Paediatric dental A&E service during the COVID-19 pandemic in the Greater London area.

PURPOSE: The UK government introduced a nationwide lockdown on the 23rd March 2020 to prevent the spread of COVID-19. All elective hospital and dental practice assessments and procedures were mandated to stop. Key hospital dental workers were required to work, and Guy's and St Thomas' NHS Foundation Trust became a designated Urgent Dental Care Centre (UDC) for the greater London area. The paediatric dental emergency walk-in service was suspended and replaced with a telephone triage system and evaluation of digital images sent by parents/carers when needed. The aim of this paper is to describe the emergency service provided by staff in the department of Paediatric Dentistry at St Thomas' Hospital during the first lockdown. METHODS: A prospective service evaluation of the modified paediatric dental emergency service was carried out between 25th March and 29th May 2020. RESULTS: Four-hundred and sixty-four patients accessed the paediatric dental emergency service via telephone during the service evaluation period. Of these, 192 (41%) had dental pain, 121 (26%) had pain and swelling of dental origin, and 89 (19%) had trauma. CONCLUSIONS: Remote telephone consultations and digital photographs were useful to screen emergency paediatric dental patients, but lack of face-to-face consultations with radiographic assessment and access to general anaesthetic services were major limiting factors.

Liquid metals: fundamentals and applications in chemistry.

Post-transition elements, together with zinc-group metals and their alloys belong to an emerging class of materials with fascinating characteristics originating from their simultaneous metallic and liquid natures. These metals and alloys are characterised by having low melting points (i.e. between room temperature and 300 °C), making their liquid state accessible to practical applications in various fields of physical chemistry and synthesis. These materials can offer extraordinary capabilities in the synthesis of new materials, catalysis and can also enable novel applications including microfluidics, flexible electronics and drug delivery. However, surprisingly liquid metals have been somewhat neglected by the wider research community. In this review, we provide a comprehensive overview of the fundamentals underlying liquid metal research, including liquid metal synthesis, surface functionalisation and liquid metal enabled chemistry. Furthermore, we discuss phenomena that warrant further investigations in relevant fields and outline how liquid metals can contribute to exciting future applications.

Cultural competence skills in a dental curriculum: A review.

This study aimed to analyse and evaluate the extent of transcultural content in the current curricula of the Doctor of Dental Surgery (DDS), Bachelor of Oral Health (BOH) and Master of Nursing Science (MNSc) courses at the University of Melbourne. METHODS: The study was conducted in two phases: a quantitative review and assessment of the current DDS, BOH and MNSc curricula at the University of Melbourne, and interviews with various staff from the University of Melbourne who were responsible for curriculum development for these courses. RESULTS: Staff from the DDS, BOH and MNSc courses concurred on the importance of transcultural skills, the necessity of covering cultural issues relevant to the main ethnic groups in Australia, obstacles faced and the lack of evaluation methods for cultural competency. The nursing curriculum had the most extensive coverage of transcultural content throughout both years of the course (total 71 formal contact hours; mean 36 formal contact hours per year). In contrast, modules on transcultural skills were limited to the first two of the 3-year BOH course (54 hours; 18 hours) and only the first of the 4-year dental curriculum (40 hours; 10 hours). CONCLUSION: The DDS course showed less time devoted to formal teaching of these concepts compared to the nursing and BOH courses despite showing a noticeable improvement from a previous assessment conducted in 2006. It is hoped that the DDS course continues to further increase the transcultural content and find ways to incorporate more transcultural education.

Periodontal treatment in private dental practice: a case-based survey.

BACKGROUND: This study aimed to assess the management and referral patterns of Victorian general dental practitioners based on periodontal diagnosis. METHODS: Following ethics approval, Victorian general dental practitioners were invited to complete five randomized text-based periodontitis scenario questionnaires. Based on their diagnosis, respondents were asked for their management options and asked to specify who would perform these treatments. Respondents were also asked about referral procedures. RESULTS: One hundred and thirty-five dentists attempted the survey. Most were in group practice and based in Melbourne. Of the total respondents, 22.5% worked in a practice employing a hygienist. The management of periodontal disease was appropriate, and treatment options increased with severity. As severity increased, patients were more likely to be referred to a periodontist. Periodontal services referred by general dentists to dental hygienists increased with the number of days the hygienists worked within a practice. Over- and underdiagnosis did not markedly affect management. The recommendation of antibiotics, mouthwashes and periodontal surgery varied depending on year and school of graduation. CONCLUSIONS: The general dentists that completed the survey are managing periodontal conditions appropriately and according to current guidelines.

Cultural competency and communication skills of dental students: clinical supervisors' perceptions.

OBJECTIVES: This study explored clinical supervisor's (CS) views and experiences of dental students' cultural competence (CC) at the Melbourne Dental School, The University of Melbourne, Australia. Additionally, this study explored CS insights into how CC could be taught. METHODS: Semi-structured one-to-one interviews were organised with consenting CS. Interview topics included the following: the importance of CC, communication and rapport, the role of culture in oral health and the need for curriculum enhancement. Interviews were recorded, transcribed and thematically analysed to identify key areas using NVivo software. RESULTS: A total of 12 CS participated in this study. CS acknowledged the importance of CC and felt that it was important for good patient management. CS's definition of CC focused primarily on language and communication skills. CS felt that dental students were generally able to manage culturally diverse patients. However, CS indicated that additional training in this area would be beneficial. Concerns were raised about the students' ability to establish good rapport and communication, with CS highlighting areas such as misuse of interpreters and use of jargon. CS felt that clinical experience, confidence and a positive attitude are effective tools for overcoming cultural barriers. Furthermore, some CS also felt that cultural competency was a skill that is learnt through experience. CONCLUSIONS: For most CS, cultural competence was an important part of the clinician-patient exchange which would benefit from enhanced curriculum. They also highlighted areas where transcultural education could be improved. The majority of CS believed dental students managed culturally diverse patients well.

Periodontal diagnosis in private dental practice: a case-based survey.

BACKGROUND: Despite the prevalence of periodontitis in Australia, there are few reports regarding periodontal diagnosis and therapies in the general dental practice setting. This study aimed to assess the degree of diagnostic accuracy in periodontal cases of Victorian general dental practitioners. METHODS: Following ethics approval, dentists were invited to complete a scenario-based questionnaire on the Australian Dental Association Victorian Branch (ADAVB) website. Five text-based clinical scenarios (from a total of 10) were randomly presented, representing patients with a range of disease levels from periodontal health/gingivitis to severe periodontitis, and respondents were asked what examinations they would usually perform. Based upon the presented results of periodontal and radiographic examinations, a periodontal diagnosis was requested. RESULTS: One hundred and thirty-five dentists attempted the survey. Most were in group practice and based in Melbourne; 22.5% of respondents worked in a practice employing a hygienist. The clinical parameters most commonly measured to diagnose periodontal disease were pocket depth and mobility. The majority of respondents diagnosed health, gingivitis and mild periodontitis correctly compared to American Academy of Periodontology guidelines. However, moderate periodontitis tended to be diagnosed as severe. CONCLUSIONS: Dentists in Victoria used appropriate clinical parameters when assessing periodontal disease and were generally accurate in their diagnoses. There is a need for consensus regarding diagnostic definitions.

Evaluating the risk of obstructive sleep apnea in type 2 diabetic patients, and its associations

OBJECTIVE: To assess the prevalence of high risk of Obstructive Sleep Apnoea (OSA) in Type 2 diabetics. To identify risk associations of OSA with obesity, sleep quality, daytime sleepiness and Acanthosis Nigricans. DESIGN AND METHODS: A cross sectional study was done in the diabetic wards of health facilities governed by three Regional Health Authorities in Trinidad. OSA risk was assessed by the Snoring, Tiredness, Observed Apnea, high blood Pressure (STOP) – Body mass index, Age, Neck circumference and Gender (BANG) questionnaire. Sleep quality and daytime sleepiness were also assessed by the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale respectively. Bioimpedance analysis was also done using a stadiometer and standard bioimpedance scale. RESULTS: A total of 281 diabetic patients and 147 non-diabetic patients were interviewed throughout Trinidad. Females made up the majority of the sample, 67% of the diabetics and 66% of the non diabetics. The prevalence of OSA was found to be 73.2% in type 2 diabetics. Non diabetics had an OSA prevalence of 39.5%. Results from a binary regression showed that having diabetes increased the probability of “High Risk of OSA” by 93.1%. CONCLUSION: The prevalence of high risk of OSA in Trinidad was high in type 2 diabetic patients, and has strong correlations with obesity and Acanthosis Nigricans.

Australian/New Zealand Bachelor of Oral Health students: sociodemographics and career decisions.

This article describes the sociodemographic profile and factors affecting career decisions of Bachelor of Oral Health (BOH) students in Australia and New Zealand. Data were collected during the 2009 and 2011 academic years via online. A total of 271 students participated. The majority were female (87.8%), single (74.5%) and of Anglo-Saxon background (59.4%), and the average age was 23.7 years. The majority indicated that their fathers had at least secondary school education. The majority (52.8%) decided to study BOH after high school, and of those who commence after high school, 53.7% worked as a dental assistant/auxiliary. Career selection was self-motivated (70.2%) and a career to 'care for and help other people' (59.6%). Most respondents wished to work in a city (59.8%), in both the public and the private sectors (47.2%). This study represents a comprehensive assessment of BOH student profile in Australia and New Zealand. Findings indicate an overall different BOH student profile compared with other oral health profession students in Australia. A significant proportion had previous employment as a dental auxiliary staff and an increasing number of male students. Findings are relevant to educators, recruitment administrators and policy makers in the way the BOH profession is presented as a career option.

Penile Carcinoma in Northern Trinidad and Tobago.

OBJECTIVE: To determine the current incidence as well as general and ethnic trends of penile carcinoma in northern Trinidad and Tobago. METHODS: A retrospective analysis was conducted on all cases of penile carcinoma presenting in north and east Trinidad, as well as Tobago over an eight-year period. RESULTS: There were 19 cases from October 2003 to February 2012 with an age range of 42-96 years, mean of 59 years; peak age of presentation was 41-50 years and the number of cases presenting per year varied from one to four, with an average of three new cases yearly. Of 19 cases, 63% (12) originated from Port-of-Spain General Hospital (POSGH), 26% (5) from Sangre Grande (SGH) and 11% (2) from Tobago (TRH). There were 14 (74%) patients of African descent, three mixed and two of East Indian descent. There were four associated inflammatory lesions, five with ulcers, five verrucous lesions and two (10.5%) with human papillomavirus (HPV). One case presented with metastatic disease to the groin with erosion into the common femoral artery resulting in a blow-out of the vessel. The patient had the vessel oversewn and an extra-anatomic bypass done. He later had an above-knee amputation due to graft infection and failure. CONCLUSION: The incidence of penile carcinoma in north Trinidad and in Tobago is low and has halved in the past two decades. It stands at 0.6 cases per 100 000 males with the peak age group being 41-50 years, and with 95% of cases occurring between 41 and 80 years. There is a statistically significant association with active infection and being Afro-Caribbean. The decreasing incidence may be attributed to better hygiene, a higher rate of circumcision and low HPV rates in our population.

Giant accessory right-sided suprarenal spleen in thalassaemia.

An accessory spleen is defined as ectopic splenic tissue that develops due to failure of fusion of cells during embryonic development as they migrate from the midline to the left upper quadrant. While benign, complications may arise which include trauma, torsion, or infarction of the ectopic tissue. Additionally, patients who have had a splenectomy secondary to treatment for previous pathology such as a haematological malignancy or idiopathic thrombocytopenia purpura may experience persistent symptoms due to the accessory splenic tissue. The presence of an accessory spleen is therefore of significant diagnostic and therapeutic importance. To the best of the authors' knowledge, this case is the second and largest reported case of a giant right suprarenal accessory spleen and highlights the difficulty in differentiation of these masses from malignant adrenal tumours.

Precise measurement of the neutron magnetic form factor G(M)n in the few-GeV2 region.

The neutron elastic magnetic form factor was extracted from quasielastic electron scattering on deuterium over the range Q;{2}=1.0-4.8 GeV2 with the CLAS detector at Jefferson Lab. High precision was achieved with a ratio technique and a simultaneous in situ calibration of the neutron detection efficiency. Neutrons were detected with electromagnetic calorimeters and time-of-flight scintillators at two beam energies. The dipole parametrization gives a good description of the data.

Search for the photoexcitation of exotic mesons in the pi+pi+pi- system.

A search for exotic mesons in the pi;{+}pi;{+}pi;{-} system photoproduced by the charge exchange reaction gammap-->pi;{+}pi;{+}pi;{-}(n) was carried out by the CLAS Collaboration at Jefferson Lab. A tagged-photon beam with energies in the 4.8 to 5.4 GeV range, produced through bremsstrahlung from a 5.744 GeV electron beam, was incident on a liquid-hydrogen target. A partial wave analysis was performed on a sample of 83 000 events, the highest such statistics to date in this reaction at these energies. The main objective of this study was to look for the photoproduction of an exotic J;{PC}=1;{-+} resonant state in the 1 to 2 GeV mass range. Our partial wave analysis shows production of the a_{2}(1320) and the pi_{2}(1670) mesons, but no evidence for the a_{1}(1260), nor the pi_{1}(1600) exotic state at the expected levels. An upper limit of 13.5 nb is determined for the exotic pi_{1}(1600) cross section, less than 2% of the a_{2}(1320) production.

Downstream from calcium signalling: mitochondria, vacuoles and pancreatic acinar cell damage.

Ca(2+) is one of the most ancient and ubiquitous second messengers. Highly polarized pancreatic acinar cells serve as an important cellular model for studies of Ca(2+) signalling and homeostasis. Downstream effects of Ca(2+) signalling have been and continue to be an important research avenue. The primary functions regulated by Ca(2+) in pancreatic acinar cells--exocytotic secretion and fluid secretion--have been defined and extensively characterized in the second part of the last century. The role of cytosolic Ca(2+) in cellular pathology and the related question of the interplay between Ca(2+) signalling and bioenergetics are important current research lines in our and other laboratories. Recent findings in these interwoven research areas are discussed in the current review.

Experimental study of exclusive 2H(e,e'p)n reaction mechanisms at high Q2.

The reaction 2H(e,e'p)n has been studied with full kinematic coverage for photon virtuality 1.75NN transition is the primary contribution at higher momenta.

Search for medium modifications of the rho meson.

The photoproduction of vector mesons on various nuclei has been studied using the CLAS detector at Jefferson Laboratory. The vector mesons, rho, omega, and varphi, are observed via their decay to e;{+}e;{-}, in order to reduce the effects of final-state interactions in the nucleus. Of particular interest are possible in-medium effects on the properties of the rho meson. The rho mass spectrum is extracted from the data on various nuclei, 2H, C, Fe, and Ti. We observe no significant mass shift and some broadening consistent with expected collisional broadening for the rho meson.

Measurement of the N-->Delta(+)(1232) transition at high-momentum transfer by pi(0) electroproduction.

We report a new measurement of the exclusive electroproduction reaction gamma(*)p-->pi(0)p to explore the evolution from soft nonperturbative physics to hard processes via the Q(2) dependence of the magnetic (M(1+)), electric (E(1+)), and scalar (S(1+)) multipoles in the N-->Delta transition. 9000 differential cross section data points cover W from threshold to 1.4 GeV/c(2), 4pi center-of-mass solid angle, and Q(2) from 3 to 6 GeV(2)/c(2), the highest yet achieved. It is found that the magnetic form factor G(M)(*) decreases with Q(2) more steeply than the proton magnetic form factor, the ratio E(1+)/M(1+) is small and negative, indicating strong helicity nonconservation, and the ratio S(1+)/M(1+) is negative, while its magnitude increases with Q(2).

Measurement of deeply virtual compton scattering with a polarized-proton target.

The longitudinal target-spin asymmetry AUL for the exclusive electroproduction of high-energy photons was measured for the first time in ep-->e;'pgamma. The data have been accumulated at JLab with the CLAS spectrometer using 5.7 GeV electrons and a longitudinally polarized NH3 target. A significant azimuthal angular dependence was observed, resulting from the interference of the deeply virtual Compton scattering and Bethe-Heitler processes. The amplitude of the sinvarphi moment is 0.252+/-0.042stat+/-0.020sys. Theoretical calculations are in good agreement with the magnitude and the kinematic dependence of the target-spin asymmetry, which is sensitive to the generalized parton distributions H and H.

Movement of calcium signals and calcium-binding proteins: firewalls, traps and tunnels.

In the board game 'Snakes and Ladders', placed on the image of a pancreatic acinar cell, calcium ions have to move from release sites in the secretory region to the nucleus. There is another important contraflow - from calcium entry channels in the basal part of the cell to ER (endoplasmic reticulum) terminals in the secretory granule region. Both transport routes are perilous as the messenger can disappear in any place on the game board. It can be grabbed by calcium ATPases of the ER (masquerading as a snake but functioning like a ladder) and tunnelled through its low buffering environment, it can be lured into the whirlpools of mitochondria uniporters and forced to regulate the tricarboxylic acid cycle, and it can be permanently placed inside the matrix of secretory granules and released only outside the cell. The organelles could trade calcium (e.g. from the ER to mitochondria and vice versa) almost depriving this ion the light of the cytosol and noble company of cytosolic calcium buffers. Altogether it is a rich and colourful story.

Eta' photoproduction on the proton for photon energies from 1.527 to 2.227 GeV.

Differential cross sections for the reaction gamma p --> eta' p have been measured with the CLAS spectrometer and a tagged photon beam with energies from 1.527 to 2.227 GeV. The results reported here possess much greater accuracy than previous measurements. Analyses of these data suggest for the first time the coupling of the eta'N channel to both the S11(1535) and P11(1710) resonances, known to couple strongly to the etaN channel in photoproduction on the proton, and the importance of J = 3/2 resonances in the process.