Pain and anxiety control in dentistry – the foundation of successful practice, but the Cinderella of dental pre-registration education

The control of patients’ pain and anxiety has been a fundamental part of the practice of dentistry since Horace Wells underwent dental treatment using nitrous oxide anaesthesia in 1844, and subsequently used it on his own patients prior to an ill-fated demonstration in Massachusetts General Hospital in 1845 [1]. The use of nitrous oxide was the first of a number of major milestones in this area. These included the use of ether by William TG Morton in 1846 [2], and the first administration of local anaesthesia for dentistry by William Halsted in 1844 [3]. The development of inhalation sedation for dentistry, as opposed to general anaesthesia, was popularised by Harry Langha who first described the technique in the 1940s before running the first postgraduate sedation course in 1949 [4]. Techniques of intravenous sedation followed with the work of Jorgensen in 1945 and then Drummond-Jackson the founder of the Society for the Advancement of Anaesthesia in Dentistry in 1957 [5].Full Tex

Developing a Task Switching Training Game for Children With a Rare Genetic Syndrome Linked to Intellectual Disability

Background. The ability to rapidly switch between tasks is important in a variety of contexts. Training in task switching may be particularly valuable for children with intellectual disability (ID), specifically ID linked to genetic syndromes such as Prader-Willi syndrome (PWS). We have developed a cognitive training game for children with PWS and performed a pilot evaluation of the programme to inform future game development. Here, we describe and critically reflect on the development and pilot evaluation process.Methods. Several novel aspects of our approach are highlighted in this paper, including the involvement (in various roles) of children with a rare genetic syndrome (PWS) in the development and evaluation of the software (participatory design) and the development of a matched control, or placebo version of the game for use in the pilot evaluation.Results.Children with PWS were capable of contributing to the design and development of a cognitive training game in various roles. In the subsequent pilot evaluation, playing the active version of the game was associated with greater improvement in task switching performance than playing the matched control (placebo) version of the game. However, attrition was an issue during both the design phase and the pilot evaluation.Conclusions. The lessons learned from our work have relevance in a wide range of contexts, such as the development of future cognitive training games; the evaluation of serious games in general; and the involvement of end-users with cognitive disabilities and/or rare syndromes in the design and development of software

People with Disabilities Leading the Design of Serious Games and Virtual Worlds.

Games and virtual worlds have many potential benefits for people with intellectual disabilities (ID) and autism spectrum disorder (ASD), in terms of training, education, and rehabilitation. However, because this population presents a wide range of specific needs and abilities, it can be difficult to design games which are engaging and present optimum levels of challenge to players. By including individuals with ID and ASD in the design phase we can help meet their specific needs and preferences by personalizing an intervention through the exploration of experimental techniques, methods and assistive technologies. By embracing the Responsible Research and Innovation approach, we bring science and society closer together to shape the world for future generations. A number of approaches for achieving such inclusion have been described, such as User Sensitive Inclusive Design, Universal Design, and Design for All. Here we discuss three specific examples of the design of games and virtual worlds for people with ID/ASD and illustrate how they attempt to meet their needs. Namely 1) a blended approach of computerised program and applied behaviour analysis for reading skills 2) immersive gameplay for employment and transferable skills training and 3) virtual reality training to enhance communication skills

‘Just engage in it or not, you get out what you put in’:student and staff experiences of feedback and feedforward in workplace-based learning environments

Feedback is central to student learning in the veterinary workplace. Feedforward, a related concept, is used to describe the way information about a student's performance may be used to improve their future performance. Feedback and feedforward practices are diverse, with varied student and staff understandings of the nature and purpose of feedback (feedback literacy). This study compared the practices of feedback and feedforward in a range of programs in one institution during student transitions from the classroom to workplace-based learning environments. The study adopted a broad inter-professional approach to include health care programs as well as social work and theater and performance studies. Profession-specific focus groups were conducted with contribution from 28 students and 31 staff from five different professions. Thematic analysis revealed that students and staff shared an understanding of the feedback and feedforward concepts, and both groups recognized the importance of emotional and relational aspects of the process. Students and staff across all professions recognized the impact of time constraints on the feedback process, although this was particularly highlighted in the health science professions. Social work and theater and performance studies students demonstrated a more nuanced understanding of the emotional and relational aspects of feedback and feedforward. Overall, the approach highlights similarities and differences in practices and experiences in different workplace contexts, creating opportunities for cross-disciplinary learning, which may have relevance more widely in higher education programs with workplace-based elements. The study underpinned the development of the LeapForward feedback training resource (https://bilt.online/the-leapforward-project/).No Full Tex

Editorial: Championing inclusion and diversity: inclusive design practices and approaches for education

Published versio

Parental Intention to Support the Use of Computerized Cognitive Training for Children With Genetic Neurodevelopmental Disorders

Children with genetic neurodevelopmental disorders (NDDs) such as Down syndrome, Prader-Willi syndrome, and Fragile X syndrome may show a range of cognitive impairments, including impairments in executive functions (EF). EF are related to general intelligence, academic achievement, and literacy and mathematical skills. EF deficits are linked to a variety of clinically and socially important behaviors. Therefore, methods for improving EF in children with NDDs could be beneficial. One method for improving EF is through cognitive training. Research on commercial brain training programmes and video games suggests that EF can be improved through training, both in healthy adults and in children with NDDs. Computerized cognitive training (CCT) therefore represents a potentially viable intervention for children with NDDs. For training to be effective, it is important that an appropriate regimen is followed. Since children are likely to engage with training at home, the intentions of their parents to support them are therefore important. However, no research has investigated the attitudes of parents of children with NDDs to CCT. To address this, we developed a questionnaire based on the theory of planned behavior, which states that a person's intention to engage in a behavior is predicted by (1) their attitude toward the behavior, (2) their perception of subjective norms regarding the behavior (i.e., perceived social pressure), and (3) their perceived control over the behavior. The questionnaire was completed by parents of children with NDDs; 58 unique responses were retained for analyses. Parents reported low levels of knowledge of CCTs, and low levels of experience with CCTs (both their own experience and their child's experience). However, our results also show that parents of children with NDDs have positive beliefs about the potential of CCT to benefit their children and intend to support the use of CCT by their children. Linear modeling showed that, of the three constructs of the theory of planned behavior, only attitudes significantly predicted intention. Finally, parents' beliefs about the benefits of CCT correlated positively with positive attitudes toward such training. We also found limited evidence that parents of boys have more positive attitudes regarding CCT than parents of girls

Subterranean sympatry : an investigation into diet using stable isotope analysis

In the Western Cape three species of mole-rat occur in sympatry, however, little is known about differences in their dietary preferences. Dietary composition of the three species; the common mole-rat (Cryptomys hottentotus hottentotus), the Cape mole-rat (Georychus capensis) and the Cape dune mole-rat (Bathyergus suillus) were examined using stable isotope analysis. Blood, fur and claw samples were collected from 70 mole-rats, in addition to several potential food items, to assess food selection of the three species under natural conditions. Overall there was a significant difference in the isotopic composition (d13C and d15N) between all three species and significant differences in their diet composition. There were also significant differences between tissues in all three species suggesting temporal variation in diet. The small size and colonial lifestyle of C. h. hottentotus allows it to feed almost 100% on bulbs, while the solitary and larger species G. capensis and B. suillus fed to a greater extent on other resources such as grasses and clover. B. suillus, the largest of the species, had the most generalized diet. However, overall all species relied most heavily upon geophytes and consumed the same species suggesting competition for resources could exist. We also showed a high level of individual variation in diet choices. This was most pronounced in B. suillus and G. capensis and less so in C. h. hottentotus. We demonstrate that stable isotope analysis can successfully be applied to examine dietary patterns in subterranean mammals and provide insights into foraging patterns and dietary variation at both the inter and intra population level.G. Robb was funded by a University of Pretoria Post-doctoral fellowship. N. Bennett and fieldwork costs were funded through the Department of Science and Technology and National Research Foundation SARChI Chair of Mammal Behavioural Ecology and Physiology.http://www.plosone.orgab201

The influence of food quantity on carbon and nitrogen stable isotope values in southern African spiny mice (Acomys spinosissimus)

Stable isotope analysis is frequently applied as a tool to examine dietary patterns in animals. However, some of the underlying assumptions associated with using this approach are increasingly being questioned. We carried out a controlled diet experiment on the southern African spiny mouse (Acomys spinosissimus Peters, 1852) to test a number of aspects relating to these assumptions and also examine the hypothesis that stable isotopes, especially δ15N, can be used to provide evidence of nutritional stress. We compared the δ13C and δ15N values of livers and blood from animals that were fed ad libitum with animals undergoing a 10% reduction in food supply. Food-restricted animals showed no significant difference in δ15N; however, δ13C values of both liver and blood were depleted. Restricted animals also had a significantly lower C:N ratio. We examined the role of lipids and found following lipid extraction that both livers and lipids still showed the same separation in carbon values. Tissue–diet discrimination values were also calculated and found to be higher for both Δ13C and Δ15N compared with other mice species. Empirical values for discrimination rates were then compared with values calculated using an alternative method based on employing generic values and were found to be dissimilar, suggesting the use of generic values are not always appropriate. Our results highlight the need for greater understanding of the assumptions associated with using stable isotope analysis to examine diet and we suggest that studying a single species under captive conditions presents an ideal method to begin to test these hypotheses.Department of Science and Technology – National Research Foundation. South African Research Chair in mammal behavioural ecology and physiology. University of Pretoria.http://www.nrcresearchpress.com/journal/cjzhb2016Zoology and Entomolog

Convalescent plasma therapy for the treatment of patients with COVID‐19: Assessment of methods available for antibody detection and their correlation with neutralising antibody levels

Introduction The lack of approved specific therapeutic agents to treat coronavirus disease (COVID‐19) associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection has led to the rapid implementation of convalescent plasma therapy (CPT) trials in many countries, including the United Kingdom. Effective CPT is likely to require high titres of neutralising antibody (nAb) in convalescent donations. Understanding the relationship between functional neutralising antibodies and antibody levels to specific SARS‐CoV‐2 proteins in scalable assays will be crucial for the success of a large‐scale collection. We assessed whether neutralising antibody titres correlated with reactivity in a range of enzyme‐linked immunosorbent assays (ELISA) targeting the spike (S) protein, the main target for human immune response. Methods Blood samples were collected from 52 individuals with a previous laboratory‐confirmed SARS‐CoV‐2 infection. These were assayed for SARS‐CoV‐2 nAbs by microneutralisation and pseudo‐type assays and for antibodies by four different ELISAs. Receiver operating characteristic (ROC) analysis was used to further identify sensitivity and specificity of selected assays to identify samples containing high nAb levels. Results All samples contained SARS‐CoV‐2 antibodies, whereas neutralising antibody titres of greater than 1:20 were detected in 43 samples (83% of those tested) and >1:100 in 22 samples (42%). The best correlations were observed with EUROimmun immunoglobulin G (IgG) reactivity (Spearman Rho correlation coefficient 0.88; p 1:100 with 100% specificity using a reactivity index of 9.1 (13/22). Discussion Robust associations between nAb titres and reactivity in several ELISA‐based antibody tests demonstrate their possible utility for scaled‐up production of convalescent plasma containing potentially therapeutic levels of anti‐SARS‐CoV‐2 nAbs