Dental students' attitudes on cardiopulmonary resuscitation training via virtual reality: an exploratory study.

Purpose Resuscitation guidelines have advocated the use of virtual learning as a form of pre-course e-learning. Virtual reality (VR) has been identified to provide a method of constructive learning with instant feedback. There are increasing publications of VR use in cardiopulmonary resuscitation (CPR) training; however, there is a dearth from the dental profession. Therefore, the aim of this exploratory study was to investigate dental students' opinions in CPR training using VR.Methods In total, 120 dental students undertook both conventional (manikin) and VR CPR training in a cross-over design. The VR scenario was in a hospital setting. Following, students completed a questionnaire evaluating their experiences.Results The majority of students (n = 88) reported that this was the first time that they had utilised VR. The experience of using VR in CPR training was rated as very good. Most students felt that the inclusion of VR in CPR training created a better learning experience and had a high learning potential. However, the hospital setting was not entirely relevant.Conclusion Dental students recommended that VR CPR training should be used as an adjunct to conventional training in dental education, but the VR scenario would benefit being a virtual dental environment.

Short-term risk assessment in the long term: A scoping review and meta-analysis of the Brøset Violence Checklist.

WHAT IS KNOWN ON THE SUBJECT?: The Brøset Violence Checklist (BVC) has been widely translated and implemented in diverse mental healthcare settings to improve prevention of violence. It is valued as a brief but effective tool in clinical practice. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review is the largest and most comprehensive international review of the BVC conducted in the 25+ years since the inception of the instrument in 1995. It integrates findings from existing studies and establishes that the tool has many impressive strengths considering the brief time investment required for completion. The review reveals that the tool has been used in more than 20 different countries around the world in a variety of mental health and other settings as both a risk assessment tool to guide clinical practice and as a formally structured intervention to minimize violence. There is much variation in how the tool is implemented and scored in different services. This variation questions its applicability as a resource and consistency and its use needs attention. This variation in use also limits the conclusions regarding best practices. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The review supports the use of the BVC as one part of the package for mental health services committed to preventive action aimed at reducing violence and coercion. The review identified that the patient perspective was often absent when completing the BVC, and so this should be considered as an option by services as part of a collaborative philosophy of care. ABSTRACT: INTRODUCTION: Existing literature on the Brøset Violence Checklist (BVC) is examined in the context of usability, implementation and validity to provide evidence-based recommendations on its application and identify opportunities for future development. AIM/QUESTION: To identify current knowledge on the BVC and guide clinicians and researchers toward the next steps in using this tool in clinical practice to prevent violence in healthcare settings. METHOD: A scoping review approach with a meta-analysis supplement was adopted to broadly identify and map available evidence on the BVC and provide specific estimates of predictive validity in different contexts. RESULTS: Sixty-two studies conducted in 23 countries addressed the implementation of the BVC across various settings. Many studies adapted the original BVC, and the clinical utility was noted as an important feature. A meta-analysis of the original BVC format estimated a pooled area under the curve at 0.83 (95% CI 0.78-0.87) in a subset of 15 studies. DISCUSSION: The BVC combines high predictive validity and good clinical utility across a wide range of settings and cultures. It should continue to be incorporated into routine practice in mental health services focused on preventing violence and coercion. IMPLICATIONS FOR PRACTICE: Development of collaborative approaches with service users involved in assessing their own risk of future violence.

National Strategies to Reduce the Use of Coercive Measures in Psychiatry in Denmark - A Review of Two Decades of Initiatives.

Coercive measures are a major infringement of the autonomy of psychiatric patients and no medical justification exists for applying mechanical restraint (MR) to these patients currently. Knowledge regarding how preventive strategies affect the use of MR is limited. This paper aimed to understand the link between the initiatives taken by national authorities and the practical implications to MR reduction. Policy texts and the number of coercive measures used in two decades were reviewed. Trends were discussed with five experts with real-life experience and suggestions were obtained regarding how to end the use of mechanical restraint in mental health care settings.

Modelling mercury concentration in Ghanaian soil.

Mercury usage in Artisanal Small Scale Gold Mining is a major anthropogenic source of mercury in the environment. In this study, mercury pools and fluxes have been established for Ghana, which has a large ASGM sector, based on estimated losses of mercury to the environment, deposition calculated with GLEMOS, a global long-range transport model for mercury in air, and mercury measured in soils and water in Ghana. A model for mercury in soils and water of Ghana with a resolution of 5 × 5 km2 and a monthly or yearly time step has been developed to assess the regional increase in soil and water concentrations that can be attributed to anthropogenic sources and to simulate scenarios into the future. The model has been calibrated to reproduce present-day mercury concentration in the soil (average 0.0193 mg kg-1) with current deposition calculated with the long-range transport model and past years' deposition based on a scenario for the historic development of the mining activity. This calculation gives an average increase in soil concentrations from anthropogenic sources of 22%. The model gives a fair description of the regional differences in soil concentrations but underestimates concentrations in regions with intense mining activity and overestimates concentrations in regions with less mining when using deposition from the long-range model as input.

Effects of Implementing the Short-Term Assessment of Risk and Treatability for Mechanical Restraint in a Forensic Male Population: A Stepped-Wedge, Cluster-Randomized Design.

The assessment and formulation of the risk of violence and other unwanted behaviors at forensic psychiatric facilities have been attempted for decades. Structured professional judgment tools, such as the Short-Term Assessment of Risk and Treatability (START), are among the recent attempts to overcome the challenge of accomplishing these goals. This study examined the effect of implementing START in clinical practice for the most serious adverse events among the target group of severely mentally ill forensic psychiatric inpatients. Results were based on the use of mechanical restraints as an outcome. This study is a pragmatic, stepped-wedge, cluster-randomized controlled trial and was conducted over 5 years. It included eight forensic psychiatric units. Fifty out of 156 patients who had a basic aggression score of more than 0 were included in the study. We found that the rate of mechanical restraint use within the START period were 82% [relative risk (RR) = 0.18], lower than those outside of the START period. Patients evaluated within the START period were also found to have a 36% (RR = 0.64) lower risk of having higher Brøset Violence Checklist scores than patients evaluated outside the START period. Previous studies on START have primarily focused on validation, the predictive capability of the assessment, and implementation. We were only able to identify one study that aimed to identify the benefits and outcomes of START in a forensic setting. This study showed a significant reduction in the chance for inpatients in a forensic psychiatric facility to become mechanically restrained during periods where the START was used as risk assessment.

Does mercury emission from small-scale gold mining cause widespread soil pollution in Ghana?

The use of mercury in small-scale gold mining is globally the largest anthropogenic source of mercury in the environment. In countries like Ghana, where small-scale gold mining is a highly important economic sector, the activity is also expected to cause local pollution. This study is based on a hypothesis that the mining activity in Ghana is causing more widespread soil pollution also outside active mining sites, and that the main part of regional differences in soil concentrations of mercury might come from pollution. Little systematic and dependable data has been collected to assess the extent of mercury contamination of soils in areas outside active mining areas. The regional aspect of mercury pollution from mining has not been studied in Ghana or other countries with a large small-scale gold mining sector. Systematic collection of soil samples on a 25 × 25 km2 net covering the entire country was carried out to ensure the representativeness of data and to allow calculation of spatial trends. The soil concentrations found in one-third of the country, where most intensive mining takes place, are three times higher than concentrations in the rest of the country. This difference cannot be explained by sources of natural variation in mercury concentrations but can be explained by decades of atmospheric deposition. It is therefore likely that the mining activity has caused a more widespread increase in soil concentrations, also outside active mining sites. The mercury concentrations found are on average 0.024 mg kg-1, which is low compared to published studies from other countries and regions and estimated world averages. All measured concentrations are well below soil quality criteria for human health. The build-up of soil concentrations in the mining area is still problematic because mercury is a hazardous substance in the environment.

Vulnerability of Aquatic Insect Species to Insecticides, Depending on Their Flight Period and Adult Life Span.

Effects of insecticides on terrestrial adult life stages of otherwise aquatic insects, such as mayflies (Ephemeroptera), stoneflies (Plecoptera), and caddisflies (Trichoptera), are largely unknown. In the present study, a risk model was used to pinpoint the species most likely to experience effects due to spray drift exposure during the adult life stage. Using data from an earlier case study with lambda-cyhalothrin, 6 species with different life cycle traits were used to explore how life cycle characteristics may influence vulnerability. In addition, we performed a generic calculation of the potential effect on the terrestrial life stages of 53 species (including 47 species with unknown sensitivity). Our approach incorporated temporal and spatial distribution of both the insect and the insecticide, creating different exposure conditions among species due to variation in the relative proportion of the populations present at the time of insecticide spraying. The Ephemeroptera species represented were least vulnerable due to their extremely short adult life span and relatively short flight period. Based on their life cycle characteristics, Plecoptera and Trichoptera species were more vulnerable. These vulnerable species segregated into 2 distinct groups; one with a long adult life span to emergent period ratio and another with a high overlap between emergent period and spraying season. We therefore recommend that future ecotoxicological tests be done on species with these life cycle characteristics. Environ Toxicol Chem 2021;40:1778-1787. © 2021 SETAC.

Contamination, exposure and risk assessment of mercury in the soils of an artisanal gold mining community in Ghana.

Mercury pollution has pervaded many artisanal gold mining communities in the world, especially in developing countries. This study aimed to evaluate the potential risk of mercury pollution in soils in Gbani, an artisanal gold mining community in Ghana. Two hundred and thirty-seven soil samples were collected from within 0-10 cm depth, from active mining sites near residences, two transects in the community, waste soil from mining processing and the surroundings of the community. The measured mean mercury soil concentrations were 71 mg Hg/kg in active mining sites, and more moderate (2.7 mg Hg/kg) along transects through the community. Enrichment Factors classified the soils of the study area as being moderately to extremely severely contaminated with mercury. The spatial distribution shows the contamination of mercury is highest at residential facilities and decreases through the community to the outskirts covered by vegetation. Hazard quotients for non-cancer effects identified air-borne exposure pathways for humans to pose the largest risk, including the inhalation of vapour. The average hazard indices recorded were 0.5 (child) and 0.1 (adult) at the grid, 2 (child) and 0.3 (adult) at the transects, 1.6 (child) and 0.2 (adult) for waste soil and 76 (child) and 10.9 (adult) at the mining sites. The inhabitants of Gbani community are therefore at risk of non-cancer effects of mercury as the hazard quotients and hazard index were above one.

Cone beam CT and treatment decision of mandibular third molars: removal vs. coronectomy-a 3-year audit.

OBJECTIVES: To assess: (1) the workflow in the treatment decision process of mandibular third molars based on a panoramic image and CBCT and (2) the impact of radiographic markers in CBCT on the decision to perform coronectomy. METHODS: 1437 teeth in 917 patients (mean age 27.8 years, range 18-72) underwent clinical and panoramic examination. If there was an indication for removal of the tooth, and signs of a close relation to the inferior alveolar nerve were present in the panoramic image, a CBCT was performed. Treatment decision based on panoramic image and CBCT was calculated. Statistical analyses were performed to assess whether signs in CBCT had an impact on the treatment decision "coronectomy". Moreover, the actually operated teeth and post-operative sensory disturbances were assessed and discussed in relation to the radiographic method. RESULTS: Based on the panoramic image, in 462 cases it was decided not to treat, 553 were scheduled for surgery, and 422 referred for a CBCT examination. "No bony separation between the tooth and mandibular canal" seen in CBCT was the main factor influencing the decision to perform a coronectomy (odds ratio = 56.8, p < 0.001). 840 mandibular third molars had undergone surgical intervention, 152 had a coronectomy and 688 were fully removed. Six patients perceived a sensory disturbance of the inferior alveolar nerve: one permanent and five temporary. CONCLUSION: 29% of the examined cases were referred for a CBCT and of these, the majority were scheduled for coronectomy based on the sign "no bony separation between the tooth and mandibular canal" seen in CBCT.

Human health risk assessment of exposure to indoor mercury vapour in a Ghanaian artisanal small-scale gold mining community.

People living or working in and around artisanal small-scale gold mining communities can be exposed to mercury vapour, which may negatively affect their health. In this study, the human exposure to air borne mercury in an artisanal mining community in the Upper East region of Ghana was investigated using Lumex RA 915 M mercury analyser, an active sampler. The concentration of mercury in air was measured inside and outside households and was related to human health risk standards. For each household, one measurement was taken from outside and three from inside at different positions. About 91% of the households where amalgam burning was reported had concentrations higher than the USEPA reference dose of 300 ng m-3 whereas 64% of the households where amalgam burning was not reported exceeded the reference dose above. The maximal (upper) instrumental limit (50,000 ng m-3) was passed for the highest concentrations, so, the upper 97.5% concentration was estimated, using censored statistics, to exceed 800,000 ng m-3 for the fireplaces. This exceeds any reported indoor household air concentration of Hg, identified by the literature review in this paper. Estimated hazard quotients were found to range from <1 to 108 within the households that are reported not to burn amalgam. In the households where amalgam burning reportedly takes place, the hazard quotient had a range of 0.01-160. Mercury concentrations measured in households with reported amalgam burning are approximately ten times higher than those households with no reported burning of amalgam. The censored data predicted hazard quotients up to 966. The results indicate that both miners and non-miners of the community are at risk of adverse health effects resulting from inhalation of mercury vapour.

National monitoring study in Denmark finds increased and critical levels of copper and zinc in arable soils fertilized with pig slurry.

The increasing consumption of copper and zinc in modern farming is linked to their documented benefit as growth promoting agents and usefulness for controlling diarrhoea. Copper and zinc are inert and non-degradable in the slurry and the environment and thereby introducing new challenges and concern. Therefore, a follow-up to pervious national soil monitoring programs on heavy metals was initiated in 2014 with special focus on the historical trends in soil concentrations of copper and zinc in Danish arable soils. Hereby it is possible to analyse trends for a 28 year period. Data shows that: 1) Amendment of soils with pig slurry has led to a significant increase in soil concentrations of copper and zinc, especially in the latest monitoring period from 1998 to 2014; 2) Predicted no-effect concentrations for soil dwelling species published by the European Union is exceeded for zinc in 45% of all soil samples, with the highest proportion on sandy soils; 3) The current use of zinc and copper in pig production may lead to leaching of metals, especially zinc, from fields fertilized with pig slurry in concentrations that may pose a risk to aquatic species.

Comparing the effect of non-medical mechanical restraint preventive factors between psychiatric units in Denmark and Norway.

BACKGROUND: The use of mechanical restraint (MR) is controversial, and large differences regarding the use of MR are often found among countries. In an earlier study, we observed that MR was used twice as frequently in Denmark than Norway. AIMS: To examine how presumed MR preventive factors of non-medical origin may explain the differing number of MR episodes between Denmark and Norway. METHODS: This study is a cross-sectional survey of psychiatric units. Linear regression was used to assess the confounding effects of the MR preventive factors, i.e. whether a difference in the impact of these factors is evident between Denmark and Norway. RESULTS: Six MR preventive factors confounded [∆exp(B)> 10%] the difference in MR use between Denmark and Norway, including staff education (- 51%), substitute staff (- 17%), acceptable work environment (- 15%), separation of acutely disturbed patients (13%), patient-staff ratio (- 11%), and the identification of the patient's crisis triggers (- 10%). CONCLUSIONS: These six MR preventive factors might partially explain the difference in the frequency of MR episodes observed in the two countries, i.e. higher numbers in Denmark than Norway. One MR preventive factor was not supported by earlier research, the identification of the patient's crisis triggers; therefore, more research on the mechanisms involved is needed. CLINICAL IMPLICATIONS: None of the six MR preventive factors presents any adverse effects; therefore, units in Denmark and Norway may consider investigating the effect of implementing, the identification of the patient's crisis triggers, an increased number of staff per patient, increased staff education, a better work environment and reduced use of substitute staff in practice.

Mechanical restraint in psychiatry: preventive factors in theory and practice. A Danish-Norwegian association study.

PURPOSE: To examine how potential mechanical restraint preventive factors in hospitals are associated with the frequency of mechanical restraint episodes. DESIGN AND METHODS: This study employed a retrospective association design, and linear regression was used to assess the associations. FINDINGS: Three mechanical restraint preventive factors were significantly associated with low rates of mechanical restraint use: mandatory review (exp[B] = .36, p < .01), patient involvement (exp[B] = .42, p < .01), and no crowding (exp[B] = .54, p < .01). PRACTICE IMPLICATIONS: None of the three mechanical restraint preventive factors presented any adverse effects; therefore, units should seriously consider implementing these measures.

Is Erica tetralix abundance on wet heathlands controlled by nitrogen deposition or soil acidification?

Erica tetralix is the key species on NW European wet heathlands, where it is often found to be the dominating plant species. Consequently, it is of considerable concern that the species has decreased significantly in cover from 28% to 18% over a six-year period. In order to understand the underlying causes, a structural equation modeling (SEM) approach was applied on ecological data from 1130 wet heathland plots. Both atmospheric N deposition and soil acidification were included in the SEM. The most important causal effect revealed by the SEM was a significant negative effect of N deposition on the cover of E. tetralix, whereas soil acidity tended to have a negative effect of relatively less importance. There was no significant effect of N deposition on soil pH, which indicates that there are no major indirect effects of N deposition on the cover of E. tetralix mediated by soil acidification.

Evidence for acidification-driven ecosystem collapse of Danish Erica tetralix wet heathland.

We report observations of disappearance of Erica tetralix in wet heathland, which is unlikely to be caused by competition, as E. tetralix is dying before its place is taken up by other species. To investigate the causes, we used both old and new data. Results showed that presence of Molinia caerulea and Calluna vulgaris were substantial in the former E. tetralix dominated areas. Measurements of the C/N ratio in the morlayer were between 21 and 26 under the E. tetralix stands. As the expected C/N ratio in a healthy nutrient poor ecosystem like the E. tetralix wet heathland is around 30, this indicates that the ratio is probably decreasing and, correspondingly, the probability of nitrogen leaching from the ecosystem is increasing. The morlayer pH was extremely low-between 3.03 and 3.78. This represents a pH decline since the 1960s, where pH values generally were above 4. This supports the hypothesis that the decrease in morlayer pH is the major factor explaining the disappearance of E. tetralix and that measures to increase pH should be considered as part of the recommendations for relevant future management.

Optically active thiophenes via an organocatalytic one-pot methodology.

A general methodology for the synthesis of trisubstituted, optically active thiophenes by an organocatalytic one-pot reaction cascade is presented. The target products are synthesized in good yields (up to 92%) and with excellent enantioselectivities (up to 98% ee). Importantly, based on practical and easily available starting materials, the presented methodology can be conducted under mild reaction conditions. To further elucidate the generality, the synthesis of optically active thienoindoles, as well as selenophenes, is also demonstrated.

Mechanical restraint--which interventions prevent episodes of mechanical restraint?- a systematic review.

PURPOSE: To identify interventions preventing mechanical restraints. DESIGN AND METHODS: Systematic review of international research papers dealing with mechanical restraint. The review combines qualitative and quantitative research in a new way, describing the quality of evidence and the effect of intervention. FINDINGS: Implementation of cognitive milieu therapy, combined interventions, and patient-centered care were the three interventions most likely to reduce the number of mechanical restraints. PRACTICE IMPLICATIONS: There is a lack of high-quality and effective intervention studies. This leaves patients and metal health professionals with uncertainty when choosing interventions in an attempt to prevent mechanical restraints.

Coercion within Danish psychiatry compared with 10 other European countries.

BACKGROUND: In 2008, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) criticized the use of mechanical restraint in Denmark and referred to it as ill-treatment. What do other European countries do better? To answer this question, we compared the use of coercive measures regarding psychiatric inpatients in Denmark and comparable European countries. AIMS: Comparing coercive measures from Denmark, Sweden, Norway, Finland, Iceland, Belgium, The Netherlands, United Kingdom, Ireland, France and Italy. METHODS: Review of international literature and a cross-sectional study performed as a questionnaire survey. RESULTS: Denmark used more mechanical restraint and holding than Finland and Norway; however Sweden used twice as much as Denmark. Finland used more seclusion than did the other countries. Norway was the country that used the smallest amount of physical coercion. Only Norway, Finland, Sweden and Denmark had comparable representative data on coercion. CONCLUSIONS: Norway used less physical restraint than Denmark. We could not find any obvious reasons for the differences in the use of physical restraint. CLINICAL IMPLICATIONS: Comparing the factors surrounding coercion between countries may serve as a basis for minimizing coercion and carrying it out in the most acceptable manner for the patients, thereby providing better psychiatric treatment in Europe.

Spread and referral of experimental pain in different jaw muscles.

AIMS: To test the hypothesis that there would be no differences in perceived pain intensity and spread and referral of pain evoked by injection of a similar amount of hypertonic saline into 6 different jaw-muscle sites in healthy female subjects. METHODS: A total of 15 healthy women participated in 3 experimental sessions separated by 1 week. In a randomized sequence, the deep layers of the masseter, superficial layers of the masseter, anterior temporalis, lateral pterygoid, medial pterygoid, and anterior digastric muscles were injected with 5.8% hypertonic saline (0.2 mL). The subjects rated the perceived intensity of pain on an electronic 0- to 10-cm visual analog scale (VAS). The distribution of pain was drawn by the subjects on anatomical maps of the face, and a Danish version of the McGill Pain Questionnaire (MPQ) was filled out. RESULTS: All injections were associated with moderate to strong pain intensity (mean peak value: 5.6 to 6.4 cm) with no significant differences between muscle sites (analysis of variance [ANOVA]: P = .520). Pain rating indices derived from the MPQ did not suggest significant differences between muscle sites (ANOVA: P = .898). However, the area of perceived pain differed significantly between muscle sites (ANOVA: P = .038) with the greatest area following the injection into the anterior temporalis muscle (Tukey: P < .05). On direct inspection, the pain maps appeared quite similar, but a new analysis technique based on a center-of-gravity method revealed significantly different coordinates and length of vectors (ANOVA: P < .001) with longer vectors associated with the pain areas in the anterior temporalis muscle compared with the other muscle sites (Tukey: P < .05). All muscles were frequently associated with referral of pain to intraoral structures (40% to 87%), but only pain in the anterior digastric muscle was referred to the tip of the tongue (53%). CONCLUSION: The data suggest no major differences in pain sensitivity between the examined jaw-muscle sites, but pain in the anterior temporalis muscle spreads to a larger area independent of pain intensity. There are subtle but detectable differences in the location and referral of pain patterns between jaw muscles. This will be helpful in the differential diagnosis of myofascial temporomandibular disorder pain.