A rapid review of serious games: From healthcare education to dental education.

INTRODUCTION: Games involving technology have the potential to enhance hand-eye coordination and decision-making skills. As a result, game characteristics have been applied to education and training, where they are known as serious games. There is an increase in the volume of literature on serious games in healthcare education; however, evidence on their impact is still ambiguous. AIMS: The aims of this study were (i) to identify high-quality evidence (systematic reviews or meta-analyses) regarding impacts of serious games on healthcare education; and (ii) to explore evidence regarding impacts of serious games in dental education. METHODS: A rapid review of the literature was undertaken to synthesise available evidence and examine serious games in healthcare education (Stage 1) and dental education (Stage 2). RESULTS: Nine systematic reviews were included in Stage 1, four of which were of high, three of moderate and two of low quality. For Stage 2, two randomised control trials with moderate quality were included. The findings demonstrated that serious games are potentially effective learning tools in terms of knowledge and skills improvement, although outcomes of serious games over traditional learning approaches were not consistent. In addition, serious games appeared to be more engaging and satisfying for students, which could be considered as the most important positive impact. CONCLUSION: Serious games provide an option for healthcare and dental education but remain underutilised and researched. At best, they offer a similar experience to other methods in relation to educational outcome; however, they can provide a supplementary strategy to engage students and improve learner satisfaction.

Lessons learned on recruitment and retention in hard-to-reach families in a phase III randomised controlled trial of preparatory information for children undergoing general anaesthesia.

BACKGROUND: Recruitment and retention are documented as two of the most difficult elements of conducting clinical trials. These issues are even more challenging in paediatric trials, particularly when the families being recruited and retained are deemed 'hard to reach'. METHODS: Through the authors' own reflection on the conduct of the trial this paper examines recruitment and retention with hard to reach families from the perspective of a recently completed clinical trial on preparatory information for children undergoing general anaesthesia for tooth extractions in which approximately 83% of those approached and eligible agreed to participate. RESULTS: The lessons learned for recruitment include: the importance of children's assent; maximising limited resources when screening and approaching potential participants; valuing families' time; and developing effective professional relationships. The retention rate was 83-85.5% at follow up time points up to 3.5 weeks following recruitment, insights into how this was accomplished include: ensuring continuity of care; determination to connect via telephone; valuing families' time; and close monitoring of appointment date changes. CONCLUSIONS: Implications for future paediatric trials with hard to reach families are discussed. TRIAL REGISTRATION: ISRCTN18265148 ; NIHR Portfolio 10,006. Date of Registration: 29 November 2013. The trial was registered after commencement but before completion of data collection.

Effectiveness and acceptability of face-to-face, blended and e-learning: a randomised trial of orthodontic undergraduates.

AIM: This study compared e-learning (EL), face-to-face learning (F2FL) and blended learning (BL) with respect to their effectiveness and student attitudes towards them. It also evaluated the effect of the order in which the components (EL and F2FL) of blended learning are delivered. DESIGN: This was a prospective cluster randomised trial comparing four parallel groups. METHOD: Eight groups of fourth year dental undergraduate students were randomly allocated to one of four intervention groups: EL, F2FL, BL1 or BL2. These four groups were assessed for their baseline comparability of knowledge and skills. Each then received the same cephalometric tutorial but delivered by the allocated mode of learning. Effectiveness was immediately assessed with a MCQ which measured short-term recall of knowledge. Student attitudes were evaluated with a questionnaire followed by a focus group discussion. RESULTS: Ninety (57%) students completed the study. Pearson's chi-square test found no statistically significant difference between F2FL and BL; EL alone was less effective (P<0.05) for four MCQ questions but with no difference for the remaining six questions. Overall students were positive towards each learning modality, but a one-way analysis of variance found BL was the most and F2FL was the least accepted (P=0.002). EL was significantly (P=0.028) less preferred. The order of the components in BL had no significant effects. CONCLUSION: These results suggest that BL is more likely than either F2FL or EL alone, to be both effective and accepted when delivering cephalometric education to undergraduates.

Online learning in dentistry: an overview of the future direction for dental education.

This paper provides an overview of the diversity of tools available for online learning and identifies the drivers of online learning and directives for future research relating to online learning in dentistry. After an introduction and definitions of online learning, this paper considers the democracy of knowledge and tools and systems that have democratized knowledge. It identifies assessment systems and the challenges of online learning. This paper also identifies the drivers for online learning, including those for instructors, administrators and leaders, technology innovators, information and communications technology personnel, global dental associations and government. A consideration of the attitudes of the stakeholders and how they might work together follows, using the example of the unique achievement of the successful collaboration between the Universities of Adelaide, Australia and Sharjah, United Arab Emirates. The importance of the interaction of educational principles and research on online learning is discussed. The paper ends with final reflections and conclusions, advocating readers to move forward in adopting online learning as a solution to the increasing worldwide shortage of clinical academics to teach dental clinicians of the future.

Homology between proteins controlling Streptomyces fradiae tylosin resistance and ATP-binding transport.

A tylosin(Ty)-producing strain of Streptomyces fradiae contains at least three genes, tlrA, tlrB, tlrC, specifying resistance to Ty (TyR). The complete nucleotide sequence of the TyR-encoding gene, tlrC, and the transcription start point of the gene were determined. The sequence contains an open reading frame coding for a protein of 548 amino acids (aa) with an Mr of 59129. The TlrC protein was identified by expression of the cloned gene by in vitro coupled transcription and translation in cell-free extracts derived from Streptomyces lividans. The N- and C-terminal halves of TlrC share extensive homology, suggesting that the protein evolved through tandem gene duplication. Each half of the deduced TlrC aa sequence also shows significant homology to numerous eukaryotic and prokaryotic membrane-associated, active-transport protein subunits. The homologous proteins include examples from the systems responsible for efflux of cytotoxic drugs from multidrug-resistant human cells and for export of hemolysin from Escherichia coli. The greatest similarity to TlrC is in regions containing the ATP-binding sites found in these proteins. These results suggest a role for the tlrC gene product as part of a multiple component, ATP-dependent transport system for the active excretion of Ty from the producing organism.

Protein quality of enteral nutrition products is consistent with label claims during shelf life and beyond expiration date.

OBJECTIVE: Eternal formulas were monitored during their shelf life and beyond expiration date to examine protein quality. DESIGN: Protein quality was determined by protein efficiency ratio (PER) bioassays and amino acid analyses. SETTING: A certified laboratory performed the PER tests according to procedures established by the Association of Official Analytical Chemists and recognized by the US Food and Drug Administration (FDA). The amino acid analyses were performed in our laboratory using validated methods. SAMPLES: Commercially available formulas (Ensure, Osmolite HN, TwoCal HN) that contained protein blends of caseinates or caseinates with soybean protein isolate were studied. MAIN OUTCOME MEASURES: Achievement of protein-quality values greater than or equal to 70% of the fresh reference casein value as determined by the PER method would be consistent with adequate protein quality as described by the FDA. Levels of indispensable amino acids that meet or exceed the standards established by the National Research Council of the National Academy of Sciences are considered high-quality proteins. Levels of amino acids throughout shelf life were compared with published label claims. RESULTS: Amino acid analyses, which included measurement of tryptophan and total sulfur amino acids, revealed that both fresh and outdated products met or exceeded standards for proteins of high biologic value and were consistent with label claims. The PER values ranged from 90% to 96% of the control diet for fresh product and 82% to 87% for products evaluated after expiration. CONCLUSION: The enteral products studied provide high-quality protein throughout the shelf life of the product.

Participating dentists' assessment of the pilot regional online videoconferencing in dentistry (PROVIDENT) project.

OBJECTIVE: To assess the educational effectiveness of delivering continuing professional education (CPE) from dental schools to small groups of dentists at distant sites via videoconferenced links using relatively inexpensive equipment and ISDN2 links. DESIGN: 41 videoconferences between the four campuses of London Dental Schools and postgraduate centres in South East England were assessed using a pre-piloted questionnaire which contained open and specific questions. The questionnaire was given to all participants at the end of each videoconference. Answers to the specific questions were graded using the Likert scale. RESULTS: 40 of the 41 videoconferences were completed satisfactorily and were attended by 257 participants, all of whom completed questionnaires. However, no individual question was answered by all the participants. Of the responses 90% were positive on the topics of appropriateness of the teaching material for delivery by videoconference and of its educational level. 90% of responses also indicated a wish to attend further videoconferences and satisfaction at avoiding the need to travel to London for similar educational activity. 87% rated the lecturers as good or excellent in their use of the medium. 85% of responses indicated that the question and answer sessions within the videoconferences were useful and 82% that the visual aids enhanced the sessions. The technical aspects of the videoconferences were rated positively but to a lesser extent than the educational aspects with 69% of positive responses for visibility of visual aids, 54% for sound quality and 76% for the lecturers use of the technology. The technical aspects of the videoconferences improved during the pilot study. In response to the open questions, participants stated that they found the most useful aspects of the videoconferences were not having to travel, access to first rate lecturers, the discussions and the opportunity to interact with experts. CONCLUSIONS: The participants in this pilot study were positive about the use of videoconferencing to deliver educational material from dental schools to small groups. Once the technology has improved, this medium has the potential to provide CPE for dentists at work or at home in response to their specific needs.

KIBRA exhibits MST-independent functional regulation of the Hippo signaling pathway in mammals.

The Salvador/Warts/Hippo (Hippo) signaling pathway defines a novel signaling cascade regulating cell contact inhibition, organ size control, cell growth, proliferation, apoptosis and cancer development in mammals. The upstream regulation of this pathway has been less well defined than the core kinase cassette. KIBRA has been shown to function as an upstream member of the Hippo pathway by influencing the phosphorylation of LATS and YAP, but functional consequences of these biochemical changes have not been previously addressed. We show that in MCF10A cells, loss of KIBRA expression displays epithelial-to-mesenchymal transition (EMT) features, which are concomitant with decreased LATS and YAP phosphorylation, but not MST1/2. In addition, ectopic KIBRA expression antagonizes YAP via the serine 127 phosphorylation site and we show that KIBRA, Willin and Merlin differentially regulate genes controlled by YAP. Finally, reduced KIBRA expression in primary breast cancer specimens correlates with the recently described claudin-low subtype, an aggressive sub-group with EMT features and a poor prognosis.

Willin/FRMD6 expression activates the Hippo signaling pathway kinases in mammals and antagonizes oncogenic YAP.

The Salvador/Warts/Hippo (Hippo) signaling pathway defines a novel signaling cascade regulating cell contact inhibition, organ size control, cell growth, proliferation, apoptosis and cancer development in mammals. The Drosophila melanogaster protein Expanded acts in the Hippo signaling pathway to control organ size. Previously, willin/FRMD6 has been proposed as the human orthologue of Expanded. Willin lacks C-terminal sequences that are present in Expanded and, to date, little is known about the functional role of willin in mammalian cells. When willin is expressed in D. melanogaster epithelial tissues, it has the same subcellular localization as Expanded, but cannot rescue growth defects associated with expanded deficiency. However, we show that ectopic willin expression causes an increase in phosphorylation of the core Hippo signaling pathway components MST1/2, LATS1 and YAP, an effect that can be antagonized by ezrin. In MCF10A cells, loss of willin expression displays epithelial-to-mesenchymal transition features and willin overexpression antagonizes YAP activity via the N-terminal FERM domain of willin. Therefore, in mammalian cells willin influences Hippo signaling activity by activating the core Hippo pathway kinase cassette.

Sizing, stoichiometry and optical absorbance variations of colloidal cadmium sulphide nanoparticles.

Simple preparative methods were used to synthesise cadmium sulphide particles in the size ranges larger than those associated with quantum confinement. UV/visible absorption spectra were measured. Rayleigh and Mie theories were used to analyse normalised absorption spectra to allow estimates of particle size and number to be obtained simultaneously. Each model was utilised in an appropriate size and wavelength range. Surprisingly, Mie calculations were found to over-estimate the absorbance of particles below 50 nm radius. Powder X-ray diffraction results showed the crystallites to be independent of particle size and suggested that the particles grew through aggregation of smaller bodies. The Mie results could therefore be interpreted in terms of changes in the particles' optical indicatrix with radius. Large poly-crystalline particles (>50 nm radius) should possess a near spherical indicatrix, fulfilling the assumptions of the Mie theory. The indicatrix of particles smaller than 50 nm should become increasingly anisotropic with decreasing size, leading to discrepancies between the Mie model and measured data. Although the results could also be explained through changes in the magnitude of the particle refractive index, compositional (Auger electron spectroscopy, energy dispersive X-ray analysis) and structural (powder X-ray diffraction) analyses of the particles complicate the hypothesis. Energy dispersive X-ray results showed that small cadmium sulphide particles possessed a large excess of sulphur suggesting a change in effective cadmium sulphide stoichiometry.

Webcasting: casting the web more widely.

In the search for a cost-effective method of delivering teaching to dispersed groups of students, webcasting is proving successful. By taking video streams and transmitting them over the Internet it allows events such as lectures, seminars, webinars and tuition sessions to be made accessible to participants in many different, remote locations. Moreover, the webcasts can be stored on a normal PC to give, those unable to see the original broadcast, the opportunity to watch it at a later, more convenient time; similarly it can be used by students for revision purposes. New developments have allowed a useful level of interactivity between presenters and students, and between students themselves. As part of a recent project at a UK dental school, webcasting was trialed amongst undergraduates and postgraduates to measure its value for dental education. The results have been very encouraging, with the latter group especially benefiting from being able to see the webcasts in their own time, on their PCs at home or work. However, as befits an ever-changing scenario, a new web-oriented facility is beginning to play a role in education: podcasting provides a more personal, individual interaction with the web.

Seeing is believing: dental education benefits from developments in videoconferencing.

Videoconferencing has been widely used to provide distant advice in many healthcare specialties across the world. However, videoconferencing has been further extended to support distance learning and has been evaluated through a number of educational projects. The use of the technology has been integrated as a core method of delivering training and education at all levels in dentistry. Advances in systems, services and standards have produced equipment and telecommunications links that are user-friendly, reliable, affordable and offer better quality image resolution. In addition, a wide range of peripheral devices can be connected to basic videoconferencing equipment to introduce a variety of teaching aids and material into a session. Projects such as PROVIDENT (Postgraduate Regional Online Videoconferencing in Dentistry) and DUET (Dental Undergraduate Education by Teleconferencing) have demonstrated that videoconferencing teaching sessions are as effective as traditional face-to-face lectures in both on-campus and off-campus teaching and reduce travel time and costs for both tutors and students. This paper describes how videoconferencing systems and services have developed and their benefits and applications in dentistry. It then goes on to describe the PROVIDENT and DUET projects as case studies.

Continuing professional development and ICT: target practice.

Ever-increasing needs and demands by dentists and all other members of the dental team for education and training at all levels - undergraduate, postgraduate and continuing - are straining the resources of existing providers of such education. At the same time, there are ever-increasing opportunities to develop online delivery and the use of a range of information and communication technology (ICT) systems and services further, in all aspects of dental education. This paper reviews recent developments that have led to an increased demand for dental postgraduate programmes and continuing professional development (CPD) courses in the United Kingdom and then discusses how ICT has and will impact on teaching practice. Examples include the use of teaching and learning resources in a virtual learning environment (VLE) and the increasing use of blended learning. The paper then explores the need for both teachers and students to adapt to the new environment to ensure they can benefit to the maximum and that teaching and learning practices are changed accordingly.

Supporting the learner and teacher online.

Whether on or off campus, all students need support if they are to successfully complete their studies. Although 'good teachers' should be 'good teachers' in any medium, their support is especially important when technology is involved. Previous articles in the series have shown that the advent of ICT has added to the complexity of the type and provision of this help and advice, not least because it now involves technical as well as pedagogical and pastoral elements. However, rather than being a problem, ICT, particularly through its online facilities, can provide levels of support over and above those required by traditional face-to-face teaching. This has implications for tutors as well as students as it places greater pressure on their time and requires them to have a new skills-set, a situation that needs to be resolved if the full benefits of online support are to be realised.

The many faces of interaction.

During the process of learning teachers and/or students interact with each other on a personal level. However, in e-learning the process is achieved through the intermediary of an information and communication technology (ICT) system or service. Descriptions of these ICT-human interface devices are given in this paper. Successful interaction depends not just on personal relationships, but also on understanding and the ability to use computers and communications equipment effectively. Interactivity, when using ICT, may as a result be different from that in a traditional classroom. The computer is the main man-machine interface and modulates people's ability to interact. Newer, mobile technology will extend the ability to interact in terms of time and place, as is illustrated by the use of portable digital assistants for dental teaching in clinics. The paper concludes that it is very important that both teachers and students should understand how to interact optimally with current and future ICT systems and devices.

Better informed in clinical practice - a brief overview of dental informatics.

Uptake of dental informatics has been hampered by technical and user issues. Innovative systems have been developed, but usability issues have affected many. Advances in technology and artificial intelligence are now producing clinically useful systems, although issues still remain with adapting computer interfaces to the dental practice working environment. A dental electronic health record has become a priority in many countries, including the UK. However, experience shows that any dental electronic health record (EHR) system cannot be subordinate to, or a subset of, a medical record. Such a future dental EHR is likely to incorporate integrated care pathways. Future best dental practice will increasingly depend on computer-based support tools, although disagreement remains about the effectiveness of current support tools. Over the longer term, future dental informatics tools will incorporate dynamic, online evidence-based medicine (EBM) tools, and promise more adaptive, patient-focused and efficient dental care with educational advantages in training.

Remember the days in the old school yard: from lectures to online learning.

Claims have been made that the traditional classroom/lecture-room mode of teaching is under threat with the future being purely online-based. There is no doubt that the impact of ICT systems and services have and will continue to transform teaching practice. From PowerPoint slides introduced to enliven lectures to virtual reality models accessed remotely, technology is bringing about new educational paradigms. The result is the emergence of new forms of distance learning with terms such as flexible learning, blended learning and full online instruction. All are making major contributions to the student experience, allowing access to more information and greater resources as well as opportunities for learning in a manner and timescale that is more attuned to their aims, abilities and lifestyles. In dental education the transition is providing undergraduates, postgraduates and CPD students with a greater variety of courses, access to more expertise and the opportunity for lifetime learning.