Learning outcomes: Exploring implications of adopting a different level of detail.

INTRODUCTION: Outcome-based programmes provide a framework to support educators and learners in understanding content and end points within taught courses. Management of these outcomes in the Dental Degree at Newcastle University has been a challenge in relation to quality assurance and enhancement, having over 1500 detailed student-level outcomes (SLO). This research aimed to explore the implications of adopting a more superficial "course" level of outcome (CLO), when reviewed against a reference set of external LO requirements. MATERIALS AND METHODS: A purposive sample of five courses within the undergraduate dental programme was selected. The mapping of both SLOs and CLOs was reviewed in relation to their total number and the mapping connections to the reference outcomes. RESULTS: There was a mean reduction of 79% in outcomes when comparing SLOs to CLOs. The number of mapping connections between CLOs and the reference set reduced in three courses and increased in two, when compared to SLOs. DISCUSSION: From a purely numerical perspective, changing the detail of learning outcomes has led to a change in mapping connections. As the delivered curriculum has remained unchanged, this demonstrates a potential impact of differing interpretations of learning outcomes. Further review of learning outcomes in relation to the domains categorised within the reference outcome document suggested more mapping links were obtained in clinically focused courses than academic or theoretical courses. CONCLUSION: A demonstrable impact in mapping connections was observed when the detail within the learning outcomes was changed. This has implications for programme leaders in structuring LOs for a curriculum.

Virtual courses: enhancing a curriculum.

INTRODUCTION: Providers of education programmes are required to demonstrate to students, staff and external regulators the content of the programme and how this aligns to key outcomes. Whilst many programme themes are straightforward to illustrate, other integral themes prove challenging to demonstrate independently. INNOVATION: A virtual course takes elements within the current programme relating to a specific theme, repackages and maps them to provide clear signposting by highlighting each occasion the theme is taught, experienced and assessed. The individual elements remain within their current course, so there is no disruption to the established curriculum, but there is an enhancement in terms of transparently displaying linkages within a theme. DISCUSSION: Using the concept of virtual courses we have found we can respond to new initiatives and requirements of external regulators, as well as providing improved signposting for staff and students. This can be undertaken without the need to redesign a whole curriculum. CONCLUSION: In well-designed and currently effective curricula, we would like to recommend that virtual course development can enhance programme transparency, demonstrate external regulatory requirements and promote quality assurance without disruption to current content.

Is the onset of influenza in the community age-related?

We studied the spread of influenza in the community between 1993 and 2009 using primary-care surveillance data to investigate if the onset of influenza was age-related. Virus detections [A(H3N2), B, A(H1N1)] and clinical incidence of influenza-like illness (ILI) in 12·3 million person-years in the long-running Royal College of General Practitioners-linked clinical-virological surveillance programme in England & Wales were examined. The number of days between symptom onset and the all-age peak ILI incidence were compared by age group for each influenza type/subtype. We found that virus detection and ILI incidence increase, peak and decrease were in unison. The mean interval between symptom onset to peak ILI incidence in virus detections (all ages) was: A(H3N2) 20·5 [95% confidence interval (CI) 19·7-21·6] days; B, 18·8 (95% CI 15·8·0-21·7) days; and A(H1N1) 17·0 (95% CI 15·6-18·4) days. Differences by age group were examined using the Kruskal-Wallis test. For A(H3N2) and A(H1N1) viruses the interval was similar in each age group. For influenza B there were highly significant differences by age group (P = 0·0001). Clinical incidence rates of ILI reported in the 8 weeks preceding the period of influenza virus activity were used to estimate a baseline incidence and threshold value (upper 95% CI of estimate) which was used as a marker of epidemic progress. Differences between the age groups in the week in which the threshold was reached were small and not localized to any age group. In conclusion we found no evidence to suggest that influenza A(H3N2) and A(H1N1) occurs in the community in one age group before another. For influenza B, virus detection was earlier in children aged 5-14 years than in persons aged ⩾25 years.

Patterns of selection and polymorphism of innate immunity genes in bumblebees (Hymenoptera: Apidae).

In response to on-going biodiversity loss, conservation genetics has established itself as an important branch of biology. Historically concentrating on assessing stochastic processes using neutral loci, there has been a recent surge of interest in understanding and quantifying variation at loci underlying ecologically important traits. To this end, patterns of selection and polymorphism at these loci must be characterized. Loci underlying immunity make good candidates in this context: they are expected to be important for population persistence and may exhibit diversifying or divergent selection. Predictions regarding the pattern of selection expected at immune system loci have been based on their interactions with pathogens, however, published studies report mixed results as to whether these are borne out or not. Here, polymorphism and selection is examined for three innate immune system loci in bumblebees: a peptidoglycan recognition protein, a putative alpha-macroglobulin, and scavenger receptor. Both intra- and inter-specific sequence variation is quantified. Very little polymorphism was encountered, precluding robust tests of selection. However, the lack of inter-specific polymorphisms suggests a lack of positive selection for the regions sequenced. Results are discussed with respect to population genetic predictions and generation of a specific immune response in insects. Alternative loci and methods for studying adaptive genetic variation in a conservation context are considered.

Are implant supported overdentures too complex to be included in the undergraduate curriculum?

To widen the availability of implant supported mandibular overdentures, their inclusion in the undergraduate clinical training curriculum has been encouraged. The aim was to determine whether implant supported mandibular overdentures provided by undergraduates could achieve similar levels of improvement in patient satisfaction and quality of life as previously demonstrated by experienced prosthodontists. Nineteen patients were treated by Stage 3 undergraduate students at Newcastle University, School of Dental Sciences. Changes between pre-treatment and 3 month post-treatment satisfaction and oral health related quality of life suggest dental undergraduates achieve similar levels of improvement as experienced prosthodontists.

Microsatellite standardization and evaluation of genotyping error in a large multi-partner research programme for conservation of Atlantic salmon (Salmo salar L.).

Microsatellite genotyping is a common DNA characterization technique in population, ecological and evolutionary genetics research. Since different alleles are sized relative to internal size-standards, different laboratories must calibrate and standardize allelic designations when exchanging data. This interchange of microsatellite data can often prove problematic. Here, 16 microsatellite loci were calibrated and standardized for the Atlantic salmon, Salmo salar, across 12 laboratories. Although inconsistencies were observed, particularly due to differences between migration of DNA fragments and actual allelic size ('size shifts'), inter-laboratory calibration was successful. Standardization also allowed an assessment of the degree and partitioning of genotyping error. Notably, the global allelic error rate was reduced from 0.05 ± 0.01 prior to calibration to 0.01 ± 0.002 post-calibration. Most errors were found to occur during analysis (i.e. when size-calling alleles; the mean proportion of all errors that were analytical errors across loci was 0.58 after calibration). No evidence was found of an association between the degree of error and allelic size range of a locus, number of alleles, nor repeat type, nor was there evidence that genotyping errors were more prevalent when a laboratory analyzed samples outside of the usual geographic area they encounter. The microsatellite calibration between laboratories presented here will be especially important for genetic assignment of marine-caught Atlantic salmon, enabling analysis of marine mortality, a major factor in the observed declines of this highly valued species.

Interaction of cationic surfactants with DNA detected by spectroscopic and acoustic wave techniques.

Interaction of the cationic surfactants benzalkonium chloride and 1-hexadecylpyridinium chloride, in the concentration range 0.1 microM to 1 mM with calf thymus DNA and with short 19-mer double-stranded DNA has been examined in solution using UV absorption and fluorescent spectroscopies and at the liquid-solution interface by thickness-shear mode acoustic wave sensor. Higher concentrations of surfactant resulted in an increase of UV absorption, and decrease of melting temperature and van't Hoff enthalpy of calf thymus DNA. Both surfactants induce fluorescence quenching of ethidium bromide which is also associated with intercalation of the molecules into the nucleic acid strand. The effect of the pyridinium compound is greater than for the other surfactant likely because of the lower size of polar head group in this molecule. With respect to acoustic wave detection at the device surface, for relatively low surfactant concentrations (below 100 microM), decreases of both series resonant frequency and motional resistance were observed. At higher surfactant concentration both parameters increased. These effects are attributed to acoustic coupling processes that occur at the device-film/liquid boundary.

Embedding implant dentistry into the undergraduate dental curriculum.

This article represents the consensus from a meeting of the British Society of Prosthetic Dentistry's Education Group which met to discuss implant dentistry at the undergraduate student level. The consensus recognises the need to embed the teaching of implant supported prostheses if such a treatment modality is to be widely practised after graduation. This short article makes some recommendations as well as detailing some challenges and barriers that need to be overcome if implant dentistry is to be successfully embedded in an undergraduate dental curriculum.

Detection of DNA damage: effect of thymidine glycol residues on the thermodynamic, substrate and interfacial acoustic properties of oligonucleotide duplexes.

Thymidine glycol residues in DNA are biologically active oxidative molecular damage sites caused by ionizing radiation and other factors. One or two thymidine glycol residues were incorporated in 19- to 31-mer DNA fragments during automatic oligonucleotide synthesis. These oligonucleotide models were used to estimate the effect of oxidized thymidines on the thermodynamic, substrate and interfacial acoustic properties of DNA. UV-monitoring melting data revealed that modified residues in place of thymidines destabilize the DNA double helix by 8-22 degrees C, depending on the number of lesions, the length of oligonucleotide duplexes and their GC-content. The diminished hybridizing capacity of modified oligonucleotides is presumably due to the loss of aromaticity and elevated hydrophilicity of thymine glycol in comparison to the thymine base. According to circular dichroism (CD) data, the modified DNA duplexes retain B-form geometry, and the thymidine glycol residue introduces only local perturbations limited to the lesion site. The rate of DNA hydrolysis by restriction endonucleases R.MvaI, R.Bst2UI, R.MspR9I and R.Bme1390I is significantly decreased as the thymidine glycol is located in the central position of the double-stranded recognition sequences 5'-CC / WGG-3' (W = A, T) or 5'-CC / NGG-3' (N = A, T, G, C) adjacent to the cleavage site. On the other hand, the catalytic properties of enzymes R.Psp6I and R.BstSCI recognizing the similar sequence are not changed dramatically, since their cleavage site is separated from the point of modification by several base-pairs. Data obtained by gel-electrophoretic analysis of radioactive DNA substrates were confirmed by direct spectrophotometric assay developed by the authors. The effect of thymidine glycol was also observed on DNA hybridization at the surface of a thickness-shear mode acoustic wave device. A 1.9-fold decrease in the rate of duplex formation was noted for oligonucleotides carrying one or two thymidine glycol residues in relation to the unmodified analog.

A randomized-controlled trial of food choices made by edentulous adults.

AIM: The aim of this study was to conduct a randomized-controlled trial to compare food choices of edentulous adults provided with implant-supported mandibular overdentures and conventional dentures. METHODS: Edentulous patients were randomly allocated to an implant group (IG) or a denture group (DG). IG subjects (n=49) were provided with conventional maxillary dentures and implant-retained mandibular overdentures. Subjects in this group refusing implants were retained using the 'intention-to-treat principle' and provided with conventional dentures. DG subjects (n=48) were provided with conventional dentures. Subjects indicated whether they consumed any of seven test foods and the level of chewing difficulty experienced. Data were collected pre-treatment and 3 months post treatment. RESULTS: IG subjects reported increased consumption of carrots, apples and nuts post-treatment (P<0.05) and decreased post-treatment difficulty in chewing apples and nuts. DG subjects reported decreased post-treatment difficulty in chewing carrots, bacon and nuts (P<0.05). Between group differences for chewing difficulty were detected for nuts that DG subjects found easier to chew than IG subjects (P=0.002). CONCLUSION: Food selection and perceived chewing difficulty improved in both groups, with no significant differences between groups. Successful rehabilitation may not result in different food selection, which may require concurrent tailored dietary interventions, but may increase available food choices.

The transition from dental school to postgraduate dental foundation training: strengthening the interaction between stakeholders.

This article demonstrates the benefits of collaboration between dental educators in undergraduate and postgraduate settings, to facilitate the transition of dental students into dental foundation training (DFT). The School of Dental Sciences at Newcastle University and Health Education England, working across north-east and north Cumbria, have strengthened links by forming a dental foundation programme undergraduate liaison group (FPUG) involving all stakeholders. The group has shared information between the organisations, enhanced stakeholder engagement, and developed several initiatives including workshops to help prepare final year students for the transition to DFT. A small investment in time has been highly effective, and the formation of a similar group merits consideration in other areas of the UK.

Just One Thing: a novel patient feedback model.

In response to the Educational Standards of the UK's General Dental Council, Newcastle University, School of Dental Sciences introduced a patient feedback card to gather and incorporate patient feedback into their undergraduate assessment framework. The cards ask for patient response to two questions about their experience, and also ask patients to identify 'Just One Thing' (JOT) the student could do to improve this. JOT cards completed during a two week period were collected to evaluate and analyse the nature of patient responses within this model. Over 90% of JOT cards scored the students as 'Excellent' with the remainder scoring the student as 'Good' or giving no response. Many of the free text comments complimented the students and also provided focused suggestions for improvement. While the overwhelming positive responses may suggest that this model for collecting feedback may not be effective at discriminating between students with varying levels of interpersonal/communication skills, the free text comments were seen to be of value in building confidence or identifying areas for improvement.

Murine Gc globulin binds to a synthetic sequential polypeptide that is a murine B lymphocyte mitogen.

A non-immunoglobulin component in mouse serum was found to compete with antibody for the binding of a polyanionic antigen, poly (Tyr-Glu-Ala-Gly). The percent of the polymer (44 ng/ml) bound at physiological pH by the serum component in normal mouse serum was low (18%), but was much higher at pH 6.0 (85%). As a result, the binding of the polyanionic peptide antigen by antibody in immune serum was considerably lower at pH 6.0 than it was at physiological pH. These results should be taken into account when dealing with similar antigens that have been frequently studied in immunology, such as poly (Glu60 Ala40) and poly (Glu60 Ala30 Tyr10). The non-immunoglobulin serum component has been identified as Gc globulin, a vitamin D-binding protein that has been shown to be present on the surface of B lymphocytes. This binding might be responsible for the murine B cell mitogenicity of poly (Tyr-Glu-Ala-Gly) that has been previously reported.

Patients' experiences of dental implant treatment: A literature review of key qualitative studies.

OBJECTIVES: To identify and summarise the findings of previous qualitative studies relating to patients' experience of dental implant treatment (DIT) at various stages of their implant treatment, by means of textual narrative synthesis. DATA/SOURCES: Original articles reporting patients' experience with dental implant were included. A two-stage search of the literature, electronic and hand search identified relevant qualitative studies up to July 2014. An extensive electronic search was conducted of databases including PubMed, Embase, Scopus, Web of Knowledge, Cochrane Database and Google Scholar. STUDY SELECTION: Included primary studies (n=10) used qualitative research methods and qualitative analysis to investigate patients' experiences with dental implants treatment. CONCLUSIONS: While the growing interest in implant treatment for the replacement of missing dentition is evident, it is essential to investigate patients' perceptions of different aspects of implant treatment. This textual narrative synthesis conducted to review qualitative studies which provided insight into patients' experience of two types of implant prostheses namely ISOD (implant-supported overdenture) and FISP (fixed implant supported prostheses). Primary reviewed studies tended to include samples of older patients with more extensive tooth loss, and to focus on experiences prior to and post-treatment rather than on the treatment period itself. Findings across reviewed studies (n=10) suggested that patients with FISP thought of implant treatment as a process of 'normalisation'(1) and believed that such implant restorations could be similar to natural teeth, whereas patients with ISOD focused more on the functional and social advantages of their implant treatment. CLINICAL SIGNIFICANCE: The growing interest in qualitative research is evident in several branches of clinical dentistry and dental implantology is not an exception. Qualitative studies concerning the patients account of their experience of dental implants is however limited. The aim of this review is to firstly identify recent work within this field and to subsequently categorise it more consistently by means of textural narrative synthesis, thus highlighting similarities and differences and enabling identification of gaps in research knowledge thereby setting the direction of further research.

Sensitization of allo-specific T lymphocytes in vivo: role of antigen-presenting cells.

The migratory behavior of antigen-presenting cells was investigated in vivo. Purified murine splenic dendritic cells and splenic and peritoneal macrophages were labelled and injected subcutaneously in the hind foot-pads of mice and monitored for seven days. In the first 24 h, a small quantity of label was recovered from popliteal but not inguinal lymph nodes with radioactive (111In-oxine and 3H-uridine) but not fluorescent (1,1'-dioctadecyl 3,3,3'3'-tetramethylindocarbocyanine perchlorate and fluorescein isothiocyanate) labelling of the antigen-presenting cells. Chemical fixation of the injected antigen-presenting cells had no effect on the detection of label in the popliteal lymph nodes, suggesting that it was unlikely to be due to active cellular migration. Label recovery from hind feet declined with time over the seven day period and was independent of the label type. Essentially the same observations were made whether the antigen-presenting cells were syngeneic or allogeneic to the injected mice and irrespective of the type of antigen-presenting cell used. However, allogeneic antigen-presenting cells, which did not migrate to the draining lymph nodes, successfully primed T lymphocytes in these lymph nodes as shown by a secondary in vitro mixed leukocyte reaction. Again, chemical fixation of the injected antigen-presenting cells had no effect on their ability to prime allogeneic T lymphocytes in the draining lymph nodes. These experiments suggest that, during experimental allo-sensitization via the subcutaneous route, indirect priming of allogeneic T lymphocytes may be a dominant pathway.

Diagnostic epidural opioid technique.

Diagnostic epidural blocks were performed on 27 chronic pain patients sequentially using saline, fentanyl, and lidocaine solution. The patients were divided into one of four groups based on their response to the epidural solutions: placebo response group--pain relief with placebo solutions; fentanyl response group--pain relief with epidural fentanyl; lidocaine response group (LRG)--pain relief with lidocaine but not fentanyl; and no response group--no pain relief with any of the solutions used. The four groups were compared on the basis of age, sex, site of pain, duration of pain, narcotic use, pain assessment index, and workmen's compensation claims. The comparisons resulted in the conclusion that LRG patients had a much longer average duration of pain than the other groups. On the basis of the information gathered, it was theorized that, despite their response to epidural lidocaine, LRG patients may actually be a group of operant pain patients. Their failure to receive analgesia from epidural fentanyl may be a learned response such that they associate any sensory input from the affected area as painful. If follow-up studies support these findings, then the diagnostic opioid technique may be a more sensitive tool in diagnosing chronic pain.

Iatrogenic gingival overgrowth in cardiac transplantation.

It is well established that both cyclosporin and nifedipine are associated with gingival overgrowth. Although both drugs are widely used in the management of organ transplant patients, there is little information on the prevalence and severity of this unwanted effect in cardiac transplant patients. This study evaluated the gingival health of 94 dentate cardiac transplant patients, all of whom were medicated with cyclosporin as a component of their immunosuppressive therapy. Sixty-three (63) of the patients were also medicated with nifedipine. Significantly higher gingival overgrowth scores (P < 0.0001) and periodontal probing depths (P = 0.001) were observed in patients medicated with the combination of cyclosporin and nifedipine than those medicated with cyclosporin alone. Likewise, there was a significantly greater need to carry out gingival surgery on patients taking the combination (62%), than those medicated with cyclosporin alone (25.8%) (P = 0.001). Patient's age, sex, duration of therapy, gingival bleeding index, and nifedipine therapy were important determinants for both the expression of gingival overgrowth and the need for surgery. Significant sequestration of nifedipine in the gingival crevicular fluid (GCF) was observed. The concentration of nifedipine in GCF did not relate to either the gingival changes or plasma concentration of the drug. Cardiac transplant patients are at risk of developing gingival overgrowth and approximately 50% require surgical intervention. This risk increases significantly when patients are medicated concomitantly with nifedipine.

Prevalence of gingival overgrowth induced by calcium channel blockers: a community-based study.

BACKGROUND: The prevalence of gingival overgrowth induced by chronic medication with calcium channel blockers is uncertain. Although there have been several studies examining this question, the results are conflicting, with previous estimates ranging from 20% to 83%. There have been only 2 studies examining the prevalence of overgrowth induced by diltiazem and amlodipine, with estimates of 74% and 3.3%, respectively. METHODS: The current study aimed to address the problems associated with these studies by examining a sample of patients taking one of 3 calcium channel blockers, who were drawn from a community-based population in northeastern England. Nine hundred eleven (911) subjects were recruited from general medical practices in the area. Of these, 442 were taking nifedipine, 181 amlodipine, and 186 diltiazem. In addition, 102 control subjects were examined. Drug and demographic data for each subject were recorded. The periodontal condition of all subjects was assessed including plaque index, papillary bleeding index, and a photograph of the anterior gingivae for subsequent analysis of overgrowth severity. RESULTS: More than six percent (6.3%) of subjects taking nifedipine were seen to have significant overgrowth. This overgrowth was statistically greater than the amount of overgrowth seen in either of the other 2 drug groups or the control population. The prevalence of gingival overgrowth induced by amlodipine or diltiazem was not statistically significant when compared to the control group. The severity of overgrowth within the nifedipine group was found to be related to the amount of gingival inflammation and also to the gender of the subject, with males being 3 times as likely to develop overgrowth than females. CONCLUSIONS: The prevalence of clinically significant overgrowth related to chronic medication with calcium channel blockers is low, i.e., 6.3% for nifedipine. Males are 3 times as likely as females to develop clinically significant overgrowth. The presence of gingival inflammation is an important cofactor for the expression of this effect.

Oral and dental problems in the organ transplant patient.

The number of people receiving organ transplants has dramatically increased over the last decade. It is now likely that a dental surgeon will come across patients who have undergone transplantation. This paper considers the particular problems that these patients are likely to present their general dental practitioners.