Site Of Placement Research Articles

Characteristics of practica in early childhood education: Variation in criteria for placements and mentor educators

ABSTRACT Practicum experiences, a critical feature in educator preparation programs, provide preservice educators opportunities to incorporate theory and practice in classrooms while under the supervision of a mentor educator. Although general descriptions of high-quality practicum experiences are provided by professional organizations and accrediting bodies, state licensing and differences across educator preparation programs contribute to variation in these experiences, which in turn have implications for the early childhood workforce. To provide a data-based understanding of program-level requirements for practicum experiences, the current study collected survey data from 227 early childhood higher education programs across 48 states in the U.S. The survey included questions about practicum placement settings, requirements and additional criteria for practicum placement sites, mentor educator requirements, age of children in the classroom, and intensity of practicum experiences. Results show that higher education programs allow several different types of placements with most programs using public school placements. Types of program and ages of children in the classroom were most frequently reported as required criteria and partnerships and feedback were most frequently reported as additional considerations in the determination of placement sites. Mentor educator education and license criteria varied by the age of the children for the practica. Higher education programs varied in the number and hours of practicum offered with more practicum hours in early elementary, kindergarten, and pre-k classrooms than in infant and toddler classrooms. The variations in characteristics and criteria for practicum placements across educator preparation programs are discussed, including implications for early childhood educator preparation programs and future research.

Sequence and gelation in supramolecular polymers.

Supramolecular polymer networks exhibit unique and tunable thermodynamic and dynamic properties that are attractive for a wide array of applications, such as adhesives, rheology modifiers, and compatibilizers. Coherent states (CS) field theories have emerged as a powerful approach for describing the possibly infinite reaction products that result from associating polymers. Up to this point, CS theories have focused on relatively simple polymer architectures. In this work, we develop an extension of the CS framework to study polymers with reversible bonds distributed along the polymer backbone, opening a broad array of new materials that can be studied with theoretical methods. We use this framework to discern the role of reactive site placement on sol-gel phase behavior, including the prediction of a microstructured gel phase that has not been reported for neutral polymer gels. Our results highlight the subtleties of thermodynamics in supramolecular polymers and the necessity for theories that capture them.

The role of medical students in junior doctors’ strikes: A cross-sectional online survey

Objectives The British Medical Association announced a successful vote towards industrial action to achieve ‘pay restoration’ on 20 February 2023; with 11 walkout periods occurring in the following months. During industrial action, concerns arose about the role medical students would play and the pressure placed upon them to ‘act up’. The objective of this study was to assess the guidance issued by medical schools and local placement sites during industrial action. Design, setting and participants This cross-sectional study collected online survey data between 7 March 2023 and 7 April 2023 from medical students across England. Main outcome measures Reports about guidance issued by medical schools and hospital placements. Results 62% of the medical schools issued guidance stating they were not cancelling clinical placements; of these, 10% said attendance was a personal choice. 17% of medical schools cancelled all clinical placements and 7% did not issue guidance. 52% of medical schools monitored attendance on strike days. 1 medical school and 3 clinical placement sites advertised paid work for students during the industrial action. Conclusion The impact industrial action has on medical students has not been examined. Our results show mixed guidance from medical schools that can contradict local placement guidance. This lack of guidance is mirrored in the existing, yet limited, literature. If students feel pressured to perform tasks outside their remit, with inadequate supervision, it can impact patient safety and their license to practice. For the safeguarding of patients, and students, further work is needed to produce standardised guidance during industrial action.

Involvement of veterinary students in the placement of intravenous catheters in adult horses in a teaching hospital does not significantly increase the rate of catheter complications.

To determine whether student involvement in intravenous catheter (IVC) placement increases the risk for complications and to report the rate and types of complications associated with IVCs in adult horses in a university teaching hospital. 455 IVCs placed in 394 horses. Data relevant to IVC placement and removal were retrieved from an electronic medical record search including records of adult horses from January 1 to December 31, 2022. Data retrieved from records included the role of the individual who prepared the site and placed the IVC, site of IVC placement, and type of IVC. The reason for removal of the IVC and presence or absence of detectable changes within the vein at the time of removal were documented in addition to clinical data, allowing for classification of each case. Data were reviewed retrospectively, and statistical analyses were performed using mixed-effects logistic regression models. Significance was set at P ≤ .05. The overall rate of complications was 15.6%, and the most common type of complication was swelling of the vein. Students were involved in 87 of 455 IVC site preparations and placements, and there were no statistically significant differences in complication rates between IVC sites prepared or placed by veterinary students versus nonstudent personnel. Veterinary personnel and clients may be hesitant to allow student involvement in IVC placement in horses, but these data suggest that student involvement does not increase the risk of IVC complications.

Preoperative Counseling in Spinal Cord Stimulation: A Designated Driver in Implantable Pulse Generator–Related Inconveniences?

BackgroundSpinal cord stimulation (SCS) has been reported to cause substantial pain relief and improved quality of life (QoL) in patients with persistent spinal pain syndrome (PSPS). Despite implantable pulse generator (IPG)-related inconveniences such as pain, shame, and discomfort affecting QoL and patient satisfaction, these are often neglected. Hence, the current study aims to determine the associations between patient satisfaction, IPG-related inconveniences, and preoperative counseling in a homogeneous group of patients with PSPS receiving SCS with IPG implantation in the gluteal or abdominal area. Materials and MethodsRetrospective data on sample characteristics were gathered from the EPIC (electronic health record software) digital patient data base. Prospective data on patient satisfaction were obtained with a questionnaire that covered various topics such as shame, pain, disturbances in daily/intense activities, night rest and/or sleep, discomfort caused by clothing, and preoperative counseling. The exact location of the IPG and its scar were determined with photo analysis. Thereafter, the site of IPG placement was classified into separate quadrants within the gluteal and abdominal area. Patient satisfaction was defined as accepting the current location of the IPG without having the wish to undergo revision surgery. ResultsIn total, 81 participants (50.9 ± 10 years) were included in this analysis, with patient satisfaction observed in 61 patients (75.3%). Among satisfied patients, more extensive preoperative counseling concerning IPG pain and discomfort was reported compared with patients who were not satisfied (p < 0.001). When comparing the two groups, significant differences were found in shame (8/81, 9.9%), IPG site pain (21/81, 25.9%), disturbance of activities (42/81, 51.9%), and clothing-related discomfort (42/81, 51.9%). ConclusionsOn the basis of the current results, shared decision-making and comprehensive preoperative provision of information are recommended to optimize patient satisfaction regarding IPG pain, discomfort, and inconveniences. Although many patients experience these disadvantages despite successful SCS for pain related to PSPS, most of them accept this if they have received adequate preoperative information about expectations.

Enhancing Mass Vaccination Programs with Queueing Theory and Spatial Optimization.

Mass vaccination is a cornerstone of public health emergency preparedness and response. However, injudicious placement of vaccination sites can lead to the formation of long waiting lines or queues , which discourages individuals from waiting to be vaccinated and may thus jeopardize the achievement of public health targets. Queueing theory offers a framework for modeling queue formation at vaccination sites and its effect on vaccine uptake. We developed an algorithm that integrates queueing theory within a spatial optimization framework to optimize the placement of mass vaccination sites. The algorithm was built and tested using data from a mass canine rabies vaccination campaign in Arequipa, Peru. We compared expected vaccination coverage and losses from queueing (i.e., attrition) for sites optimized with our queue-conscious algorithm to those obtained from a queue-naive version of the same algorithm. Sites placed by the queue-conscious algorithm resulted in 9-19% less attrition and 1-2% higher vaccination coverage compared to sites placed by the queue-naïve algorithm. Compared to the queue-naïve algorithm, the queue-conscious algorithm favored placing more sites in densely populated areas to offset high arrival volumes, thereby reducing losses due to excessive queueing. These results were not sensitive to misspecification of queueing parameters or relaxation of the constant arrival rate assumption. One should consider losses from queueing to optimally place mass vaccination sites, even when empirically derived queueing parameters are not available. Due to the negative impacts of excessive wait times on participant satisfaction, reducing queueing attrition is also expected to yield downstream benefits and improve vaccination coverage in subsequent mass vaccination campaigns.

997 Ascending Aorta Pseudoaneurysm 40 Years Following Surgical Atrial Septal Defect Repair

Abstract Background Ascending aorta pseudoaneurysm is a rare postoperative complication of cardiac surgery. It is often attributed to infection and dehiscence at sites of aortotomy, cannulation, cross-clamp placement, and proximal coronary anastomoses. Mortality risk is 29-46% and this requires prompt surgical intervention. Case summary A 48-year-old woman who underwent atrial septal defect repair at 8 years of age, presented with chest pain radiating to the right shoulder and dyspnoea. Cardiac-gated CT angiography demonstrated a 21mm pseudoaneurysm arising anteriorly from the proximal ascending aorta, 6mm above the right coronary artery ostium, likely the site of previous cardioplegia cannula. There was active blood flow from the aorta into the pseudoaneurysm sac. It was heavily calcified, apart from a thinned irregular wall inferiorly, from which rupture was imminent. She underwent emergency surgery. Using femoro-femoral cardiopulmonary bypass, the chest was safely re-entered. Under mild hypothermia and distal ascending aorta cross-clamping, the pseudoaneurysm was resected and aorta repaired using a Gelweave patch. The patient recovered uneventfully and was discharged home after one week. Discussion Accurate imaging, primarily via cardiac-gated CT angiography, is crucial for diagnosis and surgical planning in patients presenting with aortic pseudoaneurysm, particularly those close to the aortic valve and coronary arteries. Operative strategy, including need for deep hypothermic circulatory arrest and/or graft replacement of aorta, depends on pseudoaneurysm anatomy. It is recommended that preventative measures are taken during the primary operation, inserting the cardioplegia cannula tip through full-thickness purse-strings and/or addition of separate oversewing sutures after decannulation. Alternative techniques of pseudoaneurysm repair are also discussed.

Effect of Fiber-Reinforced Composite Placement Site on Fracture Resistance of Premolar Teeth: An in vitro Study.

This study aimed to investigate the fracture behavior of upper premolars with deep MOD cavities that were restored with Ribbond resin-reinforced fibers (FRCs) placed in different orientations. A total of 54 extracted maxillary premolars were randomly divided into nine groups. The experimental groups underwent MOD cavity preparation with or without root canal treatment, followed by FRCs placed in the pulpal floor, proximal walls, or both. Fracture resistance was tested using an Instron Machine. The samples were visually inspected to analyze the fracture mode. The highest fracture resistance was observed in intact teeth (1299.98 ± 284.66 MPa). Placing Ribbond fibers in the pulpal floor (1155.86 ± 244.21 MPa) or the proximal walls (1077.56 ± 260.60 MPa) significantly improved fracture resistance (p= <0.05), compared to cavities restored with only resin composite (804.58 ± 93.34 MPa). However, placing Ribbond fibers in both the pulpal and proximal walls did not enhance fracture resistance. In the MOD-RCT groups, fracture resistance was improved only when Ribbond fibers were placed in the pulpal floor and the proximal walls. Fracture mode analysis revealed a combined fracture in most of the groups. This study concluded that using FRCs significantly improved the fracture resistance of MOD cavities in premolars and revealed that the placement site could be a determinant factor.

Enterococcal Bacteremia outbreaks during SARS-COV-2 in Intensive Care Unit (ICU): The role of Strain Identification

Background: An unprecedented burden of morbidity and mortality has been reported in patients admitted to healthcare facilities with SARS-COV-2 infection globally since March 2020. A higher incidence of ICU-acquired bloodstream infection has been described with the cumulative risk increased with the length of ICU stay, use of steroids, anti-inflammatory agents, and indwelling catheters. Additionally, SARS-COV-2 infection may increase the risk of bacteremia from gastrointestinal flora such as Enterococcus species by disrupting the gastrointestinal barrier and microbiome. Methods: We aimed to investigate the outbreaks of Enterococcus bacteremia in patients with SARS-COV-2 infection and included patients aged&gt;18 years admitted to the ICU at the Oklahoma City Veterans Affairs Medical Center who were infected with SARS-COV-2 and were identified as having positive blood cultures for Enterococcus faecalis, Enterococcus faecium including vancomycin-resistant species and other bacterial or candida species between March 1, 2020, to March 9, 2022. We collected the following data: duration of hospitalization including ICU stay, unit and room location during the hospital stay, blood culture collection date and results, duration, and site of central line placement, duration of ventilation, administration of antimicrobials and COVID-19 directed therapeutics using computerized patient record system (CPRS). We sent 10 E. faecalis and 12 E. Faecium isolates for genetic analysis. DNA was sequestered from each isolate and multi-locus sequence typing (MLST) was performed by amplifying 7 regions of the E. faecalis genome and 7 regions of the E. faecium genome by polymerase chain reaction (PCR). Resulting amplicons were sequenced and allele type for each gene region and overall sequence type was determined using MLST database (http://pubmlst.org). Results: There were 22 episodes of enterococcal bacteremia in a 3-month duration in the ICU in 20 patients of which 17 were associated with another episode with the same strain (Figure-1-2). Central line placement was noted in 18/22 episodes. Genetic analysis by multi-locus sequence typing of enterococcal bacterial strains was performed by the Public Health Reference Laboratory, Palo Alto. Similar strains were localized to patients in the same geographical region in the ICU (Figure 3). The isolates from 2 other patients who presented with the same strain of Enterococcus but were never hospitalized at the same time during the COVID-19 pandemic were localized to another hospital where both had received care at different times. Conclusion: Higher rates of enterococcal bacteremia were reported during the SARS-COV-2 pandemic. Geographical proximity with strained infection control measures accounted for ICU outbreaks seen in our tertiary care setup.

Surface methodology for optimized adsorption of hazardous organic pollutant from aqueous solutions via novel magnetic metal organic framework: Kinetics, isotherm study, and DFT calculations

An efficient way to remove Janus Green B (JGB) dye from contaminated water sources is using of magnetic cerium (III) metal–organic framework (MCe-MOF). Analytical methods such as PXRD, TEM, FESEM, FT-IR, PZC, and XPS were used in the characterization of the MCe-MOF microspheres in order to assess the phase, crystallinity, shape, surface characteristics, and chemical composition of the MCe-MOF material. Impressive physical characteristics of the synthesized MCe-MOF material included a high surface area of 1340.05 m2/g. Conversely, MCe-MOF’s magnetic saturation (MS) was measured at 36.47 emu.g−1. The purpose of the study was to determine if MCe-MOF could effectively remove JGB dye from wastewater by adsorption. Adsorption settings that were studied included pH, adsorbent dose, beginning dye concentration, contact time, and temperature. The JGB electrical characteristics, reactivity, and shape were ascertained through the application of density functional theory (DFT). The placement of electrophilic and nucleophilic attack sites is in good agreement with the molecular orbitals (HOMO and LUMO) and MEP results, according to DFT. Based on the findings, MCe-MOF had a high capacity for adsorbing JGB dye, with an adsorption data fit by pseudo-second-order kinetic models and the Langmuir isotherm. It was evident from the adsorption energy of 27.8 kJ.mol−1 that chemisorption was the mode of adsorption. The optimal conditions for attaining a high adsorption capacity were found to be pH 8 and 0.02 g of MCe-MOF dose. The adsorption process of JGB dye onto MCe-MOF was seen to be spontaneous, endothermic, and random, as indicated by the temperature-dependent increases in the thermodynamic parameters ΔGo, ΔHo, and ΔSo. The adsorption process was optimized through the application of Response Surface Methodology and Box-Behnken design (RSM, BBD). The successful removal of dyes from the MCe-MOF material was made possible by these methods. While π-π bonding happens through the interaction of aromatic rings, chemisorption entails the formation of chemical interactions between the adsorbate and adsorbent. Electrostatic interactions arise from the attraction or repulsion of charges between the adsorbate and adsorbent, and pore-filling happens when the adsorbate fills the adsorbent’s pores. For the removal of JGB dye from wastewater, MCe-MOF exhibits great potential as an adsorbent because of its numerous adsorption processes and high adsorption capacity.

Development and validation of a community risk score for sexual and reproductive health in the United States.

Equitable access to sexual and reproductive health (SRH) care is key to reducing inequities in SRH outcomes. Publicly funded family-planning services are an important source of SRH care for people with social risk factors that impede their access. This study aimed to create a new index (Local Social Inequity in SRH [LSI-SRH]) to measure community-level risk of adverse SRH outcomes based on social determinants of health (SDoH). We evaluated the validity of the LSI-SRH scores in predicting adverse SRH outcomes and the need for publicly funded services. The data were drawn from more than 200 publicly available SDoH and SRH measures, including availability and potential need for publicly supported family planning from the Guttmacher Institute. The sample included 72 999 Census tracts (99.9%) in the 50 states and the District of Columbia. We used random forest regression to predict the LSI-SRH scores; 42 indicators were retained in the final model. The LSI-SRH model explained 81% of variance in the composite SRH outcome, outperforming 3 general SDoH indices. LSI-SRH scores could be a useful for measuring community-level SRH risk and guiding site placement and resource allocation.

Novel composite from chitosan and a metal-organic framework for removal of tartrazine dye from aqueous solutions; adsorption isotherm, kinetic, and optimization using Box-Benkhen design

Cosmetics, textiles, foodstuffs, and medicines frequently contain the yellow dye tartrazine. It has carcinogenic properties and can trigger allergies. In this study, a unique NH2-MIL-101(Cr)/chitosan composite (MIL/chitosan composite) was created using a hydrothermal process. The effectiveness of this composite in removing Tartrazine (TZ) from aqueous solutions was investigated. It was characterized via FT-IR, XPS, XRD, and BET analysis. The surface area of the MIL/chitosan nanoadsorbent sample was 1256.64 m2/g, where after five times recycling, it was reduced to 1068.14 m2/g. The study analyzed the impact of dye concentration, pH, temperature, and MIL/chitosan composite dosage. Experimental measurements were taken for the equilibrium isotherms of dye adsorption. The kinetic models and adsorption isotherm were used to analyze the results. The adsorption process was found to match Langmuir and pseudo-second-order kinetic models. Chemisorption was the mechanism of the adsorption process. Based on thermodynamic parameters, it was determined that the adsorption process was endothermic. The MIL/chitosan composite was recycled up to five cycles. Using the MIL/chitosan composite towards the adsorption of the tartrazine from the real sample has been checked. The interaction process between the MIL/chitosan nanoadsorbent and Tartrazine adsorbate has been investigated. The TZ electrical characteristics, reactivity, and shape were ascertained through the application of density functional theory (DFT). The placement of electrophilic and nucleophilic attack sites is in good agreement with the molecular orbitals (HOMO and LUMO) and MEP results, according to DFT. The optimization of adsorption results was accomplished using Box-Behnken design (BBD).

Improving the quality of allied health placements: student, educator and organisational preparedness

ABSTRACT Work Integrated Learning is essential for healthcare degrees where students learn to become healthcare professionals. As a complex form of learning the quality of student placement experiences are variable, impacting student wellbeing and development of professional competencies. Getting it right, students enter the workforce ready to practice. Getting it wrong can have deleterious effects on all stakeholders. Although research has examined placement quality for students, less is known about the experiences of other stakeholder groups (e.g. placement educators, university academics and professional support staff). Our research addresses this gap. Using narrative interviewing methods, underpinned by social constructionism, we interviewed fifty-one participants: 19 allied healthcare students, 15 placement educators, 12 university academics and 5 professional staff from a large Australian university. We identified four preparedness themes impacting on placement quality, namely: University, Placement Site, Placement educator and Student preparedness. Within these themes, good practice is highlighted alongside examples of unsettling experiences. Curricula should be reviewed to ensure students are prepared as agentic learners for the complexities of the workplace. Furthermore, universities should co-design placements in partnership with healthcare organisations and educators to enable students to optimise their learning and contribution to patient/client care.

Approach to Severe Mitral Annular Calcification Using Ultrasonic Aspiration

Severe mitral annular calcification (MAC) is perhaps the greatest challenge faced in mitral valve surgery. Valve replacement in the setting of severe MAC carries with it the risk of numerous surgical complications and modes of technical failure, including catastrophic atrioventricular (AV) groove disruption. In the face of these challenges, a variety of surgical approaches to severe MAC have been described but without clear consensus. We describe an approach using the Cavitron Ultrasonic Surgical Aspirator (CUSA) emphasizing minimal, focal disruption of annular calcium. Ultrasonic aspiration is applied only when needed and only at the precise site of valve suture placement to aspirate away or merely soften dense calcium such that sutures can be placed through or around the calcified annulus. Our approach is simple and eliminates the need for complete annular decalcification which risks avoidable AV groove destabilization and requires complex annular reconstruction. In our experience of 55 cases of high-risk mitral replacement in the setting of very severe MAC, we report two cases of AV groove disruption (4%), two cases of coronary injury (4%), and two cases of stroke (4%), with no cases of paravalvular leak worse than mild. In-hospital mortality was 16%, due largely to significant underlying cardiac and non-cardiac comorbidity and underscoring the often underestimated non-technical risks inherent in these cases. While no single approach may be optimal in every case of severe MAC, we feel our technique of limited ultrasonic aspiration is an important tool in the mitral surgeon's armamentarium.

Consumer experience and outcomes of insertion, removal, and management practices of short and midline peripheral intravenous catheters in acute health care: a mixed methods systematic review protocol.

This review will synthesize and integrate current research on the practices relating to the insertion, removal, and management of short and midline peripheral intravenous catheters on consumer experiences and outcomes in acute health care. The aim is to provide consolidated evidence to support policy decision-makers and health care workers in overcoming peripheral intravenous catheter device management challenges. Implementing the evidence provided by this review could increase positive consumer outcomes and reduce the gap between research evidence and clinical practice. Peripheral intravenous catheterization is a process in which a device is inserted into a patient's peripheral vein to administer medication, blood products, and therapeutic fluids. Recent studies have demonstrated the positive and negative impacts of peripheral intravenous catheter site placement, pain relief for insertion, complications, consumer engagement, and routine versus clinically indicated removal of these devices on consumers and the health care system. Managing these impacts in relation to research-practice gaps and conflicting evidence remains challenging. Moreover, consumer experiences and outcomes concerning these challenges are unclear. This review will consider quantitative, qualitative, and mixed methods studies on consumer experiences and outcomes in acute health care. The quantitative component will consider outcomes of patients' pain, satisfaction, anxiety, distress, preferences, fear, and comfort. The qualitative component will consider consumer experiences, including perceptions, preferences, perspectives, attitudes, expectations, and satisfaction. This study will follow JBI's convergent segregated approach for mixed method systematic reviews. A search of 11 databases will be conducted for peer-reviewed published articles, theses, and dissertations. There will be no age, date, or language limitations. PROSPERO CRD42023410214.

Patellar instability in a prothesis knee: MPFL plasty using hamstring tendon

Introduction: instability of the patella remains a frequent cause of failure following arthroplasty; requires treatment and a precise radiological assessment. Several therapeutic options are possible, including ligamentoplasty of the medial patellofemoral ligament, which is increasingly used, thus proving its effectiveness. Observation: we report the case of an octogenarian patient with gonarthrosis of the knee that has been progressing for several years. He benefited from a knee prosthesis, the consequences of which were marked by a progressive lateral tilt of the patella. Technique: installed in the supine position with resumption of the old approach, sampling of the half tendon was carried out with preparation of the graft on the table. The careful release of the joint and preparation of the graft placement sites then the approach to the lateral side of the patella allowed us to expose the external wing on which an external release of the patella was carried out. Fixing the graft was made, with transtendinous passage on the patellar tendon and quadriceps. Fixation on the femoral side was made by two anchors. Immobilization maintained for 45 days. Discussion: The surgical management of patellar instability on total knee prosthesis involves a diversity of surgical techniques which can be used alone or in combination depending on the etiology. Procedures involving soft tissues ranging from simple external release to MPFL plasties, as well as bone procedures which may require changing prosthetic parts in the event of a rotation defect. Conclusion: MPFL plasty is effective in the management of post-arthroplasty patellar instability and has its place in the treatment of patellar dislocations following total knee prosthesis. It is offered either as a complement to other procedures and in particular to a prosthetic revision

Morphological evaluation of the nasopalatine canal using cone beam computed tomography and its clinical implications for orthodontic miniscrew insertion.

The morphology of the nasopalatine canal is crucial in the planning of prosthetic restorations in the anterior region of the maxilla, as well as in the placement of orthodontic mini-implants. The aim of this study was to assess the morphology of the nasopalatine canal using cone beam computed tomography (CBCT) scans of patients from the University Dental Clinic in Krakow, Poland, to define the position of the canal in relation to common sites of palatal median microimplant placement, and to investigate potential correlations between the anatomy of the canal and age and gender of the patients. A total of 120 CBCT images were used to assess the anatomy of the nasopalatine canal in 3 planes of space. The bone thickness anterior to the nasopalatine canal and the distance between the distal margin of Stenson's foramen and the predicted midpalatal microimplant position were also measured. The most frequently observed canal type in the coronal plane was the Y-shaped canal, which was present in 60.8% of patients. The nasopalatine canal was classified as cone-shaped in 31.7% of the scans, cylindrical in 28.3%, hourglass-shaped in 27.5%, and banana-shaped in 12.5%. The mean length of the nasopalatine canal was 11.58 mm. The mean width of the canal was 2.89 mm at the nasal fossa level, 1.94 mm in the middle, and 5.09 mm at the palatal level. The mean bone thickness anterior to the nasopalatine canal was 9.07 mm at the level of the nasal opening, 6.84 mm at the level of the oral opening, and 7.32 mm in the middle. The mean distance between the distal margin of Stenson's foramen and the predicted midpalatal microimplant position varied from 0 to 11.94 mm, with a mean of 2.49 mm. Given the variety of nasopalatine canal forms and dimensions, detailed analysis of CBCT scans is essential prior to the placement of implants and microimplants.

ICU NURSES AND VAD ADHERENCE TO INS 2021

Abstract Background Continuous updates and evidence–based nursing practices are vital for quality patient care. In 2021, the Infusion Nursing Standard (INS) have updated vascular access device (VAD) guidelines. Evaluating nurses’ VAD knowledge according to these guidelines will improve caring quality, particularly for ICU patients that need a functioning VAD. Aim To evaluate the knowledge of ICU nurses regarding VADs according to the latest INS 2021 guidelines. Material and methods A cross–sectional study was conducted on a sample of nurses providing direct care to ICU patients. A web survey was administered using the “Nurses’ Knowledge and Self–Efficacy on Vascular Access” instrument, which assesses nurses’ knowledge and self–efficacy in relation to short (SPC) and long peripheral canula (LPC), PICC, and PORT, as for INS 2021 guidelines. The survey consisted of 32 items with four closed–answer options, of which only one was correct. Competence and skill levels were calculated by summing the correct responses and standardizing the result to 100. Results Some 35 nurses have enrolled, with an average age of 37 years (SD= 10.80), including 16 men and 19 women, working in UTIC, ICU and Stroke Unit. The highest adherence score (97%) has been registered for the PICC flushing technique before and after each use. The lowest result (14%) has been obtained regarding the performing method of blood sampling from a central VAD. Other positive results have been achieved in the selection of the correct placement sites for all VAD types, with score exceeding 90%. The second part of the questionnaire, which focused of nurses’ self–confidence, showed that nurses felt most confident in SPC section, followed by the PORT section, LPC, and lastly, PICC. Conclusions ICU nurses have a good level of competence and self–efficacy about the VAD management, adhering to the 2021 INS guidelines, although gaps have been identified in the management of SPC and some techniques and despite the high self–confidence expressed directly by nurses. Healthcare organizations should continuously monitor the ICU nurses’ competencies and skills level to implement targeted intervention and ensure the application of evidence in clinical practice, thereby improving the patients’ quality of care.

Effects of Smokeless Tobacco on Oral Health: A Cross-Sectional Study.

Smokeless tobacco (SLT) consumption poses a significant global public health challenge because of its adverse effects on oral health. Although the detrimental impact of SLT on oral tissues is well-documented, understanding its multifaceted effects is essential for effective prevention and intervention strategies. This study aimed to comprehensively assess the impact of SLT on oral health, focusing on various clinical parameters and their differences between placement and non-placement sites of SLT. A cross-sectional study involving 528 habitual users of SLT was conducted. Clinical parameters included the plaque index (PI), gingival index (GI), gingival bleeding index (GBI), gingival recession (GR), and probing depth (PD). Oral mucosal changes at SLT placement sites have also been reported. Statistical analysis was performed to compare parameters between the placement and non-placement sites. The study involved 528 subjects, mostly male (82%) and aged 21-40 years (mean±SD=31.14±9.10), habitual users of SLT. Prevalent SLT types included tobacco with betel nuts/masala/gutkha (59.9%) and tobacco with lime (54.5%). Significant differences were observed between SLT placement and non-placement sites: higher gingival inflammation (GI) at placement sites (1.54±0.61 vs. 1.45±0.54, p=0.01), lower GBI at placement sites (40.0% vs. 84.3%, p=0.001), and more prevalent GR (65.7% vs. 34.3%, p=0.03) at placement sites. Probing depths ≥ 3 mm were also less frequent at placement sites (2.67±0.72) than non-placement sites (3.37±1.03, p=0.001). These results highlight the detrimental impact of SLT on periodontal health, emphasizing the need for targeted interventions among SLT users. SLT use is associated with adverse effects on oral health, including GI, plaque accumulation, gingival bleeding, GR, and changes in the oral mucosa. Targeted interventions and public health policies are needed to address these issues effectively.

Strategic Planning of Rural Telecommunication Infrastructure: A Multi-Source Data Fusion and Optimization Model

Abstract. The United Nations has underscored the critical role of digital connectivity by integrating it into several sustainable development goals, with the ambition for nations worldwide to achieve comprehensive access by 2030. Over thousand million people, primarily in rural areas, are disconnected from the digital world, highlighting the urgent need for viable and sustainable telecommunications solutions. These areas are characterized by sparse populations and lower economic levels, presenting great challenges for connectivity. This work introduces a strategy for enhancing rural telecommunication planning using geospatial and remote sensing data, deep learning-based clustering techniques, network graphs, and terrain analysis. The objective is to develop an optimal network topology and identify prime locations for telecommunications infrastructure, such as towers or relay stations. The methodology begins with the application of an adapted Deep Embedded Clustering (DEC) technique to identify community boundaries accurately. Then, it combines geospatial data (such as roads, terrain slope, flatness, etc.) and remote sensing data (vegetation, waterways, etc.) through an optimization algorithm. This process aims to determine the most suitable sites for infrastructure placement and the best network topology for connecting these areas. The study focuses on the region of Congo, offering a detailed case study on the application of this approach. Experimental results are presented to demonstrate the effectiveness of the proposed telecommunications expansion strategy.