Is self always prioritised? Attenuating the ownership self-reference effect in memory.

The current study demonstrates the abolishment of the Ownership Self Reference Effect (OSRE) when elaborate details of a distant other-referent are provided. In a 2 (High versus Low information) × 2 (Self versus Other) experimental design, we tested the capacity for the SRE to be modulated with social saliency. Using a well-established ownership paradigm (Collard et al., 2020; Cunningham et al., 2008; Sparks et al., 2016), when the other was made socially salient (i.e. details and characteristics about the other were provided to the participant prior to encoding), no SRE emerged, such that self-owned and other-owned items were recalled with comparable accuracy. In contrast, when the other was not salient (i.e., no details about them were provided), participants accurately recalled a higher proportion of self-owned items, demonstrating a typical SRE in source memory. The degree of self- or other- referencing was not related to measured variables of closeness, similarity or shared traits with the other. Although the SRE is an established and robust effect, the findings of the current study illustrate critical circumstances in which the self is no longer prioritised above the other. In line with our predictions, we suggest that the self has automatic attributed social salience (e.g. through ownership) and that enhancing social salience by elaborating details of the other, prioritisation can expand to encapsulate an other beyond the self and influence incidental memory.

Cretaceous origins of the vibrotactile bill-tip organ in birds.

Some probe-foraging birds locate their buried prey by detecting mechanical vibrations in the substrate using a specialized tactile bill-tip organ comprising mechanoreceptors embedded in densely clustered pits in the bone at the tip of their beak. This remarkable sensory modality is known as 'remote touch', and the associated bill-tip organ is found in probe-foraging taxa belonging to both the palaeognathous (in kiwi) and neognathous (in ibises and shorebirds) clades of modern birds. Intriguingly, a structurally similar bill-tip organ is also present in the beaks of extant, non-probing palaeognathous birds (e.g. emu and ostriches) that do not use remote touch. By comparison with our comprehensive sample representing all orders of extant modern birds (Neornithes), we provide evidence that the lithornithids (the most basal known palaeognathous birds which evolved in the Cretaceous period) had the ability to use remote touch. This finding suggests that the occurrence of the vestigial bony bill-tip organ in all modern non-probing palaeognathous birds represents a plesiomorphic condition. Furthermore, our results show that remote-touch probe foraging evolved very early among the Neornithes and it may even have predated the palaeognathous-neognathous divergence. We postulate that the tactile bony bill-tip organ in Neornithes may have originated from other snout tactile specializations of their non-avian theropod ancestors.

High temperatures are associated with substantial reductions in breeding success and offspring quality in an arid-zone bird.

During hot weather, terrestrial animals often seek shaded thermal refugia. However, this can result in missed foraging opportunities, loss of body condition and impaired parental care. We investigated whether such costs could compromise breeding success in a widespread southern African bird: the Southern Yellow-Billed Hornbill Tockus leucomelas. We predicted that hornbills might be especially vulnerable to temperature-dependant reductions in parents' foraging capacity due to extreme asymmetry in sex-specific roles during breeding: females are confined within the nest cavity for most of the nesting period and the burden of provisioning falls solely on the male during this time. We followed 50 hornbill nesting attempts in the Kalahari Desert between 2012 and 2015, collecting data on provisioning rates, adult and nestling body mass, fledging success and size of fledglings. Mean daily maximum air temperatures (Tmax) during nesting attempts ranged from 33.2 to 39.1 °C. The likelihood of successful fledging fell below 50% at mean Tmax > 35.1 °C; a threshold now regularly exceeded at our study site due to recent climate warming. Additionally, offspring fledging following the hottest nesting attempts were > 50% lighter than those fledging following the coolest. Sublethal costs of keeping cool including loss of body condition, production of poor-quality offspring and breeding failure are likely to become issues of serious conservation concern as climate change progresses; even for currently widespread species. Missed-opportunity costs associated with behavioral thermoregulation and direct sublethal costs of temperature exposure should not be overlooked as a potential threat to populations, especially in environments that are already hot.

The costs of keeping cool: behavioural trade-offs between foraging and thermoregulation are associated with significant mass losses in an arid-zone bird.

Avian responses to high environmental temperatures include retreating to cooler microsites and/or increasing rates of evaporative heat dissipation via panting, both of which may affect foraging success. We hypothesized that behavioural trade-offs constrain the maintenance of avian body condition in hot environments, and tested predictions arising from this hypothesis for male Southern Yellow-billed Hornbills (Tockus leucomelas) breeding in the Kalahari Desert. Operative temperatures experienced by the hornbills varied by up to 13 °C among four microsite categories used by foraging males. Lower prey capture rates while panting and reductions associated with the occupancy of off-ground microsites, resulted in sharp declines in foraging efficiency during hot weather. Consequently, male body mass (Mb) gain between sunrise and sunset decreased with increasing daily maximum air temperature (Tmax), from ~ 5% when Tmax < 25 °C to zero when Tmax = 38.4 °C. Overnight Mb loss averaged ~ 4.5% irrespective of Tmax, creating a situation where nett 24-h Mb loss approached 5% on extremely hot days. These findings support the notion that temperature is a major determinant of body condition for arid-zone birds. Moreover, the strong temperature dependence of foraging success and body condition among male hornbills provisioning nests raises the possibility that male behavioural trade-offs translate into equally strong effects of hot weather on female condition and nest success. Our results also reveal how rapid anthropogenic climate change is likely to substantially decrease the probability of arid-zone birds like hornbills being able to successfully provision nests while maintaining their own condition.

Qualitative study to identify issues affecting quality of life in adults with craniofacial anomalies.

Our objective was to identify key issues that affect the quality of life (QoL) of adult patients with craniofacial anomalies. This was a qualitative prospective study using in-depth, semi-structured interviews. Ten patients who fulfilled the inclusion criteria were recruited during their attendance at the Adult Craniofacial Clinic at the Eastman Dental Hospital, University College London Hospitals NHS Foundation Trust. Interviews ceased when no new themes arose. A framework method of analysis was used to identify themes that related to QoL. Opinions varied and, although some were positive, the eight main themes that emerged were mainly negative. One of the main themes was that of emotional issues. Within this theme, subthemes included teasing, bullying and abuse, as well as low mood, anxiety, depression, and self-harm. Participants experienced a range of feelings as a result of their craniofacial conditions and expressed the need for further support. Healthcare professionals involved in the treatment of these patients, should be aware of these issues and give advice about how to access further support.

Career satisfaction and work-life balance of specialist orthodontists within the UK/ROI.

Objectives To investigate factors affecting career satisfaction and work-life balance in specialist orthodontists in the UK/ROI.Design and setting Prospective questionnaire-based study.Subjects and methods The questionnaire was sent to specialist orthodontists who were members of the British Orthodontic Society.Results Orthodontists reported high levels of career satisfaction (median score 90/100). Career satisfaction was significantly higher in those who exhibited: i) satisfaction with working hours; ii) satisfaction with the level of control over their working day; iii) ability to manage unexpected home events; and iv) confidence in how readily they managed patient expectations. The work-life balance score was lower than the career satisfaction score but the median score was 75/100. Work-life balance scores were significantly affected by the same four factors, but additionally were higher in those who worked part-time.Conclusions Orthodontists in this study were highly satisfied with their career and the majority responded that they would choose orthodontics again. Work-life balance scores were lower than career satisfaction scores but still relatively high. It is important for the profession to consider ways of maintaining, or improving, career satisfaction and work-life balance; including maintaining flexibility of working hours and ensuring that all clinicians have ready access to appropriate training courses throughout their careers (for example, management of patient expectations).

Regulation of Heat Exchange across the Hornbill Beak: Functional Similarities with Toucans?

Beaks are increasingly recognised as important contributors to avian thermoregulation. Several studies supporting Allen's rule demonstrate how beak size is under strong selection related to latitude and/or air temperature (Ta). Moreover, active regulation of heat transfer from the beak has recently been demonstrated in a toucan (Ramphastos toco, Ramphastidae), with the large beak acting as an important contributor to heat dissipation. We hypothesised that hornbills (Bucerotidae) likewise use their large beaks for non-evaporative heat dissipation, and used thermal imaging to quantify heat exchange over a range of air temperatures in eighteen desert-living Southern Yellow-billed Hornbills (Tockus leucomelas). We found that hornbills dissipate heat via the beak at air temperatures between 30.7°C and 41.4°C. The difference between beak surface and environmental temperatures abruptly increased when air temperature was within ~10°C below body temperature, indicating active regulation of heat loss. Maximum observed heat loss via the beak was 19.9% of total non-evaporative heat loss across the body surface. Heat loss per unit surface area via the beak more than doubled at Ta > 30.7°C compared to Ta < 30.7°C and at its peak dissipated 25.1 W m(-2). Maximum heat flux rate across the beak of toucans under comparable convective conditions was calculated to be as high as 61.4 W m(-2). The threshold air temperature at which toucans vasodilated their beak was lower than that of the hornbills, and thus had a larger potential for heat loss at lower air temperatures. Respiratory cooling (panting) thresholds were also lower in toucans compared to hornbills. Both beak vasodilation and panting threshold temperatures are potentially explained by differences in acclimation to environmental conditions and in the efficiency of evaporative cooling under differing environmental conditions. We speculate that non-evaporative heat dissipation may be a particularly important mechanism for animals inhabiting humid regions, such as toucans, and less critical for animals residing in more arid conditions, such as Southern Yellow-billed Hornbills. Alternatively, differences in beak morphology and hardness enforced by different diets may affect the capacity of birds to use the beak for non-evaporative heat loss.

Social anxiety in orthognathic patients.

There is evidence that patients seeking orthognathic treatment may be motivated by social anxiety disorder (SAD). The aim of this study was to investigate SAD in orthognathic patients using the Brief Fear of Negative Evaluation Scale (BFNES) and to compare these findings with those of the general population. This was a cross-sectional, questionnaire study conducted in two parts. Firstly, a national survey was conducted to yield data for the BFNES from a large, random sample of the UK general population. Secondly, orthognathic patients completed the BFNES. The BFNES scores are reported in two formats: the original 12-item scale (O-BFNES) and a shorter eight-item version (S-BFNES). With regards to the national survey, 1196 individuals participated. The mean O-BFNES score was 29.72 (standard deviation (SD) 9.39) and S-BFNES score was 15.59 (SD 7.67). With regards to the orthognathic sample, 61 patients participated. The mean O-BFNES score was 39.56 (SD 10.35) and the mean S-BFNES score was 24.21 (SD 8.41). Orthognathic patients had significantly higher scores than the general UK population (P<0.001), and multiple linear regression revealed that age, gender, and patient status were all independent predictors of BFNES scores. From the results of this study, orthognathic patients experience significantly higher levels of social anxiety than the general population.

Orthognathic correction of dento-facial discrepancies.

Orthognathic treatment is a process which involves orthodontics and maxillofacial surgery and is used to treat those dento-facial discrepancies which are outside the scope of conventional orthodontic treatment, for example severe Class II or Class III problems, anterior open bites and facial asymmetries. Patients who present with these severe problems may encounter a wide range of different problems ranging from functional problems (for example, difficulties biting and chewing) to self-consciousness in a wide range of work and social situations. This paper discusses the possible indications for orthognathic treatment and looks at the risks and benefits of treatment. The treatment pathway is also described.

Great expectations: what do patients expect and how can expectations be managed?

Patients' expectations of their treatment are a key determinant in their satisfaction with treatment. Expectations may encompass not only notions of the outcome of treatment, but also the process of treatment. This article explores the processes by which expectations are formed, differences in expectations across patient groups, and the psychopathology of individuals with unrealistic expectations of treatment manifest in body dysmorphic disorder.

Comparison of the instructional efficacy of an internet-based temporomandibular joint (TMJ) tutorial with a traditional seminar.

There has been growing interest in the use of virtual learning environments (VLEs) by universities over the past decade to supplement traditional teaching methods. In this study a tutorial providing information about the temporomandibular joint (TMJ), temporomandibular disorders and teaching of a thorough TMJ examination was developed on a VLE platform to enable students to enhance their examination and diagnostic skills. The success of this VLE tutorial was compared with conventional teaching by a cross-over trial. Thirty students were initially randomly allocated to one of two groups; Group 1 completed the VLE tutorial and Group 2 attended the face-to-face seminar in the first instance. The groups then crossed over and had the other method of teaching provided. The findings from the cross-over trial and the students' feedback indicated that no differences were found between either teaching modes, and both are equally effective at delivering information to students. In addition, the order in which the students received the teaching did not make a difference, but giving the teaching twice reinforced their knowledge. There is a strong case to be made for introducing clinical lectures on a VLE platform, and this form of e-learning is, in general, well perceived by new generations of students.

Orthodontic referral behaviour of West Sussex dentists.

OBJECTIVES: 1) To examine the orthodontic referral behaviour of dentists and 2) to examine dentists' familiarity with the Index of Orthodontic Treatment Need (IOTN). DESIGN: Postal questionnaire survey. SETTING: West Sussex Primary Care Trust (PCT) from September to December 2006. SUBJECTS AND METHODS: Questionnaires were sent to all dentists listed on the West Sussex PCT database, except those assumed not to make orthodontic referrals (n = 325). RESULTS: Two hundred and twenty-nine questionnaires were returned, representing a 70% response rate. Fifty-two percent of dentists in West Sussex correctly identified which type of orthodontic provider to refer three different malocclusions using picture tests. Twenty percent of dentists made correct decisions on the timing of referral for three different malocclusions using picture tests. IOTN is not routinely used by 76% of West Sussex dentists when making an orthodontic referral. CONCLUSIONS: This study provides evidence that there is a need for postgraduate training or the development of referral guidelines to assist West Sussex dentists in making referrals for orthodontic treatment to the most appropriate provider at the most appropriate time. If dentists are to act as gatekeepers of orthodontic provision on the NHS there is a need to provide more support and education for them about the use of IOTN.

Implementation of the virtual learning environment into a UK orthodontic training programme: the postgraduate and lecturer perspective.

The virtual learning environment (VLE) was formally introduced into the orthodontic postgraduate teaching programme at the UCL Eastman Dental Institute in October 2006 with the main role to support the existing didactic teaching. The aim of this study was to establish the programme co-ordinator, lecturer and postgraduate perspective on the introduction of the VLE as an adjunct to other teaching methods. All participants were interviewed utilising open-ended questions to ascertain their response. The interviews were semi-structured and were continued until no new information was elicited. The interviews suggested that the programme co-ordinator, lecturers and the majority of the postgraduates were confident that the VLE could produce a better learning experience. The VLE has a number of advantages and disadvantages, however, there is great potential for the VLE to encourage a constructivist approach to teaching and learning. Moves have been made to align aspects, such as assessment, with the VLE and the rest of the curriculum.

Factors which influence working patterns of orthodontists in the United Kingdom.

OBJECTIVE: To describe factors which influence the current working patterns of orthodontists in the United Kingdom. DESIGN AND SETTING: A cross-sectional postal questionnaire to orthodontic specialists in the United Kingdom. SUBJECTS: All those on the specialist list in orthodontics held by the General Dental Council in 2006-2007. MATERIALS AND METHODS: The data gathered included demographic details (gender, ethnicity, age, professional status and number of children), calendar year of achieving professional qualifications and current working patterns, together with details of any career breaks taken and geographical location of work. RESULTS: The response rate was 81.5%. Male and female orthodontists were seen to have different working patterns. The difference was statistically significant with male orthodontists undertaking clinical work on average 1.5 sessions more per week than their female colleagues. The calendar year of completion of undergraduate studies and the number of children an orthodontist has can significantly affect the number of clinical sessions they work each week. In recent years it has been observed that there is greater ethnic diversity among the workforce but ethnic origin appeared to have a minimal effect on the number of clinical sessions worked each week. The amount and length of career breaks taken by female orthodontists was greater than their male colleagues. In addition, there continues to be an uneven distribution of orthodontists throughout the United Kingdom. CONCLUSION: Many factors influence the current working patterns of orthodontists in the United Kingdom. However, it may be the inequitable regional distribution of orthodontists throughout the United Kingdom which is of greatest significance to orthodontic workforce planning for the future.

A national review of mandibular orthognathic surgery activity in the National Health Service in England over a nine year period: part 2--patient factors.

We aimed to investigate patients who had mandibular orthognathic surgery in England for the period 1 April 1997-30 March 2006. Data on hospital inpatient activity were extracted from the NHS Hospital Episode Statistics (HES) database for all mandibular orthognathic surgical procedures between these dates. Details of patients were investigated in relation to clinical details, socioeconomic status, other diagnoses, and clinical outcomes. Mandibular orthognathic operations were done for 8941 patients in England over the 9-year period, and the ratio of women: men was 1.7:1. The mean (SD) age at operation was 24 (9) years with no difference between sexes. There was a socioeconomic gradient in patients requesting treatment, most of whom lived in relatively affluent areas. The most common other diagnosis was "additional dentofacial anomalies" (8% of episodes). Mental or behavioural diagnoses were recorded in 41 patients (<1%). One patient died in hospital. Our results confirmed the differences in sex in patients receiving orthognathic care and highlighted socioeconomic inequalities in the treated patients. A number of coexisting diagnoses were also identified.

A national review of mandibular orthognathic surgery activity in the National Health Service in England over a nine year period: part 1--service factors.

We aimed to investigate the changing provision of mandibular orthognathic surgery in England for the period 1 April 1997-30 March 2006. Data on hospital inpatient activity were extracted from the NHS Hospital Episode Statistics (HES) database for all mandibular orthognathic surgical procedures between these dates. We investigated provider factors (in which units providing services were classified as undertaking either high or low volumes of activity) and temporal changes. There was a steady increase in the number of procedures over time, and a decrease in the mean time spent in hospital (p<0.001). Provider units with high volumes of activity had shorter inpatient stays than those that provided low volume (p<0.001) and exhibited a greater reduction in the duration of inpatient stays (p=0.02). Patterns of care are changing, and increasing numbers of treatments are being done as day-cases (p<0.001). Units with high volumes seem to be more efficient in terms of duration of hospital stay than low volume units. However, our data do not allow an insight into the quality of care provided, and further research is needed to address this issue.

Changes in the gender and ethnic balance of the United Kingdom orthodontic workforce.

OBJECTIVE: To describe the gender and ethnic trends of the United Kingdom orthodontic workforce. DESIGN AND SETTING: A cross-sectional survey using a postal questionnaire to specialist orthodontic practitioners in the United Kingdom (2006-2007).Subjects All those on the Specialist List in Orthodontics held by the General Dental Council in October 2006. MATERIALS AND METHODS: The data collected using the questionnaire included demographic details (gender, ethnicity, current age, place of birth), undergraduate and postgraduate dental schools attended, calendar years in which professional qualifications were achieved, anticipated year of retirement and geographical location of work place. RESULTS: The response rate was 81.5%. There are more male (60.2%) than female (39.8%) orthodontists presently working in the United Kingdom. Minority ethnic groups are better represented amongst the orthodontic workforce than they are in the general population, however their distribution throughout the United Kingdom is uneven. The trends in the results indicate that the gender and ethnic balance of the specialist orthodontic workforce has been changing and the proportion of females and those from non-white ethnic groups has increased. In contrast, the majority of those retiring over the next few years will be white males (60%). CONCLUSION: This study suggests that there will be greater ethnic diversity and more female orthodontists in the future workforce. Consequently, working patterns should be kept under regular review so that an optimal orthodontic service can be maintained in the United Kingdom.

Orthodontic treatment for deep bite and retroclined upper front teeth in children.

BACKGROUND: Correction of the type of dental problem where the bite is deep and the upper front teeth are retroclined (Class II division 2 malocclusion) may be carried out using different types of orthodontic treatment. However, in severe cases, surgery to the jaws in combination with orthodontics may be required. In growing children, treatment may sometimes be carried out using special upper and lower dental braces (functional appliances) that can be removed from the mouth. In many cases this treatment does not involve taking out any permanent teeth. Often, however, further treatment is needed with fixed braces to get the best result. In other cases, treatment aims to move the upper first permanent molars backwards to provide space for the correction of the front teeth. This may be carried out by applying a force to the teeth and jaws from the back of the head using a head brace (headgear) and transmitting this force to a part of a fixed or removable dental brace. This treatment may or may not involve the removal of permanent teeth. In some cases, neither functional appliances nor headgear are required and treatment may be carried out without extraction of any permanent teeth. Instead of using a headgear, in certain cases, the back teeth are held back in other ways such as with an arch across or in contact with the front of the roof of the mouth which links two bands glued to the back teeth. Often in these cases, two permanent teeth are taken out from the middle of the upper arch (one on each side) to provide room to correct the upper front teeth. It is important for orthodontists to find out whether orthodontic treatment only, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion produces a result which is any different from no orthodontic treatment or orthodontic treatment only involving extraction of permanent teeth. OBJECTIVES: To establish whether orthodontic treatment, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion, produces a result which is any different from no orthodontic treatment or orthodontic treatment involving removal of permanent teeth. SEARCH STRATEGY: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. The handsearching of the main international orthodontic journals was updated to April 2006. There were no restrictions with regard to publication status or language of publication. International researchers, likely to be involved in Class II division 2 clinical trials, were contacted to identify any unpublished or ongoing trials. SELECTION CRITERIA: Trials were selected if they met the following criteria: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of orthodontic treatments to correct deep bite and retroclined upper front teeth in children. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were to be conducted in duplicate and independently by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS: No RCTs or CCTs were identified that assessed the treatment of Class II division 2 malocclusion in children. AUTHORS' CONCLUSIONS: It is not possible to provide any evidence-based guidance to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children.

Psychological support for orthognathic patients -- what do orthodontists want?

AIMS: (1) To evaluate consultant orthodontist opinion on referral of orthognathic patients to a liaison psychiatrist or psychologist and (2) To investigate the value of training orthodontic specialists in recognition of patients with psychological profiles that might affect orthognathic outcome. DESIGN: Questionnaire-based study. SUBJECTS AND METHODS: A structured questionnaire was distributed to all consultant orthodontists in the UK. RESULTS: Approximately 40% of consultants thought that up to 10% of their orthognathic patients would benefit from psychological assessment by appropriately trained personnel. Twenty per cent of consultants were not certain what proportion of their patients would benefit from referral and over half the respondents said they do not refer any orthognathic patients for assessment. The most common reasons for referral were past/current psychiatric history (36%), unrealistic expectations (32%), 'gut instinct' (14%), no significant clinical problem (13%). Reasons not to refer were: nobody to refer to (30.5%), fear of patient reacting badly (15.8%), not sure who to refer to (14.7%), response from mental health team not useful (12.4%), waiting list too long (9.6%). The majority of clinicians felt they would benefit from training in this field (84.7%), as over 80% reported no teaching or training in psychological assessment/management. CONCLUSIONS: Although we have no evidence to prove that interdisciplinary care is better for patients, clinical experience and reports from clinicians working in large centres, tells us there are probable advantages. The development of a training programme for both orthodontists and mental health teams would seem to be beneficial for both clinicians and patients.

Which factors influence willingness-to-pay for orthognathic treatment?

The aims of this interview-based questionnaire study were to establish which factors influence willingness-to-pay (WTP) for orthognathic treatment and to compare WTP values, from both members of the general public and orthognathic patients, with the actual cost of treatment, the hypothesis being that the more highly valued the intervention, the higher the WTP value. Data were collected from 88 orthognathic patients and a convenience sample of 100 adults using the so-called 'payment card' method. Demographic data were recorded, as well as ability to pay, incisor relationship, occupation, and level of education. In addition, the resources used in orthognathic treatment were estimated for five patients who participated in the study. The results showed that there was a significant difference between the mean WTP values for the public and patient groups. Patients were prepared to pay [see symbol in tex]2750 more than members of the general public. In addition, a significant relationship was found between WTP and incisor relationship in the patient group, with Class II division 1 patients prepared to pay [see symbol in text]3130 more than those with Class III malocclusions. Ability to pay did not significantly affect WTP. The mean total costs estimated for orthognathic treatment were lower than the mean patient WTP value and similar to the mean WTP value for the public group. In terms of cost-benefit, it appears that orthognathic treatment provides 'good value for money'. This study also showed that both patients and the general public were prepared to place a monetary value on the correction of dentofacial deformity and that this form of economic evaluation is a useful tool in monitoring health care in the UK.