Due to the COVID-19 pandemic, eLearning became the lifeline of higher education. We explored university educators’ eLearning perspectives, practices, and future adoption intentions. In-depth interviews with 14 educators from a large university in Singapore were conducted. Educators had limited eLearning experience prior to COVID-19 emergency eLearning and expressed strong preferences for in-person sessions. The short notice to switch to eLearning and lack of eLearning experiences created stress and anxiety. Educators responded by making efforts that allowed for teaching to continue, conceding that some expectations had to be readjusted. Despite many obstacles, educators acknowledged reduced apprehension towards eLearning. Reflecting upon their experiences, educators highlighted opportunities and challenges of eLearning. A key opportunity was increased flexibility, which enabled students to learn independently. Additionally, eLearning triggered reflection upon educators teaching which could lead to improved practice. Reduction of some barriers to student–educator interaction were also mentioned. Key challenges include creating social, emotional, and cognitive engagement, catering to diverse student needs and providing holistic learning experiences. Considering opportunities and challenges, educators envisioned that eLearning would feature in their future teaching if practical and helpful for achieving educational goals. Hybrid or blended learning approaches were preferred, but support enabling the implementation of technology-based and pedagogy-informed teaching is necessary.

Background: The enterosalivary nitrate‐nitrite‐nitric oxide pathway is an alternative pathway of nitric oxide generation, potentially linking the oral microbiome to insulin resistance and blood pressure (BP). We hypothesized that increased abundance of nitrate‐reducing oral bacteria would be associated with lower levels of cardiometabolic risk cross‐sectionally. Methods and Results: ORIGINS (Oral Infections, Glucose Intolerance, and Insulin Resistance Study) enrolled 300 diabetes mellitus–free adults aged 20 to 55 years (mean=34±10 years) (78% women). Microbial DNA was extracted from subgingival dental plaque (n=281) and V3–V4 regions of the 16S rRNA gene were sequenced to measure the relative abundances of 20 a priori – selected taxa with nitrate‐reducing capacity. Standardized scores of each taxon's relative abundance were summed, producing a nitrate‐reducing taxa summary score ( NO ₃ TSS ) for each participant. Natural log‐transformed homeostatic model assessment of insulin resistance, plasma glucose, systolic BP, and diastolic BP were regressed on NO ₃ TSS in multivariable linear regressions; prediabetes mellitus and hypertension prevalence were regressed on NO ₃ TSS using modified Poisson regression models. Nitrate‐reducing bacterial species represented 20±16% of all measured taxa. After multivariable adjustment, a 1‐ SD increase in NO ₃ TSS , was associated with a −0.09 (95% CI , −0.15 to −0.03) and −1.03 mg/dL (95% CI , −1.903 to −0.16) lower natural log‐transformed homeostatic model assessment of insulin resistance and plasma glucose, respectively. NO ₃ TSS was associated with systolic BP only among patients without hypertension; 1‐ SD increase in NO ₃ TSS was associated with −1.53 (95% CI , −2.82 to −0.24) mm Hg lower mean systolic BP. No associations were observed with prediabetes mellitus and hypertension. Conclusions: A higher relative abundance of oral nitrate‐reducing bacteria was associated with lower insulin resistance and plasma glucose in the full cohort and with mean systolic BP in participants with normotension.

Background: The enterosalivary nitrate–nitrite–nitric oxide (NO ₃ –NO ₂ –NO) pathway generates NO following oral microbiota‐mediated production of salivary nitrite, potentially linking the oral microbiota to reduced cardiometabolic risk. Nitrite depletion by oral bacteria may also be important for determining the net nitrite available systemically. We examine if higher abundance of oral microbial genes favoring increased oral nitrite generation and decreased nitrite depletion is associated with a better cardiometabolic profile cross‐sectionally. Methods and Results: This study includes 764 adults (mean [SD] age 32 [9] years, 71% women) enrolled in ORIGINS (Oral Infections, Glucose Intolerance, and Insulin Resistance Study). Microbial DNA from subgingival dental plaques underwent 16S rRNA gene sequencing; PICRUSt2 was used to estimate functional gene profiles. To represent the different components and pathways of nitrogen metabolism in bacteria, predicted gene abundances were operationalized to create summary scores by (1) bacterial nitrogen metabolic pathway or (2) biochemical product (NO ₂ , NO, or ammonia [NH ₃ ]) formed by the action of the bacterial reductases encoded. Finally, nitrite generation‐to‐depletion ratios of gene abundances were created from the above summary scores. A composite cardiometabolic Z score was created from cardiometabolic risk variables, with higher scores associated with worse cardiometabolic health. We performed multivariable linear regression analysis with cardiometabolic Z score as the outcome and the gene abundance summary scores and ratios as predictor variables, adjusting for sex, age, race, and ethnicity in the simple adjusted model. A 1 SD higher NO versus NH ₃ summary ratio was inversely associated with a −0.10 (false discovery rate q =0.003) lower composite cardiometabolic Z score in simple adjusted models. Higher NH ₃ summary score (suggestive of nitrite depletion) was associated with higher cardiometabolic risk, with a 0.06 (false discovery rate q =0.04) higher composite cardiometabolic Z score. Conclusions: Increased net capacity for nitrite generation versus depletion by oral bacteria, assessed through a metagenome estimation approach, is associated with lower levels of cardiometabolic risk.

Objective: Alterations in the microbiome, including the periodontal microbiome, may be a risk factor for rheumatoid arthritis (RA). Most studies that have analyzed this association are relatively small, focus primarily on a single periodontal pathogen (Porphyromonas gingivalis), and are not population based. This study was undertaken to investigate the association between elevated serum levels of IgG antibodies to 19 periodontal species and the prevalence of rheumatoid factor (RF) in a large nationally representative sample of adults.Methods: The Third National Health and Nutrition Examination Survey (NHANES‐III) is a cross‐sectional sample of the noninstitutionalized US population (n = 33,994). Our study population included all dentate participants who were 60 years and older, did not have RA as defined by a modified version of the American College of Rheumatology 1987 criteria, and had complete data for both serum IgG antibodies against periodontal bacteria and serum RF antibody titer (n = 2,461).Results: Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) summarizing the relationship between the 19 periodontal serum IgG antibodies and RF seropositivity ranged from 0.53 (95% CI 0.29–0.97) to 1.27 (95% CI 0.79–2.06), and 17 of the 19 observed ORs were <1.0. The ORs for RF seropositivity among participants with elevated Prevotella intermedia (0.53 [95% CI 0.29–0.97]) and Capnocytophaga ochracea (0.54 [0.31–0.95]) IgG levels were statistically significant.Conclusion: Our findings indicate that elevated levels of IgG antibodies to periodontal bacteria are mostly unassociated with RF seropositivity in the nationally representative NHANES‐III. Elevated levels of antibodies to P intermedia and C ochracea are associated with lower odds of RF seropositivity.

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.

Recent studies have suggested that epigenetic alterations, particularly DNA methylation, play a crucial role in the pathogenesis of insulin resistance. Folate is a key source of the one-carbon group for DNA methylation, whereas the association and mechanistic linkage between folate status and insulin resistance remains unclear with very limited experimental support. We performed a cross-sectional study of 1530 nondiabetic adults in the 2011–2012 National Health and Nutrition Examination Survey (NHANES). We examined associations between serum folate and insulin resistance using multiple linear regression models adjusted for potential confounders. We detected a significant inverse relationship for serum folate, where a 25% increase in serum folate was associated with a 3.06% (95% CI, −4.72, −1.37) and 2.77% (95% CI, −4.36, −1.77) decline in HOMA-IR and insulin respectively, and a 2.55% (95% CI, 0.93, 4.21) increase in G/I ratio. Our findings demonstrate that serum folate was inversely associated with insulin resistance in U.S. nondiabetic adults.