Introduction Currently 1.2 million people with dementia (PWD) live in 15000 nursing homes across the United States (1, 2). According to PHI 2021 report data on direct care workforce included 47100 CNAs and this number will increase to 613,320 by 2030 (3). According to Bureau of Labor Statistics Occupational Employment and Wage Statistics (BLS OEWS) (May 2023), 171,290 LPNs are working in Nursing Care Facilities (4).The frontlines workers such as CNAs and LPNs spend the most time providing direct care for the nursing home residents followed by the floor nurses. Frontline workers are subjected to an increased risk of physical (5); or psychological stress and injuries (6) inflicted by agitated dementia patients in nursing homes. They are overworked, underpaid, and lack of clear path for personal growth (7) leads to increased turnover. Across 15,000 U.S. nursing homes, annual turnover of nursing staff (all direct care) is 128% on average, with median of 94%. Of this RNs have 140.7% turnover while CNAs have 129.1%, and LPNs 114%. Average turnover rate for direct care worker turnover is estimated at 40-60% (8).We are in dire need to relieve the stress and burnout for the nursing home staff who are involved in direct patient care. Currently various programs are in place such as confidential counseling, grief/bereavement support, trauma debriefing, stress reduction workshops, workload management and scheduling improvements, supportive leadership and communication/culture change, training and development specifically in dementia care, handling of agitated behavior, managing stress and emotional labor and policy and system changes including at federal level (e.g., U.S. Surgeon General / HHS), pushing for investments in the health, safety, and well-being of health workers; reducing administrative burden; ensuring access to mental health/substance use care (9,10).However, this is not enough. This approach helps the frontline workers, however the needs of PWD are not addressed in this approach which may be a root cause for the nurses’ burnout. We designed and implemented a nonpharmacological intervention AlzhaTV to help nursing home residents and their family members and staff. AlzhaTV is a nonpharmacological intervention to decrease burdens of care for PWD (11). We presented data for the 6 months at 2025AAGP (12). Now we present the results of nurse burnout at the end of one year. Methods We designed a nurse burnout survey addressing 7 key points to be answered in a Likert scale 1-5.These included1. EE: Emotional exhaustion2. Personal accomplishment3. Psychosomatic complaints4. Wi-Fi issues5. How often you think of leaving workWe conducted the survey at a nursing home in Southern US.Pre-AlzhaTV intervention surveyPost-AlzhaTV Intervention survey - 1st Round After 6 monthsPost-AlzhaTV Intervention survey – 2nd Round After 12 monthsNumber of CNAs and nurses who initiated survey were 28 of which 17 (11 CNAs and 6 Floor Nurses) completed survey. All were female. Ethnicity details are White: 1, Black: 15, one did not disclose ethnicity. Results Figure 1 shows that emotional exhaustion while leaving work shows an improvement in four of the five attributes for Floor Nurses. CNAs also show an improvement in four of the five attributes (lower exhaustion). The decline generally is maintained after 12 months, suggesting the long-term effectiveness of the AlzhaTV intervention.Figure 2 shows overall, Personal Accomplishment after 12 months is higher for all 5 attributes. This also contributes to our conclusion of the long-term effectiveness of the AlzhaTV intervention.Figure 3 shows Heart palpitation, Headaches, Insomnia, and Shortness of Breath are about the same. However, Body Aches and Fatigues are declined after 6 months and have some increase for 12 months (but still below the preintervention level).Figure 4 shows Wi-Fi availability and quality issues were lower at 6 months and then increased significantly at 12 months. This could reduce the overall effectiveness of the AlzhaTV intervention. We note that the AlzhaTV intervention is heavily dependent on Wi-Fi coverage and speed. The video streaming/downloads can slow down Wi-Fi if the existing capacity is not increased. Therefore, many of the attributes could have shown more improvement if Wi-Fi issues were addressed from the infrastructure point of view.Figure 5 shows the intention to leave job is significantly improved at 6 months (nurses 62% and CNAs 18%) and at 12 months intention to leave job for nurses showed 38% improvement (worsened from 6 months) while CNAs showed 31% improvement (improved from 6 months). However, both of these are still significantly below the preintervention level. This adds to the long-term effectiveness of the AlzhaTV intervention. This is a key result and shows a high degree of effectiveness for the AlzhaTV intervention. We believe that improved Wi-Fi coverage and speed will further improve several of the attributes of Nurses’ Burnout including intention to leave job. Additional Results Our other results generally showed improvement in most other attributes while some attributes stayed the same. More specifically, Floor Nurses performed better than CNAs for most attributes. It is likely that due to the nature of their job, Floor Nurses experience more impact of the intervention than CNAs. Conclusions A vast majority of attributes related to Nurse Burnout showed significant improvement after 6 and 12 months of using IT-based intervention. One of the overall questions of Leaving Job had 42% decline after 6 months with the intervention with range of 21% for CNA and 63% for Floor Nurses. This increased by 4% at 12 months for nurses showed 38% improvement (worsened from 6 months) while CNAs showed 31% improvement (improved from 6 months). However, it still stayed 39% lower than the preintervention level. One of the major observations is that Floor Nurses experience more impact of the AlzhaTV intervention than CNAs. We observed some increase in intention to leave work is correlated with worsening of Wi-Fi Quality and availability. The limitations of this work include (a) small sample size, which is common in the geriatric nurse domain, and (b) single nursing home survey site.Future research and decision making can address (a) designing suitable IT-based interventions to reduce nursing burden especially repetitive tasks and communication with residents and family members, (b) improved dementia training for nurses, (c) wellness program for nurses, (d) a clear path to career progression and improve overall quality of Wi-Fi availability in the nursing homes. We expect the insights from this research to be helpful for healthcare decision-makers to ease nurse burnout and turnover rate at long term care. We intend to capture qualitative data from the nurses to design well-being programs to address burnout in the nursing community.

Bimetallic (nickel–cobalt) carbonate hydroxide hydrate with varying concentrations of Co and Ni have shown great potential as electrode materials for high performance supercapacitors. However, the crystal structure of the important compound is not well established, and there is no report on their electronic properties. In this work, the nanophase nickel cobalt carbonate hydroxide hydrate samples with varying Co and Ni concentrations were synthesized using a wet chemical route and aqueous solutions of transition metal salts. Synchrotron XRD and FTIR measurements, followed by careful Rietveld refinement were used to establish crystal structure and chemical formula, which are otherwise controversial in literature. Transition metal L 3,2 and K-edge absorption spectroscopies were employed to study the electronic properties of the samples. We found that the oxidation states of Ni decrease with increase in Ni concentration, whereas those of Co remains the same. Moreover, oxygen vacancies were identified as main defects, with a preference of Ni sites over Co sites. Co ions were observed to be in low spin states, while Ni ions are in mixed spin states. The Ligand field splitting (LFS) of 3d orbitals for both Ni and Co in these samples is comparable to LFS values in transition metal oxides. Oxygen octahedra surrounding Ni ions showed greater distortion in the samples with higher Ni concentrations.

Introduction Burnout is a noted phenomenon in the healthcare community (Dall’Ora et al. 2020; Varshney et al. 2022). While there are numerous factors impacting burnout (Dall’Ora et al. 2020), the existing literature examined levels of burnout among nurses/physicians (Alacacioglu et al. 2009) and factors influencing burnout (Shah et al. 2021; Woo et al. 2020). There are numerous factors behind burnouts in nurses including financial incentives, lack of clear path for career progression, and difficult environment due to the type of patients and family members. In this study, we focus on examining how emotional exhaustion, depersonalization, personal achievement, somatic symptoms, comfort using IT and Wi-Fi issues influence nurse burnout. Methods We conducted a survey at a nursing home in the southern US. More specifically, we asked the nurses about five key attributes (Drained, Working-too-hard, Frustration, Fatigue and Strain) of emotional exhaustion. We collected data for emotional status when nurses arrive at work and leave work. We also collected data related to other parameters such as depersonalization, personal achievement, somatic symptoms, comfort with IT and Wi-Fi availability issues. We chose these items in the survey, as they are already validated from the prior literature. The sample (N=19) comprised of eight Floor Nurses (FN) and eleven Certified Nursing Assistants (CNA). The nurse demographics comprise of three ethnic groups (Black or African=17, White =1, and Asian=1); and four age groups (18-30 yrs =2, 31-45 yrs = 7, 46-60 yrs = 8, and 60+ yrs=2). Results Our analysis shows (Figure 1), emotional exhaustion either remains at the same level or increases throughout the shift for both FN and CNA. All nurses experience some degree of burnouts as a score of 3 indicates neutral and anything higher than 3 indicates the presence of emotional exhaustion. There is a significant increase in emotional exhaustion for Drained and Working-too-hard attributes among FN and CNA arriving and leaving work. The results for depersonalization, personal achievement, somatic symptoms, comfort with IT and WiFi issues and likeliness to leave job due to burnout. Please see Figures 2-9. Both FN and CNA did not identify depersonalization contributing to their burnout. The most common somatic symptoms were body ache and fatigue. Both FN and CNA were neutral on comfort with IT and WiFi issues, however the FN were more likely to leave job due to burnout than CNA. The most common challenge was staff shortage followed by communication with the dementia residents. Now, we are implementing an IT-based intervention for 90 days. Then we will again distribute the follow-up Nurse Burnout survey. We will collect and analyze the data. We will include these results in the final abstract. Conclusions There are several recommendations that can be considered in future research and decision making: (a) designing suitable IT-based interventions to reduce nursing burden especially repetitive tasks and communication with residents and family members, (b) improved dementia training for nurses, (c) wellness program for nurses, and (d) a clear path to career progression. The limitations of this work include (a) small sample size, which is common in the geriatric nurse domain, and (b) single nursing home survey site. We expect the insights from this research to be helpful for the healthcare decision-makers to ease nurse burnout. We intend to capture qualitative data from the nurses to design well-being programs to address burnout in the nursing community.

Coupling between different interactions allows the control of physical aspects in multifunctional materials by perturbing any degrees of freedom. Here, we aim to probe the correlation among structural, electronic, and magnetic observables in Sm2NiMnO6(SNMO) ferromagnetic insulator double perovskite. Our employed methodology includes thermal evolution of x-ray diffraction, x-ray absorption spectroscopy, and bulk magnetometry. The magnetic ordering in SNMO adopts two transitions, atTC= 160 K due to the ferromagnetic arrangement of Ni-Mn sublattice and atTd= 34 K because of anti-parallel alignment of polarized Sm paramagnetic moments with respect to Ni-Mn network. Signature of Ni/Mn anti-site disorders are evidenced from short-range structure and magnetization analysis. The long-range as well as short-range crystal structure of SNMO undergo changes acrossTCandTd, observed through temperature dependent variation in Ni/Mn-O bonding characters. Hybridization between Ni, Mn 3d, O 2pelectronic states show changes in the vicinity of magnetic transition. The change in crystal environments governs the magnetic response by imposing alteration in metal-ligand orbital overlap. On the other hand, it is observed that application of electric bias causes monotonic reduction in the saturation magnetic moment. By using these experimental methods, we demonstrate how the structural, electronic, and magnetic properties are correlated in SNMO, which makes it a potential platform for technological usage.

The structural, magnetic and electronic properties of Fe1-xNix (x = 0.32, 0.36, 0.40, 0.50) alloys have been investigated using synchrotron based x-ray diffraction (XRD), superconducting quantum interference device (SQUID) magnetometer and the high resolution x-ray photoelectron spectroscopy (XPS) measurements. The XRD measurement was done down to 50 K temperature. The XRD studies suggest a single phase with fcc structure for x = 0.36, 0.40, and 0.50 alloys and a mixed phase for x = 0.32 alloy containing both bcc and fcc structures. The lattice parameter of the alloys exhibits a linear dependence on temperature giving rise to a temperature independent coefficient of thermal expansion (CTE). The lowest CTE is observed for x = 0.36 Invar alloy as expected while x = 0.50 alloy exhibits the highest CTE among the alloys studied. The CTE of the fcc component of mixed phase alloy is close to that of Invar alloy. The temperature dependence of magnetization of the alloys down to 2 K reveals an overall antiferromagnetic interactions within the ferromagnetic phase causing the magnetization decreasing with lowering temperature. The field cooled and zero field cooled data show larger differences for the Invar compositions; this is also manifested in the magnetic hysteresis data at 2 K and 300 K. The Fe 2p and Ni 2p core level spectra exhibit spin-orbit split features along with a satellite feature in the Ni 2p spectra. The spectral line shapes are almost similar for all the compositions studied. Interestingly, the spin-orbit splitting for Fe 3p spectra is larger than that observed for Ni 3p suggesting additional contributions due to the exchange interaction between the Fe 3p core hole with the Fe 3d moment. This suggests large magnetic moment contribution from Fe as expected. The core level and valence band spectra, and the magnetization data suggest significant role of disorder for the Invar compositions.

The polycrystalline samples of Mn1.90Cr0.10O3(MCO) and Mn1.90Fe0.10O3(MFO) have been investigated for their temperature dependent magnetic and structural properties. The Cr and Fe substitutions have significant effect on the magnetic and structural properties of Mn2O3. Like pristine Mn2O3, the Cr and Fe substituted samples MCO and MFO also exhibit two antiferromagnetic transitions; one at ∼77 K, ∼80 K, respectively and another at ∼40 K. Our room temperature synchrotron x-ray powder diffraction (SXRD) results confirm that both the MCO and MFO samples crystallize in cubic symmetry. The temperature dependent SXRD results demonstrate the cubic to orthorhombic structural transition for the studied samples. The pristine Mn2O3shows cubic to orthorhombic transition around 310 K, whereas this structural transition shifted towards lower temperature side with these substitutions i.e. around 240 K for MCO and 260 K for MFO. Interestingly, the centrosymmetricPcabto non-centrosymmetricPca21change in symmetry is also resolved at the ferroelectric ordering temperature for MCO.

The number of people in the US with opioid abuse exceeds two million, and the total cost is approximately $100B per year. There is a need for smart interventions that can lead to better outcomes for patients and reduce the need for healthcare resources. In this study, the authors present three smart interventions for patients: (a) mobile reminders, (b) electronic monitoring, and (c) composite intervention. More specifically, the authors present a design approach for smart interventions and operationalize the interventions. They have developed an analytical model for evaluating interventions. Interventions are cost-effective for higher values of intervention effectiveness, hospital, and emergency room cost. However, with quality-of-life (QoL) improvement, cost-effectiveness improves significantly. The authors also explored the use of financial incentives for increasing the adoption of interventions. These results will help patients, healthcare professionals, decision-makers, and family members to choose the most suitable intervention to address opioid abuse.

We relate and complement the structural sensitivities of a non-centrosymmetric B20 cubic chiral magnet MnSi in the vicinity of the magnetic transition using the combined results of temperature-dependent synchrotron x-ray diffraction, dc-magnetization, ac-susceptibility, specific heat and caloric measurements. MnSi is not found to undergo structural transformation down to 18 K. However, the lattice constant exhibits an anomaly at the long-range magnetic ordering temperature. The behavior of lattice constant in the vicinity of long-range ordering temperature is in line with the magnetic changes, indicating the latent heat contribution. The results will be correlated with the magnetic, caloric and transport properties. Our study suggests the vital role of lattice/crystal structure in determining the first order nature of the zero-field magnetic phase transition of MnSi.

Polycrystalline lead-free composite ceramics composed of 0.7Bi(1-x)Sm(x)Fe(0.95)Ga(0.05)O(3)-0.3BaTiO(3) (BS(x)FG-BT) with varying doping concentration of x (0.025, 0.05, 0.10, 0.15, and 0.20) were synthesized. This study comprehensively explores the influence of co-doping Samarium (Sm) and Gallium (Ga) on the microstructures, spectral properties, electrical characteristics, and multiferroic behaviour within the 0.7BiFeO(3)-0.3BaTiO(3) system. These composite ceramics exhibited coexistence of R (rhombohedral) and T (tetragonal) phases, characterized by the space groups R3c and P4mm, respectively. The XRD and AFM results show that the Sm and Ga co-doping influenced the crystal structure as well as grain size of BS(x)FG-BT ceramics. Raman spectroscopy was used to analyze the positions of the phonon modes. High dielectric constant with high Curie temperature of 550 degrees C were obtained. The impact of grain and grain boundary on the capacitance and resistance in the ceramics was investigated utilizing Z-view software and high magnitude of bulk resistance was obtained for dopant value x = 0.20 at 300 degrees C. Enhanced multiferroic properties, remanent magnetisation M-r = 0.051 emu g(-1) with coercive field (H-c) = 6450 Oe and remanent polarization P-r = 10.98 mu C cm(-2) with coercive filed E-c = 14.73 kV cm(-1) were obtained for x = 0.20.

Lead-free composite ceramics, 0.7Bi0.95Sm0.05Fe1-xGaxO3-0.3BaTiO3 (BSFGx-BT), were made using a solid-state reaction method for x = 2.5, 5, 10, 15, and 20 %. We have investigated the effects of Samarium (Sm) and Gallium (Ga) co-doping on the crystal structure, topography, spectroscopy, electrical and multiferroic characteristics of the 0.7BiFeO3-0.3BaTiO3 (0.7BFO-0.3BTO) system for piezoelectric applications. The structural results indicate that the composite ceramics exhibited rhombohedra R and tetragonal T phases characterized by R3c and P4mm space groups, respectively which was also further confirmed by X-ray Rietveld refinement pattern analysis. In dielectric behaviour study high Curie temperature of 550 °C was obtained with high temperature stability. Furthermore, the study investigated the effects of grain and grain boundaries on capacitive and resistive properties. The ceramics displayed the characteristics of the negative temperature coefficient of resistance (NTCR). It was observed that as the Ga concentration increased, the grain resistance (Rb) also increased, reaching its maximum value for x =10 %. Additionally, at higher temperatures, this composite exhibited lower electrical resistivity. Importantly, the ceramics showed the co-existence of ferromagnetic and ferroelectric behaviour with the enhanced values of remanent magnetization (Mr)= 0.043 emu/g, coercivity (Hc) = 5730 Oe and remanent polarization (Pr) = 6.07 µC/cm2, coercive field (Ec) = 6.78 kV/cm for the composition x =10 %. These findings suggest that Sm & Ga incorporated 0.7BFO-0.3BTO composite ceramics can show promising high-temperature piezoelectric applications.

Lead-free composite ceramics, 0.7Bi0.95Sm0.05Fe1-xGaxO3-0.3BaTiO3 (BSFGx-BT), were made using a solid-state reaction method for x = 2.5, 5, 10, 15, and 20 %. We have investigated the effects of Samarium (Sm) and Gallium (Ga) co-doping on the crystal structure, topography, spectroscopy, electrical and multiferroic characteristics of the 0.7BiFeO3-0.3BaTiO3 (0.7BFO-0.3BTO) system for piezoelectric applications. The structural results indicate that the composite ceramics exhibited rhombohedra R and tetragonal T phases characterized by R3c and P4mm space groups, respectively which was also further confirmed by X-ray Rietveld refinement pattern analysis. In dielectric behaviour study high Curie temperature of 550 degrees C was obtained with high temperature stability. Furthermore, the study investigated the effects of grain and grain boundaries on capacitive and resistive properties. The ceramics displayed the characteristics of the negative temperature coefficient of resistance (NTCR). It was observed that as the Ga concentration increased, the grain resistance (Rb) also increased, reaching its maximum value for x =10 %. Additionally, at higher temperatures, this composite exhibited lower electrical resistivity. Importantly, the ceramics showed the co-existence of ferromagnetic and ferroelectric behaviour with the enhanced values of remanent magnetization (Mr)= 0.043 emu/g, coercivity (Hc) = 5730 Oe and remanent polarization (Pr) = 6.07 mu C/cm2, coercive field (Ec) = 6.78 kV/cm for the composition x =10 %. These findings suggest that Sm & Ga incorporated 0.7BFO-0.3BTO composite ceramics can show promising high-temperature piezoelectric applications.

The number of people in the US with opioid abuse exceeds two million, and the total cost is approximately $100B per year. There is a need for smart interventions that can lead to better outcomes for patients and reduce the need for healthcare resources. In this study, the authors present three smart interventions for patients: (a) mobile reminders, (b) electronic monitoring, and (c) composite intervention. More specifically, the authors present a design approach for smart interventions and operationalize the interventions. They have developed an analytical model for evaluating interventions. Interventions are cost-effective for higher values of intervention effectiveness, hospital, and emergency The authors also explored the use of financial incentives for increasing the adoption of interventions. These results will help patients, healthcare professionals, decision-makers, and family members to choose the most suitable intervention to address opioid abuse.

Vanadium-tellurite glasses, tetragonal TeO2 and orthorhombic V2O5 crystalline samples were characterized for their atomic structure properties by synchrotron X-ray diffraction, pair distribution function analysis, reverse Monte Carlo simulations (RMC) and Rietveld analysis. The pair correlation function, G(r), of V2O5 shows the first peak at 1.61 Å. G(r) of TeO2 shows three peaks at 1.57, 2.13 and 2.88 Å due to Te-O linkages of three different lengths, whereas the Te-Te atomic pair correlation shows a peak at 3.85 Å. The average coordination number of V with O in crystalline V2O5 is 4.39 while that of Te with O in crystalline TeO2 is 3.71. G(r) of the vanadium tellurite glass shows the first peak at 1.90 Å due to overlapping Te-O and V-O atomic pair correlations. The RMC analysis on diffraction data of glasses found that the V-O coordination number is in the range 5.27-5.59 and the Te-O coordination number is 5.39-5.67. However, it is found that these coordination numbers cannot be clearly defined due to short-range disorder.

In this investigation, we study the M/M/ $$\infty$$ queueing system with server breakdown and two different types of customers called loss and delay customers. The system is subject to random service interruptions due to server breakdown; the broken-down server will be recovered after repair provided by a repairman according to exponential distribution. Due to server breakdown, there may be either fully or partially interruptions in service, i.e., during breakdown each server may stop providing service or provide service with compromised efficiency. The customers’ balking behavior is incorporated during the service interruptions. The stochastic decomposition property for the system size has also established. The sensitivity analysis has performed by taking numerical examples. Adaptive neuro-fuzzy inference system (ANFIS) technique is implemented to develop ANFIS controller so as to evaluate the simulation results by including the realistic feature of fuzzy descriptors which may be noticed at several queueing scenarios.

Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter Facebook Reddit LinkedIn Tools Icon Tools Reprints and Permissions Cite Icon Cite Search Site Citation Ankur Sharma, Pinki Yadav, Indranil Bhaumik, M. N. Singh, Vasant Sathe, Gurvinderjit Singh; Publisher’s note: “Structural evaluation in vicinity of composition induced non-ergodic to ergodic crossover in niobium doped (Na0.41K0.09Bi0.5)TiO3” [J. Appl. Phys. 134, 044105 (2023)]. J. Appl. Phys. 7 September 2023; 134 (9): 099901. https://doi.org/10.1063/5.0173739 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAIP Publishing PortfolioJournal of Applied Physics Search Advanced Search |Citation Search

OBJECTIVES While opioid addiction, treatment, and recovery are receiving attention, not much has been done on adaptive interventions to prevent opioid use disorder (OUD). To address this, we identify opioid prescription and opioid consumption as promising targets for adaptive interventions and present a design framework. MATERIALS AND METHODS Using the framework, we designed Smart Prescription Management (SPM) and Smart Consumption Monitoring (SCM) interventions. The interventions are evaluated using analytical modeling and secondary data on doctor shopping, opioid overdose, prescription quality, and cost components. RESULTS SPM was most effective (30-90% improvement, for example, prescriptions reduced from 18 to 1.8 per patient) for extensive doctor shopping and reduced overdose events and mortality. Opioid adherence was improved and the likelihood of addiction declined (10-30%) as the response rate to SCM was increased. There is the potential for significant incentives ($2267-$3237) to be offered for addressing severe OUD. DISCUSSION The framework and designed interventions adapt to changing needs and conditions of the patients to become an important part of global efforts in preventing OUD. To the best of our knowledge, this is the first paper on adaptive interventions for preventing OUD by addressing both prescription and consumption. CONCLUSION SPM and SCM improved opioid prescription and consumption while reducing the risk of opioid addiction. These interventions will assist in better prescription decisions and in managing opioid consumption leading to desirable outcomes. The interventions can be extended to other substance use disorders and to study complex scenarios of prescription and nonprescription opioids in clinical studies.