Direct-write crosslinking in vacuum-deposited small-molecule films using focussed ion and electron beams.

Recent advances in helium ion microscopy (HIM) have enabled the use of fine-focused He+ beams to image and shape materials at the nanoscale. In addition to traditional ion milling, the beam can also be used to induce reactions, such as cross-linking, in films of organic molecules. Here, we compare the use of focused ion and electron beams to fabricate spatially-defined cross-linked features in nanometre-thick films of tetracene. Ion and electron beam treatments were performed using the focussed energetic beams in a HIM and a scanning electron microscope, respectively. The patterned samples were analysed by optical microscopy, HIM, atomic force microscopy and nanoindentation. For samples fabricated using both energetic beams, the total deposited particle dose could be used to modify the optical properties, thickness and hardness of the dosed regions. X-ray photoelectron spectroscopy revealed that the dosed regions exhibited a higher sp3 content, consistent with crosslinking; rinsing in solvent showed that the patterned regions were insoluble and could be isolated by removing the unmodified film through dissolution. These molecular nanopatterns demonstrate the promise for ultrahigh resolution chemical lithography, and for fabrication of nanocomponents with tailored physical properties.

Bridging the language gap: a co-designed quality improvement project to engage professional interpreters for women during labour.

Objective The aim of the study was to improve the engagement of professional interpreters for women during labour. Methods The quality improvement initiative was co-designed by a multidisciplinary group at one Melbourne hospital and implemented in the birth suite using the plan-do-study-act framework. The initiative of offering women an interpreter early in labour was modified over cycles of implementation and scaled up based on feedback from midwives and language services data. Results The engagement of interpreters for women identified as requiring one increased from 28% (21/74) at baseline to 62% (45/72) at the 9th month of implementation. Conclusion Improving interpreter use in high-intensity hospital birth suites is possible with supportive leadership, multidisciplinary co-design and within a framework of quality improvement cycles of change. What is known about the topic? Despite Australian healthcare standards and policies stipulating the use of accredited interpreters where needed, studies indicate that services fall well short of meeting these during critical stages of childbirth. What does the paper add? Collaborative approaches to quality improvement in hospitals can significantly improve the engagement of interpreters to facilitate communication between health professionals and women with low English proficiency. What are the implications for practice? This language services initiative has potential for replication in services committed to improving effective communication between health professionals and patients.

Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities.

BACKGROUND: The risk of poor maternal and perinatal outcomes in high-income countries such as Australia is greatest for those experiencing extreme social and economic disadvantage. Australian data show that women of refugee background have higher rates of stillbirth, fetal death in utero and perinatal mortality compared with Australian born women. Policy and health system responses to such inequities have been slow and poorly integrated. This protocol describes an innovative programme of quality improvement and reform in publically funded universal health services in Melbourne, Australia, that aims to address refugee maternal and child health inequalities. METHODS/DESIGN: A partnership of 11 organisations spanning health services, government and research is working to achieve change in the way that maternity and early childhood health services support families of refugee background. The aims of the programme are to improve access to universal health care for families of refugee background and build organisational and system capacity to address modifiable risk factors for poor maternal and child health outcomes. Quality improvement initiatives are iterative, co-designed by partners and implemented using the Plan Do Study Act framework in four maternity hospitals and two local government maternal and child health services. Bridging the Gap is designed as a multi-phase, quasi-experimental study. Evaluation methods include use of interrupted time series design to examine health service use and maternal and child health outcomes over a 3-year period of implementation. Process measures will examine refugee families' experiences of specific initiatives and service providers' views and experiences of innovation and change. DISCUSSION: It is envisaged that the Bridging the Gap program will provide essential evidence to support service and policy innovation and knowledge about what it takes to implement sustainable improvements in the way that health services support vulnerable populations, within the constraints of existing resources.

Paediatric lung recruitment: a review of the clinical evidence.

Lung recruitment is used as an adjunct to lung protective ventilation strategies. Lung recruitment is a brief, deliberate elevation of transpulmonary pressures beyond what is achieved during tidal ventilation levels. The aim of lung recruitment is to maximise the number of alveoli participating in gas exchange particularly in distal and dependant regions of the lung. This may improve oxygenation and end expiratory levels. Restoration of end expiratory levels and stabilisation of the alveoli may reduce the incidence of ventilator induced lung injury (VILI). Various methods of lung recruitment have been studied in adult and experimental populations. This review aims to establish the evidence for lung recruitment in the pediatric population.

Lung protective ventilation strategies in paediatrics-A review.

Ventilator Associated Lung Injury (VALI) is an iatrogenic phenomena that significantly impacts on the morbidity and mortality of critically ill patients. The hazards associated with mechanical ventilation are becoming increasingly understood courtesy of a large body of research. Barotrauma, volutrauma and biotrauma all play a role in VALI. Concomitant to this growth in understanding is the development of strategies to reduce the deleterious impact of mechanical ventilation. The majority of the research is based upon adult populations but with careful extrapolation this review will focus on paediatrics. This review article describes the physiological basis of VALI and discusses the various lung protective strategies that clinicians can employ to minimise its incidence and optimise outcomes for paediatric patients.

A simplified predictive index for the detection of women at risk for postnatal depression.

BACKGROUND: Many women who suffer from postnatal depression are never diagnosed or treated. The objective of this study was to develop an index for use in maternity settings that identifies women who may be at risk for postnatal depression. METHODS: Women (n = 1762) attending the "booking-in" clinic were screened for antenatal risk factors for postnatal depression. On the third postnatal day eligible women were screened for postnatal risk factors. The Edinburgh Postnatal Depression Scale was mailed to participants 16 weeks after the birth. A predictive index was developed, based on the mean Edinburgh Postnatal Depression Scale scores for each risk factor. The sensitivity, specificity, positive predictive value, and negative predictive value were used to assess the diagnostic value of the index. RESULTS: Seven hundred and twenty-three (50.1%) of the eligible women completed all phases of the study. Of this group, 93 (12.2%) women scored higher than 12 on the Edinburgh Postnatal Depression Scale. At a cutoff of 6, the index had positive predictive value of 39.8 percent for postnatal depression, a threefold improvement over the base rate. CONCLUSION: The Brisbane Postnatal Depression Index provides a clinically useful method for identifying women at risk for developing postnatal depression. It has applications for early intervention or to identify high-risk groups for research purposes.