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Aboriginal and Torres Strait Islander children are custodians of the world's oldest living cultures yet experience systemic inequities that infringe upon their rights to health, education, safety, and cultural identity due to ongoing colonisation. Despite these persistent disparities, few studies have explored wellbeing from Aboriginal and Torres Strait Islander children's own perspectives and lived experiences. This study addresses this gap by privileging children's voices in a large-scale, culturally grounded qualitative investigation. This study represents the first phase of the What Matters 2Kids (WM2K) project, which aims to develop a culturally relevant wellbeing measure for Aboriginal and Torres Strait Islander children aged 5-11 years. Using an Indigenist methodology and culturally responsive Art and Yarning method, 219 Aboriginal and Torres Strait Islander children across 15 sites in urban, regional, and remote Australia participated in creative sessions to express what supports their wellbeing. Data was analysed using Reflexive Thematic Analysis and a Collaborative Yarning approach. Culture emerged as a foundational element underpinning and connecting all aspects of Aboriginal and Torres Strait Islander children's wellbeing. Within this cultural foundation, seven interconnected themes were identified: and . A culturally resonant visual analogy, the \"Wellbeing Stones\", was developed to conceptualise these findings. This study provides critical insights into the holistic, relational, and culturally embedded nature of wellbeing for Aboriginal and Torres Strait Islander children, offering essential groundwork for developing culturally appropriate measurement tools and interventions with important implications for research, policy, and service provision.

Diaryldithiocarbamate complexes, [Fe(S2CNAr2)3], have been prepared and their structure, reactivity, and thermal degradation to afford iron sulfide nanomaterials have been investigated. The addition of three equivalents of LiS2CNAr2 to FeCl2·4H2O in water-air affords dark red [Fe(S2CNAr2)3] in high yields. All show magnetic measurements consistent with a predominantly high-spin electronic arrangement at room temperature. The molecular structure of [FeS2C(N-p-MeOC6H4)23] reveals the expected distorted octahedral geometry, but Fe-S distances are more consistent with a low-spin electronic configuration, likely a result of the low temperature (120 K) of the data collection. The thermal stability of [FeS2C(N-p-MeC6H4)23] has been investigated. TGA shows that it begins to decompose at a significantly lower temperature (ca. 160 °C) than previously observed for [Fe(S2CNEt2)3], and this is further lowered (to ca. 100 °C) in oleylamine. The decomposition of [FeS2C(N-p-MeC6H4)23] in oleylamine, via either a heat-up or hot injection process, affords nanoparticles of Fe3S4 (greigite), while in contrast, dry heating at 450 °C affords FeS (troilite) as large agglomerates.

IntroductionDuring critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically ventilated patients.MethodsThis was a randomised, assessor-blinded, split-mouth trial, performed at a single critical care unit. Adult, orally intubated patients with >20 teeth, where >24 hours of mechanical ventilation was expected were included. Teeth were cleaned 12-hourly using a foam swab or toothbrush (each randomly assigned to one side of the mouth). Cleaning efficacy was based on plaque scores, gingival index and microbial plaque counts.ResultsHigh initial plaque (mean=2.1 (SD 0.45)) and gingival (mean=2.0 (SD 0.54)) scores were recorded for 21 patients. A significant reduction compared with initial plaque index occurred using both toothbrushes (mean change=−1.26, 95% CI −1.57 to −0.95; p<0.001) and foam swabs (mean change=−1.28, 95% CI −1.54 to −1.01; p<0.001). There was significant reduction in gingival index over time using toothbrushes (mean change=−0.92; 95% CI −1.19 to −0.64; p<0.001) and foam swabs (mean change=−0.85; 95% CI −1.10 to −0.61; p<0.001). Differences between cleaning methods were not statistically significant (p=0.12 for change in gingival index; p=0.24 for change in plaque index). There was no significant change in bacterial dental plaque counts between toothbrushing (mean change 3.7×104 colony-forming units (CFUs); minimum to maximum (−2.5×1010 CFUs, 8.7×107 CFUs)) and foam swabs (mean change 9×104 CFUs; minimum to maximum (−3.1×1010 CFUs, 3.0×107 CFUs)).ConclusionsPatients admitted to adult intensive care had poor oral health, which improved after brushing with a toothbrush or foam swab. Both interventions were equally effective at removing plaque and reducing gingival inflammation.Trial registration numberNCT01154257; Pre-results.

This trial randomly assigned patients with coma after out-of-hospital cardiac arrest to undergo targeted hypothermia at 33°C or normothermia with treatment of fever. At 6 months, there were no significant between-group differences regarding death or functional outcomes.

In a trial involving patients with coma after out-of-hospital cardiac arrest, a strategy targeting mild hypercapnia for 24 hours did not improve neurologic outcomes at 6 months as compared with targeted normocapnia.

PurposeTo evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification.MethodsOur primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24 h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification.ResultsOf 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01–1.13), P = 0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both resolved and confirmed ARDS, age, non-respiratory SOFA score, lower PEEP and P/F ratio, higher peak pressure and respiratory rate were each associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal.ConclusionsARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population.Trial RegistrationClinicalTrials.gov NCT02010073.

Background To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments (‘treatment limitations’), and the subpopulations with treatment limitations. Results 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration : ClinicalTrials.gov NCT02010073 .

IntroductionAfter resuscitation from out of hospital cardiac arrest (OHCA), mechanical ventilation (MV) and respiratory management are fundamental to support patients in the intensive care unit (ICU) and to minimise secondary brain injury. Best practices for MV and association with clinical outcomes in patients with OHCA remain unclear.Methods and analysisThis protocol describes a pre-planned respiratory-focused series of sub-analyses within the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) trial, an ongoing interventional study evaluating 6-month mortality after randomisation in patients admitted to ICUs following OHCA. The primary aim is to describe real-world ventilator settings and gas-exchange targets during the first 72 hours after ICU admission in patients receiving invasive mechanical ventilation after OHCA. Secondary aims include to estimate the incidence of respiratory complications during ICU stay (eg, ventilator-associated pneumonia, acute respiratory distress syndrome, barotrauma); and to explore the association between early ventilator settings/gas-exchange parameters and 6-month outcomes (mortality and neurological status). Exploratory aim is to characterise weaning and extubation practices, including timing and failure rates.Eligible patients will include adult STEPCARE participants receiving invasive MV after return of spontaneous circulation with available respiratory data recorded within the STEPCARE database.Data collected in the STEPCARE trial that will be analysed include patients’ prehospital characteristics; clinical examination at hospital admission and at ICU admission; ventilator settings and arterial blood gases recorded at predefined time points during ICU stay. In particular: MV setting (mode, tidal volume, positive end-expiratory pressure, fraction of inspired oxygen, tidal volume, mechanical power, plateau/driving pressures), gas-exchange values (arterial partial pressure of oxygen and carbon dioxide, pH, arterial saturation of oxygen), timing of measurements and the occurrence/timing of respiratory complications and weaning outcomes.Ethics and disseminationThe STEPCARE study has been approved by the regional ethics committee at Lund University (Dnr 2022-02425-01, Approved IRB on 2022-06-18) and by all ethics boards in the participating countries. No additional ethical approval is required for this predefined secondary analysis, as no further data collection or interventions will be performed. Findings will be disseminated through publication in peer-reviewed journals and, where appropriate, conference abstracts and presentations. Patients and the public were not involved.ClinicalTrials.govNCT05564754.

Diaryldithiocarbamate complexes, [Fe(S[sub.2]CNAr[sub.2])[sub.3]], have been prepared and their structure, reactivity, and thermal degradation to afford iron sulfide nanomaterials have been investigated. The addition of three equivalents of LiS[sub.2]CNAr[sub.2] to FeCl[sub.2]·4H[sub.2]O in water-air affords dark red [Fe(S[sub.2]CNAr[sub.2])[sub.3]] in high yields. All show magnetic measurements consistent with a predominantly high-spin electronic arrangement at room temperature. The molecular structure of [FeS[sub.2]C(N-p-MeOC[sub.6]H[sub.4])[sub.2][sub.3]] reveals the expected distorted octahedral geometry, but Fe-S distances are more consistent with a low-spin electronic configuration, likely a result of the low temperature (120 K) of the data collection. The thermal stability of [FeS[sub.2]C(N-p-MeC[sub.6]H[sub.4])[sub.2][sub.3]] has been investigated. TGA shows that it begins to decompose at a significantly lower temperature (ca. 160 °C) than previously observed for [Fe(S[sub.2]CNEt[sub.2])[sub.3]], and this is further lowered (to ca. 100 °C) in oleylamine. The decomposition of [FeS[sub.2]C(N-p-MeC[sub.6]H[sub.4])[sub.2][sub.3]] in oleylamine, via either a heat-up or hot injection process, affords nanoparticles of Fe[sub.3]S[sub.4] (greigite), while in contrast, dry heating at 450 °C affords FeS (troilite) as large agglomerates.