Factors influencing the successful implementation of a novel digital health application to streamline multidisciplinary communication across multiple organisations for emergency care.

RATIONALE: Delivering optimal patient health care requires interdisciplinary clinician communication. A single communication tool across multiple pre-hospital and hospital settings, and between hospital departments is a novel solution to current systems. Fit-for-purpose, secure smartphone applications allow clinical information to be shared quickly between health providers. Little is known as to what underpins their successful implementation in an emergency care context. AIMS: To identify (a) whether implementing a single, digital health communication application across multiple health care organisations and hospital departments is feasible; (b) the barriers and facilitators to implementation; and (c) which factors are associated with clinicians' intentions to use the technology. METHODS: We used a multimethod design, evaluating the implementation of a secure, digital communication application (Pulsara™). The technology was trialled in two Australian regional hospitals and 25 Ambulance Victoria branches (AV). Post-training, clinicians involved in treating patients with suspected stroke or cardiac events were administered surveys measuring perceived organisational readiness (Organisational Readiness for Implementing Change), clinicians' intentions (Unified Theory of Acceptance and Use of Technology) and internal motivations (Self-Determination Theory) to use Pulsara™, and the perceived benefits and barriers of use. Quantitative data were descriptively summarised with multivariable associations between factors and intentions to use Pulsara™ examined with linear regression. Qualitative data responses were subjected to directed content analysis (two coders). RESULTS: Participants were paramedics (n = 82, median 44 years) or hospital-based clinicians (n = 90, median 37 years), with organisations perceived to be similarly ready. Regression results (F(11, 136) = 21.28, p = <0.001, Adj R2 = 0.60) indicated Habit, Effort Expectancy, Perceived Organisational Readiness, Performance Expectancy and Organisation membership (AV) as predictors of intending to use Pulsara™. Themes relating to benefits (95% coder agreement) included improved communication, procedural efficiencies and faster patient care. Barriers (92% coder agreement) included network accessibility and remembering passwords. PulsaraTM was initiated 562 times. CONCLUSION: Implementing multiorganisational, digital health communication applications is feasible, and facilitated when organisations are change-ready for an easy-to-use, effective solution. Developing habitual use is key, supported through implementation strategies (e.g., hands-on training). Benefits should be emphasised (e.g., during education sessions), including streamlining communication and patient flow, and barriers addressed (e.g., identify champions and local technical support) at project commencement.

Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care.

OBJECTIVES: To determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI). DESIGN: Real-world feasibility study, quasi-experimental design. SETTING: Prehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia. PARTICIPANTS: Paramedics or emergency department (ED) clinicians identified patients with suspected acute stroke (onset <4.5 hours; n=604) or STEMI (n=247). INTERVENTION: The Pulsara communication app provides secure, two-way, real-time communication. Assessment and treatment times were recorded for 12 months (May 2017-April 2018), with timelines compared between 'Pulsara initiated' (Pulsara) and 'not initiated' (no Pulsara). PRIMARY OUTCOME MEASURE: Door-to-treatment (needle for stroke, balloon for STEMI) Secondary outcome measures: ambulance and hospital processes. RESULTS: Stroke (no Pulsara n=215, Pulsara n=389) and STEMI (no Pulsara n=76, Pulsara n=171) groups were of similar age and sex (stroke: 76 vs 75 years; both groups 50% male; STEMI: 66 vs 63 years; 68% and 72% male). When Pulsara was used, patients were off ambulance stretcher faster for stroke (11(7, 17) vs 19(11, 29); p=0.0001) and STEMI (14(7, 23) vs 19(10, 32); p=0.0014). ED door-to-first medical review was faster (6(2, 14) vs 23(8, 67); p=0.0001) for stroke but only by 1 min for STEMI (3 (0, 7) vs 4 (0, 14); p=0.25). Door-to-CT times were 44 min faster (27(18, 44) vs 71(43, 147); p=0.0001) for stroke, and percutaneous intervention door-to-balloon times improved by 17 min, but non-significant (56 (34, 88) vs 73 (49, 110); p=0.41) for STEMI. There were improvements in the proportions of patients treated within 60 min for stroke (12%-26%, p=0.15) and 90 min for STEMI (50%-78%, p=0.20). CONCLUSIONS: In this Australian-first study, uptake of the digital communication app was strong, patient-centred care timelines improved, although door-to-treatment times remained similar.

Measurement invariance of the empowering and disempowering motivational climate questionnaire-coach in youth sport.

The purpose of this study was to test the measurement invariance (across five languages, two time points, and two experimental conditions) of the empowering and disempowering motivational climate questionnaire-coach (EDMCQ-C; Appleton et al., 2016) when completed by 9256 young sport participants (M age = 11.53 years, SD = 1.39 years; 13.5% female). Exploratory Structural Equation Modeling was used to test the validity of a 2-factor (empowering and disempowering) model running a multiple group analysis without any equality constraint (configural invariance) followed by measurement invariance of factor loadings and thresholds (scalar invariance). Findings provided support for partial invariance across languages and scalar invariance across time and experimental groups. The factors were interpretable across the analyses, and items loaded as intended by theory except for item 15. This study provides further evidence regarding the psychometric properties of the EDMCQ-C and suggests this scale (minus item 15) can be used to provide meaningful latent mean comparisons (Marsh et al., 2013) of empowering and disempowering coach-created climates across athletes speaking the five targeted languages, across time, and across experimental groups.

Initial psychometric testing of the coach-adapted version of the empowering and disempowering motivational climate questionnaire: A Bayesian approach.

The present study examined the psychometric properties of the coach-adapted version of the Empowering and Disempowering Motivational Climate Questionnaire (EDMCQ) using Bayesian structural equation modelling (BSEM). The sample included 780 (Mage = 36.4; SD = 10.8; males n = 698; females n = 54; 28 participants did not report sex) youth sport coaches representing five European countries (i.e., England, France, Greece, Norway, and Spain). The results did not support a 34-item five-factor, hierarchical, a two-factor BSEM, or a bifactor BSEM model across the participating countries. However, the results supported a reduced 19-item first-order, two-factor BSEM model that largely showed approximate metric invariance, but not approximate scalar invariance across the five countries. The pool of items constituting empowering and disempowering motivational climates should be refined to further enhance the empirical operationalisation of the coach-adapted version of the EDMCQ. Advancing the quality of translation-back-translation procedures across cultures and conducting multi-national pilot testing seems warranted as well. These recommendations may help to identify the distinctive aspects of each underlying sub-dimension of the EDMCQ, where coaches are the respondents, and pave the way for further examination of the proposed hierarchical multidimensional factor structure and the cross-cultural equivalence of the EDMCQ for this population.

Validation of the Spanish version of multidimensional inventory of perfectionism in young footballers / Validación de la versión española del inventario multidimensional de perfeccionismo en jóvenes futbolistas / Validação da versão em espanhol do inventário multidimensional do perfeccionismo em jovens futebolistas

The Multidimensional Inventory of Perfectionism in Sport (MIPS) is one sport specific measure of perfectionism developed on the basis of a combination of different multidimensional models. This study assesses the psychometrics of the MIPS in a Spanish sample of young footballers. Participants were 429 Spanish football players with ages ranging from 9 to 13 years. Confirmatory factor analyses showed that a two-dimensional model obtained adequate fit indices and Cronbach's alpha coefficients showed acceptablelevels of internal reliability. The criterion and convergent validity of the Spanish MIPS analysed in young footballers was also confirmed via its association with measures of sport anxiety, contingent self-worth and additional perfectionism dimensions. The results of this study suggest that the Spanish version of the MIPS to be used with young footballers is a well-adapted and adequate, reliable and valid sport specific instrument

El Inventario Multidimensional de Perfeccionismo en Deporte (MIPS) es una medida deportiva específica del perfeccionismo desarrollado a partir de una combinación de diferentes modelos multidimensionales. Este estudio analiza las propiedades psicométricas del MIPS en una muestra española de jóvenes futbolistas. Participaron 429 futbolistas españoles con edades comprendidas entre 9 y 13 años. Los análisis factoriales confirmatorios mostraron que un modelo bidimensional obtenía adecuados índices de ajuste y los coeficientes alfa de Cronbach mostraron niveles de fiabilidad interna aceptables. La validez criterial y convergente del MIPS español estudiada con adolescentes futbolistas ha sido confirmada analizando su asociación con medidas de ansiedad competitiva, autoestima contingente y con otras dimensiones de perfeccionismo. Los resultados de este estudio sugieren que la versión española del MIPS validada para aplicarse a jóvenes futbolistas es un instrumento específico y adecuado para deporte, bien adaptado, fiable y válido

O Inventário Multidimensional do Perfeccionismo no Esporte (MIPS) é uma medida esportiva específica do perfeccionismo desenvolvida a partir de uma combinação de diferentes modelos multidimensionais. Este estudo analisa as propriedades psicométricas do MIPS em uma amostra espanhola de jovens jogadores de futebol. Participaram 429 jogadores de futebol espanhol, com idades entre 9 e 13 anos. A análise fatorial confirmatória mostrou queum modelo bidimensional obteve taxas de ajuste adequadas e os coeficientes alfa de Cronbach mostraram níveis aceitáveis de confiabilidade interna. A validade de critério e convergente dos MIPS espanhóis estudados com jogadores de futebol juvenil foi confirmada pela análise de sua associação com medidas de ansiedade competitiva, autoestima contingente e outras dimensões do perfeccionismo. Os resultados deste estudo sugerem que a versão em espanhol do MIPS validada para aplicação em jovens jogadores de futebol é um instrumento específico e adequado ao esporte, bem adaptado, confiável e válido

Establishing Cost-Effective Computational Models for the Prediction of Lanthanoid Binding in [Ln(NO3)]2+ (with Ln = La to Lu).

Evaluating the efficiency of predictive methods is critical to the processes of upscaling laboratory processes to full-scale operations on an industrial scale. With regard to separation of lanthanoids, there is a considerable motivation to optimize these processes because of immediate use in nuclear fuel cycle operations, nuclear forensics applications, and rare-earth metal recovery. Efficient predictive capabilities in Gibbs free energies of reaction are essential to optimize separations and ligand design for selective binding needed for various radiochemical applications such as nuclear fuel disposition and recycling of lanthanoid fission products into useful radioisotope products. Ligand design is essential for selective binding of lanthanoids, as separating contiguous lanthanoids is challenging because of the similar behavior these elements exhibit. Modeling including electronic structure calculations of lanthanoid-containing compounds is particularly challenging because of the associated computational cost encountered with the number of electrons correlated in these systems and relativistic considerations. This study evaluates the predictive capabilities of various ab initio methods in the calculation of Gibbs free energies of reaction for [Ln(NO3)]2+ compounds (with Ln = La to Lu), as nitrates are critical in traditional separation processes utilizing nitric acid. The composite methodologies evaluated predict Gibbs free energies of reaction for [Ln(NO3)]2+ compounds within 5 kcal mol-1 in most cases from the target method [CCSD(T)-FSII/cc-pwCV∞Z-DK3+SO] at a fraction of the computational cost.

The Performance of two silica based ion exchange resins in the separation of 213Bi from its parent solution of 225Ac.

The performance of two inorganic ion exchange resins, Isolute SCX and Isolute SCX-2, were compared to the performance of the organic resin AG-50X8 in the separation of the radionuclide bismuth-213 from its parent solution of actinium-225. The breakthrough of the actinium-225 for all three columns was well below the toxicity level but the Isolute SCX and Isolute SCX-2 produced less of the bismuth-213 available on the column.

Structural Analysis of the Complexation of Uranyl, Neptunyl, Plutonyl, and Americyl with Cyclic Imide Dioximes.

Knowledge-based design of extracting agents for selective binding of actinides is essential in stock-pile stewardship, environmental remediation, separations, and nuclear fuel disposal. Robust computational protocols are critical for in depth understanding of structural properties and to further advance the design of selective ligands. In particular, rapid radiochemical separations require predictive capabilities for binding in the gas phase. This study focuses on gas-phase binding preferences of cyclic imide dioximes to uranyl, neptunyl, plutonyl, and americyl. Structural properties, electron withdrawing effects, and their effects on binding preferences are studied with natural bond-order population analysis. The aromatic amidoximes are found to have a larger electron-donation effect than the aliphatic amidoximes. It is also found that plutonyl is more electron withdrawing than uranyl, neptunyl, and americyl when bound to the cyclic imide dioximes studied.

Structural Characteristics, Population Analysis, and Binding Energies of [An(NO3)]2+ (with An = Ac to Lr).

Efficient predictive capabilities are essential for the actinide series since regulatory constraints for radioactive work, associated costs needed for specialized facilities, and the short half-lives of many actinides present great challenges in laboratory settings. Improved predictive accuracy is advantageous for numerous applications including the optimization and design of separation agents for nuclear fuel and waste. One limitation of calculations in support of these applications is that the large variations observed from predictions obtained with currently available methods can make comparisons across studies uncertain. Benchmarking currently available computational methodologies is essential to establish reliable practices across the community to guarantee an accurate physical description of the systems studied. To understand the performance of a variety of common theoretical methods, a systematic analysis of differences observed in the prediction of structural characteristics, electron withdrawing effects, and binding energies of [An(NO3)]2+ (with An = Ac to Lr) in gas and aqueous phases is reported. Population analysis obtained with Mulliken and Löwdin reflect a large dependence on the level of theory of choice, whereas those obtained with natural bond orbital show larger consistency across methodologies. Predicted stability across the actinide series calculated with coupled cluster with perturbative doubles and triples at the triple ζ level is equivalent to the one obtained when extrapolated to the complete basis set limit. The ground state of [Fm(NO3)]2+ and [Md(NO3)]2+ is predicted to have an electronic structure corresponding to An III state in gas and An IV in aqueous phase, whereas the ground state of [An(NO3)]2+ (with An = Ac to Es, Lr) presents an electronic structure corresponding to An IV in the gas and aqueous phase. The compounds studied with No in gas and aqueous phase present a preferred No III state, and the Lr compounds did not follow trends predicted for the rest of the actinide series, as previously observed in studies regarding its unusual electronic structure relative to its position in the periodic table.

Validity and reliability of accelerometry in identification of lying, sitting, standing or purposeful activity in adult hospital inpatients recovering from acute or critical illness: a systematic review.

OBJECTIVE: To investigate the validity and reliability of accelerometers to detect lying, sitting and standing postures or purposeful activity in hospitalized adults recovering from acute or critical illness. DATA SOURCES: CINAHL, MEDLINE, EMBASE, AMED, Cochrane Library, PEDro, PsycINFO and SPORTDiscuss were searched from inception to June 2017. Professional networks and reference lists of relevant articles were also searched. The main selection criteria were hospitalized adults with acute or critical illness and studies investigating the validity or reliability of accelerometers to identify body position or purposeful activity. REVIEW METHODS: Two authors individually assessed study eligibility and independently undertook methodological quality assessment and data extraction from selected articles. A narrative synthesis of the data was undertaken. RESULTS: Fifteen studies, collectively enrolling 385 hospitalized participants, were identified. Populations included stroke, the elderly, acute exacerbation of chronic respiratory disease, abdominal surgery and those recovering from critical illness. Correlations of r = 0.36 to 0.98 and levels of agreement of κ = 0.28 to 0.98 were reported for identification of lying, sitting or standing postures. Correlations of r = 0.4 to 0.8 with general activity were found, with r = 0.94 and 0.96 reported for step count. The reliability of accelerometry measurement was investigated in one study evaluating step count quantification (intraclass correlation coefficient (ICC) = 0.99, 95% confidence interval (CI) = 0.99-1.00). CONCLUSION: The validity of accelerometers to determine lying, sitting and standing postures or quantify purposeful activity within hospitalized acute or critically ill populations is variable. The reliability of accelerometry measurement within this setting remains largely unexplored.

Gas chemical adsorption characterization of lanthanide hexafluoroacetylacetonates.

Newly-established adsorption enthalpy and entropy values of 12 lanthanide hexafluoroacetylacetonates, denoted Ln[hfac]4, along with the experimental and theoretical methodology used to obtain these values, are presented for the first time. The results of this work can be used in conjunction with theoretical modeling techniques to optimize a large-scale gas-phase separation experiment using isothermal chromatography. The results to date indicate average adsorption enthalpy and entropy values of the 12 Ln[hfac]4 complexes ranging from -33 to -139 kJ/mol K and -299 to -557 J/mol, respectively.

Review of current nuclear fallout codes.

The importance of developing a robust nuclear forensics program to combat the illicit use of nuclear material that may be used as an improvised nuclear device is widely accepted. In order to decrease the threat to public safety and improve governmental response, government agencies have developed fallout-analysis codes to predict the fallout particle size, dose, and dispersion and dispersion following a detonation. This paper will review the different codes that have been developed for predicting fallout from both chemical and nuclear weapons. This will decrease the response time required for the government to respond to the event.

Characterization and thermogravimetric analysis of lanthanide hexafluoroacetylacetone chelates.

This work reports the thermodynamic characterizations of organometallic species as a vehicle for the rapid separation of volatile nuclear fission products via gas chromatography due to differences in adsorption enthalpy. Because adsorption and sublimation thermodynamics are linearly correlated, there is considerable motivation to determine sublimation enthalpies. A method of isothermal thermogravimetric analysis, TGA-MS and melting point analysis are employed on thirteen lanthanide 1,1,1,5,5,5-hexafluoroacetylacetone complexes to determine sublimation enthalpies. An empirical correlation is used to estimate adsorption enthalpies of lanthanide complexes on a quartz column from the sublimation data. Additionally, four chelates are characterized by SC-XRD, elemental analysis, FTIR and NMR.

Gas-phase detection of solid-state fission product complexes for post-detonation nuclear forensic analysis.

This study presents the first known detection of fission products commonly found in post-detonation nuclear debris samples using solid sample introduction and a uniquely coupled gas chromatography inductively-coupled plasma time-of-flight mass spectrometer. Rare earth oxides were chemically altered to incorporate a ligand that enhances the volatility of the samples. These samples were injected (as solids) into the aforementioned instrument and detected for the first time. Repeatable results indicate the validity of the methodology, and this capability, when refined, will prove to be a valuable asset for rapid post-detonation nuclear forensic analysis.

A Three-Wave Longitudinal Test of Self-Determination Theory's Mediation Model of Engagement and Disaffection in Youth Sport.

Research adopting self-determination theory (SDT) supports a mediation model whereby coach motivational styles (autonomy support and interpersonal control) predict athletes' engagement and disaffection in youth sport via the satisfaction and frustration of psychological needs (autonomy, competence, and relatedness). Our study extends this research by examining SDT's mediation model longitudinally with three waves of data. Two hundred fifty-two youth sports participants (Mage = 12.98; SD = 1.84; range = 11-17; female n = 67) completed measures of study variables at the start, middle, and end of a competitive soccer season. Cross-lagged path analyses revealed that associations between the two coach motivational styles and athletes' engagement were mediated by psychological need satisfaction. Furthermore, a positive reciprocal association between psychological need satisfaction and engagement emerged over time. This study therefore supports the temporal assumptions underpinning SDT's mediation model but, importantly, evidences a mutually reinforcing interplay between athletes' psychological needs and their engaged behavior.

Thermodynamic analysis of volatile organometallic fission products.

The ability to perform rapid separations in a post nuclear weapon detonation scenario is an important aspect of national security. In the past, separations of fission products have been performed using solvent extraction, precipitation, etc. The focus of this work is to explore the feasibility of using thermochromatography, a technique largely employed in superheavy element chemistry, to expedite the separation of fission products from fuel components. A series of fission product complexes were synthesized and the thermodynamic parameters were measured using TGA/DSC methods. Once measured, these parameters were used to predict their retention times using thermochromatography.

Production of Synthetic Nuclear Melt Glass.

Realistic surrogate nuclear debris is needed within the nuclear forensics community to test and validate post-detonation analysis techniques. Here we outline a novel process for producing bulk surface debris using a high temperature furnace. The material developed in this study is physically and chemically similar to trinitite (the melt glass produced by the first nuclear test). This synthetic nuclear melt glass is assumed to be similar to the vitrified material produced near the epicenter (ground zero) of any surface nuclear detonation in a desert environment. The process outlined here can be applied to produce other types of nuclear melt glass including that likely to be formed in an urban environment. This can be accomplished by simply modifying the precursor matrix to which this production process is applied. The melt glass produced in this study has been analyzed and compared to trinitite, revealing a comparable crystalline morphology, physical structure, void fraction, and chemical composition.