Wall-mounted folding chairs to promote resident physician sitting at the hospital bedside

BACKGROUND

Sitting at the bedside may improve patient-clinician communication; however, many clinicians do not regularly sit during inpatient encounters.

OBJECTIVE

To determine the impact of adding wall-mounted folding chairs inside patient rooms, beyond any impact from a resident education campaign, on the patient-reported frequency of sitting at the bedside by internal medicine resident physicians.

DESIGN, SETTING, AND PARTICIPANTS

Prospective, controlled pre-post trial between 2019 and 2022 (data collection paused 2020-2021 due to COVID-19) at an academic hospital in Baltimore, Maryland. Folding chairs were installed in two of four internal medicine units and educational activities were delivered equally across all units.

MAIN OUTCOME AND MEASURES

Patient-reported frequency of sitting at bedside, assessed as means on Likert-type items with 1 being "never" and 5 being "every single time." We also examined the frequency of other patient-reported communication behaviors.

RESULTS

Two hundred fifty six and 206 patients enrolled in the pre and post-intervention periods, respectively. The mean frequency of patient-reported sitting by resident physicians increased from 1.8 (SD 1.2) to 2.3 (1.2) on education-only units (absolute difference 0.48 [95% CI: 0.21-0.75]) and from 2.0 (1.3) to 3.2 (1.4) on units receiving chairs (1.16, [0.87-1.45]). Comparing differences between groups using ordered logistic regression adjusting for clustering within residents, units with added chairs had greater increases in sitting (odds ratio 2.05 [1.10-3.82]), spending enough time at the bedside (2.43 [1.32-4.49]), and checking for understanding (3.04 [1.44-6.39]). Improvements in sitting and other behaviors were sustained on both types of units.

CONCLUSIONS

Adding wall-mounted folding chairs may help promote effective patient-clinician communication.

Room-temperature tetragonal non-collinear Heusler antiferromagnet Pt2MnGa

Antiferromagnetic spintronics is a rapidly growing field, which actively introduces new principles of magnetic storage. Despite that, most applications have been suggested for collinear antiferromagnets. In this study, we consider an alternative mechanism based on long-range helical order, which allows for direct manipulation of the helicity vector. As the helicity of long-range homogeneous spirals is typically fixed by the Dzyaloshinskii-Moriya interactions, bi-stable spirals (left- and right-handed) are rare. Here, we report a non-collinear room-temperature antiferromagnet in the tetragonal Heusler group. Neutron diffraction reveals a long-period helix propagating along its tetragonal axis. Ab-initio analysis suggests its pure exchange origin and explains its helical character resulting from a large basal plane magnetocrystalline anisotropy. The actual energy barrier between the left- and right-handed spirals is relatively small and might be easily overcome by magnetic pulse, suggesting Pt2MnGa as a potential candidate for non-volatile magnetic memory.

(3 + 1)D superspace description of the incommensurate modulation in the premartensite phase of Ni2MnGa: a high resolution synchrotron x-ray powder diffraction study

Le Bail and Rietveld analysis of high resolution synchrotron x-ray powder diffraction (SXRPD) data shows unambiguous signatures of the failure of the commensurate 3M modulation model. Using (3 + 1) dimensional superspace group formalism, we have not only confirmed the incommensurate modulation in the premartensite phase with a modulation wavevector of q = 0.337 61(5)c* but also determined the superspace group (Immm(00γ)s00), atomic positions and amplitude of modulations for the incommensurate premartensite phase of Ni2MnGa for the first time. Our results may have important implications in the understanding of the martensitic transition and hence the magnetic field induced strains.

Bulk electronic structure of quasicrystals

We use hard x-ray photoemission to resolve a controversial issue regarding the mechanism for the formation of quasicrystalline solids, i.e., the existence of a pseudogap at the Fermi level. Our data from icosahedral fivefold Al-Pd-Mn and Al-Cu-Fe quasicrystals demonstrate the presence of a pseudogap, which is not observed in surface sensitive low energy photoemission because the spectrum is affected by a metallic phase near the surface. In contrast to Al-Pd-Mn, we find that in Al-Cu-Fe the pseudogap is fully formed; i.e., the density of states reaches zero at E(F) indicating that it is close to the metal-insulator phase boundary.

High energy resolution bandpass photon detector for inverse photoemission spectroscopy

We report a bandpass ultraviolet photon detector for inverse photoemission spectroscopy with energy resolution of 82 ± 2 meV. The detector (Sr(0.7)Ca(0.3)F(2)/acetone) consists of Sr(0.7)Ca(0.3)F(2) entrance window with energy transmission cutoff of 9.85 eV and acetone as detection gas with 9.7 eV photoionization threshold. The response function of the detector, measured using synchrotron radiation, has a nearly Gaussian shape. The n = 1 image potential state of Cu(100) and the Fermi edge of silver have been measured to demonstrate the improvement in resolution compared to the CaF(2)/acetone detector. To show the advantage of improved resolution of the Sr(0.7)Ca(0.3)F(2)/acetone detector, the metal to semiconductor transition in Sn has been studied. The pseudogap in the semiconducting phase of Sn could be identified, which is not possible with the CaF(2)/acetone detector because of its worse resolution.

An ultrahigh vacuum compatible sample holder for studying complex metal surfaces

We present a design of a compact and versatile sample holder meant for studying complex (ternary) metallic crystals that require sputtering and annealing to high temperatures under ultrahigh vacuum (10(-10) mbar range) for obtaining the clean, ordered and stoichiometric surface. A resistive heater is fixed to the sample holder and not to the sample plate, and thus can be thoroughly degassed initially to high temperatures without heating the sample. The heater, which is mounted vertically on the sample holder frame, slides into the sample plate of rectangular cross-section during sample transfer. For efficient cooling that is required for adlayer deposition, Cu braids can be pressed on the sample plate from both sides through a screw mechanism. The sample holder has 5 degrees of freedom including a tilt rotation. The sample holder has been used to study different metal surfaces such as ferromagnetic shape memory alloys, alkali metal and Mn adlayers on Al-Pd-Mn quasicrystal, aluminum metal, and Al-Mn alloys. Here, our recent results on temperature dependent low energy electron diffraction study of Ni(2)MnGa(100) are presented.

Pathfinding by cranial nerve VII (facial) motorneurons in the chick hindbrain

Cranial nerve VII (facial) motorneurons begin extending axons through rhombomeres 4 and 5 (R4 and R5) in the chick hindbrain on the second day of incubation. Without crossing the midline, facial motorneuron axons extend laterally from a ventromedial cell body location. All facial motorneuron axons leave the hindbrain through a discrete exit site in R4. To examine the importance of the exit site in R4 on motorneuron pathfinding, we ablated R4 before motorneuron axonogenesis. We find that mechanisms intrinsic to R5 direct the initial lateral orientation of R5 motorneuron axons. Upon reaching a particular lateral position, all R5 motorneuron axons must turn. In normal embryos the axons all turn rostrally to reach the nerve exit in R4. In embryos with R4 ablated, sometimes the axons turn rostrally and sometimes they turn caudally. A model combining permissive fields and chemotropic cues is presented to account for our observations.