The predictability of the mandibular curve of Wilson, buccolingual crown inclination, and transverse expansion expression with Invisalign treatment.

INTRODUCTION: This study aimed to provide an initial investigation into the mandibular curve of Wilson (COW) handling using the Invisalign appliance (Align Technology, Santa Clara, Calif). Individual buccolingual crown inclinations and transverse expansions were also investigated to detect any regions of ineffectiveness in the dental arch. METHODS: A retrospective sample of patients treated by an experienced Invisalign provider in private practice was used. All adult patients with Class I or II Angle malocclusions and mild to moderate crowding treated using a minimum of 14 Invisalign aligners without intermaxillary elastics, bite ramps, or auxiliaries and a nonextraction mandibular arch from 2013-2019 were selected. Dental models at the initial scan, the ClinCheck prediction, and the outcome after the initial series of aligners were analyzed with Geomagic Control X software (version 2017.0.3; 3D systems, Rock Hill, SC). The COW, buccolingual crown inclination relative to the occlusal plane and cusp tip expansion were compared between ClinCheck changes and achieved changes. RESULTS: Forty-two subjects met the selection criteria. 74% of subjects experienced a flatter COW than ClinCheck predictions, and the mean difference was 0.76 mm (P = 0.0149). The first molars encountered 0.52 mm (P <0.001) more buccal crown inclination than ClinCheck predictions. No other teeth experienced statistically significant buccolingual inclination differences to ClinCheck. The second molars were the only teeth to experience significantly more arch expansion than ClinCheck at 0.68 mm (P = 0.0046). CONCLUSIONS: The Invisalign appliance tended to over-flatten the mandibular COW compared with ClinCheck because of the lack of buccal root torque in the mandibular first molars during expansion. The mandibular second molars were the only teeth to experience more expansion than ClinCheck.

The predictability of the mandibular curve of Spee leveling with the Invisalign appliance.

INTRODUCTION: The purpose of this study is to provide an initial investigation into the predictability and characteristics of the mandibular curve of Spee (COS) leveling using the Invisalign appliance (Align Technology, Santa Clara, Calif) and any regions of ineffectiveness in the dental arch. METHODS: This study used a retrospective sample of patients treated by a single experienced Invisalign provider in private practice. All adult patients with Class I or II Angle malocclusions treated using a minimum of 14 Invisalign aligners without intermaxillary elastics, bite ramps, or auxiliaries and a nonextraction mandibular arch from 2013 to 2019 in the practice were selected. Dental models at the initial scan, the ClinCheck prediction, and the actual outcome were analyzed with Geomagic Control X software (version 2017.0.3; 3D systems, Rock Hill, SC). The COS and extrusion of posterior teeth relative to the occlusal plane were measured and compared. RESULTS: Forty-two subjects met the selection criteria. ClinCheck predicted 0.55 mm (P < 0.0001) more COS leveling than the actual outcome. The mean COS leveling accuracy using Invisalign was 35%, and ClinCheck overestimated the leveling in 86% of the patients. The first molars had the lowest accuracy and extrusion relative to the occlusal plane. CONCLUSIONS: To achieve desired clinical treatment goals, there should be a prescribed overcorrection of the mandibular COS leveling within the ClinCheck treatment plan, and the extrusion of mandibular first molars should be a region of focus. The clinician should consider using auxiliary appliances to improve mandibular COS leveling.

How Is Quality of mHealth Interventions for Cancer Survivors Defined and Described? An Umbrella Review.

PURPOSE: Although there are commonly accepted criteria of what defines quality of health care including cancer care, less is known about what defines quality of mHealth interventions in health care. The aim of this review was to identify how quality of mHealth interventions for cancer survivors is described and measured. METHODS: CINAHL, EmCare, JBI, Medline, SCOPUS, and ProQuest databases from January 2008 to January 2020 were searched. Review papers with search terms related to mobile devices, quality, and cancer relevant to adults with cancer were included. Interventions needed to consist of mHealth technologies, such as mobile applications or short message service, or wearable devices. Title and abstract screening, full-text screening, and data extraction were performed independently by two reviewers. Conflicts were resolved by a third reviewer. Reviews were evaluated for coverage of quality according to six metrics defined by the Institute of Medicine: patient-centeredness, equitability, safety, effectiveness, timeliness, and efficiency. Any additional quality items were recorded. A Measurement Tool to Assess systematic Reviews (AMSTAR) was used to rate the quality of the reviews included. RESULTS: The initial search yielded 766 papers with seven systematic reviews meeting the eligibility criteria. Four papers were of AMSTAR moderate quality, with three of low quality. The median number of quality metrics reported in a review was two (the range was 1-4). Efficacy and safety and timeliness and efficiency were most reported (n = 4), followed by usability (n = 3), equitability and access (n = 2), privacy and security (n = 2), and patient-centeredness (n = 2). CONCLUSION: There is great variability in how quality of mHealth interventions is defined with no reviews addressing all quality metrics. A comprehensive approach to measure quality of mHealth interventions is needed.

Vigilance regarding immune thrombocytopenic purpura after COVID-19 vaccine.

INTRODUCTION: Based on the severity of thrombocytopenia, patients with immune thrombocytopenic purpura (ITP) are at an increased risk of mucocutaneous or major bleeding. DISCUSSION: There has been an increased risk of ITP after administration of various vaccines like influenza, measles-mumps-rubella, hepatitis B, and diphtheria-tetanus-pertussis. The pathogenesis of vaccine-related thrombocytopenia is not completely clear and is probably caused by molecular mimicry. Till date, there have been few reported cases of thrombocytopenia in the pharmacovigilance databases after patients received the Pfizer and Moderna coronavirus disease-19 (COVID-19) vaccines. CONCLUSION: Emergency physicians should be aware of the occurrence of vaccine-induced ITP in patients who present with bleeding manifestations, especially after the current boost in COVID-19 vaccination drive worldwide.

Sources of variability in the prospective relation of language to social, emotional, and behavior problem symptoms: Implications for developmental language disorder.

Children with developmental language disorder (DLD) are at risk for social, emotional, and behavioral (SEB) maladjustment throughout development, though it is unclear if poor language proficiency per se can account for this risk as associations between language and SEB appear more variable among typical-language children. This study investigated whether the relationship between language and SEB problems is stronger at very low levels of language and considered confounders including socioeconomic status, sex, and nonverbal intelligence. These were examined using a population-based survey design, including children with a wide range of language and cognitive profiles, and assessed using the Strengths and Difficulties Questionnaire and six standardized language measures (n = 363, weighted n = 6,451). Structural equation models adjusted for prior levels of SEB revealed that the relationship of language at age 5-6 years to SEB at 7-9 years was nonlinear. Language more strongly predicted all clusters of SEB at disordered language levels relative to typical language levels, with standardized betas of -.25 versus .03 for behavioral, -.31 versus -.04 for peer, and .27 versus .03 for prosocial problems. Wald tests between these pairs of betas yielded p values from .049 to .014. Sex moderated the nonlinear association between language and emotional symptoms. These findings indicate a clinical need to support language development in order to mitigate against problems of SEB and to carefully monitor the mental health needs of children with DLD, particularly in the context of multiple, and potentially sex-specific, risks. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Caregiving adversity during infancy and preschool cognitive function: adaptations to context?

From a conditional adaptation vantage point, early life caregiving adversity likely enhances aspects of cognition needed to manage interpersonal threats. Yet, research examining early life care and offspring cognition predominantly relies upon experiments including affectively neutral stimuli, with findings generally interpreted as "early-life caregiving adversity is, de facto, 'bad' for cognitive performance." Here, in a Southeast Asian sample, we examined observed maternal sensitivity in infancy and cognitive performance 3 years later as preschoolers took part in three tasks, each involving both a socioemotional (SE) and non-socioemotional (NSE) version: relational memory (n = 236), cognitive flexibility (n = 203), and inhibitory control (n = 255). Results indicate the relation between early life caregiving adversity and memory performance significantly differs (Wald test = 7.67, (1), P = 0.006) depending on the SE versus NSE context, with maternal sensitivity in infancy highly predictive of worse memory for SE stimuli, and amongst girls, also predictive of better memory when NSE stimuli are used. Results concerning inhibitory control, as well as cognitive flexibility in girls, also tentatively suggest the importance of considering the SE nature of stimuli when assessing relations between the caregiving environment and cognitive performance. As not all approaches to missing data yielded similar results, implications for statistical approaches are elaborated. We conclude by considering how an adaptation-to-context framework approach may aid in designing pedagogical strategies and well-being interventions that harness pre-existing cognitive strengths.

Early language competence, but not general cognitive ability, predicts children's recognition of emotion from facial and vocal cues.

The ability to accurately identify and label emotions in the self and others is crucial for successful social interactions and good mental health. In the current study we tested the longitudinal relationship between early language skills and recognition of facial and vocal emotion cues in a representative UK population cohort with diverse language and cognitive skills (N = 369), including a large sample of children that met criteria for Developmental Language Disorder (DLD, N = 97). Language skills, but not non-verbal cognitive ability, at age 5-6 predicted emotion recognition at age 10-12. Children that met the criteria for DLD showed a large deficit in recognition of facial and vocal emotion cues. The results highlight the importance of language in supporting identification of emotions from non-verbal cues. Impairments in emotion identification may be one mechanism by which language disorder in early childhood predisposes children to later adverse social and mental health outcomes.

Maternal antenatal anxiety and electrophysiological functioning amongst a sub-set of preschoolers participating in the GUSTO cohort.

BACKGROUND: Antenatal maternal anxiety is a risk for offspring psychological and cognitive difficulties. The preschool years represent an important time for brain development, and so may be a window for intervention. However, electrophysiological investigations of maternal anxiety and preschoolers' brain functioning are lacking. We ask whether anxiety symptoms predict neurophysiology, and consider timing specificity (26-weeks antenatal or 24-months postnatal), form of insult (anxiety symptoms, per se, or also depression symptoms), and offspring gender. METHODS: The sample consisted of a subset of 71 mothers and their 3 year old children taking part in the prospective birth cohort, GUSTO. Mothers provided antenatal (26 weeks) and postnatal (2 years) anxiety and depressive symptomatology data, respectively via the "State Trait Anxiety Questionnaire" and the "Edinburgh Postpartum Depression Scale." Offspring provided electrophysiological data, obtained while they indicated the emotional expression of actors whose facial expressions remained consistent throughout a pre-switch block, but were reversed at "post-switch." RESULTS: Three electrophysiological components linked to different information processing stages were identified. The two earliest occurring components (i.e., the N1 and P2) differed across blocks. During post-switch, both were significantly predicted by maternal anxiety, after controlling for pre-switch neurophysiology. Similar results were observed with depression. Antenatal mental health remained a significant predictor after controlling for postnatal mental health. CONCLUSION: In combination with past work, these findings suggest the importance of reducing symptoms in women prior to and during pregnancy, and offering support to offspring early in development.

Mitigation of a Prospective Association Between Early Language Delay at Toddlerhood and ADHD Among Bilingual Preschoolers: Evidence from the GUSTO Cohort.

There is accumulating evidence of a prospective relation between early language problems and ADHD, a disorder associated with deficits in executive functioning. However, little is known regarding this link among bilingual children. Here, we investigate whether (i) the prediction from language to ADHD may be lower among bilinguals, and (ii) explore if this moderation can be explained by differential executive functioning ability. Utilising a prospective sample of 408 South-East Asian toddlers, bilingual exposure as a moderator of the link between language delay at 24 months to ADHD intermediate diagnosis at 54 months was first examined with an interaction model. Next, structural equation mediated moderation models examined if the proposed moderation could be explained by executive function measures of Snack Delay and Dimensional Change Card Sort (DCCS) task, when children were 41 months. Results indicate that higher levels of bilingual exposure moderated the prospective risk of language delay to ADHD diagnosis (Predominantly single-language exposed OR = 6.37; p = .011; Predominantly dual-language exposed OR = 0.30, p = .156). Thus, language delay associated with ADHD among toddlers predominantly exposed to one but not two languages. However, this could not be explained by differential executive functioning, as this moderation was not mediated by performance on Snack Delay or DCCS. Unexpectedly, bilingual exposure associated with ADHD among toddlers of typical language development. Possible explanations, including variation in the degree of social stigma and persistence of language delay between bilingual and monolingual children, and bilingualism as an additional cognitive load for ADHD, are discussed.

Greater caregiving risk, better infant memory performance?

Poor early life care often relates to cognitive difficulties. However, newer work suggests that in early-life, adversity may associate with enhanced or accelerated neurodevelopment. We examine associations between postnatal caregiving risks (i.e., higher self-reported postnatal-anxiety and lower observed maternal sensitivity) and infant relational memory (i.e., via deferred imitation and relational binding). Using subsamples of 67-181 infants (aged 433-477 post-conceptual days, or roughly five to seven months since birth) taking part in the GUSTO study, we found such postnatal caregiving risk significantly predictive of "better" performance on a relational binding task following a brief delay, after Bonferroni adjustments. Subsequent analyses suggest that the association between memory and these risks may specifically be apparent among infants spending at least 50% of their waking hours in the presence of their mothers. Our findings echo neuroimaging research concerning similar risk exposure and larger infant hippocampal volume, and likewise underscore the importance of considering developmental context in understanding early life experience. With this in mind, these findings caution against the use of cognitive outcomes as indices of experienced risk.

Clear cell sarcomas of the kidney are characterised by BCOR gene abnormalities, including exon 15 internal tandem duplications and BCOR-CCNB3 gene fusion.

AIMS: Clear cell sarcoma of the kidney (CCSK) is a rare paediatric renal malignant tumour. The majority of CCSKs have internal tandem duplications (ITDs) of the BCOR gene, whereas a minority have the YWHAE-NUTM2 gene fusion. A third 'double-negative' (DN) category comprises CCSKs with neither BCOR ITDs nor YWHAE-NUTM2 fusion. The aim of this study was to characterise 11 histologically diagnosed CCSKs immunohistochemically (with CCND1, BCOR and CCNB3 stains) and genetically. METHODS AND RESULTS: By next-generation sequencing, 10 cases (90.9%) had BCOR exon 15 ITDs, with positive BCOR immunoreactivity being found in four (36%) or eight (72%) cases, depending on the antibody clone. By reverse transcription polymerase chain reaction, none had the YWHAE-NUTM2 fusion. The DN case had a BCOR-CCNB3 fusion and strong nuclear CCNB3 and BCOR immunoreactivity. Quantitative polymerase chain reaction showed markedly elevated BCOR expression in this case, whereas BCOR ITD cases had lower levels of elevated BCOR expression. CONCLUSIONS: The majority of the CCSKs in our cohort had BCOR ITDs, and none had the YWHAE-NUTM2 fusion. We verified the strong, diffuse cyclin D1 (CCND1) immunoreactivity in CCSKs described in recent reports. BCOR immunoreactivity was not consistently positive in all CCSKs with BCOR ITDs, and therefore cannot be used as a diagnostic immunohistochemical stain to identify BCOR ITD cases. The DN case was a BCOR-CCNB3 fusion sarcoma. BCOR-CCNB3 sarcoma is typically a primary bone sarcoma affecting male adolescents, and this is the first report of it presenting in a kidney of a young child as a CCSK. The full spectrum of DN CCSKs awaits more comprehensive characterisation.

Analysis of Item-Level Bias in the Bayley-III Language Subscales: The Validity and Utility of Standardized Language Assessment in a Multilingual Setting.

Purpose: The purpose of this study was to improve standardized language assessments among bilingual toddlers by investigating and removing the effects of bias due to unfamiliarity with cultural norms or a distributed language system. Method: The Expressive and Receptive Bayley-III language scales were adapted for use in a multilingual country (Singapore). Differential item functioning (DIF) was applied to data from 459 two-year-olds without atypical language development. This involved investigating if the probability of success on each item varied according to language exposure while holding latent language ability, gender, and socioeconomic status constant. Associations with language, behavioral, and emotional problems were also examined. Results: Five of 16 items showed DIF, 1 of which may be attributed to cultural bias and another to a distributed language system. The remaining 3 items favored toddlers with higher bilingual exposure. Removal of DIF items reduced associations between language scales and emotional and language problems, but improved the validity of the expressive scale from poor to good. Conclusions: Our findings indicate the importance of considering cultural and distributed language bias in standardized language assessments. We discuss possible mechanisms influencing performance on items favoring bilingual exposure, including the potential role of inhibitory processing.

Infant night sleep trajectory from age 3-24 months: evidence from the Singapore GUSTO study.

OBJECTIVE: Longitudinal studies on night sleep trajectories throughout infancy are sparse. Moreover, most studies have examined samples in Caucasian individuals, although cultural differences in sleep habits have been described. To expand on the current literature, we aimed to determine night sleep trajectories in an Asian population from age 3-24 months. METHODS: Night sleep duration from a subset of 893 infants within the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort study was determined using the caregiver-reported Brief Infant Sleep Questionnaire. Latent growth curves were used to analyze sleep trajectories at 3, 6, 9, 12, 18, and 24 months. RESULTS: The overall trajectory was modeled with a piecewise model with two freely estimated curves. In the first phase (age 3-12 months), infants displayed an average curvilinear increase in night sleep trajectories of 0.12 h per month. In the second phase (age 12-24 months), infants continued to display a curvilinear increase, but at a slower average rate of 0.02 h per month. CONCLUSIONS: The sleep trajectory of Singaporean infants appeared similar to other predominantly Caucasian cohorts for 3-12 months but not for 12-24 months, in which infants from predominantly Caucasian cohorts mostly displayed a decreasing or a stable-plateaued trajectory. This is in concordance with existing studies that suggest that the underlying influences of night sleep shift from predominantly biological influences to increasing environmental influences with age.