Efficacy of silver-impregnated fabric in preventing spread of infection in the wrestling environment.

CONTEXT: The best practice for cleaning wrestling mats is using a residual disinfectant with continued antibacterial action. Recently available wash-in silver additives claim to confer a residual effect to fabric. OBJECTIVE: To test the efficacy of laundering with a wash-in silver additive in reducing exposure of athletes to potentially infectious microbes on apparel. DESIGN: 4-part Controlled Laboratory Study/Parallel Group Comparison Study: (1) To test whether fabrics in athletic clothing would be affected differently, we applied bacteria to control fabrics washed in detergent alone and test counterparts washed in detergent plus wash-in silver additive. Bacteria were applied to fabrics, extracted, plated, incubated, and counted. (2) To see if wash-in silver affected various bacteria differently, we washed cotton t-shirts with detergent alone or with detergent plus wash-in silver. We applied four bacterial species commonly found in the wrestling environment. Bacteria were extracted, plated, incubated, and counted. (3) To see if wash-in silver was effective in reducing bacterial contamination during practice, 32 collegiate wrestlers paired off with one wearing a test silver-treated t-shirt, and their partner wearing a control shirt. Wrestler rotations exposed shirts to 2, 4 or 8 wrestlers. Identical swatches of fabric were cut from the t-shirts. Bacteria were extracted, plated, incubated, and counted. (4) We simulated prolonged/repeated bacterial exposure as occurs during tournaments by applying bacteria directly to silver-treated and untreated singlet material repeatedly over time. Test samples were taken at regular intervals to see if bacterial growth was inhibited by the presence of the silver nanoparticles. Bacteria were extracted, plated, incubated, and counted. SETTING: Laboratory and practice. PARTICIPANTS: Collegiate D3 Wrestling Team. MAIN OUTCOME MEASURE(S): Wash-in silver would be considered effective if statistically significant reduction in bacterial count was observed at 95% confidence. RESULTS: Wash-in silver reduced bacterial growth at low levels of contamination but did not significantly reduce bacterial growth at levels seen during contact sport competitions. This was true for all bacterial species and all fabrics tested. CONCLUSIONS: The environmental and potential health risks in using a wash-in silver nanoparticle laundry additive in the wash cycle for clothing worn by wrestlers outweigh any potential infection control benefits to these athletes. We do not currently recommend adopting wash-in silver treatment as part of the laundering regimen for wrestling programs until further testing of alternate methods of silver impregnation into sports fabrics has been investigated.

Increasing the number of nursing faculty: Evaluation of a university system workforce grant.

BACKGROUND: The University of Wisconsin System Incentive Grant, Nurses for Wisconsin: Learn, Teach, Lead (N4WI) was a workforce initiative to address the nursing faculty shortage at four universities and included funding nurses to their terminal degree, postdoctoral fellowships, and loan forgiveness for faculty hires. It also included professional development opportunities for awardees. PURPOSE: The purpose of the article is to disseminate the evaluation of N4WI and discuss the impact of the project. METHODS: Methods of evaluation included assessment of data points as well as qualitative information. FINDINGS: N4WI was successful in achieving its goal of increasing nursing faculty applicants and hires at the respective schools with total awardees numbering 54. DISCUSSION: As a result of N4WI and using it as a template, nursing organizations within the state collaborated to successfully pursue state funding to grow nursing faculty called Wisconsin Nurse Educator Program to benefit the 44 nursing programs in Wisconsin.

Attosecond-pump attosecond-probe x-ray spectroscopy of liquid water.

Attosecond-pump/attosecond-probe experiments have long been sought as the most straightforward method for observing electron dynamics in real time. Although there has been much success with overlapped near-infrared femtosecond and extreme ultraviolet attosecond pulses combined with theory, true attosecond-pump/attosecond-probe experiments have been limited. We used a synchronized attosecond x-ray pulse pair from an x-ray free-electron laser to study the electronic response to valence ionization in liquid water through all x-ray attosecond transient absorption spectroscopy (AX-ATAS). Our analysis showed that the AX-ATAS response is confined to the subfemtosecond timescale, eliminating any hydrogen atom motion and demonstrating experimentally that the 1b1 splitting in the x-ray emission spectrum is related to dynamics and is not evidence of two structural motifs in ambient liquid water.

Tracking Cavity Formation in Electron Solvation: Insights from X-ray Spectroscopy and Theory.

We present time-resolved X-ray absorption spectra of ionized liquid water and demonstrate that OH radicals, H3O+ ions, and solvated electrons all leave distinct X-ray-spectroscopic signatures. Particularly, this allows us to characterize the electron solvation process through a tool that focuses on the electronic response of oxygen atoms in the immediate vicinity of a solvated electron. Our experimental results, supported by ab initio calculations, confirm the formation of a cavity in which the solvated electron is trapped. We show that the solvation dynamics are governed by the magnitude of the random structural fluctuations present in water. As a consequence, the solvation time is highly sensitive to temperature and to the specific way the electron is injected into water.

Clinicoradiological outcomes after radical radiotherapy for lung cancer in patients with interstitial lung disease.

Objective: Interstitial lung disease (ILD) is relatively common in patients with lung cancer with an incidence of 7.5%. Historically pre-existing ILD was a contraindication to radical radiotherapy owing to increased radiation pneumonitis rates, worsened fibrosis and poorer survival compared with non-ILD cohorts. Herein, the clinical and radiological toxicity outcomes of a contemporaneous cohort are described. Methods: Patients with ILD treated with radical radiotherapy for lung cancer at a regional cancer centre were collected prospectively. Radiotherapy planning, tumour characteristics, and pre- and post-treatment functional and radiological parameters were recorded. Cross-sectional images were independently assessed by two Consultant Thoracic Radiologists. Results: Twenty-seven patients with co-existing ILD received radical radiotherapy from February 2009 to April 2019, with predominance of usual interstitial pneumonia subtype (52%). According to ILD-GAP scores, most patients were Stage I. After radiotherapy, localised (41%) or extensive (41%) progressive interstitial changes were noted for most patients yet dyspnoea scores (n = 15 available) and spirometry (n = 10 available) were stable. One-third of patients with ILD went on to receive long-term oxygen therapy, which was significantly more than the non-ILD cohort. Median survival trended towards being worse compared with non-ILD cases (17.8 vs 24.0 months, p = 0.834). Conclusion: Radiological progression of ILD and reduced survival were observed post-radiotherapy in this small cohort receiving lung cancer radiotherapy, although a matched functional decline was frequently absent. Although there is an excess of early deaths, long-term disease control is achievable. Advances in knowledge: For selected patients with ILD, long-term lung cancer control without severely impacting respiratory function may be possible with radical radiotherapy, albeit with a slightly higher risk of death.

Knowledge, attitudes, and behaviors with mask use and vaccines for COVID-19 prevention at 13 colleges and universities, April 2021.

Objectives: To understand college and university student knowledge, attitudes, and behaviors (KAB) regarding COVID-19 prevention strategies. Methods: Thirteen colleges and universities volunteered to conduct an anonymous electronic survey in April 2021 to assess students' KAB about mask use and vaccination to prevent COVID-19. Results: Three-quarters of students indicated they "Always" wore a mask correctly when in public indoor places. Of those not yet vaccinated, 55% expressed concern about unknown side effects. Over half of students were unsure or believe they do not need to continue wearing masks after vaccination and older students more likely to be vaccinated. There was a significant inverse correlation between intention of getting vaccinated and intention to attend a large indoor party without a mask. Conclusions: Colleges and universities are important to community efforts to slow the COVID-19 pandemic. The KAB findings can inform approaches to increase overall mask use and vaccination uptake among young students.

X-ray induced electron and ion fragmentation dynamics in IBr.

Characterization of the inner-shell decay processes in molecules containing heavy elements is key to understanding x-ray damage of molecules and materials and for medical applications with Auger-electron-emitting radionuclides. The 1s hole states of heavy atoms can be produced by absorption of tunable x rays and the resulting vacancy decays characterized by recording emitted photons, electrons, and ions. The 1s hole states in heavy elements have large x-ray fluorescence yields that transfer the hole to intermediate electron shells that then decay by sequential Auger-electron transitions that increase the ion's charge state until the final state is reached. In molecules, the charge is spread across the atomic sites, resulting in dissociation to energetic atomic ions. We have used x-ray/ion coincidence spectroscopy to measure charge states and energies of Iq+ and Brq'+ atomic ions following 1s ionization at the I and Br K-edges of IBr. We present the charge states and kinetic energies of the two correlated fragment ions associated with core-excited states produced during the various steps of the cascades. To understand the dynamics leading to the ion data, we develop a computational model that combines Monte-Carlo/Molecular-Dynamics (MC/MD) simulations with a classical over-the-barrier model to track inner-shell cascades and redistribution of electrons in valence orbitals and nuclear motion of fragments.

Using live stream technology to conduct workplace observation assessment of trainee dental nurses: an evaluation of effectiveness and user experience.

AIM/OBJECTIVE: This study evaluates the effectiveness and users' experience of using live stream technology to conduct workplace observation assessments of trainee dental nurses. Information on the usability, accessibility, and general satisfaction of this technological technique were collected. MATERIALS AND METHODS: This nationwide cross-sectional survey was conducted in Scotland and included one focus group and three online questionnaires with qualitative and quantitative questions. The quantitative responses were described using standard descriptive analysis, while the quantitative data were investigated using thematic analysis. RESULTS: Eighty-one trainee dental nurses, 35 clinicians and 19 assessors participated in this study. Live stream observation was generally well received by the trainee dental nurses and clinicians, who thought that it had helped increase their confidence to perform practical skills. The assessors also stated that overall satisfaction was high, and that live stream observation met their expectations for efficacy. However, several technical challenges, such as network issues were brought up by responders. CONCLUSION: This study provides evidence that workplace observation assessments can be performed in the future by using live stream technology. However, additional investigation and comparison will aid in determining the most effective way of using this approach and providing feedback to promote learning among dental trainees.

The practices and beliefs of dental professionals regarding the management of patients taking anticoagulant and antiplatelet drugs.

AIM: This study aimed to inform the implementation of the updated Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, 'Management of Dental Patients taking Anticoagulant or Antiplatelet Drugs', and to determine training needs by investigating dental professionals' current practice and beliefs regarding management of patients taking these medications. METHODS: Dental professionals were recruited via the NHS Education for Scotland Portal. The online questionnaire collected demographic information, data on current practice and information about beliefs regarding behaviours related to the management of patients on anticoagulant or antiplatelet medication. Quantitative data were analysed using SPSS and subjected to frequency calculations, t-tests, one-way ANOVA and linear regression. Qualitative data were collected via free text boxes and analysed using thematic analysis. RESULTS: One hundred and fifty-seven participants responded to the questionnaire. The majority of respondents stated they were aware of the guidance and always based their practice on it. The majority of respondents always assessed the patient's individual bleeding risk prior to dental procedures. Most respondents felt that they did not know how to appropriately manage patients taking low doses of low molecular weight heparins (LMWH), and only 38% of respondents always followed SDCEP guidance about direct oral anticoagulants (DOAC) medication and procedures with a low associated risk of bleeding. DISCUSSION: This study demonstrates a need for further educational support surrounding LMWHs and management of patients on DOAC medication. Time and remuneration represent barriers to guidance implementation in primary care. CONCLUSION: There is good awareness and adherence to the guidance in primary care settings, however training needs were identified to support implementation.

Epidemiological associations of asthma status and tobacco use, substance use, and substance misuse among adults in the United States, 2015-2019.

Objective: Adults with asthma have a higher prevalence of substance use. However, knowledge is scarce regarding the associations between adults with asthma and tobacco use, substance use, and substance misuse. This study aimed to use national samples of United States adults to assess the comprehensive use and misuse of substances in adults with asthma.Method: This cross-sectional study comprised data drawn from the 2015 to 2019 National Survey on Drug Use and Health. Weighted logistic regressions were used to measure the associations of asthma status (lifetime and current) with last month's tobacco use; substance use (alcohol, marijuana, cocaine, crack, heroin, hallucinogens, inhalants); and substance misuse (pain relievers, tranquilizers, stimulants, sedatives). All regression models were controlled for sociodemographic characteristics, comorbidity, last-month serious psychological distress, and co-substance use and misuse. Results: Adults with lifetime asthma (Nweighted = 115,600,887) were less likely to use cigarettes, cigars, smokeless tobacco, inhalants, and polyuse of any substance. In contrast, adults with current asthma (Nweighted = 765,096,31) were more likely to use pipe tobacco, cocaine, non-prescribed tranquilizers, and less likely to use polytobacco products. Adults with lifetime asthma were associated with fewer last-month tobacco and inhalant use than those without lifetime asthma. However, adults with current asthma were associated with greater last month's pipe tobacco, cocaine, and non-prescribed tranquilizers. Conclusion: Thus, further longitudinal studies are recommended among adults with asthma to effectively design tailored treatment and prevention interventions.

Exploring outcomes from an innovative, pediatric-focused intervention with undergraduate nursing students.

BACKGROUND: To adapt to COVID-19 restrictions, a virtual pediatric skills day was developed to provide nursing students with practical experience prior to entering the pediatric clinical setting. Student assessment before and after participation indicate a virtual skills day is helpful in building student confidence prior to pediatric clinicals. METHODS: This mixed-method study involved a cross-sectional approach with a six-item survey administered before and immediately after the virtual pediatric skills day intervention to undergraduate junior nursing students. Outcome measures included comfort and preparation for pediatrics and families of pediatric patients. FINDINGS: After exploring outcomes from 93 students complete pre and post intervention measures, we addressed comfort themes including excited, nervous, and readiness while preparedness themes highlighted concerns with parental interactions, upset children, and COVID-19 restrictions. DISCUSSION: It is beneficial for nursing students to have clinical experiences with children prior to visiting a pediatric clinical setting. Such experiences decrease student stress and anxiety and allow meaningful opportunities to occur.

Alternative Pathway to Double-Core-Hole States.

Excited double-core-hole states of isolated water molecules resulting from the sequential absorption of two x-ray photons have been investigated. These states are formed through an alternative pathway, where the initial step of core ionization is accompanied by the shake-up of a valence electron, leading to the same final states as in the core-ionization followed by core-excitation pathway. The capability of the x-ray free-electron laser to deliver very intense, very short, and tunable light pulses is fully exploited to identify the two different pathways.

A qualitative study of organisational resilience in care homes in Scotland.

Providing care for the dependent older person is complex and there have been persistent concerns about care quality as well as a growing recognition of the need for systems approaches to improvement. The I-SCOPE (Improving Systems of Care for the Older person) project employed Resilient Healthcare (RHC) theory and the CARE (Concepts for Applying Resilience) Model to study how care organisations adapt to complexity in everyday work, with the aim of exploring how to support resilient performance. The project was an in-depth qualitative study across multiple sites over 24 months. There were: 68 hours of non-participant observation, shadowing care staff at work and starting broad before narrowing to observe care domains of interest; n = 33 recorded one-to-one interviews (32 care staff and one senior inspector); three focus groups (n = 19; two with inspectors and one multi-disciplinary group); and five round table discussions on emergent results at a final project workshop (n = 31). All interviews and discussion groups were recorded and transcribed verbatim. Resident and family interviews (n = 8) were facilitated through use of emotional touchpoints. Analysis using QSR NVivo 12.0 focused on a) capturing everyday work in terms of the interplay between demand and capacity, adaptations and intended and unintended outcomes and b) a higher-level thematic description (care planning and use of information; coordination of everyday care activity; providing person-centred care) which gives an overview of resilient performance and how it might be enhanced. This gives important new insight for improvement. Conclusions are that resilience can be supported through more efficient use of information, supporting flexible adaptation, coordination across care domains, design of the physical environment, and family involvement based on realistic conversations about quality of life.

Framing Disparities in Access to Medical Speech-Language Pathology Care in Rural Alabama.

PURPOSE: Rural-living residents of Alabama depend on rural hospitals and clinics staffed with physicians and allied health professionals including speech-language pathologists (SLPs). The purpose of the exploratory study was to examine the speech-language pathology workforce in health care facilities in nonmetropolitan Alabama counties to determine potential disparities in access and identify medical SLP deserts for rural Alabamians. METHOD: The hospitals, rural health clinics, nursing homes, and rehabilitation centers for each of the 37 nonmetropolitan counties were identified through the 2020 Alabama Department of Public Health directories, and phone surveys were completed to determine medical SLP staffing at each facility. Descriptive statistics and regression analysis were conducted. RESULTS: The initial review yielded 229 rural health care facilities with 223 ultimately included in the analysis and 176 facilities completing a phone inquiry (76.68%). Sixty-one (35.88%) reported employing at least one SLP and no facility stated staffing SLP assistants. Linear regression indicated a positive, yet moderate effect size between the reported number of SLPs staffed within each county and specific population of the county (r 2 = .519). Anecdotally, facilities reported difficulty in hiring and retaining SLPs due to rural geographical location. CONCLUSIONS: The exploratory findings suggest disparities in access to behavioral communication and swallowing care for rural residents in the state. The methodology employed for data collection and analysis may be applied to other states and U.S. territories, in an effort to frame the issue nationally and support rural health care policy across the United States. Further investigation regarding the cost effectiveness of telepractice, the availability of broadband Internet access, the efficacy of community-based service delivery, and the effectiveness of incentivized rural SLP graduate programs is warranted to mitigate the disparities in access.

Observation of site-selective chemical bond changes via ultrafast chemical shifts.

The concomitant motion of electrons and nuclei on the femtosecond time scale marks the fate of chemical and biological processes. Here we demonstrate the ability to initiate and track the ultrafast electron rearrangement and chemical bond breaking site-specifically in real time for the carbon monoxide diatomic molecule. We employ a local resonant x-ray pump at the oxygen atom and probe the chemical shifts of the carbon core-electron binding energy. We observe charge redistribution accompanying core-excitation followed by Auger decay, eventually leading to dissociation and hole trapping at one site of the molecule. The presented technique is general in nature with sensitivity to chemical environment changes including transient electronic excited state dynamics. This work provides a route to investigate energy and charge transport processes in more complex systems by tracking selective chemical bond changes on their natural timescale.

'Well, in dentistry the dentist is always the boss': a multi-method exploration of which organisational characteristics of dental practices most influence the implementation of evidence-based guidance.

OBJECTIVE: To investigate which organisational characteristics of primary care dental practices influence the implementation of evidence-based guidance. DESIGN: A multimethod study set within primary care dentistry in Scotland comprising: (1) Semistructured interviews with dental teams to inform development of a self-report questionnaire exploring the translation of guidance in primary care dentistry and (2) A questionnaire-based survey and case studies exploring which organisational characteristics influence knowledge translation. RESULTS: Interview data identified three themes: leadership, communication and context. Survey data revealed compliance with recommendations from three topics of dental guidance to be variable, with only 41% (emergency dental care), 19% (oral health assessment and review) and 4% (drug prescribing) of respondents reporting full compliance. Analysis revealed no significant relationship between practice characteristics and compliance with emergency dental care or drug prescribing recommendations. Positive associations were observed between compliance with oral health assessment and review recommendations and having a practice manager, as well as with the type of treatment offered, with fully private practices more likely, and fully National Health Service practices less likely to comply, when compared with those offering a mixture of treatment. Synthesis of the data identified leadership and context as key drivers of guidance uptake. CONCLUSIONS: Evidence-based dental recommendations are not routinely translated into practice, with variable leadership and differing practice contexts being central to poor uptake. Guidelines should aim to tailor recommendations and implementation strategies to reflect the complexities and varying contexts that exist in primary care dentistry, thus facilitating the implementation of evidence-based guidance.

How NHS Tayside dealt with the COVID-19 pandemic within Urgent Dental Care Centres: clinical staff views and experiences.

Introduction Dental staff are considered to be at increased risk of COVID-19 transmission, and national concerns about personal protective equipment (PPE) and staff safety have been widely reported. This study explores the views of staff working in Urgent Dental Care Centres (UDCCs) during the first COVID-19 lockdown.Aims To explore clinical staff views and experiences of PPE and personal safety while working in NHS Tayside's UDCCs during the initial months of the COVID-19 pandemic.Design Cross-sectional questionnaire survey.Materials and methods A questionnaire was emailed to staff working within NHS Tayside UDCCs during the first lockdown. The questions related to PPE, working environment, personal safety and wellbeing. This paper focuses on PPE and personal safety.Results Of the 176 invited to participate, 116 completed the questionnaire. The majority confirmed that they always had access to appropriate PPE and few had concerns about personal safety.Discussion Despite having worked in a high-risk environment throughout the lockdown, staff supporting the Tayside UDCCs felt safe and well-protected. This runs counter to widely reported anxieties about PPE and safety across the UK. Further investigation is required to understand this disparity.Conclusion The results indicate that PPE was adequate, accessible and staff felt protected.

Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP): a feasibility study.

BACKGROUND: Progression of dental caries can result in irreversible pulpal damage. Partial irreversible pulpitis is the initial stage of this damage, confined to the coronal pulp whilst the radicular pulp shows little or no sign of infection. Preserving the pulp with sustained vitality and developing minimally invasive biologically based therapies are key themes within contemporary clinical practice. However, root canal treatment involving complete removal of the pulp is often the only option (other than extraction) given to patients with irreversible pulpitis, with substantial NHS and patient incurred costs. The European Society of Endodontology's (ESE 2019) recent consensus statement recommends full pulpotomy, where the inflamed coronal pulp is removed with the goal of keeping the radicular pulp vital, as a more minimally invasive technique, potentially avoiding complex root canal treatment. Although this technique may be provided in secondary care, it has not been routinely implemented or evaluated in UK General Dental Practice. METHOD: This feasibility study aims to identify and assess in a primary care setting the training needs of general dental practitioners and clinical fidelity of the full pulpotomy intervention, estimate likely eligible patient pool and develop recruitment materials ahead of the main randomised controlled trial comparing the clinical and cost-effectiveness of full pulpotomy compared to root canal treatment in pre/molar teeth of adults 16 years and older showing signs indicative of irreversible pulpitis. The feasibility study will recruit and train 10 primary care dentists in the full pulpotomy technique. Dentists will recruit and provide full pulpotomy to 40 participants (four per practice) with indications of partial irreversible pulpitis. DISCUSSION: The Pulpotomy for the Management of Irreversible Pulpitis in Mature Teeth (PIP) study will address the lack of high-quality evidence in the treatment of irreversible pulpitis, to aid dental practitioners, patients and policymakers in their decision-making. The PIP feasibility study will inform the main study on the practicality of providing both training and provision of the full pulpotomy technique in general dental practice. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN17973604 . Registered on 28 January 2021. Protocol version Protocol version: 1; date: 03.02.2021.

Storytelling and the Humanbecoming Family Model.

The authors in this article will present storytelling through the lens of the humanbecoming family model. From this perspective, storytelling can be viewed as the following: (a) family storytelling as a mode of fostering personal and family becoming, (b) family storytelling as a confirming of family beliefs and values, and (c) family storytelling as a way of addressing issues of grief and loss. Selected literature is presented to highlight the essences, paradoxes, and processes of the humanbecoming family model.