Remote E-exams during Covid-19 pandemic: A cross-sectional study of students' preferences and academic dishonesty in faculties of medical sciences.

BACKGROUND: Since the emergence of coronavirus disease 2019 (Covid-19), distance education has been extensively implemented in all educational institutes and remote electronic exams (E-exams) have been adopted as a primary mode of assessment. OBJECTIVES: This cross-sectional study aimed to evaluate the experience of students at faculties of Medicine, Dentistry, Pharmacy, Nursing and Applied Medical Sciences at Jordan University of Science and Technology regarding remote E-exams preferences and academic dishonesty during the pandemic. MATERIALS AND METHODS: The survey composed of 16 questions, prepared using Google forms and distributed through students' E-learning platforms. The survey explored factors affecting students' preference for remote E-exams, methods for course assessment/evaluation, factors related to students' exam dishonesty/misconduct during remote E-exams and measures that can be considered to reduce this behavior. Data were analyzed using descriptive, cross tabulation and Chi-square tests. RESULTS: Among 730 students, approximately only one third preferred remote E-exams. This was significantly (P < 0.05) associated with academic major, efforts/time for remote E-exam preparation, questions appropriateness with study material, and academic achievements (students Grade Point Average (GPA), curriculum objectives). Combining both exams and quizzes was the most preferred method of assessment (30%), while submission of reports or short written assignments were the least preferred ones. Exam dishonesty/misconduct appears as one of the major challenges with remote E-exams. The main measures considered by students to reduce exam dishonesty included substituting the exam with other forms of assessment, using different exam forms, the use of online proctoring solutions and considering compulsory pass/fail grades. CONCLUSION: Results suggested less preference of remote E-exams among students at medical faculties. Findings from this study are highly valuable to plan for academic strategies to overcome difficulties and challenges of remote E-exams. These might include improvement for the distance teaching methodologies, rearrangement of assessment options, modification of the academic curriculum to fit the current situation, and adopting certain measures to prevent exam dishonesty and maintain academic integrity.

Perception of health and educational risks amongst dental students and educators in the era of COVID-19.

OBJECTIVE: To investigate the perceived educational and health risks associated with the COVID-19 pandemic amongst dental students and educators. METHODS: A 17-item electronic survey was sent to 496 undergraduate dental students and 53 clinical faculty members who attended clinical sessions during the outbreak period. The survey explored various aspects related to primary sources and prevention of disease exposure, dental management of suspected cases, impact of COVID-19 on students' clinical performance and effects of suspension of educational activities on academic performance and clinical competence. RESULTS: The response rate of the students' was 60.7% (n = 301). The majority of students reported that performing clinical work during the outbreak posed significant health concerns, resulted in a significant stress and negatively affected their clinical performance. The majority of students believed that aerosols generated during dental procedures are the major source for disease exposure and universal protective equipment is not effective for prevention. The decision to suspend teaching activities was supported by 89% of the students. Opinions were divided regarding the impact of the suspension on the academic performance and clinical competence. Educational videos were the most preferred form of distance education. The response rate of faculty members was 60.4% (n = 32). Responses of faculty members were similar to students, though fewer concerns were reported regarding the risk of disease transmission. All respondents agreed that extra-precautionary measures are required to ensure optimum protection against disease exposure. CONCLUSIONS: The recent COVID-19 outbreak has adversely affected various elements of dental education. High levels of major health risk perception were noted amongst students and educators. The interruption to academic and clinical activities may lead to an inevitable skill deficit within the new generation of dental graduates. Educators are under significant pressure to accommodate abrupt changes in teaching methods, find solutions to mitigate skill deficit and ensure safe clinical practice once clinical activities are resumed.

Stress and behavioral changes with remote E-exams during the Covid-19 pandemic: A cross-sectional study among undergraduates of medical sciences.

Emergence of coronavirus disease 2019 (COVID-19) forced the worldwide higher educational institutes to adopt distance learning mode. Further, remote electronic exams (E-exams) were considered as mode of assessment. Objectives: This cross-sectional study evaluated the students' experience of remote E-exams during the COVID-19 pandemic among Medical Sciences students in Jordan. Materials and Methods: A survey of 29 questions was prepared on Google forms and distributed among students at Faculties of Medical Sciences (Medicine, Dentistry, Pharmacy, Nursing and Applied Medical Sciences) at Jordan University of Science and Technology. The questions include students' demographics, stress experience, and factors contributing to stress as well as behavioral changes related to remote E-exams. Responses were analyzed using descriptive, cross tabulation and Chi-square tests. Results: Among 1019 respondents, 32% reported more stress with remote E-exams. This was associated with academic major and gender. Among students with more stress during remote E-exams, the exam duration, mode of questions navigation and technical problems (exam platform and internet connectivity) appeared as the main factors related to stress in 78%, 76% and >60%, respectively. Other factors include concern regarding the teaching methods, exam environment and students' dishonesty. Remote E-exams had negative impact on students' dietary habits (increase consumption of caffeine and high energy drinks, high sugar food, fast food), sleep (reduction in sleeping hours, more consumption of insomnia medications), physical activity (less exercises) and smoking habits (increase). Conclusion: Results suggested a negative impact of E-exams on students within Medical Faculties. Robust exam platform and remote mock E-exams are recommended to reduce students' potential stress. A stress-free environment is very essential to encourage students to adopt remote E-exams, particularly if the pandemic will take longer. Various awareness programs about students' habits related to dietary, sleep quality, physical activity and smoking are highly valuable for students' health benefits. This is of particular importance since the current students at Faculties of Medical Sciences are the future health care providers.

Simulated clinical adjustment and intra-oral polishing of two translucent, monolithic zirconia dental ceramics: An in vitro investigation of surface roughness.

OBJECTIVE: To assess the surface roughness and residual flaws in two translucent zirconia substrates following simulated clinical adjustment and intra-oral finishing/polishing. MATERIALS AND METHODS: Specimens were prepared from two translucent (5Y-ZP/8Y-ZP) and one conventional (3Y-TZP) zirconia substrates (n = 84 p/g). Arithmetic mean roughness parameter (Ra) was determined for all experimental groups at four stages (n = 21 p/g): (1) as-sintered, (2) surface grinding using a zirconia cutting diamond bur, (3) polishing using 1-step, 2-step or 4-step intra-oral polishing kits, and (4) laboratory polishing/glazing. Scanning electron microscopy (SEM) was used to evaluate residual surface flaws. Data were statistically analysed using a two-way ANOVA test, multiple and pairwise comparisons were performed using a Bonferroni post hoc test. RESULTS: Ra was significantly higher for as-sintered and ground 5Y-ZP/8Y-ZP compared to 3Y-TZP (p ≤ 0.001). Material type and polishing protocol had statistically significant effect on Ra (p < 0.001). The 4-step polishing resulted in the lowest Ra in 3Y-TZP/5Y-ZP (p ≤ 0.001). No significant differences were observed between different polishing protocols in 8Y-ZP (p≥0.655). Glazing significantly reduced Ra in all materials compared to other polishing protocols (p ≤ 0.001) except for the 4-step protocol in 3Y-TZP (p = 0.195). SEM revealed pronounced surface flaws in ground 5Y-ZP/8Y-ZP. Grinding of 3Y-TZP induced ductile material removal and thereby, minimal cohesive material loss. The 4-step polishing protocol resulted in the fewest and shallowest surface flaws in all groups. Glazing of 3Y-TZP resulted in the most homogenous surface contrary to 5Y-ZP/8Y-ZP. CONCLUSIONS: The finest surface finish was achieved using the 4-step polishing protocol in all studied materials. This protocol might be inadequate however for polishing of ground 5Y-ZP/8Y-ZP as a result of the pronounced surface damage induced by the grinding process. The glazing of 5Y-ZP/8Y-ZP might not be as predictable as for 3Y-TZP. CLINICAL SIGNIFICANCE: The higher susceptibility to surface damage, as a result of increasing dopant concentration, may render polishing of ground, translucent zirconia more complicated compared to the conventional 3Y-TZP counterparts.

Post-fatigue fracture resistance of premolar teeth restored with endocrowns: An in vitro investigation.

OBJECTIVES: To evaluate the post-fatigue load-to-failure and failure modes of endodontically treated premolar teeth restored with endocrowns fabricated from different CAD/CAM materials. MATERIALS AND METHODS: A total of 60 extracted human, single-rooted premolar teeth were endodontically treated and sectioned horizontally 2 mm above the cementoenamel junction. Sectioned teeth were restored using two reconstruction designs: endocrowns (Cendo) or post-crowns (Cpost) (n = 30 p/g). In each group, reconstructions were fabricated from 3 different CAD/CAM substrates (n = 10 p/g); a resin-based composite (Cera), a lithium disilicate glass ceramic (LiSi) and a monolithic, translucent zirconia (Zir). Additional 10 intact teeth were used as control. Restored teeth were subjected to dynamic fatigue test (10-50 N, 600,000 cycles) and thermocycling (5-55 °C, 1500 cycles). Load-to-failure and failure mode was determined following application of a static, 45° oblique compressive load on each specimen. One-way and Two-way analysis of variance (ANOVA), Tukey's post hoc and chi-square tests were used to determine statistically significant interactions among experimental and control groups. RESULTS: All specimens survived the mechanical and thermal fatigue tests. A statistically significant interaction between reconstruction design and material type was observed (p  <  0.001). CpostZir and CendoCera groups exhibited significantly higher post-fatigue load-to-failure when compared to other materials of the same reconstruction design (p ≤ 0.001). The highest frequency of catastrophic failures was observed with Zir reconstructions in both designs. Intact teeth exhibited significantly higher load-to-failure when compared to all groups (p ≤ 0.042) except CpostZir (p = 0.345). CONCLUSION: Single piece, CAD/CAM resin composite endocrowns can present a reliable option for restoring endodontically treated premolar teeth. CLINICAL SIGNIFICANCE: Endocrowns can be as effective as post-crowns provided appropriate preparation; material selection; and bonding protocols are utilized. Clinicians need to be cautious when prescribing zirconia endocrowns to restore premolar teeth owing to the low fracture resistance and high risk of catastrophic failures.

The Bacterial Microbiota of Gastrointestinal Cancers: Role in Cancer Pathogenesis and Therapeutic Perspectives.

The microbiota has an essential role in the pathogenesis of many gastrointestinal diseases including cancer. This effect is mediated through different mechanisms such as damaging DNA, activation of oncogenic pathways, production of carcinogenic metabolites, stimulation of chronic inflammation, and inhibition of antitumor immunity. Recently, the concept of "pharmacomicrobiomics" has emerged as a new field concerned with exploring the interplay between drugs and microbes. Mounting evidence indicates that the microbiota and their metabolites have a major impact on the pharmacodynamics and therapeutic responses toward anticancer drugs including conventional chemotherapy and molecular-targeted therapeutics. In addition, microbiota appears as an attractive target for cancer prevention and treatment. In this review, we discuss the role of bacterial microbiota in the pathogenesis of different cancer types affecting the gastrointestinal tract system. We also scrutinize the evidence regarding the role of microbiota in anticancer drug responses. Further, we discuss the use of probiotics, fecal microbiota transplantation, and antibiotics, either alone or in combination with anticancer drugs for prevention and treatment of gastrointestinal tract cancers.

A randomized clinical trial investigating three vital tooth bleaching protocols and associated efficacy, effectiveness and participants' satisfaction.

OBJECTIVES: To compare tooth colour change and participant's satisfaction following: home (HB), in-office (IOB) and combined (CB) bleaching treatments. METHODS: A group of 105 participants received HB, IOB and CB treatments. HB was performed using custom-made trays and 10 % carbamide peroxide for 14 days. IOB was performed using 37.5 % hydrogen peroxide applied in 3 cycles. CB bleaching treatment involved IOB followed by HB. Tooth colour change was assessed visually (VC-ΔVC) and using a digital spectrophotometry device (ES-ΔeVS). Participant's perception of oral health, smile and straightness and whiteness of teeth were evaluated using self-reported questionnaire. Parameters/responses were evaluated/collected prior bleaching and at recalls. Linear mixed models were used to estimate between- and within-group differences. RESULTS: CB resulted in significantly higher shade difference at 15 days recall (ΔVC and ΔeVS, all p ≤ 0.046). At 6 months recall, CB group demonstrated higher ΔeVS compared to IOB (p = 0.018) but the difference was not significant between the same groups when using VC (p = 0.051). Significant colour improvement was observed among all groups at 6 months recall (all within-group p < 0.001) except older participants (≥40 years) who received HB (ΔeVS: within-group p = 0.060). Overall, self-perception of oral health and satisfaction with smile and whiteness of teeth were significantly improved in all groups (all within-group p ≤ 0.001). Satisfaction levels with straightness of teeth were significantly improved for CB and IOB overall and in younger (<40 years) participants (all within-group p ≤ 0.013). CONCLUSION: CB treatment resulted in a pronounced colour improvement when compared to both techniques used individually. All bleaching protocols resulted in significant improvement of participants' perceived oral health and satisfaction with smile and whiteness of teeth. CLINICAL SIGNIFICANCE: Accelerated whitening can be achieved using a combination of in-office and home bleaching. Patients who may accept gradual whitening of teeth can be treated effectively using a cost-effective protocol and less concentrated bleaching agents.

The teaching of removable partial dentures in dental schools in Oceania.

OBJECTIVES: To examine the current arrangements and trends in the teaching of removable partial dentures (RPDs) in dental schools in Oceania. METHODS: A validated and trialled 30-item electronic survey was sent via e-mail to 12 dental schools in Oceania that offered undergraduate dentistry. The survey explored various aspects of the teaching of RPDs in preclinical and clinical courses including: educational content and process, staff members involved, facilities and techniques utilized, clinical requirements, coursework evaluation and perceived challenges to RPD teaching. RESULTS: The response rate of the survey was 75 % (n = 9). All respondent schools taught a preclinical course in RPD design and production, with the majority (67 %) starting the clinical provision of RPD patients in Year 3. The mean duration of the course was 63 h for hands-on activities and 23 h for didactic teaching. The courses were mainly taught by senior lecturers. On average, students made four units of acrylic RPD and two cobalt-chromium RPDs during the course. All respondent schools taught prescription writing for RPD. The majority of schools (n = 8) stated that they had an adequate patient pool for students to treat. Lack of adequately trained staff for teaching and pressure on teaching time from other sources were the most commonly reported challenges. CONCLUSION: The structure and content of RPD courses in dental schools of Oceania provide an adequate level of competence on the subject, and is broadly similar to other parts of the world. Plans should be in place to maintain and improve the quality of educational programmes to keep pace with growing student numbers and the rapidly evolving profession. CLINICAL SIGNIFICANCE: With increasing numbers of patients presenting to general dental practitioners requiring complex RPDs, it is paramount that undergraduate training programs produce graduates with the competencies necessary to care for such patients to a high standard.

The Windowed Removable Partial Denture: A Treatment Option for Patients with Lone-Standing Teeth.

The decision as to whether to retain or extract a single remaining natural tooth prior to the provision of dentures can be a difficult one. If the tooth is left in situ, the development of an adequate peripheral seal around the denture is not possible thereby compromising the appliance' retention. If the tooth is extracted the possibility of gaining direct retention with the use of clasps or attachments is lost. This paper aims to illustrate the use of windowed removable partial denture design and review the literature relevant to this area. The use of such a design can enhance the retention of the appliance by encircling the lone standing tooth/teeth utilising an elastomeric permanent soft lining material.