Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study.

OBJECTIVE: To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. METHODS: Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. RESULTS: Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3-1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. CONCLUSIONS: Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians' threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection. The proportion affected by pre-eclampsia amongst participants was not higher than would be expected, although we report a higher than expected proportion affected by eclampsia. There appears to be no effect on birthweight or congenital malformations in women affected by SARS-CoV-2 infection in pregnancy and neonatal infection is uncommon. This study reflects a population with a range of infection severity for SARS-COV-2 in pregnancy, generalisable to whole obstetric populations.

Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries.

OBJECTIVE: Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the American Academy of Pediatrics (AAP) Section on Neonatal-Perinatal Medicine (SONPM) National Perinatal COVID-19 Registry. METHODS: This was an analysis of data from the PAN-COVID registry (1 January to 25 July 2020), which includes pregnancies with suspected or confirmed maternal SARS-CoV-2 infection at any stage in pregnancy, and the AAP-SONPM National Perinatal COVID-19 registry (4 April to 8 August 2020), which includes pregnancies with positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN-COVID results are presented overall for pregnancies with suspected or confirmed SARS-CoV-2 infection and separately in those with confirmed infection. RESULTS: We report on 4005 pregnant women with suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2399 from AAP-SONPM). For obstetric outcomes, in PAN-COVID overall and in those with confirmed infection in PAN-COVID and AAP-SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was preterm (< 37 weeks' gestation) in 12.0% of all women in PAN-COVID, in 16.1% of those women with confirmed infection in PAN-COVID and in 15.7% of women in AAP-SONPM. Extreme preterm delivery (< 27 weeks' gestation) occurred in 0.5% of cases in PAN-COVID and 0.3% in AAP-SONPM. Neonatal SARS-CoV-2 infection was reported in 0.9% of all deliveries in PAN-COVID overall, in 2.0% in those with confirmed infection in PAN-COVID and in 1.8% in AAP-SONPM; the proportions of neonates tested were 9.5%, 20.7% and 87.2%, respectively. The rates of a small-for-gestational-age (SGA) neonate were 8.2% in PAN-COVID overall, 9.7% in those with confirmed infection and 9.6% in AAP-SONPM. Mean gestational-age-adjusted birth-weight Z-scores were -0.03 in PAN-COVID and -0.18 in AAP-SONPM. CONCLUSIONS: The findings from the UK and USA registries of pregnancies with SARS-CoV-2 infection were remarkably concordant. Preterm delivery affected a higher proportion of women than expected based on historical and contemporaneous national data. The proportions of pregnancies affected by stillbirth, a SGA infant or early neonatal death were comparable to those in historical and contemporaneous UK and USA data. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. The data presented support strong guidance for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of pregnant women and women planning pregnancy. Copyright © 2021 ISUOG. Published by John Wiley & Sons Ltd.

Does the gender of the subject affect perceived smile aesthetics when varying the dimensions of maxillary lateral incisors?

Objective: To assess whether subject gender influences aesthetic opinion when altering the width of maxillary lateral incisors. Method: Photographs of a male and a female smile, displaying only the lips and teeth, were digitally altered to produce images where the maxillary lateral incisor was proportioned 52%, 57%, 62%, 67%, 72% and 77% in relation to the width of the maxillary central incisor. The image was then made symmetrical. One hundred participants (50 male and 50 female) were asked to rank each set of photographs from 'most' to 'least attractive'. Result: The 57% lateral incisor was considered the 'most attractive' with the 77% lateral incisor the 'least attractive' however no statistically significant difference existed with relation to subject or rater gender. Conclusion: Neither the 'golden proportion' nor the 'Recurrent Aesthetic Dental' ('RED') proportion was deemed the most attractive. As subject gender did not have a significant effect, dentists should work to create aesthetic results on an individual basis, operating within a so-called 'golden range'.

Measuring oral health impact among care home residents in Wales.

OBJECTIVE: To explore inequalities in oral health impact among care home residents using OHIP-14 and ADHS criteria. BASIC RESEARCH DESIGN: Cross-sectional survey with structured interview and clinical examination using 2009 ADHS criteria including OHIP-14. Comparisons were made between groups of residents and with findings from the ADHS 2009. PARTICIPANTS: Care homes and residents were randomly selected. Those without capacity and non-English/Welsh speakers were excluded. 447 residents answered all OHIP-14 questions and had full oral examination. MAIN OUTCOME MEASURE: OHIP-14. RESULTS: Reporting of OHIP problems was more common among care home residents compared with older people examined in the ADHS 2009 (50% vs 40%). There was no difference in the mean number of impacts between residents who were: dentate/edentate; denture wearing/non-denture wearing; with/without caries. Residents reporting 'problems and pain in your mouth at the moment', or 'occasional or more frequent dry mouth', more often experienced OHIP-14 impacts. CONCLUSION: Compared with peers living in the community, both dentate and edentate care home residents are more likely to live with one or more impacts. Two simple questions related to 'Any problems and pain in your mouth?' and 'Do you have frequent dry mouth?' may help to target care home residents more likely to experience oral health impacts.

Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness.

Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (D4-6MFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV ( n = 73, 17.5%) versus FS ( n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222).

Exercise testing and training in people with Huntington's disease.

OBJECTIVE: To explore exercise response in people with Huntington's disease (HD). DESIGN: Experimental observational study with a randomly allocated subgroup before/after interventional study. SETTING: Community. SUBJECTS: People with HD (n=30) and a healthy comparator group (n=20). Thirteen people from the HD group were randomly allocated to an exercise training program. MAIN MEASURES: Heart rate (HR) and perceived exertion on the Borg-CR10 scale (RPE) during a submaximal cycle ergometer exercise test (three minute unloaded and nine minute 65%-75%HRmaximum phase). Expired air and lactate measures were available for 8 people with HD during the exercise. INTERVENTION: A 12 week gym and home walking exercise programme (n=13). RESULTS: People with HD achieved a lower work rate at nine minutes (82±42(0-195) v 107±35(50 -185) Watts (p<0.05)), but higher RPE at both three (3±2(0-7) v 1±1(0-4)) and nine minutes (7±3(1-10) v 5± 2(2-9)) both p<0.01, compared to the healthy group and did not achieve a steady state HR during unloaded cycling. People with HD also demonstrated higher than expected lactate at three 2.5±2.5(1.1-8)mmo.L-1 and nine 3.8±1.9(1.2-6.6)mmo.L-1 minutes and respiratory exchange ratio at three 0.78±0.03 (0.74-0.81) and nine minutes 0.94±0.11(0.81-1.15). After exercise training there were no changes observed in HR or RPE responses during the exercise test. CONCLUSIONS: There was a large variability in the observed metabolic and physiological responses to exercise in people with HD. The observed exercise responses suggest that altered exercise prescription parameters may be required for people with HD and that exercise response and factors' affecting this requires further investigation.

Preparing for practice - calibration of dental undergraduate students in the Index of Orthodontic Treatment Need.

OBJECTIVES: The aim of this study was to establish the success in calibrating dental students in the use of the Index of Orthodontic Treatment Need (IOTN). DESIGN: Single-centre, evaluation of teaching study. SETTING: University department, UK, 2013. SUBJECTS AND METHOD: Third-year dental students were divided into four groups and received IOTN instruction via clinical and non-clinical teaching over a three-month period. This was followed by a calibration exercise where the whole year assessed 30 study models for orthodontic treatment need using the dental health component (DHC) and modified aesthetic component (AC) of the IOTN. MAIN OUTCOME MEASURES: Student IOTN scores were compared to a gold standard using kappa statistics (κ). RESULTS: Results showed that although substantial agreement was achieved in both the DHC (κ = 0.65) and a modified AC (unweighted κ = 0.63), the year only calibrated successfully in the DHC. CONCLUSION: Third year dental students taught at Cardiff University applied the DHC of IOTN better than the AC.

A comparison of computer- and hand-generated clinical dental notes with statutory regulations in record keeping.

INTRODUCTION: Dental patient records should be of high quality, contain information to allow for good continuity of care and clinical defence (should the need ever arise) and, ideally, facilitate clinical audit. Handwritten dental records have been assessed for their compliance to statutory regulations, but the same cannot be levelled at computer-generated notes. This study aimed to compare and analyse the compliance of both methods of data recording with statutory regulations. METHOD: Fifty consecutive sets of handwritten notes and 50 sets of computer-generated notes were audited for compliance with a number of legal requirements and desirable characteristics for dental records and the results compared. The standard set for compliance with all characteristics was 100%. RESULTS: The computer-generated notes satisfied the set standard for 8 of the 11 legal requirements and three of six desirable characteristics. The handwritten notes satisfied the set standard for 1 of 11 legal requirements and none of the desirable characteristics. A statistical difference (using a 95% confidence interval) between the two methods was observed in 5 of 11 legal characteristics and three of six desirable characteristics, all of which were in favour of computer-generated notes. CONCLUSIONS: Within the limitations of this study, computer-generated notes achieved a much higher compliance rate with the set parameters, making defence in cases of litigation, continuity of care and clinical audit easier and more efficient.

Development and evaluation by a cluster randomised trial of a psychosocial intervention in children and teenagers experiencing diabetes: the DEPICTED study.

OBJECTIVE: To develop and evaluate a health-care communication training programme to help diabetes health-care professionals (HCPs) counsel their patients more skilfully, particularly in relation to behaviour change. DESIGN: The HCP training was assessed using a pragmatic, cluster randomised controlled trial. The primary and secondary analyses were intention-to-treat comparisons of outcomes using multilevel modelling to allow for cluster (service) and individual effects, and involved two-level linear models. SETTING: Twenty-six UK paediatric diabetes services. PARTICIPANTS: The training was delivered to HCPs (doctors, nurses, dietitians and psychologists) working in paediatric diabetes services and the effectiveness of this training was measured in 693 children aged 4-15 years and families after 1 year (95.3% follow-up). INTERVENTIONS: A blended learning programme was informed by a systematic review of the literature, telephone and questionnaire surveys of professional practice, focus groups with children and parents, experimental consultations and three developmental workshops involving a stakeholder group. The programme focused on agenda-setting, flexible styles of communication (particularly guiding) and a menu of strategies using web-based training and practical workshops. MAIN OUTCOME MEASURES: The primary trial outcome was a change in glycosylated haemoglobin (HbA1c) levels between the start and finish of a 12-month study period. Secondary trial outcomes included change in quality of life, other clinical [including body mass index (BMI)] and psychosocial measures (assessed at participant level as listed above) and cost (assessed at service level). In addition, patient details (HbA1c levels, height, weight, BMI, insulin regimen), health service contacts and patient-borne costs were recorded at each clinic visit, along with details of who patients consulted with, for how long, and whether or not patients consulted on their own at each visit. Patients and carers were also asked to complete an interim questionnaire assessing patient enablement (or feelings towards clinic visit for younger patients aged 7-10 years) at their first clinic visit following the start of the trial. The cost of the intervention included the cost of training intervention teams. RESULTS: Trained staff showed better skills than control subjects in agenda-setting and consultation strategies, which waned from 4 to 12 months. There was no effect on HbA1c levels (p = 0.5). Patients in intervention clinics experienced a loss of confidence in their ability to manage diabetes, whereas controls showed surprisingly reduced barriers (p = 0.03) and improved adherence (p = 0.05). Patients in intervention clinics reported short-term increased ability (p = 0.04) to cope with diabetes. Parents in the intervention arm experienced greater excitement (p = 0.03) about clinic visits and improved continuity of care (p = 0.01) without the adverse effects seen in their offspring. The mean cost of training was £13,145 per site or £2163 per trainee. There was no significant difference in total NHS costs (including training) between groups (p = 0.1). CONCLUSIONS: Diabetes HCPs can be trained to improve consultation skills, but these skills need reinforcing. Over 1 year, no benefits were seen in children, unlike parents, who may be better placed to support their offspring. Further modification of this training is required to improve outcomes that may need to be measured over a longer time to see effects. TRIAL REGISTRATION: Current Controlled Trials ISRCTN61568050. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 15, No. 29. See the HTA programme website for further project information.

In vitro interaction of chronic wound bacteria in biofilms.

OBJECTIVE: To use in vitro biofilm models of wound bacterial isolates and compare the biofilms produced for different combinations of wound bacterial species. METHOD: In vitro biofilms, generated by Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus oralis and Micrococcus luteus in microtitre plates and a constant depth film fermentor (CDFF), were studied. The tested isolates all originated from chronic venous leg ulcers. Biofilms of individual and dual combinations of these species were generated in microtitre plate wells at 37°C for 24-96 hours and also in the CDFF for 7 days. The extent of biofilm formation from these systems was then measured using crystal violet staining and/or total viable counts. RESULTS: All the chronic wound bacteria formed biofilms (both individually and in mixed culture) in these models. In mixed species microtitre plate biofilms, both P. aeruginosa and S. aureus appeared to antagonise biofilm formation by S. oralis and M. luteus, with P. aeruginosa completely inhibiting the growth of these organisms. Similar effects were evident in the CDFF model, when all four bacterial species were added simultaneously, with M. luteus being 'out-competed' by the other organisms present and occurring at numbers at the limits of detection; however, there was an apparent increase in the numbers of S. oralis compared with its single culture equivalent. CONCLUSION: The study highlighted differences in biofilm formation ability for the tested species in both closed and open model systems. Using dual species biofilms, distinct species antagonism was observed with apparent antagonism of pathogenic species over 'commensal' ones. Such a finding provides insight into possible bacterial interactions during development of 'non-healing' wound biofilms.

A competing risk survival analysis model to assess the efficacy of filling carious primary teeth.

In recent years a strategy of selective, symptom-based intervention of carious primary teeth has been developed amongst some British general dental practitioners. Practice-based studies appear to provide evidence that policies of restoration of symptomless carious primary teeth do not confer any significant benefits above those associated with non-restorative care. However, results from these studies contrast with those of many clinical trials and prospective studies of primary molar restorations. In the current investigation, cohort study data from 5,168 carious primary molar teeth from 2,654 British children aged 4-5 years at baseline, augmented with Dental Practice Board treatment data, was utilised to assess the effect of restorative treatment on the likelihood of carious teeth subsequently progressing to either exfoliation or extraction. The effect of demographic and tooth level covariates on the fate of these teeth was also assessed. Multivariate multilevel parametric survival models were applied to the analysis of the carious-exfoliation and carious-extraction transitions to which the teeth were subject, assuming an underlying data hierarchy with teeth nested within individuals. Time of occurrence of caries affected survival experience, with teeth in which caries occurred later in life being associated with higher survival rates to extraction. Amongst filled teeth, later fillings were also associated with higher survival rates to extraction. Demographic and tooth level variables had a limited effect on survival experience. Treatment was found to be significantly associated with survival with respect to extraction, with survival rates of over 80% at 14 years, double those of untreated teeth.

Modelling childhood caries using parametric competing risks survival analysis methods for clustered data.

Caries in primary teeth is an ongoing issue in children's dental health. Its quantification is affected by clustering of data within children and the concurrent risk of exfoliation of primary teeth. This analysis of caries data of 103,776 primary molar tooth surfaces from a cohort study of 2,654 British children aged 4-5 years at baseline applied multilevel competing risks survival analysis methodology to identify factors significantly associated with caries occurrence in primary tooth surfaces in the presence of the concurrent risk of exfoliation, and assessed the effect of exfoliation on caries development. Multivariate multilevel parametric survival models were applied at surface level to the analysis of the sound-carious and sound-exfoliation transitions to which primary tooth surfaces are subject. Socio-economic class, fluoridation status and surface type were found to be the strongest predictors of primary caries, with the highest rates of occurrence and lowest median survival times associated with occlusal surfaces of children from poor socio-economic class living in non-fluoridated areas. The concurrent risk of exfoliation was shown to reduce the distinction in survival experience between different types of surfaces, and between surfaces of teeth from children of different socio-economic class or fluoridation status. Clustering of data had little effect on inferences of parameter significance.

Reproducibility of facial soft tissue landmarks on 3D laser-scanned facial images.

BACKGROUND: The three-dimensional (3D) measuring technology is useful to inspect facial shape in three planes of space (X, Y, and Z). Recent work has been directed to analyse craniofacial morphology using facial soft tissue landmarks to identify facial differences among population. The reproducibility of facial landmarks is almost necessary to ensure accurate 3D facial measurements. OBJECTIVE: The aim of this study is to assess the reproducibility of facial soft tissue landmarks using laser-scan 3D imaging technology. SUBJECTS AND METHODS: Facial landmarks were assessed for 30 15(1/2)-year-old British-Caucasian children (15 males and 15 females). The sample was recruited from the Avon Longitudinal Study of Parents and Children (ALSPAC). The 3D facial images were acquired for each subject using two high-resolution Konica/Minolta laser scanners. Twenty-one facial landmarks (63 X, Y, and Z coordinates) were identified and recorded on each 3D facial image by two examiners. The reproducibility of landmarks identification at 2-week interval was assessed for one of the examiners (intra-examiner). In addition, the reproducibility of landmarks was assessed between the two examiners (inter-examiner). Using Bland-Altman plots, both intra- and inter-examiner assessments had evaluated landmarks reproducibility in three dimensions for the sample divided by gender. The reproducibility of the 3D-coordinates for each landmark was considered under three categories (< 0.5 mm, < 1 mm, and >1 mm) for both intra- and inter-examiner reproducibility assessments. RESULTS: The distribution of coordinates at the three levels of reproducibility show the following percentages: intra-examiner: < 0.5 mm (38%), < 1 mm (51%), >1 mm (11%); inter-examiner: < 0.5 mm (35%), < 1 mm (48%), >1 mm (17%). Generally, 10 landmarks were reproducible to less than 1 mm for both intra- and inter-examiner reproducibility assessments. The Labiale Superius was the most reproducible and Palebrale Superius was the least reproducible landmark. Some landmarks showed greater reliability in certain planes of space; the Glabella was more reliable in the Z than the Y axis. Gender differences were found; Subnasale was more reproducible in the Y-axis in males compared with females. CONCLUSIONS: The reproducibility of facial landmarks should be considered in the three planes of space. The majority of X-Y-Z coordinates taken to the 21 facial landmarks were reproducible to < 1 mm which is clinically acceptable. The accuracy of landmarks identification ranged from 0.39 to 1.49 mm. The reliability in identification depends on the clarity and definition of each landmark as well as gender characteristics. The different landmarks reproducibility should be considered when evaluating changes related to growth and healthcare interventions.

Effects of soft-water acclimation on the physiology, swimming performance, and cardiac parameters of the rainbow trout, Oncorhynchus mykiss.

Rainbow trout acclimated to soft water were submitted to an incremental velocity trial, and exhibited a 14% decrease in critical swimming speed (U(crit) * 1.37 +/- 0.055 vs. 1.54 +/- 0.044 m s(-1)) compared to fish kept in hard water. After a standardized swimming protocol, soft-water-acclimated fish had higher blood lactate concentrations (6.5 +/- 0.66 and 6.0 +/- 0.64 mmol L(-1) (soft water) vs. 5.0 +/- 0.46 and 3.9 +/- 0.32 mmol L(-1) (hard water)), revealing a greater use of anaerobic metabolism for the same exercise. Cardiovascular parameters were investigated while fish were swimming at increasing water velocities, revealing that soft-water-acclimated fish had lower increases in heart rate (105% vs. 118% of pre-exercise values), due to higher heart rates observed during acclimation and during the first 10 min of the swimming trial. This was also reflected by the plateau in heart rate and stroke volume observed during the swimming protocol, which can be attributed to increased cardiovascular function in response to soft-water acclimation. These results are in accord with previously reported increases in blood-to-water diffusion distance, due to proliferation of chloride cells at the gills in response to soft-water conditions, and underscore the costs and limitations of soft-water acclimation.

Three-dimensional motion analysis - an exploratory study. Part 2: reproducibility of facial movement.

OBJECTIVES: To investigate the reproducibility of using spoken word as a measure of facial movement. DESIGN: Experimental study. SETTING AND SAMPLE POPULATION: Department of Dental Health and Biological Sciences, University Dental Hospital, Cardiff. 22 normal subjects. EXPERIMENTAL VARIABLE: Subjects were asked to say the word 'puppy' in a normal, relaxed manner twice within a 10-second time interval. The sequence was recorded using a non-invasive, three-dimensional motion analysis image capture system (3DMDface Dynamic System) at 48 frames per second. OUTCOME VARIABLE: Corresponding frames between the two utterances were aligned three-dimensionally using best fit on non-moveable points on the upper half of the face. Reproducibility was measured as the percentage point deviation between +/- 0.5 mm between two corresponding frames. RESULTS: Mean intrasessional reproducibility (SD) for the group was recorded at 86.2% (5.8). The reproducibility ranged from a minimum of 66.8% to a maximum of 97.5%. When the utterance was split into its two separate viseme segments (/p//u//p/ and /p//y/), the second part of the utterance was seen to be more reproducible than the first. The male group were more reproducible than the female group. CONCLUSION: Intrasessional reproducibility of the utterance 'puppy' shows high intra- and intersubject variability in this group of normal subjects and therefore further research needs to be conducted before being able to confidently use this word as a reproducible measure of facial movement.

Three-dimensional motion analysis - an exploratory study. Part 1: assessment of facial movement.

OBJECTIVES: To objectively quantify facial movement in response to facial expression and spoken word. DESIGN: Experimental study. Setting - Department of Dental Health and Biological Sciences, University Dental Hospital, Cardiff, UK. EXPERIMENTAL VARIABLE: Facial movement was assessed in response to a standardized smile expression and the utterance 'puppy'. The sequences were recorded using a non-invasive, three-dimensional motion analysis image capture system (3dMDface Dynamic System) at 48 frames per second. OUTCOME VARIABLE: To quantify the facial movement, sequential frames of a sequence were aligned to the baseline/reference frame three-dimensionally using best fit on non-moveable points in the upper half of the face. Accuracy of the alignment process for each sequence was tested using the percentage of stable points (i.e. within +/-0.5 mm) within the upper half of the face. RESULTS: Quantifiable changes in facial topology were seen during both the standardized smile expression and the utterance 'puppy'. The mean percentage of points (SD) that remained stable within the upper half of the face during the utterance 'puppy' was 88.8% (4.7). During the standardized smile expression, there were a much lower percentage of stable points in the upper half of the face with a mean (SD) of 60.9% (3.2). CONCLUSION: The 3dMDface Dynamic System allows objective, three-dimensional, non-invasive assessment of facial movement. The utterance 'puppy' is a more appropriate measure of facial movement when compared with the standardized smile expression.

A three-dimensional look for facial differences between males and females in a British-Caucasian sample aged 151/2 years old.

BACKGROUND: Optical surface scanning accurately records the three-dimension (3D) shape of the face non-invasively. Many software programs have been developed to process and analyze the 3D data, enabling the clinicians to create average templates for groups of subjects to provide a comparison of facial shape. OBJECTIVE: Differences in facial morphology of males and females were identified using a laser scan imaging technology. SUBJECTS AND METHODS: This study was undertaken on 380 British-Caucasian children aged 15 and a half year old, recruited from the Avon Longitudinal Study of Parents and Children (ALSPAC). 3D facial images were obtained for each individual using two high resolution Konica/Minolta laser scanners. The scan quality was assessed and any unsuitable scans were excluded from the study. Average facial templates were created for males and females, and a registration technique was used to superimpose the facial shells of males and females so that facial differences can be quantified. RESULTS: Thirty unsuitable scans were excluded from the study. The final sample consisted of 350 subjects (166 females, 184 males). Females tend to have more prominent eyes and cheeks in relation to males with a maximum difference of 2.4 mm. Males tend to have more prominent noses and mouths with a maximum difference of 2.7 mm. About 31% of the facial shells match exactly (no difference), mainly in the forehead and chin regions of the face. CONCLUSIONS: Differences in facial morphology can be accurately quantified and visualized using 3D imaging technology. This method of facial assessment can be recommended and applied for future research studies to assess facial soft tissue changes because of growth or healthcare intervention.

Do teenage magazines give a genuine view of tooth colour?

OBJECTIVES: To compare the colour of incisors depicted in teenage magazines with a sample of Welsh teenagers. MATERIALS AND METHODS: A representative one month sample of magazines aimed at 9- to 16-year-old girls was obtained from a retail outlet. All images containing photographs of anterior teeth were identified and the colour of the incisor teeth measured using two commercial shade guides. An additional category of 'whiter than shade guide' was introduced. Images were viewed under standardised conditions by the same examiner; 10% were repeated. Clinical measurements under standard conditions were taken, by the same examiner, of 9- to 16-year-old children presenting to the department over a one month period, using the same shade guides; 47% of readings were repeated. Data were entered into SPSS and comparison of proportions used to compare the two groups. RESULTS: Nineteen magazines containing 268 images and 53 patients were used. Intra-examiner agreement with the two shade guides was 80% or 92% for patients and 93% or 96% for images. 0/53 (0%) clinical compared with 202/268 (75.4%) photographs were found to be whiter than the shade guide. CONCLUSIONS: Teenage magazines do not give an accurate representation of the colour of teenager's teeth. The impact of this on children's self esteem is unknown.

A randomised controlled trial to determine the effectiveness of glass ionomer sealants in pre-school children.

BACKGROUND: Caries levels in pre-school children remain high in some areas of the UK. Studies of glass ionomer fissure sealants show their potential for caries prevention in permanent teeth, but their use in primary teeth has not been reported. AIM: To determine whether a glass ionomer fissure sealant placed on primary molars in pre-school children at high risk of developing dental caries can decrease the incidence of dental caries. MATERIAL: 508 children aged 18-30 months from high caries areas of South Wales with caries-free first primary molars were recruited to the trial after informed consent. METHODS: This was a placebo-controlled individual randomised controlled trial (RCT). All children (n = 508) received a standard package of dental health education. Children in the test group (n = 241) had their first primary molars sealed with glass ionomer. All the children were re-examined once at varying intervals between 12 and 30 months. RESULTS: Analysis of the caries data revealed no significant difference between test and control groups for any of the parameters examined. Examination of the confidence intervals showed no indication that there might be a difference even if the sample size had been increased. CONCLUSION: There is no evidence that the intervention as used in this population had any effect on caries incidence and it cannot be recommended as a clinical procedure.

Relationship between beta-cell responsiveness and fasting plasma glucose in Caucasian subjects with newly presenting type 2 diabetes.

AIMS: beta-cell responsiveness was related to fasting plasma glucose to gain further understanding of pathophysiology of Type 2 diabetes. METHODS: An insulin secretion model gave fasting beta-cell responsiveness M0 (ability of fasting glucose to stimulate beta-cell) and postprandial beta-cell responsiveness MI (ability of postprandial glucose to stimulate beta-cell) by analysing glucose and C-peptide time-concentration curves sampled every 10-30 min over 240 min during a meal tolerance test (MTT; 75 g CHO, 500 kcal). Caucasian subjects with newly presenting Type 2 diabetes according to WHO criteria (N = 83, male/female: 65 : 18, age: 54 +/- 10 years, body mass index (BMI): 30.9 +/- 5.2 kg/m2, fasting plasma glucose (FPG): 11.0 +/- 3.2 mmol/L; mean +/- SD) and Caucasian healthy subjects (N = 54, m/f: 21 : 33, age: 48 +/- 9 years, BMI: 26.1 +/- 3.7 kg/m2, FPG: 5.1 +/- 0.4 mmol/L) were studied. RESULTS: A continuum inverse relationship between MI and FPG was observed. In the diabetes group, MI was closely related to FPG (rs = -0.74, P < 0.0001) and explained 60% intersubject FPG variability with the use of an exponential regression model. CONCLUSIONS: In newly presenting Type 2 diabetes in Caucasian subjects a close inverse association exists between postprandial beta-cell responsiveness and FPG.