Study protocol for ELders AT Ease (ELATE): a cluster randomised controlled trial of cognitive behaviour therapy to reduce depressive symptoms in aged care residents.

BACKGROUND: This protocol describes a study of the effectiveness of cognitive behaviour therapy (CBT) for reducing depressive symptoms in older adults living in residential aged care (RAC) facilities in Australia. Depressive symptoms are highly prevalent in this population, yet the benefits of CBT for reducing such symptoms in RAC facilities have not been widely investigated. Elders at Ease (ELATE) is a 16-session CBT intervention designed for implementation in RAC facilities. The intervention includes cognitive, behavioural and reminiscence strategies and is delivered by mental health trainees (MHTs) in collaboration with RAC facility staff and residents' family. METHODS AND ANALYSIS: ELATE will be evaluated using a cluster randomised trial comparing outcomes for residents who participate in the intervention with those living in usual care control facilities. The participants are RAC residents aged 65 years or above, with depressive symptoms (Patient Health Questionnaire-2 ≥ 3) and normal cognition or mild cognitive impairment (Standardised Mini Mental Status Examination ≥ 21). They are assessed at four time points: baseline prior to randomisation (T1), mid-treatment (T2; 2.5 months post randomisation), post-treatment (T3; 5 months post-randomisation) and 3-month follow-up (T4; 8 months post randomisation). The primary outcome is change in depressive symptoms between T1 and T3. Secondary outcomes are depressive symptoms at T4, anxiety, suicide ideation, sleep problems, quality of life, staff and family knowledge of late-life depression, stress levels and efficacy in caring for residents, and MHT levels of geropsychology competencies. Residents receiving the intervention are hypothesised to report a greater decrease in depressive symptoms between T1 and T3 compared to residents receiving usual care. The primary analysis is a regression, clustered over site to account for correlated readings, and independent variables are condition and depressive symptoms at T1. A cost-utility analysis is also undertaken. DISCUSSION: ELATE is a comprehensive CBT intervention for reducing depressive symptoms in RAC residents. It is designed to be implemented in collaboration with facility staff and residents' families, individually tailored to residents with normal cognition to mild cognitive impairment and delivered by trainee therapists. ELATE offers a model that may be widely applicable across the RAC sector. TRIAL REGISTRATION: Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number ACTRN12619001037190, prospectively registered on 22 July 2019.

Preliminary evidence for the impact of digital life stories about aged care residents on staff knowledge and understanding regarding those residents; A single arm trial.

AIMS AND OBJECTIVES: This study aimed to examine the impact of digital stories about aged care residents on staff knowledge and understanding regarding those residents. BACKGROUND: More than a quarter of a million older Australians live in residential aged care facilities. This living arrangement can inhibit the expression of a person's sense of identity. Without objects and cues that reflect the person's selfhood, it can be difficult for a person to express their uniqueness. Staff may not sufficiently appreciate the resident's individuality and therefore may not be able to customise care for the resident. DESIGN: This study used a single-arm trial design. METHODS: The study was conducted in four residential aged care facilities. Short digital life stories (3-4 min) of eight residents were constructed by student volunteers over 6 months. Participants (n = 53 care staff) completed a self-report measure of their knowledge and understanding of a resident before and after watching the resident's story. The study adhered to guidelines for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) (see Appendix S1). RESULTS: Pre- and post-test scores of the measure were compared using paired samples t-tests. These scores changed significantly, showing an improvement of knowledge and understanding regarding residents. CONCLUSIONS: Watching digital life stories were associated with improvements in knowledge and understanding by staff, and hence have the potential to foster a greater level of understanding of residents by such staff, and more person-centred care practices within residential aged care facilities. RELEVANCE TO CLINICAL PRACTICE: Digital stories about aged care residents are quick and efficient methods for improving aged care staff members' knowledge and understanding of the residents under their care. With such understanding, staff may be able to better customise care for residents, thereby validating residents' sense of identity and elevating residents' quality of life.

Cytosorb filter: An adjunct for survival in the COVID-19 patient in cytokine storm? a case report.

COVID-19 is a pandemic that has affected not only the United States, but the entire world. The impact it has had has overwhelmed the entire healthcare system, from the unknown carrier status, poor testing capabilities to hospitals running out of ventilators for severely ill patients. There has been a variety of potential treatment modalities for the various forms of illness ranging from asymptomatic carriers to the ventilated ICU patients. These include anti-inflammatory medications, antibiotics, immune-modulators, convalescent plasma, and others. The cytokine storm that inflicts some patients can be devastating to the vital organs of the human body in the form of acute respiratory distress syndrome (ARDS), renal failure, coagulopathy, and death. Cytosorbents® cytokine filter is a potential treatment methodology aimed at reducing the cytokine storm, thus serving as a bridge for therapy in the acutely ill patients infected with COVID-19. The following case report demonstrates the utility in a critically ill patient who survived the cytokine storm after receiving the cytokine filter via continuous renal replacement therapy bridging him to further definitive therapy.

A 3,2-Hydroxypyridinone-based Decorporation Agent that Removes Uranium from Bones In Vivo.

Searching for actinide decorporation agents with advantages of high decorporation efficiency, minimal biological toxicity, and high oral efficiency is crucial for nuclear safety and the sustainable development of nuclear energy. Removing actinides deposited in bones after intake is one of the most significant challenges remaining in this field because of the instantaneous formation of highly stable actinide phosphate complexes upon contact with hydroxyapatite. Here we report a hydroxypyridinone-based ligand (5LIO-1-Cm-3,2-HOPO) exhibiting stronger affinity for U(VI) compared with the reported tetradentate hydroxypyridinone ligands. This is further revealed by the first principles calculation analysis on bonding between the ligand and uranium. Both in vitro uranium removal assay and in vivo decorporation experiments with mice show that 5LIO-1-Cm-3,2-HOPO can remove uranium from kidneys and bones with high efficiencies, while the decorporation efficiency is nearly independent of the treatment time. Moreover, this ligand shows a high oral decorporation efficiency, making it attractive for practical applications.

Efficient and selective sensing of Cu2+ and UO22+ by a europium metal-organic framework.

We report here the investigation of using a luminescent europium organic framework, [Eu2(MTBC)(OH)2(DMF)3(H2O)4]·2DMF·7H2O (denoted as compound 1), for detecting of both Cu2+ and UO22+ with high sensitivity. Based on the spectroscopy analysis, compound 1 could selectively respond to Cu2+ and UO22+ ions among other selected monovalent, divalent, trivalent metal cations based on a turn-off mechanism. The detection limit of compound 1 towards Cu2+ ion was as low as 17.2 µg/L, which is much lower than the maximum tolerable concentration of Cu2+ in drinking water (2 mg/L) defined by United States Environmental Protection Agency. On the other hand, the detection limit towards UO22+ ions is 309.2 µg/L, which could be used for detecting uranium in relative severely contaminated areas. The concentration-dependent luminescence intensity evolution process could be fully understood by the absorption kinetics and isotherm investigations. Furthermore, the quenching mechanism was elucidated by the UV-vis, excitation, luminescence, and lifetime studies. Compound 1, as the first MOF based luminescence probe for both Cu2+ and UO22+ ions, provides insight into developing MOF-based multifunctional sensors for both nonradioactive and radioactive elements.

Anionic uranyl oxyfluorides as a bifunctional platform for highly selective ion-exchange and photocatalytic degradation of organic dyes.

Uranium is unique owing not only to its intriguing physiochemical properties, but also to the diverse coordination chemistry that uranyl adopts and bonding that enables rich and unpredictable topologies of uranium-bearing materials. Six anionic uranium oxyfluorides with various dimensionalities, including a 3D framework (MeUF), four 2D lamellar structures (EtUF-1, PrUF, BuUF-1, and BuUF-2), and a 1D chained topology (EtUF-2), have been rationally constructed by employing tetra-alkyl ammonium ions as structure-directing agents. By combining the tunable interlayer distance of the lamellar structures with the photooxygenation properties of uranyl ions, a bifunctional platform for highly selective ion-exchange and photocatalytic degradation over organic dyes has been developed. Specifically, BuUF-2 can efficiently capture 94.5% methylene blue (MB+) within 24 h from solution with remarkable selectivity related to both the size and the charge of organic dyes. Such size- and charge-dependent selectivity toward organic dyes has been documented for MOFs, but is rare for 2D lamellar materials. Furthermore, the removal of MB+ can be largely accelerated under UV radiation (e.g. 84.7% for BuUF-2 within 1 h) due to the photocatalytic activities of EtUF-1, EtUF-2, PrUF, and BuUF-2.

99TcO4- remediation by a cationic polymeric network.

Direct removal of 99TcO4- from the highly acidic solution of used nuclear fuel is highly beneficial for the recovery of uranium and plutonium and more importantly aids in the elimination of 99Tc discharge into the environment. However, this task represents a huge challenge given the combined extreme conditions of super acidity, high ionic strength, and strong radiation field. Here we overcome this challenge using a cationic polymeric network with significant TcO4- uptake capabilities in four aspects: the fastest sorption kinetics, the highest sorption capacity, the most promising uptake performance from highly acidic solutions, and excellent radiation-resistance and hydrolytic stability among all anion sorbent materials reported. In addition, this material is fully recyclable for multiple sorption/desorption trials, making it extremely attractive for waste partitioning and emergency remediation. The excellent TcO4- uptake capability is elucidated by X-ray absorption spectroscopy, solid-state NMR measurement, and density functional theory analysis on anion coordination and bonding.

Monitoring Ultraviolet Radiation Dosage Based on a Luminescent Lanthanide Metal-Organic Framework.

A luminescent lanthanide metal-organic framework [Tb7(OH)8(H2O)6(IDA)3(COO)3]·4Cl·2H2O (Tb-IDA, IDA = iminodiacetic acid) was hydrothermally synthesized and structurally characterized. Monitoring ultraviolet radiation was achieved by correlating the dosage with the luminescence color change in doped Gd99Tb0.1Eu0.9-IDA compound. A linear relationship is developed across a broad range from blue to yellow within a CIE chromaticity diagram.

Structural and thermodynamic stability of uranyl-deferiprone complexes and the removal efficacy of U(vi) at the cellular level.

Deferiprone (3-hydroxy-1,2-dimethyl-4(1H)-pyridone, DFP), which is a drug clinically used for removing heavy metals in vivo, was explored for its removal efficiency towards uranium. The reaction of uranyl nitrate hexahydrate with DFP at room temperature yielded the compound [(UO2)(H2O)(C7NO2H8)2]·4H2O (1), which crystallizes from a mixed solution of methanol and water (pH = 7.0). X-ray diffraction shows that the stable complexation of uranyl occurs from the coordination of two bidentate DFP ligands perpendicular to the O[double bond, length as m-dash]U[double bond, length as m-dash]O unit with a fifth coordinating oxygen atom coming from one water molecule, resulting in a pentagonal bipyramidal geometry. The formation constants of uranyl and DFP complexes were measured and the species distribution diagram illustrates that UO2L2 (94.6%) is the dominant uranyl-DFP complex in 0.1 M KCl solution at physiological pH = 7.4. The results from both crystallographic and potentiometric studies imply that the metal : ligand ratio is 1 : 2. The effectiveness of using DFP to remove uranium was examined at the cellular level, and the results suggest that it can significantly reduce the cellular uptake and increase the cellular release of U(vi) in renal proximal tubular epithelial cells (NRK-52E).

Immobilization of Alkali Metal Fluorides via Recrystallization in a Cationic Lamellar Material, [Th(MoO4)(H2O)4Cl]Cl·H2O.

Searching for cationic extended materials with a capacity for anion exchange resulted in a unique thorium molybdate chloride (TMC) with the formula of [Th(MoO4)(H2O)4Cl]Cl·H2O. The structure of TMC is composed of zigzagging cationic layers [Th(MoO4)(H2O)4Cl]+ with Cl- as interlamellar charge-balancing anions. Instead of performing ion exchange, alkali thorium fluorides were formed after soaking TMC in AF (A = Na, K, and Cs) solutions. The mechanism of AF immobilization is elucidated by the combination of SEM-EDS, PXRD, FTIR, and EXAFS spectroscopy. It was observed that four water molecules coordinating with the Th4+ center in TMC are vulnerable to competition with F-, due to the formation of more favorable Th-F bonds compared to Th-OH2. This leads to a single crystal-to-polycrystalline transformation via a pathway of recrystallization to form alkali thorium fluorides.

In Situ Reduction from Uranyl Ion into a Tetravalent Uranium Trimer and Hexamer Featuring Ion-Exchange Properties and the Alexandrite Effect.

By utilizing zinc amalgam as an in situ reductant and pH regulator, mild hydrothermal reaction between UO2(CH3COO)2·2H2O, H2SO4, and Cs2CO3 or between UO2(CH3COO)2·2H2O, C2H4(SO3H)2, and K2CO3 yielded a novel cesium UIV sulfate trimer Cs4[U3O(SO4)7]·2.2H2O (1) and a new potassium UIV disulfonic hexamer K[U6O4(OH)5(H2O)5][C2H4(SO3)2]6·6H2O (2), respectively. Compound 1 features a lamellar structure with a honeycomb lattice, and it represents an unprecedented trimeric UIV cluster composed of purely inorganic moieties. Complex 2 is built from hexanuclear U4+ cores and K+ ions interconnected by µ5-[C2H4(SO3)2]2- groups, leading to the construction of an extended framework rather than commonly observed discrete, neutral molecular sulfonate clusters. The various binding modes of the sulfate and disulfonate groups, especially the multidentate ones, enable additional bridging between metal ions, which promotes oligomerization and isolation of polynuclear species. Furthermore, compound 1 exhibits both ion-exchange properties and the Alexandrite effect, and it is the second example of a uranium complex without chromic functional ligands displaying the latter feature.

Unique Proton Transportation Pathway in a Robust Inorganic Coordination Polymer Leading to Intrinsically High and Sustainable Anhydrous Proton Conductivity.

Although comprehensive progress has been made in the area of coordination polymer (CP)/metal-organic framework (MOF)-based proton-conducting materials over the past decade, searching for a CP/MOF with stable, intrinsic, high anhydrous proton conductivity that can be directly used as a practical electrolyte in an intermediate-temperature proton-exchange membrane fuel cell assembly for durable power generation remains a substantial challenge. Here, we introduce a new proton-conducting CP, (NH4)3[Zr(H2/3PO4)3] (ZrP), which consists of one-dimensional zirconium phosphate anionic chains and fully ordered charge-balancing NH4+ cations. X-ray crystallography, neutron powder diffraction, and variable-temperature solid-state NMR spectroscopy suggest that protons are disordered within an inherent hydrogen-bonded infinite chain of acid-base pairs (N-H···O-P), leading to a stable anhydrous proton conductivity of 1.45 × 10-3 S·cm-1 at 180 °C, one of the highest values among reported intermediate-temperature proton-conducting materials. First-principles and quantum molecular dynamics simulations were used to directly visualize the unique proton transport pathway involving very efficient proton exchange between NH4+ and phosphate pairs, which is distinct from the common guest encapsulation/dehydration/superprotonic transition mechanisms. ZrP as the electrolyte was further assembled into a H2/O2 fuel cell, which showed a record-high electrical power density of 12 mW·cm-2 at 180 °C among reported cells assembled from crystalline solid electrolytes, as well as a direct methanol fuel cell for the first time to demonstrate real applications. These cells were tested for over 15 h without notable power loss.

Covalent Organic Framework Functionalized with 8-Hydroxyquinoline as a Dual-Mode Fluorescent and Colorimetric pH Sensor.

Real-time and accurate detection of pH in aqueous solution is of great significance in chemical, environmental, and engineering-related fields. We report here the use of 8-hydroxyquinoline-functionalized covalent organic framework (COF-HQ) for dual-mode pH sensing. In the fluorescent mode, the emission intensity of COF-HQ weakened as the pH decreased, and also displayed a good linear relationship against pH in the range from 1 to 5. In addition, COF-HQ showed discernible color changes from yellow to black as the acidity increased and can be therefore used as a colorimetric pH sensor. All these changes are reversible and COF-HQ can be recycled for multiple detection runs owing to its high hydrolytical stability. It can be further assembled into a mixed matrix membrane for practical applications.

Superprotonic conduction through one-dimensional ordered alkali metal ion chains in a lanthanide-organic framework.

Although no evident hydrogen-bond network appears, an ultrahigh proton conductivity of 2.91 × 10-2 S cm-1 at 363 K and 90% RH with an ultralow activation energy of 0.10 eV was observed in an anionic lanthanide-organic framework Na2[Eu(SDB)2(COO)]·0.375DMF·0.4H2O (1); both values approach the records among all reported proton-conducting MOF materials. This suggests that the proton conduction process in 1 is reminiscent of the Grotthuss mechanism, which together reveals an effective proton transportation pathway associated with aligned Na+ and their coordinated water.

Emergence of Uranium as a Distinct Metal Center for Building Intrinsic X-ray Scintillators.

The combination of high atomic number and high oxidation state in UVI materials gives rise to both high X-ray attenuation efficiency and intense green luminescence originating from ligand-to-metal charge transfer. These two features suggest that UVI materials might act as superior X-ray scintillators, but this postulate has remained substantially untested. Now the first observation of intense X-ray scintillation in a uranyl-organic framework (SCU-9) that is observable by the naked eye is reported. Combining the advantage in minimizing the non-radiative relaxation during the X-ray excitation process over those of inorganic salts of uranium, SCU-9 exhibits a very efficient X-ray to green light luminescence conversion. The luminescence intensity shows an essentially linear correlation with the received X-ray intensity, and is comparable with that of commercially available CsI:Tl. SCU-9 possesses an improved X-ray attenuation efficiency (E>20 keV) as well as enhanced radiation resistance and decreased hygroscopy compared to CsI:Tl.

Employing an Unsaturated Th4+ Site in a Porous Thorium-Organic Framework for Kr/Xe Uptake and Separation.

Actinide based metal-organic frameworks (MOFs) are unique not only because compared to the transition-metal and lanthanide systems they are substantially less explored, but also owing to the uniqueness of actinide ions in bonding and coordination. Now a 3D thorium-organic framework (SCU-11) contains a series of cages with an effective size of ca. 21×24 Å. Th4+ in SCU-11 is 10-coordinate with a bicapped square prism coordination geometry, which has never been documented for any metal cation complexes. The bicapped position is occupied by two coordinated water molecules that can be removed to afford a very unique open Th4+ site, confirmed by X-ray diffraction, color change, thermogravimetry, and spectroscopy. The degassed phase (SCU-11-A) exhibits a Brunauer-Emmett-Teller surface area of 1272 m2 g-1 , one of the highest values among reported actinide materials, enabling it to sufficiently retain water vapor, Kr, and Xe with uptake capacities of 234 cm3 g-1 , 0.77 mmol g-1 , 3.17 mmol g-1 , respectively, and a Xe/Kr selectivity of 5.7.

Phase transition triggered aggregation-induced emission in a photoluminescent uranyl-organic framework.

When exposed to water, the two-dimensional uranyl-organic layered compound [(CH3)2NH2][(UO2)(BCPBA)]·2DMF·H2O (H3BCPBA = 3,5-bis (4'-carboxylphenoxy) benzoic acid) gradually undergoes a complete single-crystal-to-single-crystal phase transition to [(CH3)2NH2][(UO2)(BCPBA)]·3.4H2O, resulting in an enhanced ligand-ligand interaction between the adjacent layers. This process gives rise to initial quenching of the uranyl photoluminescence followed by subsequent recovery of the photoluminescence with a much elevated intensity, as a unique case of aggregation-induced emission in an extended solid system, further confirmed by DFT analysis on bonding.

An Ultrastable Heterobimetallic Uranium(IV)/Vanadium(III) Solid Compound Protected by a Redox-Active Phosphite Ligand: Crystal Structure, Oxidative Dissolution, and First-Principles Simulation.

The first heterobimetallic uranium(IV)/vanadium(III) phosphite compound, Na2UV2(HPO3)6 (denoted as UVP), was synthesized via an in situ redox-active hydrothermal reaction. It exhibits superior hydrolytic and antioxidant stability compared to the majority of structures containing low-valent uranium or vanadium, further elucidated by first-principles simulations, and therefore shows potential applications in nuclear waste management.

Highly Sensitive Detection of UV Radiation Using a Uranium Coordination Polymer.

The accurate detection of UV radiation is required in a wide range of chemical industries and environmental or biological related applications. Conventional methods taking advantage of semiconductor photodetectors suffer from several drawbacks such as sophisticated synthesis and manufacturing procedure, not being able to measure the accumulated UV dosage as well as high defect density in the material. Searching for new strategies or materials serving as precise UV dosage sensor with extremely low detection limit is still highly desirable. In this work, a radiation resistant uranium coordination polymer [UO2(L)(DMF)] (L = 5-nitroisophthalic acid, DMF = N,N-dimethylformamide, denoted as compound 1) was successfully synthesized through mild solvothermal method and investigated as a unique UV probe with the detection limit of 2.4 × 10-7 J. On the basis of the UV dosage dependent luminescence spectra, EPR analysis, single crystal structure investigation, and the DFT calculation, the UV-induced radical quenching mechanism was confirmed. Importantly, the generated radicals are of significant stability which offers the opportunity for measuring the accumulated UV radiation dosage. Furthermore, the powder material of compound 1 was further upgraded into membrane material without loss in luminescence intensity to investigate the real application potentials. To the best of our knowledge, compound 1 represents the most sensitive coordination polymer based UV dosage probe reported to date.

A Large Family of Centrosymmetric and Chiral f-Element-Bearing Iodate Selenates Exhibiting Coordination Number and Dimensional Reductions.

The exploration of phase formation in the f-element-bearing iodate selenate system has resulted in 14 novel rare-earth-containing iodate selenates, Ln(IO3)(SeO4) (Ln = La, Ce, Pr, Nd; LnISeO-1), Ln(IO3)(SeO4)(H2O) (Ln = Sm, Eu; LnISeO-2), and Ln(IO3)(SeO4)(H2O)2·H2O (Ln = Gd, Dy, Ho, Er, Tm, Yb, Lu, Y; LnISeO-3), as well as two new thorium iodate selenates, Th(OH)(IO3)(SeO4)(H2O) (ThISeO-1) and Th(IO3)2(SeO4) (ThISeO-2). LnISeO-3 and ThISeO-2 crystallize in the chiral space group P212121, while LnISeO-1, LnISeO-2, and ThISeO-1 crystallize in the centrosymmetric space group P21/c. The numbers of both coordinating and hydrating water molecules crystallized in LnISeO-1, LnISeO-2, and LnISeO-3 increase along these three series, in line with the increasingly negative values of hydration enthalpies of heavier trivalent lanthanide ions. Such a systematic change in compositions, especially the first coordination sphere of Ln, further induces structural rearrangements, including coordination number and dimensional reductions. More specifically, the structures of LnISeO-1, LnISeO-2, and LnISeO-3 have undergone transitions from 2D Ln-oxo layers with 10-coordinate Ln centers to 1D Ln-oxo chains with 9-coordinate Ln centers and then to 0D Ln-oxo monomers with 8-coordinate Ln centers, respectively. The formation and characterization of this large family of Ln/Th iodate selenates suggest that such a mixed-anion system not only exhibits richer structural chemistry but also can be capable of generating intriguing properties, such as the second-harmonic generation (SHG) effect.