Integrated AlphaFold2 and DEER investigation of the conformational dynamics of a pH-dependent APC antiporter.

The Amino Acid-Polyamine-Organocation (APC) transporter GadC contributes to the survival of pathogenic bacteria under extreme acid stress by exchanging extracellular glutamate for intracellular γ-aminobutyric acid (GABA). Its structure, determined in an inward-facing conformation at alkaline pH, consists of the canonical LeuT-fold with a conserved five-helix inverted repeat, thereby resembling functionally divergent transporters such as the serotonin transporter SERT and the glucose-sodium symporter SGLT1. However, despite this structural similarity, it is unclear if the conformational dynamics of antiporters such as GadC follow the blueprint of these or other LeuT-fold transporters. Here, we used double electron-electron resonance (DEER) spectroscopy to monitor the conformational dynamics of GadC in lipid bilayers in response to acidification and substrate binding. To guide experimental design and facilitate the interpretation of the DEER data, we generated an ensemble of structural models in multiple conformations using a recently introduced modification of AlphaFold2 . Our experimental results reveal acid-induced conformational changes that dislodge the Cterminus from the permeation pathway coupled with rearrangement of helices that enables isomerization between inward- and outward-facing states. The substrate glutamate, but not GABA, modulates the dynamics of an extracellular thin gate without shifting the equilibrium between inward- and outward-facing conformations. In addition to introducing an integrated methodology for probing transporter conformational dynamics, the congruence of the DEER data with patterns of structural rearrangements deduced from ensembles of AlphaFold2 models illuminates the conformational cycle of GadC underpinning transport and exposes yet another example of the divergence between the dynamics of different families in the LeuT-fold.

Tunable Release of Ions from Graphene Oxide Laminates for Sustained Antibacterial Activity in a Biomimetic Environment.

Silver has long been recognized for its potent antimicrobial properties, but achieving a slow and longer-term delivery of silver ions presents significant challenges. Previous efforts to control silver ion dosages have struggled to sustain release for extended periods in biomimetic environments, especially in the presence of complex proteins. This challenge is underscored by the absence of technology for sustaining antimicrobial activity, especially in the context of orthopedic implants where long-term efficacy, extending beyond 7 days, is essential. In this study, the tunable, slow, and longer-term release of silver ions from the two-dimensional (2D) nanocapillaries of graphene oxide (GO) laminates incorporated with silver ions (Ag-GO) for antimicrobial applications are successfully demonstrated. To closely mimic a physiologically relevant serum-based environment, a novel in vitro study model using 100% fetal bovine serum (FBS) is introduced as the test medium for microbiology, biocompatibility, and bioactivity studies. To emulate fluid circulation in a physiological environment, the in vitro studies are challenged with serum exchange protocols on different days. The findings show that the Ag-GO coating can sustainably release silver ions at a minimum dosage of 10 µg cm-2 day-1, providing an effective and sustained antimicrobial barrier for over ten days.

Generative adversarial networks for modelling clinical biomarker profiles with race/ethnicity.

AIMS: Modelling biomarker profiles for under-represented race/ethnicity groups are challenging because the underlying studies frequently do not have sufficient participants from these groups. The aim was to investigate generative adversarial networks (GANs), an artificial intelligence technology that enables realistic simulations of complex patterns, for modelling clinical biomarker profiles of under-represented groups. METHODS: GANs consist of generator and discriminator neural networks that operate in tandem. GAN architectures were developed for modelling univariate and joint distributions of a panel of 16 diabetes-relevant biomarkers from the National Health and Nutrition Examination Survey, which contains laboratory and clinical biomarker data from a population-based sample of individuals of all ages, racial groups and ethnicities. Conditional GANs were used to model biomarker profiles for race/ethnicity categories. GAN performance was assessed by comparing GAN outputs to test data. RESULTS: The biomarkers exhibited non-normal distributions and varied in their bivariate correlation patterns. Univariate distributions were modelled with generator and discriminator neural networks consisting of 2 dense layers with rectified linear unit-activation. The distributions of GAN-generated biomarkers were similar to the test data distributions. The joint distributions of the biomarker panel in the GAN-generated data were dispersed and overlapped with the joint distribution of the test data as assessed by 3 multidimensional projection methods. Conditional GANs satisfactorily modelled the joint distribution of the biomarker panel in the Black, Hispanic, White and Other race/ethnicity categories. CONCLUSION: GAN is a promising artificial intelligence approach for generating virtual patient data with realistic biomarker distributions for under-represented race/ethnicity groups.

Generative models for age, race/ethnicity, and disease state dependence of physiological determinants of drug dosing.

Dosing requires consideration of diverse patient-specific factors affecting drug pharmacokinetics and pharmacodynamics. The available pharmacometric methods have limited capacity for modeling the inter-relationships and patterns of variability among physiological determinants of drug dosing (PDODD). To investigate whether generative adversarial networks (GANs) can learn a generative model from real-world data that recapitulates PDODD distributions. A GAN architecture was developed for modeling a PDODD panel comprised of: age, sex, race/ethnicity, body weight, body surface area, total body fat, lean body weight, albumin concentration, glomerular filtration rate (EGFR), urine flow rate, urinary albumin-to-creatinine ratio, alanine aminotransferase to alkaline phosphatase R-value, total bilirubin, active hepatitis B infection status, active hepatitis C infection status, red blood cell, white blood cell, and platelet counts. The panel variables were derived from National Health and Nutrition Examination Survey (NHANES) data sets. The dependence of GAN-generated PDODD on age, race, and active hepatitis infections was assessed. The continuous PDODD biomarkers had diverse non-normal univariate distributions and bivariate trend patterns. The univariate distributions of PDODD biomarkers from GAN simulations satisfactorily approximated those in test data. The joint distribution of the continuous variables was visualized using three 2-dimensional projection methods; for all three methods, the points from the GAN simulation random variate vectors were well dispersed amongst the test data. The age dependence trend patterns in GAN data were similar to those in test data. The histograms for R-values and EGFR from GAN simulations overlapped extensively with test data histograms for the Hispanic, White, African American, and Other race/ethnicity groups. The GAN-simulated data also mirrored the R-values and EGFR changes in active hepatitis C and hepatitis B infection. GANs are a promising approach for simulating the age, race/ethnicity and disease state dependencies of PDODD.

Alternating Superconducting and Charge Density Wave Monolayers within Bulk 6R-TaS2.

Van der Waals (vdW) heterostructures continue to attract intense interest as a route of designing materials with novel properties that cannot be found in nature. Unfortunately, this approach is currently limited to only a few layers that can be stacked on top of each other. Here, we report a bulk vdW material consisting of superconducting 1H TaS2 monolayers interlayered with 1T TaS2 monolayers displaying charge density waves (CDW). This bulk vdW heterostructure is created by phase transition of 1T-TaS2 to 6R at 800 °C in an inert atmosphere. Its superconducting transition (Tc) is found at 2.6 K, exceeding the Tc of the bulk 2H phase. Using first-principles calculations, we argue that the coexistence of superconductivity and CDW within 6R-TaS2 stems from amalgamation of the properties of adjacent 1H and 1T monolayers, where the former dominates the superconducting state and the latter the CDW behavior.

Ion exchange in atomically thin clays and micas.

The physical properties of clays and micas can be controlled by exchanging ions in the crystal lattice. Atomically thin materials can have superior properties in a range of membrane applications, yet the ion-exchange process itself remains largely unexplored in few-layer crystals. Here we use atomic-resolution scanning transmission electron microscopy to study the dynamics of ion exchange and reveal individual ion binding sites in atomically thin and artificially restacked clays and micas. We find that the ion diffusion coefficient for the interlayer space of atomically thin samples is up to 104 times larger than in bulk crystals and approaches its value in free water. Samples where no bulk exchange is expected display fast exchange at restacked interfaces, where the exchanged ions arrange in islands with dimensions controlled by the moiré superlattice dimensions. We attribute the fast ion diffusion to enhanced interlayer expandability resulting from weaker interlayer binding forces in both atomically thin and restacked materials. This work provides atomic scale insights into ion diffusion in highly confined spaces and suggests strategies to design exfoliated clay membranes with enhanced performance.

Nanoconfinement effects on water in narrow graphene-based slit pores as revealed by THz spectroscopy.

The properties of water at interfaces have long been known to differ from those of bulk water in many distinctive ways. More recently, specific confinement effects different from mere interfacial effects have been discovered upon enclosing water in very narrow cylindrical pores and planar surfaces as offered by nanotubes and slit pores, respectively. Using experimental and theoretical THz spectroscopy, we elucidate nanoconfinement effects on the H-bond network of stratified water lamellae that are hosted within graphene-based two-dimensional pores. Characteristic confinement-induced changes of the THz response are traced back to the level of structural dynamics, notably distinct resonances due to intralayer and interlayer H-bonds at correspondingly low and high intermolecular stretching frequencies and impact of dangling (free) OH bonds at the water-graphene interface that enormously broaden the librational band in sufficiently narrow pores. The interplay of these molecular effects causes characteristic changes of the THz lineshape upon nanoconfining water.

Single Isomer Heterometallic {CrIII6MII2} Rings Templated by Tetramethylammonium.

A family of heterometallic rings [Me4N]2[CrIII6MII2F8(O2CtBu)16] is reported using tetramethylammonium hydroxide pentahydrate as the source of a template, where M = Zn, Mn, Ni, and Co. The metal cores are octagons with metal-metal edges bridged by one fluoride and two carboxylate ligands. The divalent metal ions are found ordered at positions 1 and 5 in the octagon. The tetramethylammonium cations are above and below the metal plane of the ring in the crystal structure. Magnetic studies show antiferromagnetic coupling between the paramagnetic metal ions present, leading to paramagnetic ground states in each case. 1H NMR spectroscopy confirms that the structure of the {CrIII6CoII2} ring exists in solution, and electron paramagnetic resonance spectroscopy confirms the magnetic structure of the other three rings.

Ultra-thin structures of manganese fluorides: conversion from manganese dichalcogenides by fluorination.

In this study, it is predicted by density functional theory calculations that graphene-like novel ultra-thin phases of manganese fluoride crystals, that have nonlayered structures in their bulk form, can be stabilized by fluorination of manganese dichalcogenide crystals. First, it is shown that substitution of fluorine atoms with chalcogens in the manganese dichalcogenide host lattice is favorable. Among possible crystal formations, three stable ultra-thin structures of manganese fluoride, 1H-MnF2, 1T-MnF2 and MnF3, are found to be stable by total energy optimization calculations. In addition, phonon calculations and Raman activity analysis reveal that predicted novel single-layers are dynamically stable crystal structures displaying distinctive characteristic peaks in their vibrational spectrum enabling experimental determination of the corresponding phases. Differing from 1H-MnF2 antiferromagnetic (AFM) large gap semiconductor, 1T-MnF2 and MnF3 single-layers are semiconductors with ferromagnetic (FM) ground state.

Economic evaluations in the treatment and evaluation of patients with periodontal disease: A critical review.

AIM: To evaluate the types and quality of reporting of economic evaluations carried out in the clinical management of periodontal disease over 32 years from 1987 to 2019. MATERIAL AND METHODS: A systematic search of articles from 1987 to 2019 was conducted using PubMed, Web of Science, The Cochrane Central Register of Controlled Trials, Health Technology Assessment Database and Embase. The quality of the economic evaluations was assessed based on the Consolidated Health Economic Evaluation Reporting Standard checklist. Due to considerable between-study heterogeneity, a meta-analysis was not performed. RESULTS: Twenty one publications were included. 11 studies used cost-effectiveness analysis, five used cost-minimization analysis, four used cost-utility analysis and two used cost-benefit analysis. Comparators, choice of health outcomes, estimating resources and costs were fully reported in all studies. Many studies had inadequate reporting in terms of estimating resources and costs, choice of health outcomes, characterizing heterogeneity and study perspective. CONCLUSIONS: There has been an increase in health economics studies in the field of clinical periodontology over the past decade. Several studies did not report study perspective, and the health outcomes chosen were not relevant for some studies. Future studies should follow an economic evaluation checklist for high-quality reporting and consistency.

Modern Carbon-Based Materials for Adsorptive Removal of Organic and Inorganic Pollutants from Water and Wastewater.

Currently, a serious threat for living organisms and human life in particular, is water contamination with persistent organic and inorganic pollutants. To date, several techniques have been adopted to remove/treat organics and toxic contaminants. Adsorption is one of the most effective and economical methods for this purpose. Generally, porous materials are considered as appropriate adsorbents for water purification. Conventional adsorbents such as activated carbons have a limited possibility of surface modification (texture and functionality), and their adsorption capacity is difficult to control. Therefore, despite the significant progress achieved in the development of the systems for water remediation, there is still a need for novel adsorptive materials with tunable functional characteristics. This review addresses the new trends in the development of new adsorbent materials. Herein, modern carbon-based materials, such as graphene, oxidized carbon, carbon nanotubes, biomass-derived carbonaceous matrices-biochars as well as their composites with metal-organic frameworks (MOFs) and MOF-derived highly-ordered carbons are considered as advanced adsorbents for removal of hazardous organics from drinking water, process water, and leachate. The review is focused on the preparation and modification of these next-generation carbon-based adsorbents and analysis of their adsorption performance including possible adsorption mechanisms. Simultaneously, some weak points of modern carbon-based adsorbents are analyzed as well as the routes to conquer them. For instance, for removal of large quantities of pollutants, the combination of adsorption and other methods, like sedimentation may be recommended. A number of efficient strategies for further enhancing the adsorption performance of the carbon-based adsorbents, in particular, integrating approaches and further rational functionalization, including composing these adsorbents (of two or even three types) can be recommended. The cost reduction and efficient regeneration must also be in the focus of future research endeavors. The targeted optimization of the discussed carbon-based adsorbents associated with detailed studies of the adsorption process, especially, for multicomponent adsorbate solution, will pave a bright avenue for efficient water remediation.

Temporomandibular dysfunction experience is associated with oral health-related quality of life: an Australian national study.

BACKGROUND: There are very few studies of the association between temporomandibular dysfunction (TMD) and oral health-related quality of life (OHRQoL) in a representative sample from the Asia-Pacific region. Accordingly, we aimed to quantify the association of TMD with OHRQoL dimensions and overall measurement scores in a representative sample of Australian adults while accounting for a range of confounders, and statistically estimating whether TMD experience is meaningfully associated with OHRQoL. METHOD: Australia's National Survey of Adult Oral Health 2004-2006 data were used. The outcome variables were the Oral Health Impact Profile (OHIP-14) domains and overall scores while the main exposure was self-reported Diagnostic Criteria Question for TMD. The analysis accounted for confounders including oral health status obtained from the oral examination, demographics, socioeconomics, health behaviours and health including perceived stress subscales of the PSS-14. We conducted complex samples analysis while using Cohen's f2 effect size to estimate whether the association is meaningful. RESULTS: TMD prevalence was 9.9% (95% CI: 8.4-11.6%) among 4133 Australian adults. TMD experience was associated with impairments to the seven OHIP-14 OHRQoL domains (P < .05) with higher impairments observed in physical pain (B = 0.82, 95% CI: .45-1.20, P < .001), psychological discomfort (B = 0.68, 95% CI: .29-1.06, P = .001) and psychological disability (B = 0.52, 95% CI: .20-.84, P = .001) in adjusted multivariate analyses. The difference in the mean OHIP-14 scores for those reporting TMD (Mean = 13.1, 95% CI: 12.0-14.0) and those who did not (Mean = 6.6, 95% CI: 6.0-6.8) was significant (t = 7.51, P < .001). In an adjusted multivariable model for OHIP-14 scores, TMD experience was associated with higher OHIP-14 scores (B = 3.34, 95% CI: 1.94-4.75, P < .001) where the Cohen's f2 was .022. Further, perceived stress subscales: perceived distress and perceived control were associated with TMD experience and OHIP-14 scores (P < .05). CONCLUSION: Lower OHRQoL was observed in Australian adults who reported TMD experience but with small clinical importance which might support considering TMD in regular dental care. The higher impairments observed in physical pain, psychological discomfort and psychological disability domains of OHRQL can help clinicians and researchers focus their attention on these domains. The confounding effect exhibited by the perceived stress subscale might support their inclusion in future TMD and OHRQoL research.

Frailty, Acute Organ Dysfunction, and Increased Disability After Hospitalization in Older Adults Who Survive Critical Illness: A Prospective Cohort Study.

PURPOSE: We aimed to describe the association between prehospital frailty (PHF), acute organ dysfunction (AOD), and posthospital disability (PHD) outcome in older adults admitted to the intensive care unit (ICU). METHODS: In a prospective observational cohort study, we assessed PHF using the Clinical Frailty Scale (CFS) and assessed the level of AOD using Sequential Organ Failure Assessment (SOFA) scores on ICU day 1. We assessed Activities of Daily Living disability levels through to 6 months after discharge and used generalized estimating equations (log link and negative binomial family) to determine the independent association of PHF and AOD with PHD. RESULTS: Of the 302 patients enrolled, 221 (73.1%) survived the hospitalization. Prehospital frailty was associated with PHD (adjusted incident rate ratio [aIRR] 95% confidence interval [95% CI] per unit increase in CFS 1.38 [1.15-1.67], P = .001). Total day 1 SOFA score was weakly associated with PHD, (aIRR [95% CI] 1.05 [1.00-1.10], P = .037) while day 1 SOFA neurologic score was strongly associated with PHD (aIRR [95% CI] 1.42 [1.24-1.62] per unit increase in SOFA neurologic score, P < .001), and these effects were independent of PHF and other premorbid factors. CONCLUSIONS: Both PHF and early acute brain dysfunction are important factors associated with increasing PHD in older adults who survive critical illness.

Depression symptoms and recurrent aphthous stomatitis-Evidence from a population-based study in Indonesia.

OBJECTIVES: This study aims to report the prevalence and distribution of recurrent aphthous stomatitis (RAS) among Indonesian adults and to test the relationship between symptom of depression and RAS. METHODS: Data from the 2007 Indonesia Family Life Survey (IFLS 2007) were analysed to assess the association between symptom of depression and RAS. The prevalence of RAS in the previous month was self-reported. Symptom of depression was measured using the 10-item Center for Epidemiologic Studies Depression (CES-D) scale. The distribution of RAS according to age, sex and level of stress was also presented in the bivariate analysis. Multivariable logistic regression models were fitted to test associations between symptom of depression and RAS, controlling for age, sex and the stress level. RESULTS: The previous month prevalence of RAS in Indonesian population was 12%. The adjusted odds ratios (ORs) from the logistic regression models indicate that, for each unit increase in the CES-D depression score (range: 0-30), there was a 9% increase in the odds of having RAS (OR: 1.09, 95%CI: 1.08-1.10). Being older and being male was related with lower prevalence of RAS. CONCLUSIONS: A higher score of depression was related to a higher prevalence of RAS. This association was persistent even after controlling for age, sex and the level of stress.

Self-Limiting Growth of Two-Dimensional Palladium between Graphene Oxide Layers.

The ability of different materials to display self-limiting growth has recently attracted an enormous amount of attention because of the importance of nanoscale materials in applications for catalysis, energy conversion, (opto)electronics, and so forth. Here, we show that the electrochemical deposition of palladium (Pd) between graphene oxide (GO) sheets result in the self-limiting growth of 5-nm-thick Pd nanosheets. The self-limiting growth is found to be a consequence of the strong interaction of Pd with the confining GO sheets, which results in the bulk growth of Pd being energetically unfavorable for larger thicknesses. Furthermore, we have successfully carried out liquid exfoliation of the resulting Pd-GO laminates to isolate Pd nanosheets and have demonstrated their high efficiency in continuous flow catalysis and electrocatalysis.

Two-Dimensional Covalent Crystals by Chemical Conversion of Thin van der Waals Materials.

Most of the studied two-dimensional (2D) materials have been obtained by exfoliation of van der Waals crystals. Recently, there has been growing interest in fabricating synthetic 2D crystals which have no layered bulk analogues. These efforts have been focused mainly on the surface growth of molecules in high vacuum. Here, we report an approach to making 2D crystals of covalent solids by chemical conversion of van der Waals layers. As an example, we used 2D indium selenide (InSe) obtained by exfoliation and converted it by direct fluorination into indium fluoride (InF3), which has a nonlayered, rhombohedral structure and therefore cannot  possibly be obtained by exfoliation. The conversion of InSe into InF3 is found to be feasible for thicknesses down to three layers of InSe, and the obtained stable InF3 layers are doped with selenium. We study this new 2D material by optical, electron transport, and Raman measurements and show that it is a semiconductor with a direct bandgap of 2.2 eV, exhibiting high optical transparency across the visible and infrared spectral ranges. We also demonstrate the scalability of our approach by chemical conversion of large-area, thin InSe laminates obtained by liquid exfoliation, into InF3 films. The concept of chemical conversion of cleavable thin van der Waals crystals into covalently bonded noncleavable ones opens exciting prospects for synthesizing a wide variety of novel atomically thin covalent crystals.

Factors influencing the inclusion of oral health education in individualized education plans of children with autism spectrum disorders in Singapore.

BACKGROUND: Prevention of oral diseases in children with autism spectrum disorder (ASD) is possible via incorporation of oral health education (OHE) into individualized education plans. OBJECTIVES: To assess (i) whether training can improve teachers' oral heath knowledge, (ii) whether OHE is taught to children with ASD, and (iii) factors associated with teachers' perceived barriers to the implementation of OHE. DESIGN: Teachers working in special schools were recruited. Two pre-tested questionnaires were administered, before and after a training session. The effectiveness of the intervention was evaluated. Teachers were also surveyed on their teaching of caries prevention and perceived barriers of teaching OHE. RESULTS: There was a significant increase in knowledge scores post-intervention (P < 0.001). Teachers were more likely to incorporate OHE into their teaching if trained by dental professionals (P = 0.022) and provided teaching materials (P = 0.001). Teachers' level of baseline OHE knowledge was a predictor and significantly negatively associated with levels of perceived overall and personal barriers (both P < 0.001). CONCLUSION: OHE is included in the curriculum of the schools surveyed, but this is very limited. The training programme increased teachers' oral health knowledge competence scores. Levels of knowledge, lack of training, and teaching materials are barriers to incorporating OHE in their teaching curriculum.

Interim therapeutic restoration approach versus treatment under general anaesthesia approach.

BACKGROUND: Although dental treatment under general anaesthesia (GA) remains the long-established approach for treating anxious children, treatment under GA presents with increased risks, costs and parental acceptability issues. Interim therapeutic restoration (ITR) has been proposed as an alternative approach. AIM: To compare the incidence and types of failures between children managed with the ITR approach and those managed under GA within 12 months of treatment completion. DESIGN: A retrospective cohort study of children who received dental treatment utilizing the ITR approach was compared to children treated under GA. Age, gender and dental disease matching was done. Statistical analyses were carried out with Independent t-test and chi-square analyses. RESULTS: A total of 132 children (GA = 66, ITR = 66) were included, and the groups did not differ in terms of initial age, sex, dmft and initial behaviour score. ITR group had a significantly higher rate (P < 0.001; 95% CI: [0.21 to 0.97]) of restorative failure and visits required when compared to the GA group. There were no difference for incidence of pain (P = 0.55; 95% CI: [-0.074 to 0.10]) and behaviour scores (P = 0.46) between the two groups at the 12-month visit. CONCLUSIONS: ITR approach may be a viable alternative to the GA approach when treating paediatric dental patients.

Correlates of attitudes and perceived behavioural control towards oral care provision among trained and untrained nursing home caregivers in Singapore.

AIMS AND OBJECTIVES: To investigate the perspectives of nursing home caregivers towards oral care and the determinants of their attitudes and perceived behavioural control. BACKGROUND: There are few studies analysing nursing home caregivers' perspectives on the provision of oral care and factors correlated with these perspectives. DESIGN: Cross-sectional study. METHODS: Interviewer-administered survey questionnaires were completed by caregivers from five nursing homes in Singapore (n = 94). The rating-scale questionnaire items explored caregivers' attitudes, subjective norms and perceived behavioural control, as guided by the theory of planned behaviour. Demographic characteristics, oral care training received, years of work experience, oral hygiene behaviour and dental visit frequency of the caregivers, as well as organisational characteristics such as a requirement for oral care and the number of patients under their care, were obtained. RESULTS: Caregivers had very positive attitudes towards the provision of oral care. Half of the caregivers lacked confidence in providing oral care without harming the patients and this was not different by oral care training received. Multivariable linear regression analysis found that receiving oral care training and having a requirement by the nursing home to provide oral care were related to higher attitude scores but not perceived behaviour control. Having more residents under their care and on-the-job caregiver training were associated with lower perceived behavioural control. CONCLUSIONS: This study found that nursing home caregivers had positive attitudes towards providing oral care, but more modest perspectives about their ability to perform that behaviour. RELEVANCE TO CLINICAL PRACTICE: These findings have useful implications for the oral care training of nursing home caregivers. While attitudes towards the importance of oral care may be positive among nursing home caregivers, our study suggests that future interventions should include practical skills training for oral care management and consider organisational strategies for encouraging oral care provision.