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 Table of Contents  
ORIGINAL RESEARCH
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 610-616

Effect of video-recorded manikin simulation on radiographic technique performance of dental and dental hygiene students: A cross sectional study


1 Department of Dental Hygiene, University of Mississippi Medical Center School of Dentistry, Jackson, MS, USA
2 Division of Oral and Maxillofacial Radiology, Department of Care planning and Restorative Sciences, University of Mississippi Medical Center School of Dentistry, Jackson, MS, USA
3 Department of Biomedical Materials Science, University of Mississippi Medical Center School of Dentistry, Jackson, MS, USA

Date of Submission04-Aug-2021
Date of Decision29-Sep-2021
Date of Acceptance11-Oct-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
Dr. Rohan Jagtap
Division of Oral and Maxillofacial Radiology, Department of Care planning and Restorative Sciences, Department of Radiology, School of Medicine, University of Mississippi Medical Center, 2500 N State ST, D214-04, Jackson, MS.
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JIOH.JIOH_202_21

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  Abstract 

Aim: The purpose of this study was to assess the beliefs, confidence, and perceptions of dental and dental hygiene students before and after watching a video demonstrating the photo-stimulable phosphor (PSP) plate technique. Material and Methods: Overall, 40 second-year dental students and 20 first-year dental hygiene students currently enrolled in a radiology didactic course were invited via an institutional email to complete an anonymous, 18-question survey using *survey software* software, view PSP plates training video via *online platform*, and complete a post-video survey assessing the same questions as the pre-video survey. The 10-min video outlined the process for exposing a full-mouth series using PSP plates, including assembly, placement, troubleshooting, and technique. The surveys assessed the students’ beliefs, confidence, and perceptions of PSP plates using either a 5-point Likert scale or 10-point rating scale questions. Results: Of the 60 potential participants, 68% (n = 41) completed both surveys. Of the 18 questions, 4 Likert-type questions and one rating question showed statistically significant differences between pre-video and post-video survey responses. Four of the five questions revealed statistically significant differences with P-values of < 0.001. The four statistically significant results were regarding student confidence. The fifth question that showed a statistically significant difference between pre-video and post-video survey responses dealt with student preparation. Conclusion: The study revealed several items of note, including a statistically significant increase in student confidence with the radiographic technique when exposed to a procedure video. The results also showed statistically significant increases in students’ perceptions of the steps required to expose radiographs with the PSP plates after watching the technique video.

Keywords: Blended Learning, Dental Education, Dental Hygiene Education, Digital Radiography, Video Simulation


How to cite this article:
Brent B, Jagtap R, Griggs J, Carr E. Effect of video-recorded manikin simulation on radiographic technique performance of dental and dental hygiene students: A cross sectional study. J Int Oral Health 2021;13:610-6

How to cite this URL:
Brent B, Jagtap R, Griggs J, Carr E. Effect of video-recorded manikin simulation on radiographic technique performance of dental and dental hygiene students: A cross sectional study. J Int Oral Health [serial online] 2021 [cited 2022 Jan 26];13:610-6. Available from: https://www.jioh.org/text.asp?2021/13/6/610/331603


  Introduction Top


In 2017, Generation Z students replaced Millennials on college campuses across the United States. According to a study, Generation Z students consider college education crucial for a successful career. In addition, Generation Z students consider learning practical skills to be a vital component of a college education.[1] Educational experiences for Generation Z students rely heavily on digital technology. This group of students is now entering dental and dental hygiene programs. As dental radiography techniques continue to advance, the educational methods that dental and dental hygiene faculty utilize must also adapt. Technology may positively affect student performance and offer adjunctive educational methods that may increase confidence in radiographic skills before exposing radiographs on live patients.[2] Evidence from scientific literature attests that the implementation of video demonstrations enriched the educational experiences in various medical disciplines such as nursing,[3],[4],[5],[6] medical laboratory science,[7] medicine,[8],[9],[10] and veterinary medicine.[11]

Video instruction and demonstrations have been utilized in dental and dental hygiene education. One researcher reported that 100% of students perceived that watching process videos on skills helped students feel more confident in dental procedures before a clinical session ensued.[12] An additional study revealed that 94% of dental students responded favorably to using adjunctive video-based teaching tools for crown-preparation teaching in a uniform, step-by-step manner while providing feedback to students after each step.[13] A two-year study that focused on dental hygiene students’ perception of using instructional videos to assist in acquiring psychomotor skills demonstrated an 84% the first year and 79% the second year in the endorsement of the instructional videos.[14] Another study that focused on dental hygiene students who had not begun clinical practice revealed that learning dental procedures on a smartphone helped develop the students’ understanding of four-handed dental techniques.[15]

Working with ionizing radiation can potentially cause detrimental effects on human tissues; therefore, dental and dental hygiene students must learn the correct technique when exposing radiographs to avoid having to take retakes.[16],[17] Through didactic and clinical training, dental and dental hygiene students must become highly competent in dental radiography. Educators must provide thorough instructions when teaching the paralleling radiographic technique using photo-stimulable phosphor (PSP) plates.[17]

Evidence from the scientific literature supports the utilization of videos along with didactic learning and clinical training to assist in training students to become highly proficient dental radiographers. The purpose of this study was to assess the beliefs, confidence, and perceptions of dental and dental hygiene students before and after watching a video demonstrating the correct radiographic technique using PSP plates. The study’s null hypothesis was that there would be no difference between survey results after students watch a video demonstrating the PSP plate technique. The research questions were: (1) Is a video demonstration beneficial to students; (2) Would a video demonstration affect the struggles that students experience with the radiographic technique; and (3) How did a demonstration video affect the students’ perceptions of the radiographic technique with PSP plates?


  Materials and Methods Top


The University of Mississippi Medical Center’s (UMMC) Institutional Review Board (#2020V0340) approved this repeated-measures experimental study. The approach for this study involved identifying video demonstrations’ influence on participants’ beliefs, confidence, and perceptions of PSP plate radiography processes. The study was conducted at the UMMC School of Dentistry during the period from November 28, 2020 to March 20, 2021.

Inclusion criteria for subjects were: (1) second-year dental and first-year dental hygiene students, (2) students enrolled in the oral radiology course, (3) students who watched the radiology technique video, and (4) students who completed pre- and post-video survey questions.

Exclusion criteria for this study were: (1) dental and dental hygiene students not enrolled in the oral radiology course, (2) students who did not view the radiology technique video, (3) students with incomplete responses to pre- and post-video survey questions, and (4) students with any previous exposure to oral radiographic techniques.

According to Leedy and Ormond, in an observational study, “a particular aspect of behavior is observed systematically and with as much objectivity as possible.”[18] This study’s systematic observation was conducted by having the participants answer identical survey questions before and after viewing the video demonstration. Although this study’s survey was not validated before implementation, previous studies reported surveys assessing student perceptions,[13],[14],[19],[20] which the authors utilized as a guide to create the structure and question types. The authors created multiple questions assessing three main topics: confidence in radiographic procedures and techniques, beliefs of radiographic procedures and techniques, and survey respondents’ understanding of radiographic procedures and beliefs. Validation of the survey results occurred through statistical testing. No bias was noted in our study, and no dropping out of the study was noted.

Video demonstration

The Department of Oral and Maxillofacial Radiology faculty and staff at the UMMC recorded a 10-min video outlining the process for exposing a full-mouth series using PSP plates as the receptor. In the video, faculty and staff demonstrated how to assemble the PSP plates and the Precision Radiograph Instruments. The faculty member also demonstrated the correct paralleling radiographic technique, and bite-wing technique using a bite-wing tab. Placement demonstration also included maxillary and mandibular posterior and anterior periapical images. Finally, faculty and staff discussed troubleshooting techniques and how to use the computer system.

Participants/survey

Dental and dental hygiene students currently enrolled in a radiology didactic course at the institution, which included 40 second-year dental students (D2s) and 20 first-year dental hygiene students (DH3s), and they were invited via an institutional email containing a link to the Qualtrics survey to participate in the study. They were informed that participation in the survey was voluntary and were required to provide their consent if they would like to participate. Informed consent was acquired when the participants chose “I agree to participate,” which also provided access to the 18-question survey. Once in the Qualtrics software, the first statement was a paragraph describing confidentiality, anonymity, and the study’s purpose. No demographic information was collected to protect the confidentiality of participants. After completing the survey, the students were asked to view the PSP plates training video, which was uploaded in *name of platform*, the institution’s online learning platform. Immediately after viewing the video, the students were asked to complete a post-video survey assessing the same questions as the pre-video survey. Informed consent was obtained for the post-video survey in the same way as with the pre-video survey.

Research measurement methodology, statistical tests, and levels of significance

The pre-video and post-video surveys assessed students’ beliefs, confidence, and perceptions of PSP plates [Table 1]. The dependent variables were the students’ perceptions, which were measured on a 5-point Likert-scale or a 10-point rating scale, depending on the question type. The study was a repeated-measures design, where the same participants took part in each condition of the independent variable. In this case, the independent variables were the pre- and post-survey questions, which were identical. The authors described the dependent variables by using the median as a measure of central tendency and interquartile range as a measure of spread.
Table 1: Pre- and post-survey questions

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Statistical analysis

Mann–Whitney rank sum test, Shapiro–Wilk normality test, and Yates continuity correction option were applied to each question’s results [Table 2]. In addition, the authors used a nonparametric test (Wilcoxon signed-rank) to determine whether the opinions were different before and after instruction. The authors also used the Wilcoxon signed-rank test to determine whether the Likert-scale responses were different before and after instruction. The available sample size of 60 students was sufficient for 99.7% power to detect an effect size of 0.498 (at α = 0.05) in the case of 5-point scale questions. It was sufficient for 98.8% power to detect an effect size of 0.442 (at α = 0.05) in the case of 10-point scale questions.
Table 2: Results from statistical analysis

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  Results Top


Of the 60 potential participants, 68% (n = 41) completed both surveys. Of the 18 questions, five showed differences between pre-video and post-video survey responses [Table 2]. Four of the five questions revealed statistically significant differences, with P-values of < 0.001 indicating that the difference in the median values between the two groups was greater than would be expected by chance. Of the statistically significant results, three were Likert-type questions and one was a rating-scale question.

Four statistically significant results were regarding students’ confidence. Question 1 of the survey inquired about the students’ confidence in their radiographic technique with the PSP plates [Table 1]. In the pre-video survey, 26.83% (n = 11) of the students strongly agree/agree that they were confident in their radiographic technique with PSP plates. In addition, the results indicated that 36.58% (n = 15) strongly disagree/agree. After viewing the video, the post-video survey indicated that 73.17% (n = 30) of the students strongly agree/agree and 4.88% (n = 2) strongly disagree/agree that they were confident in their radiographic technique with PSP plates [Table 3].
Table 3: Percentage results of the Likert questions with interquartile range

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Question 2 of the survey inquired about the students’ confidence in completing the required steps needed when exposing radiographs with PSP plates [Table 1]. In the pre-video survey, 34.15% (n = 14) of the students strongly agree/agree that they were confident in completing the required steps needed when exposing radiographs with PSP plates. In addition, the results indicated that 31.71% (n = 13) strongly disagree/agree. After viewing the video, the post-video survey indicated that 90.25% (n = 37) of the students strongly agree/agree and 0% (n = 0) strongly disagree/agree that they were confident in completing the required steps needed when exposing radiographs with PSP plates [Table 3].

Question 10 of the survey inquired about the students’ confidence in using PSP in comparison with sensors [Table 1]. In the pre-video survey, 19.51% (n = 8) of the students strongly agree/agree that they were confident in using PSP in comparison with sensors. In addition, the results indicated that 24.39% (n = 10) strongly disagree/agree. After viewing the video, the post-video survey indicated that 41.46% (n = 17) of the students strongly agree/agree and 17.08% (n = 7) strongly disagree/agree that they were confident in using PSP in comparison with sensors [Table 3].

The 10-point rating scale question with statistically significant results requested students to rate their level of confidence in exposing radiographs with PSP plates [Table 1]. According to the pre-video survey results, 4.39 was the mean confidence level among the students in exposing radiographs with PSP plates. After viewing the video, the mean confidence level increased to 7.2 according to post-video survey results. Also, the results of the pre-video and post-video surveys indicated an increase in the median score of the confidence level among the students after viewing the video [Table 4].
Table 4: Mean and median results of the 10-point rating-scale questions

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Question 4 was the fifth question that showed a difference between pre-video and post-video survey responses. The question referenced the students’ preparation in exposing radiographs with PSP plates [Tables 1] and [2]. In the pre-video survey, 31.71% (n = 13) of the students strongly agree/agree that they were prepared to expose radiographs with PSP plates. In addition, the results indicated that 29.27% (n = 12) strongly disagree/agree. After viewing the video, the post-video survey indicated that 87.70% (n = 36) of the students strongly agree/agree and 0% (n = 0) strongly disagree/agree that they were prepared to expose radiographs with PSP plates [Table 3].

Four of the 10-point rating scale questions could not be tested without a larger sample size or repeated measures. The difference in the median values between the two groups was not great enough to exclude the possibility that the difference was due to random sampling variability; therefore, there was not a statistically significant difference [Table 4].


  Discussion Top


The ever-changing trend in technology has led to the Generation Z students expecting technology to be implemented into their education.[1] The implementation of videos into dental and dental hygiene education may provide a valuable teaching tool for the faculty as well as the students.

Scientific literature supports the implementation of video instruction and demonstration to increase students’ confidence level before attempting a procedure.[12],[13],[14],[21],[22] Implementing instructional videos into courses also decreased students’ stress levels.[14],[21] Botelho reported that videos reinforced students’ procedural and clinical knowledge, and visualization of the procedures through video aided the students in learning procedures.[12] Dental educators reported that students’ perceptions of guided video-based root canal training were positive, and students noted that the video demonstration helped bridge the gap between preclinical and clinical practice. Students noted problems with learning clinical procedures during a didactic lecture with the expectation to apply knowledge in a skills lab without visualization of the procedure. Students reported that video-based training assisted the students by providing a visualization of clinical procedures that required placing instruments or equipment in the mouth such as required during a radiographic procedure.[21]

A two-year study conducted by Lockwood et al. that focused on dental hygiene students’ perception of using instructional videos to assist in acquiring psychomotor skills noted positive impacts of instructional videos on students’ confidence levels. Students had acquired foundational and cognitive knowledge; however, they had not acquired the psychomotor skills. Results revealed that 84% of first-year students endorsed instructional videos, and 79% of second-year students endorsed instructional video usage.[14] In a study conducted by Kenny et al., it was determined that the implementation of video clips as an additional teaching aid benefited dental students with learning behavior management techniques when administering local anesthesia to children.[22]

At the time of the current study, students were enrolled in a didactic radiology course; therefore, they had not attempted any radiographic technique. The video study provided a visualization of a proper radiographic technique using PSP plates. Results from the survey indicated an increase in students’ levels of confidence in exposing radiographs as well as their radiographic technique with the PSP plates after viewing the instruction and demonstration video.

Literature supports the implementation of video instruction and demonstration as an adjunctive teaching tool to prepare students for lab procedures, with one study reporting 94% of dental students responding favorably to the use of adjunctive video-based, step-by-step instruction for crown-preparation instruction that provided feedback to students after each step. Students expressed an interest in videos being available for all Simulation labs clinical procedures. The study revealed that implementing adjunctive video-based teaching tools produced effectiveness and efficiency in the training of clinical hand skills.[13]

This study’s video prepared students to expose radiographs with PSP plates by demonstrating each required step. The steps included assembling the PSP plates and the Precision Radiograph Instruments and the correct placement of the assembled PSP plate and the Precision Radiograph Instrument. The survey results indicated that the video enabled the students’ preparation for exposing radiographs using the PSP plates.

Even with insignificant correlation, students are positively affected by enhanced educational methods. Howerton et al. evaluated dental students enrolled in an introductory radiology course who had watched a computer-aided instruction module on the radiographic technique before exposing a full-mouth series and compared end-product grades with students who had not participated in virtual training. The researchers found no statistically significant difference between the two groups of students.[19]

In addition, Nikzad et al. found a moderate, insignificant correlation between exposure to media before a prosthodontic clinical experience and a decrease in students’ stress and self-esteem. The implementation of the media improved the students’ clinical performance; however, the students still preferred live demonstrations.[20] Dental hygiene educators reported that scores did not have statistical significance in performance, even though there was a slight increase in scores after the implementation of a video-recorded clinical session on the exploring technique.[23]

This study revealed statistically significant differences with P-values of < 0.001 in four of the five questions, which indicated that the difference in the median values between the two groups was greater than would be expected by chance. The study has demonstrated that the implementation of video instruction and demonstration in the education of dental and dental hygiene students is beneficial to students.

In terms of the limitations of the study, the study had a selection bias. Some students may have had previous experience with exposing radiographs prior to dental or dental hygiene school. Previous experience could have included exposing radiographs with film, PSP plates, or sensors. Another limitation of the study was that four of the 10-point rating scale questions could not be tested due to the sample size and the lack of repeated measures. The difference in median values between the two groups was not great enough to exclude the possibility that the difference was due to random sampling variability.


  Conclusion Top


The authors recognize the importance of shifting educational methodology to accommodate the changes in today’s technology as well as the needs of the current generation’s students. The study’s aim to evaluate students’ beliefs, confidence, and perceptions of video-based demonstration of radiographic techniques proved to reveal several items of note. Students’ responses indicated an increase in their confidence in their radiographic technique as well as the steps required to expose radiographs with PSP plates after watching the technique video. With the implementation of technology in the educational methods, video demonstration within the dental and dental hygiene education is important and the topic warrants further research.

Acknowledgments

The authors would like to thank the staff of the Division of Oral and Maxillofacial Radiology, Biomaterial Sciences, and Academic Affairs, and the Dental and Dental Hygiene students who watched the videos and completed the surveys.

Financial support and sponsorship

None of the authors reported any disclosures. No funding or grants were procured for the purposes of this study.

Conflicts of interest

There are no conflicts of interest.

Authors’ contribution

B. Brent designed the study, collected and organized data, analyzed and interpreted data, and wrote the initial and final draft of the article. R. Jagtap designed the study, conducted research, provided research materials, collected and organized data, and wrote the final draft of the article. J. Griggs interpreted data and performed a statistical analysis. E. Carr designed the study, collected and organized data, and wrote the initial and final draft of the article. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.

Ethical policy and Institutional Review board statement

University of Mississippi Medical Center Institutional Review Board has approved our study (IRB #2020V0340). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Patient declaration of consent

Additional informed consent was obtained from dental and dental hygiene students for whom identifying information is included in this article.

Data availability statement

Not applicable.

 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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