Effect of educational intervention on computer-aided-design and computer-aided-manufacturing technology to preclinical dental students.

INTRODUCTION: This study evaluated the effectiveness of a video presentation instruction compared to the prevailing traditional lecture provided in the preclinical classroom when introducing computer-aided design/computer-aided manufacturing (CAD/CAM) technology. MATERIALS AND METHODS: This study was conducted as a controlled educational trial (single-blind) on 120 first-year dental students. Students were assigned to two learning groups: the control (n = 60, traditional lecture) and the intervention (n = 60, video presentation). Both groups completed a self-efficacy scale (SES) survey before instruction. Then, the intervention group actively participated in a one-session video presentation while the control group was given a traditional lecture. After the presentations, student knowledge was assessed with a hands-on simulated exercise that was scored out of 60 points. At last, students completed a post-instruction student perception and attitude (SPA) survey. Inferential hypothesis testing was conducted with two-sample t-tests, and significance was defined as p ≤ .05. RESULTS: There were no significant differences in the student pre-instruction SES scores between the control and intervention groups. After the video learning, CAD/CAM knowledge application during the hands-on simulated exercise showed significantly higher results in the intervention group as the assessment scores from the intervention group averaged 13.6 ± 2.0 points higher than the control group (p < .001). The results from the post-instruction SPA survey showed no statistically significant difference between groups. CONCLUSION: With the video presentation technique, our first-year dental students were able to greatly enhance their CAD/CAM application skills. The results from this study could be applied at other dental educational institutions with potential similar outcomes.

The benefits of incorporating active learning into online, asynchronous coursework in dental physiology.

The COVID-19 pandemic required a shift to online learning that posed particular challenges for the education of dental students. Basic science courses were presented in an online, asynchronous format to facilitate small group rotations through preclinical work. The success of active learning was previously examined in a Dental Physiology course, and it was desired to reassess those methods in an online environment. Students were provided with prerecorded lectures containing learning activities, and the effectiveness was compared with traditional lecture recordings. On surveys, dental students had more positive perceptions of online recordings that incorporated active learning strategies, with higher perceived effectiveness of the lecturer, ability to pay attention, motivation to study, and confidence with the material. This was similar to the previous study, in which face-2-face (F2F) active learning was more positively reviewed than traditional lectures. Compared with these past sections, the online cohort expressed similarly positive perceptions of the active learning sections, but the online traditional lectures were perceived to be less effective than F2F lectures. Despite the differences in student perceptions, unit exam scores were similar for didactic lectures in both online and F2F settings. Unit exam scores were significantly higher when active learning strategies were employed, with the highest performance levels in the F2F cohort. While active learning strategies continue to be effective, further research is needed to optimize these methods and engage students in online coursework. The results suggest the importance of active and collaborative learning opportunities in the education of students in physiology coursework.

The BACH project protocol: an international multicentre total Bile Acid Comparison and Harmonisation project and sub-study of the TURRIFIC randomised trial.

OBJECTIVES: Multicentre international trials relying on diagnoses derived from biochemical results may overlook the importance of assay standardisation from the participating laboratories. Here we describe a study protocol aimed at harmonising results from total bile acid determinations within the context of an international randomised controlled Trial of two treatments, URsodeoxycholic acid and RIFampicin, for women with severe early onset Intrahepatic Cholestasis of pregnancy (TURRIFIC), referred to as the Bile Acid Comparison and Harmonisation (BACH) study, with the aims of reducing inter-laboratory heterogeneity in total bile acid assays. METHODS: We have simulated laboratory data to determine the feasibility of total bile acid recalibration using a reference set of patient samples with a consensus value approach and subsequently used regression-based techniques to transform the data. RESULTS: From these simulations, we have demonstrated that mathematical recalibration of total bile acid results is plausible, with a high probability of successfully harmonising results across participating laboratories. CONCLUSIONS: Standardisation of bile acid results facilitates the commutability of laboratory results and collation for statistical analysis. It may provide the momentum for broader application of the described techniques in the setting of large-scale multinational clinical trials dependent on results from non-standardised assays.

Patient, nurse, and physician preferences: final results of the CONVENIENCE study evaluating pegfilgrastim prophylaxis via pre-filled syringe or on-body injector in cancer patients.

PURPOSE: The on-body injector (OBI) automatically delivers pegfilgrastim the day after chemotherapy (CTx), thus eliminating the need of return visits to the medical office for guideline-compliant pegfilgrastim administration. The CONVENIENCE study aimed to evaluate patient, nurse, and physician preferences as well as health economics for pegfilgrastim administration either with OBI or manually using a pre-filled syringe (PS). METHODS: Patients with early breast cancer, receiving two or three weekly anthracycline/cyclophosphamide or three weekly taxane-based CTx, and patients with Non-Hodgkin lymphoma (NHL) receiving first-line R-CHOP-14 or -21 were randomized 1:1 to receive both pegfilgrastim application forms for four consecutive CTx cycles in an alternating sequence starting either with OBI or PS. Primary endpoint was patient preference, assessed by questionnaires. RESULTS: A total of 308 patients were evaluable in the per-protocol analysis. Patients slightly preferred OBI over PS (OBI, n = 133, 43.2%; vs. PS, n = 111, 36.0%; p-value = 0.159), while study nurses slightly preferred PS (n = 19, 46.3%) over OBI (n = 18, 43.9%) and physicians clearly preferred PS (n = 24, 58.8%) over OBI (n = 15, 36.6%). Among patients with preference for OBI, saving of time was their major reason for preference (53.4%). Pegfilgrastim was administered 24-72 h after each CTx cycle in 97.6% of OBI and 63.1% of PS applications. CONCLUSION: The OBI was slightly preferred by patients and saving time was the major reason for their preference. PS was physicians' most preferable choice and slightly preferred by nurses. Using OBI, pegfilgrastim was almost always administered within the time period recommended by current guidelines, while it was often not applied as specified using PS. TRIAL REGISTRATION: No: ClinicalTrials.gov No. NCT03619993. Registered on June 25, 2018.

A statistically guided grid generation method and its application to intermolecular potential energy surfaces.

We present a method for the generation of points in space needed to create training data for fitting of nonlinear parametric models. This method uses statistical information extracted from an initial fit on a sparse grid to select optimal grid points in an iterative manner and is, therefore, called the iterative variance minimizing grid approach. We demonstrate the method in the case of six-dimensional intermolecular potential energy surfaces (PESs) fitted to ab initio computed interaction energies. The number of required grid points is reduced by roughly a factor of two in comparison to alternative systematic sampling methods. The method is not limited to fitting PESs and can be applied to any cases of fitting parametric models where data points may be chosen freely but are expensive to obtain.

Molecular dimers of methane clathrates: ab initio potential energy surfaces and variational vibrational states.

Motivated by the energetic and environmental relevance of methane clathrates, highly accurate ab initio potential energy surfaces (PESs) have been developed for the three possible dimers of the methane and water molecules: (H2O)2, CH4·H2O, and (CH4)2. While only a single monomer geometry was used for each monomer in the ab initio calculations, the PES parameterization makes it possible to produce distinct surfaces for all isotopologues within the rigid-monomer approximation. The PESs were fitted to computations at the frozen-core coupled-cluster level with single, double, and non-iterative triple excitations, employing basis sets of augmented triple- and quadruple-zeta quality plus bond functions, followed by extrapolations to the complete basis set limit. The long-range parts of the PESs are computed using the asymptotic version of symmetry-adapted perturbation theory based on a density-functional description of the monomers. All PESs are polarizable, i.e., in cluster or condensed-phase applications they approximate many-body effects by the induced dipole polarization model. The PESs were developed in a fully automated procedure applying the autoPES method, which is used for the first time to generate near-spectroscopic quality surfaces. The stationary points (SPs) on the PESs have been determined and compared with literature data. For CH4·H2O, previously unknown SPs have been identified and the first detailed study of the (CH4)2 potential energy landscape has been carried out. The PESs were used in variational quantum nuclear motion computations. For the water dimer, the resulting vibrational transitions are in excellent agreement with available high-resolution spectroscopic data. For (CH4)2, the intermonomer vibrational states are reported for the first time.

Laboratory performance of sweat conductivity for the screening of cystic fibrosis.

BACKGROUND: There are several complementary English-language guidelines for the performance of the sweat chloride test. These guidelines also incorporate information for the collection of conductivity samples. However, recommendations for the measurement and reporting of sweat conductivity are less clear than for sweat chloride. The aim of the study was to develop an understanding of the testing and reporting practices of sweat conductivity in Australasian laboratories. METHODS: A survey specifically directed at conductivity testing was sent to the 12 laboratories registered with the Royal College of Pathologists of Australasia Quality Assurance Programs. RESULTS: Nine (75%) laboratories participated in the survey, seven of whom used Wescor Macroduct® for collecting sweat and the Wescor SWEAT·CHEK™ for conductivity testing, and the remaining two used the Wescor Nanoduct®. There was considerable variation in frequency and staffing for this test. Likewise, criteria about which patients it was inappropriate to test, definitions of adequate collection sweat rate, cutoffs and actions recommended on the basis of the result showed variations between laboratories. CONCLUSIONS: Variations in sweat conductivity testing and reporting reflect many of the same issues that were revealed in sweat chloride test audits and have the potential to lead to uncertainty about the result and the proper action in response to the result. We recommend that sweat testing guidelines should include clearer statements about the use of sweat conductivity.

What is adolescent polycystic ovary syndrome?

The diagnostic criteria for adolescent polycystic ovary syndrome (PCOS) has been derived from adult criteria, which makes diagnosis challenging as criteria include normal physiological events that occur during puberty such as acne, hirsutism, menstrual irregularities, high androgen levels and polycystic ovarian morphology on pelvic ultrasound. The only criteria that applies from the adult criteria is exclusion of other conditions that mimic PCOS. Clinical findings consistent with hyperandrogenaemia during adolescence include inflammatory acne, hirsutism, alopecia and/or menstrual irregularities, which are severe and present 2 years after menarche. The measurement of androgen levels during adolescence should take into account age, puberty, type of androgen measured, assay used and diurnal rhythm. Multiple measurements are useful to demonstrate hyperandrogenaemia. The combination, severity and persistence of the hyperandrogenic symptoms and hyperandrogenaemia in girls 2 years or more post-menarche support the diagnosis of adolescent PCOS. Adolescent girls with these findings should be followed up into adulthood.

The in's and out's of science outreach: assessment of an engaging new program.

Many professors are interested in providing science outreach to local K-12 students, but may not have the time or resources needed to create an engaging presentation. The American Physiological Society supports outreach initiatives through programs such as the Physiology Understanding (PhUn) Week. Building on these activities, it was desired to create and assess an immersive and engaging Outreach Program in a disadvantaged K-12 student population. Three distinct modules were created on cardiovascular physiology, respiratory physiology, and oral health. All resources for these modules underwent peer review and publication, allowing other professors to easily execute their own outreach programming. The outreach modules were presented to 288 students in 3rd, 5th, 6th, and 7th grade classes. Implementation of the modules resulted in significant increases in student content knowledge, ranging from 32 to 57% improvement ( P < 0.001, dependent t-test), with an average increase of 46%. K-12 science teachers reported that the program was at an appropriate educational level, increased students' enthusiasm for science, and increased students' exposure to science careers. Additionally, the presenters of the Outreach Program were perceived to be enthusiastic, knowledgeable, and proficient at interacting with the students. On open-response survey items, the science teachers indicated a high level of satisfaction with the program and an enthusiasm for continued collaborations. These results indicate the importance of organized and interactive science activities for the success of a new Outreach Program.

Screening for Down syndrome in the second trimester of pregnancy.

Antenatal screening for fetal anomalies has provided women and their partners with information to make reproductive choices based on the risk of serious chromosomal or structural defects since the 1990s. Alternative tests include first-trimester screening (combined ultrasound and maternal serum markers), second-trimester maternal serum markers and noninvasive cell-free DNA testing. The recent recommendations by the Royal Australian and New Zealand College of Obstetrics and Gynaecology and the Human Genetics Society of Australasia against second-trimester triple testing are based on unsound performance criteria, raise several contestable issues around access and equity and challenge the principles of governments providing affordable options.

Informing disinvestment with limited evidence: cobalamin deficiency in the fatigued.

OBJECTIVES: Health technology reassessment and disinvestment can be difficult due to uncertainties regarding available evidence. Pathology testing to investigate cobalamin (vitamin B12) deficiency is a strong case in point. We conducted a 3-month economic evaluation of five strategies for diagnosing and treating cobalamin deficiency in adult patients hypothetically presenting with new unexplained fatigue in the primary care setting. The first consultation per patient was considered. Screening tests other than serum cobalamin were not included. METHODS: A cost-effectiveness analysis was undertaken using a decision tree to represent the diagnostic / treatment pathways, with relevant cost and utility scores assigned to different stages in the evaluation process. Input parameter values were estimated from published evidence, supplemented by expert opinion, with sensitivity analysis undertaken to represent parameter uncertainty. RESULTS: Ordering serum vitamin B12 to assess cobalamin deficiency among patients with unexplained fatigue was not cost-effective in any patient population, irrespective of pretest prevalence of this deficiency. For patients with a pretest prevalence above 1 percent, treating all with oral vitamin B12 supplements without testing was most cost-effective, whereas watchful waiting with symptoms monitoring was most cost-effective for patients with lower pretest prevalence probabilities. CONCLUSIONS: Substantial evidence gaps exist for parameter estimation: questionable cobalamin deficiency levels in the fatigued; debatable treatment methods; unknown natural history of the condition. Despite this, we reveal a robust path for disinvestment decision making in the face of a paradox between the evidence required to inform disinvestment compared with its paucity in informing initial funding decisions.

Comparison of the marginal fit of lithium disilicate crowns fabricated with CAD/CAM technology by using conventional impressions and two intraoral digital scanners.

STATEMENT OF PROBLEM: Conventional impression materials and techniques have been used successfully to fabricate fixed restorations. Recently, digital pathways have been developed, but insufficient data are available regarding their marginal accuracy. PURPOSE: The purpose of this in vitro study was to compare the marginal gap discrepancy of lithium disilicate single crowns fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) technology by using both conventional and 2 digital impression techniques. MATERIAL AND METHODS: One typodont maxillary right central incisor was prepared for a ceramic crown. Ten impressions were made by using each method: conventional with polyvinyl siloxane impression material, Lava COS (3M ESPE), and iTero (Cadent) intraoral scanning devices. Lithium disilicate (e.max CAD) crowns were fabricated with CAD/CAM technology, and the marginal gap was measured for each specimen at 4 points under magnification with a stereomicroscope. The mean measurement for each location and overall mean gap size by group were calculated. Statistically significant differences among the impression techniques were tested with F and t tests (α=.05). RESULTS: The average (±SD) gap for the conventional impression group was 112.3 (±35.3) µm. The digital impression groups had similar average gap sizes; the Lava group was 89.8 (±25.4) µm, and the iTero group was 89.6 (±30.1) µm. No statistically significant difference was found in the effects among impression techniques (P=.185) CONCLUSIONS: Within the limitations of this study, digital and conventional impressions were found to produce crowns with similar marginal accuracy.

Virtually designed and CAD/CAM-fabricated lithium disilicate prostheses for an esthetic maxillary rehabilitation: a senior dental student clinical report.

During their education, dental students seek to be involved in comprehensive esthetic treatment for the rehabilitation of lost, damaged, or discolored tooth structure. Due to technological advances and patient exposure to dental advertising, recent dental school graduates can find themselves under great expectations with limited clinical experience. With the implementation of an oral health and rehabilitation department at the University of Louisville Dental School, dental students have the opportunity to plan treatment and treat such patients under the supervision of faculty with advanced training in prosthodontics and restorative dentistry. The work flow of multiple consecutive lithium disilicate ceramic prostheses using a digital impression, virtual CAD/CAM design, and milled fabrication as planned and executed by a senior dental student is presented.

Use of intraoral digital scanning for a CAD/CAM-fabricated milled bar and superstructure framework for an implant-supported, removable complete dental prosthesis.

This report describes a clinical technique for fabricating a maxillary implant-supported, removable complete dental prosthesis by using an intraoral digital scanner to register implant positions and soft tissue morphology. The presented technique uses computer-aided design/computer-aided manufacturing (CAD/CAM) technology with a subtractive manufacturing process to fabricate a milled bar (infrastructure framework) and an additive process to fabricate a friction fit, superstructure framework. This digital restorative pathway may decrease patient discomfort and reduce the labor associated with fabricating implant-supported, removable complete dental prostheses.

A cost-effective treatment for severe generalized erosion and loss of vertical dimension of occlusion: laboratory-fabricated composite resin restorations.

This case report describes preventive and restorative treatment planning for a 56-year-old female patient with severe, chronic, poorly controlled gastroesophageal reflux disease and resulting loss of vertical dimension of occlusion. First, the demineralization process was controlled through collaboration with the patient's physician, and measures were taken to restore adequate stimulated salivary flow. Then, for financial reasons, indirect laboratory-fabricated composite resin restorations were adhesively bonded to replace lost tooth structure and reestablish the patient's collapsed vertical dimension. Indirect-laboratory fabricated restorations can be a cost-effective alternative to direct composite resin or all-ceramic restorations for the treatment of chronic severe erosion, but there are no long-term clinical reports in the current literature to support or contraindicate the use of indirect composites for this type of clinical application. Therefore, careful, long-term follow-up evaluations are planned for this patient.

A comparison of professional-level faculty and student perceptions of active learning: its current use, effectiveness, and barriers.

Active learning is an instructional method in which students become engaged participants in the classroom through the use of in-class written exercises, games, problem sets, audience-response systems, debates, class discussions, etc. Despite evidence supporting the effectiveness of active learning strategies, minimal adoption of the technique has occurred in many professional programs. The goal of this study was to compare the perceptions of active learning between students who were exposed to active learning in the classroom (n = 116) and professional-level physiology faculty members (n = 9). Faculty members reported a heavy reliance on lectures and minimal use of educational games and activities, whereas students indicated that they learned best via the activities. A majority of faculty members (89%) had observed active learning in the classroom and predicted favorable effects of the method on student performance and motivation. The main reported barriers by faculty members to the adoption of active learning were a lack of necessary class time, a high comfort level with traditional lectures, and insufficient time to develop materials. Students hypothesized similar obstacles for faculty members but also associated many negative qualities with the traditional lecturers. Despite these barriers, a majority of faculty members (78%) were interested in learning more about the alternative teaching strategy. Both faculty members and students indicated that active learning should occupy portions (29% vs. 40%) of face-to-face class time.

Digital data acquisition for a CAD/CAM-fabricated titanium framework and zirconium oxide restorations for an implant-supported fixed complete dental prosthesis.

This dental technique report describes a digital workflow with digital data acquisition at the implant level, computer-aided design and computer-aided manufacturing fabricated, tissue-colored, anodized titanium framework, individually luted zirconium oxide restorations, and autopolymerizing injection-molded acrylic resin to fabricate an implant-supported, metal-ceramic-resin fixed complete dental prosthesis in an edentulous mandible. The 1-step computer-aided design and computer-aided manufacturing fabrication of titanium framework and zirconium oxide restorations can provide a cost-effective alternative to the conventional metal-resin fixed complete dental prosthesis.

A technique for verifying and correcting a milled polyurethane definitive cast for nonsegmental implant restoration in an edentulous jaw.

This report describes a technique that uses an acrylic resin verification device and polyvinyl siloxane impression to verify and correct the analog position in a milled polyurethane definitive cast with removable periimplant soft tissue replica for a nonsegmental implant restoration in an edentulous jaw.

A comparison of traditional and engaging lecture methods in a large, professional-level course.

In engaging lectures, also referred to as broken or interactive lectures, students are given short periods of lecture followed by "breaks" that can consist of 1-min papers, problem sets, brainstorming sessions, or open discussion. While many studies have shown positive effects when engaging lectures are used in undergraduate settings, the literature surrounding use of the learning technique for professional students is inconclusive. The novelty of this study design allowed a direct comparison of engaging physiology lectures versus didactic lecture formats in the same cohort of 120 first-year School of Dentistry DMD students. All students were taught five physiological systems using traditional lecture methods and six physiological systems using engaging lecture methods. The use of engaging lectures led to a statistically significant higher average on unit exams compared with traditional didactic lectures (8.6% higher, P < 0.05). Furthermore, students demonstrated an improved long-term retention of information via higher scores on the comprehensive final exam (22.9% higher in engaging lecture sections, P < 0.05). Many qualitative improvements were also indicated via student surveys and evaluations, including an increased perceived effectiveness of lectures, decrease in distractions during lecture, and increased confidence with the material. The development of engaging lecture activities requires a significant amount of instructor preparation and limits the time available to provide traditional lectures. However, the positive results of this study suggest the need for a restructuring of the physiology curriculum to incorporate more engaging lectures to improve both the qualitative experiences and performance levels of professional students.