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The patient education process has 4 equal components to be addressed by the nurse: assessment, planning, implement, and evaluation. Excellent patient education is an "art" and "science" using nuances and evidence-based strategies to effectively educate. The assessment and evaluation components often use nuanced approaches (motivational interviewing, teach back) to engage the patient/caregiver respectfully, whereas planning and implementation rely more on evidence-based strategies such as the Patient Education Assessment of Materials. Nurses should provide education that is simple, patient centered, and multimodal to meet the health literacy needs of patients/caregivers., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Controlling the 3-D morphology of nanocatalysts is one of the underexplored but important approaches for improving the sluggish kinetics of the oxygen evolution reaction (OER) in water electrolysis. This work reports a scalable, oil-based method based on thermal decomposition of organometallic complexes to yield highly uniform Ni-Fe-based nanocatalysts with a well-defined morphology (i.e. Ni-Fe core-shell, Ni/Fe alloy, and Fe-Ni core-shell). Transmission electron microscopy reveals their morphology and composition to be NiOx-FeOx/NiOx core-mixed shell, NiOx/FeOx alloy, and FeOx-NiOx core-shell. X-ray techniques resolve the electronic structures of the bulk and are supported by electron energy loss spectroscopy analysis of individual nanoparticles. These results suggest that the crystal structure of Ni is most likely to contain α-Ni(OH)2 and that the chemical environment of Fe is variable, depending on the morphology of the nanoparticle. The Ni diffusion from the amorphous Ni-based core to the iron oxide shell makes the NiOx-NiOx/FeOx core-mixed shell structure the most active and the most stable nanocatalyst, which outperforms the comparison NiOx/FeOx alloy nanoparticles expected to be active for the OER. This study suggests that the chemical environment of the mixed NiOx/FeOx alloy composition is important to achieve high electrocatalytic activity for the OER and that the 3-D morphology plays a key role in the optimization of the electrocatalytic activity and stability of the nanocatalyst for the OER.

Background: Low health literacy in older adults has been associated with poor health outcomes (i.e., mortality, decreased physical and cognitive functioning, and less preventive care utilization). Many factors associated with low health literacy are also associated with health disparities. Interaction with healthcare providers and sources of health information are influenced by an individual's health literacy and can impact health outcomes., Purpose: This study examined the relationships between health literacy, sources of health information, and demographic/background characteristics in older adults (aged 65 years and older) related to health literacy and disparities., Methods: This descriptive, correlational study is a secondary analysis of the 2003 National Assessment of Adult Literacy, a large-scale national assessment., Results: Older adults with lower health literacy have less income and education, rate their health as poor or fair, have visual or auditory difficulties, need help filling out forms, reading newspaper, or writing notes, and use each source of health information less (print and nonprint). Many of these characteristics and skills are predictive of health literacy and associated with health disparities., Conclusion: The results expand our knowledge of characteristics associated with health literacy and sources of health information used by older adults. Interventions to improve health outcomes including health disparities can focus on recognizing and meeting the health literacy demands of older adults.

Polydopamine is a bioinspired, versatile material that can adhere to bulk and nanoscale surfaces made of disparate materials to improve their physical and chemical properties in many applications. The typical methods to coat polydopamine on the nanoparticle substrates usually take several hours to a day. This work successfully applies a dispersion method to form a controllable, uniform coating on a nanoparticle surface within minutes. Using plasmonic Ag nanoparticles as a substrate, the coating thickness can be monitored using a spectroscopic method based on the extinction peak shifts of the Ag nanoparticles. The deposition rate increases with dopamine concentration; however, too much excess dopamine leads to the formation of free dopamine particles. The optimized concentration of dopamine (i.e., ∼6 mM) can be applied to other nanoparticles by normalizing the number of particles to maintain a constant concentration of dopamine per unit surface area (i.e., 1.70 × 10 4 dopamine/nm 2 ). The molecular dynamics simulation reveals that the amount of hydrogen bonding increases with water content, suggesting that sufficient mixing using the dispersion tool facilitates the formation of hydrogen bonding, thus rapidly depositing PDA on the nanoparticle surface. The physical and chemical properties (e.g., pH response and thermal stability) can be tailored by varying the coating thickness due to the changes in the number of hydrogen bonds and the conformation of π-π interactions. This dispersion method provides a facile means to control the PDA coating thickness on nanoparticle surfaces and thus the surface properties of nanoparticles toward various applications.

Healthcare professionals teach patients and families about their health every day. Regulatory and accreditation organizations mandate patient and family education to promote better health outcomes. And recently, financial rewards for healthcare organizations are being tied to patient satisfaction (Hospital Consumer Assessment of Healthcare Providers and Systems-HCAHPS). A University of Pennsylvania Health System group of staff and patients, devoted to excellence in patient and family education, developed the graphic "R.E.A.C.H. to Teach." The purpose of the graphic is to make evidence-based practice (EBP) for patient and family education "stick" with staff. The group used concepts from the marketing book, Made to Stick, to demonstrate how to develop effective staff and patient and family education. Ideas (education) that survive ("stick") have the following attributes: simple, unexpected, concrete, credible, emotional, and narrative (story). This article demonstrates how to apply these principles and EBP to patient and family education.

Background: Despite the importance of reducing inpatient mortality, little has been reported about establishing a hospitalwide, systematic process to review and address inpatient deaths. In 2006 the University of Pennsylvania Health System's Mortality Review Committee was established and charged with reducing inpatient mortality as measured by the mortality index--observed/expected mortality., Methods: Between 2006 and 2012, through interdisciplinary meetings and analysis of administrative data and chart reviews, the Mortality Review Committee identified a number of opportunities for improvement in the quality of patient care. Several programmatic interventions, such as those aimed at improving sepsis and delirium recognition and management, were initiated through the committee., Results: During the committee's first six years of activity, the University HealthSystem Consortium (UHC) mortality index decreased from 1.08 to 0.53, with observed mortality decreasing from 2.45% to 1.62%. Interventions aimed at improving sepsis management implemented between 2007 and 2008 were associated with increases in severe sepsis survival from 40% to 56% and septic shock survival from 42% to 54%. The mortality index for sepsis decreased from 2.45 to 0.88. Efforts aimed at improving delirium management implemented between 2008 and 2009 were associated with an increase in the proportion of patients receiving a "timely" intervention from 18% to 57% and with a twofold increase in the percentage of patients discharged to home., Discussion: The establishment of a mortality review committee was associated with a significant reduction in the mortality index. Keys to success include interdisciplinary membership, partnerships with local providers, and a multipronged approach to identifying important clinical opportunities and to implementing effective interventions.

Conducted energy weapons (CEWs) (including the Advanced TASER(®) X26 model produced by TASER International, Inc.) incapacitate individuals by causing muscle contractions. In this study using anesthetized swine, the potential incapacitating effect of primarily monophasic, 19-Hz voltage imposed by the commercial CEW was compared with the effect of voltages imposed by a laboratory device that created 40-Hz square waves. Forces of muscle contraction were measured with the use of strain gauges. Stimulation with 40-Hz square waves required less pulse energy than stimulation with the commercial CEW to produce similar muscle contraction. The square-pulse stimulation, at the higher repetition rate, caused a more complete tetanus at a lower energy. Use of such a simple shape of waveform may be used to make future nonlethal weapon devices more efficient., (© 2013 American Academy of Forensic Sciences Published 2013. This article is a U.S. Government work and is in the public domain in the U.S.A.)

Water adsorption on kaolinite, illite, and montmorillonite clays was studied as a function of relative humidity (RH) at room temperature (298 K) using horizontal attenuated total reflectance (HATR) Fourier transform infrared (FTIR) spectroscopy equipped with a flow cell. The water content as a function of RH was modeled using the Brunauer, Emmett, and Teller (BET) and Freundlich adsorption isotherm models to provide complementary multilayer adsorption analysis of water uptake on the clays. A detailed analysis of model fit integrity is reported. From the BET fit to the experimental data, the water content on each of the three clays at monolayer (ML) water coverage was determined and found to agree with previously reported gravimetric data. However, BET analysis failed to adequately describe adsorption phenomena at RH values greater than 80%, 50%, and 70% RH for kaolinite, illite, and montmorillonite clays, respectively. The Freundlich adsorption model was found to fit the data well over the entire range of RH values studied and revealed two distinct water adsorption regimes. Data obtained from the Freundlich model showed that montmorillonite has the highest water adsorption strength and highest adsorption capacity at RH values greater than 19% (i.e., above ML water adsorption) relative to the kaolinite and illite clays. The difference in the observed water adsorption behavior between the three clays was attributed to different water uptake mechanisms based on a distribution of available adsorption sites. It is suggested that different properties drive water adsorption under different adsorption regimes resulting in the broad variability of water uptake mechanisms.

The geriatric population has the highest rate of low health literacy when compared with other age groups. To maximize health outcomes with this group, healthcare providers have an obligation to recognize individuals with potential for low health literacy and educate these patients in a manner that ensures understanding. Research and clinical experience have demonstrated several interventions that are useful in providing effective health education including the use of the teach-back technique, multimedia material including visual aids, simple and clear language, support persons, and experiences. The cases presented in this article emphasize awareness of individuals at risk for low health literacy and interventions that are effective in helping patients understand how to care for themselves.

Electronic control devices (including the Advanced TASER(®) X26 model produced by TASER International) incapacitate individuals by causing muscle contractions. To provide information relevant to development of future potential devices, effects of monophasic square waves with different parameters were compared with those of the X26 electronic control device, using two animal models (frogs and swine). Pulse power, electrical pulse charge, pulse duration, and pulse repetition frequency affected muscle contraction. There was no difference in the charge required, between the square waveform and the X26 waveform, to cause approximately the same muscle-contraction response (in terms of the strength-duration curve). Thus, on the basis of these initial studies, the detailed shape of a waveform may not be important in terms of generating electro-muscular incapacitation. More detailed studies, however, may be required to thoroughly test all potential waveforms to be considered for future use in ECDs., (2010 American Academy of Forensic Sciences. Published 2010. This article is a U.S. Government work and is in the public domain in the U.S.A.)

Healthcare professionals believe that it is important for patients to be educated about health for optimal outcomes. For education to occur, healthcare professionals need to know where patients seek information. The concept of health information-seeking behavior (HISB) focuses on how patients obtain information (strategies/actions). Theories/ models are presented to describe how patients obtain information and what they do with information that is available. The most recent HISB research has examined the use of the Internet for health information. Although the Internet is utilized by many individuals, studies show that the most common and trusted source of information is healthcare professionals. Individuals use other sources of health information (e.g., TV, radio, newspaper, magazines, Internet, and family/friends/coworkers) to supplement information provided by healthcare professionals. When and how individuals use supplemental information varies and is associated with many factors such as race, education, income, health literacy, and health status. Utilizing health information also depends on an individual's health orientation. As nurses, we need to utilize knowledge about HISB to assist patients in obtaining health information to optimize health outcomes.

Most individuals view ethics in healthcare as reserved only for dramatic situations such as withdrawing life support. However, almost everyday, routine decisions in healthcare involve ethics. Providing patient education in an effective manner depends upon using an ethical approach. This article discusses various philosophical approaches to making ethical decisions in healthcare, specifically patient and family and education; however, the main purpose of the article is the application of the Symphonological approach utilizing case studies.

For adults, prior information about an individual's likely goals, preferences or dispositions plays a powerful role in interpreting ambiguous behavior and predicting and interpreting behavior in novel contexts. Across two studies, we investigated whether 10-month-old infants' ability to identify the goal of an ambiguous action sequence was facilitated by seeing prior instances in which the actor directly pursued and obtained her goal, and whether infants could use this prior information to understand the actor's behavior in a new context. Experiment 1 demonstrated that the goal preview impacted infants' subsequent action understanding, but only if the preview was delivered in the same room as the subsequent action sequence. Experiment 2 demonstrated that infants' failure to transfer prior goal information across situations arose from a change in the room per se and not other features of the task. Our results suggest that infants may use their understanding of simple actions as a leverage point for understanding novel or ambiguous actions, but that their ability to do so is limited to certain types of contextual changes.

Health literacy refers to an individual's ability to understand healthcare information to make appropriate decisions. Healthcare professionals are obligated to make sure that patients understand information to maximize the benefits of healthcare. The National Assessment of Adult Literacy (NAAL) provides information on the literacy/health literacy levels of the U.S. adult population. The NAAL is the only large-scale survey of health literacy. The results of the NAAL provide information on literacy/health literacy and the relationship between background variables and literacy/health literacy. Multiple variables with potential for a relationship with literacy/health literacy were chosen for the NAAL including, but not limited to, education, language, race, gender, income, overall health, seeking health information, and health insurance.

Prior work suggests that active experience affects infants' understanding of simple actions. The present studies compared the impact of active and observational experience on infants' ability to identify the goal of a novel tool-use event. Infants either received active training and practice in using a cane to retrieve an out-of-reach toy or had matched observational experience before taking part in a habituation paradigm that we used to assess infants' ability to identify the goal of another person's tool-use acts. Active training alone facilitated 10-month-old infants' ability to identify the goal of the tool-use event. Active experience using tools may enable infants to build motor representations of tool-use events that subsequently guide action perception and support action understanding.

Educating the older adult about healthcare information can be a challenge because of the cognitive decline that accompanies the aging process. This article focuses on the cognitive "resources" that have been linked to declines in cognition: sensory input, processing speed, working memory, and inhibition. Although much attention is focused on the cognitive losses that occur with aging, there are also "gains" such as wisdom that assist the older adult in learning healthcare information. The nurse's understanding of "resources" and "gains" will assist her in choosing effective teaching strategies to use with older individuals.

The concept of health literacy is a recent addition to healthcare literature, appearing in the early to mid 1990s. Health literacy refers to individuals' ability to understand their healthcare issues and effectively care for themselves in the healthcare system. Individuals' health literacy abilities vary greatly and can be viewed on a continuum ranging from adequate to marginal to inadequate. Repeated research has demonstrated that older individuals, the geriatric patient population, are at risk of inadequate or marginal health literacy. This risk impacts health outcomes and cost for caring for the older people in our society who are the consumers of a large quantity of healthcare services. The demographic data from the research show that multiple factors influence an individual's health literacy. Besides age, individuals with less education, lower income, "blue collar" jobs, and poor health status (mental and physical) can be at risk of marginal or inadequate health literacy. Providing care to low health literacy patients is complicated by commercially prepared healthcare materials and presentations that are often written well above the average national literacy level. Studies in this review examine various approaches to healthcare education and provide viable options for educating those with low health literacy. This review stresses the importance of healthcare professionals identifying older individuals with marginal or inadequate health literacy and being able to provide education in an effective manner to this segment of the population.

In the last decade, the Internet has become a vast resource for healthcare information. Multiple Web sites, produced by the federal government, healthcare institutions, and individual healthcare providers, give Americans a wealth of useful information sources. Nurses recognize that more Americans than ever before are using the Internet and that nurses are in an excellent position to help patients learn how to search for healthcare topics and evaluate the information found. This article will focus on seeking information, judging the quality of the information, and listing specific Web sites.

Objective: COX-2 activation may mediate capecitabine induced toxicities, eg, hand-foot syndrome (HFS) and colorectal cancer progression, both of which may be improved by concurrent celecoxib., Patients and Methods: From October 2000 to December 2003, 66 patients with metastatic colorectal cancer received concurrent capecitabine at 1000 mg/m/d b.i.d. and celecoxib at 200 mg b.i.d. (XCEL). Twenty-four patients were chemo-naive, 42 patients were second-line; while 34 had XCEL with radiation., Results: The median duration of XCEL was 7.2 months (range, 1.5-38 months). Ninety percent of Grade 2/3 HFS (17%) occurred after 6 months and incidence of grade 3/4 diarrheas was 8%. The overall response rate was 38% (95% confidence interval [CI], 26-51%), with 11 patients (17%) achieving complete responses and 2 patients (3%) with near complete responses. Six patients (9%) become resectable after sustaining treatment response. The median progression-free survival (PFS) and overall survival (OS) was 8.3 months (95% CI, 7.0-11.0 months) and 22 months (95% CI, 17.8-31.5 months), respectively. Improved median PFS of 14.5 months (P = 0.0001) and OS of 31.5 months (P = 0.005) were noted in patients with normal lactate dehydrogenase (LDH) levels (n = 37) than patients with high levels of LDH (n = 29)., Conclusions: XCEL integrating radiation may improve response rate and survival and reduce toxicities, notably HFS for patients with metastatic colorectal cancer, leading to a randomized phase III study.

Providing culturally congruent patient and family education is crucial for the current U.S. society. The advances in medicine and changes in the U.S. healthcare system require that patients take a more active role in their healthcare. To assist patients in assuming this role, nurses must be prepared to teach all members of the multicultural U.S. society. This article will provide information on transcultural nursing models, approaches to assessing a patient's culture, and strategies for working in cross-cultural situations.

Despite teaching endeavors, nurses are constantly faced with patients who do not understand how to manage their healthcare. This problem has come to the forefront of healthcare issues. As a society, there is concern that despite medical advances, progress with healthcare may be in jeopardy because the skills needed by patients to manage their care are insufficient. This issue is affected by many factors. One of the most prominent factors is the lack of patient health literacy skill assessment. One of the first and most basic parts of the nursing process is to assess the patient. To teach patients, we must identify their learning needs, but the assessment cannot stop there. Nurses need to know patients' health literacy skills so that they can teach them in the best manner possible. This article provides specific information on health literacy assessment tools and the skills needed by nurses to use these tools. Each nurse must decide what tools will work for his or her patients, so that in the end, each patient will understand how to manage his or her healthcare.

Background and Objectives: Terawatt (TW) lasers have become commonplace since the development of the chirped-pulse amplification method using Ti:sapphire and Nd:glass laser rods. We have measured the minimum visible lesion (MVL) thresholds for porcine1The animals involved in this study were procured, maintained, and used in accordance with the Federal Animal Welfare Act and the "Guide for the Care and Use of Laboratory Animals" prepared by the Institute of Laboratory Animal Resources-National Research Council. Brooks City-Base, TX has been fully accredited by the Association for Assessment and Accreditation of Laboratory Animal Care, International (AAALAC) since 1967. (Yucatan mini-pig) skin using TW laser pulses., Study Design/materials and Methods: Our system produced laser pulses at 810 nm and sub-50 femtoseconds. These 1-2 TW laser pulses created multiple self-focusing (SF) filaments during propagation and were directed on the flanks of mini-pigs under anesthesia. We measured the pulse energies necessary to determine the ED(50) skin damage thresholds., Results: The MVL ED(50) threshold at 1 hour was 8 mJ and increased to 21 mJ after 24 hours. Histological sections were obtained after 1-hour and 24-hour readings., Conclusions: The damage patterns on the skin indicated the number of filaments in the laser pulse. Many of the pulses produced only superficial damage that disappeared in 24 hours and that nearly three times the pulse energy was required to cause subdural or cellular damage. With further research, non-thermal tissue ablation using TW laser pulses could provide a viable alternative to current techniques of laser use in dermatology., ((c) 2005 Wiley-Liss, Inc.)

Developing quality continuing nursing education for contact-hour approval requires a basic understanding of the continuing nursing education (CNE) system and the application process through the National Association of Orthopaedic Nurses (NAON). The Approver Unit of NAON helps CNE providers (i.e., members, chapters, and corporate members) develop education activities and obtain contact hour approval. This article contains the latest information on CNE terminology and the application process for contact hour approval through NAON.

Much controversy still surrounds accusations that American forces in the Far East during the Korean War used biological warfare against North Korea and China. An analysis of recently declassified documents reveals that, although the United States attempted to accelerate its development and acquisition of such weapons during that period, its efforts to create a viable biological warfare capability were unsuccessful. Plans to similarly expand chemical warfare stocks and capabilities were also frustrated. Technological difficulties, personnel shortages, bureaucratic battles between the armed services, and policy limitations combined to hold back advances in American chemical and biological warfare. In light of the recent fears of terrorist attacks with such weapons, this analysis highlights the great difficulties involved in developing, acquiring, and delivering such capabilities.