Telehealth physiotherapy to deliver exercise in aged care settings.

This thesis addresses critical gaps in evidence regarding fall prevention and mobility enhancement for older individuals, particularly those in aged care settings. It highlights the need for effective prevention strategies due to the health risks and economic burdens associated with falls among older adults. Challenges like funding constraints and workforce shortages hinder access to exercise in aged care. Telehealth emerges as a potential solution, but its implementation in aged care remains limited. The thesis reviews existing evidence on fall prevention interventions, including telehealth-delivered exercise programs. It explores an Intervention Component Analysis to understand the components contributing to the success of fall prevention interventions in residential aged care. The research explores the co-design process of a telephysiotherapy program, emphasising stakeholder collaboration to tailor interventions to users' needs. The TOP UP trial, a randomised controlled trial of telephysiotherapy, aims to improve mobility, reduce falls, and enhance quality of life among older adults in aged care. Findings indicate high feasibility and acceptance of telephysiotherapy, suggesting its potential for widespread adoption. Qualitative insights highlight the positive impact of tailored physiotherapy and local support on exercise motivation and independence among aged care recipients. Sustained organisational commitment, training, and external funding are crucial for the successful implementation of telephysiotherapy programs in aged care settings. If the TOP UP trial proves effective, the implementation findings of this thesis will provide valuable insights for policymakers, healthcare providers, and aged care services, aiming to enhance healthcare accessibility and improve the quality of life for older individuals. Future research should focus on large-scale studies to further explore telephysiotherapy's effectiveness and scalability in diverse aged care populations

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Denying bogus skepticism in climate change and tourism research

This final response to the two climate change denial papers by Shani and Arad further highlights the inaccuracies, misinformation and errors in their commentaries. The obfuscation of scientific research and the consensus on anthropogenic climate change may have significant long-term negative consequences for better understanding the implications of climate change and climate policy for tourism and create confusion and delay in developing and implementing tourism sector responses

The development and stability of porosity formed during the pyrolysis of polyborodiphenylsiloxane

The pyrolysis of polyborodiphenylsiloxane has been studied at temperatures up to 1600 °C under an inert atmosphere. Above 1200 °C both a nano-scale β-SiC and an amorphous phase developed while at temperatures greater than 1400 °C significant mesoporosity started to appear, with surface areas and pore volumes reaching maximum values at around 1500 °C. The porosity decreased at higher pyrolysis temperatures and disappeared completely when the material was subsequently heated in an oxidising atmosphere at temperatures above 400 °C. The mesoporosity seems to be present in carbon rich areas which appeared when SiC started to crystallise. EELS showed that boron was present at all pyrolysis temperatures. Comparisons are made with the pyrolysis of polycarbosilan

High temperature ceramics for use in membrane reactors: the development of microporosity during the pyrolysis of polycarbosilanes

The pyrolysis of polycarbosilane (PCS), a ceramic precursor polymer, at temperatures up to 700 uC under an inert atmosphere results in the development of amorphous microporous materials which have a number of potential applications, such as gas separation membranes. This paper investigates the development of microporosity during pyrolysis under nitrogen, at temperatures ranging from 300 to 700 uC, of both the cross-linked and noncross- linked starting materials. The products are characterised by nitrogen adsorption, to determine surface areas and pore volumes, solid-state NMR, electron microscopy and FTIR, and their formation is studied using thermal analysis and evolved gas analysis with on-line mass spectrometry. The cross-linked and non-crosslinked PCSs have a maximum micropore volume of 0.2 cm3 g21 at pyrolysis temperatures of between 550 and 600 uC. The microporosity is stable in air at room temperature, but is lost in oxidising atmospheres at elevated temperatures

Interventions for preventing falls in older people in care facilities

Protocol for the update and new iteration of Cochrane Collaboration review "Interventions for preventing falls in older people in care facilities and hospitals." in the care facility setting only

Physiotherapy-led telehealth and exercise intervention to improve mobility in older people receiving aged care services (TOP UP): protocol for a randomised controlled type 1 hybrid effectiveness-implementation trial

Introduction Deteriorating mobility and falls reduce independence and quality of life for older people receiving aged care services. This trial aims to establish effectiveness on the mobility of older people, and explore cost-effectiveness and implementation of a telehealth physiotherapy programme.Method and analysis This type 1 hybrid effectiveness-implementation randomised controlled trial will involve 240 people aged 65+ years receiving aged care services in community or residential settings. Participants will be randomised to either: (1) the Telehealth Physiotherapy for Older People (TOP UP) Program or (2) a wait-list control group. The 6-month intervention includes 10 physiotherapy sessions delivered by videocall (Zoom). The intervention will include the local support of an aged care worker and online exercise resources. Primary outcome is mobility at 6 months post randomisation measured by the Short Physical Performance Battery. Secondary outcomes include rate of falls, sit-to-stand, quality of life, and goal attainment at 6 months after randomisation. Regression models will assess the effect of group allocation on mobility and the other continuously scored secondary outcomes, adjusting for baseline scores. The number of falls per person over 6 months will be analysed using negative binomial regression models to estimate between-group differences. An economic analysis will explore the cost-effectiveness of the TOP UP programme compared with usual care. Implementation outcomes and determinants relating to the intervention’s reach, fidelity, exercise dose delivered, adoption, feasibility, acceptability, barriers and facilitators will be explored using mixed methods.Conclusion This is the first trial to investigate the effectiveness, cost-effectiveness and implementation of a physiotherapy intervention in aged care delivered solely by telehealth internationally. The study has strong aged care co-design and governance and is guided by steering and advisory committees that include staff from aged care service providers and end-users. Trial results will be disseminated via peer-reviewed articles, conference presentations and lay summaries.Trial registration number The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12621000734864)