Improving Nursing Oral Care Practice for Community-Dwelling Care-Dependent Older People.

AIM: Oral care is one of the most neglected nursing practices owing to a lack of training, standard nursing oral care guidelines and low confidence and skills. There is little evidence to inform the development of oral care training and guidelines, which ideally should be done in collaboration with oral health professionals. Further, there is a lack of research, particularly in New Zealand, with nursing staff caring for care-dependent older people, including those ageing in their own homes. This pilot study aimed to determine the impact of oral care training on nursing staff knowledge, attitudes and confidence in supporting community-dwelling older peoples' oral care. METHOD: Mixed methods design comprising delivery of an oral healthcare and assessment training intervention by a team comprising nursing and oral health professionals, pre- and post-intervention questionnaires (N = 14) and a post-intervention focus group with community-based nursing staff (N = 5). RESULTS: Staff knowledge significantly improved (p = 0.046) following interprofessional collaborative training, but attitude and confidence scores did not (p = 0.127), although focus group responses suggested that participants' confidence was heightened. Participants expressed the need to implement oral care practices to benefit clients' health, clarify roles and identify oral care as a core competency. They sought to make individual- and organisational-level practice changes accordingly. CONCLUSION: Oral care training based on interprofessional collaboration and education enhances nursing staff knowledge but not their confidence in oral care provision. Ongoing, hands-on practical training for nursing staff in collaboration with oral health professionals has the potential to advance nursing oral-care practice and improve care-dependent older peoples' oral care. IMPLICATION FOR PRACTICE: Oral care training and education with oral health professionals is effective to enhance nursing staff knowledge and awareness in oral health care. However, transforming knowledge into nursing oral care practice requires hands on practical training and ongoing collaboration with oral health professionals to improve care-dependent older people's oral health care.

Optimising function and well-being in older adults: protocol for an integrated research programme in Aotearoa/New Zealand.

BACKGROUND: Maintaining independence is of key importance to older people. Ways to enable health strategies, strengthen and support whanau (family) at the community level are needed. The Ageing Well through Eating, Sleeping, Socialising and Mobility (AWESSOM) programme in Aotearoa/New Zealand (NZ) delivers five integrated studies across different ethnicities and ages to optimise well-being and to reverse the trajectory of functional decline and dependence associated with ageing. METHODS: Well-being, independence and the trajectory of dependence are constructs viewed differently according to ethnicity, age, and socio-cultural circumstance. For each AWESSoM study these constructs are defined and guide study development through collaboration with a wide range of stakeholders, and with reference to current evidence. The Compression of Functional Decline model (CFD) underpins aspects of the programme. Interventions vary to optimise engagement and include a co-developed whanau (family) centred initiative (Nga Pou o Rongo), the use of a novel LifeCurve™App to support behavioural change, development of health and social initiatives to support Pacific elders, and the use of a comprehensive oral health and cognitive stimulation programme for cohorts in aged residential care. Running parallel to these interventions is analysis of large data sets from primary care providers and national health databases to understand complex multi-morbidities and identify those at risk of adverse outcomes. Themes or target areas of sleep, physical activity, oral health, and social connectedness complement social capital and community integration in a balanced programme involving older people across the ability spectrum. DISCUSSION: AWESSoM delivers a programme of bespoke yet integrated studies. Outcomes and process analysis from this research will inform about novel approaches to implement relevant, socio-cultural interventions to optimise well-being and health, and to reverse the trajectory of decline experienced with age. TRIAL REGISTRATION: The At-risk cohort study was registered by the Australian New Zealand Clinical Trials registry on 08/12/2021 (Registration number ACTRN 12621001679875 ).

Third Molar Surgery Outcomes: A Randomized Clinical Trial Comparing Submucosal and Intravenous Dexamethasone.

OBJECTIVE: Swelling, pain, and trismus after third molar surgery have a negative impact on patients' quality-of-life in the days following surgery. The study aims to compare the efficacy of submucosal (SM) dexamethasone and intravenous (IV) dexamethasone in reducing these outcomes. METHODS: The single-center study was designed as a randomized, controlled, double-blinded trial with a total of 130 participants evenly allocated into 2 treatment groups. All participants underwent the surgical removal of at least 2 mandibular third molars under intravenous sedation. The outcome variables studied were swelling, pain, and maximum incisal distances. The swelling was measured using a 3-dimensional camera (3dMD Inc, Atlanta, GA). The pain was quantified using a 100 mm visual analog scale (VAS). Maximum incisal distances were measured using a caliper. Participants completed the short-form Oral Health Impact Profile (OHIP-14). The 2 groups were compared using cross-tabulations and chi-square tests for categorical variables and analysis of variance for continuous variables. RESULTS: The participants had a mean age of 22.6 years, 56.8% females and 12.4% smokers. There were no statistically significant differences in the distribution of study variables between the 2 groups. On day 2, mean facial swelling measurements were 7.3 cm3 in the IV group and 7.8 cm3 in the SM group (P > .05). The mean pain score was 31 in the IV group and 33 in the SM group (P > .05). The mean maximum incisal distances were 33.7 mm in the IV group and 34.5 mm in the SM group (P > .05). Both groups experienced poorer quality-of-life relative to baseline scores and were affected to a similar extent. CONCLUSIONS: There are no differences in swelling, pain, and trismus between submucosal and intravenous dexamethasone in third molar surgery. Submucosal dexamethasone is a straightforward and accessible route of steroid administration in patients having third molar surgery under local anesthesia only.

Dietary Patterns and Risk of Obesity and Early Childhood Caries in Australian Toddlers: Findings from an Australian Cohort Study.

We examined associations between dietary patterns at 12 months, characterised using multiple methodologies, and risk of obesity and early childhood caries (ECC) at 24-36 months. Participants were Australian toddlers (n = 1170) from the Study of Mothers' and Infants' Life Events affecting oral health (SMILE) birth cohort. Principal Components Analysis (PCA) and the Dietary Guideline Index for Children and Adolescents (DGI-CA) were applied to dietary intake data (1, 2 or 3-days) at 12 months, and regression analysis used to examine associations of dietary patterns with body mass index Z-score and presence of ECC at 24-36 months. Two dietary patterns were extracted using PCA: family diet and cow's milk and discretionary combination. The mean DGI-CA score was 56 ± 13 (out of a possible 100). No statistically significant or clinically meaningful associations were found between dietary pattern or DGI-CA scores, and BMI Z-scores or ECC (n = 680). Higher cow's milk and discretionary combination pattern scores were associated with higher energy and free sugars intakes, and higher family diet pattern scores and DGI-CA scores with lower free sugars intakes. The association between dietary patterns and intermediate outcomes of free sugars and energy intakes suggests that obesity and/or ECC may not yet have manifested, and thus longitudinal investigation beyond two years of age is warranted.

Shape-programmed 3D printed swimming microtori for the transport of passive and active agents.

Through billions of years of evolution, microorganisms mastered unique swimming behaviors to thrive in complex fluid environments. Limitations in nanofabrication have thus far hindered the ability to design and program synthetic swimmers with the same abilities. Here we encode multi-behavioral responses in microscopic self-propelled tori using nanoscale 3D printing. We show experimentally and theoretically that the tori continuously transition between two primary swimming modes in response to a magnetic field. The tori also manipulated and transported other artificial swimmers, bimetallic nanorods, as well as passive colloidal particles. In the first behavioral mode, the tori accumulated and transported nanorods; in the second mode, nanorods aligned along the tori's self-generated streamlines. Our results indicate that such shape-programmed microswimmers have a potential to manipulate biological active matter, e.g. bacteria or cells.

Real-Time Observation of Carbon Oxidation by Driven Motion of Catalytic Ceria Nanoparticles within Low Pressure Oxygen.

Carbon particulate matter (PM) is an undesirable aerosol pollutant formed from combustors such as power plants, refineries, and engines. The most common and effective method of mitigating PM emission is the capture of particulates using a filter, before particles are released into the atmosphere. In order to develop and improve advanced filtering materials, a better understanding is required of their chemical and mechanical behavior. We report on a novel phenomenon on the mobility and oxidation behavior of catalytic iron doped ceria nanoparticles in contact with mobile carbon black nanoparticles. The process is recorded by real time imaging within an environmental transmission electron microscope. In contrast to observations in previous studies, the separated ceria nanoparticles are found to actively move on the substrate and consume the connecting carbon particles one-by-one. The velocity of particle motion is correlated to the reaction temperature and oxygen pressure, both determining the reaction rate. Modeling using the Density Functional Theory suggests this motion is driven by the chemical bonding between the surface oxygen of the catalyst and the graphite layers of carbon black, initiated through the Van der Waals force between two types of nanoparticles.

Proposed new industry code on unhealthy food marketing to children and young people: will it make a difference?

Reducing the exposure of children and young people to the marketing of unhealthy foods is a core strategy for reducing the high overweight and obesity prevalence in this population. The Advertising Standards Authority (ASA) has recently reviewed its self-regulatory codes and proposed a revised single code on advertising to children. This article evaluates the proposed code against eight criteria for an effective code, which were included in a submission to the ASA review process from over 70 New Zealand health professors. The evaluation found that the proposed code largely represents no change or uncertain change from the existing codes, and cannot be expected to provide substantial protection for children and young people from the marketing of unhealthy foods. Government regulations will be needed to achieve this important outcome.

Development of an improved data analysis approach for combined laser extinction and two-angle elastic light scattering diagnostics of soot aggregates.

An improved data analysis approach has been developed for the combined laser extinction and two-angle elastic light scattering diagnostics to relate the various measured optical cross sections to soot aggregate properties. The performance of the proposed approach is assessed using the comprehensive dataset of Santoro ethylene-air co-flow diffusion flame. Compared to previously reported studies, the proposed approach can be applied to a wider range of soot sources by removing the assumption made to the scattering regime or moment ratio of aggregate size distribution. The proposed approach also considers the contribution of scattering to extinction in determining the soot volume fraction, and this contribution is shown to increase as soot aggregate size becomes larger. The sensitivity of the calculation to the assumed parameters of the approach is examined and discussed. The mean radius of gyration of soot aggregates and the ratio of scattering intensities at the two measurement angles are shown to be independent of soot refractive index and are therefore recommended for soot model validation purposes.

Optical absorption measurements of hydrogen chloride at high temperature and high concentration in the presence of water using a tunable diode laser system for application in pyrohydrolysis non-ferrous industrial process control.

A tunable diode laser (TDL) was used to measure hydrogen chloride (HCl) spectra at 5747 cm(-1) (1.74 µm) and temperatures of 25-950 °C in a quartz cell. The purpose was to evaluate the capability of monitoring HCl concentration under pyrohydrolysis conditions using a near-infrared (NIR) laser. These conditions are characterized by 20-40% HCl, 2-40% H2O, and the presence of metal chloride vapors at temperatures of 600-1000 °C. Spectral peak area measurements of HCl-N2 mixtures at atmospheric pressure and a path length of 8.1 cm showed linear absorption behavior between concentrations of 5-95% and temperatures of 25-950 °C. Results from the addition of 2-40% water (H2O) indicate that the HCl peak area relationships are not affected for temperatures of 350-950 °C. Evaporating NiCl2 within the cell did not show spectral interference effects with HCl between 650 and 850 °C. The results from this work indicate that a near-infrared optical sensor is capable of measuring high HCl concentrations at high temperatures in the presence of high H2O content during pyrohydrolysis process conditions.

Molecular characterization of organic content of soot along the centerline of a coflow diffusion flame.

High-resolution mass spectrometry coupled with nanospray desorption electrospray ionization was used to probe chemical constituents of young soot particles sampled along the centerline of a coflow diffusion flame of a three-component Jet-A1 surrogate. In lower positions where particles are transparent to light extinction (λ = 632.8 nm), peri-condensed polycyclic aromatic hydrocarbons (PAHs) are found to be the major components of the particle material. These particles become enriched with aliphatic components as they grow in mass and size. Before carbonization occurs, the constituent species in young soot particles are aliphatic and aromatic compounds 200-600 amu in mass, some of which are oxygenated. Particles dominated by PAHs or mixtures of PAHs and aliphatics can exhibit liquid-like appearance observed by electron microscopy and be transparent to visible light. The variations in chemical composition observed here indicate that the molecular processes of soot formation in coflow diffusion flames may be more complex than previously thought. For example, the mass growth and enrichment of aliphatic components in an initial mostly aromatic structure region of the flame that is absent of H atoms or other free radicals indicates that there must exist at least another mechanism of soot mass growth in addition to the hydrogen abstraction-carbon addition mechanism currently considered in fundamental models of soot formation.

The physiological roles of placental corticotropin releasing hormone in pregnancy and childbirth.

In response to stress, the hypothalamus releases cortiticotropin releasing hormone (CRH) that travels to the anterior pituitary, where it stimulates the release of adrenocorticotropic hormone (ACTH). ACTH travels to the adrenal cortex, where it stimulates the release of cortisol and other steroids that liberate energy stores to cope with the stress. During pregnancy, the placenta synthesises CRH and releases it into the bloodstream at increasing levels to reach concentrations 1,000 to 10, 000 times of that found in the non-pregnant individual. Urocortins, which are CRH analogues are also secreted by the placenta. Desensitisation of the maternal pituitary to CRH and resetting after birth may be a factor in post-partum depression. Recently, CRH has been found to modulate glucose transporter (GLUT) proteins in placental tissue, and therefore there may be a link between CRH levels and foetal growth. Evidence suggests CRH is involved in the timing of birth by modulating signalling systems that control the contractile properties of the myometrium. In the placenta, cortisol stimulates CRH synthesis via activation of nuclear factor kappa B (NF-κB), a component in a cellular messenger system that may also be triggered by stressors such as hypoxia and infection, indicating that intrauterine stress could bring forward childbirth and cause low birth weight infants. Such infants could suffer health issues into their adult life as a result of foetal programming. Future treatment of these problems with CRH antagonists is an exciting possibility.

Protein Kinase A Subunit α Catalytic and A Kinase Anchoring Protein 79 in Human Placental Mitochondria.

Components of protein phosphorylation signalling systems have been discovered in mitochondria and it has been proposed that these molecules modulate processes including oxidative phosphorylation, apoptosis and steroidogenesis. We used electrophoresis and Western blots probed with specific antibodies to protein kinase A α catalytic subunit (PKAα Cat) and A kinase anchoring protein of approximately 79 kDa molecular weight (AKAP79) to demonstrate the presence of these two proteins in human placental mitochondria. Heavy mitochondria characteristic of cytotrophoblast were separated from light mitochondria characteristic of syncytiotrophoblast by centrifugation. PKAα Cat and AKAP79 were present in both heavy and light mitochondria with no significant difference in concentration. Sucrose density gradient separation of submitochondrial fractions indicated PKAα Cat is located predominantly in the outer membrane whereas AKAP79 is present mainly in the contact site fractions. These data indicate that PKAα Cat is present in the cytoplasm, nucleus and mitochondria of placental cells. AKAP79 is also present in human placental mitochondria but there may be anchoring proteins other than AKAP79 responsible for fixing PKA to the outer membrane. PKA may play roles in mitochondrial protein phosphorylation systems in both cytotrophoblast and syncytiotrophoblast.

Kinase inhibitory, haemolytic and cytotoxic activity of three deep-water sponges from North Western Australia and their fatty acid composition.

The c-AMP dependent protein kinase (PKA) inhibition, haemolytic activity, and cytoxicity of 21 extracts obtained from North Western Australian sponges collected from depths of 84-135 m were investigated. Hexane extracts from Ircinia/Sarcotragus sp. and Geodia sp. displayed PKA inhibitory activities of 100 and 97% respectively (at 100 microg/mL), while aq. methanol extracts from Haliclona sp. exhibited potent haemolytic activity (75%) and hexane extracts from Geodia sp. were highly toxic (88%) to the brine shrimp Artemia franciscana. As the non-polar extracts gave the greatest PKA inhibition, these were further analysed by GC-MS and 29 fatty acids were identified in the highest proportions in Ircinia/Sarcotragus sp. > Haliclona sp. > Geodia sp. In contrast to shallow-water sponges that are dominated by polyunsaturated fatty acids with a high percentage of long chain fatty acids, LCFAs (C24-C30), the deep-sea sponges investigated herein were all found to be rich in saturated fatty acids, in particular C14-C20 fatty acids, including odd and branched chain fatty acids, with only low levels (0-10%) of LCFAs. Screening of the PKA inhibitory activity of a series of commercially available fatty acids identified C14-C18 fatty acids as possessing significant PKA inhibitory activity that may contribute to the activity observed in the sponges studied.

In situ optical absorption mercury continuous emission monitor.

This paper reports the development of an in situ continuous emission monitor (CEM) for measuring elemental mercury (Hg(0)) concentration in the exhaust stream of coal-fired power plants. The instrument is based on the ultraviolet atomic absorption of a mercury lamp emission line by elemental mercury and a light-emitting diode (LED) background correction system. This approach allows an in situ measurement since the absorption of other species such as SO(2) can be removed to monitor the Hg(0) contribution only. Proof of concept was established through a laboratory-based investigation, and a limit of detection, [Hg(0)](min), of 2 microg/m(3) was measured for a 1-min averaged sample and an absorption path length of 49 cm. [Hg(0)](min) is anticipated to be better than 0.2 microg/m(3) across a 7 m diameter stack. Finally, the apparatus was field-tested in a 230 MW coal-fired power plant. The operability of the measurement in real conditions was demonstrated, leading to the first Hg(0) concentration values recorded by the in situ CEM. Comparison with an accepted standard method is required for validation.

Disparities in edentulism and tooth loss between Maori and non-Maori New Zealand women.

OBJECTIVES: Tooth loss and edentulism are important negative health outcomes; however, there is little current information about the prevalence of these conditions among adults in New Zealand (NZ). This study describes the dentate status of Maori and non-Maori NZ women with regard to tooth loss, edentulism and denture-wearing, and investigates ethnic and sociodemographic disparities within the sample. Associations between dentate status, socio-demographic and health-related factors are described. METHODS: Participants were 1,817 women who were screened for participation in a randomised controlled trial. RESULTS: 9.0% of women were edentulous and 30.3% wore a denture (partial or complete). The mean number of teeth present was 24.2, and older women had fewer teeth on average. Socio-demographic and ethnic disparities in tooth loss and edentulism were observed. Maori ethnicity was strongly associated with edentulism and tooth loss, with Maori women five times more likely than NZ European women to be edentulous. These associations held after controlling for age, education, smoking, diabetes, cardiovascular disease history, and BMI. CONCLUSIONS: Marked ethnic disparities in edentulism and tooth loss exist in New Zealand. Effective targeted programmes are needed to reduce the public health impact of poor oral health among Maori.