The Oral Status Survey Tool: construction, validity, reliability and feasibility among people with mild and moderate intellectual disabilities.

BACKGROUND: A lack of robust data about the oral health of people with intellectual disabilities (IDs) contributes to health disparities. Appropriate research tools are therefore needed. This study reports the construction and evaluation of the Oral Status Survey Tool (OSST), designed to be administered with people with disabilities by non-dental personnel. METHOD: Oral Status Survey Tool construction and evaluation was achieved adopting a non-clinical construction and content validation phase and a clinical phase to test concurrent validity, reliability and feasibility. Final refinements were also made. RESULTS: The OSST conceptual framework covered oral function (tooth count, denture wear and opposing pairs of teeth) and oral disease/treatment need (soft tissue status, oral cleanliness, gum condition, carious teeth and oral pain). A systematic literature review identified no existing suitable indices. Candidate items were identified and validated by experts generating content validation ratios. This framework was modified later to expand the function construct. In the initial clinical phase, 49 out of 60 participants underwent examination with OSST and standard dental assessments. All had mild to moderate IDs. Mean age was 43 years (SD = 16), and mean number of teeth was 22.1 (SD = 8.6). Data collectors included two dentists and three non-dentists. Later, a further 17 adults (nine female and eight male) with mild/moderate IDs were included for refinement. At this stage, data collectors included two dentists and five non-dentists. Concurrent validity was established for tooth count [intraclass correlation coefficient = 0.99 (95% confidence interval, CI: 0.99-0.99)], carious teeth [Gwet's AC2 = 0.94 (95% CI: 0.89-0.99)] and gum condition [Gwet's AC1 = 0.84 (95% CI: 0.64-1)]. For all final OSST items, inter-rater reliability ranged from moderate to very good; median test-retest reliability ranged from moderate to good. Acceptability was demonstrated for data collectors and participants. Mean time to complete the OSST was 7 min. CONCLUSIONS: The OSST is a novel tool that can record a range of clinical oral features including tooth count, denture wear, occluding pairs of teeth and functional dentition, oral cleanliness, gum condition, carious cavitation and oral pain that will be useful within health surveys of people with mild-moderate IDs and similarly neglected populations. The tool demonstrates promising attributes and acceptability. From this study, the OSST appears to be a robust tool that can be incorporated into general data collection for people with mild-moderate IDs and similar populations. A key feature is that it can be administered by well-trained non-dentists.

Single-Phonon Addition and Subtraction to a Mechanical Thermal State.

Adding or subtracting a single quantum of excitation to a thermal state of a bosonic system has the counter-intuitive effect of approximately doubling its mean occupation. We perform the first experimental demonstration of this effect outside optics by implementing single-phonon addition and subtraction to a thermal state of a mechanical oscillator via Brillouin optomechanics in an optical whispering-gallery microresonator. Using a detection scheme that combines single-photon counting and optical heterodyne detection, we observe this doubling of the mechanical thermal fluctuations to a high precision. The capabilities of this joint click-dyne detection scheme adds a significant new dimension for optomechanical quantum science and applications.

Optimal Coherent Filtering for Single Noisy Photons.

We introduce a filter using a noise-free quantum buffer with large optical bandwidth that can both filter temporal-spectral modes as well as interconvert them and change their frequency. We theoretically show that such quantum buffers optimally filter out temporal-spectral noise, producing identical single photons from many distinguishable noisy single-photon sources with the minimum required reduction in brightness. We then experimentally demonstrate a noise-free quantum buffer in a warm atomic system that is well matched to quantum dots. Based on these experiments, simulations show that our buffer can outperform all intensity (incoherent) filtering schemes for increasing indistinguishability.

The Spectrum of Histological Findings in Oral Biopsies

Aim: To undertake a retrospective analysis of the use of a diagnostic pathology service, to determine the source of oral biopsies submitted for histological analysis, and to examine the range and frequencies of histologically diagnosed oral lesions in an Irish population. Methods: A retrospective analysis was carried out on all oral biopsies submitted for histological analysis to an oral and maxillofacial diagnostic pathology service from June to December 2015. Results: In total 724 oral biopsies were submitted. The majority of diagnoses were benign (80.3%) and the remaining diagnoses were made up of malignancies (6.7%) and potentially malignant disorders (PMDs), histologically characterised by epithelial dysplasia (13%). Less than 1% of biopsies were submitted from general dentists in primary care. Conclusion: This study showed that oral biopsies are not submitted from the primary care setting, but rather from hospital-based specialist units or referral-based specialist practitioners. There was a broad range of histological diagnoses, the majority of which were benign.

Dentist's views on incorporating oral health collaborative practice into primary medical care in Ireland.

BACKGROUND: In order to address the burden of oral disease, the dental profession needs to engage in collaborative practice with medical professionals. The aim of this study was to explore dentists' views on incorporating oral health collaborative practice into primary medical care in Ireland. SETTING: Dublin Dental University Hospital, Ireland. PARTICIPANTS: Dentists with backgrounds in oral surgery, oral medicine, paediatric dentistry, special care dentistry, prosthodontics, primary care dentistry, hospital dentistry and public dental health. All participants were working in, or had worked in, Dublin Dental University Hospital for a minimum of six months full-time equivalent within the previous 5 years. METHODS: Semi-structured qualitative interviews were undertaken in five phases, transcribed verbatim and thematically analyzed. RESULTS: A total of 17 participants were recruited. After 14 interviews, no new themes were emerging and data saturation was achieved. Eleven codes were identified and organized into four themes; (i) the relative importance of oral health to systemic health, (ii) the role of dentistry in the overall health care team, (iii) oral health interprofessional education and training, (iv) opportunities for oral health collaborative practice. CONCLUSION: Dentists felt that the best way to achieve effective oral health collaborative practice with primary medical care would be to educate medical professionals on how to identify the significant risk factors for oral disease, how to promote oral health and how to facilitate access to primary dental care for their patients.

Pharmacological behaviour support for adults with intellectual disabilities: Frequency and predictors in a national cross-sectional survey.

OBJECTIVE: To report frequency and predictors of reported pharmacological behaviour support use among older adults with intellectual disabilities (ID) accessing dental care in Ireland. METHODS: Data from a nationally representative cross-sectional survey of adults with ID over 40 years of age allowed identification of the reported frequency of pharmacological behaviour support use. Predictors of pharmacological support were identified using multiple logistic regression. RESULTS: Most older adults with ID did not report the use of any pharmacological support to receive dental care: only 0.9% reported use of inhalation sedation; 2.4% intravenous (IV) sedation; 8.6% general anaesthesia (GA); and 16.0% oral sedation. Participants reporting challenging behaviour (OR = 1.9, 95% CI = 1.3-2.9), significant difficulty speaking (OR = 3.0, 95% CI = 1.8-4.8) and obvious oral problems (OR = 2.5, 95% CI = 1.6-4.1) had greater odds of reporting pharmacological, that is, GA or conscious sedation (CS), rather than nonpharmacological supports for dental care, compared to those who were not. CONCLUSIONS: People with ID report a diverse range of support use, with many using GA or CS, particularly oral sedation, for dental treatment. This highlights a need for training and governance for dentists who provide this care. Patients who present with challenging behaviour, oral problems and, interestingly, difficulty with expressive communication are more likely to report use of pharmacological supports. The above has implications for dental service design and delivery for this population.

Development of a battery of tests to measure attitudes and intended behaviours of dental students towards people with disability or those in marginalised groups.

INTRODUCTION: Recommended curricula in Special Care Dentistry (SCD) outline learning objectives that include the domain of attitudes and behaviours, but these are notoriously difficult to measure. The aims of this study were (i) to develop a test battery comprising adapted and new scales to evaluate values, attitudes and intentions of dental students towards people with disability and people in marginalised groups and (ii) to determine reliability (interitem consistency) and validity of the scales within the test battery. MATERIALS AND METHODS: A literature search identified pre-existing measures and models for the assessment of attitudes in healthcare students. Adaptation of three pre-existing scales was undertaken, and a new scale was developed based upon the Theory of Planned Behaviour (TPB) using an elicitation survey. These scales underwent a process of content validation. The three adapted scales and the TPB scale were piloted by 130 students at 5 different professional stages, from 4 different countries. RESULTS: The scales were adjusted to ensure good internal reliability, variance, distribution, and face and content validity. In addition, the different scales showed good divergent validity. DISCUSSION: These results are positive, and the scales now need to be validated in the field. CONCLUSIONS: It is hoped that these tools will be useful to educators in SCD to evaluate the impact of teaching and clinical exposure on their students.

Femtosecond laser inscription of Bragg grating waveguides in bulk diamond.

Femtosecond laser writing is applied to form Bragg grating waveguides in the diamond bulk. Type II waveguides are integrated with a single pulse point-by-point periodic laser modification positioned toward the edge of the waveguide core. These photonic devices, operating in the telecommunications band, allow for simultaneous optical waveguiding and narrowband reflection from a fourth-order grating. This fabrication technology opens the way toward advanced 3D photonic networks in diamond for a range of applications.

Incorporating Oral Health as Part of Routine Diabetes Care in Ireland.

Diabetes mellitus is a common disorder of glucose metabolism that is increasingly prevalent in the Irish population. It is associated with a range of complications leading to substantial morbidity and mortality. A less well-recognized complication of diabetes is periodontal disease. This is a chronic inflammatory disease affecting the periodontium, the specialized group of tissues that surround and support the teeth, including the gingiva (gums) and alveolar bone. Periodontal disease affects patients with diabetes with a greater prevalence and incidence than non-diabetic patients, and can itself exert negative effects on glucose control in people with diabetes. The National Clinical Programme for Diabetes in Ireland aims to reduce the morbidity and mortality associated with diabetes, which includes the development and dissemination of guidelines supporting integrated care. Based on the bidirectional relationship between diabetes mellitus and periodontal disease, we recommend that an oral health evaluation, as well as any necessary onward referral, be incorporated into the Irish recommendations for routine diabetes care, as part of the National Clinical Programme.

Neither Basic Life Support knowledge nor self-efficacy are predictive of skills among dental students.

AIM: Basic life support (BLS) is considered a core competence for the graduating dentist. This study aimed to measure BLS knowledge, self-efficacy and skills of undergraduate dental students in Dublin. METHODS: This study consisted of a cross-sectional survey measuring BLS knowledge and self-efficacy, accompanied by a directly observed BLS skills assessment in a subsample of respondents. Data were collected in January 2014. Bivariate correlations between descriptive and outcome variables (knowledge, self-efficacy and skills) were tested using Pearson's chi-square. We included knowledge and self-efficacy as predictor variables, along with other variables showing association, into a binary logistic regression model with BLS skills as the outcome measure. RESULTS: One hundred and thirty-five students participated. Almost all (n = 133, 98.5%) participants had BLS training within the last 2 years. One hundred and four (77%) felt that they were capable of providing effective BLS (self-efficacy), whilst only 46 (34.1%) scored >80% of knowledge items correct. Amongst the skills (n = 85) subsample, 38.8% (n = 33) were found to pass the BLS skills assessment. Controlling for gender, age and skills assessor, the regression model did not identify a predictive relationship between knowledge or self-efficacy and BLS skills. CONCLUSIONS: Neither knowledge nor self-efficacy was predictive of BLS skills. Dental students had low levels of knowledge and skills in BLS. Despite this, their confidence in their ability to perform BLS was high and did not predict actual competence. There is a need for additional hands-on training, focusing on self-efficacy and BLS skills, particularly the use of AED.

The use of the BDA Case Mix Model to assess the need for referral of patients to specialist dental services.

BACKGROUND: Access to health services is a right for every individual. However, there is evidence that people with disabilities face barriers in accessing dental health. One of the reasons associated with this is the unclear referral pathway existing in the Irish dental health service. The appropriate assignment of patients to relevant services is an important issue to ensure better access to healthcare. This is all the more pertinent because there are only a few trained dental practitioners to provide dental treatment for people with disabilities, as well as even fewer qualified specialists in special care dentistry. AIMS: The aim of this part of the study was to assess the use of the BDA Case Mix Model to determine the need for referral of patients to specialist dental services, and to determine any association between patient complexity and the need for adjunct measures, such as sedation and general anaesthesia for the management of people with disabilities and complex needs. METHODOLOGY: A retrospective analysis of dental records using the BDA Case Mix Model.Results The results showed that patients with different levels of complexities were being referred to the special care dentistry clinic at the Dublin Dental University Hospital. The results also showed that the need for supportive adjunct measures such as sedation and general anaesthesia was not necessarily the main reason for referring patients to specialist services. The assessment with the BDA Case Mix Model was comprehensive as it looked at many factors contributing to the cases' complexity. Not all categories in the Case Mix Model had significant association with the need for an adjunct.Conclusion The BDA Case Mix Model can be used to measure the need for supportive adjunct measures, such as sedation and general anaesthesia.

Cavity-Enhanced Room-Temperature Broadband Raman Memory.

Broadband quantum memories hold great promise as multiplexing elements in future photonic quantum information protocols. Alkali-vapor Raman memories combine high-bandwidth storage, on-demand readout, and operation at room temperature without collisional fluorescence noise. However, previous implementations have required large control pulse energies and have suffered from four-wave-mixing noise. Here, we present a Raman memory where the storage interaction is enhanced by a low-finesse birefringent cavity tuned into simultaneous resonance with the signal and control fields, dramatically reducing the energy required to drive the memory. By engineering antiresonance for the anti-Stokes field, we also suppress the four-wave-mixing noise and report the lowest unconditional noise floor yet achieved in a Raman-type warm vapor memory, (15±2)×10^{-3} photons per pulse, with a total efficiency of (9.5±0.5)%.

A survey of dental school's emergency departments in Ireland and the UK: provision of undergraduate teaching and emergency care.

AIM: Emergency dental care is a vital service that new graduates should be prepared to offer. There are few published data relating to emergency dental care education. To assess this, and to gain a profile of accident and emergency departments (A&E) in dental schools, an online survey was sent to all of the dental schools in the Republic of Ireland and the UK. SETTING: The survey addressed the school's A&E curriculum, teaching methods, undergraduate exposure and departmental details. RESULTS: The majority of A&E departments operated during normal working hours with a minority offering an out-of-hours service. Teaching of A&E topics, and undergraduate experience, vary significantly between schools. A&E departments were diversely named and exhibited significant regional variation. Approximately half employed a triage system. It is unclear what represents an adequate level of undergraduate exposure, and more research is required in this area. CONCLUSIONS: Assessment of undergraduates following time in clinic is an important component of any A&E module. We consider a reflective portfolio to represent a suitable form of assessment, and would recommend their introduction. In addition, we recommend that dental hospitals consider a nurse-led triage system.

Does Special Care Dentistry undergraduate teaching improve dental student attitudes towards people with disabilities?

INTRODUCTION: Undergraduate dental curricula increasingly aim to address student attitudes towards people with disabilities. This study reports the effectiveness of a comprehensive, blended learning Special Care Dentistry undergraduate programme to change attitudes towards people with disabilities. METHODS: A validated psychometric instrument (ATDP-Form 0) was given as a course evaluation to third-year dental students in the Dublin Dental University Hospital over 3 years from 2010 to 2013, immediately before and after the delivery of a brief comprehensive curriculum in Special Care Dentistry. RESULTS: From a population of 109 students, 100 (91.7%) pre-test and 83 (76.1%) retest responses were analysed. Mean score before the course, for all years, was 74.8 (SD = 14.7), compared with 76.8 (SD = 14.0) for all years after the course. CONCLUSIONS: Dental students in our study had neither particularly positive, or negative attitudes towards people with disabilities. There was no statistically significant difference in student attitudes before and after the educational intervention. This study, therefore, shows that a comprehensive undergraduate blended learning module, which aimed to improve attitudes towards people with disabilities, did not do so, using the described measures within the selected timeframe.

Guidance for the core content of a Curriculum in Special Care Dentistry at the undergraduate level.

Given the rapidly changing demography of populations worldwide, dental professionals of the future need to be able to meet the challenge posed by the evolving landscape in health care needs. Leading institutions are now embedding teaching and learning in special care dentistry (SCD) within their curricula, to provide students with the knowledge, skills and attitudes to meet the oral health needs of vulnerable groups within their communities. The International Association for Disability and Oral Health (iADH) has initiated the development of undergraduate curriculum guidance in SCD through a consensus process. The curriculum in SCD is defined in statements of learning outcomes with many of the skills being transferable across the undergraduate course. This curriculum includes examples of teaching and assessment, designed to enhance critical thinking in relation to SCD and to promote positive attitudes towards disability and diversity. The learning outcomes are designed to be readily adapted to conform to the generic profiles and competencies, already identified in undergraduate frameworks by global educational associations, as well as meeting the requirements of professional regulatory bodies worldwide. Suggestions for teaching and learning are not intended to be prescriptive; rather, they act as a signpost to possible routes to student learning. Ideally, this will require that students have a sufficiently diverse patient case mix during their undergraduate studies, to achieve the required levels of confidence and competence by the time they graduate. Clinical care competencies in SCD emphasise the need for learners to broaden their theoretical knowledge and understanding through practical experience in providing care for people with special health care needs. It is crucial to the development of equitable dental services for all members of a community, that these learning outcomes are embedded into evolving curricula but most importantly, that they are evaluated and refined in a dynamic way with shared learning for all teachers.

Large-alphabet time-frequency entangled quantum key distribution by means of time-to-frequency conversion.

We introduce a novel time-frequency quantum key distribution (TFQKD) scheme based on photon pairs entangled in these two conjugate degrees of freedom. The scheme uses spectral detection and phase modulation to enable measurements in the temporal basis by means of time-to-frequency conversion. This allows large-alphabet encoding to be implemented with realistic components. A general security analysis for TFQKD with binned measurements reveals a close connection with finite-dimensional QKD protocols and enables analysis of the effects of dark counts on the secure key size.

Enhancing multiphoton rates with quantum memories.

Single photons are a vital resource for optical quantum information processing. Efficient and deterministic single photon sources do not yet exist, however. To date, experimental demonstrations of quantum processing primitives have been implemented using nondeterministic sources combined with heralding and/or postselection. Unfortunately, even for eight photons, the data rates are already so low as to make most experiments impracticable. It is well known that quantum memories, capable of storing photons until they are needed, are a potential solution to this "scaling catastrophe." Here, we analyze in detail the benefits of quantum memories for producing multiphoton states, showing how the production rates can be enhanced by many orders of magnitude. We identify the quantity ηB as the most important figure of merit in this connection, where η and B are the efficiency and time-bandwidth product of the memories, respectively.

From photons to phonons and back: a THz optical memory in diamond.

Optical quantum memories are vital for the scalability of future quantum technologies, enabling long-distance secure communication and local synchronization of quantum components. We demonstrate a THz-bandwidth memory for light using the optical phonon modes of a room temperature diamond. This large bandwidth makes the memory compatible with down-conversion-type photon sources. We demonstrate that four-wave mixing noise in this system is suppressed by material dispersion. The resulting noise floor is just 7×10(-3) photons per pulse, which establishes that the memory is capable of storing single quanta. We investigate the principle sources of noise in this system and demonstrate that high material dispersion can be used to suppress four-wave mixing noise in Λ-type systems.