Profiles of objective and subjective cognitive function in Post-COVID Syndrome, COVID-19 recovered, and COVID-19 naïve individuals.

Post-COVID Syndrome has emerged as a significant public health concern worldwide with increasing evidence to suggest that individuals who have had an acute COVID-19 infection report lingering memory and attention difficulties, even in individuals who have fully recovered and no longer experiencing symptoms of COVID-19. The present study sought to investigate the profile of objective and subjective cognitive difficulties in people who have Post-COVID Syndrome, people who have fully recovered from an acute COVID infection and people who have never had COVID-19. We further sought to explore the extent to which self-reported fatigue and stress are related to subjective and objective cognitive difficulties. 162 participants including 50 people living with Post-COVID Syndrome, 59 people who have had COVID-19 but have fully recovered and 53 people who have never experienced symptoms of COVID-19 and had never tested positive for COVID-19 were recruited from Academic Prolific to complete a series of online questionnaires and neurocognitive tasks. Subjective cognitive function was measured using the Cognitive Failures Questionnaire and objective cognitive function was measured using the Cognitron cognitive test battery. We found that objective and subjective measures of cognitive function were not significantly related, suggesting that self-reports of "brain fog" are not reflecting objectively measured cognitive dysfunction. A MANOVA revealed that subjective cognitive deficits were driven by heightened perceived stress and fatigue and not significantly related to COVID-19 status. Objective cognitive function, however, was significantly related to perceived stress and COVID status whereby we observed significant objective cognitive deficits in people who have been exposed to an acute COVID-19 infection regardless of whether they had Post-COVID Syndrome or had fully recovered, as compared to people who had never had COVID-19. This suggests that an acute infection can have long term effects on cognitive function, even without persistent COVID-19 symptoms. Encouragingly, objective cognitive function was significantly associated with time since initial infection showing that cognitive deficits improved over time for people who had recovered from COVID-19. However, we did not observe the same improvement in individuals with Post-COVID Syndrome and observed that cognitive dysfunction was significantly related to the number of neurological symptoms presently experienced. These results add to the accumulating literature that COVID-19 is associated with significant cognitive difficulties following a COVID-19 infection, which appear to improve over time for those who have recovered from COVID-19 yet persist in people living with Post-COVID Syndrome.

Assessing prospective and retrospective metacognitive accuracy following traumatic brain injury remotely across cognitive domains.

The ability to monitor one's behaviour is frequently impaired following TBI, impacting on patients' rehabilitation. Inaccuracies in judgement or self-reflection of one's performance provides a useful marker of metacognition. However, metacognition is rarely measured during routine neuropsychology assessments and how it varies across cognitive domains is unclear. A cohort of participants consisting of 111 TBI patients [mean age = 45.32(14.15), female = 29] and 84 controls [mean age = 31.51(12.27), female = 43] was studied. Participants completed cognitive assessments via a bespoke digital platform on their smartphones. Included in the assessment were a prospective evaluation of memory and attention, and retrospective confidence judgements of task performance. Metacognitive accuracy was calculated from the difference between confidence judgement of task performance and actual performance. Prospective judgment of attention and memory was correlated with task performance in these domains for controls but not patients. TBI patients had lower task performance in processing speed, executive functioning and working memory compared to controls, maintaining high confidence, resulting in overestimation of cognitive performance compared to controls. Additional judgments of task performance complement neuropsychological assessments with little additional time-cost. These results have important theoretical and practical implications for evaluation of metacognitive impairment in TBI patients and neurorehabilitation.

Diffusion tensor imaging reveals changes in microstructural integrity along compressed nerve roots that correlate with chronic pain symptoms and motor deficiencies in elderly stenosis patients.

Age-related degenerative changes in the lumbar spine frequently result in nerve root compression causing severe pain and disability. Given the increasing incidence of lumbar spinal disorders in the aging population and the discrepancies between the use of current diagnostic imaging tools and clinical symptoms, novel methods of nerve root assessment are needed. We investigated elderly patients with stenosis at L4-L5 or L5-S1 levels. Diffusion tensor imaging (DTI) was used to quantify microstructure in compressed L5 nerve roots and investigate relationships to clinical symptoms and motor neurophysiology. DTI metrics (i.e. FA, MD, AD and RD) were measured at proximal, mid and distal segments along compressed (i.e. L5) and intact (i.e. L4 or S1) nerve roots. FA was significantly reduced in compressed nerve roots and MD, AD and RD were significantly elevated in the most proximal segment of the nerve root studied. FA was significantly correlated with electrophysiological measures of root function: minimum F-wave latency and peripheral motor conduction time (PMCT). In addition, FA along the compressed root also correlated with leg pain and depression score. There was also a relationship between RD and anxiety, leg pain and disability score and AD correlated with depression score. Taken together, these data show that DTI metrics are sensitive to nerve root compression in patients with stenosis as a result of age-related lumbar degeneration. Critically, they show that the changes in microstructural integrity along compressed L5 nerve roots are closely related to a number of clinical symptoms associated with the development of chronic pain as well as neurophysiological assessments of motor function. These inherent relationships between nerve root damage and phenotype suggest that the use DTI is a promising method as a way to stratify treatment selection and predict outcomes.

The straight probe: a dental misnomer.

Most dentists have a 'thingummybob' or a 'whatsit' in their instrument armamentarium, to which their dental nurse is supposed to be able to lay their hand instantly. Usually dental instruments are logically named to avoid this potential source of confusion. However, some instruments are not, of which the straight probe is one example. The straight probe is not logically named, quite simply because it is not straight. It is bent. This paper investigates the anomaly and suggests that a forgotten hero of the profession is responsible for the development of this indispensable instrument.

Antibiotic resistance and antibiotic prescribing by dentists in England 2007-2016.

The early prescribers of penicillin realised that antibiotics should be used wisely and as an adjunct to traditional surgical provision. They predicted that inappropriate use would increase sensitisation to the drug. National Health Service dentists prescribed almost 10% of antibiotics issued in NHS general practice in 2016 and an audit shows that many of these may have been prescribed inappropriately. One of the causes of antimicrobial resistance is over prescription of the drugs. This paper recalls the recommendations of some early users of penicillin, reports on the current prescription patterns of dentists in England, describes the mechanism of acquisition of anti-microbial resistance and discusses dentists' role in attempting to reduce the problem.

The importance of communication in the construction of partial dentures.

Removable partial dentures (RPDs) are still a very important treatment modality in general dentistry to replace missing teeth. With the increase in popularity of implants, RPDs are sometimes seen as an 'old-fashioned' treatment option and if not carefully designed can be damaging to oral tissue and aesthetically less favourable. However, there is still a significantly large cohort of patients for whom RPDs are the best option for replacement of teeth either due to a failing dentition, inappropriate anatomy or financial considerations. This article explores the importance of effective three way communication with the patient, the laboratory and the dental nurse to support the provision of reliable and predictable prosthodontic outcomes.

Teaching stress management in undergraduate dental education: are we doing enough?

Dentistry is recognised as a stressful profession. A number of studies focusing on undergraduate education have shown high levels of stress in dental students. However, despite calls to do so, little has been published on methods to teach future dental professionals about stress and how to manage it on a personal level. Psychological stress which is uncontrolled may have an effect on general health. It is recognised, however, that stress can be beneficial if channelled appropriately. Techniques and ways to teach management of potential stresses of a career in dentistry have still not been widely reported in either dental undergraduate or postgraduate education. An intervention used with final year dental students at the University of Portsmouth for the last four years has highlighted some of the problems raised by students coping with a stressful programme of study. Students' comments indicated the need for an educational intervention on recognising and reducing stress to be introduced earlier on in their curriculum and that it should be universally taught.

An evaluation of defensive dentistry: w(h)ither the profession?

Introduction Defensive dentistry has become a popular choice for dentists in practice over the past decade, partly in response to the supposed increasing risks to patient safety, of litigation and of health and safety concerns to patients and staff.Methods Using a quantitative analysis, care plans of 96 dentists were examined from one day in April 2017 and compared against these known risks. One thousand four hundred and seventeen care plans were coded by treatment type. The risks of completing each item were coded as high or low for either clinical risk, health and safety risk and risk of litigation. Subsequently, semi structured interviews were conducted with 12 participants; five practitioners of over 25 years' experience and seven practitioners of less than five years' experience.Results All assessments and treatments, including no treatment, had recognised risks. 'Doing nothing' also carried a risk of litigation. Four themes were identified from the interviews: 'there by the grace of God, go I', 'limitations on the scope of practice', 'fear' and 'c'est la vie'.Discussion The profession is at a crossroads. The options for the future are discussed, including immediate retraining for all dental care professionals.Conclusion Within the limitations of this study, it is concluded that increasingly, no risk or only low risk treatments will be undertaken by the profession, with both experienced and less experienced practitioners limiting their scope of practice, with possible deleterious consequences on the dental health of the population.

Relationships between the integrity and function of lumbar nerve roots as assessed by diffusion tensor imaging and neurophysiology.

PURPOSE: Diffusion tensor imaging (DTI) has shown promise in the measurement of peripheral nerve integrity, although the optimal way to apply the technique for the study of lumbar spinal nerves is unclear. The aims of this study are to use an improved DTI acquisition to investigate lumbar nerve root integrity and correlate this with functional measures using neurophysiology. METHODS: Twenty healthy volunteers underwent 3 T DTI of the L5/S1 area. Regions of interest were applied to L5 and S1 nerve roots, and DTI metrics (fractional anisotropy, mean, axial and radial diffusivity) were derived. Neurophysiological measures were obtained from muscles innervated by L5/S1 nerves; these included the slope of motor-evoked potential input-output curves, F-wave latency, maximal motor response, and central and peripheral motor conduction times. RESULTS: DTI metrics were similar between the left and right sides and between vertebral levels. Conversely, significant differences in DTI measures were seen along the course of the nerves. Regression analyses revealed that DTI metrics of the L5 nerve correlated with neurophysiological measures from the muscle innervated by it. CONCLUSION: The current findings suggest that DTI has the potential to be used for assessing lumbar spinal nerve integrity and that parameters derived from DTI provide quantitative information which reflects their function.

Empowerment in a model of outreach undergraduate dental education.

Aim To undertake a quantitative and qualitative examination into what aspects of the students' experience in outreach at University of Portsmouth Dental Academy (UPDA) are encouraging their empowerment as autonomous practitioners, ready to graduate as 'safe beginners'.Methods The study was devised as part of the educational service evaluation of outreach education at the UPDA. For the two most recent cohorts of 160 students (2014-16) an additional domain was added specifically investigating the students' sense of how their experience of outreach at the UPDA has impacted on their development to be ready for independent practice (safe beginner). The questionnaire was completed anonymously in their last week of attendance just before graduation.Results A 91% response rate for the questionnaire was achieved. To the question about 'being given an opportunity to become an independent dentist', 83% of the respondents strongly agreed. Two themes with seven subthemes were identified from the free text responses. The two themes were 'self-actualisation: developing self-awareness and self-confidence' and 'delivery of care as a dentist'.Conclusion Within the limitations of this educational evaluation, students enjoyed the increase of autonomy they gained during the year-long placement and felt that the clinical teachers empowered, encouraged and supported them to develop as autonomous dental practitioners and as 'safe beginners', to deliver holistic care in the National Health Service.

The risks and benefits of social media in dental foundation training.

The use of social media has greatly expanded in the last decade, with widespread use of smartphones, the internet, and other multimedia to enhance learning. There is evidence to suggest that social media has a place in healthcare education, but there is limited research to suggest the effectiveness or use of it in dental foundation training. This paper discusses the risks and benefits of social media and suggests that a better understanding of social media and its role in the development and practice of newly qualified dental professionals could benefit both trainees and trainers.

Experiencing the failing dentition: what dentists do.

The heavily restored, failing dentition, often associated with older patients, is one of the clinical challenges of our time. Patients tend to have high hopes for definitive, comfortable solutions and dentists may struggle to meet those expectations. In his autobiographical work, Experience, Martin Amis describes his failing dentition and its emotional consequences. His reflections have much to teach us as a profession.

Belongingness in undergraduate dental education.

Objective To undertake a detailed educational evaluation into dental students' experience of the concept of belongingness and their development as 'safe beginners' on an outreach placement at the University of Portsmouth Dental Academy (UPDA).Method The participants were asked two questions: Did you feel belongingness at UPDA?; and When in your year rotation did you feel this? They completed the educational evaluation anonymously in their last week of attendance. The quantitative data was handled with descriptive statistics and the qualitative data was analysed for recurring themes.Results A 95% response rate was achieved. Eighty six percent of respondents strongly agreed to feeling belongingness and 56% felt it after their first two weeks. Four themes were identified: 'Interaction with the preexisting people environment' (1a. Initial welcoming and warmth 1b. Continued interest in me as an individual); 'Developing collegiality' (2a. My group of fellow students 2b. Working with the dental team as a dentist 2c. The team of everyone at UPDA); 'In the clinical environment' (3a. Being a dentist with responsibility and respect 3b. The physical environment 3c. Becoming a reflective independent practitioner); and 'Leadership'.Conclusion Belongingness in dental education should be defined as:- a deeply personal and contextually mediated experience in which a student becomes an essential and respected part of the dental educational environment where all are accepted and equally valued by each other and which allows each individual student to develop autonomy, self-reflection and self-actualisation as a clinician.

Perceptions of veterinary admissions committee members of undergraduate credits earned from community colleges or online compared to traditional 4-year institutions.

Veterinary admission committees are asked to create and implement a fair, reliable, and valid system to select the candidates most likely to succeed in veterinary school from a large pool of applicants. Although numerous studies have explored grade point average (GPA) as a predictive value of later academic success, there has been little attention paid to how and where an applicant acquires his/her undergraduate coursework. Quality of academic program is an important component of applicant files, and it is suggested that the source of a candidate's coursework might influence admissions committee decisions, perhaps even outside of the committee's immediate awareness. Options for undergraduate education include taking classes at a traditional four-year institution, a community college, or online. This study provides an overview of the current state of online courses and community colleges in the US as a foundation to explore the views of veterinary admissions committee members pertaining to coursework completed at traditional residential 4-year schools or at community colleges and whether they are delivered on campus or online (at either type of institution). Survey participants reported a pattern of preference for traditional four-year residential coursework compared to online or community college courses. These results are interesting given the exponential growth of students taking online courses and data showing community colleges are providing a successful gateway to obtaining a four-year degree. This also points to the need for admission committees to discuss potential biases since the information about type of school and/or course may not be consistently available for all applicants. Finally, at a time when admitting a diverse class of students is a goal of many programs, it is of special concern that there are potential biases against courses taken online or from community colleges - venues that tend to draw a more diverse population than traditional 4-year universities.

Identifying and preparing the next generation of part-time clinical teachers from dental practice.

Part-time general dental practitioners (GDPs) and dental care professionals (DCPs) working in practice are being increasingly utilised to deliver undergraduate clinical dental education to both dental and hygiene/therapy students. As such, there is a need for appropriate recruitment processes and ongoing staff development in the different and complex role of the clinical teacher. Recently a group of experienced dental practitioners, making a journey from GDP to part-time clinical teacher, identified common themes, experiences, challenges and realisations. These were: 'what is clinical dental education?'; 'me as a clinical teacher'; and 'specific teaching issues'. The themes highlighted the complexity of dental education and the different environment of the teaching clinic from general practice. Some of the themes identified could be a starting point for the induction process to facilitate an easier transition from experienced GDP to clinical teacher. With the current demands from both students and patients alike, the 'three way dynamic of patient, student and teacher' needs to be supported if dental schools are to attract and develop the highest quality clinical teachers. It is of critical importance to give an exceptional experience to students in their clinical education as well as to patients in terms of excellent and appropriate treatment. The challenge for deans and directors of education is to find the resources to properly fund teacher recruitment, induction and the development of part-time GDPs in order to produce the expert teachers of tomorrow.

Dental students' perceptions of their experience at a residential outreach centre.

INTRODUCTION: The Portsmouth Dental Academy delivers an interprofessional education to dental students on outreach placement from King's College London Dental Institute. AIM: To establish what the dental students' attitudes to the placement are and how these correlate to the perceptions of the staff who work with them. METHOD: Using Delphi consensus procedures, a simple, closed, two-question questionnaire was developed. The questionnaire was completed by the students and then, to triangulate the results, was subsequently applied to staff who teach and assist them on clinic. RESULTS: To the question: Why do you think the experience that is commonly termed the 'Portsmouth experience' is so successful 'in the eyes of the students'?, the students ranked first the response: 'Students gain experience in primary dental care clinical practice under the current NHS contract - UDAs and KPIs'. To the second question: What do you think the students most enjoyed about working in Portsmouth?, the students ranked first: 'A sense of independence - being made to make their own decisions'. CONCLUSION: The students' major perception of the 'Portsmouth experience' centres around the placement being a realistic preparation for their future practising career. This is combined with a strong sense of belonging when studying and working at the Academy.