Physical and Electrochemical Analysis of N-Alkylpyrrolidinium-Substituted Boronium Ionic Liquids.

In this work, a series of novel boronium-bis(trifluoromethylsulfonyl)imide [TFSI-] ionic liquids (IL) are introduced and investigated. The boronium cations were designed with specific structural motifs that delivered improved electrochemical and physical properties, as evaluated through cyclic voltammetry, broadband dielectric spectroscopy, densitometry, thermogravimetric analysis, and differential scanning calorimetry. Boronium cations, which were appended with N-alkylpyrrolidinium substituents, exhibited superior physicochemical properties, including high conductivity, low viscosity, and electrochemical windows surpassing 6 V. Remarkably, the boronium ionic liquid functionalized with both an ethyl-substituted pyrrolidinium and trimethylamine, [(1-e-pyrr)N111BH2][TFSI], exhibited a 6.3 V window, surpassing previously published boronium-, pyrrolidinium-, and imidazolium-based IL electrolytes. Favorable physical properties and straightforward tunability make boronium ionic liquids promising candidates to replace conventional organic electrolytes for electrochemical applications requiring high voltages.

Understanding the health care needs of transgender and gender diverse people engaging with rural Australian sexual health centres: a qualitative interview study.

BACKGROUND: Although there is a presumption that LGBTQ+ people living in rural Australia will have poorer health outcomes than those living in metropolitan areas, minimal research has focused specifically on the perspectives of transgender and gender diverse (henceforth referred to as 'trans') people living in these regions. The purpose of this study was to understand what health and wellbeing means to trans people in a regional or rural community and identify their health needs and experiences. METHODS: A total of 21 trans people were recruited through two regional sexual health centres (SHC) and interviewed between April and August 2021. Data were analysed via reflexive thematic analysis. This paper focuses on participants' accounts of health and wellbeing regarding gender affirmation, the experience of rural living, respectful holistic care, safety in rural communities, isolation, loneliness, and employment. RESULTS: The experience of living rurally can have both positive and negative impacts on the experiences of trans people. Participants reported experiences of stigma and discrimination, reduced employment opportunities and limited social interactions, which led to feelings of isolation and loneliness; however, they also reported high quality of care, particularly with the specific SHCs which supported this research. CONCLUSION: Living rurally can impact both positively and negatively on the health and wellbeing of trans peoples, and the experiences of living in this environment are diverse. Our findings challenge the perception that rural trans people experience only poor health outcomes and shows the difference that key health services such as SHCs can make in supporting trans health.

Increasing access to screening for blood-borne viruses and sexually transmissible infections for Aboriginal and Torres Strait Islander Australians: evaluation of the Deadly Liver Mob program's 'cascade of care' across nine sites in New South Wales, Australia.

BACKGROUND: Aboriginal and Torres Strait Islander Australians are disproportionately impacted by blood-borne viruses (BBVs) and sexually transmissible infections (STIs). Stigma remains one of the key barriers to testing and treatment for BBVs and STIs, particularly among Aboriginal and Torres Strait Islander people. The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians. The program aims to increase access to BBV and STI education, screening, treatment, and vaccination for Aboriginal and Torres Strait Islander Australians in recognition of the systemic barriers for First Nations people to primary care, including BBV- and STI-related stigma, and institutional racism. This paper presents routinely collected data across nine sites on the 'cascade of care' progression of Aboriginal and Torres Strait Islander clients through the DLM program: hepatitis C education, screening, returning for results, and recruitment of peers. METHODS: Routinely collected data were collated from each of the DLM sites, including date of attendance, basic demographic characteristics, eligibility for the program, recruitment of others, and engagement in the cascade of care. RESULTS: Between 2013 and 2020, a total of 1787 Aboriginal and Torres Strait Islander clients were educated as part of DLM, of which 74% went on to be screened and 42% (or 57% of those screened) returned to receive their results. The total monetary investment of the cascade of care progression was approximately $56,220. Data highlight the positive impacts of the DLM program for engagement in screening, highlighting the need for culturally sensitive, and safe programs led by and for Aboriginal and Torres Strait Islander people. However, the data also indicate the points at which clients 'fall off' the cascade, underscoring the need to address any remaining barriers to care. CONCLUSIONS: The DLM program shows promise in acting as a 'one stop shop' in addressing the needs of Aboriginal and Torres Strait Islander people in relation to BBVs and STIs. Future implementation could focus on addressing any potential barriers to participation in the program, such as co-location of services and transportation.

Evaluating a complex health promotion program to reduce hepatitis C among Aboriginal and Torres Strait Islander peoples in New South Wales, Australia: the Deadly Liver Mob.

The Deadly Liver Mob (DLM) is a peer-delivered incentivised health promotion program by and for Aboriginal and Torres Strait Islander Australians, and was introduced in response to the disproportionate number of Aboriginal and Torres Strait Islander Australians who are impacted by blood borne viruses (BBVs) and sexually transmitted infections (STIs). The goal of the program is to increase access to BBV and STI education, screening, treatment, and vaccination in recognition and response to the systemic barriers that Aboriginal and Torres Strait Islander peoples face in accessing health care. This commentary introduces a series of papers that report on various aspects of the evaluation of the Deadly Liver Mob (DLM) program. In this paper, we explain what DLM is and how we constructed an evaluation framework for this complex health promotion intervention.

Australian statewide virtual care competency-based education framework for the healthcare workforce: a Delphi study.

This study aimed to establish shared interprofessional competencies across health professions that promote education, communication, and teamwork, preparing the virtual care workforce to work collaboratively with the patient and their carers, family members, and communities to improve health outcomes. A modified, two-round Delphi process was undertaken with an interprofessional panel selected from the public health sector workforce across one Australian state. Sixty-nine panelists participated in Round 1 and 40 panelists participated in Round 2. Fifty-eight competencies across seven domains were established to support an interprofessional approach to virtual care provision: compliance, professional practice, patient safety, communication, interprofessional collaboration, patient assessment and care planning/delivery/coordination. This virtual care education framework may assist different health disciplines to develop, revise or map new or existing undergraduate or postgraduate education programs or design professional development activities. Drawing upon the expertise of a broad range of health professionals in its development, this education framework focuses on improving interprofessional collaboration in virtual care settings.

The future of nurse education? Studying at the Open University in Scotland.

This article describes nurse education with the Open University in Scotland (OUiS). Although there are problems with nurse recruitment and retention across the UK, in Scotland the landscape is somewhat different, with greater support for students required in remote and rural areas. Despite these challenges, the OUiS continues to recruit to the commissioned numbers of places. OUiS nursing students are primarily health care support workers who are a key group within the health and social care workforce but historically have faced many challenges in developing clear career pathways into nursing. At the heart of the OU is the fundamental recognition of distance online pedagogy, complemented by work-based learning support by employers. Partnership working between the OU, employers and education commissioners is crucial to its success.

Phenotypic Characterization of Genetically Distinct Phytophthora cinnamomi Isolates from Avocado.

Phytophthora cinnamomi, the causal agent of Phytophthora root rot (PRR), is the most destructive disease of avocado worldwide. A previous study identified two genetically distinct clades of A2 mating type avocado isolates in California; however, the phenotypic variation among them was not assessed. This study described the phenotype of a subset of isolates from these groups regarding growth rate, growth temperature, virulence, and fungicide sensitivity. Isolates corresponding to the A2 clade I group exhibited higher mycelial growth rate and sensitivity to higher temperatures than other isolates. Among the fungicides tested, potassium phosphite had the highest 50% effective concentration for mycelial growth inhibition and oxathiapiprolin had the lowest. Mycelial growth rate and potassium phosphite sensitivity phenotypes correlate with specific groups of isolates, suggesting that these traits could be a group characteristic. Moreover, isolates that are more virulent in avocado and less sensitive to potassium phosphite were identified. A detached-leaf P. cinnamomi inoculation method using Nicotiana benthamiana was developed and validated, providing an alternative method for assessing the virulence of a large number of isolates. This information will help avocado PRR management and assist breeding programs for the selection of rootstocks resistant against a more diverse pathogen population.

Does Living Outside of a Major City Impact on the Timeliness of Chlamydia Treatment? A Multicenter Cross-Sectional Analysis.

BACKGROUND: Timely treatment of Chlamydia trachomatis infection reduces complications and onward transmission. We assessed client, process, and clinic factors associated with treatment delays at sexual health clinics in New South Wales, Australia. METHODS: A retrospective review of 450 consecutive clients with positive chlamydia results (not treated at the time of the consultation) was undertaken at 6 clinics (1 urban, 3 regional, and 2 remote) from October 2013. Mean and median times to treatment were calculated, overall and stratified by process steps and clinic location. RESULTS: Nearly all clients (446, 99%) were treated, with 398 (88%) treated in ≤14 days and 277 (62%) in ≤7 days. The mean time-to-treatment was 22 days at remote clinics, 13 days at regional and 8 days at the urban clinic (P < 0.001). Mean time between the laboratory receipt of specimen and reporting of result was 4.9 in the remote clinics, 4.1 in the regional, and 2.7 days in the urban clinic (P < 0.001); and the mean time between the clinician receiving the result until client treatment was15, 5, and 3 days (P < 0.01), respectively. CONCLUSIONS: At participating clinics, treatment uptake was high, however treatment delays were greater with increasing remoteness. Strategies to reduce the time-to-treatment should be explored such as point-of-care testing, faster specimen processing, dedicated clinical time to follow up recalls, SMS results to clients, and taking treatment out to clients.

Hospitalization rates of children who are blind.

BACKGROUND: To evaluate the impact of blindness on hospitalization rates of children. DESIGN: Matched cohort study. PARTICIPANTS: Children confirmed as legally blind (2003-2009), age- and gender-matched to control cohort of normally sighted children from the state register of births. METHODS: The rates and reasons for admission to hospital were compared using hospital morbidity records. The association of blindness with rates of admission and length of stay in hospital, 2003-2010, were estimated using multivariate negative binomial regression models. MAIN OUTCOME MEASURES: Descriptive statistics, incident rate ratios, and predicted means for hospital separations and length of stay. RESULTS: Fifty-nine blind and 59 control children had a combined total of 107 separations accounting for 237 bed days in hospital after the index date of legal blindness. The median age at the index date was 8 years. Over 90% of separations and 92% of bed days were incurred by 22 blind children. Blind children had four (95% confidence interval 1.9-9.3) times more hospital separations and stayed in hospital six (95% confidence interval 1.9-17.5) times longer than the control cohort children. There were more than 40 times as many comorbidities recorded by the blind children (n = 201) compared with the control children (n = 5). A third of the blind children were hospitalized for respiratory conditions. CONCLUSIONS: Children who are born or become blind in childhood have more and longer periods in hospital than sighted children likely because of complex comorbid health problems. There was a disproportionate incidence of comorbid respiratory diseases in the blind children.

Education guidelines, frameworks and resources for building virtual care capacity: An integrative review.

INTRODUCTION: Despite its reported benefits, the accelerated adoption of virtual care since the COVID-19 pandemic has occurred without critical consideration of clinician education and training. This integrative review aims to better understand the necessary education guidelines, frameworks and resources for building the confidence and capability of the workforce for virtual care delivery. METHODS: Whittemore and Knafl's (2005) five-stage methodological framework informed this review. Using a clearly articulated search strategy and reporting process, over 8000 pieces of literature were analysed. A final 46 publications comprising 26 scholarly papers and 20 pieces of grey literature were included for review. RESULTS: A set of key curriculum inclusions under three domains: clinical, administrative and technical are proposed. Many publications emphasise a domain-specific approach as the most effective means of translating virtual care knowledge and skills to practice. A number of new domain frameworks have been tailormade for specific disciplines, while well-established frameworks such as the ACGME, CanMEDS, AAMC and IPEC have been adapted for virtual care education. Virtual care checklists, clinical champions and models that involve frontline clinicians, content experts and care recipients are considered useful resources for virtual care education. DISCUSSION: Moving beyond the COVID-19 pandemic, virtual care education for current and future clinicians requires a cohesive, interprofessional approach. This approach should be rigorously evaluated as part of a continuous quality improvement process.

Evidencing Enquiry Based Learning: An Innovative Approach to Educating Children and Young People's Nursing Students.

This discussion paper gives an overview of an innovative online distance learning pre-registration BSc (Hons) Children and Young People's nursing program underpinned by Enquiry-Based Learning pedagogy. Whilst the program is delivered to all four fields of practice (Adult, Children and Young People, Learning Disability, and Mental Health), in all four nations of the UK (England, Scotland, Wales, and Northern Ireland), the focus here is Children and Young People's nursing. Nurse education programs are delivered in accordance with the Standards for Nurse Education developed by the professional nursing body in the UK. This online distance learning curriculum uses a life-course perspective for all fields of nursing. Students develop the general knowledge and skills to care for all people across the life course but as the program progresses, they learn how to care for people within their own field of practice in greater depth. The educational context of the Children and Young People's nursing program highlights that the use of Enquiry-Based Learning can help address some of the challenges faced by Children and Young People's nursing students. A critical evaluation of Enquiry-Based Learning and its use within the curriculum concludes that Enquiry-Based Learning provides Children and Young People's nursing students with the graduate attributes of being able to communicate with infants, children, young people, and their families, adopt critical thinking to clinical settings and have an ability to find, generate, or synthesize their own knowledge in order to lead and manage evidence-based quality care for infants, children, young people, and their families in a variety of care settings and within interprofessional teams.

Quality of life of the most severely vision-impaired.

BACKGROUND: To explore the interaction between vision impairment, perceived quality of life loss and willingness to trade remaining life for vision gain. DESIGN: Community-based cross-sectional study. PARTICIPANTS: Legally blind or severely vision-impaired people selected randomly from the Association for the Blind of Western Australia register. METHODS: Individuals were examined by consultant ophthalmologists and completed the Impact of Vision Impairment profile quality of life assessment and a Time Trade-Off evaluation. Vision-related utility values were calculated. The results were analysed using univariate and multivariate regression methods. MAIN OUTCOME MEASURES: IVI Rasch Logits and TTO utility values (TTO UV). RESULTS: 156 people volunteered to contribute to the study. The median age was 80 (19-97) years, and 56% were female. Being legally blind (logMAR > 1) (95% CI 1.1 to 5.2, P = 0.003), clinically depressed (95% CI -11.2 to -1.8, P = 0.007) or more than 40 years of age (95% CI 0.9 to 8.1, P = 0.015) significantly lowered overall impact of vision impairment scores. The emotional domain of impact of vision impairment was associated with willingness to trade part of remaining life. A 5-Logit increase in impact of vision impairment emotional score resulted in a 21% (95% CI 10 to 31) decrease in the odds of being likely to trade life for sight. The Australian definition of blindness compared with World Health Organisation or USA best separates those with perceived loss and appears useful in identifying vision loss-related morbidity. CONCLUSIONS: These results suggest that emotional health and lack of depression are important determinants for quality and value of life.

Assessing the diagnostic validity of a blind register.

BACKGROUND: To validate the accuracy of clinical ophthalmic information held on the West Australian blind register. DESIGN: Community-based cross-sectional study. PARTICIPANTS: Legally blind or severely vision-impaired people were selected randomly from the Association for the Blind of Western Australia register. METHODS: Individuals were reviewed by one of two consultant ophthalmologists. MAIN OUTCOME MEASURES: The positive predictive value (ppv), sensitivity and specificity for legal blindness status and diagnostic causes of vision loss were calculated using data extracted from the Association for the Blind of Western Australia blind register. RESULTS: 273 blind or near blind people were reviewed from the register total of 4271 individuals. There were more women (57%) than men, median age 81 years. For legal blindness status the ppv was 0.88 (95% confidence interval [CI] 0.82-0.92), sensitivity 0.75 (95% CI 0.74-0.84) and specificity 0.6 (95% CI 0.46-0.73). The ppv for the diagnostic causes of blindness were: age-related macular degeneration = 0.95 (95% CI 0.91-0.97), retinitis pigmentosa ppv = 1 (95% CI 0.81-1.0), diabetic retinopathy ppv = 0.9 (95% CI 0.57-0.99), optic neuropathies ppv = 0.77 (95% CI 0.51-0.92) and glaucoma ppv = 0.87 (95% CI 0.7-0.96). Forty individuals (15%) had treatable conditions contributing to their vision loss. CONCLUSIONS: The blind register diagnoses and legal blindness status are of high accuracy. This information allows useful linkages to other databases for studies of blindness interactions. A regular updating mechanism would improve the future accuracy of this valuable regional asset. The presence of untreated cataract suggests that regular follow up and appropriate treatment may help optimize vision in blind patients.

Vision self-management for older adults: a pilot study.

PURPOSE: The aim of this study was to pilot test the vision self-management programme (VSM) a newly developed, 8-week self-management intervention. The programme is a structured, repeatable and theoretically derived programme for older adults with age-related vision loss (ARVL). METHOD: A pre-and post-test design was used, and involved 12 older adults with ARVL. The activity card sort, a measure of participation in life situations, was the primary outcome measure. Secondary outcome measures examining general health and vision specific domains were also used. RESULTS: Participants reported a statistically significant increase in participation in life situations immediately following the VSM programme. However, whilst an increase in such participation was still present at 12-week follow-up, this was no longer statistically significant. In addition, the participants demonstrated statistically significant gains in both general health and vision specific domains. Although these findings are exploratory they suggest that the VSM may have both short and longer term benefits for older adults living with ARVL. CONCLUSIONS: Overall findings indicate that the participation in the self-management programme resulted in improved participation and health outcomes and support the need for further study using more rigorous designs.

Prevalence of blindness in Western Australia: a population study using capture and recapture techniques.

AIM: To determine the prevalence of blinding eye disease in Western Australia using a capture and recapture methodology. METHODS: Three independent lists of residents of Western Australia who were also legally blind were collated during the capture periods in 2008-9. The first list was obtained from the state-wide blind register. A second list comprised patients routinely attending hospital outpatient eye clinics over a 6-month period in 2008. The third list was patients attending ophthalmologists' routine clinical appointments over a 6-week period in 2009. Lists were compared to identify those individuals who were captured on each list and those who were recaptured by subsequent lists. Log-linear models were used to calculate the best fit and estimate the prevalence of blindness in the Western Australian population and extrapolated to a national prevalence of blindness in Australia. RESULTS: 1771 legally blind people were identified on three separate lists. The best estimate of the prevalence of blindness in Western Australia was 3384 (95% CI 2947 to 3983) or 0.15% of the population of 2.25 million. Extrapolating to the national population (21.87 million) gave a prevalence of legal blindness of approximately 32,892 or 0.15%. CONCLUSION: Capture-recapture techniques can be used to determine the prevalence of blindness in whole populations. The calculated prevalence of blindness suggested that up to 30% of legally blind people may not be receiving available financial support and up to 60% were not accessing rehabilitation services.

Vision self-management for older adults: a randomised controlled trial.

BACKGROUND/AIMS: Ageing of the population will result in unprecedented numbers of older adults living with age-related vision loss (ARVL). Self-management models improve health outcomes and reduce healthcare costs; however, the principles have rarely been applied in low vision services. METHODS: A two-armed randomised controlled trial of older adults (n=77) with ARVL compared 'usual care' provided by a not-for-profit community agency with an extended model of care (usual care+self-management group intervention). The primary outcome variable (participation in life situations) was measured using the Activity Card Sort. Secondary outcome measures examined general health and vision-specific domains. RESULTS: The intention-to-treat analysis demonstrated that the extended model produced significantly better participation in life situations at post-test when compared with the usual care only group. Gains were made regardless of whether participants were, or were not, depressed at baseline. The addition of the self-management group was also successful in significantly reducing depression, increasing physical and mental health, generalised and domain-specific self-efficacy, and adjustment to ARVL. With the exception of adjustment and mental health, differences were still apparent at 12 weeks' follow-up. CONCLUSION: Addition of self-management significantly improved general health and vision-specific rehabilitation outcomes for older adults with ARVL.