Registration and retention of dentists on the General Dental Council register between 2006 and 2016.

Background There is considerable uncertainty over the dental future workforce requirements in the United Kingdom. This uncertainty has not been helped by the lack of clarity on the possible impacts on workforce following the results of the referendum to leave the European Union and enactment of Article 50.Aim This paper sets out to describe the contribution to the dental workforce over the reported period of non-UK qualified dental graduates.Results For the last three years over a third of new registrants have qualified from outside of the UK with over a quarter of registrants entering through mutual recognition of their qualification. Furthermore, the findings highlight the relatively short period for which those entering the register from the European Economic Area remain on the register when compared to other entrants.Discussion Those responsible for workforce policy will need to react rapidly to these findings given the short time period remaining to negotiate the terms and conditions of Britain's exit and this must include clarification of the entitlements of the current and future dental EEA qualified graduates.

Bonfire of the verities.

The emphasis on ensuring improved governance within the UK dental care system continues to rely on the identification of poorly performing individuals. Such an approach, while addressing certain political expediencies, fails to take into account both the wider system issues and the extensive literature on how to influence performance in a positive way. If sustainable improvements in the qualities of care are to occur, an acknowledgement of the system's shortcomings by the main parties must be made and where individual performance has fallen below that regarded as acceptable, the contribution of the delivery system in general needs to be noted. In addition, changes to the clinical negligence arrangements away from an adversarial approach to one that uses an open non-punitive process is necessary. As in health, the environment that individuals find themselves in is a major determinant of good outcomes.

The standard of newly qualified dental graduates - foundation trainer perceptions.

Background There have been anecdotal concerns that the skill mix of recently qualified graduates is very different to those qualifying several years ago, in particular that the clinical skills on qualification are less. If true, such changes may have ramifications for providers of undergraduate training, postgraduate training, particularly at foundation training level, and ultimately the public.Aim The aim of this study was to assess changes in perceived standards of newly qualified graduates as reported by foundation trainers.Method A cross-sectional survey was conducted using a self-completed internet-based survey tool sent to all foundation trainers (FTs) in England, Northern Ireland and Wales.Results A total of 312 responses were obtained covering all postgraduate deaneries. There was mixed opinion regarding standards of new graduates, with 51% reporting that the overall standard of those entering foundation training was 'unsatisfactory'. Standards in key clinical areas were considered unsatisfactory by large proportions of respondents. Eighty-five percent considered standards to be unsatisfactory in 'crown and bridge', 75% in 'extraction of teeth', 74% in endodontics, 67% in removable prosthodontics, and 62% in treatment planning. Experienced trainers identified a decline in standards in particular clinical areas.Conclusions A large proportion of foundation trainers consider the current standard of new graduates to be unsatisfactory for entering foundation training. There are a number of key clinical areas of concern and a perception of declining standards.

Developing a spinal cord injury research strategy using a structured process of evidence review and stakeholder dialogue. Part III: outcomes.

STUDY DESIGN: Focus Group. OBJECTIVES: To develop a unified, regional spinal cord injury (SCI) research strategy for Australia and New Zealand. SETTING: Australia. METHODS: A 1-day structured stakeholder dialogue was convened in 2013 in Melbourne, Australia, by the National Trauma Research Institute in collaboration with the SCI Network of Australia and New Zealand. Twenty-three experts participated, representing local and international research, clinical, consumer, advocacy, government policy and funding perspectives. Preparatory work synthesised evidence and articulated draft principles and options as a starting point for discussion. RESULTS: A regional SCI research strategy was proposed, whose objectives can be summarised under four themes. (1) Collaborative networks and strategic partnerships to increase efficiency, reduce duplication, build capacity and optimise research funding. (2) Research priority setting and coordination to manage competing studies. (3) Mechanisms for greater consumer engagement in research. (4) Resources and infrastructure to further develop SCI data registries, evaluate research translation and assess alignment of research strategy with stakeholder interests. These are consistent with contemporary international SCI research strategy development activities. CONCLUSION: This first step in a regional SCI research strategy has articulated objectives for further development by the wider SCI research community. The initiative has also reinforced the importance of coordinated, collective action in optimising outcomes following SCI.

Is periodontal disease a public health problem?

Clinically defined periodontal disease is highly prevalent, has considerable impacts on individuals and society and is costly to treat; the cost of dental care is the fourth highest costs of all diseases and consuming between 5 and 10% of all healthcare resources. Changes in the epidemiology of clinically defined periodontal diseases suggest that the prevalence of severe periodontal disease is low and rates of progression of periodontal destruction tend to be relatively slow. Current periodontal care modalities have a remarkably weak evidence base, with considerable resources allocated to fund interventions that include oral hygiene instruction, scale and polishes through to surgical interventions. The public health problem lies more in the failure in design of a contract between dental professionals and the state. Such a contract needs to recognise both the wider determinants of disease and the role that dental professionals could play: a contract that concentrated on rewarding outcomes, namely a diminution in treatment need, as opposed to one based simply on the number of interventions would be a major step forward.

Review of Oral Surgery Services and Training: a case of prescription without a diagnosis.

In the Review of Oral Surgery Services and Training, the Oral Surgery Review Group supported the development of the specialty of oral surgery and some of the arguments put forward to support it concerned finance and quality. We argue that their analyses of the present situation are flawed. The economic argument and issues concerning skill-mix are very simplistic, but more importantly, the rationale given for the increase in referrals did not explore the myriad of likely reasons why in any substantive detail. These reasons include shortcomings in undergraduate training and a poor NHS primary dental contract including the arrangements for charging patients. Before implementation, the policy makers should consider a wide range of available options to address the failings, and take a "whole system approach" before they embark on developing a specialty, which may cause problems that exceed those currently facing the system.

Group sparse reconstruction using intensity-based clustering.

Compressed sensing has been of great interest to speed up the acquisition of MR images. The k-t group sparse (k-t GS) method has recently been introduced for dynamic MR images to exploit not just the sparsity, as in compressed sensing, but also the spatial group structure in the sparse representation. k-t GS achieves higher acceleration factors compared to the conventional compressed sensing method. However, it assumes a spatial structure in the sparse representation and it requires a time consuming hard-thresholding reconstruction scheme. In this work, we propose to modify k-t GS by incorporating prior information about the sorted intensity of the signal in the sparse representation, for a more general and robust group assignment. This approach is referred to as group sparse reconstruction using intensity-based clustering. The feasibility of the proposed method is demonstrated for static 3D hyperpolarized lung images and applications with both dynamic and intensity changes, such as 2D cine and perfusion cardiac MRI, with retrospective undersampling. For all reported acceleration factors the proposed method outperforms the original compressed sensing method. Improved reconstruction over k-t GS method is demonstrated when k-t GS assumptions are not satisfied. The proposed method was also applied to cardiac cine images with a prospective sevenfold acceleration, outperforming the standard compressed sensing reconstruction.

Quality indicators: the rationale behind their use in NHS dentistry.

This paper explores the concept of quality as applied to healthcare and its subsequent application to dentistry. The assessment of quality arose from the manufacturing industry and is viewed as a cornerstone of current Government thinking. The difficulties in defining and therefore in measuring are examined and, in particular, the tensions between quantifying quality at a population level and at an individual level. The findings of the application of quality measures to primary medical care are reviewed, especially those that are linked to financial reimbursement of care providers and the implications for any future dental agenda discussed.

k-t Group sparse: a method for accelerating dynamic MRI.

Compressed sensing (CS) is a data-reduction technique that has been applied to speed up the acquisition in MRI. However, the use of this technique in dynamic MR applications has been limited in terms of the maximum achievable reduction factor. In general, noise-like artefacts and bad temporal fidelity are visible in standard CS MRI reconstructions when high reduction factors are used. To increase the maximum achievable reduction factor, additional or prior information can be incorporated in the CS reconstruction. Here, a novel CS reconstruction method is proposed that exploits the structure within the sparse representation of a signal by enforcing the support components to be in the form of groups. These groups act like a constraint in the reconstruction. The information about the support region can be easily obtained from training data in dynamic MRI acquisitions. The proposed approach was tested in two-dimensional cardiac cine MRI with both downsampled and undersampled data. Results show that higher acceleration factors (up to 9-fold), with improved spatial and temporal quality, can be obtained with the proposed approach in comparison to the standard CS reconstructions.

A computationally efficient OMP-based compressed sensing reconstruction for dynamic MRI.

Compressed sensing (CS) methods in MRI are computationally intensive. Thus, designing novel CS algorithms that can perform faster reconstructions is crucial for everyday applications. We propose a computationally efficient orthogonal matching pursuit (OMP)-based reconstruction, specifically suited to cardiac MR data. According to the energy distribution of a y-f space obtained from a sliding window reconstruction, we label the y-f space as static or dynamic. For static y-f space images, a computationally efficient masked OMP reconstruction is performed, whereas for dynamic y-f space images, standard OMP reconstruction is used. The proposed method was tested on a dynamic numerical phantom and two cardiac MR datasets. Depending on the field of view composition of the imaging data, compared to the standard OMP method, reconstruction speedup factors ranging from 1.5 to 2.5 are achieved.

Whole-heart imaging using undersampled radial phase encoding (RPE) and iterative sensitivity encoding (SENSE) reconstruction.

Whole-heart isotropic nonangulated cardiac magnetic resonance (CMR) is becoming an important protocol in simplifying MRI, since it reduces the need of cumbersome planning of angulations. However the acquisition times of whole-heart MRI are prohibitive due to the large fields of view (FOVs) and the high spatial resolution required for depicting small structures and vessels. To address this problem, we propose a three-dimensional (3D) acquisition scheme that combines Cartesian sampling in the readout direction with an undersampled radial scheme in the phase-encoding plane. Different undersampling patterns were investigated in combination with an iterative sensitivity encoding (SENSE) reconstruction and a 32-channel cardiac coil. Noise amplification maps were calculated to compare the performance of the different patterns using iterative SENSE reconstruction. The radial phase-encoding (RPE) scheme was implemented on a clinical MR scanner and tested on phantoms and healthy volunteers. The proposed method exhibits better image quality even for high acceleration factors (up to 12) in comparison to Cartesian acquisitions.

Experiences of vocational trainees on their preparation and application for vocational training.

OBJECTIVES: To report the experiences of vocational trainees on the level of undergraduate preparation for the vocational training application process and their experiences of the application system. METHOD: A self-completed postal questionnaire distributed to all graduates undertaking vocational training in 2004. RESULTS: Of the 62% responding, nearly three quarters felt that they were given inadequate guidance and preparation for vocational training during their undergraduate studies. Shortcomings included help on preparing their curriculum vitae, interview techniques and guidance on choosing practices. There was a wide variation between the undergraduate schools. The application process itself was also felt to have major shortcomings. CONCLUSION: Current arrangements for the transition between the undergraduate and vocational training education systems have shortcomings. These shortcomings could be addressed by dental schools, recognising undergraduate need in these areas by working more closely with the deaneries and those responsible for vocational training.

Quantification of the shape of fiber tracts.

The fiber tracts generated using diffusion MRI are usually simply displayed and assessed visually for a specific clinical or medical research purpose. This paper proposes computational techniques that can be used to study the shape of the tracts and make interindividual comparisons. These methods make use of fundamental geometric invariants, such as curvatures and torsions, or Fourier descriptors, together with the link of a pair of curves. Intersubject comparisons only require that the starting and ending points of the tracts can be defined and do not require point-by-point correspondences such as obtained using image registration. Principal component analysis-based shape analysis is also investigated. The invariants are tested on simulations and in vivo datasets, and the scale dependence and noise sensitivity of the measures are assessed. The potential for these techniques to be used in neuroscience research and clinical applications is demonstrated.

Options for types of dental health personnel to train for ghana.

SUMMARY OBJECTIVES: To explore the degree of agreement on issues surrounding the proposals for dental health personnel requirements among key oral health personalities who are central to determining policy on oral health personnel requirements for Ghana and to make recommendations to assist in the future development of dental health personnel requirements. DESIGN: A review of the literature, published documents and in-depth semi-structured interviews. SETTING: Dental health service in Ghana PARTICIPANTS: Key oral health personalities who are central to determining policy on oral health personnel requirements for Ghana RESULTS: There was a lack of consensus regarding key aspects of planning personnel requirements including the numbers and the kinds of professionals complementary to dentistry (PCDs) to develop, who should be responsible for their training, and which people to admit as trainees of PCDs. CONCLUSION: Greater discussion between the various agencies involved should take place to help ensure consensus on the overall policy objectives.

Matrix description of general motion correction applied to multishot images.

Motion of an object degrades MR images, as the acquisition is time-dependent, and thus k-space is inconsistently sampled. This causes ghosts. Current motion correction methods make restrictive assumptions on the type of motions, for example, that it is a translation or rotation, and use special properties of k-space for these transformations. Such methods, however, cannot be generalized easily to nonrigid types of motions, and even rotations in multiple shots can be a problem. Here, a method is presented that can handle general nonrigid motion models. A general matrix equation gives the corrupted image from the ideal object. Thus, inversion of this system allows us to get the ideal image from the corrupted one. This inversion is possible by efficient methods mixing Fourier transforms with the conjugate gradient method. A faster but empirical inversion is discussed as well as methods to determine the motion. Simulated three-dimensional affine data and two-dimensional pulsation data and in vivo nonrigid data are used for demonstration. All examples are multishot images where the object moves between shots. The results indicate that it is now possible to correct for nonrigid types of motion that are representative of many types of patient motion, although computation times remain an issue.

Inhibiting BDNF expression by antisense oligonucleotide infusion causes loss of nigral dopaminergic neurons.

Brain derived neurotrophic factor (BDNF) expression is significantly reduced in the Parkinson's disease substantia nigra. This neurotrophin has potent affects on dopaminergic neuron survival protecting them from the neurotoxins MPTP and 6-hydroxydopamine (6-OHDA) commonly used to create animal models of Parkinson's disease and also promoting dopaminergic axonal sprouting. In this study, we demonstrate that an antisense oligonucleotide infusion (200 nM for 28 days) to prevent BDNF production in the substantia nigra of rats mimics many features of the classical animal models of Parkinson's disease. 62% of antisense treated rats rotate (P < or = 0.05) in response to dopaminergic receptor stimulation by apomorphine. 40% of substantia nigra pars compacta tyrosine hydroxylase immunoreactive neurons are lost (P < or = 0.00001) and dopamine uptake site density measured by (3)H-mazindol autoradiography is reduced by 34% (P < or = 0.005). Loss of haematoxylin and eosin stained nigral neurons is significant (P < or = 0.0001) but less extensive (34%). These observations indicate that loss of BDNF expression leads both to down regulation of the dopaminergic phenotype and to dopaminergic neuronal death. Therefore, reduced BDNF mRNA expression in Parkinson's disease substantia nigra may contribute directly to the death of nigral dopaminergic neurons and the development of Parkinson's disease.