The Graduating European Dentist-Domain IV: Dentistry in Society.

This position paper outlines the areas of competence and learning outcomes of "The Graduating European Dentist" that specifically relates to Dentistry in Society. In addition to treating individual patients, a Dentist must be able to focus on promoting health, monitoring interventions and implementing effective strategies of care at community and population levels. This necessarily involves understanding population demography and health trends, engaging with health policy and promoting health. A Dentist must also understand population demography and health trends, in the context of the healthcare system within which they work.

The Graduating European Dentist-Domain II: Safe and Effective Clinical Practice.

This position paper outlines the areas of competence and learning outcomes of "The Graduating European Dentist" that specifically relate to Safe and Effective Clinical Practice. Dentists are required to ensure that they are capable of providing appropriate care for their patients, whilst also effectively managing and leading the wider clinical team. The care that is provided should align to a contemporaneous evidence base wherever possible, and the quality of care and the management systems that underpin it should be regularly audited and improved.

The Graduating European Dentist: A New Undergraduate Curriculum Framework.

With "The Graduating European Dentist", ADEE provides a new approach that reflects best academic practice for European undergraduate dental education. The new suite of documents sees increased emphasis on important curriculum components such as patient safety, working as a team and patient-centred care. There is also an increased emphasis on teaching excellence, student satisfaction and student preparedness and support. Guidance relating to methods of teaching and learning, and assessment (educational measurement), is also provided. It is anticipated that this new format will further increase accessibility and utility for educators, institutions, societies and regulators, across the sector.

The Graduating European Dentist-Domain I: Professionalism.

This position paper outlines the areas of competence and learning outcomes of "The Graduating European Dentist" that specifically relate to Professionalism. Professionalism is a commitment to a set of values, behaviours and relationships, which underpin the trust that the public hold in dental care professionals. Shortcomings within this domain are often responsible for patient dissatisfaction, concern and complaint-and emphasis is placed on the importance of embedding these values from an early stage within the curriculum.

The Graduating European Dentist-Domain III: Patient-Centred Care.

This position paper outlines the areas of competence and learning outcomes of "The Graduating European Dentist" that specifically relate to patient-centred care. This approach is becoming increasingly prominent within the literature and within policy documents. Whilst working to an evidence base is critical, dentists must also be aware of the scientific basis that underpins the treatment they provide. The evaluation process, which supports treatment planning, also requires dentists to be able to listen, collate, and record pertinent information effectively. In addition, the ability to account for a patient's social, cultural and linguistic needs (cultural competence) will result in a practitioner who is able to treatment plan for patient-centred care.

The Graduating European Dentist: Contemporaneous Methods of Teaching, Learning and Assessment in Dental Undergraduate Education.

It is often the case that good teachers just "intuitively" know how to teach. Whilst that may be true, there is now a greater need to understand the various processes that underpin both the ways in which a curriculum is delivered, and the way in which the students engage with learning; curricula need to be designed to meet the changing needs of our new graduates, providing new, and robust learning opportunities, and be communicated effectively to both staff and students. The aim of this document is to draw together robust and contemporaneous methods of teaching, learning and assessment that help to overcome some of the more traditional barriers within dental undergraduate programmes. The methods have been chosen to map specifically to The Graduating European Dentist, and should be considered in parallel with the benchmarking process that educators and institutions employ locally.

Estimating the impacts of fishing on dependent predators: a case study in the California Current.

Juvenile rockfish (Sebastes spp.) are important prey to seabirds in the California Current System, particularly during the breeding season. Both seabird breeding success and the abundance of pelagic juvenile rockfish show high interannual variability. This covariation is largely a response to variable ocean conditions; however, fishing on adult rockfish may have had consequences for seabird productivity (e.g., the number of chicks fledged per breeding pair) by reducing the availability of juvenile rockfish to provisioning seabird parents. We tested the hypothesis that fishing has decreased juvenile rockfish availability and thereby limited seabird productivity over the past 30 years. We quantified relationships between observed juvenile rockfish relative abundance and seabird productivity, used fisheries stock assessment approaches to estimate the relative abundance of juvenile rockfish in the absence of fishing, and compared the differences in seabird productivity that would have resulted without rockfish fisheries. We examined the abundance of juvenile rockfish and the corresponding productivity of three seabird species breeding on Southeast Farallon Island (near San Francisco, California, USA) from the early 1980s to the present. Results show that while the relative abundance of juvenile rockfish has declined to approximately 50% of the estimated unfished biomass, seabirds achieved 75-95% of the estimated un-impacted levels of productivity, depending upon the species of bird and various model assumptions. These results primarily reflect seabirds with "conservative" life histories (one egg laid per year) and may be different for species with more flexible life history strategies (greater reproductive effort). Our results are consistent with the premise that the impacts of local rockfish fisheries on seabird productivity are less than impacts that have occurred to the prey resources themselves due to ocean climate and the ability of seabirds to buffer against changes in prey availability through prey-switching and other behavioral mechanisms.

The Impact of Replacement Conventional Dentures on Eating Experience.

INTRODUCTION: Despite much research on the impact of edentulism and prosthetic rehabilitation on food and nutrient intake, there is little information on how replacing complete dentures affects social and emotional issues around eating. OBJECTIVES: To investigate, in a cohort study, how replacing conventional complete dentures affects eating-related quality of life (ERQoL). A secondary aim was to test the responsiveness of an Emotional and Social Issues Related to Eating (ESIRE) questionnaire to change in ERQoL. METHODS: Participants, recruited from the Dental Hospital, Newcastle-upon-Tyne, UK, completed the self-administrated ESIRE questionnaire before and after provision of new conventional complete dentures. Paired t test was used to determine any change between pre- and posttreatment ESIRE scores, which can range from 0 (poor) to 100 (excellent). Cohen's d effect size was used to measure the magnitude of change in ERQoL. Standardized response mean (SRM) was used to measure the responsiveness of the ESIRE questionnaire to changes in ERQoL. RESULTS: Fifty-five participants aged 52 to 85 y (mean, 72 y), including 21 males (42%) and 29 females (58%), completed the study. A statistically significant improvement in the total ESIRE scores was found, mean (SE) +20.3 (3.30), P < 0.001. Equally, all domains of the ESIRE questionnaire showed significant improvements: enjoyment of food/eating, +27.3 (3.63), P < 0.001; self-consciousness/embarrassment, +18.1 (3.88), P < 0.001; interruption to meals, +13.3 (5.27), P < 0.05; confidence when eating, +18.7 (4.84), P < 0.001; time for eating/preparation of meals, +18.5 (4.85), P < 0.001); and functional ability to eat, +18.2 (3.67), P < 0.001). Cohen's d was large (0.95) for the total score and ranged from medium (0.37) to large (1.30) for all domains. Value of SRM was large (0.87) for the total score and ranged from medium (0.36) to large (1.1) for all domains. CONCLUSION: Denture replacement can directly improve ERQoL. The ESIRE questionnaire was responsive to clinically important changes in ERQoL. KNOWLEDGE TRANSFER STATEMENT: The results of this study improve the understanding of the impact of denture replacement on eating-related quality of life (ERQoL). Clinicians are encouraged to pay more attention to the impact of wearing conventional complete dentures on social and emotional issues around eating. The findings should motivate clinicians and inspire specialists in prosthodontics and oral rehabilitation to continue providing conventional complete dentures as a suitable treatment option for edentulous patients.

Insulin resistance limits glucose utilization and exercise tolerance in myophosphorylase deficiency and NIDDM.

Myophosphorylase deficiency [McArdle's disease (MD)] produces a defect in muscle glycogenolysis in which muscular work is limited by delivery of external sources of substrate, primarily glucose and nonesterified fatty acids, to meet energy demands associated with exercise. In the present study, we evaluated an unusual patient with both MD and non-insulin-dependent diabetes mellitus. We hypothesized that insulin resistance would limit transport of extracellular glucose to skeletal muscle during exercise, resulting in impaired exercise performance that was reversible by insulin infusion. The effect of a hyperinsulinemic "euglycemic" clamp on exercise tolerance was evaluated by in vivo 31P-magnetic resonance spectroscopy as well as total work performed. We observed that insulin infusion significantly increased the rate of systemic glucose utilization (P < 0.01) and also significantly decreased the ratio of inorganic phosphate to phosphocreatine (P < 0.001) during forearm exercise compared with the control study. Insulin clamp was also associated with an increase in total work performed (56%) during exercise. Our findings demonstrate that resistance to the biological actions of insulin, as occurs in type II diabetes mellitus, leads to a defect in glucose transport that limits the availability of extracellular glucose to exercising muscle. In our subject with a substrate-limited skeletal muscle metabolism (MD), reversal of this defect in insulin-dependent glucose transport by a hyperinsulinemic euglycemic clamp was associated with significant improvement in magnetic resonance spectroscopy parameters of skeletal muscle metabolism as well as exercise performance.

Facilitation of implant provision in primary care.

OBJECTIVE: To investigate primary care practitioner participation in implant-supported mandibular overdenture (ISOD) provision. DESIGN: Postal questionnaire. SETTING: Primary dental care, North East England 2007. SUBJECTS AND METHODS: Two hundred and ninety-five practitioners in North East England were sent questionnaires presenting a case-based scenario of a patient unable to manage a lower denture on an atrophic ridge. The questionnaire led them through the facilitation stages of ISOD provision, asking them to state their anticipated level of participation at each stage. Demographic details were also collected. RESULTS: Two hundred and seventeen responses were received (74%). Most practitioners would consider the option of provision of ISODs (89%) in this case and all who considered would discuss the option with the patient. Of those offering to facilitate treatment, 66% (122/184) would never deliver themselves, with the majority (60%, 111/184) referring within primary care. Statistical analysis showed associations between demographics and behaviour. CONCLUSIONS: The majority of practitioners in this study area would facilitate ISOD provision in this case. Practitioners who are male and working in a practice where a framework for the provision of implants already exists are most likely to facilitate provision and/or provide an ISOD within primary care.

The utilization of two frequency-shifted sinc pulses for performing volume-selected in vivo NMR spectroscopy.

A new approach to volume-selected in vivo NMR spectroscopy uses two frequency-shifted sinc pulses, in conjunction with pulsed field gradients, to destroy the coherence of the unwanted signals. A hard pi/2 pulse can then be used to read the z magnetization in the region of interest. This method is independent of T2, provides complete volume selection in a single acquisition, and can be readily implemented on most high-field commercial imaging/spectroscopy systems.