Population studies consistently support associations between poor oral (periodontal) health and systemic diseases such as cardiovascular disease (CVD) and diabetes. The aim of this study was to assess the knowledge of dentists and document their opinions regarding the evidence on oral-systemic disease relationships. A survey consisting of 39 items was developed and mailed to 1,350 licensed dentists in North Carolina. After three mailings, 667 dentists (49%) meeting inclusion criteria responded. The respondents were predominantly male (76.3%), in solo practice (59.5%), and in non-rural settings (74%). More than 75% of these dentists correctly identiied risk factors like diet, genetics, smoking, obesity, and physical inactivity for CVD and diabetes. The majority rated the evidence linking periodontal disease with CVD and diabetes as strong (71% and 67%, respectively). These dentists were most comfortable inquiring about patients' tobacco habits (93%), treating patients with diabetes (89%) or CVD (84%) and concurrent periodontal disease, and discussing diabetes-periodontal disease risks with patients (88%). Fewer respondents were comfortable asking patients about alcohol consumption (54%) or providing alcohol counseling (49%). Most agreed that dentists should be trained to identify risk factors (96%) or actively manage systemically diseased patients (74%). Over 90% agreed that medical and dental professionals should be taught to practice more collaboratively. These data indicate that these dentists were knowledgeable about oral-systemic health associations, had mixed comfort levels translating the evidence into clinical practice, but expressed support for interprofessional education to improve their readiness to actively participate in their patients' overall health management.

The concept that multisensory observation and drawing can be effective for enhancing anatomy learning is supported by pedagogic research and theory, and theories of drawing. A haptico‐visual observation and drawing (HVOD) process has been previously introduced to support understanding of the three‐dimensional (3D) spatial form of anatomical structures. The HVOD process involves exploration of 3D anatomy with the combined use of touch and sight, and the simultaneous act of making graphite marks on paper which correspond to the anatomy under observation. Findings from a previous study suggest that HVOD can increase perceptual understanding of anatomy through memorization and recall of the 3D form of observed structures. Here, additional pedagogic and cognitive underpinnings are presented to further demonstrate how and why HVOD can be effective for anatomy learning. Delivery of a HVOD workshop is described as a detailed guide for instructors, and themes arising from a phenomenological study of educator experiences of the HVOD process are presented. Findings indicate that HVOD can provide an engaging approach for the spatial exploration of anatomy within a supportive social learning environment, but also requires modification for effective curricular integration. Consequently, based on the most effective research‐informed, theoretical, and logistical elements of art‐based approaches in anatomy learning, including the framework provided by the observe–reflect–draw–edit–repeat (ORDER) method, an optimized “ORDER Touch” observation and drawing process has been developed. This is with the aim of providing a widely accessible resource for supporting social learning and 3D spatial understanding of anatomy, in addition to improving specific anatomical knowledge.

Observational studies consistently support a relationship between poor oral health and systemic diseases like cardiovascular disease and diabetes mellitus. The purpose of this study was to identify current practices and perceived barriers among North Carolina dentists regarding the incorporation of oral-systemic evidence into the delivery of patient care. A survey questionnaire was developed, pilot tested, revised, and mailed to 1,350 licensed dentists in North Carolina. The response rate was 49 percent. Bivariate analysis was used to compare practice behaviors and barriers among age, gender, practice type, and setting categorizations using the chi-square test. Respondents were predominantly male (77 percent), in solo practice (59.4 percent), and in urban or suburban settings (74 percent). Half (50 percent) reported updating medical histories at every patient visit. Younger dentists were signiicantly (p<0.05) more likely to inquire about patient blood glucose levels and utilize blood pressure guidelines. Perceived patient objections to additional fees and lack of patient acceptance were reported as signiicant barriers, especially among younger dentists. Signiicantly more rural dentists reported lack of appropriate referral options as a barrier (p<0.05). In the multivariate analysis, gender and type of practice but not age were statistically signiicant predictors of respondents' perceptions of patients' objection to additional fees. Dental schools need to prepare dental students for future roles in the assessment, management, and interprofessional collaboration that will be needed in the future.

Although associations between periodontal and systemic health have been well established, there is little evidence regarding dental hygienists' knowledge of the oral-systemic connection. The purpose of this study was to determine the knowledge levels of North Carolina dental hygienists regarding oral-systemic connections and their attitudes and conidence about incorporating this knowledge into clinical practice. A survey was developed, pilot tested, revised, and mailed to 1,665 licensed dental hygienists in North Carolina. After three mailings, the response rate was 62 percent, with 52 percent (N=859) meeting the inclusion criteria. The majority (>80 percent) of the respondents correctly identiied risk factors for diabetes and cardiovascular disease (CVD), but were less knowledgeable about risk factors for osteoporosis and adverse pregnancy outcomes. Most knew that there is strong evidence linking periodontal disease with CVD (77 percent) and diabetes (70 percent). The majority felt that dental hygienists should be trained to identify risk factors for oral-systemic disease (94 percent) and to actively manage patients with systemic disease (78 percent). Eighty-eight percent felt that dental and medical professionals should be taught to practice collaboratively. These dental hygienists had a high level of knowledge in some areas of oral-systemic disease but could improve their conidence levels and knowledge through expanded content in their educational programs and continuing education. Interprofessional education and collaboration would also assist in integration of knowledge into clinical practice.

To enhance learning and maximise student satisfaction while simultaneously optimising costs and resources within the modern context and environment of integrated anatomy education, it is vital that innovative methods of delivering learning and teaching are considered for implementation into medical curricula. The development of learning processes including observation, visualisation, haptic reasoning and visuospatial ability are strongly associated with the use of artistic approaches. In addition to being crucial for medical student learning of anatomy and other life sciences, such skills are also relevant for training in surgery, clinical observation and diagnosis. The twelve tips outlined here have been identified with the intention of providing guidance for anatomy educators aiming to incorporate innovative creative and artistic approaches into their own teaching practice within medical curricula. These proposals are underpinned by educational theory and recent research that has investigated artistic learning methods in medical education. Recommendations are also based on our personal experiences from both the undergraduate student point of view as well as the academic educator perspective with respect to the usage of creative and artistic learning approaches in anatomy education at Newcastle University.Keywords: Anatomy, Artistic learning methods, Undergraduate medical education Tip 1: Take a scholarly approach When designing and introducing any teaching innovation, in order to provide the best possible educational experience for students, it is important to draw on many aspects of the learning process and environment. To provide a strong pedagogical basis for an artistic learning approach, it is important to identify both the educational theory and research evidence that underpin the practical method. Theories of learning can provide an effective starting point when designing an innovative artistic approach, particularly those that include scope for learning that begins with a basic outline and then gradually builds upon prior knowledge of anatomical structures in order to develop complexity (Ausubel, 2012;Kolb, 1984), a process that can correspond to the production of artwork. Theories of drawing and learning through art (Catterall, 2005;Perkins, 1994;Petherbridge, 2010) can also provide useful insights into the practical educational value of artistic methods. The pedagogical value of artistic methods are primarily related to the motor skills and cognitive processes that are engaged when using such approaches. Research evidence suggests that key elements of observation (Backhouse, Fitzpatrick, Hutchinson, Thandi, & Keenan, 2017;Chamberlain et al., 2014;Jasani & Saks, 2013;Lyon, Letschka, Ainsworth, & Haq, 2013;Moore, Lowe, Lawrence, & Borchers, 2011;Pellico, Friedlaender, & Fennie, 2009) reflection and repetition (Backhouse et al., 2017;Lyon et al., 2013), and visualisation (Pandey & Zimitat, 2007) should be incorporated and emphasised within any artistic learning approach. Haptic (Jones, Minogue, ...

Since its first identification in Scotland, over 1000 cases of unexplained pediatric hepatitis in children have been reported worldwide, including 278 cases in the UK 1 . Here we report investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator subjects, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in liver, blood, plasma or stool from 27/28 cases. We found low levels of Adenovirus (HAdV) and Human Herpesvirus 6B (HHV-6B), in 23/31 and 16/23 respectively of the cases tested. In contrast, AAV2 was infrequently detected at low titre in blood or liver from control children with HAdV, even when profoundly immunosuppressed.AAV2, HAdV and HHV-6 phylogeny excluded emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T-cells and B-lineage cells.Proteomic comparison of liver tissue from cases and healthy controls, identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins.HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and in severe cases HHV-6B, may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children.

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