Adherence to Treatment and Follow-Up of Precancerous Cervical Lesions in Ethiopia.

BACKGROUND: In Ethiopia, both incidence and mortality of cervical cancer are relatively high. Screening services, which were implemented during the past few years, are currently being expanded. The World Health Organization recommends patients with a positive VIA (visual inspection with acetic acid) result should immediately receive treatment followed by rescreening after 1 year as precancerous lesions can reoccur or become residential despite treatment. MATERIALS AND METHODS: Screening logbooks dating between 2017 and 2020 were retrospectively reviewed in 14 health facilities of Addis Ababa and Oromia region. Data for 741 women with a VIA-positive result were extracted and those women were asked to participate in a questionnaire-based phone interview to gain insights about adherence to treatment and follow-up. Data were analyzed using descriptive methods and then fitted into 2 generalized linear models to test variables for an influence on adherence to follow up. RESULTS: Around 13 800 women had received a VIA screening, of which approximately 820 (5.9%) were VIA positive. While over 90% of women with a positive screen received treatment, only about half of the treated patients returned for a follow-up examination. After treatment, 31 women had a VIA-positive re-screen. We found that educational status, age over 40, no/incorrect follow-up appointment, health facility-related barriers, and use of reminders are important drivers of adherence to follow up. CONCLUSION: Our results revealed that adherence to treatment after VIA positive screening is relatively high whereas adherence to follow up recommendations still needs improvement. Reminders like appointment cards and phone calls can effectively reduce the loss of follow-up.

Prognostic and predictive impact of NOTCH1 in early breast cancer.

PURPOSE: Systemic therapy plays a major part in the cure of patients with early breast cancer (eBC). However, personalized treatment concepts are required to avoid potentially harmful overtreatment. Biomarkers are pivotal for individualized therapy. The Notch signalling pathway is widely considered as a suitable prognostic or predictive marker in eBC. This study aimed primarily at assessing the relationship between NOTCH1 mRNA expression levels and histopathological features of breast cancer tumors, as well as clinical characteristics of the correspondent eBC patients. As a secondary aim, we investigated the prognostic and predictive value of NOTCH1 by assessing possible associations between NOTCH1 mRNA expression and recurrence-free interval (RFI) and overall survival after five years of observation. PATIENTS AND METHODS: The relative NOTCH1 mRNA expression was determined in 414 tumour samples, using quantitative PCR in a prospective, multicenter cohort (Prognostic Assessment in Routine Application (PiA), 2009-2011, NCT01592825) of 1,270 female eBC patients. RESULTS: High NOTCH1 mRNA expression was detected in one-third of the tumours and was associated with negative hormone receptor status and high uPA/PAI-1 status. In addition, high NOTCH1 mRNA expression was found to be associated with more RFI related events (adjusted hazard ratio 2.1, 95% CI 1.077-4.118). Patients who received adjuvant chemotherapy and had high NOTCH1 mRNA expression in the tumour (n = 86) were three times more likely to have an RFI event (adjusted hazard ratio 3.1, 95% CI 1.321-7.245, p = 0.009). CONCLUSION: In this cohort, NOTCH1 mRNA expression had a prognostic and predictive impact. Tumours with high NOTCH1 mRNA expression may be less sensitive to cytotoxic treatment and downregulation of the Notch signalling pathway (e.g. by γ-secretase inhibitors) may be valuable for eBC therapy as an individualised treatment option.

PAM50 breast cancer subtypes and survival of patients in rural Ethiopia without adjuvant treatment: a prospective observational study.

PURPOSE: Survival rates of breast cancer (BC) patients are particularly low in rural regions in sub-Saharan Africa (SSA) which is due to limited access to therapy. In recent years, gene expression profiling (GEP) of BC showed a strong prognostic value in patients with local tumour surgery and (neo)adjuvant treatment. The aim of this study was to evaluate the impact of intrinsic subtypes on survival of patients in rural Ethiopia without any (neo)adjuvant therapy. METHODS: In total, 113 female patients from Aira Hospital with histologically proven BC and treated only with surgery were included in this study. All samples were analysed by immunohistochemistry (IHC) for estrogen receptor, progesterone receptor, HER2 and Ki67, as well as RNA-expression analysis for PAM50 subtyping. RESULTS: A positive hormone receptor status was found in 69.0% of the tumours and intrinsic subtyping demonstrated Luminal B to be the most common subtype (34.5%). Follow-up data was available for 79 of 113 patients. Two-year overall survival (OS) was 57.3% and a considerably worse OS was observed in patients with Basal-like BC compared to Luminal A BC. Moreover, advanced tumours showed an increased risk of mortality. CONCLUSION: The OS was very low in the patient cohort that received no (neo)adjuvant treatment. Immunohistochemistry and GEP confirmed endocrine-sensitive tumours in more than half of the patients, with a large proportion of Luminal B, HER2-enriched and Basal-like tumours so that adjuvant chemotherapy should be recommended.

Adherence to infliximab treatment in patients with immune-mediated inflammatory diseases from a referral center in Brazil: a cohort study.

BACKGROUND: Infliximab therapy is effective in controlling symptoms and attaining clinical remission of immune-mediated inflammatory diseases. However, treatment adherence is essential to achieve the therapeutic objective. This study aimed to determine the rate of adherence to infliximab treatment in patients treated at a referral center at a university hospital. METHOD: This ambispective cohort study included patients treated at the Professor Edgard Santos University Hospital (HUPES) referral center of our university hospital between March 2022 and February 2023. Sociodemographic, clinical, and pharmacotherapeutic data were collected from 101 patients through interviews and medical record reviews using a structured form. The adherence rate was defined as the proportion of days covered in a year. Patients who achieved an adherence rate > 80% were considered adherent. RESULTS: The treatment adherence rate was 91.04%. Individuals with inflammatory bowel diseases had a 39.1% higher risk of non-adherence to treatment compared with other patients in our sample (p < 0,05). Most patients achieved remission or control of the underlying disease activity and had good functional capacities. The main reason for absence on the scheduled date was difficulty traveling to the referral center. CONCLUSIONS: Despite the reported difficulties, treatment adherence was observed to be high. As the study was conducted in a reference unit with multidisciplinary care and continuous monitoring for treatment effectiveness, safety, and adherence, welcoming and good communication between professionals and patients may have contributed to the high adherence rate.

Using a mobile application to reduce potentially inappropriate prescribing for older Brazilian adults in primary care: a triple-blind randomised clinical trial.

BACKGOUND: Potentially inappropriate prescribing (PIP) has been evaluated in several countries, and several strategies have been devised for deprescribing drugs in older adults. The aim of this study was to evaluate the efficacy of a mobile application in reducing PIP for older adults in primary care facilities in Brazil. METHODS: This randomised, triple-blind, parallel-group trial was conducted in 22 public primary care facilities in Brazil. During the intervention phase, the general practitioners (GPs) were randomly allocated to the intervention (MPI Brasil app provides information about PIP, therapeutic alternatives and deprescribing) or control (MedSUS app provides general information about medications) group. All GPs were trained on the Clinical Decision-Making Process and how to access an Evidence-Based Health website. The GPs received an Android tablet with an installed mobile application depending on their allocated group, which they used when caring for older patients over at least 3 months. At the end of this period, a sample of older patients aged ≥ 60 years who had been awaiting medical consultation by the participating GPs were interviewed and their prescriptions analysed. The primary outcome was the frequency of PIP in and between the groups. RESULTS: Among 53 GPs who were administered the baseline survey, 14 were included in the clinical trial. At baseline, 146 prescriptions were analysed: the PIP overall was 37.7% (55/146), in the intervention group was 40.6% (28/69), and in the control group was 35.1% (27/77). After the intervention, 284 prescriptions were analysed: the PIP overall was 31.7% (90/284), in the intervention group was 32.2% (46/143), and in the control group was 31.2% (44/141) (RR: 1.16; 95% CI, 0.76-1.76). In the within-group analysis, the PIP reduced from before to after the intervention in both groups-more significantly in the intervention than in the control group (p < 0.001). In the stratified analysis of PIP frequency by GPs, there was a relative risk reduction in 86% (6/7) of GPs in the intervention group compared to 71% (5/7) in the control group. CONCLUSION: We found that the MPI Brasil app effectively reduced PIP, suggesting that it may be useful to incorporate this tool into clinical practice. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT02918643). First registration on 22/09/2016.

A Bibliometric Analysis of the 100 Most-Cited Articles Concerning Atraumatic Restorative Treatment.

INTRODUCTION: The present study aimed to identify the 100 most-cited articles concerning atraumatic restorative treatment (ART) through a bibliometric analysis. METHODS: The search was conducted in the Web of Science database in December 2023. Scopus and Google Scholar were used to compare the number of citations. The following data were extracted from the articles: title, authors, number of citations, access type, institution, country, continent, year of publication, journal, keywords, study design, and theme. Collaborative networks were generated using the VOSviewer software. Google Trends was used to investigate the global popularity of "atraumatic restorative treatment" research. RESULTS: The 100 selected articles, published between 1996 and 2019, were cited 5,092 times, ranging from 21 to 239 citations. CariesResearch (12%) and Community Dentistry and Oral Epidemiology (12%) published the highest number of articles. Clinical study (52%) was the most prevalent study design. The main theme addressed was restoration longevity (43%). Conventional high-viscosity glass ionomer was the most used restorative material (69%). The country with the highest number of articles was The Netherlands (33%) and Europe was the continent with most publications (38%). The Radboud University of Nijmegen had the highest number of articles (25%). Frencken was the most prominent author (38%). The most common keyword was "atraumatic restorative treatment" (n = 60). According to Google Trends, Tanzania was the country that searched the most about ART. CONCLUSION: The 100 most-cited articles on ART were mainly composed of clinical studies focusing on the longevity of restorations and originated in Europe.

Patient-related predictors of post-operative pain following root canal treatment: A structural model analysis.

AIM: The pathways to post-operative pain are complex and encompass factors that extend beyond the treatment protocol employed. This study aimed to identify patient-related predictors of post-operative pain following root canal treatment. METHODOLOGY: A total of 154 patients received a single-visit root canal treatment for asymptomatic necrotic mandibular molars. Before treatment, dental anxiety, dental fear and sense of coherence (SOC) were measured as predictors for each patient using validated questionnaires. Other measured predictors included gender, age, previous negative experiences at the dental offices and prior root canal treatment. Post-operative pain was assessed using the Numeric Rating Scale at multiple time-points over 30 days. Structural equation analysis was employed to evaluate the direct and indirect effects of patient-related predictors on a theoretical model of post-operative pain. The irrigant solution was also included in the model, as it was the only aspect that varied in the treatment protocol (sodium hypochlorite 2.5% and 8.25%). RESULTS: Dental anxiety (coefficient 0.028; p < .01), dental fear (coefficient 0.007; p = .02) and irrigant solution (coefficient 0.004; p = .03) exerted a direct effect on post-operative pain. SOC exerted an indirect effect on post-operative (coefficient 0.006; p = .01) through dental anxiety and dental fear. Moreover, previous negative experiences (coefficient 0.048; p = .04) exerted an indirect effect on post-operative pain through dental anxiety. CONCLUSIONS: Dental anxiety, dental fear, previous negative experiences and SOC are patient-related predictors of post-operative pain following root canal treatment. These factors should be taken into consideration in clinical practice, as patients with these characteristics may be at an increased risk of experiencing post-operative pain.

Is There an Increase in Possible Sleep Bruxism in Children Over Time? A Longitudinal Study.

BACKGROUND: Bruxism is a behaviour that has several consequences in an individual's life, especially when it starts in childhood. However, bruxism can be a potential protective factor, which is an attribute that reduces the chance of a negative health outcome. OBJECTIVES: To evaluate the incidence of sleep bruxism (SB) and dental wear in children and adolescents. MATERIALS AND METHODS: This longitudinal study began in 2014 and 2016 (baseline) with initial 1816 children followed for 5 and 3 years, respectively. The follow-up data collection started in 2019. The diagnosis of SB was parents report (baseline) and self-report (follow-up) due to age groups of each phase, and questions related to symptoms of SB were collected. Five calibrated examiners (kappa >0.7) collected the clinical data. The clinical variables were dental erosion and dental wear. Contextual, individual, behaviour and clinical characteristics were collected. A multilevel logistic regression model was used to investigate the association of contextual, individual, behaviour and clinical characteristics with SB. Poisson regression for repeated measures was performed to evaluate the incidence of SB and dental wear (incidence rate ratio-IRR and confidence interval-95% CI). RESULTS: Two hundred and fifty-three children and adolescents answered questionnaires and were clinically examined. The mean age of the follow-up in 2019 was 11.25 years old (±2.19). There was no increase in the incidence of SB (95% CI: 0.74-1.35). Children/adolescents had a 2.2 higher risk to present dental wear (95% CI: 1.89-2.60). SB at the follow-up was associated with the contextual variable, earache, erosion and awake bruxism. CONCLUSIONS: In this population, children with SB remained with this behaviour and showed higher dental wear over the years.

A Bibliometric Analysis of the Top 100 Most-Cited Papers Concerning Dental Fluorosis.

A high number of citations can indicate the potential of any specific paper to influence other research and generate changes in clinical practice. Analyzing the most-cited papers in a certain scientific field may assist researchers to identify the influential papers as well their main characteristics. The present study aimed to analyze the 100 most-cited papers concerning dental fluorosis (DF) through a bibliometric review. A search was performed in the Web of Science Core Collection (WoS-CC) database in November 2021. The papers were displayed in descending order according to the number of citations in WoS-CC. Two independent researchers performed the selection. Scopus and Google Scholar were used to compare the number of citations with WoS-CC. The following data were extracted from the papers: title, authors, number and density of citations, institution, country, continent, year of publication, journal title, keywords, study design, and theme. Collaborative networks were generated using the VOSviewer software. The top 100 most-cited papers were published between 1974 and 2014 and were cited 6,717 times (ranging from 35 to 417). Community Dentistry and Oral Epidemiology (24%), Journal of Dental Research (21%), Journal of Public Health Dentistry (17%), and Caries Research (13%) published the most papers. Observational studies (60%) and literature reviews (19%) were the most common study designs. The main topics were epidemiology (44%) and fluoride intake (32%). The countries with the highest number of papers were the USA (44%), Canada (10%), and Brazil (9%). The University of Iowa (USA) had the most papers (12%). Levy SM was the author with the highest number of papers (12%). The 100 most-cited papers on DF were mainly observational studies focused on epidemiology and originated in North America. There were few interventional studies and systematic reviews among the most-cited papers concerning this topic.

Does the composite attachment of clear aligners compromise the effectiveness of dental bleaching? An in vitro study.

INTRODUCTION: This study aimed to evaluate the effectiveness of dental bleaching with hydrogen peroxide 35% on the surface below the attachments. METHODS: Twenty-four blocks of bovine incisors were equally divided into 2 groups. The control group comprises the enamel surface free of attachments, whereas the attachment group comprises the enamel surface with attachment. Initial staining of samples was performed with black tea for 7 days; then, an attachment was made in the attachment group with Z250 resin and new staining for another 7 days in all samples. After staining, in-office bleaching was performed in both groups, and the attachments from the attachment group were removed. Color reading was performed with a spectrophotometer at all stages: initial (baseline), after 7 days of staining, after 14 days of staining, after immediate bleaching, and after 24 hours of bleaching. The color difference was calculated, and data analysis was performed using the t test for intergroup analysis. RESULTS: The results showed effective bleaching in both groups; however, there was a statistically significant difference in color change between them 24 hours after bleaching. CONCLUSION: It was concluded that the presence of attachment did not impair the action of the bleaching agent on the tooth surface.

Intrinsic subtypes in Ethiopian breast cancer patient.

PURPOSE: The recent development of multi-gene assays for gene expression profiling has contributed significantly to the understanding of the clinically and biologically heterogeneous breast cancer (BC) disease. PAM50 is one of these assays used to stratify BC patients and individualize treatment. The present study was conducted to characterize PAM50-based intrinsic subtypes among Ethiopian BC patients. PATIENTS AND METHODS: Formalin-fixed paraffin-embedded tissues were collected from 334 BC patients who attended five different Ethiopian health facilities. All samples were assessed using the PAM50 algorithm for intrinsic subtyping. RESULTS: The tumor samples were classified into PAM50 intrinsic subtypes as follows: 104 samples (31.1%) were luminal A, 91 samples (27.2%) were luminal B, 62 samples (18.6%) were HER2-enriched and 77 samples (23.1%) were basal-like. The intrinsic subtypes were found to be associated with clinical and histopathological parameters such as steroid hormone receptor status, HER2 status, Ki-67 proliferation index and tumor differentiation, but not with age, tumor size or histological type. An immunohistochemistry-based classification of tumors (IHC groups) was found to correlate with intrinsic subtypes. CONCLUSION: The distribution of the intrinsic subtypes confirms previous immunohistochemistry-based studies from Ethiopia showing potentially endocrine-sensitive tumors in more than half of the patients. Health workers in primary or secondary level health care facilities can be trained to offer endocrine therapy to improve breast cancer care. Additionally, the findings indicate that PAM50-based classification offers a robust method for the molecular classification of tumors in the Ethiopian context.

The Top 100 Most-Cited Papers in Erosive Tooth Wear: A Bibliometric Analysis.

Citation rates can be used as an indicator of the influence and relevance of scientific papers. The present study analyzed the 100 most-cited articles related to erosive tooth wear (ETW). The top 100 most-cited papers focusing on ETW topics were collected from the Web of Science database on November 11, 2020. The following bibliometric data were extracted from papers: title, authorship, institutions, countries, number of citations, year of publication, journal title, study design, topic, and keywords. Scopus and Google Scholar were searched to compare the number of citations. The VOSviewer software was used to generate collaborative network maps for the authors and keywords. The number of citations of the 100 most-cited papers ranged from 71 to 330 (average: 97.44). The papers were published between 1949 and 2015. Caries Research (28%) and The Journal of Dentistry (16%) presented the majority of papers. Laboratorial (44%) and observational studies (33%) were the most common study designs. The most studied topics were epidemiology (31%) and the erosive potential of substances (drinks, foods, or medicines) (22%). The countries with the highest number of most-cited papers were England (32%), Germany (18%), and Switzerland (10%). The University of Bern was the institution with the most papers (10%). Lussi A was the author with the highest number of papers in the top 100 (14%). The most common keyword was "dental erosion" with 64 occurrences. The top 100 most-cited papers related to ETW were composed mainly of laboratorial and observational studies focusing on epidemiology and the erosive potential of substances.

Are electronic apex locators accurate in determining working length in primary teeth pulpectomies? A systematic review and meta-analysis of clinical studies.

BACKGROUND: The lack of a well-defined apical constriction in primary teeth raises concerns regarding the accuracy of electronic apex locators (EALs) for measuring working length. OBJECTIVES: To evaluate the accuracy of EALs in determining working length in primary teeth pulpectomies. METHODS: Two reviewers searched ten databases up to September 2021. Clinical studies evaluating the accuracy of the electronic measurement of working length in primary teeth pulpectomies were included. Studies without a comparison group, with samples smaller than ten root canals, and that did not use a multiple frequency EAL were excluded. A meta-analysis was conducted to assess the paired differences in mean lengths between measurements obtained by electronic and comparative methods. In addition, a meta-analysis of proportion was applied according to the level of difference between the measures. The risk of bias and applicability of the studies were assessed using the QUADAS-2 tool. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: Twenty-nine studies were included in the qualitative analysis and twenty-three in the quantitative analysis. The methods of comparison for the electronic measurement were the radiographic method, radiovisiographic, scanning electron microscopy, and direct visualization. The meta-analysis showed that the electronic measurement tends to be shorter than radiographic measurement, while the other methods showed no difference. The proportion analysis showed a higher pooled proportion of difference values between electronic and comparative measurements within -0.5 to +0.5 mm (69.31%). The certainty of the evidence suggested very low confidence in estimating the outcome. DISCUSSION: The results of this review denote a good performance of the EALs in determining working length in primary teeth pulpectomies. However, these results are based on clinical studies with low methodological quality and high heterogeneity, which require careful interpretation for clinical practice. CONCLUSIONS: Although the results suggest acceptable accuracy of EALs in determining working length in primary teeth pulpectomies, the low quality of the included studies and the very low certainty of the evidence require clinicians to interpret these results with caution. More robust evidence is required to support that these devices are accurate for primary teeth. REGISTRATION: CRD42021277414 (PROSPERO).

Prevalence of toothache and associated factors in children and adolescents: a systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to determine the pooled prevalence of toothache in children and adolescents and to verify its association with sociodemographic characteristics and dental caries experience. MATERIAL AND METHODS: Six main and three grey literature databases were searched in February 2021. Observational studies that assessed the prevalence of toothache and associated factors were included. The methodological quality of the studies was evaluated following the guidelines by Fowkes and Fulton. Proportion and association meta-analyses were performed in MedCalc and Revman software, respectively. The certainty of the evidence was determined with the GRADE approach. RESULTS: Seventy-one studies met the inclusion criteria. Thirty-two presented high methodological quality and a low risk of bias. The overall pooled prevalence of toothache in children and adolescents was 36.2% (95%CI: 33.0-39.42; I2: 99.72%; P < 0.001). Females (OR: 1.17; 95%CI: 1.08-1.26; I2: 91%; P < 0.001) and children and adolescents whose caregivers had ≤ 8 years of schooling (OR: 1.42; 95%CI: 1.30-1.56; I2: 77%; P < 0.001) presented the higher chance of reporting toothache. Dental caries experience increased the chance of reporting toothache in 3.49 times (95%CI: 2.70-4.51; I2: 92%; P < 0.001). The certainty of the evidence was very low. CONCLUSIONS: The overall pooled prevalence of toothache was considered high. Sociodemographic characteristics (sex and caregivers' educational level) and previous dental caries experience were significantly associated with toothache reports. CLINICAL RELEVANCE: Toothache is still a recurrent issue in many countries. Thus, it is essential to understand its possible associated factors to reduce the occurrence of new episodes.

Prevalence of sequelae after traumatic dental injuries to anterior primary teeth: A systematic review and meta-analysis.

BACKGROUND/AIM: Clinical and radiographic sequelae are common following traumatic dental injuries to primary teeth. The aim of this systematic review was to assess the prevalence of such sequelae. MATERIALS AND METHODS: Searches were conducted in the PubMed, Scopus, Embase, Web of Science, and BBO/LILACS databases as well as the gray literature. The outcome of interest was the prevalence of the most common sequelae following traumatic dental injuries to anterior primary teeth. Observational studies that evaluated such sequelae were included. Data were extracted, and methodological quality was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The number of sequelae per tooth and the total number of teeth evaluated in each study were considered to calculate pooled prevalence rates with 95% confidence intervals (CI). The quality of the evidence was determined using the GRADE approach. RESULTS: Twenty-five articles were included in this systematic review and meta-analysis. The prevalence of each complication in descending order was as follows: 39.7% crown discoloration (95% CI: 29.52-50.32), 24.3% pulp necrosis with infection (95% CI: 17.34-32.06), 16.2% periapical radiolucency (95% CI: 8.88-25.49), 15.9% premature tooth loss (95% CI: 9.93-23.15), 14.8% pulp canal obliteration (95% CI: 8.46-22.73), 11.9% pathological root resorption (95% CI: 7.68-16.98), 7.1% abscess/fistula (95% CI: 4.4-10.6), and 1.8% ankylosis (95% CI: 0.82-3.17). The certainty of the evidence was very low. CONCLUSIONS: Crown discoloration was the most common sequela in injured primary teeth, but this should be interpreted with caution due to the very low certainty of the evidence. Considerable variation was found in the prevalence of each sequela.

Forcing a change: a learn-by-doing workshop on circadian rhythms to understand the complexities of human physiology.

Physiology is an integrative science that requires an understanding of the organism as a whole to acquire a deep comprehension of its functions and avoid misconceptions that may impair further learning. Thus it is necessary to develop resources that promote the integrative vision that Physiology requires. Chronobiology is a challenging discipline and one of the least addressed concepts in Physiology curricula. The activity here presented proposes a workshop with a theoretical-practical perspective in the context of the Neuroscience Conferences held annually at our university. All conference presentations are neuroscience-related topics, in combination with practical activities, some of them analyzing variables of the students themselves. We chose to assess this informal teaching scenario to involve the students with a scientific perspective while learning and hoping to increase their appreciation for different topics related to neuroscience. Specifically for this activity on chronobiology, the evaluation was carried out via a survey study including quantitative and qualitative questions and semistructured personal interviews. In general, the results reveal a very positive opinion from students regarding aspects such as the teaching methodology, the organization before and during the activity or the added value of the experience for their future professional performance. Some of the students stated they were more aware of the importance of their circadian system and even changed some of their personal daily routines after the activity. Such positive feedback encourages us to continue working in this theoretical-practical format in the future, as it contributes to improving students' perception of their own learning.

Soft Grippers for Automatic Crop Harvesting: A Review.

Agriculture 4.0 is transforming farming livelihoods thanks to the development and adoption of technologies such as artificial intelligence, the Internet of Things and robotics, traditionally used in other productive sectors. Soft robotics and soft grippers in particular are promising approaches to lead to new solutions in this field due to the need to meet hygiene and manipulation requirements in unstructured environments and in operation with delicate products. This review aims to provide an in-depth look at soft end-effectors for agricultural applications, with a special emphasis on robotic harvesting. To that end, the current state of automatic picking tasks for several crops is analysed, identifying which of them lack automatic solutions, and which methods are commonly used based on the botanical characteristics of the fruits. The latest advances in the design and implementation of soft grippers are also presented and discussed, studying the properties of their materials, their manufacturing processes, the gripping technologies and the proposed control methods. Finally, the challenges that have to be overcome to boost its definitive implementation in the real world are highlighted. Therefore, this review intends to serve as a guide for those researchers working in the field of soft robotics for Agriculture 4.0, and more specifically, in the design of soft grippers for fruit harvesting robots.

The top 100 most-cited papers authored by Dr. Jens Ove Andreasen: A bibliometric analysis.

BACKGROUND/AIM: Dr. Jens Ove Andreasen, the "father" of dental traumatology, passed away on September 26, 2020. As a tribute, the aim of this study was to catalog and analyze the top 100 most-cited papers (co)authored by Dr. Andreasen. MATERIALS AND METHODS: A bibliometric analysis was conducted on October 21, 2020, in the Web of Science Core Collection (WoS-CC) database. The numbers of citations in the WoS "All Databases" section, Scopus, and Google Scholar databases were cross-matched. Two researchers collected the following bibliometric data: title, number of citations, authors, country, year, journals, study design, and theme. The VOSviewer software was used to generate collaborative network maps for the authors and keywords. RESULTS: Of 194 papers identified in WoS-CC, a list was compiled with the 100 most-cited papers (co)authored by Dr. Andreasen. The number of citations of each paper ranged from 24 to 365 (mean: 85.4). Nine papers were cited more than 200 times. Most papers were published in Dental Traumatology (55%), between the 1990's and 2000's (60%), with a laboratory design (40%). One hundred and nine (co)authors, from 19 countries were identified in the top 100 most-cited papers. Dental traumatology was the most studied theme (52%). CONCLUSIONS: The top 100 most-cited papers (co)authored by Dr. Jens Ove Andreasen were composed mainly of laboratory and observational studies, published mostly in Dental Traumatology. The present study was a humble homage to highlight the importance of his research and work. However, his legacy goes beyond the numbers and will always remain unsurpassed.

Dental education and undue exposure of patients' image in social media: A literature review.

INTRODUCTION: The benefits of social media for health education and communication have been discussed in the literature. However, the indiscriminate utilisation by dental students and professionals, and the effects on patients' privacy and confidentiality are still little explored. OBJECTIVE: To investigate the exposure of patients' images in social media by dental students and professionals, as well as to explore how this issue is addressed in dental schools. MATERIALS AND METHODS: A literature review was performed. Search strategies were developed for the following bibliographic databases: PubMed/MEDLINE, Latin American and Caribbean Health Sciences (LILACS), Scientific Electronic Library Online (SciELO), and Scopus. There were no restrictions about the year of publication. RESULTS: 231 articles were identified through search strategies. After a two-phase process of selection, 7 studies were included. Articles mainly described how social media have been used by healthcare students and professionals and warned that this usage has often been unprofessional, risking patients' privacy and confidentiality. Thus, it is the faculty's role, as a whole, to instruct students about the wise social media usage. CONCLUSION: The undue exposure of patients' images by dental students and professionals in social media has often been observed. Educators should include social media awareness discussions on the undergraduate curriculum.

An aphid effector promotes barley susceptibility through suppression of defence gene expression.

Aphids secrete diverse repertoires of effectors into their hosts to promote the infestation process. While 'omics' approaches facilitated the identification and comparison of effector repertoires from a number of aphid species, the functional characterization of these proteins has been limited to dicot (model) plants. The bird cherry-oat aphid Rhopalosiphum padi is a pest of cereal crops, including barley. Here, we extend efforts to characterize aphid effectors with regard to their role in promoting susceptibility to the R. padi-barley interaction. We selected three R. padi effectors based on sequence similarity to previously characterized Myzus persicae effectors and assessed their subcellular localization, expression, and role in promoting plant susceptibility. Expression of R. padi effectors RpC002 and Rp1 in transgenic barley lines enhanced plant susceptibility to R. padi but not M. persicae, for which barley is a poor host. Characterization of Rp1 transgenic barley lines revealed reduced gene expression of plant hormone signalling genes relevant to plant-aphid interactions, indicating that this effector enhances susceptibility by suppressing plant defences in barley. Our data suggest that some aphid effectors specifically function when expressed in host species, and feature activities that benefit their corresponding aphid species.