Publications by authors named "P Meredith"

505 Publications

Substances and your senses: The sensory patterns of young people within an alcohol and drug treatment service.

Subst Abus 2021 Mar 22:1-9. Epub 2021 Mar 22.

Metro North Mental Health - Alcohol and Drug Service, Brisbane, Australia.

Substance use disorders (SUD) and trauma histories in adults have been linked with sensory processing patterns that are significantly different from the general population. Nevertheless, no studies have investigated sensory patterns, or the variables with which they are related, in youth with SUD. This study aimed to compare sensory patterns of this sample with normative data and consider associations between sensory patterns and: substance use, trauma, quality-of-life, mental and physical health. A cross-sectional quantitative research design was employed with a sample of 87 young people (mean age = 20.8 years) with SUD voluntarily attending a specialist youth outpatient alcohol and other drug (AOD) service. For participants, the Adolescent Adult Sensory Profile was added to measures routinely collected at the service. Participants' sensory processing patterns for low registration, sensory sensitivity, and sensation avoiding were significantly higher than the normative population, while sensation seeking was both lower and higher. Ninety-one percent reported atypical scores on one or more sensory patterns. High rates of probable Post-Traumatic-Stress-Disorder (PTSD), psychological distress, and low quality-of-life were also reported, which were meaningfully related with sensory patterns. Young people reported complex combinations of sensory processing patterns, with comorbid probable PTSD, psychological distress, and low quality-of-life. Findings reflect studies with adult AOD, trauma, and other clinical conditions, and highlight the potential value of screening for sensory patterns and applying transdiagnostic approaches which simultaneously address substance use, mental health, trauma and sensory needs to optimize outcomes for young people with SUD.
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http://dx.doi.org/10.1080/08897077.2021.1901177DOI Listing
March 2021

Reconstructive surgery for sequellae of Mycobacterium ulcerans infection (Buruli ulcer) of the upper limb.

J Plast Surg Hand Surg 2021 Mar 1:1-6. Epub 2021 Mar 1.

Institut de Chirurgie Reconstructive, Abidjan, Côte d'Ivoire.

Introduction: Infection by Mycobacterium ulcerans constitutes a neglected tropical disease whose prevalence seems to have overrun those of cutaneous tuberculosis and leprosy. Its aggressivity depends on a mycolactone toxin. Lesions may involve skin, tendon and bone with a large spectrum of manifestations: non-ulcerative (papules, nodules, plaques), ulcerative and oedematous presentations as well as osteomyelitis with muscular contraction and ankylosis. Upper limbs account for more than two thirds of the infection sites. Surgical treatment may involve tendon transpositions, partial and total skin grafts. Amputation is relegated to extreme cases.

Material And Methods: Selected iconography from patients during the last 15 years is presented. At least 1500 cases had partial skin grafts (anterior thigh). Total skin grafts (inguinal region) were used in about 200 cases. Complex lesions involved 9 ilioinguinal flaps (5 boys, 4 girls, mean age 11.2 years, range 2-16 years), 5 tendon transfers (4 boys, one girl, mean age 15.4 years, range 12-19 years) and 3 resections of the first carpal row (2 girls, 1 boy, mean age 8 years, range 4-15 years).

Results And Discussion: Out of 9 ilioinguinal flaps mild, marginal necrosis was the only complication in 2 patients without flap loss. Mean hospital stay was 26.44 days (range, 18-41 days), with return to full weight-bearing after a mean of 12 weeks (range 9-25 weeks) after discharge. Functional thumb opposition to allow pencil prehension was achieved in all three cases of resection of first carpal row resection without postoperative complications.
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http://dx.doi.org/10.1080/2000656X.2021.1884083DOI Listing
March 2021

Reply to: Performance of the National Early Warning Score in hospitalised patients infected by Covid-19.

Resuscitation 2021 Feb 15. Epub 2021 Feb 15.

Centre for Healthcare Modelling & Informatics, University of Portsmouth, Portsmouth, United Kingdom.

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http://dx.doi.org/10.1016/j.resuscitation.2021.02.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882916PMC
February 2021

Bringing sexuality out of the closet: What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?

Aust Occup Ther J 2021 Feb 17. Epub 2021 Feb 17.

Central Queensland University, Rockhampton, Qld, Australia.

Introduction: Sex has been recognised as an activity of daily living, and sexuality as an important part of our identity, with implications for our self-esteem and quality of life. Although this brings sex and sexuality within the scope of occupational therapy practice, empirical and anecdotal information suggests that neither are routinely included in therapy. The aim of this study was to investigate the experiences of therapists who are comfortable addressing sex and sexuality in practice, with a view to influencing future research and practice. The research question posed was as follows: "What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?"

Methods: Interpretative Phenomenological Analysis (IPA) was used to explore the research question. Semi-structured interviews were conducted with 11 Australian occupational therapists who were purposively recruited. Interviews were audio-recorded, transcribed verbatim, and analysed following the guidelines for IPA data analysis.

Results: Four master themes and five sub-themes emerged from the analysis and are discussed under the following headings: sexuality matters; know your boundaries; just do it; and seek support and mentoring. The themes provide insight into how occupational therapists successfully integrate sexuality into everyday practice.

Conclusion: According to the participants in this study, addressing sex and sexuality during therapy is part of providing holistic client-centred care. With clear personal and professional boundaries, occupational therapists can address sexuality within routine practice utilising core occupational therapy skills, such as communication, collaborative problem solving, pacing, positioning, and adaptive equipment. Furthermore, participants demonstrated that this can be done within a range of settings. It starts with a commitment and the motivation to find a way.
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http://dx.doi.org/10.1111/1440-1630.12723DOI Listing
February 2021

Detecting Deteriorating Patients in Hospital: Development and Validation of a Novel Scoring System.

Am J Respir Crit Care Med 2021 Feb 1. Epub 2021 Feb 1.

University of Oxford Nuffield Department of Clinical Neurosciences, 365025, Oxford, United Kingdom of Great Britain and Northern Ireland.

Rationale: Late recognition of patient deterioration in hospital is associated with worse outcomes, including higher mortality. Despite the widespread introduction of early warning score systems and electronic health records, deterioration still goes unrecognised.

Objectives: To develop and externally validate a Hospital-wide Alerting Via Electronic Noticeboard (HAVEN) system to identify hospitalised patients at risk of reversible deterioration.

Methods: A retrospective cohort study of patients 16 years of age or above admitted to four UK hospitals. The primary outcome was cardiac arrest or unplanned admission to the intensive care unit (ICU). We used patient data (vital signs, laboratory tests, comorbidities, frailty) from one hospital to train a machine learning model (gradient boosting trees). We internally and externally validated the model and compared its performance to existing scoring systems (including NEWS, LAPS-2 and eCART).

Measurements And Main Results: We developed the HAVEN model using 230,415 patient admissions to a single hospital. We validated HAVEN on 266,295 admissions to four hospitals. HAVEN showed substantially higher discrimination (c-statistic 0.901 [95% CI 0.898-0.903]) for the primary outcome within 24 h of each measurement than other published scoring systems (which range from 0.700 [0.696-0.704] to 0.863 [0.860-0.865]). With a precision of 10%, HAVEN was able to identify 42% of cardiac arrests or unplanned ICU admissions with a lead time of up to 48 h in advance, compared to 22% by the next best system.

Conclusion: The HAVEN machine learning algorithm for early identification of in-hospital deterioration significantly outperforms other published scores such as NEWS. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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http://dx.doi.org/10.1164/rccm.202007-2700OCDOI Listing
February 2021

Author Correction: Charge-generating mid-gap trap states define the thermodynamic limit of organic photovoltaic devices.

Nat Commun 2021 Jan 4;12(1):207. Epub 2021 Jan 4.

Sustainable Advanced Materials Programme (Sêr SAM), Department of Physics, Swansea University, Singleton Park, Swansea, SA2 8PP, United Kingdom.

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http://dx.doi.org/10.1038/s41467-020-20626-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782746PMC
January 2021

Experimental Evidence Relating Charge-Transfer-State Kinetics and Strongly Reduced Bimolecular Recombination in Organic Solar Cells.

J Phys Chem Lett 2020 Dec 8;11(24):10519-10525. Epub 2020 Dec 8.

Sustainable Advanced Materials (Ser-SAM), Department of Physics, Swansea University, Singleton Park, Swansea SA2 8PP, United Kingdom.

Significantly reduced bimolecular recombination relative to the Langevin recombination rate has been observed in a limited number of donor-acceptor organic semiconductor blends. The strongly reduced recombination has been previously attributed to a high probability for the interfacial charge-transfer (CT) states (formed upon charge encounter) to dissociate back to free charges. However, whether the reduced recombination is due to a suppressed CT-state decay rate or an improved dissociation rate has remained a matter of conjecture. Here we investigate a donor-acceptor material system that exhibits significantly reduced recombination upon solvent annealing. On the basis of detailed balance analysis and the accurate characterization of CT-state parameters, we provide experimental evidence that an increase in the dissociation rate of CT states upon solvent annealing is responsible for the reduced recombination. We attribute this to the presence of purer and more percolated domains in the solvent-annealed system, which may, therefore, have a stronger entropic driving force for CT dissociation.
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http://dx.doi.org/10.1021/acs.jpclett.0c02905DOI Listing
December 2020

Impact of the coronavirus pandemic on the patterns of vital signs recording and staff compliance with expected monitoring schedules on general wards.

Resuscitation 2021 01 19;158:30-38. Epub 2020 Nov 19.

Director of Research and Innovation and Consultant Respiratory Physician, Portsmouth Hospitals University NHS Trust, Professor of Respiratory Medicine, University of Portsmouth, Portsmouth, UK.

Introduction: Coronavirus disease 2019 (COVID-19) placed increased burdens on National Health Service hospitals and necessitated significant adjustments to their structures and processes. This research investigated if and how these changes affected the patterns of vital sign recording and staff compliance with expected monitoring schedules on general wards.

Methods: We compared the pattern of vital signs and early warning score (EWS) data collected from admissions to a single hospital during the initial phase of the COVID-19 pandemic with those in three control periods from 2018, 2019 and 2020. Main outcome measures were weekly and monthly hospital admissions; daily and hourly patterns of recorded vital signs and EWS values; time to next observation and; proportions of 'on time', 'late' and 'missed' vital signs observations sets.

Results: There were large falls in admissions at the beginning of the COVID-19 era. Admissions were older, more unwell on admission and throughout their stay, more often required supplementary oxygen, spent longer in hospital and had a higher in-hospital mortality compared to one or more of the control periods. More daily observation sets were performed during the COVID-19 era than in the control periods. However, there was no clear evidence that COVID-19 affected the pattern of vital signs collection across the 24-h period or the week.

Conclusions: The increased burdens of the COVID-19 pandemic, and the alterations in healthcare structures and processes necessary to respond to it, did not adversely affect the hospitals' ability to monitor patients under its care and to comply with expected monitoring schedules.
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http://dx.doi.org/10.1016/j.resuscitation.2020.11.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676313PMC
January 2021

The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Resuscitation 2021 02 8;159:150-157. Epub 2020 Nov 8.

Portsmouth Technologies Trials Unit, Portsmouth Hospitals University NHS Trust, University of Portsmouth, Portsmouth, UK.

Introduction: Since the introduction of the UK's National Early Warning Score (NEWS) and its modification, NEWS2, coronavirus disease 2019 (COVID-19), has caused a worldwide pandemic. NEWS and NEWS2 have good predictive abilities in patients with other infections and sepsis, however there is little evidence of their performance in COVID-19.

Methods: Using receiver-operating characteristics analyses, we used the area under the receiver operating characteristic (AUROC) curve to evaluate the performance of NEWS or NEWS2 to discriminate the combined outcome of either death or intensive care unit (ICU) admission within 24 h of a vital sign set in five cohorts (COVID-19 POSITIVE, n = 405; COVID-19 NOT DETECTED, n = 1716; COVID-19 NOT TESTED, n = 2686; CONTROL 2018, n = 6273; CONTROL 2019, n = 6523).

Results: The AUROC values for NEWS or NEWS2 for the combined outcome were: COVID-19 POSITIVE, 0.882 (0.868-0.895); COVID-19 NOT DETECTED, 0.875 (0.861-0.89); COVID-19 NOT TESTED, 0.876 (0.85-0.902); CONTROL 2018, 0.894 (0.884-0.904); CONTROL 2019, 0.842 (0.829-0.855).

Conclusions: The finding that NEWS or NEWS2 performance was good and similar in all five cohorts (range = 0.842-0.894) suggests that amendments to NEWS or NEWS2, such as the addition of new covariates or the need to change the weighting of existing parameters, are unnecessary when evaluating patients with COVID-19. Our results support the national and international recommendations for the use of NEWS or NEWS2 for the assessment of acute-illness severity in patients with COVID-19.
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http://dx.doi.org/10.1016/j.resuscitation.2020.10.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648887PMC
February 2021

Shedding Light on the Free Radical Nature of Sulfonated Melanins.

J Phys Chem B 2020 11 5;124(46):10365-10373. Epub 2020 Nov 5.

Department of Chemistry, Swansea University, Singleton Park, Swansea SA2 8PP, United Kingdom.

Melanin, an important class of natural pigment found in the human body, has stood out as a promising bioelectronic material due to its rather unique collection of electrical properties and biocompatibility. Among the available melanin derivatives, the sulfonated form has proven to not only be able to produce homogeneous device quality thin films with excellent adhesion, even on hydrophobic surfaces, but also to act as an ion to electron transducing element. It has recently been shown that the transport physics (and dominant carrier generation) may be related to a semiquinone free radical species in these materials. Hence, a better understanding of the paramagnetic properties of sulfonated derivatives could shed light on their charge transport behavior and thus enable improvement in regard to use in bioelectronics. Motivated by this question, in this work, different sulfonated melanin derivatives were investigated by hydration-controlled, continuous-wave X-band electron paramagnetic resonance spectroscopy and electronic structure calculations. Our results show that sulfonated melanin behaves similarly to non-functionalized melanin, but demonstrates a less pronounced response to humidity vis-à-vis standard melanin. We thus speculate on the structural and charge transport behavior in light of these differences with a view to further engineering structure-property relationships.
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http://dx.doi.org/10.1021/acs.jpcb.0c08097DOI Listing
November 2020

Charge-generating mid-gap trap states define the thermodynamic limit of organic photovoltaic devices.

Nat Commun 2020 Nov 4;11(1):5567. Epub 2020 Nov 4.

Sustainable Advanced Materials Programme (Sêr SAM), Department of Physics, Swansea University, Singleton Park, Swansea, SA2 8PP, United Kingdom.

Detailed balance is a cornerstone of our understanding of artificial light-harvesting systems. For next generation organic solar cells, this involves intermolecular charge-transfer (CT) states whose energies set the maximum open circuit voltage V. We have directly observed sub-gap states significantly lower in energy than the CT states in the external quantum efficiency spectra of a significant number of organic semiconductor blends. Taking these states into account and using the principle of reciprocity between emission and absorption results in non-physical radiative limits for the V. We propose and provide compelling evidence for these states being non-equilibrium mid-gap traps which contribute to photocurrent by a non-linear process of optical release, upconverting them to the CT state. This motivates the implementation of a two-diode model which is often used in emissive inorganic semiconductors. The model accurately describes the dark current, V and the long-debated ideality factor in organic solar cells. Additionally, the charge-generating mid-gap traps have important consequences for our current understanding of both solar cells and photodiodes - in the latter case defining a detectivity limit several orders of magnitude lower than previously thought.
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http://dx.doi.org/10.1038/s41467-020-19434-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642445PMC
November 2020

Intrinsic Detectivity Limits of Organic Near-Infrared Photodetectors.

Adv Mater 2020 Nov 19;32(47):e2003818. Epub 2020 Oct 19.

UHasselt - Hasselt University, Institute for Materials Research (IMO), Agoralaan 1 - Building D, Diepenbeek, 3590, Belgium.

Organic photodetectors (OPDs) with a performance comparable to that of conventional inorganic ones have recently been demonstrated for the visible regime. However, near-infrared photodetection has proven to be challenging and, to date, the true potential of organic semiconductors in this spectral range (800-2500 nm) remains largely unexplored. In this work, it is shown that the main factor limiting the specific detectivity (D*) is non-radiative recombination, which is also known to be the main contributor to open-circuit voltage losses. The relation between open-circuit voltage, dark current, and noise current is demonstrated using four bulk-heterojunction devices based on narrow-gap donor polymers. Their maximum achievable D* is calculated alongside a large set of devices to demonstrate an intrinsic upper limit of D* as a function of the optical gap. It is concluded that OPDs have the potential to be a useful technology up to 2000 nm, given that high external quantum efficiencies can be maintained at these low photon energies.
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http://dx.doi.org/10.1002/adma.202003818DOI Listing
November 2020

The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: a retrospective cohort study.

Age Ageing 2021 02;50(2):431-439

National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care / Applied Research Centre (NIHR CLAHRC / ARC) Wessex, Hampshire SO16 7NP, UK.

Background: Lower nurse staffing levels are associated with increased hospital mortality. Older patients with cognitive impairments (CI) have higher mortality rates than similar patients without CI and may be additionally vulnerable to low staffing.

Objectives: To explore associations between registered nurse (RN) and nursing assistant (NA) staffing levels, mortality and readmission in older patients admitted to general medical/surgical wards.

Research Design: Retrospective cohort.

Participants: All unscheduled admissions to an English hospital of people aged ≥75 with cognitive screening over 14 months.

Measures: The exposure was defined as deviation in staffing hours from the ward daily mean, averaged across the patient stay. Outcomes were mortality in hospital/within 30 days of discharge and 30-day re-admission. Analyses were stratified by CI.

Results: 12,544 admissions were included. Patients with CI (33.2%) were exposed to similar levels of staffing as those without. An additional 0.5 RN hours per day was associated with 10% reduction in the odds of death overall (odds ratio 0.90 [95% CI 0.84-0.97]): 15% in patients with CI (OR 0.85 [0.74-0.98]) and 7% in patients without (OR 0.93 [0.85-1.02]). An additional 0.5 NA hours per day was associated with a 15% increase in mortality in patients with no impairment. Readmissions decreased by 6% for an additional 0.5 RN hours in patients with CI.

Conclusions: Although exposure to low staffing was similar, the impact on mortality and readmission for patients with CI was greater. Increased mortality with higher NA staffing in patients without CI needs exploration.
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http://dx.doi.org/10.1093/ageing/afaa133DOI Listing
February 2021

Transdisciplinary Generalism: Naming the epistemology and philosophy of the generalist.

J Eval Clin Pract 2020 Sep 16. Epub 2020 Sep 16.

Primary Care Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia.

Background: Transdisciplinary research and generalist practice both face the task of integrating and discerning the value of knowledge across disciplinary and sectoral knowledge cultures. Transdisciplinarity and generalism also both offer philosophical and practical insights into the epistemology, ontology, axiology, and logic of seeing the 'whole'. Although generalism is a skill that can be used in many settings from industry to education, the focus of this paper is the literature of the primary care setting (i.e., general practice or family medicine). Generalist philosophy and practice in the family medicine setting highly values whole person care that uses integrative and interpretive wisdom to include both biomedical and biographical forms of knowledge. Generalist researchers are often caught between reductionist (positivist) biomedical measures and social science (post-positivist) constructivist theories of knowing. Neither of these approaches, even when juxtaposed in mixed-methods research, approximate the complexity of the generalist clinical encounter. A theoretically robust research methodology is needed that acknowledges the complexity of interpreting these ways of knowing in research and clinical practice.

Methods: A conceptual review of literature to define the alignment between (a) the philosophy and practice of generalism in primary care and (b) both the practical (Zurich) and philosophical or methodological (Nicolescuian) schools of transdisciplinarity.

Results: The alignment between generalism and transdisciplinarity included their broad scope, relational process, complex knowledge management, humble attitude to knowing, and real-world outcome focus.

Conclusion: The concurrence between these approaches to knowing is offered here as Transdisciplinary Generalism - a coherent epistemology for both primary care researchers and generalist clinicians to understand, enact, and research their own sophisticated craft of managing diverse forms of knowledge.
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http://dx.doi.org/10.1111/jep.13446DOI Listing
September 2020

Engineering proton conductivity in melanin using metal doping.

J Mater Chem B 2020 09 11;8(35):8050-8060. Epub 2020 Aug 11.

Department of Chemistry, Swansea University, Singleton Park, SA2 8PP, Wales, UK.

Long range electrical conduction in biomaterials is an increasingly active area of research, which includes systems such as the conductive pili, proteins, biomacromolecules, biocompatible conductive polymers and their derivatives. One material of particular interest, the human skin pigment melanin, is a long range proton conductor and recently demonstrated as capable of proton-to-electron transduction in a solid-state electrochemical transistor platform. In this work, a novel "doping strategy" is proposed to enhance and control melanin's proton conductivity, potentially enhancing its utility as a transducing material. By chelating the transition metal ion Cu(ii) into the bio-macromolecular matrix, free proton concentration and hence conductivity can be modulated. We confirm these observations by demonstrating enhanced performance in a next generation electrochemical transistor. Finally, the underlying mechanism is investigated via the use of a novel in situ hydration-controlled electron paramagnetic resonance study, deducing that the enhanced proton concentration is due to controlling the internal solid-state redox chemistry of the intrinsic polyindolequinone structure. This doping strategy should be open to any transition metal ions that bind to hydroquinone systems (e.g. polydopamine). As such, the tailoring strategy could make other soft solid-state ionic systems more accessible to applications in bioelectronics, leading to the creation of higher performance ion-electron coupled devices.
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http://dx.doi.org/10.1039/d0tb01390kDOI Listing
September 2020

Compression garment wear and sensory variables after burn: a single-site study.

Burns 2020 12 18;46(8):1903-1913. Epub 2020 Jun 18.

School of Health and Rehabilitation Sciences, The University of Queensland, Australia; The Royal Brisbane & Women's Hospital, Queensland Health, Australia. Electronic address:

Objective: Compression garments are well accepted as routine practice for scar management after burn. In a recent systematic review, six main reasons for compression garment non-adherence were identified including sensory disturbances. To further understand the impact of sensory issues, the aim of the present study is to investigate associations between sensory variables and compression garment wear.

Method: Adults (N = 117) attending a quaternary adult burns outpatient clinic completed: The Adolescent/Adult Sensory Profile; a custom-designed compression garment wear questionnaire; and three quantitative sensory testing procedures (Two-Point Discrimination, Mechanical Detection Threshold and Pressure Pain Threshold).

Results: Patients who reported lower Pressure Pain Threshold or Mechanical Detection Threshold, higher acuity for Two Point Discrimination, and higher than average sensory avoiding and sensory sensitivity patterns were less adherent with garment wear.

Conclusions: Overall, sensory factors assessed using both self-report and quantitative sensory testing were associated with compression garment adherence. This knowledge suggests the value in developing and evaluating sensory-informed treatment strategies to improve compression garment wear.
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http://dx.doi.org/10.1016/j.burns.2020.06.004DOI Listing
December 2020

An Evaluation of Agreement of Breathing Rates Measured by a Novel Device, Manual Counting, and Other Techniques Used in Clinical Practice: Protocol for the Observational VENTILATE Study.

JMIR Res Protoc 2020 Jul 20;9(7):e15437. Epub 2020 Jul 20.

Department of Respiratory Research and Innovation, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom.

Background: Respiratory rate (RR) is the most sensitive physiological observation to predict clinical deterioration on hospital wards, and poor clinical monitoring has been highlighted as a primary contributor to avoidable mortality. Patients in intensive care have their RR monitored continuously, but this equipment is rarely available on general hospital wards.

Objective: The primary objective is to assess the accuracy of the RespiraSense device in comparison with other methods currently used in clinical practice. The secondary objective is to assess the accuracy of the RespiraSense device in participants in different positions and when reading aloud.

Methods: A single-center, prospective observational study will investigate the agreement of the RespiraSense device as compared with other device measurements (capnography, electrocardiogram) and the current standard measurement of RR (manual counting by a trained health care professional). The different methods will be employed concurrently on the same participant as part of a single study visit.

Results: Recruitment to this study has not yet started as funding decisions are still pending. Therefore, results are not available at this stage. It is anticipated that the data required could be collected within 2 months of first recruitment to the study and data analysis completed within 6 months of the study start date.

Conclusions: The Evaluation of Agreement of Breathing Rates Measured by a Novel Device, Manual Counting, and Other Techniques Used in Clinical Practice (VENTILATE) study will provide further validation of the use of the RespiraSense device in subjects with abnormal respiratory rates.

International Registered Report Identifier (irrid): PRR1-10.2196/15437.
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http://dx.doi.org/10.2196/15437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399957PMC
July 2020

Prenatal Predictors of Maternal-infant Attachment.

Can J Occup Ther 2020 Oct 20;87(4):265-277. Epub 2020 Jul 20.

Background.: Increasingly, occupational therapists are working with women in the perinatal period, including supporting the developing mother-child relationship.

Purpose.: To examine prenatal predictors of maternal-infant attachment (maternal-fetal attachment, sensory patterns, adult attachment, perinatal loss, and mental health) that may provide possible avenues for assessment and intervention by occupational therapists.

Method.: Women (N = 60) were assessed during pregnancy and within one year postpartum in a cohort study. Independent tests, correlations, and multivariate regression models were conducted.

Findings.: Low threshold maternal sensory patterns, more insecure adult attachment, and poorer quality of maternal-fetal attachment were each correlated with less optimal maternal-infant attachment. Quality of prenatal attachment was the best predictor of overall postnatal attachment in multivariate regression models.

Implications.: Occupational therapists working in a range of clinical settings (e.g., mental health, substance use, and perinatal care) may work with women during pregnancy to promote their relationship with their developing baby in utero and after birth.
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http://dx.doi.org/10.1177/0008417420941781DOI Listing
October 2020

Defect/Interface Recombination Limited Quasi-Fermi Level Splitting and Open-Circuit Voltage in Mono- and Triple-Cation Perovskite Solar Cells.

ACS Appl Mater Interfaces 2020 Aug 10;12(33):37647-37656. Epub 2020 Aug 10.

Institute of Physics and Astronomy, University of Potsdam, Karl-Liebknecht-Str. 24-25, D-14476 Potsdam-Golm, Germany.

Multication metal-halide perovskites exhibit desirable performance and stability, compared to their monocation counterparts. However, the study of the photophysical properties and the nature of defect states in these materials is still a challenging and ongoing task. Here, we study bulk and interfacial energy loss mechanisms in solution-processed MAPbI (MAPI) and (CsPbI)[(FAPbI)(MAPbBr)] (triple cation) perovskite solar cells using absolute photoluminescence (PL) measurements. In neat MAPI films, we find a significantly smaller quasi-Fermi level splitting than for the triple cation perovskite absorbers, which defines the open-circuit voltage of the MAPI cells. PL measurements at low temperatures (∼20 K) on MAPI films demonstrate that emissive subgap states can be effectively reduced using different passivating agents, which lowers the nonradiative recombination loss at room temperature. We conclude that while triple cation perovskite cells are limited by interfacial recombination, the passivation of surface trap states within the MAPI films is the primary consideration for device optimization.
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http://dx.doi.org/10.1021/acsami.0c02960DOI Listing
August 2020

Implementing a system for the real-time risk assessment of patients considered for intensive care.

BMC Med Inform Decis Mak 2020 07 16;20(1):161. Epub 2020 Jul 16.

Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.

Background: Delay in identifying deterioration in hospitalised patients is associated with delayed admission to an intensive care unit (ICU) and poor outcomes. For the HAVEN project (HICF ref.: HICF-R9-524), we have developed a mathematical model that identifies deterioration in hospitalised patients in real time and facilitates the intervention of an ICU outreach team. This paper describes the system that has been designed to implement the model. We have used innovative technologies such as Portable Format for Analytics (PFA) and Open Services Gateway initiative (OSGi) to define the predictive statistical model and implement the system respectively for greater configurability, reliability, and availability.

Results: The HAVEN system has been deployed as part of a research project in the Oxford University Hospitals NHS Foundation Trust. The system has so far processed > 164,000 vital signs observations and > 68,000 laboratory results for > 12,500 patients and the algorithm generated score is being evaluated to review patients who are under consideration for transfer to ICU. No clinical decisions are being made based on output from the system. The HAVEN score has been computed using a PFA model for all these patients. The intent is that this score will be displayed on a graphical user interface for clinician review and response.

Conclusions: The system uses a configurable PFA model to compute the HAVEN score which makes the system easily upgradable in terms of enhancing systems' predictive capability. Further system enhancements are planned to handle new data sources and additional management screens.
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http://dx.doi.org/10.1186/s12911-020-01176-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366315PMC
July 2020

Exploring mentalization, trust, communication quality, and alienation in adolescents.

PLoS One 2020 15;15(6):e0234662. Epub 2020 Jun 15.

School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.

Introduction: A growing body of evidence has demonstrated the importance of mentalization for adolescents' psychosocial functioning; however, further research is needed to understand links between mentalization and other socio-cognitive factors. The aim of this quantitative, cross-sectional study was to investigate the relationship between a teen's capacity to mentalize and three attachment-related factors: parent-teen trust, parent-teen communication, and parent-teen alienation.

Methods: In an online survey, 82 (mainly) Australian adolescents (57 female; 23 male; 2 non-binary; mean age 17.09 years) completed: i) The Children's Eyes Test, which measured mentalization; and ii) The Inventory of Parent and Peer Attachment-45, which measured trust, communication quality, and alienation.

Results: In teens' relationships with both mothers and fathers, trust and communication quality were significantly positively correlated (p = .001) when controlling for age and gender. Both were significantly negatively correlated with alienation (p = .001) with control variables included. Capacity to mentalize did not correlate with trust, communication quality, or alienation in relationships with either mothers or fathers (p ≤ .05).

Conclusions: Possible reasons are proposed for why no relationship was found between mentalization and trust, communication quality, or alienation. Implications for future research are discussed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234662PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295212PMC
August 2020

Y-site physical compatibility of hydrocortisone continuous infusions with admixtures used in critically ill patients.

Am J Health Syst Pharm 2020 07;77(14):1144-1148

Prisma Health Midlands, Columbia, SC.

Purpose: Critically ill patients with septic shock often receive multiple intravenous medications, necessitating either the placement of separate lines for medication administration or administration of medications concurrently through a Y-site connector only where compatibility has been demonstrated. The purpose of this study was to examine the physical compatibility of hydrocortisone infusions and select intravenous medications through a simulated Y site.

Methods: The medications tested for simulated Y-site physical compatibility with hydrocortisone included acetaminophen, albumin, cefepime, ciprofloxacin, cisatracurium, doripenem, epinephrine, esomeprazole, ibuprofen, levofloxacin, levothyroxine, meropenem, and norepinephrine. Hydrocortisone in solution with 0.9% sodium chloride injection was combined with an equivalent volume of solutions of each test drug at maximum or commercially available concentrations used clinically in intensive care units, as appropriate. The samples were evaluated using turbidimetric measurements and examined visually against light and dark backgrounds to determine physical compatibility. Observations and analyses were completed over a one-hour period at 15-minute intervals beginning immediately after mixing. Each test was performed in triplicate.

Results: All study medications demonstrated visual and/or turbidimetric physical compatibility when combined with hydrocortisone in a simulated Y-site infusion. No medications demonstrated a visual physical incompatibility when combined with hydrocortisone.

Conclusion: Acetaminophen, albumin, cefepime, ciprofloxacin, cisatracurium, doripenem, epinephrine, esomeprazole, ibuprofen, levofloxacin, levothyroxine, meropenem, and norepinephrine exhibited physical compatibility with hydrocortisone via Y-site infusion.
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http://dx.doi.org/10.1093/ajhp/zxaa118DOI Listing
July 2020

Substance Use: Links with Sensory Sensitivity, Attachment Insecurity, and Distress in Young Adults.

Subst Use Misuse 2020 22;55(11):1817-1824. Epub 2020 May 22.

School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.

Adolescence and young adulthood are periods of increased substance use, with insecurely attached individuals at greater risk of abusing substances. With recent evidence linking insecure attachment with sensory sensitivity, and evidence that both are linked with higher levels of distress, there is a need to consider these variables in relation to substance use in a sample of young adults. A convenience sample of 223 young adults (18-24 years) completed self-report measures of attachment, sensory sensitivity, use of various substances (e.g. alcohol, legal and illegal drugs, cigarettes, energy drinks), and distress. Correlation, t-test, and regression/mediation analyses were conducted. Sensory sensitivity was positively correlated with insecure attachment. Anxious attachment was related to problematic substance use, frequent cigarette use, and misuse of prescribed medications. Avoidant attachment was associated with frequent use of cigarettes and energy drinks. Sensory sensitivity, attachment anxiety, and attachment avoidance each had significant indirect effects on problematic substance use, mediated by increased levels of distress. Sensory sensitivity and attachment insecurity both appear to impact problematic substance use in young adults through elevated levels of distress. Findings support consideration of sensory- and attachment-informed interventions with this population.
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http://dx.doi.org/10.1080/10826084.2020.1766502DOI Listing
May 2020

Shame and guilt in the postnatal period: a systematic review.

J Reprod Infant Psychol 2021 02 26;39(1):67-85. Epub 2020 Apr 26.

School of Health and Rehabilitation Science, The University of Queensland , Brisbane, Australia.

: The aim of this review was to explore the unique contribution of shame (negative evaluation of the ) and guilt (negative evaluation of ) to postnatal psychological symptoms. : Although shame and guilt are related to psychological symptoms, the separate effect of each in postnatal psychological symptoms are not yet known. : Seven electronic databases were systematically reviewed for articles on: (1) quantitative measures of shame, guilt, and psychological symptoms (2) in the postnatal period for infants under two years of age (3) published in English. : Of the 1,615 articles retrieved using PRISMA guidelines, five met criteria and were analysed independently by two reviewers using the STROBE criteria. In , shame was significantly related to stress and postnatal depression. Shame significantly predicted postnatal depression. Guilt was significantly related to postnatal depression; however, the relationship was substantially reduced when included with shame. In , shame, but not guilt, was significantly related to stress, anxiety, and depression. : Shame and guilt are trans-diagnostic phenomena, negatively impacting on postnatal psychological health, and potentially the parent-child relationship. More research is needed to develop awareness of the unique effects of shame and guilt to optimise perinatal intervention.
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http://dx.doi.org/10.1080/02646838.2020.1754372DOI Listing
February 2021

Experiences of Children with Fetal Alcohol Spectrum Disorder and Their Families: A Critical Review.

Alcohol Clin Exp Res 2020 06 6;44(6):1175-1188. Epub 2020 May 6.

Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia.

Evidence suggests that children with fetal alcohol spectrum disorder (FASD) experience challenges across many areas of their daily lives and often require interprofessional supports. Recent studies have emphasized the need for an integrated system of care for children with FASD, incorporating medical, allied health, and education services, to facilitate open communication and support for the complex needs that many children experience. To develop such a system of care, it is important to first understand the impact of FASD on children's functioning during daily activities in different environmental contexts. A critical review of existing research was conducted using a critical interpretive synthesis approach. Results revealed that while many studies discussed impacts at the body functions and structures level of children with FASD, they often did not consider the activity, participation, and environmental factors also contributing to the daily functioning of this population. Several studies discussed caregiver experiences and challenges raising a child with FASD; however, no studies investigated the lived experiences relating to impacts across activities and environments from children's perspectives. In addition, the focus on deficits overshadowed investigation into the strengths of children with FASD, leaving a gap in the picture of their daily lives. Further research is required to determine the strengths that children with FASD demonstrate and the challenges impacting their daily functioning within different environmental contexts. Insights gleaned from such research would support intervention practices to become more holistic and interprofessional.
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http://dx.doi.org/10.1111/acer.14335DOI Listing
June 2020

Charge Carrier Transport and Generation via Trap-Mediated Optical Release in Organic Semiconductor Devices.

Phys Rev Lett 2020 Mar;124(12):128001

Sustainable Advanced Materials (Sêr-SAM), Department of Physics, Swansea University, Singleton Park, Swansea SA2 8PP Wales, United Kingdom.

The impact of intermixed donor-acceptor domains in organic bulk heterojunction (BHJ) solar cells, using low-donor-content devices as model systems, is clarified. At low donor contents, the devices are found to exhibit anomalously high open-circuit voltages independent of the donor-acceptor energetics. These observations can be consistently explained by a theoretical model based on optical release of trapped holes, assuming the donors behave as trap sites in the gap of the acceptor. Our findings provide guidelines for reducing the large open-circuit voltage losses in organic solar cells and avoiding morphology-induced losses in state-of-the-art BHJ solar cells and photodetectors.
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http://dx.doi.org/10.1103/PhysRevLett.124.128001DOI Listing
March 2020

Pediatric Persistent Pain: Associations Among Sensory Modulation, Attachment, Functional Disability, and Quality of Life.

Am J Occup Ther 2020 Mar/Apr;74(2):7402205040p1-7402205040p11

Jenny Strong, PhD, is Emeritus Professor, School of Health and Rehabilitation, University of Queensland, Brisbane, Queensland, Australia.

Importance: Although attachment is associated with sensory modulation among children and adolescents and insecure attachment is associated with pain severity among adolescents, relationships among sensory modulation, attachment, and function have not previously been demonstrated in a clinical sample of children and adolescents with complex persistent pain.

Objective: To investigate relationships among sensory modulation, attachment, function, and quality of life (QOL) in a pediatric population with persistent pain.

Design: Cross-sectional quantitative design. From October 2015 to July 2017, all children, adolescents, and parents attending a clinic for assessment completed questionnaires and were provided information and consent forms. Those who consented completed sensory modulation and attachment questionnaires.

Setting: Tertiary pain management clinic.

Participants: Children (ages 8-12 yr) and adolescents (ages 13-18 yr) with persistent pain (pain of >3 mo duration or a specific pain disorder) and the capacity to answer questionnaires independently.

Measures: Standardized sensory modulation, attachment, pain intensity, functional disability, and QOL questionnaires. Hypotheses were generated before data collection.

Results: Of 152 children and adolescents, 114 children (30 girls, 9 boys) and adolescents (68 girls, 7 boys) met study criteria and consented to participate. Hierarchical multiple regression analyses revealed that sensory sensitivity predicted disability for children and adolescents, and attachment anxiety mediated the relationship between low registration and poorer school-related QOL.

Conclusion And Relevance: Behaviors related to insecure attachment patterns provide a mediating pathway from sensory modulation to functional disability; addressing such behaviors clinically may facilitate engagement in daily activities for children and adolescents with persistent pain.

What This Article Adds: Results support the need to consider the interactions between sensory modulation and attachment when addressing functional abilities with occupational therapy treatment.
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http://dx.doi.org/10.5014/ajot.2020.033308DOI Listing
June 2020

'Why didn't you just give them PRN?': A qualitative study investigating the factors influencing implementation of sensory modulation approaches in inpatient mental health units.

Int J Ment Health Nurs 2020 Aug 14;29(4):608-621. Epub 2020 Feb 14.

School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.

Clinical guidelines and policies worldwide call for sensory modulation approaches to be incorporated into inpatient mental health care to assist in eliminating the use of restrictive practices. Although increasing evidence shows that these approaches reduce patient distress and the need for seclusion and restraint, sensory modulation approaches have been challenging to implement in many psychiatric units. Implementation strategies can effectively support inclusion of new approaches by addressing potential barriers to change and supporting likely enabling factors. This study aimed to gain a better understanding of the barriers and enablers influencing implementation of sensory modulation approaches in psychiatric inpatient units in one health region in Australia. A qualitative descriptive study design was used, with three focus groups and a total of 15 participants from nursing and allied health disciplines answering questions about the use of sensory modulation approaches. Framework analysis using the Theoretical Domains Framework and thematic analysis was used to analyse data. Overall, participants were positive about the use of sensory modulation approaches, particularly for reducing distress. Four domains (Social Influences; Belief about Consequences; Professional Role and Identify; and Environmental Context and Resources) were identified as the most salient. The key influencing factors were support from peers; beliefs about risks; belief it was part of their role; and availability of resources and materials. Numerous challenges and opportunities related to implementing sensory modulation approaches in mental health inpatient units, identified in this study, provide insights to support effective implementation of these approaches, underpinning more person-centred, trauma-informed, and recovery-orientated care.
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http://dx.doi.org/10.1111/inm.12693DOI Listing
August 2020

Cancer care and occupational therapy: A scoping review.

Aust Occup Ther J 2020 04 19;67(2):172-194. Epub 2020 Jan 19.

School of Medical and Health Sciences, Edith Cowan University.

Introduction: Cancer can disrupt participation in everyday activities, suggesting a place for occupational therapy; however, there is a need to articulate the nature, scope and available evidence supporting the occupational therapy role within cancer care. In this scoping review, we identify the breadth of practice and evidence for occupational therapy in cancer care, across all stages of the disease trajectory (diagnosis to palliation/survivorship) throughout the lifespan.

Methods: Five electronic databases were searched in June 2018, for English language articles. Key words were: cancer care, OR oncolog*, OR oncologic care, OR neoplasms, OR cancer survivors, OR terminal cancer, OR cancer rehabilitation, AND occupational therap*. No date restrictions were imposed. Included were: all styles of literature including grey literature, all types of cancers and all age brackets. There were no restrictions on place of origin of papers. Following the Arksey and O'Malley (2006; International Journal of Social Research Methodology, 8: 19-32) framework for scoping reviews, the first author screened titles and abstracts, and all three authors reviewed sets of the included articles. Conflicts were discussed until consensus was reached.

Results: After evaluating 305 titles and abstracts and 111 full-text articles, 89 papers were retained. Articles included research studies (n = 43), reviews (n = 15), grey literature (n = 16), practice analyses (n = 14) and an editorial (n = 1). The occupational therapy roles described were diverse, but largely descriptive in nature, with little evidence of outcomes from treatment. Furthermore, the majority of papers addressed adult populations, with few considering children, adolescents or young adults. Most papers focused on specific stages of the disease, and none addressed the disease along its full trajectory.

Conclusion: Despite identifying a diverse range of occupational therapy roles in cancer care throughout the disease trajectory and across the lifespan, the need for professional discourse and research within our profession was highlighted. This was particularly evident for adolescents and young adults with cancer.
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http://dx.doi.org/10.1111/1440-1630.12633DOI Listing
April 2020

Melanin Biopolymers: Tailoring Chemical Complexity for Materials Design.

Angew Chem Int Ed Engl 2020 07 18;59(28):11196-11205. Epub 2020 Mar 18.

Laboratory for Atomistic and Molecular Mechanics, School of Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.

Melanins, a group of dark insoluble pigments found widespread in nature, have become the focus of growing interest in materials science for various biomedical and technological applications, including opto-bioelectronics, nanomedicine and mussel-inspired surface coating. Recent progress in the understanding of melanin optical, paramagnetic redox, and conductivity properties, including photoconductivity, would point to a revision of the traditional concept of structural disorder in terms of more sophisticated and interrelated levels of chemical complexity which however have never been defined and codified. Herein, we bring to focus the various levels of structural disorder that emerged from spectral and chemical signatures over the past decade. A revised approach to structure-property relationships in terms of intermolecular interactions is also provided that may pave the way towards the rational design of next-generation melanin-based functional materials.
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http://dx.doi.org/10.1002/anie.201914276DOI Listing
July 2020