Health-Promoting Schools Project for Palestine Children's Oral Health.

OBJECTIVES: The aim of this work was to assess the oral health outcome of a 2-year comprehensive school oral health programme based on school-health education combined with supervised toothbrushing using 1450-ppm fluoride toothpaste amongst schoolchildren in Palestine. METHODS: A quasi-experimental study (2016-2018) recruited 3939 schoolchildren aged 5 to 6 years from 30 intervention schools (n = 2333) and 31 comparison schools (n = 1606). At baseline and postintervention, mothers and schoolteachers completed World Health Organization (WHO) self-administered questionnaires about oral health of children, oral health behaviour, and family factors. Of the initial participants 75.8 per cent took part in the follow up studies. In addition, 25 calibrated dentists examined dental caries of children according to WHO criteria. Trained teachers provided comprehensive oral health education to children in the classrooms and held regular oral health sessions for mothers. Children brushed their teeth with fluoride-containing toothpaste (1450 ppm fluoride). Student t-test and logistic regression were used in the statistical analysis of changes in dental health and related knowledge, behaviours, and attitudes (P < .05). RESULTS: In both dentitions, dental caries experience declined over the project. The reduction in Decayed, Missing and Filled permanent Teeth and Decayed, Missing and Filled Surfaces in permanent teeth was 23.3% and 23.2% (P < .001), respectively. The drop in caries experience indices in the Gaza Strip was 8 to 4 times higher than in West Bank, and it reached 47.4% reduction. Mothers and teachers showed improvement in positive knowledge and attitudes towards dental care. Involvement of schoolteachers in oral health in schools and acceptance of dental health education materials significantly enhanced oral health behaviour of children. CONCLUSIONS: The project recommends national implementation of an intervention for the improvement of oral health of schoolchildren and their parents in conflict zones. The project shows the importance of the WHO Health Promoting Schools concept and involving classroom-based health education carried out by schoolteachers. It is suggested to explore the health care system's capacity in hosting effective oral health programme and maintain its efficacy.

Narrow homogeneous linewidths and slow cooling dynamics across infrared intra-band transitions in n-doped HgSe colloidal quantum dots.

Intra-band transitions in colloidal quantum dots (QDs) are promising for opto-electronic applications in the mid-IR spectral region. However, such intra-band transitions are typically very broad and spectrally overlapping, making the study of individual excited states and their ultrafast dynamics very challenging. Here, we present the first full spectrum two-dimensional continuum infrared (2D CIR) spectroscopy study of intrinsically n-doped HgSe QDs, which exhibit mid-infrared intra-band transitions in their ground state. The obtained 2D CIR spectra reveal that underneath the broad absorption line shape of ∼500 cm-1, the transitions exhibit surprisingly narrow intrinsic linewidths with a homogeneous broadening of 175-250 cm-1. Furthermore, the 2D IR spectra are remarkably invariant, with no sign of spectral diffusion dynamics at waiting times up to 50 ps. Accordingly, we attribute the large static inhomogeneous broadening to the distribution of size and doping level of the QDs. In addition, the two higher-lying P-states of the QDs can be clearly identified in the 2D IR spectra along the diagonal with a cross-peak. However, there is no indication of cross-peak dynamics indicating that, despite the strong spin-orbit coupling in HgSe, transitions between the P-states must be longer than our maximum waiting time of 50 ps. This study illustrates a new frontier of 2D IR spectroscopy enabling the study of intra-band carrier dynamics in nanocrystalline materials across the entire mid-infrared spectrum.

On the Trail of Molecular Hydrophilicity and Hydrophobicity at Aqueous Interfaces.

Uncovering microscopic hydrophilicity and hydrophobicity at heterogeneous aqueous interfaces is essential as it dictates physico/chemical properties such as wetting, the electrical double layer, and reactivity. Several molecular and spectroscopic descriptors were proposed, but a major limitation is the lack of connections between them. Here, we combine density functional theory-based MD simulations (DFT-MD) and SFG spectroscopy to explore how interfacial water responds in contact with self-assembled monolayers (SAM) of tunable hydrophilicity. We introduce a microscopic metric to track the transition from hydrophobic to hydrophilic interfaces. This metric combines the H/V descriptor, a structural descriptor based on the preferential orientation within the water network in the topmost binding interfacial layer (BIL) and spectroscopic fingerprints of H-bonded and dangling OH groups of water carried by BIL-resolved SFG spectra. This metric builds a bridge between molecular descriptors of hydrophilicity/hydrophobicity and spectroscopically measured quantities and provides a recipe to quantitatively or qualitatively interpret experimental SFG signals.

Probing the Gold/Water Interface with Surface-Specific Spectroscopy.

Water is an integral component in electrochemistry, in the generation of the electric double layer, and in the propagation of the interfacial electric fields into the solution; however, probing the molecular-level structure of interfacial water near functioning electrode surfaces remains challenging. Due to the surface-specificity, sum-frequency-generation (SFG) spectroscopy offers an opportunity to investigate the structure of water near working electrochemical interfaces but probing the hydrogen-bonded structure of water at this buried electrode-electrolyte interface was thought to be impossible. Propagating the laser beams through the solvent leads to a large attenuation of the infrared light due to the absorption of water, and interrogating the interface by sending the laser beams through the electrode normally obscures the SFG spectra due to the large nonlinear response of conduction band electrons. Here, we show that the latter limitation is removed when the gold layer is thin. To demonstrate this, we prepared Au gradient films on CaF2 with a thickness between 0 and 8 nm. SFG spectra of the Au gradient films in contact with H2O and D2O demonstrate that resonant water SFG spectra can be obtained using Au films with a thickness of ∼2 nm or less. The measured spectra are distinctively different from the frequency-dependent Fresnel factors of the interface, suggesting that the features we observe in the OH stretching region indeed do not arise from the nonresonant response of the Au films. With the newfound ability to probe interfacial solvent structure at electrode/aqueous interfaces, we hope to provide insights into more efficient electrolyte composition and electrode design.

Schoolteachers for Action Against HIV/AIDS-related Oral Disease of Children in Africa.

PURPOSE: The intention of the study was to evaluate whether Sub-Saharan schoolteachers may play a key role in oral health promotion of primary schoolchildren, particularly in terms of prevention of HIV/AIDS-related oral health problems. MATERIALS AND METHODS: The study examined the level of knowledge about oral disease and the prevention of HIV/AIDS oral lesions amongst schoolteachers of Tanzania and Burkina Faso, identified their sources of information, and evaluated their ability for HIV/AIDS intervention. A multi-centre cross-sectional study was implemented in the two Sub-Saharan African countries. Participants comprised primary school teachers selected by stratified cluster sampling: 261 teachers from Tanzania and 313 teachers from Burkina Faso. All participants completed a structured questionnaire prepared for self-administration. The questions were designed from a standardised questionnaire developed by the World Health Organization. RESULTS: Most teachers knew about the principal causes of the major oral diseases and the means of disease prevention. Nearly all teachers (95.6%) were aware of HIV/AIDS and they knew (92.3%) a virus was the direct cause of AIDS. Teachers were well informed of the general symptoms of HIV/AIDS, although oral symptoms were mentioned less often. In all, 17.6% of schoolteachers reported that children suffering from HIV/AIDS were found in their classes and 10.3% of teachers were conscious of students receiving anti-retroviral therapy (ART). Knowledge about the disease seemed to reflect mass media as a source, while teacher colleagues and health personnel played a somewhat lesser role in communication. In total, 83.2% emphasised that they should teach children about HIV/AIDS and the mouth. Schoolteachers from Tanzania (70.5%) were more often engaged in classroom-based oral health education than were the Burkinabe teachers (53.9%). CONCLUSION: The study confirms that schoolteachers may be a relevant source in the fight against HIV/AIDS among children. However, they would benefit from interaction with health personnel.

Wedge-Based Design for Phase Stable and Phase Accurate Heterodyne-Detected Sum-Frequency Generation Spectroscopy.

Phase sensitive and heterodyne-detected (HD) sum-frequency generation (SFG) spectroscopy offers the ability to separate the nonlinear susceptibility into its real and imaginary components. This provides information about the absolute orientation of molecules at interfaces while also producing an absorptive spectrum that is linear in spectral composition and can easily be decomposed into different spectral components. However, simultaneously obtaining phase accuracy and phase stability remains a challenge in SFG. Here we present a new experimental design for HD-SFG spectroscopy that incorporates a wedge pair to accurately control the timing between the local oscillator and the sample signal. This experimental approach provides high phase accuracy and long-time phase stability in a compact and flexible configuration.

Improving oral health of children in four Balkan countries: A qualitative study among health professionals.

Data from the WHO show that the oral health situation for children in the Balkan region of Europe is poor. This study aims to identify obstacles that prevent the implementation of an effective oral health program for children in the Balkan area. The study investigates the challenges that people encounter in increasing awareness, attending to dental care, and complying with examinations. Methods: This qualitative study targeted experts in preventive dentistry and oral health promotion in four countries in the Balkan region. Purposive sampling was used to recruit the participants. Data were collected in 2021 using individual in-depth interviews with participants from Albania, Bosnia and Herzegovina, Croatia, and Serbia. The study applied the thematic analysis method. Results: The experts reported four main challenges that hindered the implementation of a prevention program and regular patient attendance: (1) lack of knowledge, (2) the exclusion of oral health from overall health, (3) organization of services, and (4) skepticism of fluoride. The participants identified knowledge gaps among the general population, dental staff, and other health professionals regarding the prevention of oral diseases. Conclusion: The findings of this study may be used to promote and improve oral health among children in the identified areas and to benefit people in the region and elsewhere. This study sheds light on the existing barriers in a region where people lack information.

Oral Health Status and Oral Health Behaviour among 5- to 6-year-old Palestinian Schoolchildren - Towards Engagement of Parents and Schoolteachers for Oral Health through Schools.

PURPOSE: 1. To assess the oral health status and health behaviour of 5- to 6-year-oldchildren and the influence of socio-behavioural factors on oral health among children, and 2. evaluate dental knowledge and attitudes related to oral health promotion of children among mothers and schoolteachers in Palestine. MATERIALS AND METHODS: This cross-sectional survey was carried out in 2017, and recruited samples of children (n = 3939, 53.8% boys, 44.8% girls) from 61 primary schools, their mothers and schoolteachers (n = 53). Participants were selected randomly by multistage stratified cluster sampling. Calibrated dentists performed oral examinations of 5- to 6-year-old schoolchildren based on WHO criteria. Mothers and teachers completed WHO self-administrated questionnaires to assess children's oral health behaviour, as well as their knowledge and attitudes towards children's dental care. RESULTS: Caries prevalence of primary teeth was 83.4% and caries experience was high (dmf-s = 11.17). One-fourth of children suffered from pain or discomfort from teeth, and 57.7% of children had seen a dentist within the past 12 months, frequently due to pain or problems. Consumption of sugars was frequent and only 19.7% brushed their teeth every day. Neglect of dental visits, infrequent toothbrushing, being a child from families of urban settings and high socioeconomic status were greatly affected by caries. Mothers and schoolteachers had mostly positive attitudes towards school-based oral health care. However, the availability of dental health education materials was extremely low. CONCLUSION: The establishment of school-based oral health programmes, including effective use of toothpaste containing fluoride for caries prevention, is greatly needed to improve the oral health of Palestinian children. The introduction of fluoridated school milk is highly recommended. The establishement of school programmes should encompass active involvement of schoolteachers and mothers to promote the development of healthy lifestyles and sustainable oral health behaviours among schoolchildren. Provision of materials for health education by schoolteachers and mothers is urgently needed.

Full spectrum 2D IR spectroscopy reveals below-gap absorption and phonon dynamics in the mid-IR bandgap semiconductor InAs.

While the mid-infrared spectral region spans more than 3000 cm-1, ultrafast mid-IR spectroscopies are normally limited to the spectral bandwidth that can be generated in optical parametric amplifiers-typically a few hundred cm-1. As such, the spectral coverage in conventional two dimensional infrared (2D IR) spectroscopy captures only about 1% of the full potential 2D mid-IR spectrum. Here, we present 2D IR spectra using a continuum source as both the excitation and probe pulses, thus capturing close to the full 2D IR spectrum. While the continuum pulses span the entire mid-IR range, they are currently too weak to efficiently excite molecular vibrational modes but strong enough to induce electronic responses and excite phonons in semiconductors. We demonstrate the full spectrum 2D IR spectroscopy of the mid-IR bandgap semiconductor indium arsenide with a bandgap at 2855 cm-1. The measured response extends far below the bandgap and is due to field-induced band-shifting, causing probe absorption below the bandgap. While the band-shifting induces an instantaneous response that exists only during pulse overlap, the 2D IR spectra reveal additional off-diagonal features that decay on longer timescales. These longer-lived off-diagonal features result from coherent phonons excited via a Raman-like process at specific excitation frequencies. This study illustrates that the full spectrum 2D IR spectroscopy of electronic states in the mid-IR is possible with current continuum pulse technology and is effective in characterizing semiconductor properties.

Trends in dentate status and preventive dental visits of the adult population in Denmark over 30 years (1987-2017).

This study analyzed the trend in self-reported dentate status over 30 years (1987-2017) among Danish adults, the self-reported frequencies of preventive dental visits undertaken annually during the period 1987-2013, and the self-reported use of the 2016 recall scheme for preventive dental check-ups. The impact of social determinants (education, employment, civil status, and ethnic background) on these dental outcome variables in 2017 was explored. Questionnaire data were obtained from the Danish Health and Morbidity Surveys conducted from 1987-2017, and they were analyzed by tri-variate frequency distributions and multivariate analyses. The prevalence of complete tooth loss was 17.7% in 1987 but 3.4% in 2017. The frequency of adults having 20 or more teeth grew markedly from 1987 (65.9%) to 2017 (85.1%). Educational inequality in dentate status persisted over the period. The frequency of preventive dental visits at least annually increased from 1987 to 2013, although visits were less frequent for young people. In 2017, preventive dental check-ups were reported in intervals: less than 12 months (56.4%), 12-18 months (18.9%), 19-24 months (4.8%), and more than 24 months (5.2%). In 2017, dentate status and preventive dental check-ups varied profoundly by social determinants. In conclusion, social policies should be implemented to tackle the persistent inequities in dentate status and public health policies should target Universal Health Coverage.

Twenty-four-hour fluid administration in emergency department patients with suspected infection: A multicenter, prospective, observational study.

BACKGROUND: To describe 24-hour fluid administration in emergency department (ED) patients with suspected infection. METHODS: A prospective, multicenter, observational study conducted in three Danish hospitals, January 20 to March 2, 2020. We included consecutive adult ED patients with suspected infection (drawing of blood culture and/or intravenous antibiotic administration within 6 hours of admission). Oral and intravenous fluids were registered for 24 hours. PRIMARY OUTCOME: 24-hour total fluid volume. We used linear regression to investigate patient and disease characteristics' effect on 24-hour fluids and to estimate the proportion of the variance in fluid administration explained by potential predictors. RESULTS: 734 patients had 24-hour fluids available: 387 patients had simple infection, 339 sepsis, eight septic shock. Mean total 24-hour fluid volumes were 3656 mL (standard deviation [SD]:1675), 3762 mL (SD: 1839), and 6080 mL (SD: 3978) for the groups, respectively. Fluid volumes varied markedly. Increasing age (mean difference [MD]: 60-79 years: -470 mL [95% CI: -789, -150], +80 years; -974 mL [95% CI: -1307, -640]), do-not-resuscitate orders (MD: -466 mL [95% CI: -797, -135]), and preexisting atrial fibrillation (MD: -367 mL [95% CI: -661, -72) were associated with less fluid. Systolic blood pressure < 100 mmHg (MD: 1182 mL [95% CI: 820, 1543]), mean arterial pressure < 65 mmHg (MD: 1317 mL [95% CI: 770, 1864]), lactate ≥ 2 mmol/L (MD: 655 mL [95% CI: 306, 1005]), heart rate > 120 min (MD: 566 [95% CI: 169, 962]), low (MD: 1963 mL [95% CI: 813, 3112]) and high temperature (MD: 489 mL [95% CI: 234, 742]), SOFA score > 5 (MD: 1005 mL [95% CI: 501, 510]), and new-onset atrial fibrillation (MD: 498 mL [95% CI: 30, 965]) were associated with more fluid. Clinical variables explained 37% of fluid variation among patients. CONCLUSIONS: Patients with simple infection and sepsis received equal fluid volumes. Fluid volumes varied markedly, a variation that was partly explained by clinical characteristics.

Global application of oral disease prevention and health promotion as measured 10 years after the 2007 World Health Assembly statement on oral health.

OBJECTIVES: The WHO World Health Assembly established in 2007 a Resolution (WHA60.17) on oral health, which called upon countries to ensure that public health actions for disease prevention and health promotion are established. The objective of the present survey undertaken 10 years later (2017-2018) was to measure the application of such programmes for key population age groups in low-, middle- and high-income countries. METHODS: Oral health focal points of ministries of health worldwide (n = 101) answered a structured questionnaire on existing national oral health systems and the actual public health activities. The response rate was 58.4%. The questionnaire was used to collect information about structural factors, country workforce, financial models, provision of preventive services and promotion for oral health, school health programmes, administration of fluoride, national oral health targets and oral health surveillance. The countries were classified by national income for analysis of data. RESULTS: Coverage of population groups by primary oral health care and emergency care varied by national income. The gap between countries in delivery of preventive care was strong since low-income countries less often reported preventive activities than middle-income countries and particularly when compared to high-income countries. School oral health programmes were less frequent in low-income than other countries. Moreover, population methods of fluoridation and use of fluoridated toothpaste were unusual in low-income countries. Health education, mass communication and community events were often essential elements in health promotion. In disease prevention, many countries considered the link between oral health and general health conditions and intervention towards shared risk factors of NCDs. The health concern for the consumption of tobacco, unhealthy diet and sugars was particularly emphasized by high-income countries but less highlighted by low-income countries. Finally, while national oral health targets for children and surveillance systems were frequently reported by countries, similar systems for adolescents, adults and older people were rare. CONCLUSIONS: The inequities between countries in oral disease prevention and health promotion were substantial. Limited financial resources for preventive care and health promotion; inadequate workforce for oral health, and insufficient coverage in primary health care were observed in low-resource countries. The results of the survey demonstrate the need for building effective oral health systems oriented towards oral disease prevention and health promotion.

Changing Levels of Dental Caries over 30 Years among Children in a Country of Central and Eastern Europe - The Case of Hungary.

PURPOSE: Improved oral health of children is noted in most Western countries, but this coincides with a high burden of oral disease in several countries of Central and Eastern Europe. The purpose of the present study was to describe the current level of dental caries in Hungarian children aged 5, 6, and 12 years and to assess the long-term trends in caries over 30 years. In addition, the report aims to highlight the oral health habits of 12-year-old children in Hungary. MATERIALS AND METHODS: A representative survey was undertaken in 2016-2017 according to the WHO Pathfinder methodology, which was also applied in previous national oral health surveys of 1985, 1991, 1996, 2001, and 2008. Children of 5-6 and 12 years were sampled systematically in all surveys over 30 years. Data were gathered through clinical examinations and a questionnaire used for 12-year-olds. RESULTS: In 2016-2017, 42.6% of 5- to 6-year-olds were caries free, with the proportion lower in rural than urban settings. Approximately four primary teeth were affected by caries among children aged 5-6 years. Most of the disease burden consisted of untreated caries. Caries experience was higher for children living in rural areas. At age 12, about two permanent teeth suffered from caries, and the D-component of the caries index was high. The percentage of caries-free 6-year-olds grew from 9% in 1985 to 42.6% in 2016-2017. In 1985, 12-year-olds had on average 5 teeth affected by caries, and after 30 years, the level of caries declined to 2.3 DMFT in 2016-2017. The responses to the questionnaire showed that 11.9% of 12-year-olds visited the dentist because of oral pain or discomfort and 40.5% were dissatisfied by the appearance of their teeth. About 40% of children consumed soft drinks or sweets/candy, several times a day. CONCLUSIONS: Hungary has not yet achieved the WHO goals for children aged 5-6. While Hungary accomplished the WHO goal for oral health of 12-year-olds by the year 2000, it is seems unrealistic for the country to achieve the WHO goal for 12-year-olds by the year 2020. For better oral health of children, strong emphasis should be given to population-directed oral disease prevention, including the reduction of sugar consumption and implementing public health programmes for the effective use of fluoride.

Epidemiology of Dental Caries and Disease Prevention Among 12-Year-Olds in Slovenia Over Thirty Years (1987-2017).

PURPOSE: The first large-scale epidemiological survey on dental caries in Slovenia was conducted in 1987 and repeated in 1993, 1998, 2003, 2008, 2013 and 2017, using the same methodology. The aim of the study was to examine the trend of caries in 12-year-olds in Slovenia during a 30-year time period. The changes over time in caries experience were compared with disease trends observed in other European countries. Study Populations and Methods: The WHO National Oral Health Pathfinder Survey was applied in all seven surveys (1987-2017). The surveys were carried out in all nine geographical regions of Slovenia. For each subject, the caries experience and presence of sealants were recorded. RESULTS: The mean DMFT of 12-year-olds decreased significantly from 5.1 in 1987 to 1.5 in 2017 (p < 0.0001). The percentage of persons with sealed teeth increased from 6% in 1987 to 94% in 2017, and the percentage of caries-free persons increased from 6% to 42%. CONCLUSION: The implementation of a nation-wide preventive programme was determined to significantly contribute to the effective control of caries and continuously improve the oral health of Slovenian children. In an international perspective, the Slovenian achievements in disease prevention in terms of caries prevalence reduction may be important for other countries of the region.

'MI' reflections on a pandemic-governed 2020.

Oral/dental healthcare delivery in the post-pandemic era will be different, with challenges to overcome and positive opportunities to take. Managing the needs, wants and expectations of all stakeholders must be communicated and actioned effectively, moving forwards. It is the responsibility of all stakeholders to work together to help provide high quality, evidence-based pragmatic oral healthcare delivery for the future. Patient-focused, team-delivered, minimum intervention oral healthcare (MIOC) is applicable to all patients at all stages of their lives and underpins long-term delivery of better oral and systemic health to all. Guidance, peer-support, whole-team training along with agile commissioning and suitable incentivisation will need to support the paradigm shift to prevention-based MIOC clinical practice.

Heterodyne-detected sum frequency generation of water at surfaces with varying hydrophobicity.

Aqueous surfaces mediate many atmospheric, biological, and technological processes. At the interface, the bulk hydrogen-bonding network is terminated and the interfacial water molecules restructure according to the surface chemistry of the interface. Given the complexity of both natural and technical aqueous interfaces, self-assembled monolayers provide a platform for controllably tuning the chemical composition of the surface and thus the water restructuring. Here, we study a hydrophobic monolayer, a hydrophilic monolayer, and a mixed hydrophobic/hydrophilic monolayer in contact with water. Monolayers composed of both hydrophilic and hydrophobic chains mimic the complex and heterogeneous chemical composition of natural and technological surfaces. By employing heterodyne-detected sum frequency generation, the purely absorptive vibrational line shape of interfacial water is measured experimentally. We examined the structure of the interfacial water in contact with each of the monolayers by analyzing the relative dipole moment orientations and fitting the imaginary component of χ(2) with a combination of Lorentzian and Gaussian line shapes. For all of the monolayers, the hydrogen-bonded water points toward the monolayer, which is opposite of the orientation of the hydrogen-bonded water at the air-water interface. Additionally, a strongly hydrogen-bonded water species exists for the monolayers containing hydrophilic chains. The spectroscopic results suggest that the microscopic water structure in contact with the mixed monolayer is dominated by the hydrophilic parts of the monolayer, while the contact angle shows that at the macroscopic level the surface properties lie closer to the pure hydrophobic monolayer.

Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey.

OBJECTIVES: The aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors. DESIGN: Multicentre descriptive and analytic cross-sectional survey. SETTING: Eight EDs and four clinical microbiology departments in Denmark. PARTICIPANTS: Adults visiting the ED. MAIN OUTCOME MEASURES: Swabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients. RESULTS: We included 5117 patients in the study. Median age was 68 years (54-77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa. CONCLUSION: Every 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad. TRIAL REGISTRATION NUMBER: NCT03352167;Post-results.

Remote real-time supervision via tele-ultrasound in focused cardiac ultrasound: A single-blinded cluster randomized controlled trial.

BACKGROUND: Supervision via tele-ultrasound presents a remedy for lacking on-site supervision in focused cardiac ultrasound, but knowledge of its impact is largely absent. We aimed to investigate tele-supervised physicians' cine-loop quality compared to that of non-supervised physicians and compared to that of experts. METHODS: We conducted a single-blinded cluster randomized controlled trial in an emergency department in western Denmark. Physicians with basic ultrasound competence scanned admitted patients twice. The first scan was non-supervised, and the second was non-supervised (control) or tele-supervised (intervention). Finally, experts in focused cardiac ultrasound scanned the same patient. Two blinded observers graded cine-loops recorded from all scans on a 1-5 scale. The outcome was the mean summarized scan gradings compared with a linear mixed-effects model. RESULTS: In each group, 10 physicians scanned 44 patients. From the mean summarized gradings, on a scale from 4 to 20, the second non-supervised scan grading was 10.9 (95% CI 10.2-11.7), whereas the tele-supervised grading was 12.6 (95% CI: 11.8-13.3). From the first to the second scan, tele-supervised physicians moved 9% (1.09; 95% CI: 1.00-1.19; P = 0.041) closer to the experts' quality than the non-supervised physicians. CONCLUSION: Tele-supervised physicians performed scans of better quality than non-supervised physicians. The present study supports the use of tele-supervision for physicians with basic focused ultrasound competence in a setting where on-site supervision is unavailable.

Remote Real-Time Ultrasound Supervision via Commercially Available and Low-Cost Tele-Ultrasound: a Mixed Methods Study of the Practical Feasibility and Users' Acceptability in an Emergency Department.

Minor emergency departments (ED) struggle to access sufficient expertise to supervise learners of lung and cardiac point-of-care ultrasound (POCUS). Using tele-ultrasound (tele-US) for remote supervision may remedy this situation. We aimed to evaluate the feasibility of real-time supervision via tele-US when applied to an everyday ED clinic. We conducted a mixed methods study that assessed practical feasibility, determined performance, and explored users' acceptability of supervision via tele-US. Technical performance was assessed quantitatively by the ratio in mean gray value between images on site and as received by the supervisor, and by after-compression frame rate. Qualitatively, 12 exploratory semi-structured interviews were conducted with exposed junior doctors and supervisors. Remote supervision via tele-US was performed with 10 junior doctors scanning 45 included patients. During performance assessment, neither alternating internet connection nor software significantly changed the mean gray value ratio. The lowest median frame rate of 4.6 (interquartile range [IQR]: 3.1-5.0) was found by using a 4G internet connection; the highest of 28.5 (IQR: 28.5-29.0) was found with alternative computer and local area network internet connection. In interviews, supervisors stressed the importance of preserving frame rate, and junior doctors emphasized a need for shared ultrasound terminology. In the qualitative analysis, setup mobility, accessibility, and time consumption were emphasized as being of key importance for future clinical implementations. Remote supervision via a commercially available and low-cost tele-US setup is operational for both junior doctors and supervisors when applied to lung and cardiac POCUS scans of hospitalized patients.

Childhood trampoline injuries.

INTRODUCTION: With the increasing use of recreational trampolines, more injuries are seen in emergency depart-ments (ED). Little is known about the relationship between adherence to safety precautions and injuries. This retro-spective study aims to describe the types of injuries and the precautions taken when using trampolines, and to investigate the relationship between injuries and safety precautions. METHODS: We reviewed patient lists and the medical records of children younger than 18 years who were treated between 1 April and 30 September 2014 at the ED of Hospital Unit West, Denmark. Demographic data and type of injury were recorded. Patients or guardians were contacted for a structured telephone interview to describe the safety precautions they had taken before the injury occurred. A total of 113 patients were identified, and 100 patients were included in the phone interviews. A total of 13 patients were excluded due to incorrect/missing phone numbers or lack of a Danish home address. RESULTS: 6% of all children treated in the ED had trampoline-related injuries. A total of 58 (51.3%) patients had fracture injuries, and 55 (48.7%) patients had non-fracture injuries. 4% had complied with all five recommended safety precautions. CONCLUSIONS: This study describes types of injuries and safety precautions related to trampoline use. 6% of all children in the ED had an injury related to trampoline use. 4% complied with all five recommended safety precautions. FUNDING: none. TRIAL REGISTRATION: not relevant.