Effectiveness of a Smartphone-Based Stress Management Program for Depression in Hospital Nurses During COVID-19 in Vietnam and Thailand: 2-Arm Parallel-Group Randomized Controlled Trial.

BACKGROUND: During the COVID-19 pandemic, health care professionals experienced high levels of depression. However, extant research has not highlighted effective internet-based psychological interventions to improve the mental health in this population during the pandemic. It remains unclear whether self-guided, internet-based cognitive behavioral therapy (iCBT) programs are effective in improving the mental health of health care workers during the COVID-19 pandemic. OBJECTIVE: The aim of this study was to evaluate the effectiveness of a smartphone-based iCBT stress management program for reducing the depression experienced by nurses in Vietnam and Thailand. METHODS: From March to April 2022, a 2-arm, parallel-group randomized controlled trial was implemented. One arm offered a 7-week self-guided iCBT program, and the other offered treatment as usual as a control arm. Full-time nurses were recruited from 6 hospitals: 2 hospitals in Vietnam and 4 hospitals in Thailand. The primary outcome of this program was the severity of depression measured by the Depression Anxiety Stress Scale-21 items. Follow-up surveys were conducted to measure the change in depression severity at 3 months (July-August 2022) and at 6 months (October-November 2022) after baseline. Mixed modeling for repeated measures was used to test the effects of the intervention compared with the control for the follow-up. RESULTS: A total of 1203 nurses were included in this study: 602 in the intervention group and 601 in the control group. The follow-up rate at 3 and 6 months ranged from 85.7% (515/601) to 87.5% (527/602). The completion rate for the program was 68.1% (410/602). The group difference in depression was significant at the 3-month follow-up (coefficient=-0.92, 95% CI -1.66 to -0.18; P=.02) and nonsignificant at the 6-month follow-up (coefficient=-0.33, 95% CI -1.11 to 0.45; P=.41). The estimated effect sizes were -0.15 and -0.06 at the 3- and 6-month follow-ups, respectively. CONCLUSIONS: Our study shows that the smartphone-based iCBT program was effective in reducing depression at the 3-month follow-up among hospital nurses in Vietnam and Thailand during the COVID-19 pandemic. However, the effect size was small, and therefore, these results may not be clinically meaningful. TRIAL REGISTRATION: UMIN Clinical Trials Registry UMIN000044145; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050128. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.20944/preprints202303.0450.v1.

An Intervention to Enhance Recognition of Nursing Assistant Roles and Enhance Information-Sharing.

This column describes a quasi-experimental trial that examined the effects of an intervention in which both nurses and nursing assistants shared their perceptions of the nursing assistant role on the frequency of information-sharing behaviors. In the intervention group, the frequency of nurses' linguistic responses in the intervention group increased in the nursing assistants' evaluations. The frequency of nursing assistants' linguistic response and feedback in the intervention group increased in self-evaluation and nurses' evaluation, respectively.

Certified nurse specialists in cancer nursing and prophylactic antiemetic prescription for chemotherapy patients.

PURPOSE: The prevention of chemotherapy-induced nausea and vomiting (CINV), a common chemotherapy side effect, should be attempted by oncology nurses. Certified nurses could be certified nurse specialists in cancer nursing (CNSCNs), who have high-level graduate education, or certified nurses in cancer chemotherapy nursing (CNCCNs), who have short-term training. The relationship between these certifications and compliance with the CINV prevention guidelines has not been investigated. We aimed to evaluate the association between certified nurse staffing and prescription of prophylactic antiemetic drugs for chemotherapy patients with high emetic risk. METHODS: We used health service utilisation data for cancer patients diagnosed in 2016 from 474 hospitals nationwide in Japan and a list of certified nurses published by the Japanese Nurse Association. Patients receiving highly emetic chemotherapy were included. A multilevel mixed-effect logistic regression analysis was conducted to estimate the prescription of prophylactic antiemetic drugs associated with CNSCN and/or CNCCN staffing. RESULTS: Data of 46,306 patients were analysed. Overall, 68.4% and 94.0% of the patients received chemotherapy at hospitals with CNSCNs and CNCCNs, respectively. Small cell lung cancer, non-small cell lung cancer, breast cancer, and oesophageal cancer were positively associated with the prescription of recommended antiemetic drugs. CNSCNs was significantly associated with the prescription of prophylactic antiemetic drugs, while CNCCNs was positively but non-significantly associated with antiemetic prescriptions. CONCLUSION: This study is the first to demonstrate that CNSCN placement was significantly associated with prescribing antiemetic drugs recommended by clinical guidelines. Patients are likely to receive appropriate supportive care with the proper placement of CNSCNs.

Work-related communication mediates the relationship between perceived diversity climate and psychological empowerment among part-time nurses: A cross-sectional study.

AIM: This study investigates which work-related communication mediates the relationship between diversity climate and psychological empowerment among part-time nurses. BACKGROUND: Part-time nurses' high psychological empowerment is desirable because it may lead to high quality nursing practice. METHODS: Anonymous self-report questionnaires or web-based surveys were used to measure diversity climate (Climate for Inclusion Scale), psychological empowerment (Japanese version of the Psychological Empowerment Scale) and work-related communication (scale developed in this study). The respondents were part-time nurses from departments with shift work in six Japanese hospitals having over 200 beds. The surveys were conducted from September to October 2020. Multiple regression analyses and a significance test of indirect effects were then conducted. RESULTS: Among the work-related communication components, 'expressing thoughts about their work' fully mediated the relationship between diversity climate and psychological empowerment. CONCLUSIONS: It is important for part-time nurses to be actively 'expressing thoughts about their work' to enhance their psychological empowerment. Positive diversity climate is also important because it allows part-time nurses to express their thoughts regarding work. IMPLICATIONS FOR NURSING MANAGEMENT: Managers can enhance part-time nurses' psychological empowerment by encouraging them to express their work-related opinions based on the diversity climate.

Perceived impact of nurse turnover on the organization: A Delphi study on managers of nursing.

AIMS: The study aimed to identify the aspects and items of nurse turnover impact on organizations as perceived by nursing management. BACKGROUND: Turnover rate does not capture the extent to which an organization is affected by turnover. Another indicator is required to assess the control status of turnover impact. METHODS: A Delphi study was conducted in 2021, where 2670 managers of nursing at 712 hospitals were asked to complete the survey three times. Factor analysis was conducted on these items for which a consensus was reached. RESULTS: Overall, 232 managers who responded multiple times, including the third survey, were included in the analysis. Consensus was reached for 36 items affected by turnover and considered important for nursing management. Using exploratory factor analysis, the following six factors were extracted: quality of nursing care, physical and mental health of nursing staff, workload and working conditions of nursing staff, relationships among nursing staff members, sense of responsibility among nursing staff, and cost and benefit of hiring replacement personnel. CONCLUSIONS: Six factors consisting of 36 items were extracted that can be used to assess the impact of nurse turnover. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can assess the status of the organization more appropriately by understanding the factors that impact nurse turnover in vaious facilitites and look at strategies to overcome the impact on nurse staffing.

Key strategies for managing nursing care under the COVID-19 pandemic: A multiple-case study of nursing directors.

AIM: We aim to identify measures implemented by hospital nursing directors early in the COVID-19 pandemic and enabling factors. BACKGROUND: Managerial factors affect nurses' physical and mental health and willingness to work, especially early in a pandemic. METHOD: We used multiple-case study of 15 hospitals, comparing management approaches by interviewing 28 nursing directors and their assistants from August to December 2020. RESULTS: Hospitals that accepted COVID-19 patients and hospitals that unexpectedly experienced clusters underwent a nursing provision system organization phase, followed by an adjustment phase to maintain nursing organization function. Two factors aided measure implementation: an emergency system and staff protection policies. CONCLUSION: Early epidemic management strategies apply across contexts. The hospital's basic attitude is key to effective implementation of the strategies. IMPLICATIONS FOR NURSING MANAGEMENT: The results suggest that hospitals, nursing directors and nurses can each prepare for future emerging infectious disease epidemics.

Relationships between the components of nurse managers' transformational leadership and organisational learning subprocesses in a hospital ward: A cross-sectional study.

AIMS: To investigate the association between the five components of nurse managers' transformational leadership and each process of organisational learning in a hospital ward. BACKGROUND: Elucidating the components of nurse managers' transformational leadership that promote organisational learning is needed. METHODS: In 2018, 591 self-report questionnaires from two hospitals in Japan were analysed, using the measurement scale for Organizational Learning Subprocesses and Multifactor Leadership Questionnaire. Hierarchical linear modelling was conducted using the wards' mean scores of five components of transformational leadership and five subprocesses of organisational learning. RESULTS: None of the transformational leadership components were significantly associated with information acquisition, but all five were significantly positively associated with information distribution and information integration. Only some of the five components showed a significant association with information interpretation and organisational memory. CONCLUSION: Transformational leadership may be effective to promote the four organisational learning processes other than information acquisition. IMPLICATIONS FOR NURSING MANAGEMENT: A nurse manager should exercise leadership other than transformational leadership, or use other strategies to promote information acquisition. However, particular behaviours of transformational leadership, such as intellectually stimulating behaviours and personal considerations, could be effective in promoting the understanding of information among the members and establishing new routines.

Nursing assistants' desired roles, perceptions of nurses' expectations and effect on team participation: A cross-sectional study.

AIMS: To examine the gap between nursing assistants' desired roles and their perceptions of nurses' expectations, and the relationship between these perceptions and nursing assistants' nursing team participation. BACKGROUND: Nursing assistants' role perceptions may be related to their participation in nursing teams. METHODS: We performed a secondary analysis of questionnaire data from 1,316 nursing assistants in Japan. RESULTS: Participants rated their desired roles higher than their perceptions of nurses' expectations of them. Where perceptions of nurses' expectations were higher, higher desired role scores were associated with greater nursing team participation. Where perceptions of nurses' expectations were lower, the desired role score was not associated with team participation. CONCLUSIONS: Nursing assistants perceive their roles as higher and inclusive of more duties than what nurses have expected of them. When perceptions of nurse expectations were high, they performed at a higher level. When perceptions of nurse expectations were low, they performed at a lower level, despite their desire to do more. IMPLICATIONS FOR NURSING MANAGEMENT: It may be useful for nurses and nursing assistants to jointly reflect on and promote awareness of nursing assistants' functional roles in the ward. This would promote nursing assistant team participation and optimize their scope of practice.

Exploring nurses' clinical reasons for bed transfers in acute care wards: An observational study.

AIMS: To investigate the number of bed transfers (patient transfers within the same ward) and their reasons in acute care wards of mid-sized hospitals with multibed and private rooms. BACKGROUND: Bed transfers, even when necessary, are burdensome for patients; however, the reasons for bed transfers in various types of rooms remain unclear. METHODS: An observational study was conducted in seven wards in three hospitals in Japan. Nurses completed a questionnaire regarding each bed transfer, which elicited the reasons for the transfer. We classified transfer patterns based on the functions of the patients' rooms and the number of beds in each room and analysed scores. RESULTS: Overall, 560 responses were analysed. The average number of bed transfers per day was 2.7. In total, 43% of bed transfers were conducted for patients aged over 70. The most frequent bed transfer pattern was 'transfer between patient rooms with the same number of beds', and the most frequent reason was 'patient did not need that bed'. CONCLUSIONS: Unnecessary bed transfers could be reduced by ward designs that reflect nurses' clinical judgement. IMPLICATIONS FOR NURSING MANAGEMENT: Monitoring data for the reason regarding bed transfer contributes to hospital planning and decreases unnecessary bed transfers.

The influence of learning circumstances and on-the-job opportunities for professional growth on perceived person-environment fit among hospital nurses: A longitudinal study.

AIMS: The study aimed to determine the influence of learning circumstances (learning inside and outside hospitals, and communication about the nursing practice with colleagues) and on-the-job opportunities for professional growth on each dimension of person-environment fit (needs-supplies, demands-abilities, person-organisation and person-group fit) among nurses. BACKGROUND: It is desirable for each dimension of person-environment fit to be high, as it links to many work-related outcomes. METHODS: A longitudinal survey using a questionnaire was conducted in February 2019 (Time 1) and October 2019 (Time 2). A simple linear regression analysis and a multiple linear regression analysis were conducted, using data from 324 nurses. RESULTS: The results of the simple regression analysis showed that three variables related to learning circumstances at Time 1 were positively related to each dimension of person-environment fit at Time 2. The multiple regression analysis showed on-the-job opportunities for professional growth at Time 1 related to person-environment fit at Time 2. CONCLUSIONS: To achieve high person-environment fit, nurses should be aware of on-the-job opportunities for professional growth. IMPLICATIONS FOR NURSING MANAGEMENT: To achieve high person-environment fit, nurse managers should evaluate nurses' abilities and assign them jobs that would help improve their nursing skills.

Relationship between nurses' perceptions of nursing assistant roles and information-sharing behaviors: A cross-sectional study.

Information-sharing between nurses and nursing assistants is necessary for appropriate inpatient care. Nurses who perceive nursing assistant roles highly may display positive behaviors related to information-sharing with nursing assistants. This study aims to examine the relationship between nurses' perceptions of nursing assistant roles and the frequency of their sharing information with nursing assistants. Using a self-administered, cross-sectional survey questionnaire, data from 2,642 nurses in 182 hospitals were collected. Nurses' perceptions of nursing assistant roles were measured with a scale containing four factors: (i) improving patients' abilities through daily care; (ii) caring for various patients using broad perspectives; (iii) facilitating co-ordination and co-operation among team members; and (iv) increasing the amount of information on patients among team members. Information-sharing behaviors included "expressing," "asking," "linguistic response," and "feedback." Multiple regression analyses for each nurse's information-sharing behaviors were conducted. Nurses' perceptions of nursing assistant roles were positively correlated with the frequency of sharing information with nursing assistants. The degree of the correlations differed, depending on the type of information-sharing behavior. Therefore, improving nurses' understanding of nursing assistant roles might increase their information-sharing behaviors.

Quality of work among part-time nurses and its relationship to job satisfaction and work values: A cross-sectional study.

This study compared the quality of work between part-time and full-time nurses and investigated the relationship between quality of work and satisfaction with the work itself among part-time nurses. Quality of work was measured by specific work content and job characteristics. It was hypothesized that work content would affect satisfaction mediated by job characteristics. Furthermore, the moderating effects of intrinsic work values on the relationship between job characteristics and satisfaction were examined. A cross-sectional survey was conducted with 444 part-time and 795 full-time nurses working in Japanese hospital wards in 2017. The Mann-Whitney U test, χ2 test, and hierarchical multiple regressions were used. Work content differed between part-time and full-time nurses; however, job characteristics and satisfaction showed little difference. Work content was not associated with satisfaction mediated by job characteristics. Within the job characteristics, autonomy and feedback had positive effects on the satisfaction of part-time nurses, whereas interaction with work values was insignificant. When assigning work, it is important to allow part-time nurses to experience higher levels of autonomy and feedback regardless of their intrinsic work values.

The effect of work environment on burnout among nursing directors: A cross-sectional study.

AIM: Identifying the relationship between burnout status and hospital size and workplace environment among hospital nursing directors. BACKGROUND: Although the demands on nursing staff and managers are increasing, nursing directors' burnout is an under-researched topic. METHODS: An anonymous survey was conducted with 205 nursing directors across all 654 hospitals in Tokyo, Japan. The survey instruments were the Japanese version of the Burnout Scale, the Organizational Justice Questionnaire, the Nursing Work Empowerment Scale and the Workplace Support Scale. RESULTS: Nursing directors who were close to burnout were from smaller rather than large hospitals. Correlations were found between emotional exhaustion and interactional justice, age, resources, moral support from hospital executives, and self-reflection support from subordinates. Regarding depersonalization, correlations were found with interactional justice, age and work support from subordinates. Regarding participants' personal accomplishment, correlations were found with procedural justice, interactional justice and opportunities. CONCLUSIONS: Nursing directors of smaller hospitals tend to experience greater burnout. The impact of work environment on burnout is greater than that of facility and individual characteristics. IMPLICATIONS FOR NURSING MANAGEMENT: To mitigate burnout, hospitals should ensure high organizational justice, provide access to resources and opportunities, and encourage moral support from executives and work support from subordinates.

Frontline nurse managers' visions for their units: A qualitative study.

AIMS: To elucidate frontline nurse managers' visions of their units. BACKGROUND: Managers have the opportunity to imagine and share their visions for effective unit management. METHODS: Semi-structured interviews were conducted with 12 frontline nurse managers working at inpatient units in two hospitals between 2016 and 2017. Data were qualitatively analysed using an inductive approach, focusing on participants' intents. RESULTS: Although participants showed four types of difficulties in verbalizing visions, five categories and 18 subcategories were extracted through analysis of their descriptions about actual cases reflecting their visions. The categories were (a) provide excellent care to ensure patient recovery based on reliable knowledge and skills, (b) make efforts to broaden patients' futures, (c) create a climate for pursuing better practice, (d) all staff continuously pursue professional development and (e) provide nursing care that responds to external changes. All categories were common to all participants' images of the future and linked together to form each manager's vision. CONCLUSION: Frontline managers experienced difficulty in articulating their visions. However, through episodes, they represented images of visions. The managers' visions comprised five categories reflecting various perspectives. IMPLICATIONS FOR NURSING MANAGEMENT: Using a conceptualized vision framework, and identifying difficulties in verbalizing their images, can help managers articulate their visions.

Understanding and measuring nurses' professionalism: Development and validation of the Nurses' Professionalism Inventory.

AIMS: To develop a self-report assessment inventory to evaluate nurses' professionalism and test its validity and reliability. BACKGROUND: Professionalism is essential for nurses' development. To promote professionalism, evaluation indices must be developed. METHODS: The Nurses' Professionalism Inventory (NPI) was constructed through a literature review and interviews with expert nurses and other medical personnel. An anonymized cross-sectional survey that included this inventory was administered to 5,739 nurses in hospitals throughout Japan. RESULTS: A total of 4,183 (72.8%) questionnaires were returned, of which 3,655 (63.7%) with valid responses were used for further analyses. The Nurses' Professionalism Inventory consists of five subscales containing 28 items: (a) accountability, (b) self-improvement, (c) professional attitude, (d) advancement of the nursing profession and (e) professional membership. The internal consistency reliability (Cronbach's alpha) ranged from 0.84 to 0.90. Confirmatory factor analysis revealed that this five-factor structure had good fit. The test-retest intraclass correlations were consistently greater than 0.6. CONCLUSIONS: The Nurses' Professionalism Inventory is valid and reliable. IMPLICATIONS FOR NURSING MANAGEMENT: The Nurses' Professionalism Inventory could be used to evaluate changes in nurses' professionalism and programmes designed to promote nurses' professionalism.

Cost-utility analysis of an advanced pressure ulcer management protocol followed by trained wound, ostomy, and continence nurses.

The high prevalence of severe pressure ulcers (PUs) is an important issue that requires to be highlighted in Japan. In a previous study, we devised an advanced PU management protocol to enable early detection of and intervention for deep tissue injury and critical colonization. This protocol was effective for preventing more severe PUs. The present study aimed to compare the cost-effectiveness of the care provided using an advanced PU management protocol, from a medical provider's perspective, implemented by trained wound, ostomy, and continence nurses (WOCNs), with that of conventional care provided by a control group of WOCNs. A Markov model was constructed for a 1-year time horizon to determine the incremental cost-effectiveness ratio of advanced PU management compared with conventional care. The number of quality-adjusted life-years gained, and the cost in Japanese yen (¥) ($US1 = ¥120; 2015) was used as the outcome. Model inputs for clinical probabilities and related costs were based on our previous clinical trial results. Univariate sensitivity analyses were performed. Furthermore, a Bayesian multivariate probability sensitivity analysis was performed using Monte Carlo simulations with advanced PU management. Two different models were created for initial cohort distribution. For both models, the expected effectiveness for the intervention group using advanced PU management techniques was high, with a low expected cost value. The sensitivity analyses suggested that the results were robust. Intervention by WOCNs using advanced PU management techniques was more effective and cost-effective than conventional care.

Factors of Good Collaboration in Home-Based End-of-Life Care: A Questionnaire Survey of Japanese Home Care Nurses, Home Helpers, and Care Managers.

Good interprofessional work (IPW) is essential to provide quality home-based end-of-life (EOL) care. The purpose of this study was to explore the factors of "good collaboration," as evaluated separately by home care nurses (HNs), home helpers (HHs), and care managers (CMs). The relationship was examined between their evaluation of good collaboration and their recent actual experience of interprofessional collaborative work for a home-based EOL case. The questionnaire was returned nationwide by 378 HNs, 305 HHs, and 476 CMs, and data were collected on 177 EOL cases from HNs, 84 cases from HHs, and 123 cases from CMs. Evaluation of good collaboration by HNs was associated with working with a CM with whom they had multiple collaborative experiences, the client being independent for their toileting until just before dying, and sharing information regarding the client's EOL decision with an HH 1 month before dying. Evaluation of good collaboration by HHs was associated with working at an agency that collaborated with fewer CM agencies and working at an agency that allowed staff to visit dying clients. Evaluation of good collaboration by CMs was associated only with the client being dependent for toileting. Our results highlighted the characteristics of how each professional seeks to collaborate depending on their preparedness, contexts, and resultant expectations toward other professionals when entering the IPW for home-based EOL care. To promote good IPW for home-based EOL care further, professionals need to understand these differences among ourselves and try to meet others' expectations.

Self-alignment of low-valent octanuclear palladium atoms.

A linear tetraphosphine, meso-bis[(diphenylphosphinomethyl)phenylphosphino]methane (dpmppm) was used to synthesize linear octapalladium-extended metal atom chains as discrete molecules of [Pd8(µ-dpmppm)4](BF4)4 (1) and [Pd8(µ-dpmppm)4L2](BF4)4 (L=2,6-xylyl isocyanide (XylNC; 2), acetonitrile (3), and N,N-dimethylformamide (dmf; 4)), which are stable in the solution states and show interesting temperature-dependent photochemical properties in the near IR region. Variable temperature NMR studies demonstrated that at higher temperature T≈140 °C the Pd8 chains were dissociated into Pd4 fragments, which were thermodynamically self-aligned to restore the Pd8 chains at lower temperature T<60 °C. The coldspray ionization mass spectra suggested a possibility for further aggregation of the linear tetrapalladium units.

Strongly luminous tetranuclear gold(I) complexes supported by tetraphosphine ligands, meso- or rac-bis[(diphenylphosphinomethyl)phenylphosphino]methane.

A series of tetragold(I) complexes supported by tetraphosphine ligands, meso- and rac-bis[(diphenylphosphinomethyl)phenylphosphino]methane (meso- and rac-dpmppm) were synthesized and characterized to show that the tetranuclear Au(I) alignment varies depending on syn- and anti-arrangements of the two dpmppm ligands with respect to the metal chain. The structures of syn-[Au4 (meso-dpmppm)2X]X'3 (X = Cl; X' = Cl (4 a), PF6 (4 b), BF4 (4 c)) and syn-[Au4 (meso-dpmppm)2]X4 (X = PF6 (4 d), BF4 (4 e), TfO (4 f); TfO = triflate) involved a bent tetragold(I) core with a counter anion X incorporated into the bent pocket. Complexes anti-[Au4 (meso-dpmppm)2]X4 (X = PF6 (5 d), BF4 (5 e), TfO (5 f)) contain a linearly ordered Au4 string and complexes syn-[Au4 (rac-dpmppm)2X2]X'2 (X = Cl, X' = Cl (6 a), PF6 (6 b), BF4 (6 c)) and syn-[Au4 (rac-dpmppm)2]X4 (X = PF6 (6 d), BF4 (6 e), TfO (6 f)) consist of a zigzag tetragold(I) chain supported by the two syn-arranged rac-dpmppm ligands. Complexes 4 d-f, 5 d-f, and 6 d-f with non-coordinative large anions are strongly luminescent in the solid state (λmax = 475-515 nm, Φ = 0.67-0.85) and in acetonitrile (λmax = 491-520 nm, Φ = 0.33-0.97); the emission was assigned to phosphorescence from (3) [dσ*σ*σ* pσσσ] excited state of the Au4 centers on the basis of DFT calculations as well as the long lifetime (a few µs). The emission energy is predominantly determined by the HOMO and LUMO characters of the Au4 centers, which depend on the bent (4), linear (5), and zigzag (6) alignments. The strong emissions in acetonitrile were quenched by chloride anions through simultaneous dynamic and static quenching processes, in which static binding of chloride ions to the Au4 excited species should be the most effective. The present study demonstrates that the structures of linear tetranuclear gold(I) chains can be modified by utilizing the stereoisomeric tetraphosphines, meso- and rac-dpmppm, which may lead to fine tuning of the strongly luminescent properties intrinsic to the Au(I) 4 cluster centers.