Virtual reality and haptics in dental education: Implementation progress and lessons learned after a decade.

INTRODUCTION: The search for alternative training environments in dentistry responded mainly to scarcity and lack of standardisation of training material and non-availability of specific clinical procedures. The development of haptic virtual reality (VR) dental trainers provides a platform where irreversible procedures can be safely and unlimitedly practised. The aim of this study was to assess the educational implementation of these devices and evaluate schools' satisfaction. METHODS: Dental schools that were using haptic VR dental trainers, were approached. The Dental Trainer User Inventory (DTUI), addressing the educational implementation and users' satisfaction, was developed and distributed. RESULTS: Twenty-seven schools completed the DTUI. The total number of VR dental trainers available varied from one to 42 devices with a mean of 7 devices. The dental trainer was mostly made available from the first year (63.0%) of the undergraduate program, but it was mostly integrated into the curriculum by the third year (70.4%). Curricular integration was reported by 18 schools (66.7%), while nine schools (33.3%) indicated that they had not yet achieved integration. Twenty-one schools (69.4%) were 'satisfied' or 'very satisfied' with the devices, while two schools (7.4%) were dissatisfied and six schools (22.2%) were neither satisfied nor dissatisfied. CONCLUSION: VR haptic dental trainers are implemented in multiple dental programs and are also being used for educational research and clinical training. Even though curricular changes and teachers' acceptance remain a challenge, most schools are satisfied with VR haptic dental trainers and would recommend the device to other schools.

Students' learning environment perception and the transition to clinical training in dentistry.

INTRODUCTION: The learning environment (LE) influences students' behaviour, and predicts academic achievement, satisfaction and success. Measuring students' perception of the LE provides relevant information for curricular quality assurance. In this study, a LE assessment was used to observe variations in students' LE perception throughout the curriculum, to illustrate the possible influence that preclinical training (Pt) and clinical training (Ct) have on students' learning experience. MATERIALS AND METHODS: All students in the six-year undergraduate dental programme (n = 849) at the Academic Centre for Dentistry Amsterdam (ACTA) were approached and divided into Pt and Ct groups according to their training phase in the curriculum. The LE was assessed using the Dundee Ready Educational Environment Measure (DREEM), and the results were evaluated using the Statistical Package for the Social Sciences (SPSS) software for distribution (Kolmogorov-Smirnov normality test), internal reliability (Cronbach's alpha) and comparative analysis (one-way ANOVA). RESULTS: The questionnaire was completed by 216 (response rate=65%) Pt students and by 379 (response rate=75%) Ct students. With a general DREEM score of 124.3, significantly higher scores were found during Pt (DREEM=133.4) in comparison with the Ct phase of the curriculum (DREEM=119.2). DREEM scores steadily decreased throughout the 6-year curriculum, with the highest drops in LE perception observed in the second and third years of the programme. Significant differences in all DREEM domains were observed, with lower scores for Ct. CONCLUSION: Students' LE perception deteriorates throughout the curriculum, especially within the Pt-Ct transition, during the second and third years of the programme. An inferior LE perception was observed in every domain of the LE questionnaire within this transition showing a learning experience, which requires an educational intervention. Further research is required to better understand the educational needs of the Pt-Ct transition at this school.

Head-to-head Comparison of Transrectal Ultrasound-guided Prostate Biopsy Versus Multiparametric Prostate Resonance Imaging with Subsequent Magnetic Resonance-guided Biopsy in Biopsy-naïve Men with Elevated Prostate-specific Antigen: A Large Prospective Multicenter Clinical Study.

BACKGROUND: There is growing interest to implement multiparametric magnetic resonance imaging (mpMRI) and MR-guided biopsy (MRGB) for biopsy-naïve men with suspected prostate cancer. OBJECTIVE: Primary objective was to compare and evaluate an MRI pathway and a transrectal ultrasound-guided biopsy (TRUSGB) pathway in biopsy-naïve men with prostate-specific antigen levels of ≥3ng/ml. DESIGN, SETTING, AND POPULATION: A prospective, multicenter, powered, comparative effectiveness study included 626 biopsy-naïve patients (from February 2015 to February 2018). INTERVENTION: All patients underwent prebiopsy mpMRI followed by systematic TRUSGB. Men with suspicious lesions on mpMRI also underwent MRGB prior to TRUSGB. MRGB was performed using the in-bore approach. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Clinically significant prostate cancer (csPCa) was defined as grade group ≥2 (Gleason score ≥3+4) in any core. The main secondary objectives were the number of men who could avoid biopsy after nonsuspicious mpMRI, the number of biopsy cores taken, and oncologic follow-up. Differences in proportions were tested using McNemar's test with adjusted Wald confidence intervals for differences of proportions with matched pairs. RESULTS AND LIMITATIONS: The MRI pathway detected csPCa in 159/626 (25%) patients and insignificant prostate cancer (insignPCa) in 88/626 patients (14%). TRUSGB detected csPCa in 146/626 patients (23%) and insignPCa in 155/626 patients (25%). Relative sensitivity of the MRI pathway versus the TRUSGB pathway was 1.09 for csPCa (p=0.17) and 0.57 for insignPCa (p<0.0001). The total number of biopsy cores reduced from 7512 to 849 (-89%). The MRI pathway enabled biopsy avoidance in 309/626 (49%) patients due to nonsuspicious mpMRI. Immediate TRUSGB detected csPCa in only 3% (10/309) of these patients, increasing to 4% (13/309) with 1-yr follow-up. At the same time, TRUSGB would overdetect insignPCa in 20% (63/309). "Focal saturation" by four additional perilesional cores to MRGB improved the detection of csPCa in 21/317 (7%) patients. Compared with the literature, our proportion of nonsuspicious mpMRI cases is significantly higher (27-36% vs 49%) and that of equivocal cases is lower (15-28% vs 6%). This is probably due to the high-quality standard in this study. Therefore, a limitation is the duplication of these results in less experienced centers. CONCLUSIONS: In biopsy-naïve men, the MRI pathway compared with the TRUSGB pathway results in an identical detection rate of csPCa, with significantly fewer insignPCa cases. In this high-quality standard study, almost half of men have nonsuspicious MRI, which is higher compared with other studies. Not performing TRUS biopsy is at the cost of missing csPCa only in 4%. PATIENT SUMMARY: We compared magnetic resonance imaging (MRI) with MRI-guided biopsy against standard transrectal ultrasound biopsy for the diagnosis of prostate cancer in biopsy-naïve men. Our results show that patients can benefit from MRI because biopsy may be omitted in half of men, and fewer indolent cancers are detected, without compromising the detection of harmful disease. Men also need fewer needles to make a diagnosis.

Neuropsychological treatment of dyslexia: does type of treatment matter?

In this study, 123 children with a diagnosis of developmental dyslexia were assigned to different treatment groups, either variations of Bakker's intervention program based on the balance model or a control, a specific reading training group. Thorough cognitive and neuropsychological assessment allowed determination of the subtype of dyslexia according to the balance model and the neuropsychological profile with respect to reading and spelling abilities, verbal memory, and phonemic awareness. Characteristics of hemisphere-specific stimulation were systematically manipulated in an effort to shed light on the bases and mechanisms of reading improvement. It was shown that the effects of treatment vary according to type of dyslexia and that the different intervention programs have differential effects on reading-related neuropsychological functions. Since opposite effects can be produced by the same type of treatment in different dyslexia subtypes, the results of the study suggest that accurate classification of subtype on the base of reading and reading-related variables is advantageous for an optimal planning of the therapy.

Arthur Benton and a bunch of Dutch flowers.

This paper shows how Arthur Benton's excellent research in the field of neuropsychological topics like hemispheric specialization, Gerstmann syndrome, aphasia, prosopagnosia and visuospatial deficits has influenced the development of the field of neuropsychology in The Netherlands. Also, his outstanding methodological knowledge and clinical experience have had an enormously significant impact on neuropsychological assessment in this country. Benton's knowledge about the different topics in neuropsychology was tremendous, while at the same time he was always critical and aware of findings he was not able to understand.

Cognitive brain potentials in kindergarten children with subtyped risks of reading retardation.

Cognition-related brain responses to meaningful and meaningless figures were registered in 5-year-old kindergarten children who either had been subtyped as being at-risk of developing an L- or P-type dyslexia (LAL versus LAP) or who were not at-risk. While identifying, naming, or categorizing pictures, event-related potentials (ERP) were registered. Three cognition-related components were found: the N460, the P780, and the Slow Wave (SW). LAP-children produced weak N460 activity across tasks, whereas LAL children, and to a lesser degree, non-risk children produced robust task-dependent activity. This finding may indicate that LAP-children lack semantic input while processing the figures. P780 latencies to frequently occurring figures were found hemisphere-dependent: LAP-children showed longer latencies in the right than in the left hemisphere, whereas the distribution was reversed in the LAL and non-risk children. It was also found that the right hemisphere is generally responsible for a lion's share of the processing of figures and therefore it seems that the right hemisphere of LAP-children invests ample time in doing so. Whereas LAP-children showed largest SW amplitude differences between frequent and infrequent stimuli at posterior locations, LAL children did so at frontal locations. Assuming that the SW represents working-memory processes, it may be that working-memory in LAP-children deals with figure-relevant visual-spatial information and with figure-derived concepts in LAL children. Overall, the findings suggest that LAL and LAP represent two different groups of kindergartners at risk of dyslexia and that these differences, to some degree, fit with the presumed etiology of L- and P-type dyslexia.

Maternal diet influences gene expression in intestine of offspring in chicken (Gallus gallus).

The diet of the mother during pregnancy influences the onset of different diseases and health-related traits in the offspring. We investigated the influence of the mother hen diet on the intestinal gene expression pattern in the offspring. Hens received for 11 weeks either a commercial feed or a commercial feed supplemented with vitamins and minerals. The offspring of the two groups showed no changes in growth rate or feed conversion. Of this offspring, gene expression patterns in the intestine were measured at 3 and 14 days of age with an intestinal cDNA-microarray. Between the two groups, 11 genes were found to be differentially expressed both at 3 and 14 days of age. Thus, these genes were differently regulated when the intestine is developing as well as when the intestine is more mature. Genes that are differentially expressed at day 3 and/or day 14 affect intestinal turnover, proliferation and development, metabolism and feed absorption. To confirm that differences in gene expression are related to intestinal development, we investigated intestinal proliferation. This indeed also showed differences in proliferation between the two groups at day 3 and day 14 of age. The gene expression and proliferation results indicate that feed of the hens influences the functionality of intestine of the offspring at day 3 and 14 of age.

Treatment of developmental dyslexia: a review.

Remarkably few research articles on the treatment of developmental dyslexia were published during the last 25 years. Some treatment research arose from the temporal processing theory, some from the phonological deficit hypothesis and some more from the balance model of learning to read and dyslexia. Within the framework of that model, this article reviews the aetiology of dyslexia sub-types, the neuropsychological rationale for treatment, the treatment techniques and the outcomes of treatment research. The possible mechanisms underlying the effects of treatment are discussed.

Neuropsychological intervention in kindergarten children with subtyped risks of reading retardation.

Kindergarten children at risk of developing language problems were administered the Florida Kindergarten Screening Battery. A principal components analysis revealed a verbal and a visual-spatial component and subsequent discriminant function analyses a high verbal/low visual-spatial group (LAL: Latent L) and a high visual-spatial/low verbal group (LAP: Latent P). LAL- and LAP-children were considered at risk for developing an L- or P-type of dyslexia, respectively. As is common practice with children suffering from manifest L- or P- dyslexia, the LAL- and LAP-kindergartners received right and left hemisphere stimulation, respectively. The outcomes were compared with those of bilateral hemispheric stimulation and no intervention. Reading tests were administered in primary school Grades 1 and 5/6; teachers' evaluation of reading took place in Grade 5/6. Overall, the LAL- and LAP- groups showed significant backwardness in word and text reading, both at early and late primary school. Types of intervention made a difference though: not significantly backward in early word, late word, and late text reading were the LAL-children who had received right hemisphere stimulation. Nonintervened LAP-children did not show significant backwardness in early word reading and late text reading, nor did LAP-children who had received left hemisphere or bilateral stimulation. Early text reading was not affected by any treatment. Teacher's evaluations were in support of these findings.

Magnetic resonance perfusion-weighted imaging of acute cerebral infarction: effect of the calculation methods and underlying vasculopathy.

BACKGROUND AND PURPOSE: Various calculation methods are available to estimate the transit-time on MR perfusion-weighted imaging (PWI). Each method may affect the results of PWI. Steno-occlusive disease in the parent vessels is another factor that may affect the results of the PWI. The purpose of this study was to elucidate the effect of the calculation methods and underlying vasculopathy on PWI. METHODS: From a pool of 113 patients who had undergone PWI during the study period, a total of 12 patients with nonlacunar ischemic strokes who were scanned within 24 hours after onset of symptom were selected for the study. The patient population consisted of 6 patients who had extracranial internal carotid artery stenosis (>70%) and 6 individuals without stenosis. Seven different postprocessing methods were evaluated: first moment, ratio of area to peak, time to peak (TTP), relative TTP, arrival time, full-width at half-maximum, and deconvolution methods. Follow-up MR or CT images were used to determine the areas that evolved into infarcts, which served as the gold standard. Sensitivity and specificity of each transit time technique were calculated. RESULTS: Calculation methods with high sensitivity were the first moment (sensitivity, 74%), TTP (sensitivity, 77%), and deconvolution methods (sensitivity, 81% to 94%). Between the 2 groups with and without internal carotid artery stenosis, the specificity of most of the techniques was lower in the internal carotid artery stenosis group. The first moment and deconvolution methods maintained relatively high specificity even in the stenosis group. CONCLUSIONS: The calculation technique and presence of underlying vasculopathy have a direct impact on the results of PWI. The methods with high sensitivity even in the presence of steno-occlusive disease were the first moment and deconvolution methods with arterial input function derived from the peri-infarct arteries; the deconvolution method was the superior choice because of higher lesion conspicuity.