Physiotherapy service provision in a specialist adult cystic fibrosis service: A pre-post design study with the inclusion of an allied health assistant.

What is the impact of including an allied health assistant (AHA) role on physiotherapy service delivery in an acute respiratory service? A pragmatic pre-post design study examined physiotherapy services across two 3-month periods: current service delivery [P1] and current service delivery plus AHA [P2]. Clinical and non-clinical activity quantified as number, type and duration (per day) of all staff activity categorised for skill level (AHA, junior, senior). Physiotherapy service delivery increased in P2 compared to P1 (n = 4730 vs n = 3048). Physiotherapists undertook fewer respiratory (p < 0.001) and exercise treatments (p < 0.001) but increased reviews for inpatients (p < 0.001) and at multidisciplinary clinics in P2 (56% vs 76%, p < 0.01). The AHA accounted for 20% of all service provision. AHA activity comprised mainly non-direct clinical care including oversight of respiratory equipment use (e.g. supply, set-up, cleaning, loan audits) and other patient-related administrative tasks associated with delegation handovers, supervision and clinical documentation (72%), delegated supervision of established respiratory (5%) and exercise treatments (10%) and delegated exercise tests (3%). The AHA completed most of the exercise tests (n = 25). AHA non-direct clinical tasks included departmental management activities (11%). No adverse events were reported. AHA inclusion in an acute respiratory care service changed physiotherapy service provision. The AHA completed delegated routine clinical and non-clinical tasks. Physiotherapists increased clinic activity and annual reviews. Including an AHA role offers sustainable options for enhancing physiotherapy service provision in acute respiratory care.

Long-Term Survival and Health-Related Quality of Life in Adults After Extra Corporeal Membrane Oxygenation.

BACKGROUND: The study aims to determine long-term survival, health-related quality of life (HRQoL) and functional and physical outcomes of adult extra corporeal membrane oxygenation (ECMO) patients as there are limited and conflicting data in this area. METHODS: All patients receiving ECMO from April 2009 until June 2014 at The Prince Charles Hospital, Brisbane had Kaplan Meier survival calculated. Quality of life (QoL) was assessed using the Short Form Health Survey (SF-36v2), EQ5D-5L, The Frenchay Activities Index (FAI) and a return to work survey. From December 2011, these measures and 6-minute walk distance (6MWD) were assessed at hospital discharge and 12 months post-discharge. RESULTS: Seventy-seven (77) patients (45 veno-arterial and 32 veno-venous) received ECMO of whom 47/77 (61%) survived to hospital discharge. There were no deaths recorded in those discharged alive from the intensive care unit at median follow-up time 1,011days (range 227-2,014 days). Mean SF-36 scores (n=33) and EQ5D were assessed at a median of 606days after hospital discharge. SF-36 scores were significantly (p<0.05) worse than age-matched norms in all domains except vitality, bodily pain and mental health. Thirteen (13) (39%) participants had persistent problems with mobility and usual activity as measured by EQ5D. At 12 months post-ECMO, 6MWD was 531(IQR:397.3-626.8)m; 72% (IQR:53.2-77.6%) predicted but had improved by 223m (p=0.002) when compared to baseline. Nineteen (19) of 20 participants who had been employed pre-ECMO had returned to work. CONCLUSIONS: All ECMO patients discharged from hospital were alive at follow-up. Despite improvements in physical measures and HRQoL, long-term functional deficits persist when compared to that of aged- and sex-matched norms.

Deconvoluting the Innocent vs. Non-innocent Behavior of N,N-diethylphenylazothioformamide Ligands with Copper Sources.

Redox-active ligands lead to ambiguity in often clearly defined oxidation states of both the metal centre and the ligand. The arylazothioformamide (ATF) ligand class represents a redox-active ligand with three possible redox states (neutral, singly reduced, and doubly reduced). ATF-metal interactions result in strong colorimetric transitions allowing for the use of ATFs in metal detection and/or separations. While previous reports have discussed dissolution of zerovalent metals, the resulting oxidation states of coordination complexes have proved difficult to interpret through X-ray crystallographic analysis alone. This report describes the X-ray crystallographic analysis combined with computational modelling of the ATF ligand and metal complexes to deconvolute the metal and ligand oxidation state of metal-ATF complexes. Metal(ATF)2 complexes that originated from zerovalent metals were found to exist as dicationic metal centers containing two singly reduced ATF ligands. When employing Cu(I) salts instead of Cu(0) to generate copper-ATF complexes, the resulting complexes remained Cu(I) and the ATF ligand remained "innocent", existing in its neutral state. Although the use of CuX (where X = Br or I) or [Cu(NCMe)4]Y (where Y = BF4 or PF6) generated species of the type: [(ATF)Cu(µ-X)]2 and [Cu(ATF)2]Y, respectively, the ATF ligand remained in its neutral state for each species type.

Benchmarking service provision, scope of practice, and skill mix for physiotherapists in adult cystic fibrosis care delivery.

BACKGROUND: Increasing age, numbers, and complexity of care are potentially impacting physiotherapy service delivery for adults with cystic fibrosis (CF). PURPOSE: This study aimed to describe physiotherapy service provision, scope of practice, and skill mix in a large tertiary adult CF center, and determine if services were meeting clinical practice recommendations. METHODS: A prospective cross-sectional study examined inpatient and outpatient physiotherapy care across a three-month period in a tertiary adult CF center. Physiotherapy services were described by number and skill level of physiotherapists, total hours of activity, and number, type, and duration of each physiotherapy activity. RESULTS: Twenty-two physiotherapists provided care. Respiratory (n = 1058, 38%), and exercise treatments (n = 338, 12%) were the most frequent. Exercise testing (n = 20, 1%), and detailed treatment reviews (n = 79, 3%) occurred infrequently. Time for research was limited. Junior physiotherapists undertook more exercise treatments per day (p < .01), with senior physiotherapists attending outpatient clinics (p < .01). CONCLUSION: A large number of physiotherapists were involved in the delivery of services. Recommended respiratory and exercise treatments were frequently provided; however, other recommended activities occurred infrequently. The impact of increasing age, numbers of patients, and complexity of care may be contributing to demand exceeding supply for physiotherapy services. Future studies are required to determine innovative approaches to address the gaps in clinical practice recommendations.

The synthesis and crystal structure of bis-[3,3-diethyl-1-(phenyl-imino-κN)thio-urea-κS]silver hexa-fluorido-phosphate.

The structure of the title complex, [Ag(C11H15N3S)2]PF6, has monoclinic (P21/c) symmetry, and the silver atom has a distorted square-planar geometry. The coordination complex crystallized from mixing silver hexa-fluorido-phosphate with a concentrated tetra-hydro-furan solution of N,N-di-ethyl-phenyl-azo-thio-formamide [ATF; systematic name: 3,3-diethyl-1-(phenyl-imino)-thio-urea] under ambient conditions. The resultant coordination complex exhibits a 2:1 ligand-to-metal ratio, with the silver(I) atom having a fourfold AgN2S2 coordination sphere, with a single PF6 counter-ion. In the crystal, however, one sulfur atom from an ATF ligand of a neighboring complex coordinates to the silver atom, with a bond distance of 2.9884 (14) Å. This creates a polymeric zigzag chain propagating along the c-axis direction. The chains are linked by C-H⋯F hydrogen bonds, forming slabs parallel to the ac plane.

Cognitive behavioural therapy (CBT) for patients with chronic lung disease and psychological comorbidities undergoing pulmonary rehabilitation.

BACKGROUND: The study aimed to determine the effects of adding cognitive behavioural therapy (CBT) to pulmonary rehabilitation to treat patients with chronic lung disease and comorbid anxiety and/or depression symptoms. METHODS: An open, parallel group, randomised controlled trial (RCT) was conducted, with longitudinal follow-up of 12 months. CBT was delivered in 2 face-to-face sessions and 4 phone sessions to patients with depression or anxiety undergoing pulmonary rehabilitation. The main outcome measures were change in Geriatric Depression Scale (GDS) and Geriatric Anxiety Inventory (GAI); secondary outcomes were St. Georges Respiratory Questionnaire (SGRQ), 6-minute walk test (6MWT) and pulmonary rehabilitation attendance. RESULTS: A total of 65 patients were randomized to Intervention (n=24) and Control (n=41) groups. Of the 24 patients in the Intervention group, 6 patients (25%) withdrew and 4 patients (12.5%) failed to attend more than 2 CBT sessions, which was significantly more than the Control group. The majority of patients (75.4%) had chronic obstructive pulmonary disease. Fourteen (21.5%) had symptoms of depression only, 12 (18.4%) had symptoms of anxiety only, and 39 (60.0%) had symptoms of both anxiety and depression. In the Intervention group, GDS significantly improved at the end of pulmonary rehabilitation (mean difference -3.1, 95% CI: -4.39 to -1.70; P=0.0001), 3 months follow-up (mean difference -1.5, 95% CI: -4.17 to -0.75; P=0.008), and at 12 months follow-up (mean difference -1.6, 95% CI: -3.29 to -0.03, P=0.04), compared to baseline. The Control group demonstrated improvement in GDS by the end of pulmonary rehabilitation (mean difference -1.3, 95% CI: -2.4 to -0.27; P=0.01) which was not maintained at 3 months (P=0.14) and 12 months (P=0.25). GAI significantly improved by the end of rehabilitation in both the Intervention (mean difference -2.6, 95% -4.69 to -0.57; P=0.01) and Control groups (mean difference -2.6, 95% -4.16 to -1.14; P=0.001) and there was no significant improvement at 3 and 12 months. No statistically significant differences in changes in GDS or GAI were observed between the Intervention and Control groups at any time point. There was no significant improvement in SGRQ or 6MWT. There was a significant increase in attended pulmonary rehabilitation sessions in the Intervention group, compared to the Control group (mean difference 1.59; 95% CI: 0.11 to 3.07; P=0.03). CONCLUSIONS: In this RCT of patients with chronic lung diseases attending pulmonary rehabilitation, there was no evidence found for improved symptoms of anxiety or depression or health-related quality of life with the addition of CBT given in a mixed face-to-face and telephone format, compared to usual care. Slower than anticipated recruitment, leading to a smaller than planned sample size, and a high dropout rate in the group allocated to CBT may have limited the effectiveness of the behavioural intervention approach in this study.

An Investigation of Polyoxometalate Hybrid Materials as Patternable Dielectrics and Lithographic Resists.

Polyoxometalate (POM) hybrid materials have shown potential as spin-coatable, patternable dielectric thin-films and components for lithographic resists. In particular, the octamolybdate cluster has been shown to possess good spin-coating properties and the patterning capabilities of hybrid octamolybdate thin-films were explored using a combination of broadband UV and electron beam lithography (EBL) techiniques. Dielectric properties of these films were determined by ellipsometry, and octamolybdate clusters were subsequently investigated as negative resists in various blends for potential uses in next-generation photolithography, where contrast, sensitivity, and line edge roughness characteristics were determined. Preliminary evidence for the suppression of the diffusion of photo-generated acids is presented.

para-Octaiodophenylsilsesquioxane, [p-IC6H4SiO(1.5)]8, a nearly perfect nano-building block.

The cubic symmetry of octafunctional octaphenylsilsesquioxanes [ROPS, (RC6H4SiO(1.5))8] coupled with a 1 nm diameter offers exceptional potential to assemble materials in three dimensions with perfect control of periodicity and the potential to tailor global properties at nanometer length scales. OPS itself is very inert and insoluble and can only be functionalized via electrophilic reactions with difficulty and with poor substitutional selectivity. However, functionalized OPS products are robust and highly soluble, offering easy purification and processing. In contrast to previous studies, we report here that OPS reacts with ICl at sub-ambient temperatures to provide (following recrystallization) [p-IC6H4SiO(1.5)]8, or I8OPS, in good yields and with excellent selectivity: >99% mono-iodo substitution with >93% para substitution as determined by H2O2/F- cleavage of the Si-C bonds to produce iodophenols. I8OPS in turn can be functionalized using conventional catalytic coupling reactions to provide sets of >93% para-substituted, functionalized compounds (alkynes, alkenes, aryl amines, phosphonates, aryl amines, polyaromatics, etc.), suggesting the potential to develop diverse nano-building blocks for the assembly of a wide variety of materials, some with novel photonic, electronic, and structural properties.