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Discusses the use of the magneto-optical Kerr effect to study the magnetic properties of an ultrathin epitaxial cobalt wedge grown on platinum(111). Application of the Kerr domain imaging to investigate the spin-reversal mechanism in the cobalt layers; Information on the magnetic measuring technique; Results of anisotropy.

Presents information on a study which applied local and polar Kerr effect measurements on an epitaxial cobalt wedge grown on palladium. Experimental procedure; Results; Discussion.

The mating effort questionnaire (MEQ) is a multi-dimensional self-report instrument that captures factors reflecting individual effort in upgrading from a current partner, investment in a current partner, and mate seeking when not romantically paired. In the current studies, we sought to revise the MEQ so that it distinguishes among two facets of mate seeking-mate locating and mate attracting-to enable a more nuanced measurement and understanding of individual mating effort. Moreover, we developed additional items to better measure partner investment. In total, the number of items was increased from 12 to 26. In Study 1, exploratory factor analysis revealed that a four-factor solution, reflecting partner upgrading, mate locating, mate attracting, and partner investment, yielded the best fit. In Study 2, this structure was replicated using confirmatory factor analysis in an independent sample. Based on extant studies documenting the relationships between psychopathy, short-term mating effort, and sexual risk taking, a structural equation model (SEM) indicated that trait psychopathy positively predicted mate locating, mate attracting, and partner upgrading and negatively predicted partner investment. A separate SEM showed that partner upgrading positively predicted risky sexual behaviors, while partner upgrading and mate locating positively predicted acceptance of cosmetic surgery., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: The patient-centered medical home (PCMH) may provide a key model for ambulatory patient safety. Our objective was to explore which PCMH and patient safety implementation and social network factors may be necessary or sufficient for higher patient safety culture., Methods: This was a cross-case analysis study in 25 diverse U.S. PCMHs. Data sources included interviews of a clinician and an administrator in each PCMH, surveys of clinicians and staff, and existing data on the PCMHs' characteristics. We used coincidence analysis, a novel method based on set theory and Boolean logic, to evaluate relationships between factors and the implementation outcome of patient safety culture., Results: The coincidence analysis identified 5 equally parsimonious solutions (4 factors), accounting for all practices with higher safety culture. Three solutions contained the same core minimally sufficient condition: the implementation factor leadership priority for patient safety and the social network factor reciprocity in advice-seeking network ties (advice-seeking relationships). This minimally sufficient condition had the highest coverage (5/7 practices scoring higher on the outcome) and best performance across solutions; all included leadership priority for patient safety. Other key factors included self-efficacy and job satisfaction and quality improvement climate. The most common factor whose absence was associated with the outcome was a well-functioning process for behavioral health., Conclusions: Our findings suggest that PCMH safety culture is higher when clinicians and staff perceive that leadership prioritizes patient safety and when high reciprocity among staff exists. Interventions to improve patient safety should consider measuring and addressing these key factors., Competing Interests: The authors disclose no conflict of interest. This research was funded by the Agency for Healthcare Research and Quality (grant number R01 HS024859). The views expressed are those of the authors and not necessarily those of the Agency for Healthcare Research and Quality., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

In this article we attend to recent critiques of psychometric applications of life history (LH) theory to variance among humans and develop theory to advance the study of latent LH constructs. We then reanalyze data (n = 4,244) previously examined by Richardson et al. (Evolutionary Psychology, 15(1), 2017, https://doi.org/10.1177/1474704916666840 to determine whether (a) previously reported evidence of multidimensionality is robust to the modeling approach employed and (b) the structure of LH indicators is invariant by sex. Findings provide further evidence that a single LH dimension is implausible and that researchers should cease interpreting K-factor scores as empirical proxies for LH speed. In contrast to the original study, we detected a small inverse correlation between mating competition and Super-K that is consistent with a trade-off. Tests of measurement invariance across the sexes revealed evidence of metric invariance (i.e., equivalence of factor loadings), consistent with the theory that K is a proximate cause of its indicators; however, evidence of partial scalar invariance suggests use of scores likely introduces bias when the sexes are compared. We discuss limitations and identify approaches that researchers may use to further evaluate the validity of the K-factor and other applications of LH to human variation., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Health research is published at a breathtaking pace and quantity; however, even when research is systematically developed into best practices and/or clinical guidelines, it often is not implemented into practice. Project ECHO ( E xtension for C ommunity H ealthcare O utcomes) is an evidence-based professional development approach that can help nurses to stay current and apply new knowledge to practice. The purpose of this article is to describe ECHO as a model for professional development and capacity building through learning networks. This article describes the ECHO model, evidence supporting its use, the infrastructure needed to implement an ECHO network, and two nursing ECHO learning networks. [ J Contin Educ Nurs . 2021;52(4):198-204.] .

Objectives: We examined anticipated preferences for end-of-life (EOL) care in healthy older adults in the context of various terminal disease scenarios to explore the relationship between personal values and diseases and conditions that would influence EOL care choices., Methods: Qualitative Descriptive Analysis was used to derive themes and the relationship between EOL preference themes and personal value themes in 365 respondents in a national sample of healthy older adults who completed a survey on their anticipated preferences for end-of-life (EOL) care., Results: Reluctance to burden close others was the most frequently voiced personal value across all conditions affecting EOL preferences, followed by the personal value of quality of life. Concern about whether one's wishes would be honored was more commonly voiced in the context of hypothetical, prospective terminal cancer than in neurological conditions. Respondents who voiced desire for autonomy in how they would die clearly attributed extreme pain as the primary influence on EOL preferences., Conclusions: Comprehensive assessment of patient personal values should include consideration of particular chronic disease scenarios and death trajectories to fully inform EoL preferences., Clinical Implications: Because personal values do influence EOL preferences, care should be taken to ascertain patient values when presenting diagnoses, prognoses, and treatment options. In particular, patients and families of patients with progressive neurological diseases will likely face a time when the patient cannot self-represent EOL wishes. Early discussion of values and preferences, particularly in the context of cognitive disease is vital to assure patient-directed care.

Background: Outpatient surgeries are common and most patients experience pain postoperatively requiring nursing attention to pain management. Scripting, recommended for consistent, targeted communication to improve patient satisfaction, has limited evidence to support its use., Aims: To explore the effect of scripted messages on self-reported pain control and patient satisfaction with care in outpatient surgical patients., Methods: A retrospective medical record review pre- and postintervention evaluated a pain management scripted message delivered at two time points (preoperatively and postoperatively). Intention to treat analysis compared patient reports of pain control and patient satisfaction with care 48 hours postdischarge from outpatient surgical procedures., Results: A total of 231 records (98 preintervention; 133 postintervention) were analyzed. The sample included 144 (62%) male, 156 (68%) married with mean age of 57.6 (SD = 16.1) years. The majority (90%) received general anesthesia, and the most common surgical procedures were urologic (24%), colorectal (17%), and laparoscopy (13%). A Mann-Whitney U test indicated patient reported pain control was statistically significantly greater for the postintervention group (mean rank = 62.66) compared to the preintervention group (mean rank = 51.95), U = 1,258, p = .01 with an effect size φ = .223., Linking Evidence to Action: A scripted message showed statistical significance and a small clinical effect in pain control that adds to the body of knowledge around the effectiveness of scripting delivered by nurses. Although it is encouraging that even the small dose of scripting had a significant effect on postoperative pain control, the feasibility issues around similar study designs will require considerable resources to surmount. Practice change is a complex process requiring sensitivity to work and patient flow especially in specialty care units. Resistance to change when evidence is not robust may be especially difficult related to scripting, often perceived as a mandated intrusion into the nurse-patient relationship., (© 2018 Sigma Theta Tau International.)

Background: Differences in end-of-life (EOL) care preferences (eg, location of death, use of life-sustaining treatments, openness to hastening death, etc) based on hypothetical death scenarios and associated physical and/or cognitive losses have yet to be investigated within the palliative care literature., Aim: The purpose of this study was to explore the multidimensional EOL care preferences in relation to 3 different hypothetical death scenarios: pancreatic cancer (acute death), Alzheimer disease (gradual death), and congestive heart failure (intermittent death)., Design: General linear mixed-effects regression models estimated whether multidimensional EOL preferences differed under each of the hypothetical death scenarios; all models controlled for personal experience and familiarity with the disease, presence of an advance directive, religiosity, health-related quality of life, and relevant demographic characteristics., Setting/participants: A national sample of healthy adults aged 50 years and older (N = 517) completed electronic surveys detailing their multidimensional preferences for EOL care for each hypothetical death scenario., Results: The average age of the participants was 60.1 years (standard deviation = 7.6), 74.7% were female, and 66.1% had a college or postgraduate degree. Results revealed significant differences in multidimensional care preferences between hypothetical death scenarios related to preferences for location of death (ie, home vs medical facility) and preferences for life-prolonging treatment options. Significant covariates of participants' multidimensional EOL care preferences included age, sex, health-related quality of life, and religiosity., Conclusion: Our hypothesis that multidimensional EOL care preferences would differ based on hypothetical death scenarios was partially supported and suggests the need for disease-specific EOL care discussions.

Inorganic mercury, in the form of mercurous chloride, or calomel, is intentionally added to some cosmetic products sold through informal channels in Mexico and the US for skin lightening and acne treatment. These products have led to multiple cases of mercury poisoning but few investigations have addressed the contamination of cream users' homes. We report on several cases of mercury poisoning among three Mexican-American families in California from use of mercury-containing skin creams. Each case resulted in widespread household contamination and secondary contamination of family members. Urine mercury levels in cream users ranged from 37 to 482 µg/g creatinine and in non-users from non-detectable to 107 µg/g creatinine. Air concentrations of up to 8 µg/m³ of mercury within homes exceeded the USEPA/ATSDR health-based guidance and action level of <1.0 μg/m³. Mercury contamination of cream users' homes presented a multi-pathway exposure environment to residents. Homes required extensive decontamination, including disposal of most household items, to achieve acceptable air levels. The acceptable air levels used were not designed to consider multi-pathway exposure scenarios. These findings support that the calomel is able to change valence form to elemental mercury and volatilize once exposed to the skin or surfaces in the indoor environment.

Background: The introduction of innovative specialty pharmaceuticals with high prices has renewed efforts by public and private healthcare payers to constrain their utilization, increase patient cost-sharing, and compel government intervention on pricing. These efforts, although rational for individual payers, have the potential to undermine the public health impact and overall economic value of these innovations for society. The emerging archetypal example is the outcry over the cost of sofosbuvir, a drug proved to cure hepatitis C infection at a cost of $84,000 per person for a course of treatment (or $1000 per tablet). This represents a radical medical breakthrough for public health, with great promise for the long-term costs associated with this disease, but with major short-term cost implications for the budgets of healthcare payers., Objectives: To propose potential financing models to provide a workable and lasting solution that directly addresses the misalignment of incentives between healthcare payers confronted with the high upfront costs of innovative specialty drugs and the rest of the US healthcare system, and to articulate these in the context of the historic struggle over paying for innovation., Discussion: We describe 3 innovative financing models to manage expensive specialty drugs that will significantly reduce the direct, immediate cost burden of these drugs to public and private healthcare payers. The 3 financing models include high-cost drug mortgages, high-cost drugs reinsurance, and high-cost drug patient rebates. These models have been proved successful in other areas and should be adopted into healthcare to mitigate the high-cost of specialty drugs. We discuss the distribution of this burden over time and across the healthcare system, and we match the financial burden of medical innovations to the healthcare stakeholders who capture their overall value. All 3 models work within or replicate the current healthcare marketplace mechanisms for distributing immediate high-cost events across multiple at-risk stakeholders, and/or encouraging active participation by patients as consumers., Conclusion: The adoption of these 3 models for the financing of high-cost drugs would ameliorate decades-long economic conflict in the healthcare system over the value of, and financial responsibility for, drug innovation.

More than 35% of Medicare beneficiaries receive care from providers operating under some form of shared savings/risk type of pay-for-performance incentive. Implementation of payment reform without a corresponding change to coverage, benefit, and other payment requirements, however, creates conflicting incentives that may nullify the intended aim of payment reform: to improve health outcomes, while saving costs. If related policies do not evolve to align with payment reform, those entities contracted to receive new bundled payments, such as hospitals or physician groups, will only be able to redesign care to the extent that care meets the myriad of related payment policy requirements. Shifting greater medical management authority from payers to entities managing the payment bundles is a gradual process, as the experience of commercial payers proves. Transitioning the responsibility for modifying coverage, benefit, and payment requirements from CMS to principal accountable bundlers (PABs) will depend on the PAB's degree of financial risk sharing as well as scope of the episode.

Look-back studies to identify paediatric patients with post-transfusion hepatitis C have been conducted at several tertiary-care hospitals in Canada. A general look-back study was conducted at the Hospital for Sick Children in Toronto for the time period December 1985 to May 1990. All patients transfused at the Hospital for Sick Children during this time period were identified from hospital Blood Bank records. Letters of notification were sent by registered mail to all recipients excluding those known to have died. In the letter anti-HCV testing was recommended. Letters were mailed to 6332 transfusion recipients; 4496 letters were delivered. Of these 146 anti-HCV-positive transfusion recipients (92 pts < 18 yrs old; 54 pts > 18 yrs old) were identified. Sixty-four of these patients were definitely transfused only during this time period. Assuming that all notified patients were tested, the minimum prevalence of new infection in this time period was 1.4%. When possible, identified patients were tested for presence of HCV RNA in the serum by RT-PCR. The proportion of patients anti-HCV positive but HCV RNA negative on one or more occasions was similar in both whole cohort and subset: approximately one-third. These data suggest that chronic hepatitis C may be less likely to develop after transfusion in children than in adults.

Liposomes (phospholipid artificial membrane vesicles) have been used in targeted drug delivery and recently in the development of oral vaccines using purified soluble antigens for the induction of mucosal immune responses. Although the mechanisms by which liposomes promote the induction of responses to soluble antigens have not been clearly shown, it has been suggested that these vesicles, when given orally, are taken up by M cells for delivery of antigen to underlying lymphoid cells of the Peyer's patch. This study investigated in vivo the uptake of liposomes by cells of Peyer's patch. Following exposure of surgically constricted segments of rat small intestine to small unilamellar liposomes or gold-labelled solid core liposomes, Peyer's patches were removed, fixed, and processed for examination by transmission electron microscopy. Sections of Peyer's patch from experimental animals showed M cells with endocytic vesicles containing liposomes. Vesicles containing liposomes were also observed between M cells and lymphoid cells. These results indicate that intact liposomes are endocytosed by M cells and provide evidence for a possible mechanism by which M cells deliver antigen to lymphoid cells in the Peyer's patch. These findings support the potential usefulness of liposomes in oral vaccine development.

We were able to demonstrate type II collagen in synovial phagocytes of osteoarthritis (OA) and rheumatoid arthritis (RA) patients, using a monoclonal antibody to human type II collagen and immunoperoxidase staining. In addition, using immunoelectron microscopy, we demonstrated labeled fragments in synovial phagocytes of both RA and OA patients. This immunohistochemical assay may prove to be a sensitive indicator of cartilage erosion in patients with OA and RA.

Three experiments examined age-related consistent mapping (CM) and varied mapping (VM) practice effects. In separate experiments, young (age, 19-22), middle-aged (37-50), and older (64-88) adults' performance was examined using semantic-category and letter-based search paradigms. After extensive practice, major age differences occurred in CM search. Young and middle-aged subjects showed near-zero comparison slopes, large reductions in mean reaction times, and substantial reductions in response variability. Although older adults' reaction time decreased with CM practice, the reduction in reaction time, comparison slope, and response variability was small compared with the other groups. In VM search, older subjects were slower than the other age groups, but all groups exhibited similar linear set-size functions, search termination, and comparison-load effects. We concluded that age-associated declines in cognitive performance may be due in large part to the degree with which older adults can acquire or use automatic processes to perform tasks.