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The Relation Between Transport Properties and Solvation Structure for Electrolytes.
No full textWith continued progress in portable technology, energy storage has become an important factor to improve upon as batteries are found in a variety of everyday devices. Lithium-ion batteries are particularly common, although current technology features shortcomings in thermal stability, efficiency, and cost. Such shortcomings are related to current electrolytes in such technologies. The following experiment aims, for noteworthy alternative electrolytes, to analyze both macroscopic measurements related to transport properties and spectroscopy measurements that give insight into samples’ solvation structures. Such data are then used to identify the most promising electrolytes of the ones tested. Solutes tested include the promising imide-based solutes of LiFSI and LiTFSI. Solvents tested include H2O, along with the simple organic solvents of MeOH and ACN. Using the data outlined, H2O has been identified and affirmed to be a particularly stable solvent for electrolytes, while LiTFSI has been identified as a particularly promising solute. Although LiFSI in H2O features the highest absolute ionic conductivity measurements, LiTFSI in H2O has been identified as the electrolyte with overall the most optimal measurements, and such an electrolyte at high concentrations may show additional promise if tested in batteries
Implementation of the Nurse-Driven Palliative Care Referral Protocol: A Quality Improvement Project
No full textImplementation of the Nurse-Driven Palliative Care Referral Protocol
Background and Purpose: Palliative care enhances quality of life, symptom management, and patient–family communication for individuals with serious illness. Despite strong evidence and national recommendations for early integration, referrals remain inconsistent and often occur late. At Advocate Sherman Hospital, only 17.9% of eligible oncology inpatients received palliative care consults. The absence of standardized referral criteria, reliance on provider discretion, and misconceptions equating palliative care with hospice contributed to delayed or missed consults. The purpose of this quality improvement (QI) project was to increase palliative care referrals by 20% within eight weeks through the implementation of a standardized, nurse-driven referral protocol on the inpatient oncology unit.
Model and Methods: This QI project was guided by the Iowa Model of Evidence-Based Practice to Promote Quality Care, which provided a systematic framework for identifying clinical gaps, implementing change, and evaluating outcomes. The project was conducted on a 24-bed oncology unit at Advocate Sherman Hospital, a 255-bed community hospital within the Advocate Aurora Health System. Two validated tools—the Surprise Question (SQ) and the Palliative Care Screening Tool (PCST)—were used to standardize identification of patients appropriate for palliative care referral. Oncology nurses screened all new admissions and inter-unit transfers each shift. When a patient scored ≥4 on the PCST, the nurse communicated findings to the attending physician or oncologist, indicating that the patient met referral criteria; the provider then placed the palliative care consult order. Data were collected from electronic medical records and paper screening logs. Pre- and post-implementation referral rates were compared using a chi-square test, and nurse self-efficacy was analyzed using a Wilcoxon signed-rank test (p \u3c .05).
Process Change: Prior to implementation, the project lead conducted structured education sessions for oncology nurses on early palliative care principles, use of the SQ and PCST, and standardized communication strategies. Educational materials included a PowerPoint presentation, quick-reference guides, and informational flyers for nurses and families. During the eight-week intervention, screening forms were collected daily, and weekly audits and biweekly debriefings were conducted to ensure fidelity, address workflow challenges, and provide real-time feedback.
Results: Palliative care referral rates increased from 17.9% to 40.2% post-implementation (χ² [1, N = 244] = 12.58, p \u3c .001), surpassing the target goal. Goals-of-care discussions were documented for 100% of referred patients, and screening compliance averaged 90%, demonstrating strong protocol adherence. Nurse self-efficacy scores improved significantly (p \u3c .001), reflecting increased confidence in identifying and initiating referrals. The intervention required no additional cost and was seamlessly integrated into existing nursing workflows.
Conclusions: Implementation of a nurse-driven palliative care referral protocol significantly improved consult rates, communication, and nurse confidence in initiating palliative care discussions. The Iowa Model provided a structured framework that guided successful practice change. This nurse-led, cost-neutral intervention demonstrated feasibility, sustainability, and scalability across oncology and other acute care settings, promoting timely, patient-centered palliative care.
References
Harden, K., Price, D. M., Duffy, E., & Galunas, L. (2017). Palliative care: Improving nursing knowledge, attitudes, and behaviors. Clinical Journal of Oncology Nursing, 21(5), E232–E238. https://doi.org/10.1188/17.CJON.E232-E238
Hausner, D., Tricou, C., Mathews, J., Wadhwa, D., Pope, A., Swami, N., Hannon, B., Rodin, G., Krzyzanowska, M. K., Le, L. W., & Zimmermann, C. (2021). Timing of palliative care referral before and after evidence from trials supporting early palliative care. The Oncologist, 26(4), 332-340. https://doi.org/10.1002/onco.13625
Schierenbeck, S. J., & Elertson, K. (2022). Effect of a palliative care screening tool for oncology patients. Journal of Hospice & Palliative Nursing, 24(2), 119–124. https://doi.org/10.1097/NJH.0000000000000825
Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., Dahlin, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., Billings, J. A., & Lynch, T. J. (2010). Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine, 363(8), 733–742. https://doi.org/10.1056/NEJMoa1000678
Yen, Y. F., Lee, Y. L., Hu, H. Y., Sun, W. J., Ko, M. C., Chen, C. C., Wong, W. K., Morisky, D. E., Huang, S. J., & Chu, D. (2022). Early palliative care: The surprise question and the palliative care screening tool—better together. BMJ Supportive & Palliative Care, 12(2), 211–217. https://doi.org/10.1136/bmjspcare-2019-00211
A Quality Improvement Project on Risk Stratification and Screening for Sleep Apnea in Cardiology Outpatient Setting
No full textAbstract
Background: Obstructive sleep apnea (OSA) is the most prevalent sleep disorder and is strongly associated with cardiovascular disease (CVD), but remains widely underdiagnosed due to inconsistent and non-standardized screening practices in outpatient settings.
Local Problem: Patients with CVD were reported to be diagnosed with OSA following sleep studies at an outpatient cardiology clinic. The need for a consistent, evidence-based approach to risk-stratification and screening was recognized.
Aim: The aim of this project was to increase the OSA risk stratification rate among new adult cardiology patients from 53% to at least 85% over a 16-week implementation period by incorporating the STOP-BANG questionnaire into the clinic workflow, thereby leading to increased sleep apnea screening.
Methods: 16-week implementation period of the project, the convenience sample included all new adult patients 18 years and older without a prior sleep apnea diagnosis, as well as patients with untreated sleep apnea.
Interventions: The project established a standardized process for risk stratification and screening for OSA using the validated STOP-BANG questionnaire. A total of 103 new patients completed the STOP-BANG questionnaire; after exclusions, 96 patients comprised the final project sample (n = 96).
Results: The project attained a 100% response rate for risk stratification of OSA utilizing the STOP-BANG questionnaire among all new adult patients in the cardiology clinic. There were 58 (60.4%) patients who successfully completed the sleep study.
Conclusion: Patients who were risk-stratified for sleep apnea are likely to complete a sleep study, be referred and seek treatment if found positive, and receive treatment
Closeness, Conflict, and Achievement: The Role of Parent–Child Relationships in Homeschooled and Public-Schooled Children
No full textThe parent–child relationship has been found to be a predictor of children’s academic and socio-emotional outcomes, with parent-child closeness linked to motivation and persistence (Mo & Singh, 2008; Silinskas & Kikas, 2022) and parent-child conflict associated with emotional and behavioral difficulties (Dotterer et al., 2008; Pinquart, 2017). The homeschooling context may increase these associations since children spend more time with their parents, who have caregiving and instructional roles (Padilla, 2021; Thomas, 2016). Even with growing research on academic and socio-emotional outcomes, few studies have examined whether the strength of the parent–child relationship is influenced negatively or positively by schooling type. This study investigates whether parent–child closeness and conflict are differentially associated with academic achievement, internalizing symptoms, and externalizing symptoms across homeschooling and traditional schooling contexts, and whether the results are more pronounced for homeschoolers. We hypothesized that parent-child closeness would be positively associated with academic performance and negatively associated with internalizing and externalizing symptoms, while parent-child conflict would have the opposite effect. These associations were expected to be stronger among homeschooled children due to increased parent–child interaction and instructional involvement. Participants included 102 mother–child dyads (51 homeschooled, 51 traditionally schooled) in Grades 1–5. Parents completed validated measures of closeness and conflict, and children reported on their socioemotional functioning and completed standardized assessments of reading, math, and writing and answered measures of socio-emotional functioning. The results indicate that none of the associations between parent–child relationship quality and child outcomes differed by schooling type, suggesting that the links between closeness, conflict, and children’s adjustment operate similarly in homeschool and public-school contexts. On a scholastic level, public-school students scored significantly higher than homeschool students in writing achievement, and marginally significantly higher in reading and writing achievement. There were no group differences in internalizing or externalizing symptoms. Across the full sample, higher parent–child conflict was modestly associated with children’s academic and socio-emotional functioning. Parent-child closeness was not associated with any outcomes
