Daily MIPP and quarterly MIV applications do not appear to reduce significantly WSLs incidence during fixed orthodontic treatment.
Introduction The regular collection of three-dimensional (3D) imaging data is critical to the development and implementation of accurate predictive models of facial skeletal growth. However, repeated exposure to x-ray based modalities such as cone-beam computed tomography (CBCT) have unknown risks that outweigh many potential benefits, especially in pediatric patient populations. One solution is to make inferences about the facial skeleton from external 3D surface morphology captured using safe non-ionizing imaging modalities alone. However, the degree to which external 3D facial shape is an accurate proxy of skeletal morphology has not been previously quantified. As a first step in validating this approach, here we test the hypothesis that population-level variation in the 3D shape of the face and skeleton significantly covary. Methods We retrospectively analyzed 3D surface and skeletal morphology from a previously collected cross-sectional CBCT database of non-surgical orthodontics patients, and used geometric morphometrics and multivariate statistics to test the hypothesis that shape variation in external face and internal skeleton covary. Results External facial morphology is highly predictive of variation in internal skeletal shape (Rv=0.56, p<0.0001; PLS1-13=98.7% covariance, p<0.001) and asymmetry (Rv=0.34, p<0.0001; PLS1-5=90.2% covariance, p<0.001), while age (r2=0.84, p<0.001) and size-related (r2=0.67, p<0.001) shape variation are also highly correlated. Conclusions Surface morphology is a reliable source of proxy data for the characterization of skeletal shape variation, and thus is particularly valuable in research designs where reducing potential long-term risks associated with radiological imaging methods is warranted. We propose that longitudinal surface morphology from early childhood through late adolescence has the potential to be a valuable source of data that will facilitate the development of personalized craniodental planning and treatment plans while reducing exposure levels to “as low as reasonably achievable” (ALARA).
Objective To identify factors associated with delayed or omission of indicated steroids for children seen in the emergency department (ED) for moderate-severe asthma exacerbation. Methods This was a retrospective study of pediatric (age ≤ 21 years) patients treated in a general academic ED January 2006-September 2011 with a primary diagnosis of asthma (ICD-9 code 493.xx) and moderate-severe exacerbations. A moderate-severe exacerbation was defined as requiring ≥2 (or continuous) bronchodilators. We determined the proportion of visits in which steroids were inappropriately omitted or delayed (> 1 hour from arrival). Multivariable logistic regression models were used to identify patient, physician, and system factors associated with delayed or omitted steroids. Results Of 1,333 pediatric asthma ED visits, 817 were for moderate-severe exacerbation; 645 (79%) received steroids. Patients <6 years (odds ratio 2.25 [95% confidence interval 1.19–4.24]), requiring more bronchodilators (2.82 [2.10–3.79]), initially hypoxic (2.78 [1.33–5.83]), or tachypneic (1.52 [1.05–2.20]) were more likely to receive steroids. Median time to steroid administration was 108 minutes (IQR: 65–164). Steroid administration was delayed in 502 (78%) visits. Patients with hypoxia (1.91 [1.11–3.27]) or tachypnea (1.82 [1.17–2.84]) were more likely to receive steroids ≤1 hour of arrival whereas children <2 years (0.16 [0.07–0.35]) and those arriving during periods of higher ED volume (0.79 [0.67–0.94]) were less likely to receive timely steroids. Conclusion In this ED, steroids were under-prescribed and frequently delayed for pediatric ED patients with moderate-severe asthma exacerbation. Greater ED volume and younger age are associated with delays. Interventions are needed to expedite steroid administration, improving adherence to NIH asthma guidelines.
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