Student nurses' pain knowledge and attitudes towards pain management over the last 20 years: A systematic review.

OBJECTIVE: To discover if nursing students have improved their level of pain knowledge and their attitudes towards pain management over the last 20 years. DESIGN: Systematic review utilising the Kable, Pich, and Maslin-Prothero 12 step approach to document a search strategy. DATA SOURCES: A search was conducted from 2000 to 2020 using CINAHL, PubMed, Embase and ProQuest. REVIEW METHODS: Studies exploring the level of pain management knowledge and attitudes of nursing students were included. The Critical Review Form - Quantitative Studies provided the appraisal framework (Law et al., 1998). A narrative synthesis of eligible studies was undertaken. RESULTS: Six studies with a total of 1454 participants were included. The studies demonstrated that nursing students have not improved their level of pain knowledge and attitudes towards pain management in the last 20 years. Whilst many nursing students thought they possessed adequate pain knowledge, the studies all demonstrated that their pain knowledge is lacking and that they do not have appropriate attitudes towards pain. Students did not recognise the patient who was not grimacing as being in pain despite the patient report of pain. CONCLUSIONS: These findings support the notion that nursing education does not include sufficient focus on pain identification and management. Alignment of nursing pain education with the curriculum developed in 1993 by the International Association for the Study of Pain is needed to ensure nurses have appropriate knowledge so that patients can receive effective pain management.

Marking mosquitoes in their natural larval sites using 2H-enriched water: a promising approach for tracking over extended temporal and spatial scales.

BACKGROUND: 1.Tracking mosquitoes using current methods of mark-release-recapture are limited to small spatial and temporal scales exposing major gaps in understanding long-range movements and extended survival. Novel approaches to track mosquitoes may yield fresh insights into their biology which improves intervention activities to reduce disease transmission.Stable isotope enrichment of natural mosquito breeding sites allows large-scale marking of wild mosquitoes absent human handling. Mosquito larvae that develop in 2H-enriched water are expected to be detectable for over four months using tissue mass-fraction 2H measurements, providing opportunities for long-term mark-capture studies on a large scale. APPROACH: 2.A laboratory study followed by a field experiment of mosquito larval habitat 2H-enrichment was conducted in Mali, to evaluate potential labeling of wild mosquitoes. Twelve natural larval sites were enriched using [2H]-Deuterium-oxide (D2O, 99%). Enrichment level was maintained by supplementation following dilution by rains. Availability of 2H to mosquito larvae was enhanced by locally collected and cultured microorganisms (i.e. protozoa, algae and bacteria) reared in deuterated water, and provided as larval diet. Putative natural predators were removed from the larval sites and first instar larvae Anopheles gambiae s.l. larvae were added every other day. Emergence traps enabled collection of eclosing adults. Adult mosquitoes were kept at laboratory conditions for analysis of label attrition with age. RESULTS: 3.Deuterium enrichment of wild mosquitoes above background levels (maximum = 143.1 ppm) became apparent 5-6 days after initial exposure, after which 2H values increased steadily until ~24 days later (to a mean of approx. 220 ppm). Anopheles and Culex mosquitoes showed significantly different 2H values (211 and 194.2 ppm respectively). Both genera exhibited exponential label attrition (e (-x)) amounting to 21.6% by day 30 post emergence, after which attrition rate continuously decreased. Males of both taxa exhibited a higher mean 2H value compared to females. CONCLUSIONS: 4.Deuterium-oxide proved useful in marking mosquitoes in their natural larval sites and although costly, may prove valuable for studies of mosquitoes and other aquatic insects. Based on our field study, we provide a protocol for marking mosquito larval sites using deuterium-oxide.

Oxygen isotope analyses of biogenic opal and quartz using a novel microfluorination technique.

RATIONALE: Measuring δ(18)O values in silicates is difficult and hazardous in comparison with measurements of carbonate minerals due to the difficulty in breaking Si-O-Si bonds. A novel method for measurement of δ(18)O values from quartz and biogenic silica utilizing high-temperature pyrolysis with continuous-flow isotope ratio mass spectrometry (CF-IRMS) is presented. METHODS: Samples were prepared by offline dehydroxylation/dehydration under vacuum at 1060°C. The dehydroxylated samples are mixed with polytetrafluoroethylene (PTFE) powder (2.3:1 PTFE/Si) and graphite in silver foil capsules and reacted in a vario PYRO cube TC/EA system in a glassy carbon reaction tube. Quartz and biogenic opal samples react with available carbon in a microfluorination environment upon decomposition of the PTFE, producing CO for analysis via CF-IRMS. RESULTS: Silicate samples reacted quantitatively, producing data with yields ≥88% from ~400 µg samples. Multiple analyses with international standards demonstrated accuracy for replicate measurements (1σ range ±0.3-0.6‰), comparing favorably with previously published techniques. CONCLUSIONS: New data produced with the microfluorination technique are comparable with data from studies using existing methodologies. The microfluorination technique has the potential to greatly increase the number of laboratories producing silicate oxygen isotope data for mineralogic, paleoclimatic and biogeochemical applications.

Chromium in intertidal sediments of the Clyde, UK: potential for remobilisation and bioaccumulation.

Detailed surveys of intertidal sediments have been performed along the north and south shores of the Inner Clyde estuary, UK. Surface sediment data reveal significant spatial variation in Cr content and an association with major sediment characteristics and location within the estuary. Depth variation for Cr and other heavy metals cannot be explained by variation in major geochemical controls such as grain size and organic matter and highlights the impact of historical contamination on sediment quality. These elevated levels at depth may still have environmental impact through redox-reactivity, in association with iron and manganese. Sequential extraction of sediments and pore water analysis of Cr(VI) and Cr(III) provide detailed information on release potential from the sediments. The implication of Cr mobility for biota in the estuary has been assessed by the analysis of a common marine bivalve, Mytilus edulis (Blue Mussel) and a burrowing polychaete, Nereis diversicolor (rag worm) from a number of survey sites. Bioconcentration factors for Mytilus indicate that the weakly held portion of sediment Cr is available for uptake and in the case of Nereis, bioaccumulation appears to be inhibited by sediment organic matter.