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Europe’s extraordinary response to those fleeing the Russian invasion of Ukraine in February 2022 has prompted many criticisms of Europe’s treatment of other refugees, and indeed people of colour and members of ethnic minorities fleeing Ukraine. While stark, this differentiated response in not unusual: The global refugee regime treats different refugees differently, as a matter of course. Refugees often encounter racialized migration controls, and systems which privilege some refugees over others. The article seeks to clarify when these practices violate the international legal prohibitions on discrimination on grounds of race and nationality. To do so, it focuses on race discrimination in general international human rights law, clarifying the interaction between general human rights principles and instruments, and the specialist instrument in the field, the International Convention on the Elimination of all Forms of Racial Discrimination. We identify how differences in treatment on grounds of nationality may engage the prohibition on race discrimination both directly (in particular when nationality equates to national origin) or indirectly. Concerning nationality discrimination, the article focuses in particular on the added value of Article 3 of the 1951 Convention on the Status of Refugees, which obliges states to ‘apply the provisions of this Convention to refugees without discrimination as to race, religion or country of origin.’ We examine Article 3 both within the overall scheme of the Refugee Convention and as a source to guide interpretation of international human rights norms.

Developing a cancer theranostic nanoplatform with diagnosis and treatment capabilities to effectively treat tumors and reduce side effects is of great significance. Herein, we present a drug delivery strategy for photosensitizers based on a new liquid metal nanoplatform that leverages the tumor microenvironment to achieve photodynamic therapeutic effects in pancreatic cancer. Eutectic gallium indium (EGaIn) nanoparticles were successfully conjugated with a water-soluble cancer targeting ligand, hyaluronic acid, and a photosensitizer, benzoporphyrin derivative, creating EGaIn nanoparticles (EGaPs) via a simple green sonication method. The prepared sphere-shaped EGaPs, with a core-shell structure, presented high biocompatibility and stability. EGaPs had greater cellular uptake, manifested targeting competence, and generated significantly higher intracellular ROS. Further, near-infrared light activation of EGaPs demonstrated their potential to effectively eliminate cancer cells due to their single oxygen generation capability. Finally, from

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Launched on 2021 December 9, the Imaging X-ray Polarimetry Explorer (IXPE) is a NASA Small Explorer Mission in collaboration with the Italian Space Agency (ASI). The mission will open a new window of investigation—imaging x-ray polarimetry. The observatory features three identical telescopes, each consisting of a mirror module assembly with a polarization-sensitive imaging x-ray detector at the focus. A coilable boom, deployed on orbit, provides the necessary 4-m focal length. The observatory utilizes a three-axis-stabilized spacecraft, which provides services such as power, attitude determination and control, commanding, and telemetry to the ground. During its 2-year baseline mission, IXPE will conduct precise polarimetry for samples of multiple categories of x-ray sources, with follow-on observations of selected targets.

BackgroundMuch of the blame of the increasing death toll by drug overdoses has justifiably been attributed to the United States’ current opioid epidemic. However, nearly 80% of overdoses related to opioids involve another drug substance or alcohol. The objective of this study was to elucidate overrepresentation of drugs in polypharmacy arrests by identifying drugs that were more likely to be found in conjunction with other substances, using the drug arrest data provided by the Maine Diversion Alert Program (DAP).MethodsSingle drug arrest and multiple drug arrest totals reported to the DAP were examined. Drugs involved in the arrests were classified by Drug Enforcement Administration Schedule (I-V or non-controlled prescription) and categorized into five drug families: hallucinogens, opioids, sedatives, stimulants, and miscellaneous. Multiple drug arrest totals were compared to single drug arrest totals to create a Multiple-to-Single Ratio (MSR) specific to each drug family and each drug. Chi-square approximations without Yates correction and two-tailed P values were used to determine statistical significance through GraphPad’s 2×2 contingency tables.ResultsOver three-fifths (63.8%) of all arrests involved a single drug. Opioids accounted for over-half (53.5%) of single arrests, followed by stimulants (27.7%) and hallucinogens (7.7%). Similarly, nearly two-fifths (39.6%) of multiple arrests were opioids, followed by stimulants (30.8%) and miscellaneous (13.0%). Miscellaneous family drugs were recorded with the highest Multiple-to-Single Ratio (1.51), followed by sedatives (1.09), stimulants (0.63), opioids (0.42), and hallucinogens (0.35). Carisoprodol (8.80), amitriptyline (6.34), and quetiapine (4.69) had the highest MSR values and therefore were the three most overrepresented drugs in polysubstance arrests.ConclusionThe abuse of opioids, both alone and in conjunction with another drug, deserves continued surveillance in public health. In addition, common prescription drugs with lesser-known misuse potential, especially carisoprodol, amitriptyline, and quetiapine, require more attention by medical providers for their ability to enhance the effects of other drugs or to compensate for undesired drug effects.

The current pandemic and concomitant framework of crisis has led to unprecedented restrictions on global movement, and hence on the ability of refugees to seek protection. These measures have been implemented as a matter of urgency on account of the immediacy of the public health challenge, yet risk violating international refugee and human rights law. This experience provides an opportunity to reflect on an equally compelling, although less imminent, threat, namely displacement linked to the impacts of climate change. This article considers these twin challenges and reflects on the capacity and limits of international law to address both crises, while balancing the competing rights and interests at stake. It argues that a key challenge for international law and policy is how to harness the sense of urgency generated by COVID-19 for the long-term ‘climate crisis’, without resorting to emergency mechanisms of reactive, short-term, restrictive, and exceptional measures. © 2021, University of New South Wales Law Journal. All rights reserved.

Introduction Electronic adherence monitoring (EAM) is increasingly used to improve adherence. However, there is limited evidence on the effect of EAM in across chronic conditions and on patient acceptability. We aimed to assess the effect of EAM on adherence and clinical outcomes, across all ages and all chronic conditions, and examine acceptability in this systematic review and meta-analysis. Methods A systematic search of Ovid MEDLINE, EMBASE, Social Work Abstracts, PsycINFO, International Pharmaceutical Abstracts and CINAHL databases was performed from database inception to December 31, 2020. Randomised controlled trials (RCTs) that evaluated the effect of EAM on medication adherence as part of an adherence intervention in chronic conditions were included. Study characteristics, differences in adherence and clinical outcomes between intervention and control were extracted from each study. Estimates were pooled using random-effects meta-analysis, and presented as mean differences, standardised mean differences (SMD) or risk ratios depending on the data. Differences by study-level characteristics were estimated using subgroup meta-analysis to identify intervention characteristics associated with improved adherence. Effects on adherence and clinical outcomes which could not be meta-analysed, and patient acceptability, were synthesised narratively. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed, and Risk of bias (RoB) assessed using the Cochrane Collaboration’s RoB tool for RCTs. The review is registered with PROSPERO CRD42017084231. Findings Our search identified 365 studies, of which 47 studies involving 6194 patients were included. Data from 27 studies (n = 2584) were extracted for the adherence outcome. The intervention group (n = 1267) had significantly better adherence compared to control (n = 1317), (SMD = 0.93, CI:0.69 to 1.17, p2 = 86%). There was a significant difference in effect according to intervention complexity (p = 0.01); EAM only improved adherence when used with a reminder and/or health provider support. Clinical outcomes were measured in 38/47 (81%) of studies; of these data from 14 studies were included in a meta-analysis of clinical outcomes for HIV, hypertension and asthma. In total, 13/47 (28%) studies assessed acceptability; patient perceptions were mixed. Interpretation Patients receiving an EAM intervention had significantly better adherence than those who did not, but improved adherence did not consistently translate into clinical benefits. Acceptability data were mixed. Further research measuring effects on clinical outcomes and patient acceptability are needed.

Eutectic gallium indium (EGaIn), a Ga-based liquid metal alloy holds great promise for designing next generation core-shell nanoparticles (CSNs). A shearing assisted ligand-stabilization method has shown promise as a synthetic method for these CSNs; however, determining the role of the ligand on stabilization demands an understanding of the surface chemistry of the ligand-nanoparticle interface. EGaIn CSNs have been created functionalized with aliphatic carboxylates of different chain length allowing a fundamental investigation on ligand stabilization of EGaIn CSNs. Raman and diffuse reflectance Fourier transform spectroscopies (DRIFTS) confirm reaction of the ligand with the oxide shell of the EGaIn nanoparticles. Changing the length of the alkyl chain in the aliphatic carboxylates (C2-C18) may influence the size and structural stability of EGaIn CSNs, which is easily monitored using atomic force microscopy (AFM). No matter how large the carboxylate ligand, there is no obvious effect on the size of the EGaIn CSNs, except the particle size got more uniform when coated with longer chain carboxylates. The AFM force distance (F-D) measurements are used to measure the stiffness of the carboxylate coated EGaIn CSN. In corroboration with DRIFTS analysis, the stiffness studies show that the alkyl chains undergo conformational changes upon compression.

Background: Pandemics and the large-scale outbreak of infectious disease can significantly impact morbidity and mortality worldwide. The impact on intensive care resources can be significant and often require modification of service delivery, a key element which includes rapid expansion of the critical care workforce. Pandemics are also unpredictable, which necessitates rapid decision-making and action which, in the lack of experience and guidance, may be extremely challenging. Recognising the potential strain on intensive care units (ICUs), particularly on staffing, a working group was formed for the purpose of developing recommendations to support decision-making during rapid service expansion. Methods: The Critical Care Pandemic Staffing Working Party (n = 21), representing nursing, allied health, and medical disciplines, has used a modified consensus approach to provide recommendations to inform multidisciplinary workforce capacity expansion planning in critical care. Results: A total of 60 recommendations have been proposed which reflect general recommendations as well as those specific to maintaining the critical care workforce, expanding the critical care workforce, rostering and allocation of the critical care workforce, nurse-specific recommendations for staffing the ICU, education support and training during ICU surge situations, workforce support, models of care, and de-escalation. Conclusion: These recommendations are provided with the intent that they be used to guide interdisciplinary decision-making, and we suggest that careful consideration is given to the local context to determine which recommendations are most appropriate to implement and how they are prioritised. Ongoing evaluation of recommendation implementation and impact will be necessary, particularly in rapidly changing clinical contexts.

IntroductionThe Diversion Alert Program (DAP) was established to curb the misuse of drugs and help identify people in need of substance use disorder (SUD) treatment. Law enforcement compiled arrest data into a database accessible by health care providers. The objectives of this investigation were to identify regional and demographic differences in drug use and misuse in Maine.MethodsAll arrests (N = 11,234) reported to the DAP from 2013 to 2018 were examined by county, arrestee demographics, and classified into families (opioids, stimulants, sedatives). The Automation of Reports and Consolidated Orders System (ARCOS) tracks the distribution of controlled pharmaceuticals (schedule I-V). Opioids were converted to oral morphine mg equivalents (MME). County and zip-code heat maps were constructed.ResultsThe counties with the most arrests per capita were Cumberland, Androscoggin, and Penobscot. Opioids were the most common drug class in arrests in all counties except Aroostook, where stimulants were most common. Medical distribution of opioids varied. With the exception of buprenorphine, which doubled, many prescription opioids like hydrocodone, fentanyl, and oxymorphone exhibited large (>50%) reductions. Methadone was the predominant opioid statewide (56.4% of the total MME) although there were sizeable differences (Presque Isle = 8.6%, Bangor = 78.9%) and this is likely impacted by use for SUD treatment. Amphetamine distribution increased by 67.9%. Conclusions: The DAP was useful to prevent information silos and enhance communication between law enforcement and health care providers. Maine’s DAP was a unique system to identify patients in need of additional treatment resources. The increase in prescription stimulants may warrant continued monitoring.

There is limited evidence on total knee arthroplasty (TKA) that retains the anterior and the posterior cruciate ligaments. Bi-cruciate retaining (BCR) TKA is considered to show improved clinical function and kinematics. This survey aimed to (1) identify interest in and acceptance of BCR TKA surgery and (2) to capture the range of indications for BCR in the opinion of practicing knee surgeons. 346 surgeons with experience in TKA surgery completed a bi-lingual online survey. Demographics, arthroplasty experience as well as acceptance of and indications for BCR TKA were collected. 53 surgeons were experienced in BCR TKA and 225 would consider implanting it. A mean of 19.5% of TKA patients were considered eligible for BCR TKA. 56.3% were thought to have intact ACL at the time of TKA surgery. Surgeons were not likely to perform BCR TKA in patients with inflammatory arthritis, aged over 80, BMI above 34.9 kg/m2, a varus or valgus deformity of more than 10° and flexion contractures of more than 10°. There is strong interest among orthopedic surgeons to perform BCR TKA and the percentage of potentially eligible patients is high. Significant joint deformity is a limitation of BCR TKA, while age and high BMI are less relevant. BCR TKA experienced surgeons are less restrictive.

BackgroundThe opioid overdose crisis is especially pronounced in Maine. The Diversion Alert Program (DAP) was developed to combat illicit drug use and prescription drug diversion by facilitating communication between law enforcement and healthcare providers with the goal of limiting drug-related harms and criminal behaviors. Our objectives in this report were to analyze 2014-2017 DAP for: 1) trends in drug arrests and, 2) differences in arrests by offense, demographics (sex and age) and by region.MethodsDrug charges (N = 8,193, 31.3% female, age = 33.1 ± 9.9) reported to the DAP were examined by year, demographics, and location.ResultsThe most common substances of the 10,064 unique arrests reported were heroin (N = 2,203, 21.9%), crack/cocaine (N = 945, 16.8%), buprenorphine (N = 812, 8.1%), and oxycodone (N = 747, 7.4%). While the overall number of arrests reported to the DAP declined in 2017, the proportion of arrests involving opioids (heroin, buprenorphine, or fentanyl) and stimulants (cocaine/crack cocaine, or methamphetamine), increased (p < .05). Women had significantly increased involvement in arrests involving sedatives and miscellaneous pharmaceuticals (e.g. gabapentin) while men had an elevation in stimulant arrests. Heroin accounted for a lower percentage of arrests among individuals age > 60 (6.6%) relative to young-adults (18-29, 22.3%, p < .0001). Older-adults had significantly more arrests than younger-adults for oxycodone, hydrocodone, and marijuana.ConclusionHeroin had the most arrests from 2014-2017. Buprenorphine, fentanyl and crack/cocaine arrests increased appreciably suggesting that improved treatment is needed to prevent further nonmedical use and overdoses. The Diversion Alert Program provided a unique data source for research, a harm-reduction tool for health care providers, and an informational resource for law enforcement.

Copyright © 2019 British Institute of International and Comparative Law. This article is an output of a major research project examining the notion of imminence in the law on international protection. It is the first piece of scholarship to identify an emerging trend, namely the introduction of imminence - whether invoked implicitly or explicitly - as a potential barrier to refugee status or complementary protection. The article analyses the jurisprudence of relevant international bodies and courts and critiques the validity of this notion as a tool for assessing States' protection obligations.

Background As new hospitals are built to replace old and ageing facilities, intensive care units are being constructed with single patient rooms rather than open plan environments. While single rooms may limit hospital infections and promote patient privacy, their effect on patient safety and work processes in the intensive care unit requires greater understanding. Strategies to manage changes to a different physical environment are also unknown. Objectives This study aimed to identify challenges and issues as perceived by staff related to relocating to a geographically and structurally new intensive care unit. Methods This exploratory ethnographic study, underpinned by Donabedian's structure, process and outcome framework, was conducted in an Australian tertiary hospital intensive care unit. A total of 55 participants including nurses, doctors, allied health professionals, and support staff participated in the study. We conducted 12 semi-structured focus group and eight individual interviews, and reviewed the hospital's documents specific to the relocation. After sorting the data deductively into structure, process and outcome domains, the data were then analysed inductively to identify themes. Findings Three themes emerged: understanding of the relocation plan, preparing for the uncertainties and vulnerabilities of a new work environment, and acknowledging the need for change and engaging in the relocation process. Discussion and conclusions A systematic change management strategy, dedicated change leadership and expertise, and an effective communication strategy are important factors to be considered in managing ICU relocation. Uncertainty and staff anxiety related to the relocation must be considered and supports put in place for a smooth transition. Work processes and model of care that are suited to the new single room environment should be developed, and patient safety issues in the single room setting should be considered and monitored. Future studies on managing multidisciplinary work processes during intensive care unit relocation will add to the learnings we report here.

Droplets capture an environment-dictated equilibrium state of a liquid material. Equilibrium, however, often necessitates nanoscale interface organization, especially with formation of a passivating layer. Herein, we demonstrate that this kinetics-driven organization may predispose a material to autonomous thermal-oxidative composition inversion (TOCI) and texture reconfiguration under felicitous choice of trigger. We exploit inherent structural complexity, differential reactivity, and metastability of the ultrathin (∼0.7-3 nm) passivating oxide layer on eutectic gallium-indium (EGaIn, 75.5% Ga, 24.5% In w/w) core-shell particles to illustrate this approach to surface engineering. Two tiers of texture can be produced after ca. 15 min of heating, with the first evolution showing crumpling, while the second is a particulate growth above the first uniform texture. The formation of tier 1 texture occurs primarily because of diffusion-driven oxide buildup, which, as expected, increases stiffness of the oxide layer. The surface of this tier is rich in Ga, akin to the ambient formed passivating oxide. Tier 2 occurs at higher temperature because of thermally triggered fracture of the now thick and stiff oxide shell. This process leads to inversion in composition of the surface oxide due to higher In content on the tier 2 features. At higher temperatures (≥800 °C), significant changes in composition lead to solidification of the remaining material. Volume change upon oxidation and solidification leads to a hollow structure with a textured surface and faceted core. Controlled thermal treatment of liquid EGaIn therefore leads to tunable surface roughness, composition inversion, increased stiffness in the oxide shell, or a porous solid structure. We infer that this tunability is due to the structure of the passivating oxide layer that is driven by differences in reactivity of Ga and In and requisite enrichment of the less reactive component at the metal-oxide interface.

Background Current strategies for new and redesigned intensive care units (ICUs) involve incorporation of single occupancy rooms. These changes have largely been made for infection control and patient privacy reasons. However, there is limited literature available on how to manage the transition of an ICU from shared room to a single room environment. Aims The aim of this study was to evaluate staff members' perceived effectiveness of a multicomponent intervention to facilitate transition from a shared to a single room setting. Methods This qualitative study was conducted in a 20-bed ICU of an Australian tertiary teaching hospital. In total, 24 staff members were interviewed in five groups and five individual interviews 6 months after the ICU relocation. Findings Three themes emerged from data analysis: (1) facilitating staff members' transition and engagement during relocation planning; (2) simulating new work processes for the single room setting; and (3) supporting nurses working in the single rooms. The components of the intervention, including the change agent, the relocation working party, Assistance, Coordination, Contingency, Education, Supervision, and Support nurse rounding model, and the safe single room model, were perceived as important strategies to support the relocation transition. The regular newsletter and the information dissemination strategy informed by the social networking survey were viewed to improve communication. Staffing levels and education models that are suitable for the single room setting were identified as areas for improvement. Discussion and Conclusion A systematic change management approach, clear communication, staff engagement, and continuously monitoring new work processes are important strategies to ensure the success of the relocation. Delivery of education in the clinical area needs to be further explored to ascertain the impact of a single room environment on its delivery. Intervention co-creation involving research team members and the clinical staff was important in building change management capacity, which may contribute to intervention sustainability and continued clinical practice improvement.

Proactive planning and managing moving from old to newly built hospitals, and the relocation process of patients for complex specialized units such as intensive care units, are necessary for both patient safety and staff well-being. This article provides an exemplar for how theory can be used to facilitate a positive relocation experience. Using change management theory, a systematic approach to cocreate implementation strategy among researchers and clinicians was critical to the success of this project.

ObjectivesThe Maine Diversion Alert Program grants healthcare providers access to law enforcement data on drug charges. The objectives of this report were to analyse variations in drug charges by demographics and examine recent trends in arrests, prescriptions of controlled substances and overdoses.DesignObservational.SettingArrests, controlled prescription medication distribution and overdoses in Maine.ParticipantsDrug arrestees (n=1272) and decedents (n=2432).Primary outcome measuresArrestees were analysed by sex and age. Substances involved in arrests were reported by schedule (I–V or non-controlled prescription) and into opioids, stimulants or other classes. Controlled substances reported to the Drug Enforcement Administration (2007–2017) were evaluated. Drug-induced deaths (2007–2017) reported to the medical examiner were examined by the substance(s) identified.ResultsMales were more commonly arrested for stimulants and schedule II substances. More than two-thirds of arrests involved individuals under the age of 40. Individuals age >60 were elevated for oxycodone arrests. Over three-fifths (63.38%) of arrests involved schedule II–IV substances. Opioids accounted for almost half (44.6%) of arrests followed by stimulants (32.5%) and sedatives (9.1%). Arrests involving buprenorphine exceeded those for oxycodone, hydrocodone, methadone, tramadol and morphine, combined. Prescriptions for hydrocodone (−56.0%) and oxycodone (−46.9%) declined while buprenorphine increased (+58.1%) between 2012 and 2017. Deaths from 2007 to 2017 tripled. Acetylfentanyl and furanylfentanyl were the most common fentanyl analogues identified.ConclusionsAlthough the overall profile of those arrested for drug crimes in 2017 involve males, age

The protection of stateless persons has long been understood as a challenge for the international community, yet for many of the past sixty years a prioritised focus on refugees has dominated, indeed arguably eclipsed, the plight and protection needs of stateless persons. Guy Goodwin-Gill has long argued for a refocus of international attention and effort on the plight, predicament and protection needs of stateless persons. In a seminal contribution over two decades ago he observed that at that time, statelessness was perceived by many as a mere ‘technical problem,’ yet ‘statelessness is indeed a broad human rights issue, even as it retains a distinct technical dimension.’ In this contribution, we examine the challenge set by Goodwin-Gill for the international community, namely, the need for greater recognition and protection of stateless persons, in light of developments over the more than two decades that have passed since his incisive analysis. We celebrate the positive developments and identify areas of ongoing challenge. We focus on the key initiatives he identified as requiring attention, and assess progress that has been made in relation to each, while concentrating predominantly on the need for closer attention to the relevance of developments in human rights law.

Research consistently demonstrates that intensive care unit (ICU) patients experience pain, discomfort and anxiety despite analgesic and sedative use. The most painful procedure reported by critically ill patients is being turned. Music diminishes anxiety and discomfort in some populations; however, its effect on critically ill patients remains unknown. This research aimed to identify the effect of music on discomfort experienced by ICU patients during turning using a single blind randomized cross-over design. Seventeen post-operative ICU patients were recruited and treatment order randomized. Discomfort and anxiety were measured 15 min before and immediately after two turning procedures. Findings indicated that listening to music 15 min before and during turning did not significantly reduce discomfort or anxiety. Pain management might effectively be addressing discomfort and anxiety experienced during turning. Given previous studies have identified turning as painful, current results are promising and it might be useful to determine if this is widespread.

The effect of enantiomeric trifluoromethyl-indolyl-acetic acid ethyl esters on the fibrillogenesis of Alzheimer's amyloid beta (Abeta) peptide is described. These compounds have been previously identified as effective inhibitors of the Abeta self-assembly in their racemic form. Thioflavin-T Fluorescence Spectroscopy and Atomic Force Microscopy were applied to assess the potency of the chiral target compounds. Both enantiomers showed significant inhibition in the in vitro assays. The potency of the enantiomeric inhibitors appeared to be very similar to each other suggesting the lack of the stereospecific binding interactions between these small molecule inhibitors and the Abeta peptide.

Birth in Australia does not necessarily mean Australian citizenship as in the case of Tania Singh who was born in Mildura, Victoria as she was unable to satisfy either of the requisite conditions, namely that one of her parents was at the time of her birth an Australian citizen, or that she had been a resident in Australia for a period of ten years. The primary issue here was not whether Singh was a citizen of Australia but rather whether she held the constitutional status of non-alien.

Methanol adsorbed on the (100) face of MgO has been studied at room temperature and elevated methanol pressures using transmission Fourier transform infrared spectroscopy. From these investigations, we find evidence of two structures for the adsorbed methanol. At low coverages, the methanol molecules congregate into two-dimensional islands that are strongly associated with the substrate. The properties of this submonolayer-to-monolayer thin film are similar to those of solid methanol. Once the available surface sites are occupied and a complete monolayer has formed, the methanol begins to condense in multilayers, creating a thin film on the surface with properties similar to liquid methanol.

Investigations of the interactions occurring between the MgO(100) surface and a series of small molecules—methanol, water, and acetic acid—have been performed. The molecule of interest is introduced to a sample cell containing 15–20 MgO(100) crystals and allowed to establish a dynamic equilibrium with the substrate. The adlayer formed on the crystal faces is observed by transmission Fourier transform infrared spectroscopy. The substrates are also inspected with atomic force microscopy both before and after exposure of the surface to the species of interest. The interactions of these adsorbates with MgO(100) under room temperature conditions and pressures on the order of 10 Torr vary from physisorbed methanol to dissociatively chemisorbed acetic acid, which reacts with the MgO(100) forming magnesium acetate under these experimental conditions.

Several neurodegenerative diseases are characterized by the formation of highly organized and extremely stable fibrillar aggregates as well as their soluble oligomers. One of the approaches to deve...

In this article, we present analyses from a researcher-practitioner partnership in the District of Columbia Public Schools, where we are exploring the impact of educational software on students’ academic achievement. We analyze a unique data set that combines student-level information from the district with data of student usage of a mathematics game platform: First in Math (FIM). These data offer a window into long-standing issues in the educational technology literature around implementation, equity, and student achievement. We show that time spent in FIM was correlated with improved future performance on standardized math assessments for students in Grades 4–8. However, student time spent using FIM was highly related to factors such as race, gender, and prior achievement. Such observations from data are helpful for school districts and researchers to inform equitable implementation of new technologies and maximize benefits to learners.

Purpose: To evaluate the impact of a redesigned intensive care unit (ICU) nursing discharge process on ICU discharge delay, hospital mortality, and ICU readmission within 72 hours. Methods: A quality improvement study using a time series design and statistical process control analysis was conducted in one Australian general ICU. The primary outcome measure was hours of discharge delay per patient discharged alive per month, measured for 15 months prior to, and for 12 months after the redesigned process was implemented. The redesign process included appointing a change agent to facilitate process improvement, developing a patient handover sheet, requesting ward staff to nominate an estimated transfer time, and designing a daily ICU discharge alert sheet that included an expected date of discharge. Results: A total of 1,787 ICU discharges were included in this study, 1,001 in the 15 months before and 786 in the 12 months after the implementation of the new discharge processes. There was no difference in in-hospital mortality after discharge from ICU or ICU readmission within 72 hours during the study period. However, process improvement was demonstrated by a reduction in the average patient discharge delay time of 3.2 hours (from 4.6 hour baseline to 1.0 hours post-intervention). Conclusions: Involving both ward and ICU staff in the redesign process may have contributed to a shared situational awareness of the problems, which led to more timely and effective ICU discharge processes. The use of a change agent, whose ongoing role involved follow-up of patients discharged from ICU, may have helped to embed the new process into practice.

Extended daily diafiltration (EDDf) is a prolonged intermittent dialysis technique introduced as an alternative to continuous renal replacement therapy in critically ill patients. Although EDDf has the advantages of ease of use, low cost and patient tolerability, there is concern that the high blood and dialysate flow rates used with EDDf may precipitate haemodynamic instability.To identify whether haemodynamic changes occur during the course of EDDf therapy in adult patients who are admitted to the intensive care unit with sepsis and require dialysis.A prospective observational study of patients fitting the inclusion criteria who were admitted to the ICU of the Gold Coast Hospital, Queensland, during the period 1 January 2002 to 31 December 2005.Mean arterial pressure (MAP) and heart rate (HR) before, during and after EDDf treatment.178 EDDf treatments were administered to 44 patients. Haemodynamic parameters remained stable during EDDf, despite median blood flow rates of 265 mL/min and dialysate flow rates of 300 mL/min: MAP was 81.2 mmHg before EDDf v 82.7 mmHg after EDDf (P = 0.13); HR was 100.4 beats/min before EDDf v 98.9 beats/ min after EDDf (P = 0.23). For treatments in which vasopressive support was required (n = 75), no increase in dose requirement was observed. Patient mortality at the time of hospital discharge (41%) was less than the rate predicted by APACHE III scores (52%).EDDf did not significantly worsen haemodynamic stability in patients with sepsis during their treatment.

A potential therapeutic approach for Alzheimer’s disease is to reduce the amount of toxic amyloid-beta oligomers and fibrillar amyloid plaques. In order to contribute to this approach the ability of small organofluorine compounds that were previously reported as successful inhibitors of fibrillogenesis to destabilize preformed fibrils of the amyloid-beta peptide was studied. These organofluorine molecules including chiral compounds were tested in vitro using standard methods based on Thioflavin-T (THT) fluorescence spectroscopy, atomic force microscopy (AFM) and Fourier-transform infrared spectroscopy (FTIR). It was observed that 5′-halogen substituted 3,3,3-trifluoromethyl-2-hydroxyl-(indol-3-yl)-propionic acid esters showed significant activity in the disassembly of the preformed fibrils. Since the same compounds were identified as strong fibrillogenesis inhibitors as well, this dual action makes them promising candidates for further drug development.

Background Prolonged intermittent renal replacement therapy (PIRRT) is a dialysis modality for critically ill patients that in theory combines the superior detoxification and haemodynamic stability of the continuous renal replacement therapy (CRRT) with the operational convenience, reduced haemorrhagic risk and low cost of conventional intermittent haemodialysis. However, the extent to which PIRRT should replace these other modalities is uncertain because comparative studies of mortality are lacking. We retrospectively examined the mortality data from three general intensive care units (ICUs) in different countries that have switched their predominant therapeutic approach from CRRT to PIRRT. We assessed whether this practice change was associated with a change in mortality rate. Methods Data were analysed from ICUs in New Zealand, Australia and Italy. The study population comprised all patients requiring renal replacement therapy from 1 January 1995 to 31 December 2005 (n = 1347), the period of time spanning the change from CRRT to PIRRT in each unit. Poisson regression models were used to estimate the incident rate ratio (IRR) for death, comparing the periods before and after change to PIRRT in each unit. Estimates were adjusted for patient illness severity (APACHE II score) and for the underlying time trend in mortality rate over time. Results The change from CRRT to PIRRT was not associated with any increase in mortality rate, with an adjusted IRR of 1.02 (0.61-1.71). The IRR was virtually identical in the three ICUs (P-value = 0.63 for the difference in the IRR between ICUs). Conclusions Switching from CRRT to PIRRT was not associated with a change in mortality rate. Pending the results of a randomized trial, our study provides evidence that PIRRT might be equivalent to CRRT in the general ICU patient.

While electrochemical double-layer capacitors (EDLC) are well suited to time-dependent high-power output applications,1 they are much more limited in terms of their overall energy density, when compared to lithium ion batteries.2 The lithium ion capacitor (LIC), a hybrid asymmetric supercapacitor that employs a lithiated carbon as the negative electrode (faradaic storage) and a high surface area carbon as the positive electrode (capacitive storage), can help to bridge that gap. However just as with lithium ion batteries, the formation of the SEI layer during primary lithiation of the negative electrode is a key factor in the development of a LIC. In previously reported work, an in-situ electrochemical-mass spectroscopic (MS) technique was used to investigate the composition of the gases that are generated during the primary lithiation process.3 From that analysis, it was concluded that the generation of the gaseous by-products comes as a result of two 1-electron reduction reactions. The radical anion that is first produced from the first reduction can undergo one of two terminal reaction pathways, the selection of which is dependent upon the cell potential. The focus of this work was to continue that investigation by performing a systematic analysis of the composition of the electrolyte during the primary lithiation of the carbon negative electrode. The negative electrodes for a LIC were prepared from a carbon film that was composed of an activated carbon powder, carbon black and PVDF for use as the binder. The experiments were performed such that the lithiation of the carbon electrode was halted at different cell potentials during the process to study how the composition of the electrolyte changed during the initial SEI layer formation. At each hold potential stage the electrolyte within the cell was gently and thoroughly mixed, after which a 5-μL aliquot was then removed and diluted for analysis by LC-MS. The results from the LC-MS analysis of the electrolyte were correlated with DRIFTS analyses of the developing SEI layer and the results of the gas-phase and EIS analyses previously reported.3 It was determined that other decomposition reactions gave rise to unique compounds that would be expected to have an effect on the performance of the electrolyte. An in-depth analysis of the spectral data from twelve significant peaks noted in the chromatographic data was performed to determine probable empirical formulas. Using that information and the work of the Laruelle group,4 structures of these compounds and possible mechanisms that could account for their formation were determined. On the basis of their proposed structures, these compounds possess structural similarities to compounds that have been identified as components of the SEI layer.5 In addition, while the rates of formation of these electrolyte-soluble compounds exhibited a correlation with the cell potential, the potentials at which formation of these compounds is initiated varies significantly. The analysis of the composition of the electrolyte and how it changed during SEI layer formation provided an opportunity to gain further insight into the electrochemical processes that form the SEI layer. References: 1. A. Burke, J. Power Sources, 91, 37–50 (2000). 2. B. E. Conway, J. Electrochem. Soc., 138, 1539–1548 (1991). 3. G. Gourdin, D. Zheng, P. H. Smith, and D. Qu, Electrochim. Acta, 112, 735–746 (2013). 4. G. Gachot et al., J. Power Sources, 178, 409–421 (2008). 5. D. Aurbach and Y. S. Cohen, in Lithium-Ion Batteries: Solid-Electrolyte Interphase, P. B. Balbuena and Y. Wang, Editors, p. 70–139, Imperial College Press, London (2004). Figure 1: LC-MS chromatogram of the electrolyte after the lithiation process. Figure 1

The mismatch between intensive care unit (ICU) bed availability and demand may be improved with timely patient discharges, however little is known about the nature and contributing factors of discharge delays. This study investigated the impact of a specific intervention—the ICU liaison nurse role—in reducing ICU discharge delay using a prospective block intervention study. One hundred and eighty-six ICU patients (101 control and 85 liaison nurse intervention) with an ICU length of stay of three days or longer and who survived to ICU discharge were examined. The liaison nurse was involved in assessment of patients for transfer to the ward, with a major focus on coordinating patient transfer including liaison with ward staff prior to and following ICU discharge. Logistic regression was used to quantify the risk of discharge delay associated with the liaison nurse intervention with adjustment for potential confounding variables. While no demographic or clinical variables were significant predictors of ICU discharge delay, those in the liaison nurse group were almost three times less likely to experience a discharge delay of at least two hours and about 2.5 times less likely to experience a delay of four or more hours. The positive effect of the liaison nurse role in reducing the discharge delay remained after adjusting for potential confounders. We conclude that the liaison nurse role is effective in reducing the discharge delay in ICU transfer.

Introduction In many jurisdictions around the world, the possibility of an ‘internal flight alternative’ (IFA) (often referred to as ‘internal relocation alternative’) is invoked to deny refugee status to persons at risk of being persecuted for a Convention reason in part, but not all, of their country of origin. In this, as in so man areas of refugee law and policy, the viability of a universal commitment to protection is challenged by divergence in State practice. The goals of this paper are therefore, first, briefly to review the origins and development of the practice of considering IFA as an aspect of the refugee status determination process; secondly, to identify key protection concerns in leading formulations of the IFA rule; and, thirdly, to propose relevant substantive and procedural standards which recognize the legal plausibility in some circumstances of considering internal protection alternatives, but which we believe avoid most of the protection pitfalls of current practice and doctrine. For the sake of clarity, we refer to the ‘best standard’ approach proposed in this paper as the ‘internal protection alternative’ (IPA), a form of words which more precisely captures the essence of the permissible range of State discretion. In short, we believe that refugee status may not lawfully be denied simply because the asylum seeker ought first to have attempted to flee within his or her own State, nor even on the grounds that it would presently be possible for the applicant to secure ‘safety’ in the home country by relocating internally.

To determine if there is a difference in methicillin-resistant Staphylococcus aureus (MRSA) colonisation rates between patients over the age of 60 years admitted to Auckland Hospital from either residential care facilities (RCF) or the community.A prospective cohort study. The following information was collected: patient demographics; admission in the last 12 months; presence of risk factors for MRSA colonisation; any history of MRSA colonisation. Swabs from the nose, perineum and any infected wounds or skin lesions were collected. Urine was cultured if the patient had a urinary catheter in situ.19 (9%) patients of 213 from RCF, and 6 (3%) patients of 201 from the community were positive for MRSA (p = 0.02). Patients admitted to hospital in the previous 12 months were three times more likely to be colonised with MRSA than others (p = 0.01). Excluding those patients already known to be MRSA positive, patients admitted from RCF were six times more likely to be newly found to be MRSA positive. Twenty four of the 25 MRSA isolates were EMRSA-15.Patients from RCF are statistically more likely to be colonised with MRSA compared with patients of similar age admitted from the community. Identification of such high-risk carriers allows targeted infection control activity to control MRSA within hospitals.

THE FUTURE OF FAMILIES IN ICU - THE POSITIVE EFFECTS OF PARTNERING WITH FAMILIES Marion L. Mitchell1, Wendy Chaboyer1, Liz Burmeister2, Michelle Foster3 1School of Nursing and Midwifery, Research Centre for Clinical and Community Practice Innovation, Griffith University, Brisbane, Australia; 2 ICU, Princess Alexandra Hospital, Brisbane, Australia; 3ICU, Gold Coast Hospital, Southport, Australia. Generally, families are not actively involved in ICU patients' care in meaningful ways. A Family-Centred-Care (FCC) model formalises the family and patient as the unit of care. FCC is comprised of three concepts - respect, collaboration and support. This study evaluated the effects on FCC of ICU nurses partnering with families to provide fundamental care. A pre-test, post-test design was used with families at the control site experiencing usual conditions whereas those at the intervention site were invited to assist with their relative's care. All participants provided written consent. The FCC survey measured families' perceptions of respect, collaboration and support at baseline and then 48 hours. A total of 174 family members participated (75 control, 99 intervention). Total FCC sores at baseline were 3.19 (control) and 3.39 (intervention) and at follow-up were 3.18 (control) and 3.46 (intervention) (range1-5). Multivariate logistic regression identified independent predictors of FCC scores. After pre-test score, the FCC intervention was the strongest predictor of post-test score. Other predictors included when the patient was female and the patient's partner (Table 1). This study indicates that ICU nurses partnering with family members to provide fundamental care significantly improved family's perceptions of respect, collaboration and support. FCC provides a model for future improvements to families' experience of ICU. TABLE 1: Predictors of Post-test FCC Survey Total FCC Variable (reference group) OR (95% CI) p Pre-test score 5.48 (4.9-6.12)

SPIE grants to authors (and their employers) of papers, posters, and presentation recordings published in SPIE Proceedings or SPIE Journals on the SPIE Digital Library (hereinafter "publications") the right to post an author-prepared version or an official version (preferred version) of the publication on an internal or external server controlled exclusively by the author/employer or the entity funding the research, provided that (a) such posting is noncommercial in nature and the publication is made available to users without charge; (b) an appropriate copyright notice and citation appear with the publication; and (c) a link to SPIE's official online version of the publication is provided using the item's DOI. This authorization does not extend to third-party web sites not owned and maintained by the author/employer such as ResearchGate, Academia.edu, YouTube, etc. The Imaging X-ray Polarimetry Explorer (IXPE) will add polarization to the properties (time, energy, and position) observed in x-ray astronomy. A NASA Astrophysics Small Explorer (SMEX) in partnership with the Italian Space Agency (ASI), IXPE will measure the 2-8-keV polarization of a few dozen sources during the first 2 years following its 2021 launch. The IXPE Observatory includes three identical x-ray telescopes, each comprising a 4-m-focal-length (grazingincidence) mirror module assembly (MMA) and a polarization-sensitive (imaging) detector unit (DU), separated by a deployable optical bench. The Observatory's Spacecraft provides typical subsystems (mechanical, structural, thermal, power, electrical, telecommunications, etc.), an attitude determination and control subsystem for 3-axis stabilized pointing, and a command and data handling subsystem communicating with the science instrument and the Spacecraft subsystems.