The Undergraduate preparation of dentists: Confidence levels of final year dental students at the School of Dentistry in Cardiff

Objective To investigate the self-reported confidence and preparedness of final year undergraduate students in undertaking a range of clinical procedures. Methods A questionnaire was distributed to final year dental students at Cardiff University, six months prior to graduation. Respondents rated their confidence in undertaking 39 clinical procedures using a 5-point scale (1 = can undertake on own with confidence, 5 = unable to undertake). Students also responded yes/no to experiencing four difficulties and to three statements about general preparedness. Results 71% (N = 51) responded of which 55% (N = 28) were female. Over half reported being 'anxious that the supervisor was not helping enough' (57%) and 'relying heavily on supervisor for help' (53%). Eighty percent 'felt unprepared for the clinical work presented' and gender differences were most notable here (male: 65% N = 33; females: 93% N = 47). Mean confidence scores were calculated for each clinical procedure (1 = lowest; 5 = highest). Confidence was highest in performing 'simple scale' and 'fissure sealant' (mean-score = 5). Lowest scores were reported for 'surgical extractions involving a flap (mean-score = 2.28)', 'simple surgical procedures' (mean-score = 2.58) and the 'design/fit/adjustment of orthodontic appliances' (mean-score = 2.88). Conclusions As expected complex procedures that were least practised scored the lowest in overall mean confidence. Gender differences were noted in self-reported confidence for carrying out treatment unsupervised and feeling unprepared for clinical work

Leveraging Snow Plow Dashboards Cams and Connected Vehicle Speed Data to Improve Winter Operations Performance Measures

Recent developments in mobile phone applications for polling traffic and roadway condition data from the public have led to new data sources that complement traditional Intelligent Transportation System (ITS) sensors, weather stations, and automatic vehicle location (AVL) on fleet vehicles. This study compared qualitative assessments by different users of snow plow dashboard images with interstate connected vehicle speeds. The data set was composed of 1,119 geotagged images collected during a snowstorm on February 2-3, 2016, on Interstate 80. The images were classified by three users into one of seven categories to describe the road conditions. The classification of images saw the greatest deviation when road conditions were “wet,” “dry,” or “icy,” suggesting some variation in the interpretation of these categories by the users. Connected vehicle speed data was used to validate conditions and analyze speeds at GPS locations of each image for a two-hour window around when the image was taken to identify any potential impacts the plows have made. The Kolmogorov-Smirnov test was used for all before and after combinations to determine which comparisons were the most significant between minutes before and after the plow, and found that speed data taken between 17 to 12 minutes before the plow had the greatest maximum distance improvement on the speed distributions 25 to 35 minutes after the plow has gone through. Longer term, these techniques will provide a framework for agencies to dynamically monitor changing road conditions and respond to changing weather conditions

A whole-team approach to optimising general dental practice teamwork: development of the Skills-optimisation Self-evaluation Toolkit (SOSET)

Introduction Studies across the health service reveal benefits of teamwork and barriers to its optimal use. Drawing upon the established Maturity Matrix Dentistry method, the Skills Optimisation Self-Evaluation Toolkit (SOSET) was developed to enable the whole dental team to critically review how they address skill-mix in delivery of patient-centred oral healthcare in their practice. This paper outlines the development of the SOSET and explores its usefulness to general dental practice teams. Methods Research literature and interview data from general dental practice teams were coded for high-level factors (positive and negative) influencing teamwork. We used this coding to identify skill-mix domains, and within each, define criteria. The SOSET process was refined following consultations with dental professionals and piloting. Results Eighty-four papers were coded and 38 dental team members were interviewed across six sites. The SOSET matrix was developed containing nine domains reflecting the use of skill-mix, each containing six development-level criteria. The domains addressed factors such as team beliefs on skill-mix and knowledge of team members' scope of practice, patient demand, the business case, staffing and training, and the practice premises. The process was piloted in 11 practices across South Wales, and feedback was received from 92 staff members. Results showed that the SOSET process was straightforward, that the whole team could contribute to discussion and that it would be used to improve practice. Following piloting, four domains were merged into two new domains, and the number of criteria within all domains was reduced and the wording simplified (seven domains, with four criteria each). Conclusion We used a systematic and rigorous process to develop the SOSET to support dental teams to progress their teamwork practices. Its usefulness was demonstrated in the pilot. The SOSET is now being offered to general dental practices across Wales

Galactic halo cusp-core: tidal compression in mergers

We explain in simple terms how the buildup of dark haloes by merging compact satellites, as in the CDM cosmology, inevitably leads to an inner cusp of density profile $\rho \propto r^{-\alpha}$ with \alpha \gsim 1, as seen in cosmological N-body simulations. A flatter halo core with $\alpha <1$ exerts on the satellites tidal compression in all directions, which prevents deposit of stripped satellite material in the core region. This makes the satellite orbits decay from the radius where $\alpha \sim 1$ to the halo centre with no local tidal mass transfer and thus causes a rapid steepening of the inner profile to $\alpha >1$. These tidal effects, the resultant steepening of the profile to a cusp, and the stability of this cusp to tandem mergers with compact satellites, are demonstrated using N-body simulations. The transition at $\alpha \sim 1$ is then addressed using toy models in the limiting cases of impulse and adiabatic approximations and using tidal radii for satellites on radial and circular orbits. In an associated paper we address the subsequent slow convergence from either side to an asymptotic stable cusp with \alpha \gsim 1. Our analysis thus implies that an inner cusp is enforced when small haloes are typically more compact than larger haloes, as in the CDM scenario, such that enough satellite material makes it intact into the inner halo and is deposited there. We conclude that a necessary condition for maintaining a flat core, as indicated by observations, is that the inner regions of the CDM satellite haloes be puffed up by about 50% such that when they merge into a bigger halo they would be disrupted outside the halo core. This puffing up could be due to baryonic feedback processes in small haloes, which may be stimulated by the tidal compression in the halo cores.Comment: 19 pages, Latex, mn2e.cls, some revisions, MNRAS in pres

The dental core training experience: the views of trainees and their postgraduate training leads

Introduction Dental core training (DCT) is an optional, postgraduate programme with a duration of one to three years that dentists in the UK can pursue to further strengthen their skillset. Aims To understand career motivations and preferences of trainees pursuing DCT, and their perceptions and experiences of the programme. Methods Data were gathered from 176 DCT trainees across England through focus groups or individual paper-based responses to questions, as well as telephone interviews with ten associate postgraduate dental deans/training programme directors. Results Trainees were generally positive about their overall DCT experience. They developed confidence, self-reliance and skills in teamwork and clinical aspects, gaining from exposure to conditions uncommon in general practice. Limitations and challenges varied by post and unit. The importance of broad, cross-specialty experience was recognised. Although run-through training would eliminate unwelcome annual relocation, it was deemed unsuitable for all trainees, particularly those intending a career in general practice. Conclusion DCT appears to be advantageous for those intending careers in general dental practice, those aiming for specialist practice and those uncertain of their future career trajectory. Although trainees reported positive training experiences and significant gains, future considerations are suggested, including maintaining flexibility to accommodate different motives for DCT and limiting across-unit variation

Professionalism in the dental practice: perspectives from members of the public, dentists and dental care professionals

Introduction This paper examines views on professionalism in the dental practice workplace through a thematic analysis of data from eight focus groups. Methods Focus groups were conducted with 19 dentists, 13 dental care professionals and 19 members of the public in England and Wales. The research was part of a larger mixed-methods study of professionalism in dentistry commissioned by the General Dental Council. Results The four most prominent themes in the focus group data were: communication, the cost of treatment, the role of the dental team and consequences of professionalism concerns. Participants agreed that these are fundamental professionalism issues, although there was some difference of opinion about addressing them. There was disagreement about the responsibilities of different members of the dental team in maintaining professionalism. Conclusion We conclude that communication skills training should be a central part of the professionalism at all levels of training. Education about team working could foster a more collaborative approach to professionalism across the dental team and support good, patient-centred oral healthcare. Support and guidance are required to help professionals reflect and learn from mistakes

Are the standards of professionalism expected in dentistry justified? Views of dental professionals and the public

Introduction: In the UK, the General Dental Council specifies nine principles of professional standards that dental registrants must follow. There are views that such standards are high, patients' expectations are rising, and the professionalism of dental professionals is increasingly scrutinised. This paper explores whether the high standards expected in dentistry are justified. Methods: We applied thematic analysis to 772 free-text responses from dental team members and the public to a modified Delphi survey. Respondents described their views of professional and unprofessional behaviours in dentistry. Data were obtained as part of a larger review of professionalism in dentistry. Results: Two lines of argument were identified: professionalism standards are high, but justifiably so; and professionalism standards are too high. Within these, four broad themes emerged: patient trust; comparison with other professions; a culture of fear; and perfection. Conclusion: High professionalism standards are justified in a profession where patient trust is paramount. However, a problem lies in the culture that surrounds professionalism in terms of litigation and dental professionals feel pressure to possess an unattainable, infallible nature. These negative impacts need minimising. We suggest that undergraduates and continuing professional development approach professionalism with care, to foster a supportive, positive and reflective culture of professionalism

Serine-arginine protein kinase 1 (SRPK1), a determinant of angiogenesis, is upregulated in prostate cancer and correlates with disease stage and invasion

Vascular endothelial growth factor (VEGF) undergoes alternative splicing to produce both proangiogenic and antiangiogenic isoforms. Preferential splicing of proangiogenic VEGF is determined by serine-arginine protein kinase 1 (SRPK1), which is upregulated in a number of cancers. In the present study, we aimed to investigate SRPK1 expression in prostate cancer (PCa) and its association with cancer progression. SRPK1 expression was assessed using immunohistochemistry of PCa tissue extracted from radical prostatectomy specimens of 110 patients. SRPK1 expression was significantly higher in tumour compared with benign tissue (p<0.00001) and correlated with higher pT stage (p=0.004), extracapsular extension (p=0.003) and extracapsular perineural invasion (p=0.008). Interestingly, the expression did not correlate with Gleason grade (p=0.21), suggesting that SRPK1 facilitates the development of a tumour microenvironment that favours growth and invasion (possibly through stimulating angiogenesis) while having little bearing on the morphology or function of the tumour cells themselves