Tendon graft through the coracoid tunnel versus under the coracoid for coracoclavicular/acromioclavicular reconstruction shows no difference in radiographic or patient-reported outcomes.

INTRODUCTION: The purpose of this prospective study was to report the outcomes of two different methods in CC and AC reconstruction for the treatment of AC separation using a tendon graft and knot-hiding titanium clavicular implant. MATERIALS AND METHODS: Twenty-seven patients with Rockwood grade III and V acromioclavicular (AC) separations were randomized into two groups. The primary outcome was whether taking the tendon graft through the coracoid risked a fracture. The following were secondary outcomes: follow-up of clavicular wound healing and Nottingham Clavicle score, Constant score, and Simple Shoulder Test results obtained preoperatively and 24 months postoperatively. The anteroposterior radiographic change between the clavicular and coracoid cortexes and the clavicular tunnel diameter was measured postoperatively and 24 months postoperatively. General patient satisfaction with the outcome (poor, fair, good, or excellent) was assessed 2 years postoperatively. RESULTS: No coracoid fractures were detected. No issues in clavicular wound healing were detected. The mean Nottingham Clavicle score increased from a preoperative mean of 42.42 ± 13.42 to 95.31 ± 14.20 (P < 0.00). The Constant score increased from a preoperative mean of 50.81 ± 17.77 to 96.42 ± 11.51 (P < 0.001). The Simple Shoulder Test score increased from a preoperative mean of 7.50 ± 2.45 to 11.77 ± 1.18 (P < 0.001). The changes were significant. The coracoclavicular distance increased from 11.88 ± 4.00 to 14.19 ± 4.71 mm (P = 0.001), which was significant. The clavicular drill hole diameter increased from 5.5 to a mean of 8.00 ± 0.75 mm. General patient satisfaction was excellent. CONCLUSIONS: There were no significant differences between the two groups. There were no implant related complications in the clavicular wound healing. The results support the notion that good results are achieved by reconstructing both the CC and AC ligaments with a tendon graft. STUDY REGISTRATION: This clinical trial was registered on Clinicaltrials.gov.

Military performance of men with attention-deficit/hyperactivity disorder: findings from a follow-up study in the Northern Finland birth cohort 1986.

PURPOSE: The aim of this study was to assess the military performance of men with adolescent attention-deficit/hyperactivity disorder (ADHD) and men with childhood ADHD (in remission during adolescence) as compared with controls without ADHD. METHODS: The study employs the general population-based Northern Finland Birth Cohort 1986 (NFBC1986) together with data received from the Finnish Defence Forces (FDF). A total of 38 men with childhood ADHD and 67 with adolescent ADHD were compared with 160 controls. RESULTS: The men with adolescent ADHD were more often deemed unfit for military service, had more military health care visits, more often committed at least one offence during service, received poorer evaluations for team leadership skills and indulged in more alcohol consumption and smoking than the controls, while those with childhood ADHD did not differ from the controls in their military fitness, but received poorer evaluations for team leadership skills and smoked more than did the controls. CONCLUSION: The conscripts with adolescent ADHD performed worse on many military parameters, but the men with ADHD in remission did not seem to suffer from such negative effects on military performance. The childhood ADHD group in particular was nevertheless somewhat limited in size, which might have led to a Type II error.

Costs and duration of orthodontic-surgical treatment with mandibular advancement surgery.

OBJECTIVES: The aim was to analyse the costs and duration of orthodontic-surgical treatment with mandibular advancement in the public health care sector in Finland. MATERIALS: The study was conducted as a retrospective registry study in a public district hospital on all nonsyndromic patients that were ethnic Finns and treated with full fixed appliances and mandibular advancement surgery in 2016-2020. RESULTS: The mean treatment duration of the included 45 patients was 28.1 months, including 18.9 months pre and 9.2 months postoperative orthodontics. The median number of visits was 27, including 17 visits before and 9 visits after surgery. The mean total treatment time was 14.5 h. The mean total direct costs per course of treatment were 7574 € to the municipality and 947 € to the patient. The costs positively correlated with the duration of the treatment (rho = 0.71, P = .000), but were not associated to gender or age of patient. The mean surgery time was 78 minutes, and significantly less with an experienced surgeon (P = .002). It was calculated that the mean minimum treatment costs would be 45% of the present total, achievable with a patient with optimum dental arches at the start of treatment. LIMITATIONS: The major limitation of the study is the relatively small number of study subjects. CONCLUSION: A 55% share of the costs is influenced by case- and operator-dependent factors. This indicates that the complexity and performance of the orthodontic phases of treatment are important determinants in the cost structure.

Long-term effects of the home literacy environment on reading development: Familial risk for dyslexia as a moderator.

This study aimed to gain better understanding of the associations between literacy activities at home and long-term language and literacy development. We extended the home literacy environment (HLE) model of Sénéchal and LeFevre (Child Development [2002], Vol. 73, pp. 445-460) by including repeated assessments of shared reading, oral language, and reading comprehension development, including examination of familial risk for dyslexia as a moderator, and following development over time from ages 2 to 15 years. Of the 198 Finnish participants, 106 have familial risk for dyslexia due to parental dyslexia. Our path models include development in vocabulary (2-5.5 years), emerging literacy (5.5 years), reading fluency (8 and 9 years), and reading comprehension (8, 9, and 15 years) as well as shared book reading with parents (2, 4, 5, 8, and 9 years), teaching literacy at home (4.5 years), and reading motivation (8-9 years). The results supported the HLE model in that teaching literacy at home predicted stronger emerging literacy skills, whereas shared book reading predicted vocabulary development and reading motivation. Both emerging literacy and vocabulary predicted reading development. Familial risk for dyslexia was a significant moderator regarding several paths; vocabulary, reading fluency, and shared reading were stronger predictors of reading comprehension among children with familial risk for dyslexia, whereas reading motivation was a stronger predictor of reading comprehension among adolescents with no familial risk. The findings underline the importance of shared reading and suggest a long-standing impact of shared reading on reading development both directly and through oral language development and reading motivation.

Calcaneal Bone Bruise After Surgery for Insertional Achilles Tendinopathy.

OBJECTIVE: Excision of the posterosuperior corner of the calcaneus (EPCC) is routinely undertaken in athletes after failure of conservative management of insertional Achilles tendinopathy. Some patients can experience sharp calcaneal pain during postoperative rehabilitation, a sign of a calcaneal bone bruise (CBB). DESIGN: Case series, level of evidence IV. SETTING: University teaching hospital. PATIENTS: This study reports 8 patients who developed postoperative CBB after having started impact training too early. INTERVENTION: Patients in whom a diagnosis of CBB had been formulated were followed to return-to-play and resolution of bone edema by MRI. MAIN OUTCOME MEASURES: Detection of CBB after EPCC. RESULTS: After routine EPCC for insertional Achilles tendinopathy, 8 patients presented with sharp pain for a mean 7.1 weeks (median 6 weeks, range 5-11 weeks) before clinical suspicion of CBB. At that stage, MRI showed clear evidence of a bone bruise, with a diagnosis of CBB formulated at an average of 10.8 postoperative weeks (range 6-16 weeks). Calcaneal bone bruise resolved with modified symptom-free loading. Patients returned to play at average on 5.6 months (range 2-9 months) after the diagnosis of postoperative CBB. CONCLUSIONS: We describe 8 athletes who developed painful CBB following routine EPCC for insertional Achilles tendinopathy after having increased their level of activities too soon after the index procedure. In these patients, the diagnosis of postoperative CBB can be formulated by MRI and more cautious rehabilitation implemented.

Leisure Reading (But Not Any Kind) and Reading Comprehension Support Each Other-A Longitudinal Study Across Grades 1 and 9.

This study examines associations between leisure reading and reading skills in data of 2,525 students followed from age 7 to 16. As a step further from traditional cross-lagged analysis, a random intercept cross-lagged panel model was used to identify within-person associations of leisure reading (books, magazines, newspapers, and digital reading), reading fluency, and reading comprehension. In Grades 1-3 poorer comprehension and fluency predicted less leisure reading. In later grades more frequent leisure reading, particularly of books, predicted better reading comprehension. Negative associations were found between digital reading and reading skills. The findings specify earlier findings of correlations between individuals by showing that reading comprehension improvement, in particular, is predicted by within-individual increases in book reading.

Association between snoring and deciduous dental development and soft tissue profile in 3-year-old children.

INTRODUCTION: The aim was to study the association between snoring and development of occlusion, maxillary dental arch, and soft tissue profile in children with newly completed deciduous dentition. METHODS: Thirty-two (18 female, 14 male) parent-reported snorers (snoring ≥3 nights/week) and 19 (14 female, 6 male) nonsnorers were recruited. Breathing preference (nose or mouth) was assessed at the mean age of 27 months by otorhinolaryngologist. At the mean age of 33 months, an orthodontic examination was performed, including sagittal relationship of second deciduous molars, overjet, overbite, and occurrence of crowding and lateral crossbite. Bite index was obtained to measure maxillary dental arch dimensions (intercanine and intermolar width, arch length). A profile photograph was obtained to measure facial convexity. RESULTS: No significant differences were found between nonsnorers and snorers in any of the studied occlusal characteristics or in measurements of maxillary dental arch dimensions. Snorers were found to have a more convex profile than nonsnorers. Occurrence of mouth breathing was more common among snorers. CONCLUSIONS: Parent-reported snoring (≥3 nights/week) does not seem to be associated with an adverse effect on the early development of deciduous dentition, but snoring children seem to have more convex profile than nonsnorers. Snoring is a mild sign of sleep-disordered breathing, and in the present study its short time lapse may not have had adequate functional impact on occlusion.

Craniofacial and occlusal development in 2.5-year-old children with obstructive sleep apnoea syndrome.

OBJECTIVES: Paediatric obstructive sleep apnoea syndrome (OSAS) is associated with a range of changes in craniofacial and occlusal development. There is, however, little knowledge of how early in life these changes can be found. The aim of the present study was to determine whether changes in dental arch morphology, occlusion, facial profile, tonsil size, breathing habit or body mass index (BMI) can already be found among 2.5-year-old children with OSAS. MATERIALS AND METHODS: Fifty-two children were recruited to the study. Of these, OSAS was diagnosed in 9 children and 18 children did not snore in polysomnography. These two groups were subsequently compared when evaluating polysomnographic, otorhinolaryngological and dental variables. RESULTS: Children with OSAS had narrower inter canine width than non-snoring children (P = 0.032). Furthermore, children with OSAS had larger adenoid size with respect to the nasopharyngeal volume (P = 0.020) and more tendency to mouth breathing (P = 0.002). No statistically significant differences were found when comparing palatine tonsil size, occlusal characteristics, soft tissue profile measurements or BMI. LIMITATIONS: The limitation of the study is the small sample size. CONCLUSION: Children with OSAS had narrower upper inter canine width than non-snoring children at the age of 2.5 years. Larger adenoid size and mouth breathing tendency were also more common among children with OSAS. Further studies with larger sample sizes are needed to determine if other changes in craniofacial and occlusal development can be found in this age group.

Arthroscopic Coracoclavicular Ligament Reconstruction Using a Synthetic Polycaprolactone-Based Polyurethane Urea Tendon Graft: A Report of 5 Cases.

BACKGROUND: Several techniques have been introduced to treat acromioclavicular (AC) separation using the semitendinosus tendon as a graft for coracoclavicular (CC) ligament reconstruction. However, the tendon may have been used previously or the patient may not want it harvested. Hence, synthetic tendon transfers have become increasingly popular. METHODS: Five patients with chronic AC separations were treated. A synthetic polyurethane urea tendon graft (Artelon Tissue Reinforcement [ATR]) was chosen for its ability to partially transform into connective tissue. The patient follow-up period lasted 45 to 60 months. RESULTS: The mean preoperative Constant Score increased from 64.8 to 100 postoperatively. The mean preoperative Simple Shoulder Test increased from 7.2 to 12 postoperatively. The mean postoperative increase of the CC distance was 1.5 mm. The mean expansion of the clavicular drill hole from the original was 2.1 mm. According to the postoperative magnetic resonance imaging, the grafts had healed well and the cross-sections of the grafts were up to 10.5 mm between the coracoid and the clavicle. DISCUSSION: The synthetic ATR tendon strip was a practical method for reconstructing a torn CC ligament complex. The ATR graft appears promising for future CC ligament reconstructions.

Eye Movements of Radiologists Reflect Expertise in CT Study Interpretation: A Potential Tool to Measure Resident Development.

Purpose To establish potential markers of visual expertise in eye movement (EM) patterns of early residents, advanced residents, and specialists who interpret abdominal computed tomography (CT) studies. Materials and Methods The institutional review board approved use of anonymized CT studies as research materials and to obtain anonymized eye-tracking data from volunteers. Participants gave written informed consent. Early residents (n = 15), advanced residents (n = 14), and specialists (n = 12) viewed 26 abdominal CT studies as a sequence of images at either 3 or 5 frames per second while EMs were recorded. Data were analyzed by using linear mixed-effects models. Results Early residents' detection rate decreased with working hours (odds ratio, 0.81; 95% confidence interval [CI]: 0.73, 0.91; P = .001). They detected less of the low visual contrast (but not of the high visual contrast) lesions (45% [13 of 29]) than did specialists (62% [18 of 29]) (odds ratio, 0.39; 95% CI: 0.25, 0.61; P < .001) or advanced residents (56% [16 of 29]) (odds ratio, 0.55; 95% CI: 0.33, 0.93; P = .024). Specialists and advanced residents had longer fixation durations at 5 than at 3 frames per second (specialists: ß = .01; 95% CI: .004, .026; P = .008; advanced residents: ß = .04; 95% CI: .03, .05; P < .001). In the presence of lesions, saccade lengths of specialists shortened more than those of advanced (ß = .02; 95% CI: .007, .04; P = .003) and of early residents (ß = .02; 95% CI: .008, 0.04; P = .003). Irrespective of expertise, high detection rate correlated with greater reduction of saccade length in the presence of lesions (ß = -.10; 95% CI: -.16, -.04; P = .002) and greater increase at higher presentation speed (ß = .11; 95% CI: .04, .17; P = .001). Conclusion Expertise in CT reading is characterized by greater adaptivity in EM patterns in response to the demands of the task and environment. © RSNA, 2016 Online supplemental material is available for this article.

Magnetic Resonance Imaging With a Novel Hip Flexion Scanning Position for Diagnosing Proximal Hamstring Tendinopathy.

Background: Making a diagnosis of proximal hamstring tendinopathy (PHT) may be challenging, as patients with correlating clinical symptoms may have normal or minimal findings on magnetic resonance imaging (MRI) scans. Purpose/Hypothesis: The purpose of this study was to assess the effect of a novel hip flexion (HF) scanning position on the MRI diagnosis of PHT. It was hypothesized that the HF position, which simulates the symptom-provoking sitting position, would reveal PHT pathology more accurately than the standard scanning position. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with chronic PHT symptoms were included. Chronicity was defined as symptoms that were present for >3 months. Each patient underwent an MRI in 2 parts: (1) the standard pelvic examination in the supine position and (2) the novel HF position in which the patient lays on his or her side with the hip at 90° of flexion. Tendon insertion areas of the semimembranosus and the biceps femoris were analyzed independently by 2 experienced musculoskeletal radiologists, and the findings were classified as normal, tendinosis, or rupture. The MRI findings for both the standard and HF positions were compared in every patient, and the percentage of different diagnoses between the 2 MRI positions was reported. Results: In total, 38 patients (67 tendons) were analyzed. In 71% of the patients, the HF position revealed more severe injury than the standard position. The HF position showed a rupture in 16% of the tendons, with findings classified as tendinosis in the standard position. Of the tendons diagnosed as normal in the standard position, 6% were classified as rupture and 11% as tendinosis in the HF position. Conclusion: The novel HF scanning position offered additional value in the diagnosis of PHT in symptomatic patients when compared with the standard hip-in-neutral position. This position can improve the diagnostics of PHT, especially if an athlete or an active patient with gluteal area pain has normal or minimal MRI findings in the standard position.

Discrepancies between Radiology Specialists and Residents in Fracture Detection from Musculoskeletal Radiographs.

(1) Background: The aim of this study was to compare the competence in appendicular trauma radiograph image interpretation between radiology specialists and residents. (2) Methods: In this multicenter retrospective cohort study, we collected radiology reports from radiology specialists (N = 506) and residents (N = 500) during 2018-2021. As a reference standard, we used the consensus of two subspecialty-level musculoskeletal (MSK) radiologists, who reviewed all original reports. (3) Results: A total of 1006 radiograph reports were reviewed by the two subspecialty-level MSK radiologists. Out of the 1006 radiographs, 41% were abnormal. In total, 67 radiographic findings were missed (6.7%) and 31 findings were overcalled (3.1%) in the original reports. Sensitivity, specificity, positive predictive value, and negative predictive value were 0.86, 0.92, 0.91 and 0.88 respectively. There were no statistically significant differences between radiology specialists' and residents' competence in interpretation (p = 0.44). However, radiology specialists reported more subtle cases than residents did (p = 0.04). There were no statistically significant differences between errors made in the morning, evening, or night shifts (p = 0.57). (4) Conclusions: This study found a lack of major discrepancies between radiology specialists and residents in radiograph interpretation, although there were differences between MSK regions and in subtle or obvious radiographic findings. In addition, missed findings found in this study often affected patient treatment. Finally, there are MSK regions where the sensitivity or specificity is below 90%, and these should raise concerns and highlight the need for double reading and should be taken into consideration in radiology education.

Deep learning accurately classifies elbow joint effusion in adult and pediatric radiographs.

Joint effusion due to elbow fractures are common among adults and children. Radiography is the most commonly used imaging procedure to diagnose elbow injuries. The purpose of the study was to investigate the diagnostic accuracy of deep convolutional neural network algorithms in joint effusion classification in pediatric and adult elbow radiographs. This retrospective study consisted of a total of 4423 radiographs in a 3-year period from 2017 to 2020. Data was randomly separated into training (n = 2672), validation (n = 892) and test set (n = 859). Two models using VGG16 as the base architecture were trained with either only lateral projection or with four projections (AP, LAT and Obliques). Three radiologists evaluated joint effusion separately on the test set. Accuracy, precision, recall, specificity, F1 measure, Cohen's kappa, and two-sided 95% confidence intervals were calculated. Mean patient age was 34.4 years (1-98) and 47% were male patients. Trained deep learning framework showed an AUC of 0.951 (95% CI 0.946-0.955) and 0.906 (95% CI 0.89-0.91) for the lateral and four projection elbow joint images in the test set, respectively. Adult and pediatric patient groups separately showed an AUC of 0.966 and 0.924, respectively. Radiologists showed an average accuracy, sensitivity, specificity, precision, F1 score, and AUC of 92.8%, 91.7%, 93.6%, 91.07%, 91.4%, and 92.6%. There were no statistically significant differences between AUC's of the deep learning model and the radiologists (p value > 0.05). The model on the lateral dataset resulted in higher AUC compared to the model with four projection datasets. Using deep learning it is possible to achieve expert level diagnostic accuracy in elbow joint effusion classification in pediatric and adult radiographs. Deep learning used in this study can classify joint effusion in radiographs and can be used in image interpretation as an aid for radiologists.

Speech perception in the child brain: cortical timing and its relevance to literacy acquisition.

Speech processing skills go through intensive development during mid-childhood, providing basis also for literacy acquisition. The sequence of auditory cortical processing of speech has been characterized in adults, but very little is known about the neural representation of speech sound perception in the developing brain. We used whole-head magnetoencephalography (MEG) to record neural responses to speech and nonspeech sounds in first-graders (7-8-year-old) and compared the activation sequence to that in adults. In children, the general location of neural activity in the superior temporal cortex was similar to that in adults, but in the time domain the sequence of activation was strikingly different. Cortical differentiation between sound types emerged in a prolonged response pattern at about 250 ms after sound onset, in both hemispheres, clearly later than the corresponding effect at about 100 ms in adults that was detected specifically in the left hemisphere. Better reading skills were linked with shorter-lasting neural activation, speaking for interdependence of the maturing neural processes of auditory perception and developing linguistic skills. This study uniquely utilized the potential of MEG in comparing both spatial and temporal characteristics of neural activation between adults and children. Besides depicting the group-typical features in cortical auditory processing, the results revealed marked interindividual variability in children.

Longitudinal associations between poor reading skills, bullying and victimization across the transition from elementary to middle school.

Students with poor reading skills and reading difficulties (RDs) are at elevated risk for bullying involvement in elementary school, but it is not known whether they are at risk also later in adolescence. This study investigated the longitudinal interplay between reading skills (fluency and comprehension), victimization, and bullying across the transition from elementary to middle school, controlling for externalizing and internalizing problems. The sample consists of 1,824 students (47.3% girls, T1 mean age was 12 years 9 months) from 150 Grade 6 classrooms, whose reading fluency and comprehension, self-reported victimization and bullying, and self-reported externalizing and internalizing problems were measured in Grades 6, 7, and 9. Two cross-lagged panel models with three time-points were fitted to the data separately for reading fluency and comprehension. The results indicated that poorer fluency and comprehension skills in Grade 6 predicted bullying perpetration in Grade 7, and poorer fluency and comprehension skills in Grade 7 predicted bullying perpetration in Grade 9. Neither fluency nor comprehension were longitudinally associated with victimization. The effects of reading skills on bullying perpetration were relatively small and externalizing problems increased the risk for bullying others more than poor reading skills did. However, it is important that those who struggle with reading get academic support in school throughout their school years, and social support when needed.

Arthroscopic Coracoclavicular Reconstruction Combined with Open Acromioclavicular Reconstruction Using Knot Hiding Clavicular Implants Is a Stable Solution.

PURPOSE: The purpose of this noninterventional, register-based study was to report the outcomes and wound healing of surgically treated chronic acromioclavicular (AC) dislocations using a tendon graft and knot-hiding titanium implants. METHODS: Thirty-two cases with chronic AC separation underwent an arthroscopic coracoclavicular (CC) ligament reconstruction and an open AC ligament reconstruction using knot-hiding titanium implants. The wound healing was assessed 2 months after the operation. The Nottingham Clavicle score, Constant score, and Simple Shoulder Test were obtained postoperatively and at a minimum of one-year postsurgery. The radiographic change in distance between the clavicular and coracoid cortices and clavicular tunnel diameter was measured. General patient satisfaction with the outcome (poor, fair, good, or excellent) was also assessed 1 year postoperatively. RESULTS: The mean Nottingham Clavicle score increased from a preoperative mean of 41.66 ± 9.86 to 96.831 ± 5.86 (P ≤ .05). The Constant score increased from a preoperative mean of 44.66 ± 12.54 to 93.59 ± 7.01 (P ≤ .05). The Simple Shoulder Test score increased from a preoperative mean of 7.00 ± 2.14 to 11.84 ± .63 (P ≤ .05). The coracoclavicular distance increased from 11.32 ± 3.71 to 13.48 ± 3.79 mm (P ≤ .05). The clavicular drill hole diameter increased from 6 mm to a mean of 6 to a mean of 8.13 ± 1.12 mm. Twenty-three (71.9%) patients reported an excellent outcome, and nine (28.1%) reported a good outcome. One clavicular fracture occurred but no coracoid fractures. There was one reconstruction failure leading to a reoperation. CONCLUSIONS: In this series, combining the arthroscopic CC ligament reconstruction to an open reconstruction of the AC joint with a tendon graft proved to be a stable solution. The knot-hiding titanium implant effectively eliminated the problems related to the clavicular wound healing. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Is securing normal dentofacial development an indication for tonsil surgery in children? A systematic review and meta-analysis.

OBJECTIVE: Tonsil surgeries are common operations in the field of paediatric otorhinolaryngology. Often, the indication for these operations is hypertrophied tonsils. Paediatric sleep-disordered breathing and mouth-breathing are conventional situations caused by the hypertrophied tonsils. Both of these are further associated with dentofacial development alterations. Securing normal dentofacial development, or restoring it, is often used as an indication for tonsil surgery. In this review and meta-analysis, we assessed the contemporary literature to clarify whether tonsil surgery has an effect on dentofacial development in children. METHODS: Studies with children aged 3-10 years who underwent tonsil surgery and were compared to non-operated controls using dentofacial parameters were included to the review. Search strategies were planned for specific databases. The Newcastle-Ottawa scale was used to assess the risk of bias. A meta-analysis was performed when the data was methodologically homogenous enough to be pooled. RESULTS: The inclusion criteria for the review were fulfilled in 8 studies. The overall quality of the individual studies was judged to be moderate at best. The data were methodologically homogenous enough to be pooled for the meta-analysis in only 2 studies. The results of the meta-analysis revealed that tonsil surgery has a positive effect on the growth direction of the mandible (p < 0.001). CONCLUSIONS: There is modest evidence that suggests that tonsil surgery has a positive effect on the dentofacial development in children with hypertrophied tonsils. Securing normal dentofacial development should be one component, but not the only one, when the indications for tonsil surgery in children are considered.

Longitudinal Effects of the Home Learning Environment and Parental Difficulties on Reading and Math Development Across Grades 1-9.

This study focuses on parental reading and mathematical difficulties, the home literacy environment, and the home numeracy environment as well as their predictive role in Finnish children's reading and mathematical development through Grades 1-9. We examined if parental reading and mathematical difficulties directly predict children's academic performance and/or if they are mediated by the home learning environment. Mothers (n = 1590) and fathers (n = 1507) reported on their reading and mathematical difficulties as well as on the home environment (shared reading, teaching literacy, and numeracy) when their children were in kindergarten. Tests for reading fluency, reading comprehension, and arithmetic fluency were administered to children in Grades 1, 2, 3, 4, 7, and 9. Parental reading difficulties predicted children's reading fluency, whereas parental mathematical difficulties predicted their reading comprehension and arithmetic fluency. Familial risk was associated with neither formal nor informal home environment factors, whereas maternal education had a significant relationship with both, with higher levels of education among mothers predicting less time spent on teaching activities and more time spent on shared reading. In addition, shared reading was significantly associated with the development of reading comprehension up to Grades 3 and 4, whereas other components of the home learning environment were not associated with any assessed skills. Our study highlights that taken together, familial risk, parental education, and the home learning environment form a complex pattern of associations with children's mathematical and reading skills.

Development of the letter identity span in reading: evidence from the eye movement moving window paradigm.

By means of the moving window paradigm, we examined how many letters can be identified during a single eye fixation and whether this letter identity span changes as a function of reading skill. The results revealed that 8-year-old Finnish readers identify approximately 5 characters, 10-year-old readers identify approximately 7 characters, and 12-year-old and adult readers identify approximately 9 characters to the right of fixation. Comparison with earlier studies revealed that the letter identity span is smaller than the span for identifying letter features and that it is as wide in Finnish as in English. Furthermore, the letter identity span of faster readers of each age group was larger than that of slower readers, indicating that slower readers, unlike faster readers, allocate most of their processing resources to foveally fixated words. Finally, slower second graders were largely not disrupted by smaller windows, suggesting that their word decoding skill is not yet fully automatized.

Kindergarten Training in Phonological Awareness: Fluency and Comprehension Gains Are Greatest for Readers at Risk in Grades 1 Through 9.

Training in phonological awareness has brought about well-documented positive effects on learning to read in lower-primary grades. Less is known about long-term gains extending to upper-primary and junior high school. The few longitudinal studies covering at least 5 years suggest that gains in decoding are sustained, whereas effects on reading comprehension have either not been studied or produced equivocal results. The present study followed up the reading development of 209 Finland Swedish students from kindergarten until Grade 9, half of whom participated in an 8-month phonological intervention in kindergarten. The intervention group outperformed the control group in both word reading and reading comprehension in Grades 1 through 9. However, albeit statistically significant, the differences at the group level were small. The main result was a clear-cut difference in both skills among readers at risk belonging to the lowest 25% in foundational skills at the beginning of kindergarten. In Grade 6, altogether 60% of the nontrained readers at risk still belonged to the lowest quartile in reading comprehension as opposed to 24% of their peers in the intervention group. The pattern was repeated in Grade 9, with trained readers at risk performing at the level of nontrained mainstream readers.