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Background: No studies have evaluated the unique potential of nurse‐led silver diamine fluoride (SDF) application for children to bridge the gap in interprofessional collaboration. Aim: To investigate the attitudes, beliefs and perceptions of nurses regarding nurse‐led SDF application at the well‐child visit and identify possible barriers and make recommendations. Design: Mixed methods design involving a questionnaire and semi‐structured individual interviews were conducted. Results: All eligible nurses (n = 110) completed the questionnaire, and 16 were interviewed. Questionnaire responses highlighted that nurses were not confident in providing oral health services (score: <3 of 5) beyond oral hygiene advice (score: ≥3.9 of 5) but believed that they should be providing these services for individuals with difficulty accessing care. Interviews reflected that most nurses viewed oral health care as an important part of paediatric health but were limited by knowledge, time and manpower. Most were willing to expand their job scope to include SDF application with formal education and training, competency assessments and approaches to counter time limitations. Conclusion: Where nurses are already providing basic oral healthcare, nurse‐led SDF application could be the next step. Findings suggest that systemic changes should include strategies to empower and motivate nurses to apply SDF at the well‐child visit. [ABSTRACT FROM AUTHOR]

Objectives: Prevention complements the curative management of oral diseases. Effective preventive interventions involve the adoption of oral health promoting behaviours. Little is known about the awareness of oral disease and its prevention among Singaporean adults as well as their prevailing oral health attitudes and behaviours. The aim of the study was to describe the oral health knowledge, attitudes and behaviours of adults in Singapore. Methods: A random sample of adults (≥21 years old) in Singapore was selected to complete an interviewer‐administered questionnaire. The questionnaire gathered information about their knowledge of the aetiology, signs and symptoms as well as prevention of dental caries and periodontal disease; attitudes about the value of teeth, locus of control in maintaining oral health and oral health behaviours including toothbrushing, flossing and dental attendance. Results: A total of 1196 adults of weighted mean age 48 years old with almost equal proportions of males and females responded to the questionnaire. Participants were more unaware about the causes of periodontal disease (25.7%) than dental caries (4%). While more than 90% of participants felt that healthy teeth were important and could affect their overall health, many (67.0%) felt it was natural to lose their teeth with old age. Among the participants, 83.5% brushed their teeth twice a day; 41.9% flossed their teeth and 53.9% visited the dentist at least once a year. Conclusions: The study findings showed good knowledge around dental caries but some gaps around periodontal disease. It also found that participants perceived having limited control over preventing tooth loss. Irregular dental attendance and poor denture wearing habits were also noted. The findings shed light on key areas to focus on through oral health promotion to improve overall oral health. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to present key findings from the 2019 national adult oral health survey in Singapore (NAOHS). Methods: A multi‐stage stratified sampling method was used to recruit participants for a representative national adult oral health survey. A total of 12 212 households were randomly selected from the National Database on Dwellings in Singapore. Within each household eligible persons aged ≥65 years were automatically invited to participate while a Kish selection method was used to invite those between 21 and 64 years old. The survey comprised a face‐to‐face interview questionnaire and a clinical examination which recorded details of tooth loss, DMFT, DMFS and prevalence of periodontal disease according to the CPITN and the US CDC‐AAP classifications. Weighted analysis was performed to adjust for oversampling, non‐response and post‐stratification. Multivariate regression with backward stepwise selection was carried out to identify predictors of chronic periodontal disease and untreated dental caries. Results: Six hundred and sixty‐three participants completed both the questionnaires and the clinical examination. The prevalence of edentulousness was 2.7%. Of participants, 34.8% presented with untreated dental caries with a higher proportion found in those who were aged ≥60 years, of Malay ethnicity, living in 1–2‐room public housing and who only visited the dentist when there was a problem. Mean DMFS and DMFT indices were 24.7 and 7.9 respectively. Based on the CDC‐AAP classification, the prevalence of moderate–severe chronic periodontitis was 56.9% and increased with age, with a higher proportion in males. Participants with untreated dental caries were more likely to have moderate or severe periodontal disease. Conclusions: Survey findings showed high prevalence of dental caries and periodontal disease, at 34.8% and 77.6% respectively. A clear socio‐economic gradient in the distribution of tooth loss, untreated dental caries and moderate‐to‐severe periodontitis was observed. [ABSTRACT FROM AUTHOR]

Objectives: Oral healthcare service is not well integrated with existing healthcare policy in nursing homes (NHs) globally. This qualitative study aimed to identify dentists' perspectives on structural and system barriers that hinder oral healthcare (OHC) provision to seniors in NHs in Singapore and to understand the consequences of these barriers. Methods: Nineteen dentists (8 males and 11 females, 36.0 [IQR: 32.0–48.5] years old) were recruited through combination of purposive and snowball sampling. Four focus group discussions were conducted via teleconferencing, and each discussion had 4–5 anonymised participants. Sessions lasted 90–120 min and were audio‐recorded and transcribed verbatim. Thematic analysis was conducted on data collected using NVivo software (Version12, QRS International). Results: Participants agreed that the current OHC system for seniors in NHs is not well developed. The challenges dentists faced were categorised in three themes: [1] general oral healthcare system level; [2] local nursing home setting level; and [3] geriatric oral healthcare education level. These challenges are complexly intertwined and have contributed to several consequences such as a shortage of dentists in NHs and their diminished motivation to serve. It has also limited the quality of dental service they are able to provide in NHs, contributing to the current poor access of dental services for seniors in NHs. Conclusions: Dentists in Singapore face many structural and systemic barriers in providing OHC to seniors in NHs, some of which are unique to the local context. Newfound understanding of these barriers and its consequences will be helpful in developing strategic approaches to overcome these challenges. [ABSTRACT FROM AUTHOR]

Objectives: To address the following research questions: (i) What is the current situation and future vision on oral healthcare service in nursing homes (NHs) in Singapore? (ii) What are the enablers to achieve the future vision? (iii) How do views differ between dentists with and without clinical experiences in NHs? Background: Oral healthcare services in NHs need to reflect the perspectives of a diverse range of stakeholders and establish shared goals, however there is scarce evidence of in‐depth dentists' insights. Material and methods: Dentists were purposively recruited. Focus group discussions with 4–5 participants each were conducted via teleconferencing. Data were analysed thematically. Results: The participants (n = 19, median 36.0 years) recognised the need of comprehensive reform of the oral healthcare paradigm in NHs: symptomatic care to preventive care, disease‐oriented care to person‐centred care and more active collaborative care. Overall, five domains of enabling factors emerged: (1) to improve general system of oral healthcare in NHs, (2) to increase the number of dentists engaging in NHs, (3) to improve the quality of dental practice, (4) to improve the quality of daily oral care and (5) to promote seniors' cooperative attitude to oral healthcare. There was a noticeable difference in the perception on how to encourage dentists to serve in NHs. Conclusion: There is a need for a comprehensive reform of the oral healthcare paradigm for seniors in NHs in Singapore. A multi‐tiered strategy using both top‐down and bottom‐up approaches is required. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has necessitated an unprecedented shift from face‐to‐face teaching to e‐learning. Previous surveys revealed the negative impact of COVID‐19 on dental education and the physical and psychological well‐being of dental students. This qualitative study aimed to investigate the perspectives of dental educators towards e‐learning during the pandemic and the impact of this experience on their future adoption of e‐learning. Materials and Methods: Semi‐structured interviews with dental educators from the National University of Singapore were conducted over Zoom. Audio recordings were transcribed verbatim and subjected to thematic analysis. Data saturation was reached. Consolidated criteria for reporting qualitative research (COREQ) was followed. Results: Fifteen out of 22 (68%) eligible dental educators were interviewed. Educators had minimal prior e‐learning experience. They encountered difficulties in engaging students, assessing students' understanding and adapting their teaching. A practical challenge was to ensure the well‐rounded training of competent dentists with adequate patient‐interaction skills through e‐learning. Self‐motivation of the audience, class size, type of teaching and complexity of the material were perceived as factors influencing the suitability of the e‐learning format. Educators reported an increased confidence after this emergency e‐learning experience. Some considered sustaining or expanding e‐learning in their future teaching practice and highlighted the need for continued investment and institutional support, training on the pedagogy of e‐learning modalities and curriculum redesign to accommodate blended learning approaches. Conclusions: Although the shift to e‐learning during the COVID‐19 pandemic presented a myriad of challenges, dental educators gained experience and confidence which may accelerate the pace of future e‐learning adoption and innovation. [ABSTRACT FROM AUTHOR]

Purpose: The range of child behaviors encountered in real‐life situations far exceeds that of any classroom‐based simulated scenarios. For such reasons, clinical training with real‐time clinical supervisor's feedback is optimal for learner‐centricity. This study aimed to objectively evaluate the effect of video feedback on the student dentist's ability to manage behaviors in children. Methods: Third‐year dental student volunteers were randomly allocated to two groups: control and intervention. They were video recorded for three pediatric dental treatment sessions and received standard feedback for all sessions. Additionally, the intervention group received two constructive 1‐on‐1 feedback sessions after the first and second video sessions. Students' application of behavior management techniques for all recorded treatment sessions was scored with a study‐specific objective scale (maximum score: 20; larger score indicating better performance) by two independent and blinded evaluators. A self‐administered student questionnaire elicited subjective feedback on the intervention. Results: There was a significant difference (p = 0.008) between behavior management scores when comparing all pre‐intervention sessions (10.74 ± 3.55) and all post‐intervention sessions (13.57 ± 2.96). The intervention significantly improved these techniques: 1. Providing specific feedback – positive reinforcement and descriptive praise (p = 0.006) and 2. Distraction – Using imagination with stories and singing (p = 0.035). The feedback sessions (4.29 ± 0.54) were perceived to be significantly (p = 0.032) more effective than having the students view the videos on their own (3.76 ± 0.87). Conclusion: Video feedback improved the behavior management scores of student dentists. The faculty feedback sessions were found by student dentists to improve confidence and the techniques for managing children. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to investigate the salivary proteome profiles of pregnant women with gingivitis (PG) or without gingivitis (HP) and non‐pregnant healthy controls (HC) by employing iTRAQ‐based proteomics. Materials and methods: Saliva samples were collected from 30 Chinese women comprising 10 subjects in each of the three groups (PG, HP, and HC). The samples were subjected to iTRAQ‐based proteomics analysis, and ELISA was performed to validate the results. The subsequent observations were validated in a cohort of 48 subjects. Results: Pathways associated with neutrophil‐mediated immune response and antioxidant defence mechanism were significantly higher in PG than HC. The abundance of salivary cystatins (S, SA, and SN) and antimicrobials were significantly decreased in PG and HP, while cystatin C and D were additionally decreased in PG. Cystatin C was mapped to all the major catabolic pathways and was the most re‐wired protein in pregnancy gingivitis. Further validation demonstrated cystatin C to be significantly lower in PG than HC. Conclusions: While the decrease in levels of salivary cystatins and antimicrobial proteins may predispose healthy pregnant women to pregnancy gingivitis, it may cause persistence of inflammation in pregnant women with gingivitis. [ABSTRACT FROM AUTHOR]

Background/aim: Patients suffering dental trauma are unprepared for the disability challenge and necessary rehabilitation, while a traumatic event places an expanded demand on the dentist who is focused on treating disease. The aim of this study was to examine the impact of traumatic dental injuries (TDI) on patients and to compare patients' and dentists' perceptions of the event.Material and Methods: TDI patients (aged ≥ 21 years) attending a tertiary dental hospital from 2011 to 2013, and their dentists were recruited with informed consent. An exploratory sequential mixed-methods design was adopted. The Oral Health Impact Profile (OHIP-14) quantitatively identified patients with "very often," "fairly often" or "occasionally" in at least one of the OHIP-14 questions (Phase 1) to participate in the qualitative phase of the study through focus group discussions (FGD) (Phase 2). FGD for dentists was conducted separately.Results: Quantitative analysis showed 28%-55% of TDI patients had "occasional" to "very often" discomfort during eating, increased self-consciousness and embarrassment. Qualitative analysis showed patients were concerned with aesthetic disability, treatment cost and potential tooth loss but overcame their negative outlook and accepted prescribed protective measures. Dentists appreciated patients' concerns about aesthetics and functional disruptions but were less attuned to patients' sense of guilt and fear of judgement.Conclusions: TDI exert functional, psychological and social impacts on patients. Patients' and dentists' perspectives were useful for understanding the need for continuity of care, and the findings could contribute to effective TDI management. [ABSTRACT FROM AUTHOR]

We examined 261 5-, 7-, and 10-year-olds' (147 in Hong Kong, 114 in the USA) evaluations of hypothetical scenarios where mothers sought to control personal domain events by prohibiting, persuading, or shaming the child. The scenarios also varied in their description of personal events as either essential or peripheral to the self. Compliance was endorsed least (and emotions attributed to actors were most positive) when mothers gently persuaded and endorsed most (with emotion attributions most negative) when mothers prohibited personal choices. Evaluations of compliance and associated emotions for shaming fell in-between. When mothers were described as gently persuading, young children (and Chinese children) gave priority to personal choices more when acts were described as essential rather than peripheral to the self, based on personal reasons. When mothers were described as shaming, noncompliance increased with age, along with pragmatic justifications for choices, particularly when events were essentialized. Positive emotions in response to shaming also increased with age, but differentially for Chinese and American children. [ABSTRACT FROM AUTHOR]

Moyamoya disease is a unique chronic cerebrovascular condition caused by progressive stenosis of the arteries around the circle of Willis with prominent arterial collateral circulation. Noonan-like syndrome with loose anagen hair (NSLH) is characterized by short stature, characteristic facial phenotype, darkly pigmented and hairless skin, mild psychomotor delay with attention deficit disorder, and easily pluckable, sparse, thin, slow growing hair. Mutations in SHOC2 have been reported to underlie NSLH. In this paper, we describe two individuals with NSLH who also have moyamoya disease and in whom heterozygous germline mutation in SHOC2 was found. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

A total of 267 five-, seven-, and ten-year-olds ( M = 7.62), 147 in Hong Kong and 120 in the United States, evaluated hypothetical personal (and moral) events described as either essential or peripheral to actors' identity. Except for young Chinese in the peripheral condition, straightforward personal events were overwhelmingly evaluated as acceptable based on personal justifications. Children primarily endorsed compliance, but attributed negative emotions to actors when mothers forbade personal choices, especially when described as essential to identity. Conventional justifications declined among Chinese children and pragmatic justifications for these judgments increased with age for all children, as did judgments that personal events were up to the child. Rules were seen as more legitimate and events were seen as more up to mothers to decide for moral than personal events. [ABSTRACT FROM AUTHOR]

In the last decade or so, the question of scale has been epitomised by the intense urbanisation of Southeast Asia with its burgeoning high-rises. Wong Mun Summ, Richard Hassell and Alina Yeo of WOHA describe four projects that ameliorate high-density living through design strategies that simultaneously harness innovative technological solutions and traditional knowledge to introduce comfort and green space into the living environment. [ABSTRACT FROM AUTHOR]

The enzyme choline kinase (CK), which catalyzes the phosphorylation of choline to phosphorylcholine in the presence of ATP, has an essential role in the biosynthesis of phosphatidylcholine, the major constituent of all mammalian cell membranes. CK is encoded by two separate genes expressing the three isoforms CKα1, CKα2 and CKβ that are active as homodimeric or heterodimeric species. Metabolic changes observed in various cancer cell lines and tumors have been associated with differential and marked up-regulation of the CKα genes, and specific inhibition of CKα activity has been proposed as a potential anti-cancer strategy. As a result, less attention has been given to CKβ and its interaction with CKα. With the aim of profiling the intracellular roles of CKα and CKβ, we used RNA interference (RNAi) as a molecular approach to down-regulate the expression of CK in HeLa cells. Individual and simultaneous RNAi-based silencing of the CK α and β isoforms was achieved using different combinations of knockdown strategies. Efficient knockdown was confirmed by immunodetection using our isoform-specific antibodies and by quantitative real-time PCR. Our analyses of the phenotypic consequences of CK depletion showed the expected lethal effect of CKα knockdown. However, CKβ- and CKα + CKβ-silenced cells had no aberrant phenotype. Therefore, our results support the hypothesis that the balance of the α and β isoforms is critical for cancer cell survival. The suppression of the cancer cell killing effect of CKα silencing by simultaneous knockdown of both isoforms implies that a more effective CK-based anti-cancer strategy can be achieved by reducing cross-reactivity with CKβ. [ABSTRACT FROM AUTHOR]

We report a 57-year-old woman with a 20-year history of hepatitis B presenting with progressive proximal lower limb weakness for the previous 1 month. Previous medical history included a pericardial and pleural effusion, of which no cause was found and pulmonary tuberculosis which has been adequately treated. Examination revealed multiple telangiactasia over face and nail beds and bilateral proximal lower limb weakness of power 4/5. Biochemical investigation revealed a raised erythrocyte sedimentation rate of 36 mm/h, elevated creatinine kinase levels (14 363 IU/L) and raised liver enzymes (alanine aminotransferase 445 IU/L, aspartate aminotransferase 606 IU/L) with high hepatitis B virus DNA (1 021 158 copies/mL). Nerve conduction tests and muscle biopsy were consistent with polymyositis. She received entacavir for hepatitis B treatment. Despite treatment with entacavir for 10 weeks, her weakness persisted and prednisolone was added. Upon commencement of prednisolone, her symptoms and biochemical profiles returned to normal. [ABSTRACT FROM AUTHOR]

Objective: The aim of this pilot study was to assess the oral health knowledge among staff working in a local nursing home managed by a voluntary welfare organisation. Method: A self-administered questionnaire was completed by 53 nursing staff working in a home with 270 residents. The questionnaire was structured to assess the staff's knowledge of dental caries, periodontal disease and the care and use of dentures. Results: 99.6% of the respondents felt that oral health care of the elderly was very important. However, only 45.3% of them attributed the cause of dental caries to the frequent intake of sugar. Bacteria in dental plaque was identified by 88.7% of them as the main cause of periodontal disease while 96.2% of them indicated that dentures should be cleaned at least once a day and rinsed after every meal. Conclusion: The staff of this nursing home demonstrated positive knowledge of periodontal disease and denture care. However, their knowledge of dental caries revealed substantial room for improvement. This could signal an area for future staff training and development. Such efforts would help establish a team of caregivers who can improve the oral health and quality of life for residents in the nursing home. [ABSTRACT FROM AUTHOR]

Several diagrams are presented which explains the bond functionalization of catalyzed carbon and hydrogen of azaarenes for the facile access to oxindoles and the iron-catalyzed alkylation and alkenylation of indole.