S A ; 116(27): 13249-13254, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31160468

RESUMO

The CuO2 antiferromagnetic insulator is transformed by hole-doping into an exotic quantum fluid usually referred to as the pseudogap (PG) phase. Its defining characteristic is a strong suppression of the electronic density-of-states D(E) for energies |E| < [Formula: see text], where [Formula: see text] is the PG energy. Unanticipated broken-symmetry phases have been detected by a wide variety of techniques in the PG regime, most significantly a finite-Q density-wave (DW) state and a Q = 0 nematic (NE) state. Sublattice-phase-resolved imaging of electronic structure allows the doping and energy dependence of these distinct broken-symmetry states to be visualized simultaneously. Using this approach, we show that even though their reported ordering temperatures T DW and T NE are unrelated to each other, both the DW and NE states always exhibit their maximum spectral intensity at the same energy, and using independent measurements that this is the PG energy [Formula: see text] Moreover, no new energy-gap opening coincides with the appearance of the DW state (which should theoretically open an energy gap on the Fermi surface), while the observed PG opening coincides with the appearance of the NE state (which should theoretically be incapable of opening a Fermi-surface gap). We demonstrate how this perplexing phenomenology of thermal transitions and energy-gap opening at the breaking of two highly distinct symmetries may be understood as the natural consequence of a vestigial nematic state within the pseudogap phase of Bi2Sr2CaCu2O8.

13.
Science ; 364(6444): 976-980, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31171694

RESUMO

High magnetic fields suppress cuprate superconductivity to reveal an unusual density wave (DW) state coexisting with unexplained quantum oscillations. Although routinely labeled a charge density wave (CDW), this DW state could actually be an electron-pair density wave (PDW). To search for evidence of a field-induced PDW, we visualized modulations in the density of electronic states N(r) within the halo surrounding Bi2Sr2CaCu2O8 vortex cores. We detected numerous phenomena predicted for a field-induced PDW, including two sets of particle-hole symmetric N(r) modulations with wave vectors QP and 2Q P , with the latter decaying twice as rapidly from the core as the former. These data imply that the primary field-induced state in underdoped superconducting cuprates is a PDW, with approximately eight CuO2 unit-cell periodicity and coexisting with its secondary CDWs.

14.
Nat Commun ; 9(1): 5210, 2018 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-30523265

RESUMO

In cuprate superconductors, the doping of carriers into the parent Mott insulator induces superconductivity and various other phases whose characteristic temperatures are typically plotted versus the doping level p. In most materials, p cannot be determined from the chemical composition, but it is derived from the superconducting transition temperature, Tc, using the assumption that the Tc dependence on doping is universal. Here, we present angle-resolved photoemission studies of Bi2Sr2CaCu2O8+δ, cleaved and annealed in vacuum or in ozone to reduce or increase the doping from the initial value corresponding to Tc = 91 K. We show that p can be determined from the underlying Fermi surfaces and that in-situ annealing allows mapping of a wide doping regime, covering the superconducting dome and the non-superconducting phase on the overdoped side. Our results show a surprisingly smooth dependence of the inferred Fermi surface with doping. In the highly overdoped regime, the superconducting gap approaches the value of 2Δ0 = (4 ± 1)kBTc.

15.
Nat Mater ; 17(10): 869-874, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30177690

RESUMO

Strong electronic correlations, emerging from the parent Mott insulator phase, are key to copper-based high-temperature superconductivity. By contrast, the parent phase of an iron-based high-temperature superconductor is never a correlated insulator. However, this distinction may be deceptive because Fe has five actived d orbitals while Cu has only one. In theory, such orbital multiplicity can generate a Hund's metal state, in which alignment of the Fe spins suppresses inter-orbital fluctuations, producing orbitally selective strong correlations. The spectral weights Zm of quasiparticles associated with different Fe orbitals m should then be radically different. Here we use quasiparticle scattering interference resolved by orbital content to explore these predictions in FeSe. Signatures of strong, orbitally selective differences of quasiparticle Zm appear on all detectable bands over a wide energy range. Further, the quasiparticle interference amplitudes reveal that [Formula: see text], consistent with earlier orbital-selective Cooper pairing studies. Thus, orbital-selective strong correlations dominate the parent state of iron-based high-temperature superconductivity in FeSe.

16.
Proc Natl Acad Sci U S A ; 115(21): 5389-5391, 2018 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-29728464

RESUMO

There has been growing speculation that a pair density wave state is a key component of the phenomenology of the pseudogap phase in the cuprates. Recently, direct evidence for such a state has emerged from an analysis of scanning tunneling microscopy data in halos around the vortex cores. By extrapolation, these vortex halos would then overlap at a magnetic-field scale where quantum oscillations have been observed. Here, we show that a biaxial pair density wave state gives a unique description of the quantum oscillation data, bolstering the case that the pseudogap phase in the cuprates may be a pair density wave state.

17.
Science ; 357(6346): 75-80, 2017 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-28684522

RESUMO

The superconductor iron selenide (FeSe) is of intense interest owing to its unusual nonmagnetic nematic state and potential for high-temperature superconductivity. But its Cooper pairing mechanism has not been determined. We used Bogoliubov quasiparticle interference imaging to determine the Fermi surface geometry of the electronic bands surrounding the Γ = (0, 0) and X = (π/aFe, 0) points of FeSe and to measure the corresponding superconducting energy gaps. We show that both gaps are extremely anisotropic but nodeless and that they exhibit gap maxima oriented orthogonally in momentum space. Moreover, by implementing a novel technique, we demonstrate that these gaps have opposite sign with respect to each other. This complex gap configuration reveals the existence of orbital-selective Cooper pairing that, in FeSe, is based preferentially on electrons from the d yz orbitals of the iron atoms.

18.
Proc Natl Acad Sci U S A ; 113(45): 12661-12666, 2016 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-27791157

RESUMO

Theories based upon strong real space (r-space) electron-electron interactions have long predicted that unidirectional charge density modulations (CDMs) with four-unit-cell (4a0) periodicity should occur in the hole-doped cuprate Mott insulator (MI). Experimentally, however, increasing the hole density p is reported to cause the conventionally defined wavevector QA of the CDM to evolve continuously as if driven primarily by momentum-space (k-space) effects. Here we introduce phase-resolved electronic structure visualization for determination of the cuprate CDM wavevector. Remarkably, this technique reveals a virtually doping-independent locking of the local CDM wavevector at [Formula: see text] throughout the underdoped phase diagram of the canonical cuprate Bi2Sr2CaCu2O8 These observations have significant fundamental consequences because they are orthogonal to a k-space (Fermi-surface)-based picture of the cuprate CDMs but are consistent with strong-coupling r-space-based theories. Our findings imply that it is the latter that provides the intrinsic organizational principle for the cuprate CDM state.

19.
Nature ; 532(7599): 343-7, 2016 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-27074504

RESUMO

The quantum condensate of Cooper pairs forming a superconductor was originally conceived as being translationally invariant. In theory, however, pairs can exist with finite momentum Q, thus generating a state with a spatially modulated Cooper-pair density. Such a state has been created in ultracold (6)Li gas but never observed directly in any superconductor. It is now widely hypothesized that the pseudogap phase of the copper oxide superconductors contains such a 'pair density wave' state. Here we report the use of nanometre-resolution scanned Josephson tunnelling microscopy to image Cooper pair tunnelling from a d-wave superconducting microscope tip to the condensate of the superconductor Bi2Sr2CaCu2O8+x. We demonstrate condensate visualization capabilities directly by using the Cooper-pair density variations surrounding zinc impurity atoms and at the Bi2Sr2CaCu2O8+x crystal supermodulation. Then, by using Fourier analysis of scanned Josephson tunnelling images, we discover the direct signature of a Cooper-pair density modulation at wavevectors QP ≈ (0.25, 0)2π/a0 and (0, 0.25)2π/a0 in Bi2Sr2CaCu2O8+x. The amplitude of these modulations is about five per cent of the background condensate density and their form factor exhibits primarily s or s' symmetry. This phenomenology is consistent with Ginzburg-Landau theory when a charge density wave with d-symmetry form factor and wavevector QC = QP coexists with a d-symmetry superconductor; it is also predicted by several contemporary microscopic theories for the pseudogap phase.

20.
Osteoporos Int ; 27(3): 943-951, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26449355

RESUMO

SUMMARY: Falls are a costly public health problem worldwide. The literature is devoid of prospective data that identifies factors among fallers that significantly drive health care resource utilization. We found that cognitive function--specifically, executive functions--and cognitive status are significant determinants of health resource utilization among older fallers. INTRODUCTION: Although falls are costly, there are no prospective data examining factors among fallers that drive health care resource utilization. We identified key determinants of health resource utilization (HRU) at 6 and 12 months among older adults with a history of falls. Specifically, with the increasing recognition that cognitive impairment is associated with increased falls risk, we investigated cognition as a potential driver of health resource utilization. METHODS: This 12-month prospective cohort study at the Vancouver Falls Prevention Clinic (n = 319) included participants with a history of at least one fall in the previous 12 months. Based on their cognitive status, participants were divided into two groups: (1) no mild cognitive impairment (MCI) and (2) MCI. We constructed two linear regression models with HRU at 6 and 12 months as the dependent variables for each model, respectively. Predictors relating to mobility, global cognition, executive functions, and cognitive status (MCI versus no MCI) were examined. Age, sex, comorbidities, depression status, and activities of daily living were included regardless of statistical significance. RESULTS: Global cognition, comorbidities, working memory, and cognitive status (MCI versus no MCI ascertained using the Montreal Cognitive Assessment (MoCA)) were significant determinants of total HRU at 6 months. The number of medical comorbidities and global cognition were significant determinants of total HRU at 12 months. CONCLUSION: MCI status was a determinant of HRU at 6 months among older adults with a history of falls. As such, efforts to minimize health care resource use related to falls, it is important to tailor future interventions to be effective for people with MCI who fall. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01022866.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Disfunção Cognitiva/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Colúmbia Britânica/epidemiologia , Cognição , Disfunção Cognitiva/psicologia , Estudos de Coortes , Comorbidade , Função Executiva , Feminino , Avaliação Geriátrica/métodos , Humanos , Estudos Longitudinais , Masculino , Limitação da Mobilidade , Testes Neuropsicológicos , Equilíbrio Postural , Estudos Prospectivos , Fatores de Risco
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